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Background: In low-resource regions of the world, discharge against medical advice (DAMA) is one empiric contributory factor to poor in-hospital outcome that is not often mentioned. This study aims to investigate the determinants of DAMA from a rural neurosurgical service in a developing country. Methods: This was a prospective observational study of all patients who discharged against medical advice in our service between November 2018 and October 2019. Results: There were 88 patients, 67 (76.1%) males, in the study, (M:F = 3.2:1), representing 17.4% of our patient population in the study period. The peak incidence was in the 20-29 years age group which accounted for 37.5% of the cases. About 55% of the patients presented directly to our center; 31.8% were referred from other hospitals, while 3.4% came from traditional caregivers and 1.1% from religious homes. Head injury was the most common indication for presentation (76.1% of the cases). The duration of hospital stay ranged from 2 h to 14 days. Majority of the patients (87.5%) left the hospital within 8 h of presentation. The reason for DAMA was financial constraints in 50% of cases, inadequate health literacy in 20.5%, financial constraints and poor health literacy together in 12.5%, religious misgivings in 4.5%, and traditional belief in 2.3%. Neurotrauma was predictive of early DAMA (P = 0.001). Conclusion: The rate of DAMA was high in our study. Financial constraints with other socioeconomic limitations were the most common causes of DAMA in our environment. [ABSTRACT FROM AUTHOR]

Background: A major goal in neurotrauma management is the prevention of secondary neuronal injuries. This goal is time bound as neurological deficits once established are usually irreversible. Late presentation is the norm in most neurotrauma patients in developing countries. Aims: The aim of the study was to review the timing of presentation of neurotrauma patients and the possible causes of their late presentation for neurosurgical care in our practice. Methods: A cross-sectional study of a 4-month prospective database of neurotrauma patients presenting to the University College Hospital, Ibadan, was done. The participants' biodata, injury characteristics, initial-care details before referral, and information on timing and causes of delay were analyzed. Results: The study subjects included 111 patients, 80.2% (89/111) were males, and 52.8% aged 21–40 years. Head injury (HI), spinal cord injury (SCI), and combined HI and SCI occurred, respectively, in 80.2%, 14.4%, and 5.4%. Road accidents followed by falls were seen in 73.9% and 14.4% (16), respectively. Just 46.8% (52/111) cases presented within 12 h of injury and only 37 (33.3%) within 4 h. Majority, 83.8% (93/111) were referrals from primary care. These referrals were delayed in 81.7% (76/93) of these. The referring health facilities were located intracity with our center in 54%. Other causes of delayed presentation of these study participants included long-distance travel to our center, lack of funds, or a combination of the above factors. Eighty-nine patients (80.2%) were brought in by family members and the remaining minority by passers-by and road safety personnel. Conclusions: Delayed referral from primary care features prominently in timing of presentation of neurotrauma patients in Nigeria. There is a need for collaboration as well as continuing medical education between the neurotrauma specialists and primary care physicians. [ABSTRACT FROM AUTHOR]

Introduction: As in most low-middle income countries (LMIC) there is dearth of original reports on the outcome of spontaneous intracerebral haemorrhage (sICH) from sub-Saharan Africa (SSA). Methods: This is a 5-year prospective consecutive study of cases of sICH referred for operative care in an SSA neurosurgeon's practice. The in-hospital outcome was assessed and the determinants thereof were interrogated using univariate and multivariate logistic regression analyses. Results: There were 63 subjects, 38 (60.3%) males, aged 28-85years, mean 55.7 (SD, 12.7). Clinical presentation was in poor prognostic stage in most: >57% in coma; significant mass effect on brain CT in 78.3% and associated IVH in 65%. Surgical evacuation of ICH was offered 23 patients (36.5%), more likely in those with mass effect on CT. In-hospital mortality was 62.3%, and good outcome on dichotomized mRS- 27.4%. These proportions were similar between the surgical and non-surgical patient sub-groups. On univariate analysis, statistically significant clinical-radiological associations of these outcomes (p<0.05 in each case) include presentation in coma, unadjusted OR (95% CI) 24.73 (4.90-124.90); in state of critical illness, 28.00 (6.58-119.23); with respiratory distress/aspiration pneumonitis, 12.31 (3.04-49.77), and ICH with associated IVH, 6.48 (1.86-22.61). On multivariate binary logistic regression analysis, only presentation in a state of critical illness was predictive of death, adjusted OR 97.32(3.67-2583.93, p <0.01). Conclusion: In this typical sub-Sahara African LMIC, spontaneous ICH presents in poor prognostic mode, with coma and general critical illness. In-hospital outcome was poor in this study subjects, notwithstanding the definitive treatment, with / without surgery, received. [ABSTRACT FROM AUTHOR]