Factors favouring discharge against medical advice and refusal of hospitalisation in the paediatric emergency department of the Gabriel Touré University Hospital

Abstract

Introduction Within the paediatric emergency department of the CHU Gabriel Touré, the consent of the parents or accompanying persons has always been the essential element in the doctor's care of the child. No medical act or treatment can be carried out without the free and informed consent of the parents or carers, and this consent can be withdrawn at any time. However, after a few days of hospitalisation, some parents decide to interrupt the care and leave against the advice of the nursing staff. Others refuse hospitalization upon admission. The objective of our study was to study the factors that favour discharge against medical advice and refusal of hospitalisation of children in the paediatric emergency department of the CHU Gabriel Touré. Materials and method: This was a prospective, cross-sectional and descriptive study which took place from 01 January 2018 to 30 September 2018, or a period of 09 months. It concerned children from 1 month to 15 years of age for whom treatment had not been started or had been interrupted by decision of the parents or carers. The data were collected on an individual survey form prepared for the survey. Data entry and analysis were done on Microsoft Windows 2007 and EPI info software. Results: During the study period, we were able to collect 34 patients out of 1259 children hospitalised in the emergency department, either a frequency of 2.7%. Children aged 1 to 59 months were the most affected with 79.5%. The sex ratio was 1.26. Mothers were young (18-29 years) in the majority of cases (53%), and uneducated (73.5%). The fathers were young (20-34 years) and not educated (64.7%). The most common reason for consultation was dyspnea + fever (46.9%). The majority of parents (79.4%) were not affiliated to a health insurance scheme. Discharges against medical advice were more frequent (76.5%) than refusals of hospitalisation (23.5%). The most common reasons for discharge against medical advice and refusal of hospitalisation were lack of funds (30.7% and 50% respectively). Consultation with a traditional practitioner was the alternative mentioned by the majority of parents after discharge against medical advice or refusal of hospitalisation (79.5%). Conclusion: The main factors that favour discharge against medical advice and refusal of hospitalisation are the lack of financial means and the illiteracy of parents.