Article Sidebar
Downloads
Main Article Content
Abstract
Introduction. Discharge against medical advice (DAMA) is a global public health issue with potentially serious consequences for patients. In Cameroon, its frequency and determinants in gynaecology and obstetrics are poorly understood. This study determined the frequency and factors associated with DAMA in gynaecology and obstetrics departments in Yaoundé. Methods. We conducted a retrospective cross‑sectional study from January 2022 to December 2024 in two referral hospitals in Yaoundé, including all admitted patients. We analysed the records of patients who left against medical advice. Results. Among 4,476 admissions, 174 patients left against medical advice (frequency 3.9%). One hundred and forty‑three complete records were analysed. Median age was 27 years; 48.3% were aged 20‑29 years. Most had secondary education (60.8%), were unemployed or students (56.7%). The main reasons for admission were pelvic pain (48.3%) and vaginal bleeding (38.5%). The most frequent diagnoses were postpartum haemorrhage (20.3%), severe malaria in pregnancy (14.7%) and premature rupture of membranes (13.3%). DAMA was justified by financial difficulties in 85.3% of cases, and the patient initiated the discharge in 39.2% of cases. A DAMA form was present in 75.5% of records but was often incomplete. Fourteen per cent of patients were readmitted for a complication. Conclusion. Discharge against medical advice in gynaecology and obstetrics in Yaoundé mainly affects young women and is overwhelmingly driven by financial constraints. Strengthening health coverage and emergency obstetric care financing mechanisms is essential.
Keywords
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
References
- 1. Guilaine Téclaire Lekani. Facteurs favorisants les sorties contre avis médical aux urgences [Mémoire Online]. [cité 22 oct 2023]. 2017. Disponible sur: https://www.memoireonline.com/03/20/11669/Facteurs-favorisants-les-sorties-contre-avis-medical-aux-urgences.html
- 2. Yao L B, Akobe A J R, M’Bra K I, Niaré Sery B J L, Kouassi K J E, Kouassi A A N et al. Les raisons du refus et abandon de soins aux urgences chirurgicales du Centre Hospitalier et Universitaire de Bouaké, Côte d’Ivoire. P Afr M J. 2021 ; 38(291) : doi.org/10.11604/pamj.2021.38.291.22340
- 3. Traore T, Toure L, Diassana M, Malle K, Diallo S, Diallo A et al. Amputation des membres suite au traitement traditionnel à l’Hôpital de Mopti (Mali). Health Sci. Dis. 2021 ; 22(4) :76-80
- 4. Ding R, Jung J J, Kirsch T D, Levy F, McCarthy M L. Uncompleted Emergency Department Care: Patients who leave against medical advice. Acad Emerg Med. 2007; 14(10):870-876. doi.org/10.1197/j.aem.2007.06.027
- 5. Fadare J O, Babatunde O A, Olanrewaju T, Busari O. Discharge against medical advice: Experience from a rural Nigerian hospital. Ann Nigerian Med. 2013;7(2):60-5
- 6. Akinbodewa A A, Adejumo O A, Adejumo O A, Adebayo F Y, Akinbodewa G O, Alli E O et al. Evaluation of administration of discharge medical advice: Ethico-legal considerations. Niger Postgrad Med J. 2016; 23(3):141-145. Doi:10.4103/1117-1936.190346.
- 7. Ngongang G F O, Fonkoue L, Ndoye E H O, Arabo S, Mefo Nono A, Conde N et al. Discharge against medical advice (DAMA) in patients with long bone fractures at YEC: Epidemiological, clinical, evolutionary and medico-legal aspects. IP Int J Forensic Med Toxicol Sci. 2024; 9(1):9‑12. doi.org/10.18231/j.ijfmts.2024.003
- 8. Schaefer G R, Matus H, Schumann J H, Sauter K, Vekhter B, Meltzer D O, et al. Financial responsibility of hospitalized patients who left against medical advice: medical urban legend? J Gen Intern Med. 2012; 27(7):825‑30. doi:10.1007/s11606-012-1984-x.
- 9. Karimi S A P, Saravi B M, Farahabbadi E B, Zamanfar D, Fallah M, Abokheily M A. Studying the rate and causes of discharge against medical advice in hospitals affiliated to Mazandaran University of Medical Sciences. Materia Socio-Medica. 2014; 26(3):203-7. doi.ord/10.5455/msm.2014.26.203.207.
