Temporal trends of discharge against medical advice among maxillofacial trauma patients at the Yaoundé Central Hospital, Cameroon (2009–2012): a retrospective study

<title>Abstract</title> <p>Background Discharge against medical advice (DAMA), also referred to as hospital elopement, is a recognised marker of the quality and accessibility of hospital care, particularly in low- and middle-income countries. This study analysed its temporal trend among patients admitted for maxillofacial trauma at the Yaoundé Central Hospital, Cameroon. Methods A retrospective descriptive study was conducted on twenty-four patients admitted for maxillofacial trauma following road traffic accidents who left against medical advice between 2009 and 2012. Socio-demographic, clinical and socio-economic variables were collected. The temporal trend was assessed using linear regression and the Cochran-Armitage trend test, with a significance threshold of 0.05. Reporting followed the STROBE guidelines. Results The annual number of DAMA episodes rose steadily from 1 case in 2009 (4.2%) to 3 in 2010 (12.5%), 8 in 2011 (33.3%) and 12 in 2012 (50.0%), a highly significant increasing trend (p &lt; 0.001). Financial hardship accounted for 75.0% of departures and perceived clinical improvement for 25.0%. The mean age was 32.17 ± 7.39 years, with a male predominance (83.3%). The mean length of stay was 7.25 days, and in 91.7% of cases the decision originated from the patient. Bivariate comparisons showed no statistically significant difference between subgroups (p &gt; 0.05). Conclusions The steady rise in DAMA reflects chiefly a lack of financial accessibility and a perfectible quality of therapeutic communication. Integrated strategies combining social support, improved patient communication, optimised care protocols and quality monitoring are warranted to reverse this trend.</p>