Stroke is a major cause of disability and one of the leading causes of death worldwide (1). It is typically defined as a neurological deficit pertaining to an acute focal injury of the central nervous system (CNS) via vascular causes, which include cerebral infarction, intracerebral hemorrhage, and subarachnoid hemorrhage (2). The most common risk factors for stroke include hypertension, impaired cardiac function, smoking, poor lifestyle factors, dyslipidemia, obesity, diabetes, and having a family history of stroke (3). The majority of ischemic stroke occurs in low- and middle-income countries, where incidents of fatal hemorrhage and ischemic strokes develop more often at younger ages. Additionally, compared to developed countries, the prevalence of stroke has recently increased in developing nations (4).

Sudan, a least developed country according to the United Nations, had about 25% of stroke admissions among patients older than 60 years old (5). Furthermore, stroke was reported to be among the top 25 causes of premature death in Sudan between 1990 and 2019 (6). Moreover, statistics from the World Health Organization (WHO) in 2019 show that stroke was the third-top cause of death in both genders, with 48.09 deaths per 100,000 people, in addition to 48,595 new stroke cases recorded in 2019 (7).

Unfortunately, stroke risk factors were found to be higher in poor socioeconomic level societies. Nonetheless, community stroke awareness programs are one of the several components that is considered absolutely necessary for stroke care (8). The outcome of stroke can be greatly improved through early detection, prompt transfer to medical care, and implementation of appropriate medical therapy (9). However, preventive approaches mostly revolve around understanding stroke risk factors, identifying the warning signs, and treating the concomitant conditions. According to the World Bank classification, Sudan is a low-income country (10). In addition, the literacy rates in Sudan is low, particularly among young women (11). With the adult literacy rate of 60.7% (12), identifying the existing gaps in knowledge among Sudanese population regarding stroke can help recognize areas to be targeted to improve overall public health and healthcare practices. Additionally, increased understanding about stroke has been linked with high income status, smoking history, and educational attainment (13). Therefore, it is essential to screen for socioeconomic status, educational achievement, and lifestyle factors.

Comprehensive research focusing on the factors associated with knowledge and awareness of stroke among Sudanese population is extremely essential as it allows the design for targeted interventions and educational campaigns tailored to the unique challenges faced by the population. This research seeks to provide valuable insights into the importance of enhancing stroke knowledge and awareness, aiming to minimize the occurrence of strokes, preventing recurrence, and ensuring early patient recognition. We intend to expand upon existing knowledge by examining a cohort of participants across Sudan. Additionally, the findings from this study could potentially influence the development and implementation of effective interventions, drawing upon reliable population-based data. Thus, the study aimed to evaluate the awareness and knowledge of stroke within the general population in Sudan and identify factors influencing this awareness.

The present study aimed at examining factors associated with stroke knowledge and awareness among the general population of Sudan. It is extremely important to prevent stroke and initiate early and timely management through assessing people’s knowledge and awareness of risk factors and their modifications, as well as their warning symptoms and management. Therefore, creating effective educational and preventative measures are crucial for assessing the factors associated with stroke knowledge among different sociodemographic groups within communities.

The results indicated that around half of the sample were females, and aged between 30 and 49 years old. Moreover, more than half of the participants have low- or medium-monthly incomes. In addition, the majority of the participants have university education, with more than two-thirds of them were employed. Most of the participants had heard of the condition previously and reported that stroke is a disease of brain, and it is a serious disease. Overall, participants’ general knowledge about stroke was insufficient, with only about a third of participants correctly identifying all risk factors, all consequences, and early symptoms of stroke.

Previous studies reported suboptimal in different communities regarding strokes, even among those who had experienced it before (17–19). A recent study in Sudan reported a relatively low mean awareness score among Sudanese people (20). In addition, the mean awareness score was found to be statistically associated with the level of education (20). According to our study findings, a variable level of knowledge about stroke was found among participants. The participants in our study expressed better general knowledge about stroke compared to previous study in Sudan (20). Our findings can be interpreted by the fact that the majority of our participants had university educational level which could have raised the level of knowledge. Additionally, most of our participants identified at least one risk factor, one symptom related to stroke and one consequence. In addition, the percentages were higher than those reported in the literature (21–23), revealing that at least one stroke risk factor may be identified by the majority of the study sample, probably as most of our study participants had higher educational levels and were employed.

As for the risk factors, there are several modifiable and non-modifiable risk factors associated with stroke, including age, race, hypertension, diabetes, and many more (24), which are becoming more prevalent among the Sudanese community according to the stepwise approach to surveillance survey of 2005 (STEPS) (25). In our study, 96.3% of 410 participants identified at least one associated risk factor for stroke compared to previous published studies in the last 3 years, which reported in the UAE (99.8%, n = 545), Saudi Arabia (99.5%, n = 398), Jordan (98.1%, n = 573), Lebanon (97.8%, n = 551), and Iraq (85.6%, n = 609) (8, 26–29).

