Discharge against medical advice: cross-sectional survey from a regional orthopaedic hospital in sub-Saharan Africa.

PURPOSE: Discharge against medical advice (DAMA) is a worldwide phenomenon. It continues to challenge the healthcare system and has profound effects on outcomes of treatment. It is when a patient leaves the hospital against the treating physician's recommendation. The objectives of this study are to identify the prevalence, associated factors, and proffer recommendations to mitigate the anomaly in our local/regional healthcare system. METHODS: This was a cross-sectional study with data collected from consecutive patients who sought DAMA at the accident and emergency department of the hospital from October 2020 to March 2022. Data were analyzed using SPSS version 26. Descriptive and inferential statistics were used for data presentation. RESULTS: Ninety-nine cases of DAMA out of 4608 patients seen at the Emergency Department during the study period, giving a prevalence rate of 2.14%. 70.7% (70) of these patients were aged 16-44 years with male-to-female ratio of 2.5:1. An estimated half the number of the patients who DAMA were traders 44.4% (44), 14.1% (14) were in paid employment, 22.2% (22) were unskilled workers, and 3% (3) unemployed. Financial constraint was the leading cause in 73 (73.7%) cases. The majority of patients had limited or no formal education, and this was significantly associated with DAMA (P = 0.032). Ninety-two patients (92.6%) sought discharge within 72 h of admission and 89 (89.9%) admitted to leaving to seek alternative methods of care. CONCLUSION: DAMA is still a problem in our environment. Comprehensive health insurance must be mandatory for all citizens with improved scope and coverage, especially for trauma victims.

Posterior-Only Approach for the Correction of Severe Post-tubercular Kyphosis.

Tuberculosis of the vertebral column (Pott's disease) accounts for up to one-half of musculoskeletal tuberculous infections. The eradication of the infective organism (Mycobacterium tuberculosis) is achievable with chemotherapy. However, such patients with spinal tuberculosis are at risk of developing spinal deformity, and 3%-5% of the patients develop severe deformity greater than 60°. A 30-year-old female presented with back pain of 11 years, discharging sinus, and progressively worsening kyphotic deformity of eight-year duration. She had completed a full course of anti-tubercular chemotherapy. Her neurological examination was within normal limits. Antero-posterior and lateral view radiographs showed osteolytic destruction and collapsed T12 and L1 vertebrae with a thoracic kyphosis of 90°. We did a single-stage posterior-approach closing-opening osteotomy surgery utilizing costotransversectomy (T12 and L1 corpectomy, the insertion of expandable titanium cage, T10 to L3 pedicle screw, and rod fusion). Postoperative kyphosis was 25°. Her motor and sensory functions remained preserved following surgery. The duration of follow-up was 18 months post operation. The mainstay of treatment of severe post-tubercular kyphosis (PTK) is surgery. The correction is complex and could be staged or with multiple approaches and consequent high risk of complications. A single-stage posterior-approach surgery is less invasive.