Burden of cognitive impairment and associated factors among Rheumatic heart disease patients at Jakaya Kikwete cardiac institute, Dar es salaam, Tanzania

Abstract

ABSTRACT Background: Globally rheumatic heart disease (RHD) affects an estimated thirty to seventy million people. Despite a drop in the incidence of RHD fatalities around the world, 90% of them still live in developing nations. The burden of RHD in Tanzania is around 1-3% of the population. In patients with RHD neuropsychiatric manifestation has been observed such as cognitive impairment (CI). However, there is a noticeable research gap concerning CI, in RHD patients, particularly in Tanzania. This study is aiming at addressing this gap. Objective: We aimed to determine the burden of CI and its associated factors among RHD patients at Jakaya Kikwete Cardiac Institute (JKCI), Tanzania. Methodology: Hospital-based cross-sectional study was conducted from November 2023 to February 2024 at the JKCI. A sample size of 216 RHD patients aged ≥ 14 years was provided with informed consent/assent. We excluded patients with mental illness before being diagnosed with RHD. Recruitment was done by a consecutive sampling technique. A face-to face interviewer-based questionnaire was used to obtain the socio-demographic and clinical characteristics of the study participants. The general practitioner assessment of cognition (GPCOG) tool is used to diagnose and assess the severity of CI. Data entry and cleaning were done using the REDcap tool, then data was analyzed using STATA version 15.1. Descriptive statistics was summarized using frequencies and proportions for categorical variables and a measure of central tendencies with respective measures of dispersion for numerical variables. Bivariable and multivariable logistic regression was used to assess associated factors of CI among patients with rheumatic heart disease. Ethical approval was sought from the MUHAS and JKCI Research and Ethics Committee. Results A total of 216 patients with a diagnosis of RHD were studied. Above three-quarters were outpatient, with a median age of 27 years, and female predominance (51.4%). More than half 123 (56.9%) participants attained a secondary level of education or higher, nearly two-thirds 127 (58.8%) were insured and less than half 88 (40.7%) were employed. In substance use, less than a quarter 12 (5.6%) were cigarette smokers but more than a quarter 61 (28.2%) were alcohol drinkers. Prevalence of cognitive impairment was 44 (20.4%); old age (aPR=1.04; 95% CI: 1.02-1.05, p<0.0001), positive HIV status (aPR= 5.00; 95%CI:1.85 13.53, p=0.02), undernutrition (aPR=2.44; 95%CI:39-4.29, p<0.002), History of atrial fibrillation (aPR=3.16; 95%CI:1.08-9.30, p=0.036), and history of stroke (aPR=2.58; 95%CI:1.43-4.68, p =0.002) were independently associated with CI. Conclusion and Recommendations: We recommend all patients with RHD to be screened for cognitive impairment, specifically in patients with atrial fibrillation, positive HIV status, old age, undernutrition, and stroke