|Year : 2016 | Volume
| Issue : 1 | Page : 54-59
Knowledge and attitude towards stroke among workers in Cairo University Hospitals
Hatem S Shehata1, Sandra M Ahmed1, Ahmed M Abdelalim1, Naglaa El Sherbiny2
1 Department of Neurology, Faculty of Medicine, Cairo University, Cairo, Egypt
2 Department of Public Health, Fayoum University, Fayoum, Egypt
|Date of Submission||07-Jun-2015|
|Date of Acceptance||26-Jul-2015|
|Date of Web Publication||15-Feb-2016|
Ahmed M Abdelalim
MD, Department Neurology, Faculty of Medicine, Cairo University, Cairo, 11562
Source of Support: None, Conflict of Interest: None
Stroke is a major cause of mortality and morbidity worldwide. Poor knowledge of stroke risk factors, symptoms and appropriate response to stroke are possible causes of poor outcome.
The aim of this study was to evaluate the knowledge and attitude towards different aspects of stroke in a sample of Cairo University Hospitals' workers.
Patients and methods
A structured self-administered questionnaire was administered by 111 workers who were classified into clinical workers (physicians, house officers, nurses, laboratory technician and pharmacists) and nonclinical workers (administrative, sanitary and security workers).
Out of 111 participants, 92 completed the questionnaire. Most participants had heard of stroke (91.3%), mostly through encountering a family member with a stroke rather than through mass media (10.9%). Hypertension was the most common identified stroke risk factor (66.3%). Clinical workers were more likely to identify risk factors. The most common identified stroke symptoms were slurring of speech (38.5%) and elevated blood pressure (38.5%). Clinical workers were more likely to identify symptoms such as slurring of speech (P = 0.042) and altered state of consciousness (P < 0.001). The most frequent response to an attack of stroke was transferring the patients to a hospital (59.8%).
Knowledge and perception of stroke in Cairo University Hospitals' workers appear to be poor, especially among nonclinical workers. Planning educational programs for raising the level of knowledge and awareness of stroke, both on the level of hospital workers and on the public level, is important to improve stroke management and outcome.
Keywords: Attitude, awareness, hospital workers, knowledge, stroke
|How to cite this article:|
Shehata HS, Ahmed SM, Abdelalim AM, El Sherbiny N. Knowledge and attitude towards stroke among workers in Cairo University Hospitals. Egypt J Neurol Psychiatry Neurosurg 2016;53:54-9
|How to cite this URL:|
Shehata HS, Ahmed SM, Abdelalim AM, El Sherbiny N. Knowledge and attitude towards stroke among workers in Cairo University Hospitals. Egypt J Neurol Psychiatry Neurosurg [serial online] 2016 [cited 2018 Feb 24];53:54-9. Available from: http://www.ejnpn.eg.net/text.asp?2016/53/1/54/176374
| Introduction|| |
Stroke is a leading cause of death and disability. Only a limited number of studies have addressed the epidemiology of stroke in Egypt ,, with no accurate national estimates of prevalence or incidence of stroke. The annual incidence of stroke in Egypt has been roughly estimated to be 150 000-210 000 .
Poor knowledge of stroke risk factors , symptoms and appropriate response to acute stroke are causes of delay of stroke treatment and a possible cause of poor outcome ,. Although awareness of stroke is improving, there is still a gap in public knowledge about stroke even in the developed countries ,,,,.
In the absence of national public stroke education and awareness programs in most developing countries, hospital workers have become an important source for information for the public and are frequently contacted by family, friends and neighbours in this respect ,.
| Aim|| |
Our objective was to examine the knowledge and attitude towards different aspects of stroke in a sample of Cairo University Hospitals' workers.
| Patients and methods|| |
This study was a hospital-based survey study conducted in Cairo University Hospitals (Egypt). It included hospital workers affiliated to Cairo University Hospitals. Hospital workers were classified into clinical (physicians, house officers, nurses, laboratory technicians, pharmacists), who are involved directly in the healthcare process; and nonclinical workers (administrative, sanitary staff, security staff), who participate indirectly in the healthcare process. This study was approved by the local ethical committee and all participants signed informed consent before inclusion in the study.
