# Prevalence and associated factors of unilateral spatial neglect among patients with stroke at Mbarara Regional Referral Hospital, Uganda: a cross-sectional study

## TL;DR

This study found that more than half of stroke patients in Uganda had unilateral spatial neglect, with severe strokes and right-brain damage being key risk factors.

## Contribution

The study provides new prevalence data and risk factors for unilateral spatial neglect in stroke patients in a low-resource setting in Uganda.

## Key findings

- The prevalence of unilateral spatial neglect was 53.8% among stroke patients.
- Severe stroke, right-hemisphere lesions, and age ≥60 years were significantly associated with USN.
- USN was most common in the acute phase of stroke recovery.

## Abstract

Unilateral spatial neglect (USN) is a common neurocognitive deficit following stroke. It impairs rehabilitation and functional outcomes, particularly in low-resource settings where data are limited. This study determined the prevalence of USN and its associated factors among patients with stroke at Mbarara Regional Referral Hospital (MRRH), southwestern Uganda.

We conducted a cross-sectional study from August 12 to December 15, 2024. Patients with a recent stroke event within the preceding 0–4 months receiving care at MRRH were enrolled using consecutive sampling. Patients who were unable to see or were aged <18 years were excluded. USN was assessed using the Sunnybrook Neglect Assessment Procedure (SNAP): scores >5 indicating USN. Sociodemographic, clinical, and lifestyle factors were collected via structured questionnaires. Multivariable modified Poisson regression was used to identify factors associated with USN, reporting adjusted prevalence ratios (aPR) with 95% confidence intervals (CI).

We enrolled 117 participants with a median age of 68 years (interquartile range [IQR]: 56–78). Most were female (65.8%). The prevalence of USN was 53.8% (n=63; 95% CI: 44–63). USN was more prevalent in the acute phase (60%) compared to the subacute (32%) and chronic phases (8%). Factors significantly associated with USN included severe stroke (aPR=1.47, 95% CI: 1.12–1.92, p=0.005), right-hemisphere lesions (aPR=1.58, 95% CI: 1.14–2.19, p=0.006), age ≥60 years (aPR=1.66, 95% CI: 1.02–2.72, p=0.042), and right-handedness (aPR=0.94, 95% CI: 0.94–0.99, p<0.001). \

This study revealed a high prevalence of USN among patients with stroke at a referral hospital in southwestern Uganda. Stroke severity, right-hemisphere lesions, advanced age, and right-handedness were associated with USN. Targeted rehabilitation and early screening for patients with stroke with risk factors, particularly those with severe strokes or advanced age, could optimize recovery and improve long-term outcomes.