INTRODUCTION:

Stroke or cerebrovascular accident, which considerably affects the individuals’ entire quality of life, is the third leading cause of death worldwide, with an incidence of approximately 1 million cases per year¹ and its fatality is more in Sub-Saharan Africa countries, which showed that 8 % of global death from stroke occurred in these countries². High blood pressure, also termed as hypertension is a condition that afflicts almost 1 billion people worldwide and is a leading cause of mortality and morbidity.

Therefore, this disease is often referred “Silent Killer.” In most of the instances, this disease remains asymptomatic until severe to express as one of the following outcomes: stroke, myocardial infarction, renal dysfunction, visual problems and others. Thus, hypertension is affirmed as the major risk factor for stroke, coronary artery disease and myocardial infarction³.

The incidence of stroke among adults was less than 2 in some developing countries in 1990, whereas there was stroke occur in 5% of Western European adults, 8 % of Americans and 13 % of Saudi Arabians. In Thailand, stroke was the fourth leading cause of death at 28.96 per 100,000 in 2009 and in India, death due to stroke for the year 1998 – 1999 was 36/100,000. A statistical analysis on gender influence on stroke showed that women always outnumbered men, except in the age group of 50- to 69⁴.

Hypertension affects nearly 1 billion individuals worldwide and is responsible for approximately 7.1 million deaths per year. In India, 25-30 % of the urban population and 10 - 12 % of the rural areas suffer from high BP and are thus hypertensive individuals prone to stroke risk. Furthermore, this was observed that 30 % are still unaware that they have hypertension, despite 59% of them are receiving treatment to hypertension⁵. The study conducted in Australia reported that within 12 months of stroke – approximately 37 % die and 10 % experience a recurrent stroke. Of those who survive stroke - approximately 51 % are disabled in one of the day-to-day activities and 50 % exhibit cognitive impairment or dementia⁶. Similarly, a survey in different parts of India showed prevalence of stroke to be approximately 200 per 100, 000 population. India thus faces an enormous socioeconomic burden to meet the cost of rehabilitation of stroke victims, as more people are now surviving the peak age (55-65 years) common for stroke occurrence⁷.

Hypertension is described as one of the most common causes of stroke; and the incidence of stroke among hypertensive patients is increasing in developing countries⁸. Unlike that of developed countries, ischemic stroke, which is mostly associated with poor control of hypertension, is the commonest type of stroke in Africa⁹.

Identication of the major lifestyle risk factors of stroke and its warning signs has a direct implication for the prevention of stroke with the possible therapeutic measures in high risk group such as hypertensive patients¹⁰. In addition, poor knowledge leads to low compliance in making use of preventive programmes^11,12.

Awareness and knowledge in general population, regarding risk factors and warning symptoms of stroke are essential for the prevention and initiation of immediate effective treatment of stroke. Besides that awareness of risk factors may also improve adherence to medical advice regarding lifestyle modifications. Systematic reviews have shown that one time advice from healthcare workers during routine patient interactions can have an appreciable impact on patient’s behaviour^13,14.

However, persons at risk often tend to misunderstand their own risk, underestimating their probability for stroke and assuming that adverse events will not happen to them¹⁵. Sama et al reported about one fourth of patients in their study, who recalled being informed of their increased risk by physician did not perceive themselves to be at risk for stroke¹⁶.

The five stroke warning signs established by the (American) National Institute of Neurological Disorders and Stroke (NINDS 2010): numbness or weakness in the face, arms, or legs (especially on one side of the body);confusion, difficulty speaking or understanding speech; vision disturbances in one or both eyes; dizziness, trouble walking, loss of balance or coordination; severe headache with no known cause. The symptoms listed above are almost identical to those provided by Australia's National Stroke Foundation (NSF 2010), which includes a sixth sign, “difficulty swallowing”.

According to WHO (World health Organisation), it is the second commonest cause of death worldwide 1. In 2005, stroke deaths accounted for 87% of deaths in developing countries and an estimated 5.8 million people died from stroke worldwide2. It is projected that deaths due to stroke will rise to 6.5 million by 2015 and by 2020; stroke and coronary artery disease together are expected to be the leading cause of lost healthy life years. Surveys in different parts of India have shown that the prevalence of stroke varies in different regions of India and ranges from 40 to 270 per 100,000 population.4-7.

