Dear Editor
The burden of stroke is rising in low to middle income countries (LMIC) (1). These countries, however, do not possess the resources for this transition from communicable diseases to a greater proportion of chronic disease.
With this in mind, we performed a study in a peri-urban slum in Karachi, Pakistan to validate a stroke symptom questionnaire that can be used by community workers to identify community dwelling stroke patients. We also assessed participants' knowledge regarding stroke symptoms and risk factors.
Two community workers interviewed 322 participants after receiving initial training. The sensitivity and specificity of the questionnaire for detecting stroke was 77.1% (CI: 64.1%-86.9%) and 85.8% (CI: 83.5%-87.5%). Hemianesthesia (72.9%) and hemiplegia (64.6%) were the most sensitive symptoms.
The overall knowledge of participants was poor (Table 1) with an average of 2.9 correct responses per participant. 182 participants (59.2%) failed to answer any question correctly. Around 25% identified stroke as a preventable condition. Only 13% to 15% subjects identified hypertension, diabetes and tobacco as risk factors for stroke despite the self-reported prevalence of the conditions being 60%, 12% and 80% respectively.
Table 1. Knowledge of Stroke Participants.
| True/False statement regarding stroke | Correct Responses n (%) |
|---|---|
| Stroke is a short-lasting illness | 54 (17.6) |
| It is possible to prevent stroke | 78 (25.4) |
| Stroke is a treatable condition | 60 (19.5) |
| Hemiplegia is a symptom of stroke | 78 (25.4) |
| Chest pain is a symptom of stroke | 26 (8.5) |
| People who have had a stroke, need to take medicine for the rest of their lives | 44 (14.3) |
| High Blood Pressures increase risk of stroke | 40 (13.0) |
| Some people can tell that they have high Blood Pressure | 16 (5.2) |
| People with Diabetes Mellitus have higher risk of stroke | 45 (15.0) |
| Tobacco use increases the risk of stroke | 46 (15.0) |
| Stress is also a cause of stroke | 85 (27.7) |
| Diet rich in fruits and vegetables can protect against stroke | 86 (28.0) |
| High cholesterol can also cause stroke | 43 (14.0) |
| Men and women are at equal risk of stroke | 86 (28.0) |
| Physical activity decreases risk of stroke | 50 (16.3) |
| Obesity is a cause stroke | 45 (14.7) |
Our study identifies a pragmatic and cost effective tool that can be useful in communities that lack healthcare infrastructure. It allows task shifting of screening stroke patients in the community to CHWs who demonstrated high acceptability rates. Our study also shows the need to improve the knowledge regarding stroke risk factors and management in the community that seems to resort to indifference in the face of what they consider inevitable fate.
Acknowledgments
Funding Disclosure: This study was funded by Award Number D43TW008660 from the Fogarty International Center and National Institute of Neurologic Disorders and Stroke. The funders had no role in study design, data collection and analysis, decision to publish, preparation of the manuscript or the decision to submit it for publication. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Fogarty International Center, National Institute of Neurologic Disorders and Stroke or the National Institute of Health.
Footnotes
Author Contributions: Maria Khan and Ayeesha Kamran Kamal conceived the study idea and design, performed the study and interpreted data. Hasan Rehman assisted in writing and editorial process. All authors have read the manuscript and provided input on its content and final version.
Conflict of Interest: None declared.
Contributor Information
Maria Khan, Email: maria.khan@aku.edu.
Hasan Rehman, Email: hasanrehman89@gmail.com.
Ayeesha Kamran Kamal, Email: ayeesha.kamal@aku.edu.
References
- 1.Feigin VL, Lawes CM, Bennett DA, Barker-Collo SL, Parag V. Worldwide stroke incidence and early case fatality reported in 56 population-based studies: a systematic review. Lancet Neurol. 2009 Apr;8(4):355–69. doi: 10.1016/S1474-4422(09)70025-0. [DOI] [PubMed] [Google Scholar]