Place of residence and timely access to stroke care in Ethiopia

Place of residence and timely access to stroke care in Ethiopia | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Place of residence and timely access to stroke care in Ethiopia Bereket Sinshaw, Senay Zerihun, Nahom Mulugeta, Berhanu Tarekegn This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6580909/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 12 Aug, 2025 Read the published version in SN Comprehensive Clinical Medicine → Version 1 posted 10 You are reading this latest preprint version Abstract Background In Ethiopia, stroke related deaths are increasing due to lifestyle changes and improved life expectancy. Limited access to healthcare facilities, diagnostic investigations, and patient delays in receiving medical attention negatively influence the outcome of stroke in Ethiopia. Objectives This study investigates the association between places of residence and timely stroke care access in Ethiopia. Methods Medical records containing complete patient information and confirmed diagnosis of stroke using neuroimaging techniques were included in the study. The patients’ place of residence was categorised into those who lived in Addis Ababa and those lived outside Addis Ababa. Timely stroke care was defined as patients who present within 24 hours after onset of symptoms and signs of stroke. The necessary data was entered into SPSS version 26 and logistic regression was used to assess associations between the patient’s residency and timely stroke care access. Result Place of residency and referral were significantly associated with arrival time at the stroke centre. Compared to patients from AA, patients from outside AA had 7.5 times higher odds of arriving later than 24 hours (AOR = 7.5; 95%CI 2.96, 19.1; p < 0.001). Similarly, compared to self-referred patients, patients referred by health institutions had 8.7 times higher odds of arriving later than 24 hours (AOR = 8.7; 95%CI 3.4, 22.04; p < 0.001) Conclusion The findings suggest that individuals residing in Addis Ababa and those who are self-referred are more likely to seek medical attention promptly after stroke onset. These result underscore the need for targeted interventions to improve stroke care access in regions outside the capital and the need for timely referral in health facilities. stroke place of residence timely access to care Ethiopia Figures Figure 1 1. BACKGROUND A stroke or cerebrovascular accident (CVA) is a focal or global disturbance of cerebral function caused by blockage or rupture of blood vessels that supply the brain with symptoms lasting 24 hours or longer or causing death with no apparent cause other than that of vascular origin( 1 – 2 ). Most strokes are ischaemic due to reduced blood flow, generally resulting from arterial occlusion. A rarer type of ischaemic stroke is venous infarction due to occlusion of cerebral veins or venous sinuses. The remaining 10–40% of stroke presentations, depending on regional epidemiology, are haemorrhagic and results from the rupture of cerebral arteries( 3 – 5 ). Stroke is a leading cause of disability, dementia, and death worldwide. Approximately 70% of deaths from stroke and 87% of stroke-related disability occur in low-income and middle-income countries. In sub-Saharan countries, stroke incidence was higher in urban areas compared to rural areas. However, the study also found that stroke severity and outcomes were worse in rural areas due to limited access to healthcare facilities and delays in seeking treatment( 6 – 9 ). Stroke is one of the leading causes of death and disability in Ethiopia, with an estimated incidence rate of 126 per 100,000 people. Stroke care services are largely unavailable in the country, with only a few hospitals providing specialized care for stroke patients. As a result, many stroke patients in Ethiopia do not receive the appropriate care they need, leading to poor outcomes and a high mortality rate( 10 – 13 ). Geography is a critical factor affecting access to healthcare services, including stroke care in Ethiopia. The country has a population of over 112 million people, and stroke is a leading cause of morbidity and mortality. However, the majority of Ethiopians live in rural areas, where access to healthcare is limited. The lack of infrastructure, transportation, and trained healthcare professionals makes it difficult for people living in remote regions to receive timely and appropriate care(( 14 – 17 ) The burden of stroke in Ethiopia is further compounded by poor access to specialized stroke care services, a shortage of trained healthcare professionals, and inadequate healthcare infrastructure in the country. This has led to low rates of thrombolysis and endovascular treatment for acute ischemic stroke patients( 18 – 19 ). While there is no direct evidence on whether increased access to stroke care can reduce mortality rates in Ethiopia specifically, studies suggest that improving access to care could lead to positive outcomes for stroke patients in Low- and middle- income countries, particularly those in Africa( 20 – 22 ). 2. METHODS 2.1 Study Design and Setting It is a retrospective cross-sectional study done at Yehuleshet Neurology Centre in Addis Ababa, Ethiopia. All patients with a confirmed stroke presenting to the neurology centre during the study period of 36 months,1st of September 2019 to August 30th 2022, were included in the study. 2.2 Study participants All Patients with acute and sub-acute stroke cases confirmed using brain computerized tomography scan and/or magnetic resonance imaging and evaluated at Yehuleshet neurology centre during the study period were included. The study excluded patients who had a stroke at Yehuleshet Neurology Centre, did not have complete medical records, as well as patients who came to the clinic more than three weeks after their stroke onset. 2.3 Study variables The dependant variable is timely stroke service care access while the main independent variable is place of residence. Additional independent variables include age, sex, diabetes miletus, hypertension, structural heart disease, previous stroke, type of stroke, mode of referral, extremity weakness, aphasia and seizure 2.4 Sample size All Patients who fulfilled the inclusion criteria during the study period were included. The medical record numbers (MRN) of stroke patients were taken from the Health Management Information System (HMIS) of Yehuleshet Neurology centre. 2.5 Data analysis and presentation Data were reviewed, cleaned, and analysed using IBM SPSS Version 26. Descriptive statistics was used to summarize patient baseline characteristics using proportions for dichotomous, means, and SDs for continuous variables and medians and interquartile ranges for non-normally distributed continuous variables. Logistic regression was used to assess associations between the patient’s residency and timely stroke care access. Initially, bivariate analysis was conducted for factors affecting timely stroke care access and variables with P < 0.25 on bivariate analysis were entered on multivariate logistic regression to identify independently associated factors affecting timely stroke care access. The significance of Odds Ratio (OR) was determined with 95% CI and P < 0.05. Factors affecting timely stroke care access were controlled for possible confounders. 2.6 Operational definitions Stroke or cerebrovascular accident (CVA) Patients with brain imaging (Brain CT and/or MRI) evidence of ischemia or haemorrhage in brain parenchyma after they present with sudden onset of trouble walking, speaking and understanding, a paralysis or numbness of the face, arm or leg. Acute Stroke Stroke within the first week of onset Sub-acute Stroke Stroke within 1 to 3 weeks of onset Timely stroke care Access Patients who presents to the neurology centre within 24 hours of sign and symptoms of stroke Glasgow coma scale (GCS) Measurement scale which helps to measure the level of consciousness. It is interpreted as Good GCS ( 13 – 15 ), Moderate GCS ( 9 – 12 ), Poor GCS (≤ 8) Stroke onset time - Stroke onset time was taken as the time the person was last seen normal First medical contact (FMC) - The first contact made with a neurologist. This was obtained from the patient’s chart Place of residence - is the region where a person lives at the time of onset of stroke. The study categorized patients by their place of residence at the time they had a stroke. It distinguished between patients who lived in Addis Ababa and those who lived outside of it 3. RESULT 3.1 Sociodemographic data The study included 284 patients, of which 102 (35.9%) were females and 182 (64.1%) were males. The age of the participants ranged from 15 to 93 years with a mean age of 58.51 ± 16 years. During arrival, 117 (41.2%) patients were referred from health facilities while 167 (58.8%) were self-referred. Among the total participants, 167 (58.8%) of the patients were from Addis Ababa, whereas 117 (41.2%) of the patients came from outside of Addis Ababa. 