Awareness on Stroke Warning Signs and Risk Factors amongst Rural Population in Selangor

Stroke is a neurological disorder known to be the third leading cause of death in Malaysia. Eighty percent of the cases occurred due to abrupt blockage of blood supply to the brain causing the affected brain area to become damaged and lead to disability or even death [1]. The gold standard treatment via tissue plasminogen activator, however, is most effective to be administered within three hours after the onset of stroke symptoms [2]. According to previous report in 2020, most of the stroke patients that arrived late at the emergency medical care unit were due to the delay in deciding to seek medical attention following the stroke symptoms [3]. Lack of knowledge about the stroke risk factor, signs, and symptoms as well as the tendency of procrastination can result in delay in seeking medical treatment. Several studies had reported the poor level of understanding as well as awareness of stroke signs and symptoms among urban population in Malaysia [4,5]. Therefore, the objective of this cross-sectional study is to explore the awareness and action towards stroke symptoms and risk factors amongst rural population in Selangor, Malaysia. A cross- sectional questionnaire-based study via snowball sampling was conducted amongst the adult individuals residing in several districts of Hulu Selangor, Sabak Bernam and Kuala Selangor that are recognized as rural areas by the Selangor state council. The study used a set of developed questionnaires that consists of two sections: sociodemographic characteristics as well as the awareness and action towards stroke symptoms and risk factors. Descriptive analysis was used to express the variables. Of the 343 respondents, the mean ±SD for awareness on stroke symptoms was 3.9±1.82 out of a total score of 8 whereas awareness on stroke risk factors was 8.9±3.68 out of a total score of 13 (Table 1). The awareness about the stroke symptoms was considered poor as only 36.44% subjects were able to identify all five symptoms of stroke. Meanwhile only 32.4% of respondents were aware of all the risk factors for stroke despite all of them (100%) had heard about stroke. Although most of the respondents recognized stroke as an emergency condition, only 31.8% of them were aware of the appropriate action of calling an ambulance upon recognizing stroke symptoms (Table 2). Previous reports on awareness of stroke symptoms and risk factors were mostly conducted among urban population is Selangor. In 2014, a similar survey conducted among residents in Kajang reported that only 35% of the respondents had satisfactory knowledge of the stroke warning signs while 29% had satisfactory knowledge on the stroke risk factors. Although 78% can correctly recall Emergency Medical Systems number, only 11% were aware of calling the ambulance as the most appropriate action towards witnessing stroke symptoms in individuals [4]. On the other hand, a more recent study conducted among Petaling Jaya residents in 2019 reported that 82.9% to 92.1% of the respondents were able to recognize common symptoms of stroke followed by 74.2% of the study respondents saying that they would go to hospital within 4.5 hours of stroke onset [5]. On contrary, the present study indicates a poor awareness and action towards stroke symptoms amongst rural population in Selangor. Thus, it is suggested that future intervention programs should focus on health promotion and awareness program related to cardiovascular diseases to the community living in the rural districts of Selangor.