The study instrument used was a structured self-administered questionnaire , which consisted of four sections: sociodemographic (age, sex, occupation, marital status, education), knowledge of stroke (causes, symptoms, warning signs, risk factors), self-reported risk factors of stroke, and response to an attack of stroke.
Data were collected, coded and analysed using SPSS software (version 21; SPSS Inc., Chicago, Illinois, USA). Numeric data were expressed as mean ± SD. The χ2 -test was used to test the differences in responses among clinical and nonclinical subjects. P-value less than or equal to 0.05 was considered statistically significant.
| Results|| |
Out of 111 participants, 92 completed the questionnaire. The participants included 42 (45.7%) men and 50 (54.3%) women, their ages ranging from 18 to 52 years with a mean age of 30.89 ± 8.303 years. There were 32 (34.8) clinical workers and 60 (65.2) nonclinical workers. The mean age of nonclinical workers (33.37 ± 8.17 years) was significantly higher than that of clinical workers (26.25 ± 6.43 years) (P < 0.001). Level of education was significantly higher in the clinical group (P < 0.001). The demographic characteristics of the study group is shown in [Table 1].
Knowledge of stroke
The majority of the participants had heard of stroke (n = 84, 91.3%), with no significant difference between clinical and nonclinical workers (P > 0.05). Yet, only 45 (48.9%) could successfully define stroke or how it happens with significantly better knowledge in the clinical group (P < 0.001).
The most frequent source of information was encountering a patient with a stroke (n = 24, 26.1%), which was mostly a family member (52.4%). Mass media represented the source for only 10 (10.9%) participants. Nonclinical workers were more likely to know about stroke from a friend in comparison with clinical workers (P = 0.013). Other sources were mentioned by 34 (37%) participants, mostly clinical workers (P = 0.007) [Table 2].
|Table 2: Knowledge and source of information about stroke among participants|
Click here to view
Causes and risk factors of stroke
The risk factors and causes of stroke identified by participants in order of frequency were hypertension (n = 61, 66.3%), stress (n = 44, 47.8%), smoking (n = 40, 43.5%), high blood cholesterol (n = 36, 39.1%), obesity (n = 30, 32.6%), diabetes mellitus (n = 17, 18.5%), drug/alcohol intake/abuse (n = 16, 17.4%), lack of exercise (n = 12, 13%), old age (n = 10, 10.9%), unhealthy diet (n = 7, 7.6%) and genetic causes (n = 6, 6.5%). Clinical workers significantly identified risk factors and causes such as smoking (P = 0.029), obesity (P < 0.001), high blood cholesterol (P < 0.001), diabetes mellitus (P = 0.001), lack of exercise (P = 0.021) and genetic causes (P = 0.018) in comparison with nonclinical workers [Table 3].
Warning signs and symptoms of stroke
The warning signs and symptoms of stroke identified by participants in order of frequency were slurring of speech (n = 35, 38.5%), elevated blood pressure (n = 35, 38.5%), fainting (n = 23, 25%), headache (n = 21, 22.8%), altered consciousness (n = 20, 38.5%), weakness of a part or one side of the body (n = 18, 19.6%) and dizziness (n = 17, 18.5%). Clinical workers were more likely to identify symptoms such as slurring of speech (P = 0.042), altered state of consciousness (P < 0.001), fainting (P < 0.001) and dizziness (P = 0.027) compared with nonclinical workers who more frequently answered 'I don't know' (P = 0.007) [Table 4].
Response and action taken towards an attack of stroke
The most frequent response to an attack of stroke was transferring the patients to a hospital (n = 55, 59.8%), followed by calling a specialist (n = 23, 25%), calling a nurse (n = 12, 13%) and go to a pharmacy (n = 4, 4.3%), with no significant differences in response among clinical and nonclinical participants [Table 5]. Women were more likely to answer 'Go to hospital' compared with men (P = 0.011).
