Are we aware of stroke risk factors and warning signs amid COVID-19? Knowledge and attitude towards risk-factors, signs and symptoms of stroke among the UAE population during COVID-19 pandemic: A cross-sectional study

Background: Despite significant advancements in healthcare, the burden of stroke continues to rise in the developed world, especially during the COVID-19 pandemic. Association between COVID-19 infection and stroke is well established. Factors identified for the delay in presentation and management include a lack of awareness regarding stroke. We aimed to assess the general public knowledge and attitudes on stroke and stroke risk factors in the United Arab Emirates during the COVID-19 pandemic. Methods: A cross-sectional study was conducted between September 2021 and January 2022 among adults ≥18 years old. Participants completed a self-administered questionnaire on sociodemographic characteristics and stroke knowledge and attitudes. Knowledge and attitude scores were calculated based on the number of correct responses. Linear regression analysis was performed to determine the factors related to knowledge and attitude towards stroke. Results: Of the 500 respondents, 69.4% were females, 53.4% were aged between 18 and 25, and nearly half were students (48.4%). The mean knowledge score was 13.66 (range 2-24). Hypertension (69%), smoking (63.2%), stress (56.4%) obesity/overweight (54.4%), and heart disease (53.6%) were identified as risk factors. Overall, the knowledge of signs/symptoms was suboptimal. The mean attitude score was 4.41 (range, 1-6); 70.2% would call an ambulance if someone were having a stroke. A monthly income of 11,000-50,000 AED and being a student were associated with positive knowledge. Being a non-health worker and lacking access to electronic media sources were associated with worse attitudes. Conclusion: Overall, we identified poor knowledge and suboptimal attitudes toward stroke. These findings reflect the need for effective public health approaches to improve stroke awareness, knowledge, and attitudes for effective prevention in the community. Presently, this is of utmost necessity, given the increased occurrence of stroke and its severity among COVID-19 patients.

[1]  Angelo Cascio Rizzo,et al.  Ischemic Stroke and Vaccine-Induced Immune Thrombotic Thrombocytopenia following COVID-19 Vaccine: A Case Report with Systematic Review of the Literature , 2022, Cerebrovascular Diseases.

[2]  G. Collins,et al.  The burden of stroke and its attributable risk factors in the Middle East and North Africa region, 1990–2019 , 2022, Scientific Reports.

[3]  H. Hosseini,et al.  Factors Associated with Knowledge and Awareness of Stroke Among the Jordanian Population: A Cross-Sectional Study , 2021, F1000Research.

[4]  A. Almalki,et al.  Public knowledge and awareness of stroke among adult population in Taif city, Saudi Arabia , 2021, Neurosciences.

[5]  Jing Zhao,et al.  Age-Related Disparities in Stroke Knowledge Among Community Older Adults , 2021, Frontiers in Neurology.

[6]  P. S. Gill,et al.  Global, regional, and national burden of stroke and its risk factors, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019 , 2021, The Lancet Neurology.

[7]  S. Abdalla,et al.  Stroke prevention: knowledge of the general population in Riyadh Region, Saudi Arabia. , 2021, European review for medical and pharmacological sciences.

[8]  Mohannad Alshibani,et al.  Stroke Risk Factor Awareness Among Populations in Saudi Arabia , 2021, International journal of general medicine.

[9]  D. Werring,et al.  Cerebral venous thrombosis after vaccination against COVID-19 in the UK: a multicentre cohort study , 2021, The Lancet.

[10]  S. Bhandari,et al.  Knowledge, attitude, and practice of stroke and thrombolysis among students preparing for undergraduate medical entrance examination in Kathmandu, Nepal , 2021, Health science reports.

[11]  S. Vasoo,et al.  Acute Ischemic Stroke During the Convalescent Phase of Asymptomatic COVID-2019 Infection in Men , 2021, JAMA network open.

[12]  Heba M Zahid,et al.  Public Awareness of Ischemic Stroke in Medina city, Kingdom of Saudi Arabia , 2021, Neurosciences.

[13]  Mohammed Abutaima,et al.  Level of awareness regarding stroke among Riyadh population , 2021, Journal of family medicine and primary care.

[14]  M. Świat,et al.  Adequate Knowledge of Stroke Symptoms, Risk Factors, and Necessary Actions in the General Population of Southern Poland , 2020, Brain sciences.

[15]  D. Werring,et al.  Characteristics and outcomes of COVID-19 associated stroke: a UK multicentre case-control study , 2020, Journal of Neurology, Neurosurgery, and Psychiatry.

[16]  W. Robertson,et al.  Does socioeconomic position affect knowledge of the risk factors and warning signs of stroke in the WHO European region? A systematic literature review , 2020, BMC Public Health.

[17]  R. López-Liria,et al.  Knowledge on Signs and Risk Factors in Stroke Patients , 2020, Journal of clinical medicine.

[18]  T. He,et al.  Health literacy and its effect on chronic disease prevention: evidence from China’s data , 2020, BMC Public Health.

[19]  O. Shamaa,et al.  Knowledge about stroke among adults in Sharjah, United Arab Emirates , 2019, International Journal of Research in Medical Sciences.

[20]  P. Gorelick,et al.  Stroke knowledge among middle and high school students , 2019, The Journal of international medical research.

