Assessment of Knowledge on Risk Factors, Warning Signs, and Early Treatment Approaches of Stroke among Community Adults in North India: A Telephone Interview Survey

Impact of Sex and Gender in Stroke in South and Southeast Asia: A Rapid Scoping Review

BACKGROUND

South Asia and Southeast Asia account for more than 40% of the global stroke burden, with differences in stroke risk factors, mortality, and outcomes compared to high-income countries. Sociocultural norms compound the preexisting biological risk differences, resulting in a disproportionate burden of stroke in women in this region. This review summarizes the sex and gender differences across the stroke care continuum in South Asia and Southeast Asia over the past 20 years.

SUMMARY

Despite a higher incidence of stroke in men than women in South and Southeast Asia, women have greater stroke severity and poorer outcomes after stroke. Higher levels of premorbid disability and poor physical health at baseline may be contributory. There is a high prevalence of vascular risk factors such as hypertension, dyslipidemia, cardiac sources of embolism, as well as metabolic syndrome and insulin resistance, among the women in this region. Smoking is uncommon among women; however, other forms of smokeless tobacco, such as tobacco leaf and betel nut chewing, are more prevalent, especially in the rural areas in these countries. Women are more likely to have delayed presentations to the hospital due to untimely recognition of stroke symptoms; however, with regards to door-to-needle times or intravenous thrombolysis (IVT) rates, we found equivocal data. Wide gaps exist in stroke awareness and healthcare-seeking behaviors, with women more commonly opting for public hospitals and low-cost wards, more likely to discontinue treatment, and less likely to adhere to poststroke rehabilitation.

KEY FINDINGS

This review exposes the gender lacunae in stroke service provision across South Asia and Southeast Asia while acknowledging the many knowledge gaps in our understanding. Although the biological risk differences are non-modifiable, educational, policy, and economic measures to mitigate sociocultural barriers are much needed in the region. Sound epidemiological data are needed from more countries to better understand these differences and bridge this gap. It is imperative to advocate and implement policies and programs for stroke care viable for women, cognizant of the gender and cost bias, as well as the interplay of social and cultural structures specific to the regions.

Navigating the Knowledge of Risk Factors, Warning Signs, of Stroke - A Community-Based Cross-Sectional Study Among Saudi Adults in Riyadh Saudi Arabia

Background

The incidence of stroke is increasing in everyday life as a result of modifiable cerebrovascular risk factors and aging. Therefore, the goal of this study was to assess knowledge of the risk factors, and warning signs, of stroke and to determine associated demographic factors among individuals living in Riyadh, Saudi Arabia.

Methods and Materials

A cross-sectional online study using a convenience sampling of general population living in Riyadh was carried out over three months in 2023 using a series of questionnaires that was adopted from the previous study. Before data collection, the study tool was subjected to pilot testing among a small sample of individuals to validate for consistency and reliability. The data was collected using social media platforms. A statistical package for the social science (SPSS version 27) was used.

Results

Four hundred and sixty-two individuals completed the survey. Among those 69.5%, identified hypertension as a risk factor for stroke followed by hyperlipidemia (42.9%), heart disease (44.8%). In addition, most of the respondents (n = 332, 71.9%) knew that numbness or weakness of the face and/or limbs of the body was a warning sign of stroke. In this, 73.5% (n=249) of the respondents agreed that if they saw an individual suffering from a stroke, they would like to take the patient to the hospital immediately. However, there was a significant association between the knowledge of the respondents about the risk factor of stroke and educational degree (p=0.011), and parents working in healthcare settings (p =0.015).

Conclusion

In conclusion it was observed that a significant respondents had an adequate knowledge of stroke risk factors, while most were unaware of the early warning signs of a stroke. To promote primary prevention and early management/outcomes, we advise that future regional campaigns focus on raising knowledge and recognition of stroke symptoms.

Stumbling Blocks to Stroke Thrombolysis: An Indian Perspective

Background and purpose

Stroke is a leading cause of morbidity and mortality worldwide. Developing countries, however, still lag behind in providing timely thrombolytic therapy (TLT) to many eligible patients owing to various reasons. This study aims to identify such factors.

Materials and methods

This was a descriptive observational study undertaken over a period of 18 months at a tertiary care teaching hospital and included 252 acute ischemic stroke patients of which 200 were not thrombolyzed. The reasons for nonthrombolysis were recorded and analyzed.