3.2. Clinical characteristics Extremity weakness was the most common symptom among patients with a percentage of 69.7%, followed by headache with a percentage of 22.2%, dysarthria with a percentage of 18.3%, and aphasia with a percentage of 14.4%. Almost half of them had a right-side weakness with a percentage of 52.5%, and two-thirds had hemiparesis/plegia with a percentage of 65.8%; the rest had monoparesis/plegia with a percentage of 3.5%, and one patient had Tetraparesis/plegia. (Table 1 and Table 2 ) Table 1 Clinical characteristics Variable Frequency n Percentage % Patients taking drug prior to arrival Yes 174 61.3% Type of Drug Aspirin 54 31% Statin 50 28.7% Anticoagulant 11 6.3% Antihypertensive 126 72.4% Antidiabetic 56 32.2% Other 30 17.2% Total 174 100% Clinical signs and symptoms Yes 284 100% Headache 63 22.2% Seizure 25 8.8% Decreased Level of consciousness 19 6.7% Extremity weakness 198 69.7% Aphasia 41 14.4% Dysarthria 52 18.3% Obscuration of Vision 12 4.2% Ataxia & incoordination 35 12.3% Memory Alteration 26 9.2% Hemi paresthesia/ Pain 35 12.3% Double vision 8 2.8% Hemianopsia 2 0.7% Urinary incontinence 4 1.4% Duration of Onset of Symptoms 0–6 hrs./Early hyperacute 40 14.1% > 6–24 hrs./Late hyperacute 32 11.3% > 24 hrs. − 1 week/Acute 142 50.0% > 1–3 weeks/Subacute 70 24.6% Table 2 Characteristics of Seizure and Extremity weakness Variable Frequency n Percentage % Seizure Generalized 16 64% Focal 9 36% Extremity weakness Right 104 52.5% Left 91 46% Both 3 1.5% Hemiparesis/Plegia 187 65.8% Monoparesis/Plegia 10 3.5% Tetraparesis/plegia 1 0.4% Following the onset of stroke symptoms, the study participants arrived at the stroke center within 6 hours (40, 14.1%), within 24 hours (32, 11.3%), within one week (142, 50.0%) and 70(24.6%) arrived within one to three weeks. (Fig. 1 ). In the study, 174(61.3%) of the participants were taking drugs prior to arrival; among which 126(72.4%) are taking antihypertensive, 56(32.2%) antidiabetics, 54(31%) aspirin, and 50(28.7%) statins; the rest are taking anticoagulant and other medications respectively. (Table 2 ) 3.3. Comorbidity The most common comorbidity identified in this study was hypertension which was seen in 152(53.5%) of the study participants followed by diabetes mellitus with a percentage of 21.5% among individuals; structural heart disease was seen in thirty individuals with a percentage of 10.6%, atrial fibrillation was seen in twenty-one individuals with a percentage of 7.4%, previous history of stroke was seen in twenty individuals with a percentage of 7%, and smoking was seen in twelve individuals with a percentage of 4.2%. (Table 3 ) Table 3 Comorbidity Variable Frequency n Percentage %, n = 284 Percentage %, n = 205 Comorbidity/Risk factors Any Risk factors (Total) 205 72.2% Unknown 79 27.8% Specific types among patients with Risk factors DM 61 21.5% 29.8% HTN 152 53.5% 74.1% Previous stroke 20 7% 9.8% TIA 2 0.7% 1.0% Atrial fibrillation 21 7.4% 10.2% Dyslipidemia 7 2.5% 3.4% Structural HD 30 10.6% 14.6% HIV 5 1.8% 2.4% Alcohol intake 8 2.8% 3.9% Smoking 12 4.2% 5.9% Other 8 2.8% 3.9% 3.4 Neuroimaging Finding Following brain imaging, it was shown that among study participants who underwent brain imaging tests, ischemic stroke was seen in 247 (87%), while hemorrhagic stroke was seen in 37 (13%). The most commonly involved side or area for stroke lesions was the left side seen in 126 (44%), followed by the right side 106 (37%), and bilateral involvement was seen in 40 (14%). Considering area or location for stroke lesions; the frontal lobe, parietal lobe, basal ganglia, temporal lobe, and occipital lobe were involved in 96(33%),95(33%),90(31%),64(22%), and 34(12%) of cases respectively. (Table 4 ) Table 4 Neuroimaging Findings Variable Frequency n Percentage % Type of stroke Ischemic 247 87.0% Hemorrhagic 37 13.0% Side of the area of stroke lesions Right 112 39.4% Left 125 44.0% Both 40 14.1% Not specified 7 2.5% Area of Stroke Frontal 96 33.8% Temporal 64 22.5% Occipital 34 12% Parietal 95 33.5% Basal Ganglia 90 31.7% Brainstem 17 6% Cerebellum 21 7.4% Periventricular 21 7.4% Subcortical 20 7% Thalamus 18 6.3% 3.5 Place of residency impact in timely stroke care access To investigate the relationship between arrival time at stroke center (dependent variable) and the independent variables, a binary logistic regression analysis were conducted. First a bivariate/univariate binary logistic regression analysis for each independent variable with the duration from time of symptom onset till arrival at stroke center was performed. Then, variables that had a p-value of less than or equal to 0.25 in the bivariate logistic regression analysis were included in the multivariable logistic regression analysis. The independent variables that were included in the multivariable logistic regression analysis were age, sex, address, mode of referral, extremity weakness and type of stroke. (Table 5 ) The results of the multivariable logistic regression analysis revealed that address and referral were significantly associated with arrival time at stroke center, while extremity weakness was marginally significant. Compared to patients from AA, patients from outside AA had 7.5 times higher odds of arriving later than 24 hours (AOR = 7.5; 95%CI 2.96, 19.1; p < 0.001). Similarly, compared to self-referred patients, patients referred by HC had 8.7 times higher odds of arriving later than 24 hours (AOR = 8.7; 95%CI 3.4, 22.04; p < 0.001). Extremity weakness also showed a marginally significant relationship with arrival time at stroke center, with patients without extremity weakness having 2.3 times higher odds of arriving later than 24 hours than those with extremity weakness (AOR = 2.3 ;95%CI 1.12,4.8; p = 0.023). None of the other variables, such as age, sex, type of stroke, seizure, aphasia, DM, HTN, previous stroke or structural HD had a significant effect on arrival time at stroke center in this study. (Table 5 ) Table 5 Logistic regression analysis of factors affecting on Timely Stroke Care Access Variables 24 hrs. COR 95%CI p-value AOR 95%CI p-value Age(years) < 65 36(50%) 132(62.3%) 1.65(0.96,2.8) 0.07 1.01(0.5,1.9) 0.9 ≥ 65 36(50%) 80(37.7%) 1 Sex Female 33(45.8%) 69(32.5%) 0.6(0.3,0.98) 0.04 0.62(0.3,1.2) 0.15 Male 39(54.3%) 143(67.5%) 1 Address Outside AA 6(8.3%) 111(52.4%) 12.1(5.0,29.1) < 0.001 7.5(2.96,19.1) < 0.001 AA 66(91.7%) 101(47.6%) 1 Referral HC 6(8.3%) 111(52.4%) 12.1(5.0,29.1) < 0.001 8.7(3.4,22.04) < 0.001 Self 66(91.7%) 101(47.6%) 1 Seizure Yes 6(8.3%) 19(9%) 1.1(0.42,2.83) 0.9 No 66(91.7%) 193(91%) 1 Extremity weakness Yes 56(77.8%) 142(67%) 1 No 16(22%) 70(33%) 1.7(0.9,3.22) 0.09 2.3(1.12,4.8) 0.023 Aphasia Yes 12(16.7%) 29(13.7%) 0.8(0.38,1.7) 0.53 No 60(83.3%) 183(86.3%) 1 DM Yes 16(29.1%) 45(30%) 1.05(0.5,2.1) 0.9 No 39(70.9%) 105(70%) 1 HTN Yes 39(70.9%) 113(75.3%) 1.25(0.6,2.5) 0.52 No 16(29.1%) 37(24.7%) 1 Previous stroke Yes 7(12.7%) 13(8.7%) 0.65(0.3,1.73) 0.39 No 48(87.3%) 137(91.3%) 1 Structural HD Yes 8(14.5%) 22(14.7%) 1.01(0.4,2.4) 0.98 No 47(85.5%) 128(85.3%) 1 Type of stroke IS 67(93.1%) 180(84.9%) 0.4(0.16,1.12) 0.08 0.55(0.18,1.7) 0.3 HS 5(6.9%) 32(15.1%) 1 4. DISCUSSION In this study, our main findings were that address and referral were significantly associated with arrival time at stroke center, while extremity weakness was marginally significant. Patients from outside Addis Ababa were 7.5 times more likely to arrive at the stroke center later than 24 hours compared to those residing in the city, (AOR = 7.5; 95%CI (2.96, 19.1); p < 0.001). This finding suggests that individuals living in Addis Ababa may benefit from better access to stroke care facilities or possess greater awareness of stroke symptoms or availability of transportation, and the need for prompt medical attention. Similar study conducted in China has also highlighted the influence of geographical factors on timely stroke care access( 23 – 26 ). Studies conducted in other settings have also highlighted the influence of geographical factors on quality of care and outcomes for a variety of medical conditions( 27 – 29 ). Distance is a known barrier to timeliness of stroke care access. Patients residing far from the nearest stroke center may encounter challenges such as lack of road infrastructure, traffic congestion, high transportation cost and limited ambulance service( 30 – 32 ). In this study, almost half of the patients came from outside Addis Ababa, which might imply a