Knowledge and Practices Regarding Stroke and Associated Factors among Patients Attending the Internal Medicine Outpatient Clinic at Al‑Thawra General Hospital in Ibb, Yemen

Stroke is a sudden, devastating event where blood flow to part of the brain is blocked or a vessel bursts, causing brain cells to die. It is a leading cause of death and long-term disability worldwide, but the burden falls heaviest on low- and middle-income countries, where access to emergency care is often limited. The outcome of a stroke depends heavily on time; receiving treatment within the first few hours can mean the difference between recovery and permanent damage. However, treatment is useless if people do not recognize the warning signs or know to call for help immediately. In many parts of the world, including the Middle East, public awareness of these signs and the factors that cause strokes remains inconsistent. Complicating matters further are local habits and cultural practices that may increase risk but are not widely understood as dangerous. Understanding what people know about these risks, and whether they actually change their behavior to protect themselves, is essential for saving lives.

In the city of Ibb, Yemen, researchers set out to investigate this gap between what people know and what they do. They focused on patients visiting the internal medicine clinic at Al-Thawra General Hospital, asking them about their understanding of stroke and their daily habits. The study took place over four months in 2026 and included 400 adults. The researchers used a detailed questionnaire to measure two things: how much the patients knew about stroke symptoms, causes, and consequences, and how often they engaged in healthy behaviors like checking their blood pressure, eating well, or seeking emergency help when symptoms appeared. A significant part of this investigation involved a local custom: the chewing of khat, a leafy plant that contains a stimulant similar to amphetamines and is deeply ingrained in Yemeni social life. Previous studies in Yemen had already linked khat chewing to a higher risk of stroke, but it was unclear if the public understood this connection.

The results revealed a striking contradiction. The patients possessed a reasonable amount of knowledge about stroke. On average, they answered about three-quarters of the knowledge questions correctly. They generally understood that stroke is a brain disease, that it can be prevented, and that sudden weakness in the limbs is a warning sign. They also correctly identified high blood pressure, smoking, and heart disease as major risk factors. However, when the researchers looked at how this knowledge translated into action, the picture changed dramatically. The patients' actual preventive practices were poor. Only about half of the participants engaged in healthy behaviors consistently. Very few checked their blood pressure or sugar levels regularly, and even fewer visited their doctors for routine follow-ups. Perhaps most alarming was the response to a potential stroke: only 27 percent said they would call emergency services immediately if symptoms appeared. Instead, nearly half said they would rely on home remedies, a dangerous delay that could lead to irreversible brain damage.

One of the most critical findings concerned the local habit of khat chewing. While nearly 70 percent of the participants admitted to chewing khat regularly, less than 60 percent recognized it as a risk factor for stroke. This disconnect suggests that the community has not yet absorbed the message that this common cultural practice is harmful to their brain health. The study found that people who chewed khat were significantly less likely to have good knowledge about stroke overall. Furthermore, those who chewed khat were also less likely to practice healthy behaviors. The researchers also discovered that marital status played a role; married individuals were much more likely to have good knowledge about stroke compared to those who were widowed. Surprisingly, people with lower or moderate incomes showed better knowledge than those with high incomes, possibly because they attended public clinics where they received more structured health education.

The study also highlighted a confusing pattern regarding heart disease. Patients who already had heart disease were actually less likely to have good knowledge about stroke prevention than those without heart disease. This suggests that when people are diagnosed with one serious condition, they may focus entirely on that specific illness and miss the broader message about preventing other related problems like stroke. Similarly, having diabetes was linked to poorer preventive practices, indicating that the burden of managing a chronic disease might make it harder for people to adopt new healthy habits. The researchers concluded that while the people in Ibb know enough to recognize a stroke when they see it, they are not acting on that knowledge to prevent it or to respond quickly when it happens.

The authors emphasize that bridging this gap requires more than just sharing facts. Because the study was conducted in a single hospital over a short period, the findings reflect the situation in that specific location and cannot be automatically applied to all of Yemen without further research. However, the data points to a clear need for culturally tailored education. Campaigns must specifically address the dangers of khat chewing without stigmatizing the users, helping them understand that this common habit is a direct threat to their brain health. Public health messages also need to move beyond simple lists of symptoms to teach people exactly what to do in an emergency, stressing that calling for help is the only safe option. Until people connect their daily habits to their long-term health risks and feel empowered to act, the gap between knowing and doing will continue to cost lives.