Department of Pediatrics, North Bengal Medical College, Darjeeling, West Bengal, India.
Community Medicine, Medical College Kolkata, Kolkata, West Bengal, India.
J Trop Pediatr. 2021 Jan 29;67(1). doi: 10.1093/tropej/fmaa110.
To determine the burden and etiological factors of leave against medical advice (LAMA) in Indian children.
In this prospective study, legal guardians of 528 patients who took the decision of LAMA were interviewed (using structured question answers based multi-option) and data were captured over a period of 16 months. The resultant database was analyzed using standard statistical methods.
About 6.12% of childhood LAMA cases were dealt out of total pediatric admission including newborns. Neonatal preponderance noted in cases of LAMA from intensive care unit (ICU; 57.14%, p < 0.05). The overall male (n = 293) to female (n = 235) ratio in this study was 1.25:1. Number of LAMA patients was higher from rural area (83.33%), mostly admitted in ICU (93.65%, Pearson's chi-squared test, p < 0.05). Higher proportion (29.47%) of patients with infection availed LAMA from neonatal age group but overall LAMA patients fall under category of respiratory disorders (22.35%). Interest of the domestics issues other than suffering child was considered primary during LAMA for those admitted in ward as compared with ICU patients [odds ratio (OR): 1.73, CI: 1.02-2.94, p < 0.05]. ICU patients were reportedly to be taken to private health care facility (OR: 1.93, CI: 1.06-3.49, p < 0.05). Duration of stay before taking LAMA from ward was <7 days (85.59%, OR: 0.19, CI: 0.11-0.35, p < 0.05). Upper-lower socio-economic class attributed financial constraint as the main reason for LAMA (Pearson's chi-squared test, Chi-square value: 152.23, p < 0.05).
This study tried to elucidate the determinants of childhood LAMA in rural Indian setting.
确定印度儿童中未经医嘱离院（LAMA）的负担和病因因素。
在这项前瞻性研究中，对决定 LAMA 的 528 名患儿的法定监护人进行了访谈（采用基于多项选择的结构化问答），并在 16 个月的时间内收集了数据。使用标准统计方法分析所得数据库。
在儿科总住院患者中，约有 6.12%的患儿未经医嘱离院，包括新生儿。重症监护病房（ICU）中 LAMA 病例以新生儿为主（57.14%，p<0.05）。本研究中男性（n=293）与女性（n=235）的比例为 1.25:1。来自农村地区（83.33%）的 LAMA 患者人数较多，主要在 ICU 住院（93.65%，Pearson's chi-squared 检验，p<0.05）。感染（29.47%）是新生儿组 LAMA 的主要原因，但总体而言，LAMA 患者属于呼吸道疾病（22.35%）。与 ICU 患者相比，在病房住院的患者中，除患儿痛苦外，家庭问题的利益被认为是 LAMA 的主要原因（优势比（OR）：1.73，95%置信区间（CI）：1.02-2.94，p<0.05）。据报道，ICU 患者被送往私立医疗机构（OR：1.93，95%CI：1.06-3.49，p<0.05）。从病房带 LAMA 之前的住院时间<7 天（85.59%，OR：0.19，95%CI：0.11-0.35，p<0.05）。中低社会经济阶层将经济限制作为 LAMA 的主要原因（Pearson's chi-squared 检验，卡方值：152.23，p<0.05）。
本研究试图阐明印度农村地区儿童 LAMA 的决定因素。