- 10. Noohi K, Komsari S, Nakhaee N, Feyzabadi V Y. Reasons for Discharge against Medical Advice: A case study of Emergency Departments in Iran. Int J Health Policy Manag. 2013; 1(2):137-42. doi:10/15171/ijhpm.2013.25
- 11. Connie F L, Matovina C N, Premkumar A, Watson K. Obstacles to accepting care: Understanding why obstetric patients leave against medical advice. Matern child health. 2024; 28(9):1612-1619 http://doi.org/10.1007/s10995-024-03959-7
- 12. Sogoba D, Goita D, Diallo B A, Ngueking Djukem A, Magassouba O, Fofana A et al. Etat des lieux sur les sorties contre et sans avis médical des patients hospitalisés au service des maladies infectieuses et tropicales du centre hospitalier universitaire (CHU) du Point G (Bamako). Jaccr Africa. 2024 ; 8(3) :196-205. doi/org/10.70065/24JA83.009L01270
References
1. Guilaine Téclaire Lekani. Facteurs favorisants les sorties contre avis médical aux urgences [Mémoire Online]. [cité 22 oct 2023]. 2017. Disponible sur: https://www.memoireonline.com/03/20/11669/Facteurs-favorisants-les-sorties-contre-avis-medical-aux-urgences.html
2. Yao L B, Akobe A J R, M’Bra K I, Niaré Sery B J L, Kouassi K J E, Kouassi A A N et al. Les raisons du refus et abandon de soins aux urgences chirurgicales du Centre Hospitalier et Universitaire de Bouaké, Côte d’Ivoire. P Afr M J. 2021 ; 38(291) : doi.org/10.11604/pamj.2021.38.291.22340
3. Traore T, Toure L, Diassana M, Malle K, Diallo S, Diallo A et al. Amputation des membres suite au traitement traditionnel à l’Hôpital de Mopti (Mali). Health Sci. Dis. 2021 ; 22(4) :76-80
4. Ding R, Jung J J, Kirsch T D, Levy F, McCarthy M L. Uncompleted Emergency Department Care: Patients who leave against medical advice. Acad Emerg Med. 2007; 14(10):870-876. doi.org/10.1197/j.aem.2007.06.027
5. Fadare J O, Babatunde O A, Olanrewaju T, Busari O. Discharge against medical advice: Experience from a rural Nigerian hospital. Ann Nigerian Med. 2013;7(2):60-5
6. Akinbodewa A A, Adejumo O A, Adejumo O A, Adebayo F Y, Akinbodewa G O, Alli E O et al. Evaluation of administration of discharge medical advice: Ethico-legal considerations. Niger Postgrad Med J. 2016; 23(3):141-145. Doi:10.4103/1117-1936.190346.
7. Ngongang G F O, Fonkoue L, Ndoye E H O, Arabo S, Mefo Nono A, Conde N et al. Discharge against medical advice (DAMA) in patients with long bone fractures at YEC: Epidemiological, clinical, evolutionary and medico-legal aspects. IP Int J Forensic Med Toxicol Sci. 2024; 9(1):9‑12. doi.org/10.18231/j.ijfmts.2024.003
8. Schaefer G R, Matus H, Schumann J H, Sauter K, Vekhter B, Meltzer D O, et al. Financial responsibility of hospitalized patients who left against medical advice: medical urban legend? J Gen Intern Med. 2012; 27(7):825‑30. doi:10.1007/s11606-012-1984-x.
9. Karimi S A P, Saravi B M, Farahabbadi E B, Zamanfar D, Fallah M, Abokheily M A. Studying the rate and causes of discharge against medical advice in hospitals affiliated to Mazandaran University of Medical Sciences. Materia Socio-Medica. 2014; 26(3):203-7. doi.ord/10.5455/msm.2014.26.203.207.
10. Noohi K, Komsari S, Nakhaee N, Feyzabadi V Y. Reasons for Discharge against Medical Advice: A case study of Emergency Departments in Iran. Int J Health Policy Manag. 2013; 1(2):137-42. doi:10/15171/ijhpm.2013.25
11. Connie F L, Matovina C N, Premkumar A, Watson K. Obstacles to accepting care: Understanding why obstetric patients leave against medical advice. Matern child health. 2024; 28(9):1612-1619 http://doi.org/10.1007/s10995-024-03959-7
12. Sogoba D, Goita D, Diallo B A, Ngueking Djukem A, Magassouba O, Fofana A et al. Etat des lieux sur les sorties contre et sans avis médical des patients hospitalisés au service des maladies infectieuses et tropicales du centre hospitalier universitaire (CHU) du Point G (Bamako). Jaccr Africa. 2024 ; 8(3) :196-205. doi/org/10.70065/24JA83.009L01270