Reasons of Discharge Against Medical Advice Among Children in Oman： A Teaching Hospital Experience

Discharge against medical advice （DAMA） is a serious problem in healthcare delivery, as it can lead to further complications of the diseases that patients are suffering from. This study aimed to evaluate the reasons for signing DAMA for children in a tertiary teaching hospital in Oman. A prospective study was performed through telephone interviews with the mothers of children who were DAMA during one year （November 2013-November 2014）. Out of 3,647 discharges in general pediatric wards, there were 38 cases of DAMA, giving a prevalence rate of 1%. The DAMA happened within 24 hours of admission in 63.8%. Around two thirds of the patients were infants （65.96%）. In some cases, the diagnosis at time of discharge was life threatening diseases. The most common reason for the DAMA as stated by the mothers was child improvement, based on clinical and laboratory findings （40.4%o）, while social problems attributed for 29.8% of DAMA. However, the reasons were not documented in the electronic medical files of 57.4% of the patients, 57.4% of the cases reported by the mothers to be better two weeks after DAMA and the remaining either remained the same, readmitted or were following up in the clinic. Despite the low prevalence rate of DAMA found in this study, this is a stressing phenomenon occurring in a tertiary hospital in Oman, thus, further studies should be conducted to establish specific protocols to protect children from such practices.

Results of the Traditional Treatment of Fractures of Patients Discharged against Medical Advice from the Orthopedics Department of the Ouahigouya Regional University Hospital (Burkina Faso)

Introduction: Binding retains an important place in Africa. Leaving a health facility to see a bonesetter is common there, but a source of complications. The purpose of this work was to analyze the results obtained by bonesetter after discharge against medical advice. Methodology: Analytical cross-sectional study over a period of one year, including all patients admitted for limb fracture, discharged against medical advice for treatment with a bonesetter. Results: Thirty-nine patients were selected. The average age was 36.9 years, and the sex ratio was 5.50. The fractures were open in 35.9%. At a mean follow-up of 19 months, the course was marked by pain in 34.4% and inequality in limb length in 62.5%. Thirteen fractures (40.6%) were consolidated with axis defect, and 11 were without axis defect (34.4%). There were eight non-union (25%), and eleven patients (34.4%) presented with stiffness in one or more joints. Seven patients had died. Discussion: The problem of discharge against medical advice is found in all hospitals but is particularly marked for fractures in our context. The absence of an X-ray and ignorance of the rules of asepsis lead to complications. Only the fractures of the two bones of the leg had progressed well (5/8 good results). The rate of vicious calluses (40.6%) and non-union (25%) is high. Conclusion: Although a few cases have progressed favorably, the results of patients traditionally treated after discharge against medical advice are generally poor.