PEDIATRIC DISCHARGE AGAINST MEDICAL ADVICE IN BOUAKE, COTE-DIVOIRE, 1980-1992

Discharge information was obtained from pediatric ward logbooks of the Centre Hospitalier Regional de Bouake from 1982 to 1992. While number of children admitted per month and discharge diagnosis remained relat ively stable throughout the period, the proportion of children who lef t the hospital against medical advice increased by nearly 5 times duri ng the 11-year period to over 12% of all pediatric admissions. The pro portion of discharges against medical advice decreased to 10% of ail p ediatric admissions after institution of a programme to provide essent ial drugs at cost to patients (previously only available from private pharmacies). Most children who were taken from the hospital left withi n the first two days of hospitalization. The admission diagnoses of th ese children suggest that most had serious, life-threatening illness a nd that they left the hospital prior to having received adequate treat ment. The increase in pediatric ward discharge against medical advice occurred simultaneously with serious budgetary shortfalls in the hospi tal resulting in inadequacy of medicines and basic equipment. Hospital staff suspected that most of the discharges against medical advice we re caused by families being unable to afford the purchase of medicines and supplies necessary for inpatient treatment. it is suggested that widespread policies of decreasing funding for basic curative services in public hospitals may be associated with a substantial increase in p reventable child mortality.