Results

The study included 252 acute ischemic stroke patients of which only 20% were thrombolyzed. Of the 200 nonthrombolyzed patients, 55% arrived out of the window period while patient-related factors were the second biggest factor preventing thrombolysis. Hospital factors at 14% and financial constraints at 4.5% contributed significantly. Delayed consent emerged as an important factor making 6% of the delays.

Conclusion

Stroke thrombolysis still faces various pre- and intrahospital barriers in India. There is an urgent need to improve infrastructure and organizational streamlining to enable eligible patients to receive prompt treatment.

How to cite this article

Shah A, Diwan A. Stumbling Blocks to Stroke Thrombolysis: An Indian Perspective. Indian J Crit Care Med 2023;27(9):616-619.

Disparities in Stroke Patient-Reported Outcomes Measurement Between Healthcare Systems in Brazil

Introduction

Acute stroke interventions, such as stroke units and reperfusion therapy, have the potential to improve outcomes. However, there are many disparities in patient characteristics and access to the best stroke care. Thus, we aim to compare patient-reported outcome measures (PROMs) after stroke in two stroke centers representing the public and private healthcare systems in Brazil.

Methods

PROMs through the International Consortium for Health Outcomes Measures (ICHOM) were assessed at 90 days after the stroke to compare two Brazilian hospitals in southern Brazil: a public university and a private stroke center, both with stroke protocols and stroke units.

Results

When compared with the private setting (n = 165), patients from the public hospital (n = 175) were younger, had poorer control of risk factors, had more frequent previous strokes, and arrived with more severe strokes. Both hospitals had a similar percentage of IV thrombolysis treatment. Only 5 patients received mechanical thrombectomy (MT), all in the private hospital. Public hospital patients presented significantly worse outcomes at 3 months, including worse quality of life and functional dependence (60 vs. 48%, p = 0.03). Poor outcome, as measured by the mRS score, was significantly associated with older age, higher NIHSS score, and the presence of heart failure. However, the public practice was a strong predictor of any self-reported disability.

Conclusion

Patients assisted at a good quality public stroke center with the same protocol used in the private hospital presented worse disability as measured by mRS and patient-reported outcome measures, with greater inability to communicate, dress, toilet, feed, and walk.

Awareness, Recognition, and Response to Stroke among the General Public-An Observational Study

Objective  To evaluate awareness and response to stroke among the general public.

Materials and Methods  In this prospective, observational study, self-reported stroke awareness questionnaire was administered in 2000 consecutive participants who visited outpatient clinic of a tertiary care hospital. For data analysis, comparison included for awareness of stroke and response in case of stroke.

Results  The average age of the study participants was 39.64 ± 15.55 (17–85), with 651(32.6%) women. Among the respondents, 786(39.3%) participants mentioned stroke as blood clot in the brain; 268(13.4%) stated it as brain hemorrhage. Awareness of stroke was higher in people in cities (71.0 vs. 8.5%; p  < 0.001) and graduates (75.3 vs. 60.9%; p  < 0.001) or knew a family member or friend who had stroke (42.7 vs. 30.4%; p  < 0.001). Most commonly recognized risk factors included stress (1,152; 57.6%) and hypertension (1,148; 57.4%). Most identified warning sign was weakness of one side of body (807; 40.4%) and speech impairment (658; 32.9%). Participants who were aware of stroke knew a greater number of risk factors (3.75 ± 2.88 vs. 2.45 ± 2.66; p  < 0.001) and warning signs (2.85 ± 2.25 vs. 1.49 ± 1.41; p <0.001). Among 1,138 participants who were aware of stroke, 166 (14.6%) participants knew one correct response in case of a stroke, either call a doctor (49.3 vs. 35.0%; p <0.001) or call an ambulance (41.1 vs. 34.9%; p  = 0.055). Participants who knew one correct response to stroke had at least a family member/friend who had stroke (44.1 vs. 34.3%; p  < 0.022).

Conclusion  We report that among 56.9% of the participants who were aware of stroke most could not name more than four risk factors or three warning signs of stroke. Only 14.6% of those aware of stroke knew appropriate response to stroke.

Comparative Evaluation of Stroke Awareness of Individuals Whose First-Degree Relatives had a Stroke and that of Individuals Whose First-Degree Relatives Did Not

OBJECTIVE

To assess the stroke awareness levels of individuals whose first-degree relatives had a stroke and to compare the results with those of individuals whose first-degree relatives did not have a stroke.

