Cognitive impairment and its associated factors among street homeless adults in Harar and Dire Dawa cities, Eastern Ethiopia, 2024: A community-based cross-sectional study

Abstract

Background: Cognitive health is a crucial but often neglected component of well-being for street homeless adults. Cognitive impairment can severely affect quality of life, autonomy, and independence, making it more difficult for street homeless adults to access social services and exit homelessness. Despite its importance, research on cognitive impairment among street homeless adults in Ethiopia is notably limited. Therefore, this study was conducted to address these gaps by evaluating the prevalence and factors associated with cognitive impairment among street homeless adults in Harar and Dire Dawa cities. Objective: The objective of this study was to assess the prevalence of cognitive impairment and its associated factors among street homeless adults in Harar and Dire Dawa cities, Eastern Ethiopia, 2024. Methods: A community-based cross-sectional study was conducted among 584 participants in Harar and Dire Dawa cities from April 24 to August 15, 2024. The participants were selected using a single-stage cluster sampling technique. Data were collected using a pretested, structured, interviewer-administered questionnaire. Data were entered using Epi info version 7.2, and analysis was conducted using SPSS version 25.0. Bivariate and multivariable logistic regression, odds ratios along with 95% confidence interval (CI) at a p-value of <0.05 was used to declare significant association of independent variable. Results: The prevalence of cognitive impairment was 70.4% (95% CI: 66.4-74.0). Significant associations were found between cognitive impairment and several factors, including being aged 55 years and above (AOR= 3.56, 95% CI:1.23, 11.33), no formal education (AOR= 2.65,95% CI:1.11,6.35), increased duration of homeless (AOR= 3.25, 95% CI:1.11, 9.46), history of traumatic brain injury (AOR= 2.26 95% CI: 1.12, 4.55), severe depression (AOR= 2.96, 95% CI: 1.25, 7.01), high risk of alcohol use (AOR= 2.35, 95% CI:1.02, 5.41) and high risk of cigarette use (AOR= 2.28, 95% CI:1.12, 4.65) Conclusion and Recommendation: More than half of street homeless adults have cognitive impairment. Older age, prolonged duration of homelessness, no formal viii education, severe depression, traumatic brain injury, high-risk alcohol use, and high-risk cigarette use were identified as associated factors among adult street homeless in Harar and Dire Dawa cities. Considering these determinants, screening, and providing appropriate interventions for cognitive impairment among street homeless adults should be of great concern.