Stroke signs knowledge and factors associated with a delayed hospital arrival of patients with acute stroke in Kinshasa

Background: Rapid recognition and early medical intervention are essential to reduce strokerelated 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: 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 with an average age of 57.9 +/- 13.1 years were included. Only 27 (13.4%) patients immediately associated the initial symptoms with a stroke episode. Delayed hospital arrival was observed in 180 (89.1%) patients. Unmarried status (adjusted odds ratio [aOR], 2.29; 95% confidence interval [CI], 1.17 -4.88; p = 0.007), low education level (aOR, 2.29; 95% CI, (1.12 -5.10; p = 0,014), absence of impaired consciousness (aOR, 3.12; 95% CI, 1.52 -4.43; p = 0.005), absence of a history of hypertention (aOR, 1.85; 95% CI, 1.18 -3.78; p = 0.041), absence of a history of diabetes (aOR, 1.93; 95% CI, 1.15 -4.58; p = 0.013), heavy alcohol consumption (aOR, 1.83; 95% CI, 1.12 -2.83; p = 0.045), absence of a severe to very severe stroke (aOR, 4.93; 95% CI, 0.82 -1.01; p = 0.002), and presence of ischemic stroke (aOR, 2.93; 95% CI, 1.54 -4.59; p = 0.001) were identified as independent determinants of delayed hospital arrival. Conclusions: This study depicted a low stroke awareness rate and a much longer prehospital delay than evidence -based guidelines recommend and identified eight factors that public health actions could target to promote the earliest management of stroke.