To determine the factors associated with discharge against medical advice (DAMA), and the readmission and mortality rate at one-month follow-up among these children.

This prospective cohort study enrolled consecutive children (6 months–12 years) from one designated inpatient ward. Clinical and demographic data, and information about reasons for DAMA were collected using a structured interview. Outcome of DAMA patients was assessed telephonically at one month after discharge.

Out of 538 children, 28 (5.2%) obtained DAMA. Predictors of DAMA on multivariate analysis were partial/unimmunized status, underlying chronic disease, and higher Pediatric Early Warning Score (PEWS) at admission. The most common contributors to DAMA included hospital-related reasons (n = 17, 60.7%), disease-related reasons (n = 9, 32.1%), and sociodemographic reasons (n = 7, 25%). A total of 25 children could be followed up at one month; of these 10 were readmitted at another hospital, and 5 died.

The high rates of readmission and mortality among these children emphasize the need for targeted interventions to address the underlying causes of DAMA.