Background: Stroke prognosis is strongly dependent on early treatment, particularly thrombolysis, which is effective within the first 4.5 hours. Objective : To identify factors associated with delayed medical consultation (>3 hours after symptom onset) among stroke patients in Pointe-Noire. Methods: A prospective cross-sectional study was conducted from July to October 2024 at the General Hospital of Loandjili. All adult patients (≥18 years) with radiologically confirmed stroke were included. Demographic, clinical, and behavioral data were collected. Multivariate logistic regression was performed to identify associated factors. Results: Of 151 patients, 66.7% sought consultation after 3 hours. Factors independently associated with delayed consultation included: initial contact with a non-specialized medical provider (adjusted OR = 3.89, p = 0.026), nighttime symptom onset (adjusted OR = 2.84, p = 0.025), and living ≥ 5 km from the hospital (adjusted OR = 3.97, p = 0.002). Protective factors included dizziness (adjusted OR = 0.36, p = 0.044) and going directly to the hospital (adjusted OR = 0.39, p = 0.040). Conclusion: Delayed consultation remains a serious concern and is influenced by geographic, temporal, and behavioral factors. Public awareness campaigns, improved emergency systems, and decentralized care networks are essential to reduce these delays.
KeywordsStrokeDelayed ConsultationPointe-NoireRepublic of the Congo
Feigin, V.L., Brainin, M., Norrving, B., Martins, S.O., Pandian, J., Lindsay, P., et al . (2025) World Stroke Organization: Global Stroke Fact Sheet 2025. International Journal of Stroke , 20, 132-144. https://doi.org/10.1177/17474930241308142
Orellana-Urzúa, S., Rojas, I., Líbano, L. and Rodrigo, R. (2020) Pathophysiology of Ischemic Stroke: Role of Oxidative Stress. Current Pharmaceutical Design , 26, 4246-4260. https://doi.org/10.2174/1381612826666200708133912
Béjot, Y., Touzé, E., Jacquin, A., Giroud, M. and Mas, J. (2009) Épidémiologie des accidents vasculaires cérébraux. Médecine / Sciences , 25, 727-732. https://doi.org/10.1051/medsci/2009258-9727
Goyal, M. and Ospel, J. (2020) Challenges to Stroke Care 5 Years after Endovascular Therapy Became the Standard. The Lancet Neurology , 19, 210-211. https://doi.org/10.1016/s1474-4422(20)30005-3
Johnson, M. and Bakas, T. (2010) A Review of Barriers to Thrombolytic Therapy: Implications for Nursing Care in the Emergency Department. Journal of Neuroscience Nursing , 42, 88-94. https://doi.org/10.1097/jnn.0b013e3181ce5a48
Le, S.M., Copeland, L.A., Zeber, J.E., Benge, J.F., Allen, L., Cho, J., et al . (2020) Factors Affecting Time between Symptom Onset and Emergency Department Arrival in Stroke Patients. eNeurologicalSci , 21, Article 100285. https://doi.org/10.1016/j.ensci.2020.100285
Rossnagel, K., Jungehülsing, G.J., Nolte, C.H., Müller-Nordhorn, J., Roll, S., Wegscheider, K., et al . (2004) Out-of-Hospital Delays in Patients with Acute Stroke. Annals of Emergency Medicine , 44, 476-483. https://doi.org/10.1016/j.annemergmed.2004.06.019
Yu, R.F., San Jose, M.C.Z., Manzanilla, B.M., Oris, M.Y. and Gan, R. (2002) Sources and Reasons for Delays in the Care of Acute Stroke Patients. Journal of the Neurological Sciences , 199, 49-54. https://doi.org/10.1016/s0022-510x(02)00103-x
Wester, P., Rådberg, J., Lundgren, B. and Peltonen, M. (1999) Factors Associated with Delayed Admission to Hospital and In-Hospital Delays in Acute Stroke and TIA: A Prospective, Multicenter Study. Stroke , 30, 40-48. https://doi.org/10.1161/01.str.30.1.40
Yakubu, H.A., Marfo, R.O., Boakye-Yiadom, J., Aidoo, F.M., Sarfo, F.S. and Oteng, R.A. (2025) Time Delays in Emergency Stroke Care in a Low-Resource Referral Hospital in Ghana. African Journal of Emergency Medicine , 15, Article 100882. https://doi.org/10.1016/j.afjem.2025.05.006
Yanagida, T., Fujimoto, S., Inoue, T. and Suzuki, S. (2015) Prehospital Delay and Stroke-Related Symptoms. Internal Medicine , 54, 171-177. https://doi.org/10.2169/internalmedicine.54.2684
Zhu, Y., Zhang, X., You, S., Cao, X., Wang, X., Gong, W., et al . (2020) Factors Associated with Pre-Hospital Delay and Intravenous Thrombolysis in China. Journal of Stroke and Cerebrovascular Diseases , 29, Article 104897. https://doi.org/10.1016/j.jstrokecerebrovasdis.2020.104897
