Can trained field community workers identify stroke using a stroke symptom questionnaire as well as neurologists? Adaptation and validation of a community worker administered stroke symptom questionnaire in a peri-urban Pakistani community.

Authors

Maria Khan,, Agha Khan University
Ayeesha Kamran Kamal, Agha Khan UniversityFollow
Muhammad S. Ilyas, Dow University of Health Sciences, Pakistan.
Muhammad Islam, Aga Khan UniversityFollow
Iqbal Azam Syed, Aga Khan UniversityFollow
Azam Virk,, Aman Foundation.
Alia Nasir, Aga Khan University
Hasan Rehman,, Aga Khan University
Anita Arif,, Aga Khan University
Muhammad Jan,, Aga Khan University
Anjum Akhtar,, Aga Khan University
Minaz Mawani, Aga Khan UniversityFollow
Junaid Abdul Razzak,, AMAN Foundation Karachi
Omrana Pasha, Agha Khan UniversityFollow

Document Type

Article

Department

Department of Medicine

Abstract

Background: Stroke is a leading cause of morbidity and mortality worldwide. There is a paucity of data from South Asia where stroke is highly prevalent. Validated tools administrable by Community Health Workers (CHWs) are required to identify stroke in the community in a resource strapped region such as this.

Methods: The study was conducted in a transitional slum in Karachi, Pakistan. Questionnaire for Verifying Stroke-Free Status (QVSFS) was adapted and translated into Urdu. Two CHWs, trained by a neurologist, selected 322 community dwelling subjects using purposive sampling. Each CHW collected data independently which was validated by a vascular neurologist who directly examined each participant. To assess the effect of audit and feedback, data from the final 10% of the subjects was collected following a second training session for the CHWs. Sensitivity, specificity and Cohen’s kappa was determined for the CHW administered questionnaire against neurovascular assessment.

Results: Mean age of participants was 56.5 years with 71% of participants being women. The sensitivity and specificity of the questionnaire of detecting stroke was 77.1% (CI: 64.1%–86.9%) and 85.8% (CI: 83.5%–87.5%). The chance corrected agreement using the Cohen’s Kappa statistic was 0.51 (CI: 0.38–0.60). Kappa ranged from 0.37 to 0.58 for each of the seven stroke symptoms. Hemianesthesia (72.9%) and hemiplegia (64.6%) were the most sensitive symptoms. The performance and agreement improved from moderate to substantial after audit and feedback.

Conclusion: We found a reasonable sensitivity and specificity and moderate agreement between CHW administered QVSFS and assessment by a vascular neurologist.

Publication (Name of Journal)

Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association.

Recommended Citation

Khan,, M., Kamal, A., Ilyas, M. S., Islam, M., Syed, I. A., Virk,, A., Nasir, A., Rehman,, H., Arif,, A., Jan,, M., Akhtar,, A., Mawani, M., Razzak,, J. A., Pasha, O. (2015). Can trained field community workers identify stroke using a stroke symptom questionnaire as well as neurologists? Adaptation and validation of a community worker administered stroke symptom questionnaire in a peri-urban Pakistani community.. Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association., 24(1), 91-99.
Available at: https://ecommons.aku.edu/pakistan_fhs_mc_med_med/345