|Year : 2018 | Volume
| Issue : 1 | Page : 30-34
Awareness of stroke and knowledge of its risk factors among respondents in Shika community, Kaduna State, Nigeria
Abdulhakeem Abayomi Olorukooba1, Yahaya Mohammed2, Shamsudeen Suleiman Yahaya3, Lawal Amadu4, Jimoh Mohammed Ibrahim1, Mary Ojonema Onoja-Alexander1
1 Department of Community Medicine, Ahmadu Bello University, Zaria, Nigeria
2 Department of Medicine, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
3 Katsina State Primary Healthcare Development Agency, Katsina State Ministry of Health, Katsina, Nigeria
4 Nigerian Field and Laboratory Training Program, Abuja, Nigeria
|Date of Web Publication||10-Oct-2018|
Dr. Abdulhakeem Abayomi Olorukooba
Department of Community Medicine, Ahmadu Bello University, Zaria
Source of Support: None, Conflict of Interest: None
Context: Reduction in risk of stroke is possible through prevention, modification, or treatment of the emerging or established modifiable risk factors. Aims: The aim of this study is to assess the knowledge regarding stroke risk factors and factors affecting this knowledge among residents of Shika, Zaria. Settings and Design: A community-based cross-sectional descriptive study was conducted among 133 respondents in Shika community. Subjects and Methods: A pretested, semi-structured, interviewer-administered questionnaire was used to obtain data from the respondents. Statistical Analysis Used: Data were analyzed using IBM-SPSS version 21. Descriptive summary statistics such as mean and standard deviation (SD) were used to present numeric data such as age while frequencies and proportions were used for categorical data such as knowledge level. Chi-square test and Fischer's exact test were used to determine the association between categorical variables at a significant level of P< 0.05. Results: Majority of the respondents were males (64.7%), with a mean (± SD) age of 33 ± 14 years, and had tertiary education (46.6%). About 82.0% of them had ever heard of stroke. Only 21.8% of respondents had good knowledge (any respondent able to identify ≥2 established factors) of stroke risk factors. There was a statistically significant relationship between knowledge of stroke risk factors and gender of respondents (P = 0.04, χ2 = 6.25) as well as with the educational status of respondents (P < 0.001). Conclusion: Knowledge of stroke risk factors was found to be poor among the respondents, and educational status and gender of respondents were found to be associated factors. To increase public knowledge of stroke, community-based educational strategies based on the results of this study should focus on people with poor educational background.
Keywords: Hypertension, Kaduna, modifiable risk factors, noncommunicable disease
|How to cite this article:|
Olorukooba AA, Mohammed Y, Yahaya SS, Amadu L, Ibrahim JM, Onoja-Alexander MO. Awareness of stroke and knowledge of its risk factors among respondents in Shika community, Kaduna State, Nigeria. Arch Med Surg 2018;3:30-4
|How to cite this URL:|
Olorukooba AA, Mohammed Y, Yahaya SS, Amadu L, Ibrahim JM, Onoja-Alexander MO. Awareness of stroke and knowledge of its risk factors among respondents in Shika community, Kaduna State, Nigeria. Arch Med Surg [serial online] 2018 [cited 2019 Apr 24];3:30-4. Available from: http://www.archms.org/text.asp?2018/3/1/30/243033
| Introduction|| |
Stroke is a major cause of disability and death worldwide. Annually, 15 million people worldwide suffer a stroke. Of these, 5 million die and another 5 million are left permanently disabled, placing a burden on family and community. Stroke occurs everywhere in the world and can affect all age groups. However, it is more common in blacks and the elderly, especially men. After the age of 55 years, the risk of stroke doubles with each passing decade. The World Health Organization estimates that by the year 2030, 80% of all strokes will occur in low- and middle-income countries which are still trying to cope with the problems of communicable diseases such as malaria and tuberculosis. Worldwide, stroke is the third most common cause of death and the leading cause of long-term disability. It places great demands on family members and caregivers. Stroke is an enormous financial burden not only for the families of patients but also for society as a whole.
Stroke, just like many other noncommunicable diseases, has risk factors which when prevalent in a community increase its prevalence in that community.
