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July2011 Vol.48 Issue:      3 (Supp.) Table of Contents
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Awareness of Stroke in Adults and Pediatrics among Fayoum University Hospital Workers and Medical Students

Naglaa El Sherbiny1, Hadeer Abdel Ghaffar2 and Sherine El-Mously3

 

Departments of Public Health1, Pediatrics2, Neurology3, Fayoum University; Egypt

 



ABSTRACT

Background: Stroke is a devastating public health problem in Egypt and it is considered the third leading cause of death in the developed countries. The hospital workers are an important source of stroke knowledge. Objective: We aim to assess the stroke knowledge among Fayoum University hospital workers and medical students. Methods: A cross sectional hospital based survey was conducted on (202) participants from Fayoum University hospital workers and medical students. They were divided into two groups: health care providers (HCPs) and non-health care providers (NHCPs) who were interviewed using a structured questionnaire on stroke knowledge in both adults and children. Results: The HCPs represented (65.8%) of the study sample, (93.6%) had knowledge about stroke while (30.7%) only knew that stroke might occur in the pediatric age group; (17.3%) knew the possible causes and only (4.5 %) were oriented that the inborn errors of metabolisms might be a cause of stroke  in  children. The common known important stroke risk factors reported were hypertension (65.8%); followed by obesity (58.9%), stress (55.9%), and smoking (48.5%). The main source of information was through getting contact with someone having stroke in both groups (34.6%, 21.7% respectively). Eighty five percent of HCPs and 40.6% of NHCPs might transfer the patients to the hospital as a first action seeking for proper treatment. Conclusion: A huge gap of knowledge about stroke symptoms was present between the HCPs and NHCPs indicating the urgent need for a community based stroke awareness programs. [Egypt J Neurol Psychiat Neurosurg.  2011; 48(3): 235-240]

 

Key Words:  awareness, stroke, adult, children, health workers

 

Correspondence to Sherine El-Mously, Department of Neurology, Fayoum University, Egypt.  Tel.: +20846300587   Email: smm02@fayoum.edu.eg





INTRODUCTION

 

Stroke is a life-altering public health problem worldwide. It is considered the third leading cause of death in developed countries; and the leading cause of disability among adults1. There is a stroke about every minute; and a person dies of stroke about every 3.5 minutes. Stroke affects about four out of 1000 people2. In Egypt, in a multicenter study, prevalence of stroke has been found to be 4.6/1000 in urban areas, 5.6/1000 in rural areas with a mean of 4.5/1000. The annual incidence was 2.1/1000/year3. The burden is much higher in developing countries because of epidemiological and demographic transition4. Ignorance and poor control of stroke risk factors have been considered as important factors leading to an increased prevalence of stroke amongst Africans5.

Lecouturier et al.6 recommended that stroke should be treated as a medical emergency. Jones et al.7 concluded that knowledge of stroke symptoms among general public and high risk people is generally poor. However, most of them recognized the need for an emergency response which was not translated into action.

 

In children, the recognition of stroke is almost delayed because of low incidence of stroke and lack of specific assessment measures to this entity. The causes of pediatric stroke are significantly different from that of adult. Nearly half of survivors of pediatric stroke may have neurological deficits affecting the functional status, and different neuro-cognitive domains leading to reduced quality of life8,9.

Prevention and early intervention are the success keys in reducing death and disability from stroke. Primary prevention is established through a community-based education programs raising the stroke knowledge10. The success of primary preventive measures as reduction in the risk of stroke and increase in the speed of hospital presentation after the onset of stroke is influenced by the level of knowledge about stroke in the general population. Thus, health care workers might have a challenging  role in providing stroke information to the public11.

Aim of the work: to assess the knowledge of Fayoum University hospital workers about stroke regarding the risk factors and warning symptoms. These factors will lead to a proper diagnosis and early treatment looking for reducing the burden of stroke.

SUBJECTS AND METHODS

 

A hospital based survey was conducted among Fayoum University hospital workers, who were divided into two groups: 133 (65.8%) health care providers (HCPs) including 31 (15.3%) house officer’s, 39 (19.3%) nurses, 45 (22.3%) clinical medical students, 7 (3.5%) pharmacists, and 11 (5.4%) laboratory scientists.  The other group included 69 (34.2%) non-health care provider (NHCPs) gathering other categories of workers in the hospital as follow: 38 (18.8%) administrative, 8 (4%) record staff, 23 (11.4%) cleaning and security officers. The two groups were interviewed using a pre-tested, structured closed questionnaire. There was an inclusion criterion of being a staff in Fayoum University hospital, while the exclusion criteria were either the refusal to participate in the study or being a resident doctor who is considered to have optimal knowledge and experience.

