Discharge against medical advice amongst orthopaedic patients in Nnewi, South-East Nigeria, and its public health implications

Background : Discharge Against Medical Advice (DAMA) is a term used when patients opt to leave a hospital against the advice of the doctor. Trauma patients account for a significant percentage of these. This study was aimed at determining the prevalence of and reasons for DAMA amongst Orthopaedic and trauma patients in Nnamdi Azikiwe University Teaching Hospital, Nnewi. Methodology : A two-year prospective study was carried out between March 2010 and February 2012 using an interviewer administered proforma. All orthopaedic patients admitted through the Accident and Emergency (A&E) Unit as well as from the clinics who signed the DAMA form were eligible and recruited for the study. Results : Out of 1256 orthopaedic admissions, 74 signed the DAMA form giving a prevalence rate of 5.89% with a male to female ratio of 2.5 to 1. Their age range was 4–92years with a mean age of 35.5years. Trauma accounted for 97.3% of all the cases with 32.4% of the patients presenting to hospital within 1–8hrs of injury. The common reasons for DAMA were non-acceptance of treatment options and lack of confidence in the doctor (42%), followed by family/parental pressure (30%). Conclusion : The prevalence of DAMA in orthopaedic patients was high when compared to DAMA in other medical specialties in Nigeria. Pubic enlightenment on appropriate health-seeking attitude for the proper management of fractures and bone pathologies to avoid disabling complications should be the advocacy.