In many countries (Nigeria inclusive), despite the public health impact of stroke, it is of a lower priority than other diseases. It is a well-known fact that early presentation at the point of care and enhanced control of risk factors for stroke provides better opportunity for more effective stroke treatment and prevention. However, many stroke patients present late at hospitals due to lack of knowledge about stroke and its risk factors.
A key consideration to improve stroke prevention may be public awareness of stroke and its risk factors and changes in behavior toward controlling these chronic conditions. It is possible to prevent stroke through prevention, modification, or treatment of the emerging or modifiable risk factors. These risk factors have been broadly categorized into modifiable and nonmodifiable risk factors. The modifiable risk factors include but not limited to conditions such as high blood pressure, heart diseases, diabetes mellitus, hyperlipidemia, and obesity, while the fixed nonmodifiable risk factors include sex, race, heredity, and age.
Studies have shown that the knowledge of stroke and its risk factors is poor in the general population.,, Lack of public knowledge with regard to stroke and its risk factors is a major factor that influences the incidence and outcome of stroke.
The public knowledge about symptoms and risk factors of stroke as well as their knowledge on stroke prevention through modification of risk factors have little been studied in Nigeria, especially in the Northern region. This study serves as a basis for health interventions in the community as well as provides baseline information for further research.
We conducted a community-based household survey to determine the awareness of stroke and the baseline knowledge regarding stroke risk factors and sources of information as well as factors that affect the knowledge of stroke risk factors among residents of Shika community, Kaduna State, Nigeria.
| Subjects and Methods|| |
A community-based cross-sectional descriptive study was carried out in Shika community in January 2015. Shika is a semi-urban town which houses a community of 15,284 inhabitants in Giwa Local Government Area of Kaduna State. The community has a primary health-care center, a private clinic, and a sizeable number of patent medicine stores. The minimum sample size for this study was calculated using the Leslie-Kish formula for calculation of sample size for cross-sectional study. A total of 133 residents were recruited for this study. Informed consent was obtained from all the study participants. All adults residing in Shika community during the period of the study constituted the study population. Only individuals 18 years and above were included in the study. Residents who have ever had stroke were excluded from the study. Data were collected with the aid of pretested, semi-structured, interviewer-administered questionnaire which was adapted from previous studies., The questionnaire had two sections: the first section was on sociodemographic characteristics of the respondents while the second section had variables for measuring awareness and knowledge of the respondents. The modifications made included questions on commonly (but not established) believed risk factors of stroke such as stress and evil spirits. This is so as to know the level of misconception among the populace. The respondents were selected using a multistage sampling technique. In the first stage (selection of houses), a stratified sampling technique was used based on the four areas (ungwas) in the community. From each of these 4 ungwas lettered A–D, 35 houses were selected randomly from each of the 4 ungwas in the community making a total of 140 houses. The second stage (selection of households) was done using simple random sampling by selecting one household in each of the selected houses making a total of 140 households. In the third stage (selection of respondents), one eligible adult in each of the selected households was selected using simple random sampling until the required sample size was attained. Data obtained were entered into and analyzed using the Statistical Package for the Social Sciences software version 21 (SPSS Inc., Chicago, IL, USA). Frequencies and proportions were used to represent categorical data, while mean and standard deviation were used to represent numeric data such as age. Good knowledge was considered as when a respondent is able to mention at least two established stroke risk factors, while fair knowledge was when a respondent is able to mention just one and poor knowledge was when a respondent is unable to mention any of the risk factors.
Approval to carry out the study was obtained from the Research Ethics Committee of Kaduna State Ministry of Health. Permission was sought from the Giwa Local Government Chairman. Thereafter, informed verbal consent was obtained from the respondents before administering the questionnaire on them.
| Results|| |
A total of 133 respondents were interviewed with a response rate of 100%. The mean age of the respondents was 33 ± 14 years. Majority (82.0%) were in the age group of 20–39 years. Eighty-six of the respondents (64.7%) were male, 67 (50.4%) were married, while only 62 (46.6%) had tertiary education [Table 1].
One hundred and nine of the respondents (82.0%) were aware of stroke. Their major source of information was from health-care workers (30.6%) [Table 2].
The most common risk factors of stroke were “hypertension,” identified by 65 respondents (59.4%), and “heart diseases,” identified by 52 respondents (47.4%). A smaller proportion of respondents (24.8%) listed cigarette smoking as a risk factor for stroke [Table 3].