Self-reported risk factors of stroke
The most self-reported risk factor was hypertension (n = 17, 18.5%) and smoking (n = 17, 18.5%), followed by high cholesterol (n = 11, 12%), obesity (n = 10, 10.9%) and diabetes mellitus (n = 9, 9.8%). Smoking was significantly more prevalent in male participants (n = 15, P < 0.001). The lifetime risk of developing stroke was identified by 60 (65.2%) participants, whereas 41 (44.6%) believed it could be recurrent. Perception of lifetime risk of stroke was not significantly associated with self-reporting of stroke risk factors (P > 0.05).
| Discussion|| |
In this study we evaluated knowledge and attitude towards stroke in a sample of Cairo University Hospital workers. Limited studies have evaluated stroke awareness among hospital workers or stroke awareness campaign participants ,,, and most of these studies rather focused on community awareness.
Most participants (91.3%) had heard about stroke, yet only 45 (48.9%) could successfully define a stroke or how it happens. While the most frequent source of information was encountering a patient suffering a stroke (26.1%) (mostly family members), mass media represented the source for only 10 (10.9%) participants, and nonclinical workers were more likely to know about stroke from a friend. Surprisingly, 'other sources' were mentioned by 37% of the participants. More or less, similar results were shown in Fayoum University and Ain Shams University Hospital workers in Egypt , and in other developing countries ,, where mass media was lagging behind as a source for stroke awareness.
The role of mass media in raising public awareness of stroke is of utmost importance  and would positively influence emergency department visits by stroke patients . Mass media has been shown to be the main source of stroke awareness in developed countries , and effectively impacts knowledge of stroke in younger generations . This may reflect the discrepancy in stroke education and awareness programs or approach to the public through mass media among developed and developing countries.
The most frequently reported risk factors were hypertension (66.3%), stress (47.8%), smoking (43.5%), high blood cholesterol (39.1%) and obesity (32.6%). Surprisingly, diabetes mellitus was less identified than was expected (18.5%), especially by nonclinical workers. The least reported risk factors were old age, unhealthy diet and genetic causes. Clinical workers were more likely to identify smoking, obesity, high blood cholesterol, lack of exercise and genetic causes (in addition to diabetes mellitus) as compared with nonclinical workers. In agreement with these results, Hamdy et al.  in their study showed that hypertension, stress, obesity and smoking were the most common reported stroke risk factors, and that age and lack of exercise were among the least recognized risk factors. In addition, diabetes mellitus was reported only by one-third of the participants and age and lack of exercise were among the least recognized risk factors . Other studies of hospital workers in Fayoum  and Nigeria  also reported hypertension to be the most common risk factor; although diabetes mellitus was reported more frequently than in our study, it was much less reported relative to hypertension. Diabetes mellitus seems to be generally undermined as a risk factor for stroke by public ,.
The most common warning signs and symptoms of stroke as identified by participants were slurring of speech (38.5%), elevated blood pressure (38.5%), whereas only 19.6% identified weakness of the body or one side as a symptom of stroke. Clinical workers were more likely to identify symptoms as slurring of speech, altered state of consciousness, fainting and dizziness compared with nonclinical workers who more frequently answered 'I don't know'. These results are in agreement with those of previous studies ,, but recognition of weakness as a warning sign of stroke was less identified compared with other studies ,. Generally, knowledge of stroke warning signs seems to be suboptimal even in some developed countries ,, and is linked to older age and poor education ,.
The most frequent response to an attack of stroke was transferring the patient to a hospital (59.8%), followed by calling a specialist (25%), calling a nurse (13%) and go to a pharmacy (4.3%), with no significant differences in response among clinical and nonclinical participants and with no influence of age group or level of education. This is more or less similar to the results obtained by previous studies ,,. Knowledge and awareness of proper measures that should be taken when identifying an attack of stroke has been shown to significantly decrease prehospital delay . Some studies reported differences in responses on the basis of ethnic or sociodemographic factors ,,, but this was not the case in the current study.
In the current study females were more likely to answer 'Go to hospital' compared with males. Many studies have shown better knowledge and attitude towards stroke in females ,,.
The most self-reported risk factor was hypertension (18.5%) and the lifetime risk of developing stroke was identified by 65.2% of participants, whereas 44.6% believed it could be recurrent. Perception of lifetime risk of developing stroke has been linked to awareness of self-reported risk factor in some studies , but in other studies respondents with self-reported risk factor were unaware of an increased risk of stroke especially in the elderly ,.
