Abstract
Background
Stroke is a chronic, debilitating health condition with serious and often fatal implications. Lack of public awareness is one of the main reasons for the delay in getting timely intervention.
Purpose
This study was conducted to evaluate the knowledge and awareness of risk factors and warning signs and symptoms of stroke among the general population.
Method
A self-structured questionnaire on stroke, risk factors of stroke and warning signs and symptoms of stroke was administered to 2,868 healthy individuals (65.83%; n = 1,888 males and 34.17%; n = 980 females) from Northeast India. A descriptive statistics approach was undertaken for data analysis.
Results
The mean age of the cohort was 43 ± 12.2 years. About 45.50% (n
Conclusion
Data from the survey suggested that there is scarce knowledge and awareness among the community adults regarding stroke, its risk factors and its alarming signs and symptoms. Awareness among the general public is of utmost importance for early recognition and treatment of stroke. Educating the vulnerable public can improve the chances of survival and recovery post-stroke.
Introduction
Stroke is a serious public health concern. 1 It is the second leading cause of death and is a significant cause of long-term and permanent disability worldwide.2, 3 More than 12 million strokes occur per year globally. 2 Over the past few decades, India has experienced a surge in stroke cases owing to an increase in lifespan, sedentary lifestyle, rising trends of hypertension, diabetes, smoking, alcohol use, drug abuse and daily stress.4–6 Stroke is the fourth and fifth leading cause of mortality and morbidity in India, respectively. 7 At present, crude prevalence of stroke in India ranges from 26 to 757 per 100,000 people per year, while crude stroke incidence ranges from 108 to 172 per 100,000 people per year. 7 India has higher annual incidence rates of stroke as compared to the developed nations. 8 Death due to stroke in India is estimated to be 694,144 annually. 7 In 2016, a study conducted by the Indian Council of Medical Research revealed stroke as the fifth common cause of disability adjusted life years (DALYs). 9 Stroke contributes 37.9% of the total neurological disorder DALYs in India. 10 These statistics indicate a huge burden of stroke and underscore the urgency of an in-depth study of stroke cases across India.
Early initiation of thrombolysis and mechanical thrombectomy has proven to be benchmarks in the treatment and management of stroke. 11 A better stroke outcome is seen if patients visit the hospital within the therapeutic window period of <4.5–6 hours. 11 Studies have shown that <20% of the stroke patients report within this window period and thrombolytic therapy is received by only 3.5% patients.12, 13 Delay in reaching the hospital within the window period to get treatment benefits is one of the major obstacles for the stroke patients. Recent studies have shown that even though door-to-needle time has considerably reduced, however, there is still not much improvement in the onset-to-door times. 14 Inadequate knowledge about the warning signs of stroke by patients and relatives often leads to delayed arrival at the hospital, which further leads to delay in getting appropriate medical or emergency care within the therapeutic window period. 9 Lack of radiological facilities at the primary care centre or family/private doctor clinic, delay in transporting the patient to the appropriate hospital and financial limitations are some of the other hurdles for prehospital delay.12, 13
The benefits of treatment are highest when stroke patients receive the quickest intervention after the onset of initial signs and symptoms. Thus, accurate knowledge of warning signs and risk factors of stroke can greatly reduce the incidence of stroke. A few studies have been undertaken in India, but such type of studies are scarce from Northeast India. The present study was thus aimed at documenting the knowledge and awareness of stroke among the general population from Northeast India and was thus intended to help in the planning and strategising of community-based stroke prevention and management.
Materials and Methods
This cross-sectional community-based survey was conducted among the general population of Assam, Meghalaya, Manipur, Tripura, Nagaland, Mizoram and Arunachal Pradesh. Field staff were interviewed and selected for the survey. They were given thorough knowledge about stroke and its warning signs and symptoms and risk factors. A self-structured stroke awareness questionnaire was administered to 2,868 healthy participants from the general population by the field staff, along with the investigators. Participants from both genders and above 18 years of age and who gave consent to participate in the survey were included in the study. Participants below 18 years of age, with cognitive or linguistic inability, previous history of stroke and who did not consent to the survey were excluded from the study.
The self-structured stroke questionnaire was translated into local languages and included nine multiple-choice questions about awareness of stroke, organ of occurrence of stroke, risk factors of stroke, warning signs of stroke, knowledge of blood pressure, blood sugar and blood cholesterol. All answers were given only by the respondents. No intervention in any form was attempted by the field staff or the investigators to prompt the respondents.
Statistical analysis was performed using Statistical Package for Social Sciences software, version 20.0. Categorical variables were expressed as percentages and the chi-square test was used for categorical variables. Statistical significance was considered if p ≤ .05.
Results
Completed questionnaires were collected from 2,868 respondents, who comprised 65.83% (n = 1,888) males and 34.17% (n = 980) females. The mean age of the cohort was 43 ± 12.2 years.
Awareness About Stroke
Are You Aware of the Disease Called Stroke?
Where Does Stroke Occur?
Awareness About Risk Factors of Stroke
Are You Aware of the Risk Factors of Stroke?
If Yes, Please Name Some of the Risk Factors of Stroke?a
Knowledge About Warning Signs and Symptoms of Stroke
Do You Know the Warning Signs and Symptoms of Stroke?
If Yes, Please Name a Few Warning Signs and Symptoms of Strokea
Knowledge About Blood Pressure
Do You Know Your Blood Pressure?
