Knowledge of alarm signs of stroke among caretakers of stroke patients and first contact healthcare providers at two tertiary referral hospitals in Uganda.

backgroundStroke is a leading cause of disability and mortality worldwide and existing global literature suggests that public knowledge of stroke symptoms is generally poor. Algorithms that encompass stroke alarm signs and partly address this knowledge gap of stroke symptoms in the public like FAST (Face, Arm, Speech, Time) and BE- FAST (Balance, Eyes, Face, Arm, Speech, Time) have been developed. However, the diagnostic value of BE-FAST in acute ischemic stroke has been found higher than in FAST. Although acute stroke recognition algorithms like BE-FAST are widely accepted, applied and generally easy to administer, their utility in Uganda is unknown. This study therefore intended to describe how well the alarm signs and symptoms of stroke summarized in the BE-FAST algorithm are known by acute stroke patients' caretakers (PCs) and first contact stroke healthcare providers (HCPs) at the two major stroke referral hospitals in Uganda and how this knowledge by the PCs affects time of arrival of their stroke patients for rapid stroke intervention services.

methodsThis was a cross-sectional survey study design using data collected over ten weeks by structured questionnaire based in-depth interviews of autonomously consented adult study participants. Data analysis was performed using the IBM SPSS statistics package, version 27.0.1.0. Descriptive variables were compared using Fisher's exact tests and statistical analyses for correlation were performed using Kendall's tau-b or tau-c as appropriate. Of the total 120 respondents interviewed (60 first contact HCPs and 60 PCs), 10 caretakers were excluded because they achieved less than Uganda's primary seven level of education leaving 110 respondent entries to eventual statistical analysis.

resultsFemales comprised the majority of the first contact HCPs (55%) and PCs (68%). Majority of the first contact HCPs were medical interns (38.3%) allocated to either the neurology ward or the emergency ward of a study site hospital. The PCs had a median age of 31.5 years (IQR 25.0-41.3) and only 9% had been through university level education, the majority having made it only to secondary school (52.0%). Of the 60 healthcare worker respondents, only 20 (33.3%) were familiar with the BE-FAST algorithm and none of the PCs knew or had heard about it. Half (50%) of the caretakers had their patients arrive to hospital beyond 24 h from their patient's time last known well for stroke treatment (between 2 and 5 days). Because caretakers had no knowledge of the BE-FAST algorithm, its correlation to their acute stroke patients' hospital intervention arrival time could not be tested.

conclusionKnowledge of acute stroke recognition aids like BE-FAST was poor amongst first contact HCPs and was non-existent amongst caretakers of acute stroke patients at the two largest stroke referral hospitals in Uganda. This calls for focused integration of acute stroke recognition modules in the curricula of HCPs in Uganda at all levels and facilities of their training and for education in knowledge of acute stroke alarm signs to the country's general public, through media and community outreach programs, using understandable local dialects.