Stroke signs knowledge and factors delaying acute stroke patients’ hospital arrival in the absence of stroke care systems. A Kinshasa multicenter cross-sectional study

Abstract

Abstract Background The global burden of stroke is overwhelming. Rapid recognition and early medical intervention are essential to reduce stroke-related mortality and long-term disability. This study aimed to evaluate awareness of stroke symptoms/signs and determine factors delaying the hospital arrival of patients with acute stroke in Kinshasa. Methods This multicentric cross-sectional study was conducted in all medical facilities in the city of Kinshasa, where medical imaging facilities for stroke diagnosis were available and operational 24 h a day. Patients with stroke and/or accompanying family members were interviewed using a standard questionnaire, and their medical records were reviewed. Factors independently associated with a late arrival (≥ 4.5 h) to the hospital were identified using the logistic regression test in forward multivariate analysis. Results Overall, 202 patients aged 57.9 ± 13.1 years (of whom 106 (52.5%) were men and 96 (47.5%) were women) were included in this study. Only 13% of the patients immediately associated the first symptoms with a stroke episode, and only 29% had the initiative to consult a hospital immediately. Only 10% consulted the recruitment hospital within 4.5 h. Factors independently associated with delayed arrival were age < 60 years (p = 0.014, adjusted odds ratio [aOR] 3.2), being unmarried (p < 0.043, aOR 2.1), low educational level (p = 0.026, aOR 3.4), attending revival churches (p = 0.037, aOR 2.1), lack of stroke awareness (p = 0.002, aOR 2.4), awake consciousness (p = 0.014, aOR 6.5), history of hypertension (p = 0.016, aOR 3.8), history of diabetes mellitus (p = 0.047, aOR 4.3), excessive alcohol consumption (p = 0.038, aOR 2.9), ischemic stroke (p = 0.045, aOR 5.0), and low NIHSS score (p = 0.037, aOR 3.3 ). Conclusions This study depicted a low stroke awareness rate and a much longer prehospital delay than evidence-based guidelines recommend and identified 12 factors that public health actions could target to promote the earliest management of stroke.