Study Designs: This is a cross- sectional, analytical, observational study which was applied on selected 202 hospital workers out of 600. The study participants were selected by systematic random sampling.

Study Instrument: Total of (225) questionnaires were distributed among hospital workers, and (202) complete, accurate questionnaire forms were available for analysis with a respondent rate of (89.7%). The questionnaire consisted of 26 questions, which were divided into 4 sections. The first section included six questions related to socio-demographic status. The second section was concerned with knowledge of stroke via 13 questions evaluating the causes, risk factors, and treatments’ preference. Regarding awareness of participant about stroke in children, five questions were included in the third section. The fourth section was formed of two questions assessing the possible management of stroke in both adults and children.

Ethical Consideration: This study was reviewed and approved by the Faculty of Medicine Research Ethical Committee, and a waiver of consent form was approved as we used an anonymous self-administered questionnaire with no private or sensitive information.

Data entry and statistical analysis: Data were collected, coded and analyzed using SPSS software version 18 under windows 7, simple descriptive analysis in the form of percentage distribution, means and standard deviations were done. Suitable inferential statistics were done to test the level of significance with a confidence level of 0.05.

 

RESULTS

 

The age of the respondent ranged from (18 to 55) years with a mean (± SD) of (27.43±7.72 years). The female were 65.3% (N=132) and male were 34.7% (N=70). The HCPs represented 65.8% of the study sample, those having high educational level represented 80.2% (N= 162), while those who completed the secondary education were16.3% (N=33), primary and preparatory education were 3.5% (N=7) of the total sample.

Stroke Knowledge: Most of our sample 93.6% (N=189) had their knowledge about stroke while only 30.7% (N=62) of the sample knew that stroke might occur in the pediatric age group; and 17.3% (N=35) knew the possible causes.

Source of information: The main source of information was through getting contact with someone having stroke in both groups (34.6%, 21.7% respectively). The HCPs read and learnt about stroke in school (23.3%, 21.1% respectively).While the NHCPs mainly took their information from the family (21.7%) and the mass media (18.8%) (Table 1).

Causes of stroke in adults: The common cause of stroke reported by study participants was hypertension representing (65.8%); followed by other chronic non-communicable diseases such as high cholesterol (54%), and diabetes Mellitus (DM)  (41.1%). Also, the lifestyle factors were highly recognized such as obesity (58.9%), stress (55.9%), and smoking (48.5%). A very low percent (5%) might believe in evil spirit, which is correlated with the lowest percentage of the sample completing their primary (2.5%) and preparatory education (1%) (Figure 1).

Symptoms of stroke in adults: The commonest symptom of stroke identified by HCPs was the altered level of consciousness (53.4%), while the commonest one was slurring of speech 29% in the NHCPs. There was a statistical significant difference (P<0.05) in all symptoms between both groups (Table 2).

Causes of stroke in children: The HCPs were aware about the common causes of stroke in children but only few of them had knowledge about its causes especially the inborn errors of metabolism (4.5 %). None of NHCPs knew about causes of stroke in children. There was a statistical significant difference between the two groups regarding all causes of stroke in children except diarrhea and inborn errors of metabolism (Table 3).

Symptoms of stroke in children: The HCPs knew about the stroke symptoms in children especially headache, slurred speech, and blurring vision while weakness in one side, convulsions and altered consciousness were present in the least percentage. None of the NHCPs had knowledge about symptoms of stroke in children. There was statistical significant difference between both groups (P< 0.05) (Table 4).

Comparison between HCPs & NHCPs in the action taken towards a stroke attack: One hundred and thirteen (85%) of HCPs and 28 (40.6%) of NHCPs might transfer the patient to the hospital as a first action seeking for a proper treatment while 74.4% (N=99) of HCPs and 46.4% (N=32) of NHCPs might call a specialist with a statistical significant difference between both groups (P=0.000) (Table 5).


 

Table 1. Sources of Information.