long travel time and distance to reach the stroke center. Moreover, some patients came from neighboring countries such as Somalia, Djibouti and Eritrea, which might further increase the travel time and distance. Additionally, self-referral emerged as a significant factor associated with timely stroke care access. Patients referred from health centers or institutions were 8.7 times more likely to arrive at the stroke center later than 24 hours compared to those self-referred patients, (AOR = 8.7;95%CI 3.4,22.04; p < 0.001). This finding underscores the importance of public education and awareness campaigns that empower individuals to recognize stroke symptoms and take immediate action. This study showed in majority of cases (74.6%), the time from symptom onset to arrival at the stroke center was more than 24 hours, which exceeded the recommended time window for thrombolytic therapy (6 hours) or endovascular treatment (24 hours)( 33 – 34 ). This delay could result in poor clinical outcomes and increased mortality and disability among stroke patients( 28 ). In terms of the sociodemographic characteristics of the study participants, a predominance of males was observed 64.1%(n = 182), which aligns with existing research on stroke epidemiology( 2 , 20 , 30 ).Furthermore, the mean age of the participants, 58.51 ± 16 years, corresponds to the typical age distribution reported for stroke cases worldwide. Neuroimaging findings indicated that ischemic stroke was the predominant stroke subtype 87%( n = 247) among the study participants, consistent with previous reports( 17 , 20 , 22 ). The involvement of specific regions, such as the frontal lobe 33.8%(n = 96), parietal lobe 33.5% (n = 95) and basal ganglia 31.7%(n = 90), underscores the impact of stroke on crucial brain structures responsible for motor and cognitive functions( 35 – 36 ). 5. CONCLUSION This study provides valuable insights into the effect of residence on timely stroke care access in Addis Ababa, Ethiopia. The findings suggest that individuals residing in Addis Ababa and those who are self-referred are more likely to seek medical attention promptly after stroke onset. These findings underscore the need for targeted interventions to improve stroke care access in regions outside the capital and the need for timely referral in health facilities. Future research should be carried out in public health facilities to explore a more comprehensive understanding of the challenges and opportunities for stroke care in Ethiopia. Declarations Ethics approval and consent to participate Ethical clearance was sought from Addis Continental Institute of Public Health ethical review committee. After explaining about the purpose and the possible benefit of the study, permission to gather secondary data was obtained from the research committee of Yehuleshet Neurology Centre. Confidentiality of information was maintained. Consent for publication Not applicable Code Availability The statistical analyses in this study were performed using IMB SPSS Statistics Version 26. The software is commercially available and was used under license. No custom code was generated. Author Contributions Conceptualization: BS SZ Formal analysis: BS SZ NM BT. Development or design of methodology: BS SZ Entering data into computer software: BS SZ. Supervision: BS SZ NM BT. Validation: BS SZ BT . Writing original draft: BS SZ Writing review & editing: BS SZ BT NM . All authors read and approved the final manuscript Availability of data and material The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. Conflict of interests The authors have declared that no competing interests exist. Funding No funding was obtained for this study. Acknowledgement We would like to thank Addis Continental Institute of Public Health for providing ethical clearance and Yehuleshet Neurology Centre for providing data. References Global Burden of Diseases I, Bennett DA, Krishnamurthi RV, Barker-Collo S, Forouzanfar MH, Naghavi M, et al. The global burden of ischemic stroke: findings of the GBD 2010 study. Glob Heart. 2014 Mar;9(1):107–12. GBD 2016 Stroke Collaborators. 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Cite Share Download PDF Status: Published Journal Publication published 12 Aug, 2025 Read the published version in SN Comprehensive Clinical Medicine → Version 1 posted Editorial decision: Revision requested 24 Jun, 2025 Reviews received at journal 21 Jun, 2025 Reviewers agreed at journal 10 Jun, 2025 Reviewers agreed at journal 05 Jun, 2025 Reviews received at journal 02 Jun, 2025 Reviewers agreed at journal 28 May, 2025 Reviewers invited by journal 28 May, 2025 Editor assigned by journal 16 May, 2025 Submission checks completed at journal 16 May, 2025 First submitted to journal 02 May, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6580909","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":463803449,"identity":"88576e1c-a670-4830-9953-709be2ad4143","order_by":0,"name":"Bereket Sinshaw","email":"","orcid":"","institution":"Yehuleshet Medical Centre","correspondingAuthor":false,"prefix":"","firstName":"Bereket","middleName":"","lastName":"Sinshaw","suffix":""},{"id":463803450,"identity":"9aa1f8a6-ea30-4e25-8990-c7f58389540a","order_by":1,"name":"Senay Zerihun","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA7ElEQVRIiWNgGAWjYDADNgkg8QHEYCdFC+MMEIOZaGuAWph5QAxCWuTbew9+5vljk88n3WP22ObXNnk+ZgbGDx9zcGsxOHMuWZqHJ82yTeaMuXFu323DNmYGZsmZ2/BokcgxkOaROGzAJpFjJp3bc5sRqIWNmRePFvn5b4x/8xj8h2ix7LltT1ALww0eM2mehAMQLQw/bicS1GJwJsfMcs6BZKCWtDLJ3obbyW3MjM14/SLffsb4xps/dgbyM5K3Sfz4c9t2fnvzwQ8f8TkMCJh4YCzGNjDZgF89SMkPOPMPQcWjYBSMglEwAgEA/HdGeFLUI7sAAAAASUVORK5CYII=","orcid":"","institution":"Byumba Teaching Hospital","correspondingAuthor":true,"prefix":"","firstName":"Senay","middleName":"","lastName":"Zerihun","suffix":""},{"id":463803451,"identity":"32df9700-8308-417a-b9ab-56a789655dc1","order_by":2,"name":"Nahom Mulugeta","email":"","orcid":"","institution":"Zewditu Hospital","correspondingAuthor":false,"prefix":"","firstName":"Nahom","middleName":"","lastName":"Mulugeta","suffix":""},{"id":463803452,"identity":"6762f976-702a-49d7-a407-dab3f1e71ee3","order_by":3,"name":"Berhanu Tarekegn","email":"","orcid":"","institution":"Bahir Dar University","correspondingAuthor":false,"prefix":"","firstName":"Berhanu","middleName":"","lastName":"Tarekegn","suffix":""}],"badges":[],"createdAt":"2025-05-02 21:23:11","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6580909/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6580909/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s42399-025-02029-5","type":"published","date":"2025-08-12T15:58:05+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":83812805,"identity":"51914d8e-74b4-4f9b-9a86-1ff16810f389","added_by":"auto","created_at":"2025-06-03 07:15:27","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":29735,"visible":true,"origin":"","legend":"\u003cp\u003eTime from onset of symptoms till first evaluation at Clinic\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6580909/v1/5a45ab3b7b381fc59bb23adc.png"},{"id":89311305,"identity":"b8bf9134-d5a9-45b6-8109-2c131fb51113","added_by":"auto","created_at":"2025-08-18 16:10:37","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1081345,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6580909/v1/a388083a-f66b-45f6-a288-d053c7153c7b.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Place of residence and timely access to stroke care in Ethiopia","fulltext":[{"header":"1. BACKGROUND","content":"\u003cp\u003eA stroke or cerebrovascular accident (CVA) is a focal or global disturbance of cerebral function caused by blockage or rupture of blood vessels that supply the brain with symptoms lasting 24 hours or longer or causing death with no apparent cause other than that of vascular origin(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eMost strokes are ischaemic due to reduced blood flow, generally resulting from arterial occlusion. A rarer type of ischaemic stroke is venous infarction due to occlusion of cerebral veins or venous sinuses. The remaining 10\u0026ndash;40% of stroke presentations, depending on regional epidemiology, are haemorrhagic and results from the rupture of cerebral arteries(\u003cspan additionalcitationids=\"CR4\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eStroke is a leading cause of disability, dementia, and death worldwide. Approximately 70% of deaths from stroke and 87% of stroke-related disability occur in low-income and middle-income countries. In sub-Saharan countries, stroke incidence was higher in urban areas compared to rural areas. However, the study also found that stroke severity and outcomes were worse in rural areas due to limited access to healthcare