Considering recent studies in the Middle East region to our study results, the aware that stroke is a type of brain disease were various among the participants with the highest in Jordan and Lebanon with more than 95.0% of the participants (28), then Iraq (92.8%) (27), Saudi Arabia (89.7%) (29), and the UAE (70.8%) (26), while the results of our studies indicated that 93.2% of the participants. In related to the participants’ awareness of stroke is preventable, the results reported by the participants were also various among the countries, with the highest in Iraq (85.6%) (27), then our Sudan sample with 83.4%, then Jordan and Saudi Arabia with 81.0% (8, 29), Lebanon (80.0%) (28), and the UAE (42.9%) (26).

A significant improvement in the rates of identified risk factors of stroke among the Sudanese community was noticed, as a previous study reported that 27.6% of their study participants did not have sufficient knowledge about stroke risk factors, contrary to our findings, where it was only 3.7% (20). According to this study, hypertension was the most reported risk factor, followed by psychological stress and obesity. Similarly, a comparative study of risk factors in young adults and older adult stroke patients in Sudan reported that arterial hypertension was the dominant risk factor among young adults and the older adult, followed by smoking (30). As well as previous studies conducted in Lebanon revealed that hypertension and psychological stress were among the most reported risk factors as well (28), in Jordan (8), Saudi (29), UAE (26), and Iraq (27).

Regarding warning signs and consequences of stroke, almost 85% reported sudden difficulty in speaking or understanding speech as the most common warning sign, followed by sudden weakness/numbness/tingling, which is similar to the findings of Lebanese and New Zealand studies (28, 31). However, a previous Sudanese survey reported paralysis of one side of the body as the most commonly identified warning symptom by 30.7%, followed by sudden difficulty in speaking or understanding by 27.1%. In comparison to the findings of the previous study, the rates of the identified consequences of stroke were significantly improved among Sudanese people. Almost 33% of the previous study participants did not know any stroke warning symptoms (20), while in our study, the percentage was only 4.9%. The improvement in the knowledge of the Sudanese community regarding risk factors, symptoms, and consequences related to stroke in our study could be attributed to the higher educational level and employment of the majority of our study participants.

Our results revealed a significant correlation between gender and knowledge about stroke risk factors, as females had better knowledge compared to males. In agreement with our study findings, other studies reported similar results (32–35). On the other hand, better knowledge of stroke warning signs among males was reported as well (8, 27). Based on the literature, the lack of consistency in the results of different studies makes it ambiguous to call for a clear association between gender differences and knowledge of stroke warning signs and risk factors (8, 27). As well as the multivariable analysis showed that patients with no depression had a significant correlation in identifying stroke risk factors, early stroke symptoms, and stroke consequences. A previous study revealed a significant inverse correlation between depression and knowledge. It is reported that depressed patients had poorer knowledge and a decline in knowledge as depression increases, suggesting that cognitive function may be impaired by depression (36, 37).

In general, the Sudanese community demonstrated suboptimal knowledge regarding stroke risk factors, early symptoms, and consequences. Females and individuals without a medical history of depression exhibited higher knowledge scores. Recognition of specific aspects varied, with social media serving as a prominent information source. Tailored interventions focusing on individuals with inadequate stroke literacy are needed to improve stroke awareness. Further studies, more representative of the general Sudanese population and with a larger sample size, are necessary to confirm our findings.

The original contributions presented in the study are included in the article/supplementary material, further inquiries can be directed to the corresponding author.

The studies involving humans were approved by the research ethics committee of the Faculty of Pharmacy, Al Neelain University, Khartoum, Sudan (NPH1021). The studies were conducted in accordance with the local legislation and institutional requirements. The participants provided their written informed consent to participate in this study.

EE: Writing – review & editing, Writing – original draft. FJ: Writing – original draft, Writing – review & editing, Conceptualization, Methodology. DS: Methodology, Writing – original draft. HaA: Writing – original draft. MA: Writing – original draft, Writing – review & editing. ZKha: Methodology, Writing – original draft. YA: Writing – original draft, Writing – review & editing. MB: Writing – original draft, Writing – review & editing. ZKhi: Writing – original draft. HuA: Writing – original draft. NM: Investigation, Writing – original draft. SC: Formal analysis, Writing – original draft. SK: Writing – review & editing. SH: Formal analysis, Writing – review & editing. DM: Writing – review & editing, Conceptualization, Data curation, Methodology, Supervision. HH: Writing – review & editing.