FACTORS ASSOCIATED WITH DISCHARGE AGAINST MEDICAL ADVICE AMONG CHILDREN UNDER 6 MONTHS ADMITTED WITH INFECTIONS AT MBARARA REGIONAL REFERRAL HOSPITAL AND HOLY INNOCENTS CHILDREN’S HOSPITAL, SOUTHWESTERN UGANDA

Abstract

Introduction: Discharge against medical advice (DAMA) occurs when a patient /care giver in case of a child leaves a clinical setting before the end of treatment, and against medical recommendation by the medical team. This has become a major problem in health care delivery in Ugandan health facilities as it is associated with high post discharge mortality. Objectives: The study was guided by three objectives: namely, to find out the prevalence of DAMA among children under 6 months admitted at Mbarara Regional Referral and Holy Innocents Children’s Hospitals, to examine the socio-economic and socio demographic factors associated with DAMA among children under 6 months admitted with infections at Mbarara Regional Referral and Holy Innocents Children Hospitals and to establish clinical factors associated with DAMA among children under 6 months admitted with infections at Mbarara Regional Referral and Holly Innocents Children Hospitals. Methodology: This study utilised secondary data of the Smart Discharges Study, a prospective observational cohort study to develop prognostic models for post-discharge mortality in children below 6 months admitted at the 2 hospitals with infection between March 2018 and February 2020. Data of 1074 participants was considered. Simple and multiple logistic regression models were used to examine associations between DAMA and the independent variables i.e., demographic, socio, and clinical factors. Results: Out of the 1074 participants enrolled, 110 were DAMA giving a prevalence of 10.2%. Patients admitted at MRRH, the Multivariable results revealed that children whose mother’s HIV status was positive were 4.4 times more likely to discharge against medical advice compared to children whose mother’s HIV status was negative (AOR=4.4; 95% CI (11.3-15.9); p<0.001). Additionally, patients whose axillary temperature of 36C-37.5C were 76% less likely to discharge against medical advice compared to patients who had a temperature <360C (AOR=0.24; 95%CI (0.06-0.99); p<0.050). Similarly, Patients who had an axillary temperature of ≥390C were 82% less likely to discharge against medical advice compared to patients who had an axillary temperature of <360C (AOR=0.18; 95%CI (0.03 - 0.95); p=0.044). While Patients who were admitted at HICH and spent more than 2 hours traveling to the hospital were 74% less likely to discharge against medical advice compared to those who spent less than 30 minutes (AOR = 0.26; 95%CI (0.06 – 0.99); p=0.049). Maternal HIV status was also statistically significant with discharge against medical advice. Patients whose mothers were HIV positive were 9fold more likely to discharge against medical advice compared to their counterparts who were HIV negative (AOR = 8.9; 95%CI (6.8 – 25.8); p<0.01). Other factors were not significantly associated with DAMA. Conclusion: Maternal HIV status, temperature and distance from facility to home were highy associated with discharge against medical advice. Understanding the specific populations at a higher risk of DAMA may provide insights into aspects of health services that need to be addressed to improve quality of care for all patients. Recommendations: Caregivers with treatment abandonment ideation, so that they can be given empathetic support to avert abandonment. Health care providers should intensify on-going counselling sessions with caregivers on the importance of completing hospital treatment and identify