{"id":"5e221252-9226-4c62-834d-d2230e693a41","slug":"determinants-of-discharge-against-medical-advice-from-a-rural-neurosurgical-service-in-a-developing-country-a-prospective-observational-study","title":"Determinants of discharge against medical advice from a rural neurosurgical service in a developing country: A prospective observational study","authors":["Toyin Ayofe Oyemolade","Amos Olufemi Adeleye","Oluwakemi C. Ogunyileka","Folawemimo M. Arogundade","Ayodele J. Olusola","Oluwadamilola O. Aribisala"],"abstract":"Background: In low-resource regions of the world, discharge against medical advice (DAMA) is one empiric contributory factor to poor in-hospital outcome that is not often mentioned. This study aims to investigate the determinants of DAMA from a rural neurosurgical service in a developing country. Methods: This was a prospective observational study of all patients who discharged against medical advice in our service between November 2018 and October 2019. Results: There were 88 patients, 67 (76.1%) males, in the study, (M:F = 3.2:1), representing 17.4% of our patient population in the study period. The peak incidence was in the 20–29 years age group which accounted for 37.5% of the cases. About 55% of the patients presented directly to our center; 31.8% were referred from other hospitals, while 3.4% came from traditional caregivers and 1.1% from religious homes. Head injury was the most common indication for presentation (76.1% of the cases). The duration of hospital stay ranged from 2 h to 14 days. Majority of the patients (87.5%) left the hospital within 8 h of presentation. The reason for DAMA was financial constraints in 50% of cases, inadequate health literacy in 20.5%, financial constraints and poor health literacy together in 12.5%, religious misgivings in 4.5%, and traditional belief in 2.3%. Neurotrauma was predictive of early DAMA (P = 0.001). Conclusion: The rate of DAMA was high in our study. Financial constraints with other socioeconomic limitations were the most common causes of DAMA in our environment.","thumbnailUrl":"https://sni-digital-videos.s3.amazonaws.com/articles/5e221252-9226-4c62-834d-d2230e693a41/featured/hero-1781563168987.png","publishDate":"2020-09-12T00:00:00.000Z","doi":"10.25259/SNI_559_2020","categories":["Socio-Economics, Politics, and Medicine","Original Article"],"fullTextUrl":"https://surgicalneurologyint.com/api/articles/5e221252-9226-4c62-834d-d2230e693a41/pdf"}