Abstract
<jats:p>Background: Stroke is a leading cause of premature mortality and disability in sub-Saharan Africa. Effective prevention depends on timely recognition of stroke symptoms and awareness of its risk factors. This study assessed stroke knowledge and its independent predictors among at-risk middle-aged adults in a semi-urban Nigerian community. Methods: A community-based cross-sectional study was conducted among 316 adults aged 40–65 years using interviewer-administered questionnaires. Stroke knowledge was defined as adequate recognition of both stroke symptoms and risk factors. Pearson's chi-square test and multivariable binary logistic regression were used to identify independent predictors of combined stroke knowledge. Results: Although 296 (93.7%) respondents were aware of stroke, only 112 (35.4%) demonstrated good combined knowledge of stroke symptoms and risk factors. Sudden weakness of face, arm, or leg was the most correctly identified symptom (78·6%), while sudden visual disturbance (34·1%) and severe headache (37·6%) were poorly recognized. Hypertension was the most identified risk factor (87·6%), but atrial fibrillation (32·9%), alcohol (51·4%), and diabetes (57·0%) were inadequately recognized. Good heart disease knowledge (aOR 3.09, 95% CI 1.82–5.28; p < 0.001) and a previous diagnosis of hypertension (aOR 2.32, 95% CI 1.14–4.71; p = 0.020) were independently associated with good combined stroke knowledge, whereas post-secondary education (aOR 0.37, 95% CI 0.15–0.93; p = 0.034) was inversely associated. Conclusion: Despite high stroke awareness, comprehensive knowledge of stroke symptoms and risk factors remains suboptimal among at-risk middle-aged adults. Integrating stroke education into existing cardiovascular prevention services may provide a practical strategy for improving stroke literacy in high-risk populations.</jats:p>