Physicians’ knowledge of transient ischaemic attack management in Nigeria: a national cross-sectional survey

Abstract

Transient ischaemic attack (TIA) represents a critical window for stroke prevention, yet physician knowledge and system readiness vary across healthcare settings. Evidence describing national patterns of TIA management knowledge among physicians in low- and middle-income countries remains limited. This national cross-sectional survey aims to evaluate Nigerian physicians’ knowledge of TIA diagnosis and management, identify factors associated with adequate knowledge, and explore perceived barriers to optimal TIA care. A nationwide descriptive cross-sectional survey was conducted among licensed medical doctors practicing in Nigeria using a structured online questionnaire. Knowledge of TIA presentation, investigations, and management was assessed using a composite scoring system categorized as poor, fair, or good. Descriptive statistics summarized participant characteristics and knowledge patterns. Bivariate analyses and multinomial logistic regression were performed to identify independent predictors of knowledge level. A total of 404 physicians participated. Overall, 38.1% demonstrated good knowledge of TIA management, while 40.6% had fair knowledge and 21.3% had poor knowledge. Most respondents correctly identified the high early risk of stroke following TIA (79.0%) and recommended urgent brain imaging (80.2%) and vascular imaging (76.5%). However, only 30.2% had received formal TIA training within the previous five years, and fewer than one-third reported the presence of local referral pathways. The most frequently reported barriers included patient-related factors (71.0%), limited access to urgent neuroimaging (61.4%), and lack of guideline-based protocols (38.9%). Multinomial logistic regression analysis demonstrated significant regional variation in knowledge levels, with lower odds of good knowledge observed outside the South-West region. While Nigerian physicians demonstrate moderate awareness of key TIA management principles, important gaps remain in guideline-based practice and system-level readiness. Targeted educational initiatives, improved access to neuroimaging, and development of structured referral pathways may enhance early stroke prevention efforts.