Signing against medical advice in a special care baby unit in a tertiary center in Northwestern Nigeria

Abstract

Introduction: Children are at the mercy of their caregivers in most developing countries where inadequate health policies and funding make accessing health-care difficult and expensive. Therefore, it may not be surprising for caregivers declining medical care for their children. This study therefore seeks to determine the prevalence of signing against medical advice (SAMA) and common reasons for SAMA in our health center. Materials and Methods: This was a retrospective review of all cases of SAMA seen over a 3-year period from January 2010 to December 2012. Results: There were 59 cases of SAMA comprising 32 (54.2%) males and 27 (45.8%) females, male to female ratio of 1.2:1. Low birth weight (26%), birth asphyxia (12%), and neonatal sepsis (11%) were the most common diagnoses associated with cases of SAMA. The cost of medical care was the most common reason of asking for SAMA (66.0%), followed by preference for alternative care (17%). The year 2011 recorded the highest case of SAMA with 33 cases reported while 2010 and 2012 had 13 cases each. January 2012 had the highest cases of SAMA. Conclusion: SAMA is of great concern; this was observed more among newborns with diagnoses of low birth weight and birth asphyxia. Furthermore, the cost of care was a major reason for asking for SAMA, hence a drawback in delivering effective healthcare.