In the current study there were no significant differences in knowledge or attitude towards stroke among different age groups and levels of education.
The results of our study point towards a big gap between having 'heard about stroke', identifying stroke warning signs, and taking the right action towards an attack of stroke. Unless having encountered a patient with stroke, within the family or from friends, the overall knowledge and attitude towards stroke among workers in Cairo University Hospitals remains poor.
The main limitation of the current study is the limited number of hospital-based studies in the literature and the differences in study design when compared with population-based studies. In addition, clinical workers were significantly younger than were nonclinical workers, which may have augmented the discrepancies in awareness or knowledge of some aspects of stroke in the study.
| Conclusion|| |
The knowledge and attitude towards stroke in Cairo University Hospitals' workers appears to be relatively poor. Clinical workers seem to have better knowledge but still inadequate to effectively improve public stroke awareness. There is a gap that needs to be filled through planning and implementation of educational and orientation programs targeting hospital workers and further the community to improve the stroke awareness and knowledge and to avoid delay in seeking medical help, which in return would improve stroke management and outcome in Egypt.
Many thanks to Dr Sherine El-Mously Assistant professor of Neurology, Fayoum University, Dr Ramez Moustafa Assistant Professor of Neurology, Ain Shams University, Dr Hadeer Abdelghaffar Professor of Pediatrics, Fayoum University for their help and support. Many thanks to house officers of Neurology Department, Cairo University, for their help in organizing and implementing the study.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
MR K, HN A, H F. Incidence and prevalence of nonfatal cerebrovascular stroke and TIA in Upper Egypt (Sohag). Egypt J Neurol Psychiatry Neurosurg 1996; 33
Khedr EM, Elfetoh NA, Al Attar G, Ahmed MA, Ali AM, Hamdy A, et al.
Epidemiological study and risk factors of stroke in Assiut Governorate, Egypt: community-based study. Neuroepidemiology 2013; 40
El Tallawy HN, Farghaly WM, Rageh TA, Shehata GA, Metwaly NA, Abo Elftoh N, et al.
Epidemiology of major neurological disorders project in Al Kharga district, New Valley, Egypt. Neuroepidemiology 2010; 35
Abd-Allah F, Moustafa RR. Burden of stroke in Egypt: current status and opportunities. Int J Stroke 2014; 9
Gupta A, Thomas P. General perception of stroke. Knowledge of stroke is lacking. BMJ 2002; 325
California Acute Stroke Pilot Registry (CASPR) Investigators. Prioritizing interventions to improve rates of thrombolysis for ischemic stroke. Neurology 2005; 64
Deng YZ, Reeves MJ, Jacobs BS, Birbeck GL, Kothari RU, Hickenbottom SL, et al.
IV tissue plasminogen activator use in acute stroke: experience from a statewide registry. Neurology 2006; 66
Pancioli AM, Broderick J, Kothari R, Brott T, Tuchfarber A, Miller R, et al.
Public perception of stroke warning signs and knowledge of potential risk factors. JAMA 1998; 279
Reeves MJ, Rafferty AP, Aranha AA, Theisen V. Changes in knowledge of stroke risk factors and warning signs among Michigan adults. Cerebrovasc Dis 2008; 25
Sug Yoon S, Heller RF, Levi C, Wiggers J, Fitzgerald PE. Knowledge of stroke risk factors, warning symptoms, and treatment among an Australian urban population. Stroke 2001; 32
Derex L, Adeleine P, Nighoghossian N, Honnorat J, Trouillas P. Knowledge about stroke in patients admitted in a French Stroke Unit. Rev Neurol (Paris) 2004; 160
Carroll C, Hobart J, Fox C, Teare L, Gibson J. Stroke in Devon: knowledge was good, but action was poor. J Neurol Neurosurg Psychiatry 2004; 75
Kamran S, Bener AB, Deleu D, Khoja W, Jumma M, Al Shubali A, et al.
The level of awareness of stroke risk factors and symptoms in the Gulf Cooperation Council countries: Gulf Cooperation Council stroke awareness study. Neuroepidemiology 2007; 29
Schneider AT, Pancioli AM, Khoury JC, Rademacher E, Tuchfarber A, Miller R, et al.