facilities and delays in seeking treatment(\u003cspan additionalcitationids=\"CR7 CR8\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eStroke is one of the leading causes of death and disability in Ethiopia, with an estimated incidence rate of 126 per 100,000 people. Stroke care services are largely unavailable in the country, with only a few hospitals providing specialized care for stroke patients. As a result, many stroke patients in Ethiopia do not receive the appropriate care they need, leading to poor outcomes and a high mortality rate(\u003cspan additionalcitationids=\"CR11 CR12\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eGeography is a critical factor affecting access to healthcare services, including stroke care in Ethiopia. The country has a population of over 112\u0026nbsp;million people, and stroke is a leading cause of morbidity and mortality. However, the majority of Ethiopians live in rural areas, where access to healthcare is limited. The lack of infrastructure, transportation, and trained healthcare professionals makes it difficult for people living in remote regions to receive timely and appropriate care((\u003cspan additionalcitationids=\"CR15 CR16\" citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eThe burden of stroke in Ethiopia is further compounded by poor access to specialized stroke care services, a shortage of trained healthcare professionals, and inadequate healthcare infrastructure in the country. This has led to low rates of thrombolysis and endovascular treatment for acute ischemic stroke patients(\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eWhile there is no direct evidence on whether increased access to stroke care can reduce mortality rates in Ethiopia specifically, studies suggest that improving access to care could lead to positive outcomes for stroke patients in Low- and middle- income countries, particularly those in Africa(\u003cspan additionalcitationids=\"CR21\" citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e).\u003c/p\u003e"},{"header":"2. METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Study Design and Setting\u003c/h2\u003e \u003cp\u003eIt is a retrospective cross-sectional study done at Yehuleshet Neurology Centre in Addis Ababa, Ethiopia. All patients with a confirmed stroke presenting to the neurology centre during the study period of 36 months,1st of September 2019 to August 30th 2022, were included in the study.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Study participants\u003c/h2\u003e \u003cp\u003eAll Patients with acute and sub-acute stroke cases confirmed using brain computerized tomography scan and/or magnetic resonance imaging and evaluated at Yehuleshet neurology centre during the study period were included. The study excluded patients who had a stroke at Yehuleshet Neurology Centre, did not have complete medical records, as well as patients who came to the clinic more than three weeks after their stroke onset.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.3 Study variables\u003c/h2\u003e \u003cp\u003eThe dependant variable is timely stroke service care access while the main independent variable is place of residence. Additional independent variables include age, sex, diabetes miletus, hypertension, structural heart disease, previous stroke, type of stroke, mode of referral, extremity weakness, aphasia and seizure\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e2.4 Sample size\u003c/h2\u003e \u003cp\u003eAll Patients who fulfilled the inclusion criteria during the study period were included. The medical record numbers (MRN) of stroke patients were taken from the Health Management Information System (HMIS) of Yehuleshet Neurology centre.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e2.5 Data analysis and presentation\u003c/h2\u003e \u003cp\u003e Data were reviewed, cleaned, and analysed using IBM SPSS Version 26. Descriptive statistics was used to summarize patient baseline characteristics using proportions for dichotomous, means, and SDs for continuous variables and medians and interquartile ranges for non-normally distributed continuous variables. Logistic regression was used to assess associations between the patient\u0026rsquo;s residency and timely stroke care access. Initially, bivariate analysis was conducted for factors affecting timely stroke care access and variables with P\u0026thinsp;\u0026lt;\u0026thinsp;0.25 on bivariate analysis were entered on multivariate logistic regression to identify independently associated factors affecting timely stroke care access. The significance of Odds Ratio (OR) was determined with 95% CI and P\u0026thinsp;\u0026lt;\u0026thinsp;0.05. Factors affecting timely stroke care access were controlled for possible confounders.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003e2.6 Operational definitions\u003c/h2\u003e \u003cp\u003e \u003cstrong\u003eStroke or cerebrovascular accident (CVA)\u003c/strong\u003e \u003cp\u003ePatients with brain imaging (Brain CT and/or MRI) evidence of ischemia or haemorrhage in brain parenchyma after they present with sudden onset of trouble walking, speaking and understanding, a paralysis or numbness of the face, arm or leg.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eAcute Stroke\u003c/strong\u003e \u003cp\u003eStroke within the first week of onset\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eSub-acute Stroke\u003c/strong\u003e \u003cp\u003eStroke within 1 to 3 weeks of onset\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eTimely stroke care Access\u003c/strong\u003e \u003cp\u003ePatients who presents to the neurology centre within 24 hours of sign and symptoms of stroke\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eGlasgow coma scale (GCS)\u003c/strong\u003e \u003cp\u003eMeasurement scale which helps to measure the level of consciousness. It is interpreted as Good GCS (\u003cspan additionalcitationids=\"CR14\" citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e), Moderate GCS (\u003cspan additionalcitationids=\"CR10 CR11\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e), Poor GCS (\u0026le;\u0026thinsp;8)\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eStroke onset time\u003c/b\u003e - Stroke onset time was taken as the time the person was last seen normal\u003c/p\u003e \u003cp\u003e \u003cb\u003eFirst medical contact (FMC)\u003c/b\u003e - The first contact made with a neurologist. This was obtained from the patient\u0026rsquo;s chart\u003c/p\u003e \u003cp\u003e \u003cb\u003ePlace of residence -\u003c/b\u003e is the region where a person lives at the time of onset of stroke. The study categorized patients by their place of residence at the time they had a stroke. It distinguished between patients who lived in Addis Ababa and those who lived outside of it\u003c/p\u003e \u003c/div\u003e"},{"header":"3. RESULT","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003e3.1 Sociodemographic data\u003c/h2\u003e \u003cp\u003eThe study included 284 patients, of which 102 (35.9%) were females and 182 (64.1%) were males. The age of the participants ranged from 15 to 93 years with a mean age of 58.51\u0026thinsp;\u0026plusmn;\u0026thinsp;16 years. During arrival, 117 (41.2%) patients were referred from health facilities while 167 (58.8%) were self-referred.\u003c/p\u003e \u003cp\u003eAmong the total participants, 167 (58.8%) of the patients were from Addis Ababa, whereas 117 (41.2%) of the patients came from outside of Addis Ababa.