Knowledge About Blood Sugar
Do You Know Your Blood Sugar?
Knowledge About Blood Cholesterol
Do You Know Your Blood Cholesterol?
Comparison with Previous Studies
Summary of Previous Surveys Undertaken in India in Relation to Knowledge Regarding Stroke.
Discussion
Stroke is an alarming health issue in developing countries such as India, as compared to developed nations. 21 It is considered to be a leading cause of mortality and morbidity across the globe. 22 Modification of risk factors and early recognition of alarming signs and symptoms can greatly prevent the onset of stroke and ensure the possibility of early treatment and better recovery. 23 Early initiation of thrombolysis has proven to be a benchmark in the treatment of ischaemic stroke patients with the maximum chance of recovery. 23 Many studies have reported that failure to recognise the warning signs and symptoms of stroke by patients or their family members is one of the main reasons for pre-hospital delay and delay in getting timely treatment.1,15–17,20 In this study, we have evaluated the knowledge and awareness of stroke, its risk factors and its alarming signs and symptoms in a community-based sample population of adults above 18 years of age across the seven sister states of Northeast India.
In the present survey, a large majority of the population was not aware of stroke, which was higher as compared to the study conducted by Sirisha et al. 20 Less than one fourth of the sampled population could correctly identify the brain as the affected organ, which was much lower than the studies conducted by Kurmi et al. Deepthi et al. and Pandian et al.8, 9, 15 In the present study, the most common response was heart as the organ involved. Similarly, other studies have also reported that patients thought stroke occurred in the heart.9, 20
Awareness about the risk factors of stroke was marginally higher than one-fourth of the sampled population and the remaining three-fourths of the population could not identify a single risk factor. High blood pressure or hypertension was the common risk factor recognised by less than half of respondents and was similar to the studies by Kurmi et al., Menon et al. and Pandian et al.8, 15, 17 Smoking, alcohol, diabetes, heart disease, lack of exercise and positive family history were the other risk factors identified by the respondents, which constituted slightly more than half of the respondents.
Unfortunately, more than half of the adult population was unable to recognise at least one single warning sign and symptom of stroke, which was much higher as compared to other studies.9, 15, 18 Paralysis on one side of the body was the most common response provided by less than half of the respondents and was found to be similar to the responses reported in the previous studies from India.9, 15, 20 Responses pertaining to other alarming signs and symptoms, including sudden difficulty in speaking, falling unconscious, sudden spinning of the head and sudden blindness, formed the remaining proportions.
Interestingly yet unfortunately, almost the entire sampled population had no knowledge about their own blood pressure, blood sugar and blood cholesterol levels, which indicated a serious gap between awareness and their preventive health behaviour. Lack of knowledge and poor attitude towards their own health could also be one of the reasons for delay or missing out on early intervention.
To the best of our knowledge, this is the first community-based study of knowledge and awareness of stroke conducted among the adult population of the Northeastern states of India. Our participants had limited knowledge and awareness about the risk factors and warning signs and symptoms of stroke. Also, poor awareness about their own blood parameters was observed among the participants of our study. Based on the data obtained from our survey, a number of initiatives were started including setting up of regional stroke centre and stroke prevention clinics, conduction of ‘catch them young’ programme for school children, convincing opinion leaders to speak about stroke, initiation of stroke help card, training and educating the doctors and paramedics to treat stroke patients and encouraging targeted health behaviours in public health by engaging and promoting 6,000 active community health workers known as ‘Swasthya Mitras’ (Friend of Health) who constantly work for preventive, promotive and curative care in rural and semi-urban populations of Assam.24, 25
Conclusion
As per our surveyed data, it can be concluded that knowledge and awareness about stroke, risk factors of stroke, warning signs and symptoms of stroke are relatively poor among the general community adults of Assam, Meghalaya, Manipur, Tripura, Nagaland, Mizoram and Arunachal Pradesh. Educating the general and vulnerable public through stroke awareness camps can prevent stroke and disability and can also increase the chances of recovery post-stroke. Our hospital has undertaken a number of health initiatives and has continuously worked for preventive, promotive and curative care for the general population.
Footnotes
Acknowledgements
We would like to thank all the study participants whose data were collected and used for the study.
Authors’ Contribution
MG contributed to the study concept and design, data acquisition, analysis and interpretation, statistical analysis, literature overview and discussion. NCB contributed to the study concept and design, data acquisition, analysis and interpretation, statistical analysis, literature overview and discussion, critical review of the manuscript and provided scientific guidance and supervision. NB and RD contributed to the study concept and design, data interpretation and critical revision of the manuscript. ARB contributed to the study concept and design, data acquisition, analysis and interpretation. PD, ApB and VL contributed to data analysis and interpretation and critical revision of the manuscript and provided scientific guidance. KW and ASA contributed to the literature overview and discussion and critical review of the manuscript. SK provided scientific guidance and supervision. SG contributed to data acquisition, statistical analysis and critical revision of the manuscript. AB contributed to study design, data acquisition, data analysis and interpretation, statistical analysis and literature review and discussion.
Statement of Ethics
The institutional ethics committee of the hospital waived the ethical clearance for this study.
Declaration of Conflicting Interests
The authors declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.
Funding
The authors received no financial support for the research, authorship and/or publication of this article.
Informed Consent
Informed consent was taken from all the participants of the study.
