The success of programs aiming at improving the life of people with CVS depends on public awareness and attitudes toward this disease. The level of knowledge regarding CVS was still inadequate even among medical staff and highly educated persons. However, they were found to have little or inadequate knowledge about some aspects of this serious condition such as the risk factors and warning symptoms.
Sources of information
In our study, the main sources of knowledge about CVS were from seeing someone with stroke in 63.2% followed by public media in 46.5%. But the most striking result was that 5.4% of participants got their information from physicians, at the same time 29.17% of the participants had family member with CVS. This is almost consistent with all of the previous studies where there were variations between studies about the sources of information about CVS. According to the study conducted in Benin , 25.1% had heard about stroke from their relatives; 13.9% from television, radio, and the Internet; 11.7% from rumors; 9.5% from school and their general culture; 11.8% from physicians; and 20.4% did not have a specific source of information or could not recall.
Similar reports from Pakistan  showed that 56% of their study population got their information from a friend or relative, 30.9% had information because they had a stroke patient in the family, and 20% have learnt about stroke from television. In Oman , the majority of subjects 45.2% obtained their information mainly by personal experiences through the community, 39.3% from relatives, 14.7% from friends, 3.7% from newspapers, and 0.8% from television. But the surprising thing was that only 4.5% of subjects got their information about stroke from health professionals. According to Ain Shams and Fayoum University study , 34.3% got their information from seeing someone with stroke, 20.7% from mass media, 16% from reading about stroke, and 14.1% from school/university education. This result indicates that almost all physicians have no time to educate caregivers.
Risk factors of CSV
In the current study, the main risk factor for CVS was hypertension in 15.8%, followed by stress in 15.6% of the participants when open-ended questions were asked. The ability to identify risk factors appeared to be strongly related to how the questions were asked. When close-ended questions were asked, hypertension and stress as risk factors for CVS had risen to 92.2% and 59.9%, respectively. This result was in agreement with different studies that showed the most frequent identifiable risk factor for stroke was as follows. In Ain Shams and Fayoum University study , 73.8% was hypertension and 54.9% was stress; in Spain , 92% was hypertension; in South Korea , 68% was stress; in Georgia , 96% was hypertension; in Hong Kong , 90% was hypertension; in UK , 94.1% was hypertension; in Benin , 34.5% was hypertension and 7.6% was stress; in India , 54% was hypertension; in Pakistan , 69.1% was hypertension and 55.8% was stress; and in Oman , 34.5% was hypertension.
The difference between results of open- and close-ended questions in current study may be contributed to the educational level as 71% of participants in our study were illiterate or had primary and secondary education. The results of Ain Shams and Fayoum University study  were better than those of our study because their participants were workers in university hospitals.
In our study, diabetes mellitus was less frequent risk factor for CVS as 16.8% of participants reported it when close-ended question was asked. This result was negative when compared to previous studies about diabetes mellitus as risk factor for CVS in UK  62.4%, in Hong Kong  60%, in Spain  59%, in Georgia  69%, in India  31%, in Pakistan  33.4%, and in Oman  22.8%, while this result was positive when compared to the result of Benin  0.3%.
Warning symptoms of CVS
Paralysis of one side of the body was identified by 26.9% of our participants as the commonest warning symptom when open-ended question was asked and this is comparable to 65% reported from Oman , 62.2% reported from India , 62% from Hong Kong, 60% from South Korea , 24% from Georgia , and 88% from Spain . When close-ended questions were asked, it had risen to 81.8%.
Only 4.9% of our participants were able to recognize altered consciousness as a stroke warning symptom in comparison to 58% reported in a study conducted in Hong Kong , 4% in South Korea , 80% in Spain , 34.2% in Fayoum and Ain shams universities , and 13.3% in Nigeria . When close-ended questions were asked, it had risen to 74.6%.
Numbness of one side of the body has been reported by 79.2% of our participants with close-ended questions, and no one mentioned it in open-ended question in comparison to 92% with close-ended question and 2% with open-ended question in West Virginia , 24% with open-ended question in South Korea , 95% with close-ended question in Georgia , 69 % with open-ended question in Spain , and 60.6% with open-ended question in Pakistan .
Speech disturbance was reported by 69.7% with close-ended question of our participants in comparison to Ireland  54% with open-ended question, West Virginia  88% with close-ended question, Oman  30% with open-ended question, Hong Kong  65% with open-ended question, Georgia  93% with close-ended question and 16% with open-ended question, Spain  80% with open-ended question, Pakistan  41.2% with open-ended question, and Benin  12.8% with open-ended question.
The ability to identify warning symptoms of CVS appeared to be strongly related to how the questions were asked. Unfortunately 68.2% of our participants did not know any warning symptoms of CVS. These results were negative when compared to Oman  32.0%, India  29%, and Benin  27.2%. Again lack of awareness was predominant in our results; it was higher among illiterates and associated with low educational role of physicians.
Actions to be taken by the participants when seeing a patient with CVS
The most frequent actions to be taken when seeing a patient with CVS were going directly to hospital in 86% followed by going to neurologist in 45.4% when close-ended question was asked. These results agreed with West Virginia study  as 94% go to hospital and 94% call 911; in Spain , 45% call emergency and 41%call GP; in Hong Kong , 49% call emergency and 29% go to hospital; in Australia , 67% call emergency and 23% go to hospital; in Ain Shams and Fayoum , 56.1% go to hospital followed by 32.1% contact a specialist physician; in Benin , 94.1% of subjects reported that they go to a hospital; in Pakistan , the response was to take individual to emergency department/hospital in 26.16% of participants; and in Oman , 73.0% of subjects reported that they would go immediately to a hospital emergency department.
In this study, call religious person and call herbalist were 14.7% and 8.5% respectively in comparison to 4.5% and 0.3% according to Ain Shams and Fayoum Universities . Approximately 1.1% of urban participants call religious person in comparison to 28.3% in rural participants. About 97.8% of urban participants preferred to go to the hospital within 4 h of CVS in comparison to 28.6% in rural participants. These results mostly reflect school educational level difference.