 

Sources of information

HCPs

N= 133

NHCPs

N= 69

P value

N

%

N

%

Seen someone with stroke

46

34.6

15

21.7

0.41

Read about stroke

31

23.3

5

7.2

0.003**

Learned in school

28

21.1

1

1.4

0.000**

Mass Media

21

15.8

13

18.8

0.358

Friends

8

6

11

15.9

0.023*

Family

8

6

15

21.7

0.001**

*Significant at p<0.05 ** Significant at p<0.01

 

Table 2. Symptoms of stroke in adults.

 

Symptoms of stroke

HCPs

 N= 133

NHCPs

N= 69

P value

N

%

N

%

Altered consciousness

71

53.4

15

21.7

0.000**

Slurring of speech

60

45.1

20

29

0.018*

Fainting

58

43.6

11

15.9

0.000**

Headache

56

42.1

17

24.6

0.012*

Weakness on one side of the body

49

36.8

13

18.8

0.006**

Dizziness

40

30.1

11

15.9

0.020*

*Significant at p<0.05 ** Significant at p<0.01

 

Table 3. Causes of stroke in children.

 

Known causes of stroke in children

HCPs

 N = 133

NHCPs

N = 69

P value

N

%

N

%

Hereditary causes

44

33.1

0

0

0.000*

Blood diseases

32

24.1

0

0

0.000*

Congenital malformation of arteries

19

14.3

0

0

0.000*

Head trauma

14

10.5

0

0

0.002*

Infection

16

12

0

0

0.001*

Inborn errors of metabolism

6

4.5

0

0

0.078

Diarrhea

3

2.3

0

0

0.283

*Significant at p<0.01

 

Table 4. Symptoms of stroke in children.

 

Known symptoms of stroke

in children

HCPs

 N = 133

NHCPs

 N = 69

P value

N

%

N

%

Headache

19

14.3

0

0

0.000**

Slurring speech

18

13.5

0

0

0.000**

Blurring of vision

13

9.8

0

0

0.004**

Weakness in one side

10

7.5

0

0

0.014*

Convulsion

8

6

0

0

0.033*

Altered consciousness

4

3

0

0

0.185

*Significant at p<0.05 ** Significant at p<0.01

Table 5. Comparison between HCPs and (NHCPs) regarding the action taken in response to stroke.

 

Action taking in response to stroke

HCPs

 N = 133

NHCPs

 N = 69

P value

N

%

N

%

Transfer the patient to the hospital

113

85

28

40.6

0.000*

Call a specialist

99

74.4

32

46.4

0.000*

Take a drug at home

0

0

1

1.4

0.342

Call a religious person

1

0.8

1

0.5

0.568

* Significant at p<0.01

 

 

 

Figure 1. Causes of stroke.

 

 


DISCUSSION

 

Health care workers were considered an important source of information and have a pivotal role in educating the public about stroke 12. In the current study, the HCPs  represented 65.8% of the study sample, considering them the most important source of information among their community. The current study found that hypertension was perceived as the commonest cause of stroke which was in agreement with many other studies1,12,13,14. The recognition of hypertension as a risk factor for stroke will help in primary prevention of stroke in our community. Only, 41.1% knew that DM is a risk factor for stroke. The prevalence of DM is rising in most developing countries as a result of nutritional transition to western diets15. Interestingly, obesity (58.9%) and hypercholesterolemia (54%) were more recognized as risk factors for stroke compared to DM and all of them are less recognized than hypertension. The previously mentioned diseases are components of the metabolic syndrome which is a huge public health problem worldwide and it is responsible for a growing number of deaths all over the world out of vascular diseases16. Finally, the evil spirit came the least known factor (5%) for stroke occurrence which is lower than the obtained result (13.8%) of 1.  This indicates that most of the sample knows that stroke has realistic causes.

People appeared knowledgeable about the risk factors of stroke but their recognition of the warning signs was poor17,18. This was in agreement of our results in which the commonest symptom of stroke identified by the HCPs was altered level of consciousness while the NHCPs identified the slurring of speech as the commonest stroke symptom. On the other hand, weakness on one side of the body was less recognized as an important stroke symptom among both groups. Other studies showed that weakness on one side of the body is the commonest stroke symptom12,14.

When it comes to the action taken towards a patient with stroke, the majority of the HCPs  will transfer the patient to the hospital or call a specialist,  while few NHCPs have chosen to call first a specialist or to take a stroke patient to the hospital. A good specialist will guide  the patient or his family to urgently transfer the patient to the hospital. This seems logic for hospital workers to think about going to the hospital or calling a specialist, however, the rapidity of the response will be tainted by the proper knowledge about the warning symptoms and signs of stroke.