According to the India stroke factsheet updated in 2012, the estimated age-adjusted prevalence rate for stroke ranges between 84/100,000 and 262/100,000 in rural and between 334/100,000 and 424/100,000 in urban areas .In India, awareness of the warning symptoms of stroke among general public is far from satisfactory. Surveys in the last decade revealed that about one-fourth of the urban and one-third of rural respondents who were unaffected had no knowledge of any warning symptom of stroke. Only 55% of the urban population was aware of one warning symptom of stroke; 16.2% were aware of two symptoms; and only 6.2% could identify three symptoms. Analysis has shown that improved socioeconomic status and higher education raise awareness of the warning symptoms of stroke for both rural and urban subjects.¹⁷

Study on Awareness of risk factors and warning symptoms of stroke in general population. A hospital-based survey was conducted. The study subjects (N=467) were the general population who visited (neurology, cardiology, surgery and medicine) selected OPD's of AIIMS, New Delhi. Results indicate that 96.15% of study subjects had excellent knowledge of warning symptoms of stroke i.e. they knew the most common presentation of stroke(sudden numbness or weakness of the face, arm, or leg especially one side of the body) plus one other well established warning symptom of stroke.¹⁸

A statistical analysis on gender influence on stroke showed that women always outnumbered men, except in the age group of 50- to 69. Hypertension, thus gains importance as a prominent medical and public health issue. Hypertension affects nearly 1 billion individuals worldwide and is responsible for approximately 7.1 million deaths per year. In India, 25-30 % of the urban population and 10 - 12 % of the rural areas suffer from high BP and are thus hypertensive individuals prone to stroke risk. Furthermore, this was observed that 30 % are still unaware that they have hypertension, despite 59% of them are receiving treatment to hypertension. The study conducted in Australia reported that within 12 months of stroke – approximately 37 % die and 10 % experience a recurrent stroke. Of those who survive stroke - approximately 51 % are disabled in one of the day-to-day activities and 50 % exhibit cognitive impairment or dementia. Similarly, a survey in different parts of India showed prevalence of stroke to be approximately 200 per 100, 000 population.¹⁸

MATERIALS AND METHODS:

A non-experimental descriptive research design was used in this study. The setting of the study was in Medical ward and OPD, Sri Ramachandra Hospital , Porur, Chennai-116. Sri Ramachandra Hospital provides health care across all medical and surgical specialities and super specialities with 1100 beds. Sri Ramachandra Hospital has separate unit for Medical condition. All the hypertensive Patients admitted in ward and accompanying with patient attending medical OPD, Sri Ramachandra Hospital. 300 samples were collected by using Purposive sampling technique is used for the study. Hypertensive patients with stages I, who are willing to participate and who are able to speak Tamil or English.

Description of the instrument:

It has 3 components

1. Demographic data – Age, gender, education and family history of hypertension, occupation, duration of illness, duration of treatment, family history of HT and family history of stroke 2. Self structured questionnaire on risk factors of stroke.

Maximum marks – 13 Minimum marks – 0

Sl. No.	Score	Interpretation
1	1-4	Poor knowledge
2	5-8	Moderate knowledge
3	> 8	Good knowledge

2. Self structured questionnaire on symptoms of stroke.

Score interpretation as follows

Maximum marks – 11 Minimum marks – 0

Sl. No.	Score	Interpretation
1	1-3	Poor knowledge
2	4-6	Moderate knowledge
3	> 6	Good knowledge

Data Collection Procedure:

After obtaining prior permission from Principal faculty of Nursing, HOD of Nursing Foundation Sri Ramachandra Medical College and Research Institute the data were collected from the patient with hypertension. The purpose of the study was explained and written informed consent was obtained from them. The questionnaires were distributed to the samples in English and or Tamil and assurance was given to them that the confidentiality will be maintained throughout the project. The data was collected from. Each participant was given 30 minutes to complete the questionnaire on one to one basis and explanation was given wherever required.

RESULTS:

Table 1 Frequency and percentage distribution of background variables among patients with hypertensive

S.No	Demographic variable	Number	%
1.	Age 1. 21-30	15	5.0
	2. 31- 40	47	15.7
	3. 41- 50	93	31.0
	4. 51	145	48.3
2.	Sex: 1. Male	149	49.7
2.	2. female	151	50.3
3.	Educational Status 1. No formal education	123	41.0
	2. Higher Secondary	157	42.3
	3. Under graduate	45	15.0
	4. Post graduate	5	1.7
4.	Occupation 1. Skilled	116	38.7
4.	2. unskilled	184	61.3
5.	Family income 1. Rs. 5000-10000	124	41.3
	2. Rs. 11000-15000	135	45.0
	3. Rs. 16000-20000	30	10.0
	4. Rs. 20000 above	11	3.7
6.	Duration of illness 1. 1-2 years	104	34.7
	2. 3-4 years	128	42.7
	3. 4 above	68	22.7
7.	Type of family 1. Nuclear family	156	52.0
7.	2. Joint family	144	32.7
8.	Family history of hypertension 1.Yes	202	67.3
8.	2.No	98	32.7
9.	Family history of stoke 1.Yes	59	19.7
9.	2.No	241	30.3

Table-2, Frequency and percentage distribution of Level of known on warning symptoms among hypertensive patients.