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e3.2. Clinical characteristics\u003c/h2\u003e \u003cp\u003eExtremity weakness was the most common symptom among patients with a percentage of 69.7%, followed by headache with a percentage of 22.2%, dysarthria with a percentage of 18.3%, and aphasia with a percentage of 14.4%. Almost half of them had a right-side weakness with a percentage of 52.5%, and two-thirds had hemiparesis/plegia with a percentage of 65.8%; the rest had monoparesis/plegia with a percentage of 3.5%, and one patient had Tetraparesis/plegia. (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e and Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eClinical characteristics\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFrequency n\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePercentage %\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"8\" rowspan=\"9\"\u003e \u003cp\u003e\u003cb\u003ePatients taking drug prior to arrival\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eYes\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e174\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e61.3%\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eType of Drug\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAspirin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e31%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStatin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e28.7%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAnticoagulant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.3%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAntihypertensive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e126\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e72.4%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAntidiabetic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e32.2%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17.2%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e174\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e100%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"13\" rowspan=\"14\"\u003e \u003cp\u003e\u003cb\u003eClinical signs and symptoms\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eYes\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e284\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e100%\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHeadache\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22.2%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSeizure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8.8%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDecreased Level of consciousness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.7%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eExtremity weakness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e198\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e69.7%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAphasia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14.4%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDysarthria\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18.3%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eObscuration of Vision\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.2%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAtaxia \u0026amp; incoordination\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12.3%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMemory Alteration\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9.2%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHemi paresthesia/ Pain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12.3%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDouble vision\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.8%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHemianopsia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.7%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUrinary incontinence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.4%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003eDuration of Onset\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003eof Symptoms\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u0026ndash;6 hrs./Early hyperacute\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14.1%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;6\u0026ndash;24 hrs./Late hyperacute\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11.3%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;24 hrs. \u0026minus;\u0026thinsp;1 week/Acute\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e142\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e50.0%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;1\u0026ndash;3 weeks/Subacute\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24.6%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCharacteristics of Seizure and Extremity weakness\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFrequency n\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePercentage %\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSeizure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGeneralized\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e64%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFocal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e36%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003eExtremity weakness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e104\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e52.5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLeft\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e46%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBoth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHemiparesis/Plegia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e187\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e65.8%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMonoparesis/Plegia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTetraparesis/plegia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.4%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eFollowing the onset of stroke symptoms, the study participants arrived at the stroke center within 6 hours (40, 14.1%), within 24 hours (32, 11.3%), within one week (142, 50.0%) and 70(24.6%) arrived within one to three weeks. (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eIn the study, 174(61.3%) of the participants were taking drugs prior to arrival; among which 126(72.4%) are taking antihypertensive, 56(32.2%) antidiabetics, 54(31%) aspirin, and 50(28.7%) statins; the rest are taking anticoagulant and other medications respectively. (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e)\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003e3.3. Comorbidity\u003c/h2\u003e \u003cp\u003eThe most common comorbidity identified in this study was hypertension which was seen in 152(53.5%) of the study participants followed by diabetes mellitus with a percentage of 21.5% among individuals; structural heart disease was seen in thirty individuals with a percentage of 10.6%, atrial fibrillation was seen in twenty-one individuals with a percentage of 7.4%, previous history of stroke was seen in twenty individuals with a percentage of 7%, and smoking was seen in twelve individuals with a percentage of 4.2%. (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComorbidity\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFrequency n\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePercentage %, n\u0026thinsp;=\u0026thinsp;284\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePercentage %, n\u0026thinsp;=\u0026thinsp;205\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"12\" rowspan=\"13\"\u003e \u003cp\u003eComorbidity/Risk factors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAny Risk factors (Total)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e205\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e72.2%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnknown\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e27.8%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eSpecific types among patients with Risk factors\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21.5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e29.8%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHTN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e152\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e53.5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e74.1%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrevious stroke\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e9.8%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTIA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.7%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.0%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAtrial fibrillation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.4%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e10.2%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDyslipidemia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3.4%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStructural HD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10.6%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e14.6%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHIV\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.8%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.4%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAlcohol intake\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.8%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3.9%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSmoking\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.2%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e5.9%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.8%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3.9%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003e3.4 