Maria Khan1, Ayeesha Kamran Kamal2, Omrana Pasha3, Muhammad Islam4, Iqbal Azam5, Azam Virk6, Alia Nasir7, Anita Andani8, Muhammad Jan8, Anjum Akhtar9, Junaid Abdul Razzak10. 1. Fogarty Cerebrovascular Research Fellow, The International Cerebrovascular Translational Clinical Research Training Program ( Fogarty International Center, National Institutes of Health) and Department of Medicine, Aga Khan University, Karachi, Pakistan ; Joint First Authors. 2. Associate Professor Neurology, Stroke Service, The International Cerebrovascular Translational Clinical Research Training Program (Fogarty International Center, National Institutes of Health) and Department of Medicine, Aga Khan University, Karachi, Pakistan ; Joint First Authors. 3. Associate Professor, Director Masters in Epidemiology and Biostatistics program, Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan. 4. Senior Instructor, Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan. 5. Assistant Professor, Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan. 6. Field Coordinator, AMAN Foundation, Karachi, Pakistan. 7. Senior Community Work, AMAN Foundation, Karachi, Pakistan. 8. Research Coordination and Data Management Stroke Service, The International Cerebrovascular Translational Clinical Research Training Program (Fogarty International Center, National Institutes of Health) , Section of Neurology, Department of Medicine, Aga Khan University, Karachi, Pakistan. 9. Post Graduate Medical Education Stroke Fellow, Aga Khan University, Karachi, Pakistan. 10. Chairman and Associate Professor, Department of Emergency Medicine, Aga Khan University and Chief Executive Officer- AMAN Health, AMAN Foundation Karachi, Pakistan.
Abstract
BACKGROUND: Stroke is the second leading cause of mortality and the leading cause of disability in the world today. The disease burden is on the rise in developing nations, but there is scarcity of data from these regions to inform policy decisions. Stroke burden can be determined by clinical diagnosis alone in the public health context and is a far more feasible way to assess disease status in low- to middle-income countries like Pakistan. We aim to translate and adapt a validated stroke symptom questionnaire, train community health workers in its administration, and verify it against assessment by two trained neurologists. METHODS/ DESIGN: This is a prospective study, which we aim to carry out in Ibrahim Hyderi, a periurban slum of Karachi. We translated into Urdu the questionnaire for verifying stroke free status (QVSFS), which is an internationally validated tool to assess the same. Two community health workers (CHW) will be identified and will receive training by neurologists, which will include teaching regarding stroke pathophysiology, symptomatology, and detection. They will be familiarized with the QVSFS, and their questionnaire administration will be assessed through roleplay. We intend to recruit 322 subjects from the same community and the CHWs will gather data on them. The same subjects will later be assessed by two trained neurologists, and the findings collaborated to validate those obtained by the CHWs. Sensitivity, specificity, positive and negative predictive values, and Cohen's kappa will be determined for the CHW-administered questionnaire tested against assessment by two neurologists together and separately for the two CHWs. Data analysis will be done using SPSS version 19.0. DISCUSSION: The results of this study will determine if and how well CHW-administered questionnaires are at assessing stroke status in a community. This will facilitate use of the same as a practical alternative for stroke surveillance in the country. TRIAL REGISTRATION: NCT02073955.
BACKGROUND:Stroke is the second leading cause of mortality and the leading cause of disability in the world today. The disease burden is on the rise in developing nations, but there is scarcity of data from these regions to inform policy decisions. Stroke burden can be determined by clinical diagnosis alone in the public health context and is a far more feasible way to assess disease status in low- to middle-income countries like Pakistan. We aim to translate and adapt a validated stroke symptom questionnaire, train community health workers in its administration, and verify it against assessment by two trained neurologists. METHODS/ DESIGN: This is a prospective study, which we aim to carry out in Ibrahim Hyderi, a periurban slum of Karachi. We translated into Urdu the questionnaire for verifying stroke free status (QVSFS), which is an internationally validated tool to assess the same. Two community health workers (CHW) will be identified and will receive training by neurologists, which will include teaching regarding stroke pathophysiology, symptomatology, and detection. They will be familiarized with the QVSFS, and their questionnaire administration will be assessed through roleplay. We intend to recruit 322 subjects from the same community and the CHWs will gather data on them. The same subjects will later be assessed by two trained neurologists, and the findings collaborated to validate those obtained by the CHWs. Sensitivity, specificity, positive and negative predictive values, and Cohen's kappa will be determined for the CHW-administered questionnaire tested against assessment by two neurologists together and separately for the two CHWs. Data analysis will be done using SPSS version 19.0. DISCUSSION: The results of this study will determine if and how well CHW-administered questionnaires are at assessing stroke status in a community. This will facilitate use of the same as a practical alternative for stroke surveillance in the country. TRIAL REGISTRATION: NCT02073955.
Entities:
Keywords:
Burden of Stroke; QVSFS; Validation; stroke symptom questionnaire (SSQ)
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