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(Stroke. 2008;39:292.)
© 2008 American Heart Association, Inc.

Original Contributions

Stroke Awareness in Brazil

Alarming Results in a Community-Based Study

Octávio Marques Pontes-Neto, MD; Gisele Sampaio Silva, MD, PhD; Marley Ribeiro Feitosa, MD; Nathalie Lôbo de Figueiredo, MD; José Antonio Fiorot, Jr, MD; Talitha Nery Rocha; Ayrton Roberto Massaro, MD, PhD João Pereira Leite, MD, PhD

From the Department of Neurology (O.M.P.N., J.P.L.), Ribeirão Preto School of Medicine, University of São Paulo, São Paulo, Brazil; Federal University of Ceará (M.R.F., N.L.F.); Federal University of São Paulo (G.S.S., J.A.F., A.R.M.), São Paulo, Brazil; and the School of Medicine and Public Health of Bahia (T.N.R.), Salvador, Brazil.

Correspondence to Octávio Marques Pontes-Neto, MD, Department of Neurology, University of São Paulo, School of Medicine at Ribeirão Preto. Ribeirão Preto, Campus Universitário, CEP 14049-900, Brazil. E-mail octaviopontes{at}rnp.fmrp.usp.br

Background and Purpose— Stroke is the leading cause of death in Brazil. This community-based study assessed lay knowledge about stroke recognition and treatment and risk factors for cerebrovascular diseases and activation of emergency medical services in Brazil.

Methods— The study was conducted between July 2004 and December 2005. Subjects were selected from the urban population in transit about public places of 4 major Brazilian cities: São Paulo, Salvador, Fortaleza, and Ribeirão Preto. Trained medical students, residents, and neurologists interviewed subjects using a structured, open-ended questionnaire in Portuguese based on a case presentation of a typical patient with acute stroke at home.

Results— Eight hundred fourteen subjects were interviewed during the study period (53.9% women; mean age, 39.2 years; age range, 18 to 80 years). There were 28 different Portuguese terms to name stroke. Twenty-two percent did not recognize any warning signs of stroke. Only 34.6% of subjects answered the correct nationwide emergency telephone number in Brazil (#192). Only 51.4% of subjects would call emergency medical services for a relative with symptoms of stroke. In a multivariate analysis, individuals with higher education called emergency medical services (P=0.038, OR=1.5, 95%, CI: 1.02 to 2.2) and knew at least one risk factor for stroke (P<0.05, OR=2.0, 95% CI: 1.2 to 3.2) more often than those with lower education.

Conclusions— Our study discloses alarming lack of knowledge about activation of emergency medical services and availability of acute stroke treatment in Brazil. These findings have implications for public health initiatives in the treatment of stroke and other cardiovascular emergencies.

Key Words: awareness • education • emergency medical services • risk factors • symptoms