[21]  Arsalan Ahmad,et al.  Awareness of Stroke and Health-seeking Practices among Hypertensive Patients in a Tertiary Care Hospital: A Cross-sectional Survey , 2019, Cureus.

[22]  L. Schwamm,et al.  Neuroimaging Paradigms to Identify Patients for Reperfusion Therapy in Stroke of Unknown Onset , 2018, Front. Neurol..

[23]  A. Alhazzani,et al.  In Hospital Stroke Mortality: Rates and Determinants in Southwestern Saudi Arabia , 2018, International journal of environmental research and public health.

[24]  V. Karan,et al.  Factors Affecting the Effective Management of Acute Stroke: A Prospective Observational Study , 2018, Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine.

[25]  S. Melnikov,et al.  Age-Group and Gender Differences in Stroke Knowledge in an Israeli Jewish Adult Population , 2017, The Journal of cardiovascular nursing.

[26]  B. Menon,et al.  Female Caregivers and Stroke Severity Determines Caregiver Stress in Stroke Patients , 2017, Annals of Indian Academy of Neurology.

[27]  M. Elkind,et al.  Stroke Risk Factors, Genetics, and Prevention , 2017, Circulation research.

[28]  Muteb Alotaibi,et al.  Knowledge and Attitude of Stroke Among Saudi Population in Riyadh, Kingdom of Saudi Arabia , 2017 .

[29]  S. Melnikov,et al.  Gender differences in feelings and knowledge about stroke. , 2016, Journal of clinical nursing.

[30]  L. Caplan,et al.  Knowledge, attitude, and practice of stroke among high school students in Nepal , 2016, Journal of neurosciences in rural practice.

[31]  H. Hosseini,et al.  The epidemiology of stroke in the Middle East , 2016, European stroke journal.

[32]  R. Clarke,et al.  Emerging Risk Factors for Stroke: What Have We Learned From Mendelian Randomization Studies? , 2016, Stroke.

[33]  B. Ray,et al.  Knowledge, attitude, and practice in relation to stroke: A community-based study from Kolkata, West Bengal, India , 2016, Annals of Indian Academy of Neurology.

[34]  R. Alonso-Gonzalez,et al.  Knowledge of stroke a study from a sex perspective , 2015, BMC Research Notes.

[35]  Michael D. Hill,et al.  Diagnosis and management of acute ischemic stroke: speed is critical , 2015, Canadian Medical Association Journal.

[36]  A. Gjelsvik,et al.  Analysis of Gender Differences in Knowledge of Stroke Warning Signs. , 2015, Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association.

[37]  R. Hahn,et al.  Education Improves Public Health and Promotes Health Equity , 2015, International journal of health services : planning, administration, evaluation.

[38]  Mitchell S. V. Elkind,et al.  Advances in stroke prevention , 2015, Annals of the New York Academy of Sciences.

[39]  R. Hu,et al.  [Survival rate and risk factors of mortality among first-ever stroke patients]. , 2014, Zhonghua liu xing bing xue za zhi = Zhonghua liuxingbingxue zazhi.

[40]  M. Sajatovic,et al.  Knowledge and Perception of Stroke: A Population-Based Survey in Uganda. , 2014, ISRN stroke.

[41]  Martin McKee,et al.  Prevalence, awareness, treatment, and control of hypertension in rural and urban communities in high-, middle-, and low-income countries. , 2013, JAMA.

[42]  Seung-Hoon Lee,et al.  Public Awareness of Stroke in Korea: A Population-Based National Survey , 2012, Stroke.

[43]  Angelina Bockelbrink,et al.  Knowledge of Risk Factors, and Warning Signs of Stroke: A Systematic Review from a Gender Perspective , 2011, International journal of stroke : official journal of the International Stroke Society.

[44]  Helen Rodgers,et al.  Response to symptoms of stroke in the UK: a systematic review , 2010, BMC health services research.

[45]  A. Anderson,et al.  Validity and reliability testing of a short questionnaire developed to assess consumers’ use, understanding and perception of food labels , 2009, European Journal of Clinical Nutrition.

[46]  M. Dieterich,et al.  Gender-specific differences in stroke knowledge, stroke risk perception and the effects of an educational multimedia campaign , 2010, Journal of Neurology.

[47]  A. Falavigna,et al.  Awareness of stroke risk factors and warning signs in southern Brazil. , 2009, Arquivos de neuro-psiquiatria.

[48]  P. Ingrand,et al.  Awareness within the French population concerning stroke signs, symptoms, and risk factors , 2009, Clinical Neurology and Neurosurgery.

[49]  C. Bushnell.  Stroke and the female brain , 2008, Nature Clinical Practice Neurology.

[50]  A. Thrift,et al.  Knowledge of Risk Factors and Warning Signs of Stroke , 2005, Vascular health and risk management.

[51]  T. Ingall.  Stroke--incidence, mortality, morbidity and risk. , 2004, Journal of insurance medicine.

[52]  Jane C Khoury,et al.  Trends in community knowledge of the warning signs and risk factors for stroke. , 2003, JAMA.

[53]  John Wiggers,et al.  Knowledge of Stroke Risk Factors, Warning Symptoms, and Treatment Among an Australian Urban Population , 2001, Stroke.