Neuroimaging Finding\u003c/h2\u003e \u003cp\u003eFollowing brain imaging, it was shown that among study participants who underwent brain imaging tests, ischemic stroke was seen in 247 (87%), while hemorrhagic stroke was seen in 37 (13%). The most commonly involved side or area for stroke lesions was the left side seen in 126 (44%), followed by the right side 106 (37%), and bilateral involvement was seen in 40 (14%). Considering area or location for stroke lesions; the frontal lobe, parietal lobe, basal ganglia, temporal lobe, and occipital lobe were involved in 96(33%),95(33%),90(31%),64(22%), and 34(12%) of cases respectively. (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eNeuroimaging Findings\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFrequency n\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003ePercentage %\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eType of stroke\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIschemic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e247\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e87.0%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHemorrhagic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e13.0%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eSide of the area of\u003c/p\u003e \u003cp\u003estroke lesions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e112\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e39.4%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLeft\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e125\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e44.0%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBoth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e14.1%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNot specified\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"9\" rowspan=\"10\"\u003e \u003cp\u003eArea of Stroke\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFrontal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e33.8%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTemporal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e22.5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOccipital\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e12%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eParietal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e33.5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBasal Ganglia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e31.7%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBrainstem\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCerebellum\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7.4%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePeriventricular\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7.4%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSubcortical\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThalamus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6.3%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003e3.5 Place of residency impact in timely stroke care access\u003c/h2\u003e \u003cp\u003eTo investigate the relationship between arrival time at stroke center (dependent variable) and the independent variables, a binary logistic regression analysis were conducted. First a bivariate/univariate binary logistic regression analysis for each independent variable with the duration from time of symptom onset till arrival at stroke center was performed. Then, variables that had a p-value of less than or equal to 0.25 in the bivariate logistic regression analysis were included in the multivariable logistic regression analysis. The independent variables that were included in the multivariable logistic regression analysis were age, sex, address, mode of referral, extremity weakness and type of stroke. (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eThe results of the multivariable logistic regression analysis revealed that address and referral were significantly associated with arrival time at stroke center, while extremity weakness was marginally significant. Compared to patients from AA, patients from outside AA had 7.5 times higher odds of arriving later than 24 hours (AOR\u0026thinsp;=\u0026thinsp;7.5; 95%CI 2.96, 19.1; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Similarly, compared to self-referred patients, patients referred by HC had 8.7 times higher odds of arriving later than 24 hours (AOR\u0026thinsp;=\u0026thinsp;8.7; 95%CI 3.4, 22.04; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Extremity weakness also showed a marginally significant relationship with arrival time at stroke center, with patients without extremity weakness having 2.3 times higher odds of arriving later than 24 hours than those with extremity weakness (AOR\u0026thinsp;=\u0026thinsp;2.3 ;95%CI 1.12,4.8; p\u0026thinsp;=\u0026thinsp;0.023). None of the other variables, such as age, sex, type of stroke, seizure, aphasia, DM, HTN, previous stroke or structural HD had a significant effect on arrival time at stroke center in this study. (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eLogistic regression analysis of factors affecting on Timely Stroke Care Access\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;24 hrs.\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;24 hrs.\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCOR 95%CI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eAOR 95%CI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAge(years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36(50%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e132(62.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.65(0.96,2.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.01(0.5,1.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36(50%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e80(37.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e33(45.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e69(32.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.6(0.3,0.98)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.62(0.3,1.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.15\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e39(54.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e143(67.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAddress\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOutside AA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6(8.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e111(52.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e12.1(5.0,29.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e7.5(2.96,19.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e66(91.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e101(47.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eReferral\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6(8.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e111(52.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e12.1(5.0,29.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e8.7(3.4,22.04)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSelf\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e66(91.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e101(47.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSeizure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6(8.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e19(9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.1(0.42,2.83)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e66(91.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e193(91%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eExtremity weakness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e56(77.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e142(67%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16(22%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e70(33%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.7(0.9,3.22)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2.3(1.12,4.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.023\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAphasia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12(16.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e29(13.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.8(0.38,1.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e60(83.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e183(86.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eDM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16(29.