Caregivers’ reasons and health professionals’ perceptions of pediatric discharge against medical advice in Eastern Ethiopia: a mixed-methods study

Sep 30, 2026

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Discharge against medical advice among children creates a major healthcare challenge by interrupting essential treatment, increasing complications, and potentially leading to death. The study evaluates caregivers’ reasons and health professionals’ perceptions of pediatric DAMA in eastern Ethiopia. A mixed-methods design combines a cross-sectional survey of 82 DAMA cases with in-depth interviews. Findings identify improvement perception, prolonged hospitalization, dissatisfaction with care, and financial constraints, alongside knowledge gaps, cultural and religious beliefs, and limited family support.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages13

Reading Time33 min

AccessFree to download

Abstract

Background

Objective

Methods

Results

Conclusion

Introduction

Definition and challenges of pediatric DAMA

Prevalence across income settings

Clinical and system consequences

Libe etal. BMC Pediatrics (2026) 26:19 BMC Pediatrics [https://doi.org/10.1186/s12887-025-06348-3](https://doi.org/10.1186/s12887-025-06348-3) RESEARCH Open Access Caregivers’ reasons and health professionals’perceptions of pediatric discharge against medical advice in Eastern Ethiopia: a mixedmethods study Temesgen Teferi Libe 1*, Yirgalem Alemu Keery2, Samrawit Abebaw Tegene 1, Firew Kasaye Giday3, Bethlehem Demeke Eshetie3 and Meron Melese Nidaw4 Abstract Background Discharge against medical advice among children remains a critical challenge in healthcare, as it interrupts essential treatment, increases complications, and may result in death. Objective This study assessed the caregivers’ reasons and health professionals’ perceptions of pediatric discharge against medical advice in eastern Ethiopia. Methods A mixed-methods design was employed, combining a cross-sectional survey of caregivers whose children were discharged against medical advice with in-depth interviews of health professionals. Quantitative data were analyzed using descriptive statistics, while qualitative data were thematically analyzed. Results Among 82 pediatric DAMA cases, the most frequent caregiver-reported reasons for DAMA were perceived clinical improvement (59 . 8%), prolonged hospitalization (25 . 6%), dissatisfaction with care (14 . 6%), and financial constraints (7 . 3%) . Health professionals highlighted additional contributing factors, including knowledge gaps, cultural and religious beliefs, and lack of family support. DAMA was perceived as common, emotionally distressing, and ethically challenging for providers, who often faced repeated cases without clear institutional guidance. Conclusion Pediatric DAMA is shaped by an interplay of caregiver, socioeconomic, and systemic factors. Addressing it requires strengthening caregiver education, improving provider–caregiver communication, expanding financial and psychosocial support, and establishing institutional guidelines that empower health professionals to act in the best interest of children. Keywords Pediatrics, Discharge against medical advice, Health professionals, Caregivers, Reasons, Perceptions, Ethical dilemma, Low-income countries, Ethiopia *Correspondence: Temesgen Teferi Libe [libe.temesgen.temesgen@gmail.com](libe.temesgen.temesgen@gmail.com) 1Haramaya University College of Health and Medical Science, Harar, Ethiopia 2Haramaya University College of Education and Behavioral Sciences, Diredawa, Ethiopia 3Haramaya University College of Law, Diredawa, Ethiopia 4Jigjiga University College of Health and Medical Sciences, Jigjiga, Ethiopia © The Author(s) 2025. Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit [http://creati](http://creati)[vecommons.org/l](vecommons.org/l)icenses/by-nc-nd/4.0/. Libe et al. BMC Pediatrics (2026) 26:19 Introduction Discharge against medical advice (DAMA) in children is a serious challenge in healthcare, defined as the premature withdrawal of a child from hospital care by parents or legal guardians without formal p

FAQs

What does pediatric discharge against medical advice (DAMA) mean in this study?

It refers to the premature withdrawal of a child from hospital care by parents or legal guardians without formal physician approval.

What were the most frequent caregiver-reported reasons for DAMA?

The study reports perceived clinical improvement, prolonged hospitalization, dissatisfaction with care, and financial constraints among 82 pediatric DAMA cases.

How do health professionals explain why DAMA happens?

They highlight knowledge gaps, cultural and religious beliefs, and lack of family support, describing DAMA as common, emotionally distressing, and ethically challenging for providers.

Sep 30, 2026

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