Les sorties contre avis médical en pédiatrie au CHU de Brazzaville (Congo)

Discharge against Medical Advice in Eight Tertiary Hospitals in Nigeria: A Prospective Study

BACKGROUND

Discharge against medical advice (DAMA) is when a patient decides to leave the hospital without the consent of the treating physician. It poses serious clinical, ethical, and legal challenges to the individual physician as well as the hospital.

AIM

To determine the prevalence and reasons for DAMA in orthopedic departments of eight tertiary hospitals in Nigeria.

MATERIALS AND METHODS

This was a prospective multi-center descriptive study undertaken in eight tertiary Nigerian hospitals. Consecutive patients who requested for DAMA within 1 year of the study and who consented to participate in the study had face-to-face interviews. Data obtained were documented in a questionnaire and analyzed with SPSS version 20.

RESULTS

The total number of patients studied was 373 with a mean age 34.7 ± 17.5 years. About a quarter of them (25.5%) were between 31 and 40 years. A prevalence rate of 1.9% was found with financial constraint being the predominant reason for DAMA (40.8%). Other reasons include family preference for unorthodox treatment (18.8%) and treatment dissatisfaction (7.0%) among others.

CONCLUSION

The study findings indicate a low DAMA rate when compared to previous studies in this region. It also indicates that financial constraints, family preference for unorthodox care, and low educational status are major drivers of DAMA. Deepened health insurance and other measures that can reduce the prevalence of DAMA should be prioritized to improve treatment outcomes.

Discharge against medical advice in paediatric patients

Objectives

Discharge against medical advice (DAMA) from the hospital may negatively impact patients’ well-being. The present study aimed to investigate the main reasons for DAMA among parents of children admitted to the paediatric ward of the Ali Ebne Abitaleb Hospital in Zahedan, Iran.

Methods

Participants in this case–control study included 130 children who had been admitted to the hospital's paediatric ward. Participants were divided into two equal groups: (1) those with incomplete treatment and (2) those who stayed in the hospital until the completion of their management and followed regular discharge procedures. A self-administered questionnaire was utilised for data collection.

Results

Participants included 130 children aged <1–18 years with an average of 3.3 ± 3.7 years; 51.5% (67) were girls, and 48.5% (63) were boys. The results showed a significant relationship between DAMA and the father's level of education (p < 0.05), length of hospitalization (p < 0.001), and duration of treatment (p = 0.027). No significant correlation was found for other factors (p > 0.05).

Conclusion

This study found that the key reasons for DAMA were as follows: lack of satisfaction with physicians and hospital staff, family disturbance due to the presence of other children at home, inadequate economic situation, and being away from home. Providing professional education to parents and expressing the benefits and disadvantages of refusing complete treatment may help parents make better decisions.

[African histoplamosis. A report of three pediatric cases]

Histoplasmosis duboisii (Histoplasma capsulatum var duboisii) is uncommon disease especially in children. It is observed in Africa where the incidence is unknown. The authors report a series of three pediatric cases. The report concerned 2 girls and one boy who were 3, 9 and 4 year-old, respectively. Symptoms evolved for more than two months in each case. At admission, we found fever and poor general condition. Observed lesions were lymphnodes localisation disseminated (cases 1 and 2), subcutaneous (cold abscess) and cutaneous simulating molluscum contagiosum (case 2), osteoarticular (cases 2 and 3), abdominal including peritoneal and hepatosplenic (case 1). In all cases, a mild leukocytosis was found and an accelerated erythrocyte sedimentation rate (ESR) greater than 70mm. The HIV serology was negative. The treatment consisted of itraconazole in 2 cases and ketoconazole in one case. The evolution was insidious, leading to the discharge against medical advice. The death occurred at home in all cases.

CONCLUSION

Histoplasmosis duboisii can realize two main clinical presentations (localized or disseminated), affecting the skin, lymph nodes, bones, sometimes the intra-abdominal organs. HIV serology is not always positive in disseminated forms. The evolution is unpredictable and capricious under antifungal treatment. The disease should be well explained to prevent a possible discharge against medical advice, often pejorative.

[Professional absenteeism in the pediatric service of the general hospital of Loandjili in Pointe-Noire (Congo)]

The supply and the quality of care dispensed in a service depend on the quality of the technical and human tray, but also from effective presence of the staff during the work time. The purpose of this study is to determine the absenteeism level of the paramedical staff in General Pediatric and Neonatology of Loandjili General Hospital (Pointe Noire) and identifying causes. A cross-sectional study has been conducted from January 1(st) to June 30(th) 2011 on 21 nurses in General Pediatric and 20 in Neonatology. The absenteeism level was obtained by the link of the number of missing days out of the number of the work days x 100. The absence was justified when it relieved from a reason informed by the administrative texts of the firm; and authorized when it requested the authorization of the administration of the firm. In total, 370 absences have been unregistered, the average absenteeism level was of 8.4%. The absence was justified in 242 cases (65.4%) and authorized in 178 cases (48.1%) which 84 times in writing and 94 times verbally. When the absence was justified, it was the fact of the disease of a member of the family in 82 cases, of the death or the burial of a member of the family in 81 cases, of the agent disease, 84 cases, or other reasons in the remains of cases. The absence occurred between 7 a.m. and 14 p.m. in 57.3%, 14 p.m. and 7 p.m.in, 25.7% and between 7 p.m. and 7 a.m. in 17.0%. The absenteeism was mainly observed (85.7%) for the nurses of about 30 years old and those (59.5%) whom the seniority in the service was inferior or equal 5 years. The absences justified were more observed (p< 10(-4)) for nurses of about 30 years old and those whom the seniority did not pass 5 years. The absenteeism of nurses constitutes a real social and administrative problem that deserves a particular attention considering its impact on the supply and the quality of cares.