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e45(30%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.05(0.5,2.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e39(70.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e105(70%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eHTN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e39(70.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e113(75.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.25(0.6,2.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16(29.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e37(24.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePrevious stroke\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7(12.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13(8.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.65(0.3,1.73)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e48(87.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e137(91.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eStructural HD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8(14.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22(14.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.01(0.4,2.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e47(85.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e128(85.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eType of stroke\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e67(93.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e180(84.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.4(0.16,1.12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.55(0.18,1.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5(6.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e32(15.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"4. DISCUSSION","content":"\u003cp\u003eIn this study, our main findings were that address and referral were significantly associated with arrival time at stroke center, while extremity weakness was marginally significant. Patients from outside Addis Ababa were 7.5 times more likely to arrive at the stroke center later than 24 hours compared to those residing in the city, (AOR\u0026thinsp;=\u0026thinsp;7.5; 95%CI (2.96, 19.1); p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). This finding suggests that individuals living in Addis Ababa may benefit from better access to stroke care facilities or possess greater awareness of stroke symptoms or availability of transportation, and the need for prompt medical attention. Similar study conducted in China has also highlighted the influence of geographical factors on timely stroke care access(\u003cspan additionalcitationids=\"CR24 CR25\" citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). Studies conducted in other settings have also highlighted the influence of geographical factors on quality of care and outcomes for a variety of medical conditions(\u003cspan additionalcitationids=\"CR28\" citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eDistance is a known barrier to timeliness of stroke care access. Patients residing far from the nearest stroke center may encounter challenges such as lack of road infrastructure, traffic congestion, high transportation cost and limited ambulance service(\u003cspan additionalcitationids=\"CR31\" citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e). In this study, almost half of the patients came from outside Addis Ababa, which might imply a long travel time and distance to reach the stroke center. Moreover, some patients came from neighboring countries such as Somalia, Djibouti and Eritrea, which might further increase the travel time and distance.\u003c/p\u003e \u003cp\u003eAdditionally, self-referral emerged as a significant factor associated with timely stroke care access. Patients referred from health centers or institutions were 8.7 times more likely to arrive at the stroke center later than 24 hours compared to those self-referred patients, (AOR\u0026thinsp;=\u0026thinsp;8.7;95%CI 3.4,22.04; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). This finding underscores the importance of public education and awareness campaigns that empower individuals to recognize stroke symptoms and take immediate action.\u003c/p\u003e \u003cp\u003eThis study showed in majority of cases (74.6%), the time from symptom onset to arrival at the stroke center was more than 24 hours, which exceeded the recommended time window for thrombolytic therapy (6 hours) or endovascular treatment (24 hours)(\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e). This delay could result in poor clinical outcomes and increased mortality and disability among stroke patients(\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn terms of the sociodemographic characteristics of the study participants, a predominance of males was observed 64.1%(n\u0026thinsp;=\u0026thinsp;182), which aligns with existing research on stroke epidemiology(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e).Furthermore, the mean age of the participants, 58.51\u0026thinsp;\u0026plusmn;\u0026thinsp;16 years, corresponds to the typical age distribution reported for stroke cases worldwide. Neuroimaging findings indicated that ischemic stroke was the predominant stroke subtype 87%( n\u0026thinsp;=\u0026thinsp;247) among the study participants, consistent with previous reports(\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). The involvement of specific regions, such as the frontal lobe 33.8%(n\u0026thinsp;=\u0026thinsp;96), parietal lobe 33.5% (n\u0026thinsp;=\u0026thinsp;95) and basal ganglia 31.7%(n\u0026thinsp;=\u0026thinsp;90), underscores the impact of stroke on crucial brain structures responsible for motor and cognitive functions(\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e).\u003c/p\u003e"},{"header":"5. CONCLUSION","content":"\u003cp\u003eThis study provides valuable insights into the effect of residence on timely stroke care access in Addis Ababa, Ethiopia. The findings suggest that individuals residing in Addis Ababa and those who are self-referred are more likely to seek medical attention promptly after stroke onset. These findings underscore the need for targeted interventions to improve stroke care access in regions outside the capital and the need for timely referral in health facilities. Future research should be carried out in public health facilities to explore a more comprehensive understanding of the challenges and opportunities for stroke care in Ethiopia.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical clearance was sought from Addis Continental Institute of Public Health ethical review committee. After explaining about the purpose and the possible benefit of the study, permission to gather secondary data was obtained from the research committee of Yehuleshet Neurology Centre. Confidentiality of information was maintained.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCode Availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe statistical analyses in this study were performed using IMB SPSS Statistics Version 26. The software is commercially available and was used under license. No custom code was generated.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConceptualization: BS SZ Formal analysis: BS SZ NM BT. Development or design of methodology: BS SZ \u0026nbsp;Entering data into computer software: BS SZ. Supervision: BS SZ NM BT. Validation: \u0026nbsp;BS SZ BT . Writing original draft: BS SZ \u0026nbsp;Writing review \u0026amp; editing: BS SZ \u0026nbsp;BT NM . All authors read and approved the final manuscript\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and material\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interests\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors have declared that no competing interests exist.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo funding was obtained for this study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to thank Addis Continental Institute of Public Health for providing ethical clearance and Yehuleshet Neurology Centre for providing data.\u0026nbsp;\u003c/p\u003e\n"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eGlobal Burden of Diseases I, Bennett DA, Krishnamurthi RV, Barker-Collo S, Forouzanfar MH, Naghavi M, et al. 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Available from: https://pubmed.ncbi.nlm.nih.gov/33546620/\u003c/li\u003e\n\u003cli\u003eGlobal, regional, and national burden of stroke and its risk factors, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019 - PubMed [Internet]. [cited 2023 Jun 4]. Available from: https://pubmed.ncbi.nlm.nih.gov/34487721/\u003c/li\u003e\n\u003cli\u003eChobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL, et al. Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertens Dallas Tex 1979. 2003 Dec;42(6):1206\u0026ndash;52. \u003c/li\u003e\n\u003cli\u003eHerttua K, Martikainen P, Batty GD, Kivim\u0026auml;ki M. Poor Adherence to Statin and Antihypertensive Therapies as Risk Factors for Fatal Stroke. J Am Coll Cardiol. 2016 Apr 5;67(13):1507\u0026ndash;15. \u003c/li\u003e\n\u003cli\u003eMurray CJL, Vos T, Lozano R, Naghavi M, Flaxman AD, Michaud C, et al. Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet Lond Engl. 2012 Dec 15;380(9859):2197\u0026ndash;223. \u003c/li\u003e\n\u003cli\u003eKwakkel G, Kollen B, Twisk J. Impact of time on improvement of outcome after stroke. Stroke. 2006 Sep;37(9):2348\u0026ndash;53. \u003c/li\u003e\n\u003cli\u003eStroke care in Africa: A systematic review of the literature - Gerard Urimubenshi, Dominique A Cadilhac, Jeanne N Kagwiza, Olivia Wu, Peter Langhorne, 2018 [Internet]. [cited 2023 Jun 4]. Available from: https://journals.sagepub.com/doi/10.1177/1747493018772747\u003c/li\u003e\n\u003cli\u003eMark O\u0026rsquo;Meara R, Ganas U, Hendrikse C. Access to acute stroke care: A retrospective descriptive analysis of stroke patients\u0026rsquo; journey to a district hospital. Afr J Emerg Med. 2022 Dec 1;12(4):366\u0026ndash;72. \u003c/li\u003e\n\u003cli\u003eKhalema D, Goldstein LN, Lucas S. A retrospective analysis of time delays in patients presenting with stroke to an academic emergency department. SA J Radiol. 2018 Jun 21;22(1):1319. \u003c/li\u003e\n\u003cli\u003eYuan J, Lu ZK, Xiong X, Li M, Liu Y, Wang LD, et al. Age and geographic disparities in acute ischaemic stroke prehospital delays in China: a cross-sectional study using national stroke registry data. Lancet Reg Health West Pac. 2023 Jan 16;33:100693. \u003c/li\u003e\n\u003cli\u003eJones AP, Haynes R, Sauerzapf V, Crawford SM, Zhao H, Forman D. Travel times to health care and survival from cancers in Northern England. Eur J Cancer Oxf Engl 1990. 2008 Jan;44(2):269\u0026ndash;74. \u003c/li\u003e\n\u003cli\u003eLin CC, Bruinooge SS, Kirkwood MK, Hershman DL, Jemal A, Guadagnolo BA, et al. Association Between Geographic Access to Cancer Care and Receipt of Radiation Therapy for Rectal Cancer. Int J Radiat Oncol Biol Phys. 2016 Mar 15;94(4):719\u0026ndash;28. \u003c/li\u003e\n\u003cli\u003eTong D, Reeves MJ, Hernandez AF, Zhao X, Olson DM, Fonarow GC, et al. Times from symptom onset to hospital arrival in the Get with the Guidelines--Stroke Program 2002 to 2009: temporal trends and implications. Stroke. 2012 Jul;43(7):1912\u0026ndash;7. \u003c/li\u003e\n\u003cli\u003eNiklasson A, Herlitz J, Jood K. Socioeconomic disparities in prehospital stroke care. Scand J Trauma Resusc Emerg Med. 2019 May 2;27:53. \u003c/li\u003e\n\u003cli\u003eChang KC, Tseng MC, Tan TY. Prehospital delay after acute stroke in Kaohsiung, Taiwan. Stroke. 2004 Mar;35(3):700\u0026ndash;4. \u003c/li\u003e\n\u003cli\u003eAzzimondi G, Bassein L, Fiorani L, Nonino F, Montaguti U, Celin D, et al. Variables associated with hospital arrival time after stroke: effect of delay on the clinical efficiency of early treatment. Stroke. 1997 Mar;28(3):537\u0026ndash;42. \u003c/li\u003e\n\u003cli\u003eLachkhem Y, Rican S, Minvielle \u0026Eacute;. Understanding delays in acute stroke care: a systematic review of reviews. Eur J Public Health. 2018 Jun 1;28(3):426\u0026ndash;33. \u003c/li\u003e\n\u003cli\u003eTeuschl Y, Brainin M. Stroke education: discrepancies among factors influencing prehospital delay and stroke knowledge. Int J Stroke Off J Int Stroke Soc. 2010 Jun;5(3):187\u0026ndash;208. \u003c/li\u003e\n\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"sn-comprehensive-clinical-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"sncm","sideBox":"Learn more about [SN Comprehensive Clinical Medicine](https://www.springer.com/journal/42399)","snPcode":"42399","submissionUrl":"https://submission.nature.com/new-submission/42399/3","title":"SN Comprehensive Clinical Medicine","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"stroke, place of residence, timely access to care, Ethiopia","lastPublishedDoi":"10.21203/rs.3.rs-6580909/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6580909/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eIn Ethiopia, stroke related deaths are increasing due to lifestyle changes and improved life expectancy. Limited access to healthcare facilities, diagnostic investigations, and patient delays in receiving medical attention negatively influence the outcome of stroke in Ethiopia.\u003c/p\u003e\u003ch2\u003eObjectives\u003c/h2\u003e \u003cp\u003eThis study investigates the association between places of residence and timely stroke care access in Ethiopia.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eMedical records containing complete patient information and confirmed diagnosis of stroke using neuroimaging techniques were included in the study. The patients\u0026rsquo; place of residence was categorised into those who lived in Addis Ababa and those lived outside Addis Ababa. Timely stroke care was defined as patients who present within 24 hours after onset of symptoms and signs of stroke. The necessary data was entered into SPSS version 26 and logistic regression was used to assess associations between the patient\u0026rsquo;s residency and timely stroke care access.\u003c/p\u003e\u003ch2\u003eResult\u003c/h2\u003e \u003cp\u003ePlace of residency and referral were significantly associated with arrival time at the stroke centre. Compared to patients from AA, patients from outside AA had 7.5 times higher odds of arriving later than 24 hours (AOR\u0026thinsp;=\u0026thinsp;7.5; 95%CI 2.96, 19.1; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Similarly, compared to self-referred patients, patients referred by health institutions had 8.7 times higher odds of arriving later than 24 hours (AOR\u0026thinsp;=\u0026thinsp;8.7; 95%CI 3.4, 22.04; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001)\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThe findings suggest that individuals residing in Addis Ababa and those who are self-referred are more likely to seek medical attention promptly after stroke onset. These result underscore the need for targeted interventions to improve stroke care access in regions outside the capital and the need for timely referral in health facilities.\u003c/p\u003e","manuscriptTitle":"Place of residence and timely access to stroke care in Ethiopia","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-06-03 07:15:23","doi":"10.21203/rs.3.rs-6580909/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-06-24T06:47:32+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-21T22:21:55+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"334854802472824047774412591527287552614","date":"2025-06-10T13:00:57+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"61841877403304115348631455953356628127","date":"2025-06-05T19:00:41+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-02T20:33:43+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"88974915958534867555097939026476404611","date":"2025-05-28T17:30:39+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-05-28T16:38:54+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-05-16T09:08:26+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-05-16T08:46:07+00:00","index":"","fulltext":""},{"type":"submitted","content":"SN Comprehensive Clinical Medicine","date":"2025-05-02T21:11:16+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"sn-comprehensive-clinical-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"sncm","sideBox":"Learn more about [SN Comprehensive Clinical Medicine](https://www.springer.com/journal/42399)","snPcode":"42399","submissionUrl":"https://submission.nature.com/new-submission/42399/3","title":"SN Comprehensive Clinical Medicine","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"472ab295-f881-418c-bf52-77f652232864","owner":[],"postedDate":"June 3rd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-08-18T16:09:46+00:00","versionOfRecord":{"articleIdentity":"rs-6580909","link":"https://doi.org/10.1007/s42399-025-02029-5","journal":{"identity":"sn-comprehensive-clinical-medicine","isVorOnly":false,"title":"SN Comprehensive Clinical Medicine"},"publishedOn":"2025-08-12 15:58:05","publishedOnDateReadable":"August 12th, 2025"},"versionCreatedAt":"2025-06-03 07:15:23","video":"","vorDoi":"10.1007/s42399-025-02029-5","vorDoiUrl":"https://doi.org/10.1007/s42399-025-02029-5","workflowStages":[]},"version":"v1","identity":"rs-6580909","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6580909","identity":"rs-6580909","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}