Assessment Of The General Knowledge Of Stroke:A Cross-sectional Study In Sangmelima,Cameroon

Global burden of stroke has been widely reported presenting Cerebrovascular accident or stroke as one of the leading causes of morbidity and mortality in the world.In 2005,Stroke deaths accounted for 87% of deaths in developing countries and 10% of global mortality.Some studies had shown that people had a good or excellent knowledge of risk factors and warning symptoms of stroke like for examples in India,in Iran,and in Germany;while several others had shown the opposite like for instance in Oman.In Cameroon,strokes were almost unknown to the general public in Cameroon 20 years ago.Previous studies revealed that insufficient knowledge of stroke warning signs was one of the main reasons against early arrival at a hospital for acute stroke treatment;and may be influenced by the socio-demographic characteristics of people such as age,educational level,religion,household income and family history of stroke.The current study thus aimed to evaluate general awareness of stroke(definition,risk factors,warning signs/symptoms and complications)within people living in the city of Sangmelima,Cameroon.ObjectivesThe current study described the general knowledge of stroke: a cross-sectional study in Sangmelima,Cameroon with an aim to evaluate general level of awareness on stroke definition,risk factors,and clinical features(warning signs/symptoms and complications)in general public living in that area.We set three specific objectives that are reminiscent of the following: firstly identify the socio-demographic characteristics of participants,secondly identify the informations the participants have about stroke term,definition,causes,risk factors,symptoms and finally establish the relationship between the socio-demographic characteristics and the participants' knowledge on strokeMethodsIt is a community-based cross-sectional study conducted from September 2017 to May 2018 in Cameroon,city of Sangmelima,among 505 randomly selected adults(?18 years)with their consent.The study was approved by the Sangmelima District Health Service Chief,representative of the Ministry of Public Health in the city of Sangmelima.A two-part self-administered bilingual(English and French)questionnaire was used to collect the data in several places,a total of 52 questions.The first part recorded the socio-demographic data and the second one evaluated the participant's general knowledge on stroke definition,stroke risk factors,stroke warning signs and symptoms and stroke complications.Data were analyzed using SPSS or Statistical Package for the Social Sciences version 20.0(IBM Inc.,Chicago,Illinois,USA).We attributed scores for each answer as it follows: “1 point” for a correct answer and “0 point” for an incorrect or any other answer.The results were presented as frequencies and percentages and participants were divided into2 groups(good and low)according to their scores to determine the level of knowledge: stroke definition(respondents who got ? 8.5 scores out of 17 questions had a low level of knowledge,and those who got > 8.5 scores had a good level);stroke risk factors(respondents who got ? 5 scores out of 10 questions had a low level of knowledge,and those who got > 5 scores had a good level);stroke clinical features(respondents who got ? 5.5 scores out of 11 questions had a low level of knowledge,and those who got > 5.5 scores had a good level).The Chi square test or non parametric equivalent was used as univariate analysis to examine whether there was an association or a relationship between the socio-demographic characteristics of our study population and their knowledge on stroke.Furthermore,we performed a multiple logistic regression to identify the different predictors of a lower level of awareness and a stepwise forward procedure was used to select variables to be retained in the final model.We defined the statistical significance as p < 0.05.ResultsIn total,505 individuals were enrolled.The results thus obtained showed us that majority of our respondents,mostly made up of women(276 or 54.7%)lived in rural areas(419 or 83%)and were unemployed(282 or 55.8%).The most represented age groups were: 25-34 years(47.1%)and18-24 years(35%).The findings also revealed that most of our 505 participants had already heard about stroke in their life which is a good finding;television(66.9%)was the main sources of information on the disease.Besides,healthcare providers(46.3%)were not among those main sources of information recorded which means that important measures must be taken to ensure that healthcare practioners are more involved in raising awareness process.81.2% of our respondents knew that the disease is preventable and needs urgent care 85.9%.High blood pressure was the most frequently identified risk factor 449(88.9%)followed by stress 444(87.9%).The most frequently identified signs/symptoms were weakness/numbness/paralysis of one part of the body 429(83%)and facial deformity 316(62.6%).Moreover,our participants were also aware of the most common stroke complications death 450(89.1%)and paralysis 415(82.2%).Also,we found that the level of knowledge of our study population on stroke is really good because many of the respondents could correctly define the disease and were also able to correctly identify stroke risk factors,stroke clinical features(signs/symptoms and complication).Moreover,it is effectively influenced by the socio-demographic characteristics of the study population.However,even though majority of respondents got a good level of knowledge,we still found people who had a low level of knowledge on stroke definition,stroke risk factors,stroke clinical features,and stroke in general: women,people living in rural area,low educated people,unemployed people,people with a low income level,smokers,young people,and people who were alcohol consumers still got low scores.This can be explained by the fact that majority of our respondents,mostly made up of women,lived in rural areas in the villages and withdrawn areas and unemployed.In addition,women had alower level of knowledge on stroke and were under-educated compared to men therefore less likely to have access to the right information about stroke.ConclusionThroughout our study the following factors have been identified as influent factors on a low level of knowledge: young people,and the low educated people.Meanwhile,the female,the rural area,unemployed people,people with low income level,smokers,and alcohol consumers also got low scores.Thus despite the fact that the statistical analyses could not confirm the significance between the knowledge level on stroke and those factors,it should not be neglected.Those challenges motivated the following suggestions: Ensure primary education for all and mostly for female population because most illiterates in the world are rural women;Promote gender equality and women's empowerment: Rural girls are doubly disadvantaged in overall participation in secondary school as enrollment in secondary school has implications for future employment and economic opportunities,as well as health.IEC(information,education and communication)is an important aspect of all public health programs because education aims to promote a better understanding of stroke among general public so there is a need of strengthening the ongoing health education programs and activities.Therefore,health education and promotion should continue to raise the awareness through public education campaigns/activities among the masses,risk groups(women,youth,smokers,and alcohol consumers)and also within health providers.Awareness activities could be organized at all levels(urban and especially rural areas)in public places to catch a large public.This can be achieved by using internet,social media,television,radio or magazines;by distributing leaflets,flyers;adding advertising spots and also by conducting lectures.Implement a coordinated program of education and training to raise and sustain awareness among the public.And finally,all these measures cannot be taken and applied without a political commitment which is needed to strengthen the healthcare system and policies on stroke prevention which are crucial.Inaddition it is also needed to ensure human resources,financial resources and infrastructures to effectively conduct the awareness activities.