MATERIALS AND METHODS

This cross-sectional study was conducted between March and May 2019, with first-degree relatives of patients who had a stroke (group 1) and a comparable set of individuals whose first-degree relatives did not have a stroke (group 2). Participants were asked to complete a questionnaire asking about signs and symptoms, risk factors, treatment options, information sources, responses after the development of stroke, and early treatment of stroke.

RESULTS

In response to the questions about the signs and symptoms of stroke, group 1 mentioned dizziness and comprehension disorder as a symptom of stroke more frequently than the other group. Stress was the second most frequently mentioned risk factor (by 81% of group 1 and 80.5% in group 2). When the participants were asked about the sources of information about stroke, family circle and friends were the most frequently mentioned sources for both groups.

CONCLUSION

The present study can serve as a guide in planning training to improve stroke awareness in the future, especially by including individuals whose first-degree relatives had a stroke.

Recognition of stroke-related knowledge among community residents and the improvement after intensive health education: a cross-sectional study

BACKGROUND

The high morbidity, mortality, and disability rates of stroke constitute a heavy burden to the society. The level of understanding about stroke warning symptoms and first aid systems among community residents was generally low. The aim of our work is to investigate stroke-related knowledge in community residents of Jinjiang district of Chengdu and to raise public awareness about stroke through an intensive educational program.

METHODS

Nine communities in Jinjiang district were sampled and a questionnaire about stroke-related knowledge was applied before and after stroke educational activities. We analyzed the impact of such activities in stroke recognition and management.

RESULTS

We collected 1685 valid questionnaires. The awareness about stroke risk before educational activities was 11.4%. The recognition of stroke warning signs among community residents was 29.8-59.5%. Among them, the recognition of major signs, such as limb weakness, language disorder, and imbalance was more than 50%. When faced with five stroke warning signs, the proportion of participants who chose to make an emergency call was 41.5%. Less than 10% of the participants chose to consult a doctor, take medicine, or wait. After strengthening publicity and educational activities regarding stroke, there was a significant improvement in the identification of stroke risk factors, warning signs, and stroke management. The percentage of participants who chose to make an emergency call increased from 53.2 to 82.7%.

CONCLUSIONS

The knowledge about stroke among community residents in Jinjiang District of Chengdu was low. Strengthening publicity and educational activities may raise awareness about stroke prioritizing call emergency after the onset of stroke signs.

Level of Knowledge on Stroke and Associated Factors: A Cross-Sectional Study at Primary Health Care Centers in Morocco

Background:

Stroke is increasingly becoming a major cause of disability and mortality. However, it can be prevented by raising awareness about risk factors and early health care management of patients.

Objective:

The aim of this study is to assess the level of knowledge on stroke, its risk factors, and warning signs in the population attending urban primary health care centers in the city of Agadir, Morocco.

Methods:

This is a multicentric cross-sectional study with a descriptive and analytical purpose. The study was conducted at five urban primary health care centers in Agadir in centralwest Morocco. All persons over the age of 18 years who consulted the health centers and who agreed to fill in the questionnaire were recruited, except for the foreign population and health workers. An interview questionnaire was used to assess the level of knowledge on stroke.

Findings:

A total of 469 participants were involved in the study. The median knowledge score was 8 (Interquartile range 4–13). High blood pressure (55.7%), depression and stress (48.8%) were the most well-known risk factors. Sudden weakness of the face, arms or legs (37.3%) was the main warning sign cited by the participants. Multivariate analysis revealed that illiteracy (OR 1.92; CI_95%: 1.08–3.44) primary education (OR 3.43; CI_95%: 1.63–7.21), rural residential (OR 1.67; CI_95%: 1.07–2.59), no history of stroke among respondents (OR 16.41; CI_95%: 4.37–61.59) and no history of stroke among relatives, acquaintances, or neighbors (OR 4.42; CI_95%: 2.81–6.96), were independently associated with a lower level of knowledge of stroke (Table 4).

Conclusions:

The low level of knowledge on stroke among this Moroccan population indicates the importance of implementing stroke education initiatives in the community. More specifically, proximity education and awareness programs ought to be considered to anchor lifestyle preventive behaviors along with appropriate and urgent actions regarding the warning signs of stroke.