Stroke knowledge and screening in a high prevalence, low‐income community

The burden of stroke is rising in lowto middle-income countries (LMIC) (1). These countries, however, do not possess the resources for this transition from communicable diseases to a greater proportion of chronic disease. With this in mind, we performed a study in a peri-urban slum in Karachi, Pakistan, to validate a stroke symptom questionnaire that can be used by community workers to identify communitydwelling stroke patients. We also assessed participants’ knowledge regarding stroke symptoms and risk factors. Two community workers interviewed 322 participants after receiving initial training. The sensitivity and specificity of the questionnaire for detecting stroke was 77·1% (CI: 64·1%–86·9%) and 85·8% (CI: 83·5%–87·5%). Hemianesthesia (72·9%) and hemiplegia (64·6%) were the most sensitive symptoms. The overall knowledge of participants was poor (Table 1) with an average of 2·9 correct responses per participant. One hundred eighty-two participants (59·2%) failed to answer any question correctly. Around 25% identified stroke as a preventable condition. Only 13% to 15% subjects identified hypertension, diabetes and tobacco as risk factors for stroke despite the self-reported prevalence of the conditions being 60%, 12% and 80% respectively. Our study identifies a pragmatic and cost-effective tool that can be useful in communities that lack health-care infrastructure. It allows task shifting of screening stroke patients in the community to community workers who demonstrated high acceptability rates. Our study also shows the need to improve the knowledge regarding stroke risk factors and management in the community that seems to resort to indifference in the face of what they consider inevitable fate.