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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.

Objectives: The Coronavirus disease 2019 (COVID-19) pandemic is currently ravaging the entire world. Doctors as well as other healthcare workers as front-liners in tackling this disease are at a higher risk of exposure to the virus and its potential consequences. The objectives of this study were to assess the knowledge of doctors on the mode of transmission of the virus, to assess their willingness and readiness to work at the COVID-19 treatment center, to identify factors that affect their willingness to work at the treatment center, and to assess their knowledge on infection prevention and control (IPC) practices. Materials and Methods: All medical doctors who attended the COVID-19 sensitization and preparedness meeting with the management of Federal Medical Centre, Owo, Ondo State Nigeria, were recruited into the study after an informed consent was obtained. Study period spanned from the beginning of April 2020 to middle of June 2020. A structured, pre-tested questionnaire was administered to collect relevant information. Results: A total of 112 doctors that were in attendance had the questionnaires administered to them; however, 106 (94.64%) questionnaires were returned. Out of these, 64.2% had correct knowledge of the mode of transmission of COVID-19. We observed that only 34.9% of doctors were willing to work in the treatment center while 1.9% were indifferent. The perceived lack of adequate training and insufficient personal protective equipment (PPE) for staff were major reasons why some doctors were not willing to work in these centers. Fifty percent of the participants got the correct meaning of donning and doffing and three quarters of them had good knowledge of IPC practice. Conclusion: We found in our study that a substantial number of doctors were unwilling to work in COVID-19 treatment areas due to a number of factors including perceived inadequate PPE and inadequate knowledge. The factors that would influence their willingness to work in COVID-19 treatment center were more training, provision of inducement or extra allowances and life insurance schemes. We recommend that in addition to putting emphasis on training, re-training, and providing appropriate equipment, special inducement allowance, and life insurance for healthcare workers might be helpful to encourage them to work in COVID-19 treatment centers.