The respondents' knowledge on stroke risk factors was generally poor as only 24 (21.8%) had good knowledge of stroke risk factors, 37 (33.8%) had fair knowledge, and 48 (44.4%) had poor knowledge.
There was a statistically significant relationship between knowledge of risk factors and sex of the respondents (χ2 = 6.256, df = 2, P= 0.04) as well as their educational status (χ2 = 25.917, df = 8, P = 0.001) [Table 4].
|Table 4: Relationship between age, sex, occupational status, and knowledge of stroke risk factors among the respondents|
Click here to view
| Discussion|| |
This community-based study indicates the desirability of improving the level of public knowledge on stroke risk factors as having good knowledge of stroke risk factors among the population is anticipated to considerably add to stroke prevention efforts. A high (82%) awareness of stroke among the respondents of this study was identified. This is particularly a good finding as awareness of stroke is a prerequisite to having knowledge about its risk factors. However, despite this high awareness recorded, there was a deficiency in knowledge of stroke risk factors among participants of this study. Only 29 (21.8%) of the respondents had good knowledge of stroke risk factors. This finding is lower than what was found in a study in Maiduguri that reported only 49.4% of participants with good knowledge of stroke risk factors. Other similar studies have also documented poor knowledge of stroke risk factors among the general public.,,, The deficiency in knowledge of stroke risk factors in this study could be attributed to the low educational status of the respondents as over half of them (53.4%) had no postsecondary education. Other studies have reported higher level of knowledge of stroke risk factors among its respondents.
As with other studies of stroke risk factors,, the most identified risk factor for stroke in this study was hypertension (59.4%). This finding is higher than what was recorded in an Australian, Brazilian, and an American population study where only 31.8%, 42%, and 43% of respondents, respectively, recognized hypertension as a risk factor for stroke. In addition, factor such as stress was commonly identified by about half (51.1%) of the respondents, although this is not established as a risk factor for stroke. A similar finding was recorded among the Australian population. Health promotion in this area could provide clarification of this misconception in risk factors for stroke. On the contrary, established risk factors such as excess alcohol consumption and diabetes were identified by 30.8% and 35.3% of the respondents, respectively.
In this study, only a third (30.6%) of the respondents received information on stroke risk factors from health professionals. This finding is similar to the results of an Australian study where the majority of the respondents (87.1%) relied on general life experiences or family members as their primary source of knowledge rather than on professionals or as part of their formal school programs. This finding is, however, in contrast to findings from a study in the United Kingdom where more than half (51%) of the respondents received information about stroke risk factors from their general health practitioners. The role of health workers in disseminating health information has been undermined in Nigeria. Information sourced from health professionals should be more accurate and better accepted by the general public than from any other source. Information, communication, and technology including social media networking are also ways that could be utilized as means of health education of the public on important issues regarding stroke and its risk factors.
Our study found no significant association between the respondents' age and knowledge of stroke risk factors (P = 0.15). This is in contrast to several other similar studies.,,, There was a significant association between knowledge of stroke risk factors and respondents' gender (P = 0.04) and level of education (P < 0.001). The female gender and tertiary education were both associated with better knowledge about stroke risk factors. Similar findings were documented in several other studies.,,,,
To the best of our knowledge, there has been no high-profile national stroke education campaign in Nigeria. There is thus a likely possibility therefore that interregional deficiencies in awareness and knowledge of stroke risk factors may occur. No comparative data, however, are presently available for Northern Nigeria. In light of this, the results may not be generalizable across Nigeria. We suggest, given the similarities between our results and those in other countries, that the lack of knowledge we have identified would be similar elsewhere in Nigeria. This study may serve as a basis for further studies to determine practice of stroke prevention as well as new interventional studies that would seek for means of improving the knowledge of stroke risk factors among the general population.
| Conclusion|| |
In our study, we assessed the baseline knowledge of stroke risk factors and factors affecting this knowledge. Despite that more than two-thirds of the respondents in Shika community were aware of stroke, the knowledge of stroke risk factors was generally poor. Educational attainment and gender were found to be associated with knowledge of stroke risk factors.
To increase public knowledge of stroke and to reduce the time taken by patients to call emergency services, when stroke symptoms occur, community-based educational strategies based on the results of this study should focus on high-risk populations such as elderly persons and persons with risk factors for stroke.
