Abstract 270: Evaluating the Knowledge of Stroke Management among Nigerian Medical Doctors
Authors: Yakubu Aliu Opeyemi , Morakinyo Oreoluwa , Nwachukwu Chibuike , Ghazal Ismat , Olalude Oluwakemi , Ezegwui Chidimma , Amuta Augustine , Akinyemi Rufus 
Published: March 2024

Introduction
According to the World Health Organization, Stroke is the 2nd leading cause of death, responsible for approximately 11% of total deaths worldwide (1). In Nigeria, stroke accounts for 4% ‐ 17% of medical deaths (2).Effective stroke management is essential to reduce morbidity and mortality. Few trained neurologists in Nigeria who are mostly concentrated in the cities, making non‐specialists the backbone of initial acute stroke assessment and management in Nigeria. Physician‐related factors have been identified as one of the factors leading to suboptimal stroke care. There is limited literature analysing the proficiency of non‐specialists in the optimal management of stroke in Nigeria. This study was vital for the evaluation of the knowledge of acute stroke care among medical doctors and the factors responsible for the disparity in their skills.

Methods
A descriptive cross‐sectional survey was conducted among 404 medical doctors across all six geopolitical zones in Nigeria using the Acute Stroke Management Questionnaire (ASMaQ). Data were analysed using descriptive statistics and simple logistic regression to predict the relationship between independent variables and the outcome variable (good knowledge vs poor knowledge).

Results
39.1 % of respondents encounter stroke patients a few times a month, 52% work without a neurologist ,and 88.4% work in hospitals without stroke units. 67% (95% CI =63% – 72%) of respondents had good overall knowledge of stroke management. General Stroke Knowledge (GSK) domain had the largest percentage of good knowledge (88.6%, 95% CI= 85‐92%), followed by Hyperacute Stroke Management (HSM), (52.5%, 95% CI=47.3% – 57.7%) and Advanced Stroke Management (ASM), (49.5%, 95%CI= 49.5% –54.4%).Most participants (>85%) demonstrated good knowledge of stroke signs and symptoms. Only 21.8% and 4.2% of respondents work in facilities equipped with intravenous thrombolysis and mechanical thrombectomy respectively. 92% erroneously believe that a full neurological examination is essential in acute stroke while 33.4% demonstrated poor knowledge of blood pressure control in patients with acute stroke .Working in Primary Healthcare Centre (PHCs) and Government Hospital was a significant predictor of overall poor knowledge of stroke. Compared to Private Hospitals, working in Government Hospitals had 1.98 times the odds of poor knowledge (P = 0.011) and medical doctors in Primary Healthcare Practice had 2.29 times the odds of poor knowledge than those in Tertiary Hospitals (P = 0.045).

Conclusion
Despite the fact that the majority demonstrated good knowledge of stroke management, there is a significant knowledge deficit in the ASM domain. This study highlights the need for regular retraining and professional development of medical doctors in acute stroke management in Nigeria. There is an urgent need to address the critical shortage of neurologists in the country and improve access to thrombolysis care in order to reduce the burden of stroke related‐morbidity and mortality.