S.NO	Level of knowledge	Frequency	Percentage
1.	Poor knowledge.	220	73.3
2.	Moderate knowledge	58	19.3
3.	Good knowledge	4	1.3

Table-3 Frequency and percentage distribution of, Level of knowledge on risk factors among hypertensive patients

SI.No	Level of knowledge	Frequency	Percentage
1.	Poor knowledge	156	52.0
2.	Moderate knowledge	109	36.3
3.	Good knowledge	10	3.3

Table – 4 Frequency and percentage distribution of risk factors among hypertension patients

Risk factor questions	Yes		No
ITEMS	Numbers	%	Numbers	%
Alcohol consumption	168	56.0%	132	44.0%
Tobacco use (smoking or any other form)	113	37.7	187	62.3%
Diabetes mellitus	89	29.7	211	70.3
Family history of stroke	76	25.3	244	74.7
Transient ischemic attack (TIA)	20	6.7	280	93.3
Heart disease	33	11.0	267	89.0
Hypercholesterolemia	51	17.0	249	83.0
High fat	118	39.0	183	61.0
High sodium diet consumption	93	31.0	207	69.0
Obesity	117	39.0	183	61.0
Lack of exercise / sedentary life style	120	40.0	180	60.0
Old age	152	50.7	148	49.3
Use of contraceptive drugs	43	14.3	257	85.7

Table – 5 Frequency and percentage distribution of warning symptoms among hypertension patients.

Warning symptoms	Yes		No
ITEMS	Numbers	%	Numbers	%
Sudden numbness or weakness of the face, arm or leg, especially on one side of the body	142	47.3	158	52.7
Sudden confusion	108	36.0	192	64.0
Sudden difficulty in understanding written and spoken words	43	14.3	257	85.7
Sudden trouble in walking	69	23.0	231	77.0
Sudden loss of balance or coordination	55	18.3	245	81.7
Sudden difficulty in speaking	54	18.0	246	82.0
Sudden trouble in seeing with one or both eyes	35	11.7	265	88.3
Unconsciousness	52	17.3	247	82.3
Sudden severe headache with no known cause/chronic headache	136	45.3	164	54.7
Difficulty in breathing	72	24.0	228	76.0
Pain in limbs	107	35.7	193	64.3
Obesity	63	21.0	237	79.0
Fever	63	13.0	261	87.0
Difficulty in eating	49	16.3	251	83.7
Chest pain	134	44.7	166	55.3
Incontinence	31	10.3	269	89.7

Table 6 Shows there was an associated between risk factors educational status, occupations and family income

		Risk Factors
S.No	Demo graphic variable	Number	Mean	Standard deviation	X2value	P value
1	Age 21-30	15	4.73	2.93	2.45	0.06
	31-40	47	4.21	2.57
	51	93	4.29	1.87
2	Sex Male	145	4.11	2.35	1.04	0.30
2	Female	151	3.84	2.26	1.04	0.30
3	Educational status No formal education	123	3.39	2.07	11.09	0.00
	Higher secondary	127	3.94	2.23
	Undergraduate	45	5.35	2.38
	Post graduate	5	6.60	2.88
4	Occupation Skilled	116	4.68	2.33	19.11	0.00
4	Unskilled	184	3.52	2.18	19.11	0.00
5	Family Income RS.5000-10000	124	3.40	2.41	6.719	0.000
	Rs.11000-15000	135	4.14	1.99
	Rs.16000-20000	30	5.23	2.54
	Rs.20000-above	11	4.90	2.30
6	Duration of Illness 1-2year	104	4.40	2.23	2.973	.053
	3-4year	128	3.82	2.25
	4above	68	3.60	2.45
7	Type of Family Joint family	144	4.04	2.42	0.268	0.605
7	Nuclear	156	3.91	2.20	0.268	0.605
8	Family History of Hypertension Yes	202	4.19	2.35	5.77	0.01
8	No	98	3.52	2.16
9	Family history of stroke Yes	59	4.37	2.16
9	No	241	3.87	2.33

Table 7 Association selected demographical variables with warning symptoms sex, occupation, Family income, Family history of hypertension.

