Profiles Related to Discharges against Medical Advice for Fractures of Limbs in the Borgou District Hospital (CHUD-B) in 2024 in Northern Benin

Abstract

Introduction : Outings against medical advice (OAMA) in patients with limb fractures represent a real obstacle for orthopedic care in Benin. They are often motivated by economic, cultural, and organizational factors that can lead to significant functional complications. Objective: This study aims to identify the reasons for OAMA at CHUD-B in 2024 by specifying the decision-making profile and associated contextual factors in patients with limb fractures. Methods: Descriptive, prospective study conducted at CHUD-B (emergencies and surgery) between January 2024 and September 2024. Patients with limb fractures who were discharged against medical advice were included. The data were collected via a questionnaire and file review, then analyzed using descriptive statistics. Results: Of 230 patients admitted for limb fracture, 59 were included after OAMA (prevalence 25.65%). Average age was 30.55 years ± 17.39 years (3 - 85 years), with a male predominance at 79.66%. In 74.58% of cases, the decision came from a male parent, the patient himself in 23.73%, and a traditional practitioner in 1.69%. Several reasons were reported: the preference for traditional treatment dominated at 61.02% for various reasons, the lack of financial resources at 45.76%, the hospital’s geographical inaccessibility (13.56%), lack of confidence in the hospital (10.17%), poor reception (8.47%), dissatisfaction with a family member by modern medicine (6.78%), the negative representation of surgery, anesthesia and implants (1.69%). Conclusion : In northern Benin, OAMA for limb fractures is common and finds its roots in local and national socio-economic specificities (low insurance coverage, low income, low education level, poor patient care), hence the need for more active advocacy for integrated strategies to reverse the trend.