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

Background: 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. Methods: 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). Results: We enrolled 117 participants with a median age of 68 years (inter-quartile 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). \ Conclusion: 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.