The researchers wish to express their heartfelt gratitude to Shika community utilized for the study. Furthermore, the individual respondents that participated in the study are highly appreciated.
Financial support and sponsorship
This is a self-funded study.
Conflicts of interest
There are no conflicts of interest.
| References|| |
Mathers CD, Loncar D. Projections of global mortality and burden of disease from 2002 to 2030. PLoS Med 2006;3:e442.
Lawrence MB. Stroke. Yale University, School of Medicine Heart Book. New York. William Morrow and Co.1992. p. 215-9.
Mathers CD, Loncar D. Updated Projections of Global Mortality and Burden of Disease, 2002-2030: Data Sources, Methods and Results. Geneva: World Health Organization; 2005.
Thrift AG, Cadilhac DA, Thayabaranathan T, Howard G, Howard VJ, Rothwell PM, et al.
Global stroke statistics. Int J Stroke 2014;9:6-18.
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;32:1926-30.
Kleindorfer D, Khoury J, Broderick JP, Rademacher E, Woo D, Flaherty ML, et al.
Temporal trends in public awareness of stroke: Warning signs, risk factors, and treatment. Stroke 2009;40:2502-6.
Kumar PJ, Clark ML. Kumar and Clark Clinical Medicine. Edinburgh: Saunders; 2001.
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;279:1288-92.
Campos-Sousa RN, Soares VY, Almeida KJ, Carvalho LI, Jacobina KS, Athayde Netto AE, et al.
Knowledge of stroke among a Brazilian urban population. Arq Neuropsiquiatr 2007;65:587-91.
Ajayi AO, Ojo OO. Knowledge and perception of stroke among at risk medical out-patients in a tertiary health institution in Nigeria. Ann Afr Med 2007;6:51-3.
] [Full text]
Vincent-Onabajo G, Moses T. Knowledge of stroke risk factors among stroke survivors in Nigeria. Stroke Res Treat 2016;2016:1902151.
Weltermann BM, Homann J, Rogalewski A, Brach S, Voss S, Ringelstein EB, et al.
Stroke knowledge among stroke support group members. Stroke 2000;31:1230-3.
Hickey A, O'Hanlon A, McGee H, Donnellan C, Shelley E, Horgan F, et al.
Stroke awareness in the general population: Knowledge of stroke risk factors and warning signs in ldoer adults. BMC Geriatr 2009;9:35.
Chaturvedi S, Femino L. A pilot study regarding knowledge of stroke risk factors in an urban community. J Stroke Cerebrovasc Dis 1997;6:426-9.
Hickey A, Holly D, McGee H, Conroy R, Shelley E. Knowledge of stroke risk factors and warning signs in Ireland: Development and application of the stroke awareness questionnaire (SAQ). Int J Stroke 2012;7:298-306.
Cossi MJ, Preux PM, Chabriat H, Gobron C, Houinato D. Knowledge of stroke among an urban population in Cotonou (Benin). Neuroepidemiology 2012;38:172-8.
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;289:343-6.
Morgan LJ, Chambers R, Banerji J, Gater J, Jordan J. Consumers leading public consultation: The general public's knowledge of stroke. Fam Pract 2005;22:8-14.
Umeano-Enemuoh JC, Uzochukwu B, Ezumah N, Mangham-Jefferies L, Wiseman V, Onwujekwe O, et al.
A qualitative study on health workers' and community members' perceived sources, role of information and communication on malaria treatment, prevention and control in Southeast Nigeria. BMC Infect Dis 2015;15:437.
Adeyoyin SO, Oyewusi F. Survey of the needs and utilization of health Information among young adults in Abeokuta, Ogun state, Nigeria. Libr Philos Pract E J 2015. Available from: https://www. digitalcommons.unl.edu/libphilprac/1296
. [Last accessed on 2018 Apr 19].
Al Shafaee MA, Ganguly SS, Al Asmi AR. Perception of stroke and knowledge of potential risk factors among omani patients at increased risk for stroke. BMC Neurol 2006;6:38.
Sug Yoon S, Heller RF, Levi C, Wiggers J. Knowledge and perception about stroke among an Australian urban population. BMC Public Health 2001;1:14.
[Table 1], [Table 2], [Table 3], [Table 4]