		Warning symptoms
S.no	Demo graphic variable	Number	Mean	Standard deviation	Frequency	P value
1	Age 21-30	15	4.00	1.41	1.77	.15
	31-40	47	4.25	2.59
	41-40	93	4.35	2.47
	51	145	3.67	2.30
2	Sex Male	149	4.35	2.47	6.98	0.04
2	female	151	3.67	2.24	6.98	0.04
3	Educational status No formal education	123	3.66	2.19	2.92	0.034
	Higher secondary	127	4.04	2.43
	Undergraduate	45	4.48	2.38
	Post graduate	5	6.20	4.02
4	Occupation skilled	116	4.23	2.65	3.733	.010
4	unskilled	184	3.71	2.15	3.733	.010
5	Family Income RS.5000-10000	124	3.70	2.41	3.733	.012
	Rs.11000-15000	135	3.94	2.17
	Rs.16000-20000	30	5.26	2.76
	Rs.20000-above	11	4.45	2.58
6	Duration Of Illness 1-2year	104	4.23	2.39	886	.413
	3-4year	128	3.92	2.28
	4 above	68	3.76	2.55
7	Type of family Nuclear	156	4.00	2.32	.003	.960
7	Joint family	144	3.98	2.45	.003	.960
8	Family history of hypertension Yes	202	4.00	2.51	7.76	.006
8	No	98	3.91	1.99	7.76	.006
9	Family History of Stroke Yes	59	4.33	2.41	1.54	0.214
9	No	241	3.90	2.37

DISCUSSION:

The focus of study is to assess the awareness of risk factor and symptoms of stroke among patient with hypertension at Sri Ramachandra Hospital, Porur, Chennai-116 .study was collected among 300 samples. The data was collected in the psychiatric OPD.

Table-1 Reveals that the age 15(50%) were belongedto21-30 year and 47 (15.7) were belonged to 31-40 years and 93(31.0%) Were belonged to 41-50 years and 145 (48.3%) were belonged to above 51 years with regards sex 149 (49.7%) were male and 151( 50.3%) were female had secondary level educational status 123(41.0%) being a and no formal education and 127(42.3%) being a higher secondary and 45(15.0%) being a under graduate and 5(1.7%) being a post graduate with regards occupation 116(38.7%)of them were skilled and 184(61.3%) of them were unskilled in regard to duration of illness 104(34.7%)is having 1-2 year and 128 (42.7%) is having 3-4 years and 68 (22.7%)is having above 4years with regards 156 (52.0%)were belonged to nuclear family and 144 (48.0%) were belonged to joint family

Table 2 shows that Majority of the sample 220(73.3%) had poor knowledge and 58(19.3%) had moderate knowledge and 4(1.3%) had good knowledge on risk factors.Table 3 Reveals that majority of the sample 156 (52.0%) had poor knowledge and 109(36.3%) had poor knowledge 109 (36.3%) had moderate knowledge and 10(3.3%) had good knowledge on warning symptoms. Table 4 shows that the major risk factors are alcohol consumption and old age

Table 5 and warning symptoms are Sudden numbness of the face, arm or leg, especially on one side of the body and Sudden severe headache with no known cause/chronic headacheTable 6 reveals that there was an association between level of knowledge on risk factors of education status occupation , family income, family history of hypertension .Table 7 Shows that there was an association between level of knowledge on warning symptoms of sex, education status, occupation, family income, family history of hypertension.

These findings were strongly supported by the study of Sug Yoon S, Heller RF, Levi C, Wiggers J, Fitzgerald PE (2016) conducted study on knowledge of stroke risk factors, warning symptoms, and treatment among an Australian urban population. A community-based telephone interview survey was conducted in the Newcastle urban area in Australia. A total of 1278 potential participants between the ages of 18 to 80 were selected at random from an electronic telephone directory. A trained telephone interviewer conducted a telephone survey using the Computer-Assisted Telephone Interviewing (CATI) program. Result was a total of 822 participants completed the telephone interview. Six hundred three participants (n in stroke. The most common risk factors for stroke identified by respondents were smoking (identified by 324 [39.4%]) and stress (identified by 277 [33.7%]). The most common warning sign of stroke described by respondents was "blurred and double vision or loss of vision in an eye," listed by 198 (24.1%). A total of 626 (76.2%) respondents correctly listed >/=1 established stroke risk factor, but only 409 (49.8%) respondents correctly listed >/=1 warning sign[10].

CONCLUSION:

The study concluded that majority of the sample 220(73.3%) had poor knowledge on risk factors and majority of the sample 156 (52.0%) had poor knowledge on warning symptoms, so this shows knowledge regarding stroke risk factors and warning signs was significantly low among hypertensive patients, in which majority of participants were unable to identify any risk factors and warning signs of stroke. These findings suggest the need for all stakeholders to emphasize stroke education to help individuals to understand and manage stroke risk factors as well as its warning signs through public or social media and school and health education crucially for low-income high risk subjects.

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Received on 23.05.2020 Modified on 29.12.2020

Research J. Pharm. and Tech 2021; 14(11):5769-5774.

DOI: 10.52711/0974-360X.2021.01003