Mellor, R.M., Bailey, S., Sheppard, J., Carr, P., Quinn, T., Boyal, A., et al . (2015) Decisions and Delays within Stroke Patients’ Route to the Hospital: A Qualitative Study. Annals of Emergency Medicine , 65, 279-287.e3. https://doi.org/10.1016/j.annemergmed.2014.10.018
Sharobeam, A., Jones, B., Walton-Sonda, D. and Lueck, C.J. (2020) Factors Delaying Intravenous Thrombolytic Therapy in Acute Ischaemic Stroke: A Systematic Review of the Literature. Journal of Neurology , 268, 2723-2734. https://doi.org/10.1007/s00415-020-09803-6
Evenson, K.R., Rosamond, W.D. and Morris, D.L. (2001) Prehospital and In-Hospital Delays in Acute Stroke Care. Neuroepidemiology , 20, 65-76. https://doi.org/10.1159/000054763
Kazadi Kabanda, I., Kiangebeni Ngonzo, C., Emeka Bowamou, C., Divengi Nzambi, J., Kiatoko Ponte, N., Tuyinama Madoda, O., et al . (2024) Stroke Signs Knowledge and Factors Associated with a Delayed Hospital Arrival of Patients with Acute Stroke in Kinshasa. Heliyon , 10, e28311. https://doi.org/10.1016/j.heliyon.2024.e28311 https://www.cell.com/heliyon/abstract/S2405-8440(24)04342-1
Kakame, K.T., Nakibuuka, J., Mukiza, N., Andia-Biraro, I., Kaddumukasa, M., Burant, C., et al . (2023) Prevalence and Factors Associated with Pre-Hospital Delay among Acute Stroke Patients at Mulago and Kiruddu National Referral Hospitals, Kampala: A Cross-Sectional Study. BMC Neurology , 23, Article No. 381. https://doi.org/10.1186/s12883-023-03413-1
Nyangui Mapaga, J., Gnigone, P.M., Mambila Matsalou, G.A., Mboumba Mboumba, C.F., Ndao Eteno, M., Sabrina, M.K., et al . (2025) Délai d’admission des patients victimes d’accidents vasculaires cérébraux ischémiques à l’unité neurovasculaire du centre hospitalier universitaire de Libreville: Un obstacle à la thrombolyse intraveineuse des infarctus cérébraux. Revue Neurologique , 181, S84. https://doi.org/10.1016/j.neurol.2025.01.164
Jin, H., Zhu, S., Wei, J.W., Wang, J., Liu, M., Wu, Y., et al . (2012) Factors Associated with Prehospital Delays in the Presentation of Acute Stroke in Urban China. Stroke , 43, 362-370. https://doi.org/10.1161/strokeaha.111.623512
Maestroni, A., Mandelli, C., Manganaro, D., Zecca, B., Rossi, P., Monzani, V., et al . (2008) Factors Influencing Delay in Presentation for Acute Stroke in an Emergency Department in Milan, Italy. Emergency Medicine Journal , 25, 340-345. https://doi.org/10.1136/emj.2007.048389
Sim, J., Shin, C., An, K. and Todd, M. (2016) Factors Associated with the Hospital Arrival Time in Patients with Ischemic Stroke in Korea. Journal of Cardiovascular Nursing , 31, E10-E16. https://doi.org/10.1097/jcn.0000000000000313
Moser, D.K., Kimble, L.P., Alberts, M.J., Alonzo, A., Croft, J.B., Dracup, K., et al . (2007) Reducing Delay in Seeking Treatment by Patients with Acute Coronary Syndrome and Stroke: A Scientific Statement from the American Heart Association Council on Cardiovascular Nursing and Stroke Council. Journal of Cardiovascular Nursing , 22, 326-343. https://doi.org/10.1097/01.jcn.0000278963.28619.4a
Pancioli, A.M., Broderick, J., Kothari, R., Brott, T., Tuchfarber, A., Miller, R., Khoury, J. and Jauch, E. (1998) Public Perception of Stroke Warning Signs and Knowledge of Potential Risk Factors. JAMA , 279, 1288-1292. https://doi.org/10.1001/jama.279.16.1288
Ganeti, D.D., Dulo, A.O., Ilala, B.W., Benti, N.B., Diriba, M., Abdulwehab, S., et al . (2025) Prehospital Delay and Associated Factors among Stroke Patients in Africa: A Systematic Review and Meta-analysis. PLOS One , 20, e0326323. https://doi.org/10.1371/journal.pone.0326323
Fladt, J., Meier, N., Thilemann, S., Polymeris, A., Traenka, C., Seiffge, D.J., et al . (2019) Reasons for Prehospital Delay in Acute Ischemic Stroke. Journal of the American Heart Association , 8, e013101. https://doi.org/10.1161/jaha.119.013101
Revathi, S., Kavitha, M. and Shankar, V. (2022) Factors Associated with Prehospital Delay in Patients with Acute Stroke in South India. Indian Journal of Community Medicine , 48, 82-90. https://doi.org/10.4103/ijcm.ijcm_213_22
Fogelholm, R., Murros, K., Rissanen, A. and Ilmavirta, M. (1996) Factors Delaying Hospital Admission after Acute Stroke. Stroke , 27, 398-400. https://doi.org/10.1161/01.str.27.3.398
Urimubenshi, G., Cadilhac, D.A., Kagwiza, J.N., Wu, O. and Langhorne, P. (2018) Stroke Care in Africa: A Systematic Review of the Literature. International Journal of Stroke , 13, 797-805. https://doi.org/10.1177/1747493018772747