Trends in community knowledge of the warning signs and risk factors for stroke. JAMA 2003; 289
Hamdy H, Abdel-Monem A, Emara T, Moustafa R, Abdel Bar A, Abuzeid S, et al.
Knowledge and attitudes towards stroke among workers in two university hospitals. Egypt J Neurol Psychiatry Neurosurg 2013; 50
Akinyemi RO, Ogah OS, Ogundipe RF, Oyesola OA, Oyadoke AA, Ogunlana MO, et al.
Knowledge and perception of stroke amongst hospital workers in an African community. Eur J Neurol 2009; 16
Obembe AO, Olaogun MO, Bamikole AA, Komolafe MA, Odetunde MO. Awareness of risk factors and warning signs of stroke in a Nigeria university. J Stroke Cerebrovasc Dis 2014; 23
Milner A, Lewis WJ, Ellis C. Knowledge of stroke risk factors and early warning signs of stroke among students enrolled in allied health programs: a pilot study. J Allied Health 2008; 37
El Sherbiny N, Abdel Ghaffar H, El-Mously S. Awareness of stroke in adults and pediatrics among Fayoum University Hospital workers and medical students. Egypt J Neurol Psychiatry Neurosurg 2011; 48
Aly Z, Abbas K, Kazim SF, Taj F, Aziz F, Irfan A, et al.
Awareness of stroke risk factors, signs and treatment in a Pakistani population. J Pak Med Assoc 2009; 59
Pandian JD, Jaison A, Deepak SS, Kalra G, Shamsher S, Lincoln DJ, Abraham G Public awareness of warning symptoms, risk factors, and treatment of stroke in northwest India. Stroke 2005; 36
Davis SM. Community stroke education using mass media: past results and future implications. Stroke 2007; 38
Hodgson C, Lindsay P, Rubini F. Can mass media influence emergency department visits for stroke? Stroke 2007; 38
Baldereschi M, Di Carlo A, Vaccaro C, Polizzi B, Inzitari D, Promotion Implementation of Stroke Care in Italy Project Working Group. Stroke knowledge in Italy. Neurol Sci 2015; 36
Nedeltchev K, Fischer U, Arnold M, Kappeler L, Mattle HP. Low awareness of transient ischemic attacks and risk factors of stroke in a Swiss urban community. J Neurol 2007; 254
Kraywinkel K, Heidrich J, Heuschmann PU, Wagner M, Berger K. Stroke risk perception among participants of a stroke awareness campaign. BMC Public Health 2007; 7
Donkor ES, Owolabi MO, Bampoh P, Aspelund T, Gudnason V. Community awareness of stroke in Accra, Ghana. BMC Public Health 2014; 14
Ramírez-Moreno JM, Alonso-González R, Peral-Pacheco D, Millán-Núñez MV, Aguirre-Sánchez JJ. Stroke awareness is worse among the old and poorly educated: a population-based survey. J Stroke Cerebrovasc Dis 2015; 24
Koo JE, Lim YS, Myung SJ, Suh KS, Kim KM, Lee HC, et al
. Hepatic myelopathy as a presenting neurological complication in patients with cirrhosis and spontaneous splenorenal shunt. Korean J Hepatol 2008; 14
Coutinho JM, Klaver EC, Roos YB, Stam J, Nederkoorn PJ. Ethnicity and thrombolysis in ischemic stroke: a hospital based study in Amsterdam. BMC Neurol 2011; 11
Bay JL, Spiroski AM, Fogg-Rogers L, McCann CM, Faull RL, Barber PA. Stroke awareness and knowledge in an urban new zealand population. J Stroke Cerebrovasc Dis 2015; 24
Alaqeel A, AlAmmari A, AlSyefi N, Al-Hussain F, Mohammad Y. Stroke awareness in the Saudi community living in Riyadh: prompt public health measures must be implemented. J Stroke Cerebrovasc Dis 2014; 23
Lundelin K, Graciani A, García-Puig J, Guallar-Castillón P, Taboada JM, Rodríguez-Artalejo F, Banegas JR. Knowledge of stroke warning symptoms and intended action in response to stroke in Spain: a nationwide population-based study. Cerebrovasc Dis 2012; 3 :161-168.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]