Regarding the knowledge about stroke occurring in children, (30.7%) of the study sample knew that stroke might occur in children and only (17.3%) of them knew the possible causes. The recognition of stroke in children is often delayed due to the low incidence of stroke and lack of specific assessment measures in this age group8. HCPs were aware about common causes of stroke in children especially hereditary causes and blood diseases which were in agreement with 19 reviewing the association between inherited and acquired coagulation disorders with ischemic stroke. Regarding the awareness about the inborn errors of metabolism as an important cause of stroke in children, only few of the HCPs knew about it. The awareness for HCPs about this category of causes is very important because stroke could be recurrent. Concerning knowledge about stroke symptoms in children, the HCPs were aware with headache, slurred speech, and blurring vision while weakness in one side, convulsions or altered consciousness were the least recognized symptoms inspite of their importance for an early diagnosis. The early recognition of stroke symptoms and signs was very important for early management20.

 

Conclusion

There is a huge gap of knowledge about stroke symptoms between HCPs and NHCPs indicating an urgent need for educational programs about warning symptoms and risk factors of stroke, integrated with awareness about the inborn errors of metabolism and the metabolic syndrome. The early recognition of stroke symptoms and signs will help in prompt management, thus, reducing the burden of stroke morbidity and mortality.

 

[Disclosure: Authors report no conflict of interest]

REFERENCES

 

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2.      Mitchell S, Elkind M. Stroke in the elderly. Mount Sinai J Med (New York). 2003; 70 (1): 27-37.

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14.    Al Shafee M, Ganguly S, Al Asmi A. Perception of stroke and knowledge of potential risk factors among Omani patients at increased risk for Stroke. BMC Neurol. 2006); 6: 38.

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الملخص العربي

 

تمثل السكتة الدماغية مشكلة كبيرة من مشاكل الصحة العامة في جميع أنحاء العالم وتعتبر السبب الثالث للوفاة في الدول المتقدمة. العاملون في المستشفيات هم المصدر الأساسي للمعرفة حول القضايا المتعلقة بالصحة مثل السكتة الدماغية. يهدف هذا البحث الي  تقييم درجة معرفة العاملين والطلاب في مستشفي جامعة الفيوم  بالسكتة الدماغية.

منهجية البحث: اجمالي حجم العينة 202. تم تقسيم العاملين في المستشفي الي مجموعتين: المجموعة الأولي تمثل مقدمي الخدمة الصحية وطلاب البكالوريوس والمجموعة الثانية تمثل العاملين الإداريين في المستشفي. تم عمل مقابلات باستخدام استبيان منظم لمعرفة معلوماتهم عن السكتة الدماغية في الكبار والأطفال. النتائج: يمثل مقدمو الخدمة الصحية 65.8% من حجم العينة. 93.6% منهم لديهم معلومات عن السكتة الدماغية بشكل عام و 30.7% فقط يعرفون إنها تحدث أيضا في الأطفال و 17.3% يعرفون أسباب حدوثها وفقط (4.5٪) يعلمون أن أمراض  خلل التمثيل الغذائى قد تكون سببا للسكتة الدماغية لدى الأطفال.من الأسباب المعروفة التي تمثل عوامل خطورة بالنسبة لمريض السكتة الدماغية جاء ارتفاع ضغط الدم بنسبة 65.8% يليه السمنة بنسبة 58.8% ثم الضغط العصبي 55.9% وأخيرا مرض السكر بنسبة 48.5%. أظهر البحث ان المصدر الرئيسي للمعلومات هو التعامل مع الأشخاص المصابين بالسكتة الدماغية طبقا للنسب التالية 34.6% و21.7%. من المجموعتين. كما ان نسبة 85% من مقدمى الخدمة الصحية  و40.6% من العاملين الغير صحيين أفادوا بأن التصرف المبدئي للتعامل مع حالات السكتة الدماغية هو سرعة نقل المصاب إلي المستشفي. نستخلص من البحث ان هناك فجوة كبيرة في المعلومات بين مقدمي الخدمة الصحية والعاملين الإداريين في المستشفي فيما يخص السكتة الدماغية. هناك حاجة ملحة الي توعية مجتمعية بالأعراض التحذيرية الخاصة بالسكتة الدماغية فيما يخص الكبار والأطفال للحد من مخاطرها.

 



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