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BMC Psychiatry

, 20:21 | Cite as

Factors affecting current khat chewing among male adults 15–59 years in Ethiopia, 2016: a multi-level analysis from Ethiopian Demographic Health Survey

  • Temesgen Yihunie Akalu
  • Adhanom Gebreegziabher BarakiEmail author
  • Haileab Fekadu Wolde
  • Ayenew Molla Lakew
  • Kedir Abdela Gonete
Open Access
Research article
Part of the following topical collections:
  1. Substance-related disorders, addiction and impulse control

Abstract

Background

Regular khat chewing causes gingivitis, tooth loss, gastric disorders, cardiac complications, male impotence, sleeplessness, and several mental health problems. Based on the Ethiopian Demographic and Health Survey (EDHS) 2016, 12% of women and 27% of men have reported having ever chewed khat. Even though khat addiction is a major public health problem, studies that consider both individual level and community level factors are limited. Therefore, this study aimed to determine the prevalence and factors affecting current khat chewing among male adults in Ethiopia.

Methods

Data from EDHS, a community-based cross-sectional study conducted from January 18, 2016, to June 27, 2016, was used. A multistage stratified cluster sampling technique was used to select participants. Both descriptive and analytical statistics were done. Bi-variable and multivariable multilevel logistic regression analyses were performed to determine factors affecting current khat chewing. Adjusted Odds ratio (AOR) with 95% Confidence Interval (CI) for variables with P-value < 0.05 was used as a measure of association.

Result

A total of 12,595 male adults were included. The prevalence of current khat chewing was 23.61% (95% CI: 22.87, 24.36). Age 20–24 years; (AOR = 2.68, 95% CI: 2.02, 3.56), being uneducated (AOR = 1.62, 95% CI: 1.10, 2.39), professional/technical/managerial job (AOR = 3.59, 95% CI: 2.18, 5.91), Muslim religion (AOR = 18.30, 95% CI: 13.54, 24.74), poorest wealth index (AOR = 0.67, 95% CI: 0.51, 0.89), being divorced (AOR = 0.38, 95% CI: 0.21, 0.69), history of alcohol drinking in the last 30 days (AOR = 2.15, 95% CI: 1.69, 2.73), and history of cigarette smoking in the last 30 days (AOR = 14.92, 95% CI: 10.88, 20.47), and Amhara region (AOR = 0.07, 95% CI: 0.04, 0.14) were significantly associated with khat chewing.

Conclusion

Khat chewing remains high in Ethiopia with certain regional variations. The uneducated, older age, Alcohol and cigarette users, Muslims, and professional workers were at higher risk of khat chewing whereas the poorest wealth index and being divorced reduced its risk. Policymakers should consider a multi-faceted policy approach that accounts for regional variation and the identified risk factors to alleviate the problem.

Keywords

Khat Ethiopia EDHS Multilevel 

Background

Khat, native to Ethiopia, and the southern Arabian Peninsula is an evergreen shrub cultivated as a bush or small tree [1]. Its young buds and tender leaves (the main utilized part) contain amphetamine-like psychoactive substances, which produce euphoria and stimulation [2]. People chew khat for a variety of reasons, these include entertainment, as part of social events, to spend time, as a culture and some also use it to stay active when studying [3].

Regular khat chewing: causes gingivitis, tooth loss, gastric disorders, cardiac complications, male impotence, sleeplessness, and several mental health problems [4, 5, 6, 7]. A study from Ethiopia suggests that khat chewing resulted in poor lung function and oxygen saturation [8], risky sexual behavior [9, 10], and psychosis [11]. In addition, concurrent use of khat with alcohol and cigarette smoking was highly associated with sleep disturbance [12].

High prevalence of khat chewing has been recorded in Yemen and the Jazan region of Saudi Arabia. According to global synthetic drug assessment in 2014, the prevalence of khat chewing among people aged 16 and above in Yemen was 52% [13]. In the last several years, khat has been increasingly transported from East Africa including (Ethiopia, Kenya, and Uganda) and the Arabian Peninsula (Yemen) to other regions [14]. A large amount of khat is smuggled from Ethiopia and Kenya to the United Kingdom and the Netherlands by plane, where until recently it has not been under national control in either of the countries [15].

Based on the Ethiopian Demographic and Health Survey (EDHS) 2016, 12% of women and 27% of men report having ever chewed khat [16]. Khat consumption increases with age and peaks at age 30–34 among both women (15%) and men (34%) [17].

The major predisposing factors for khat chewing include; family member who had history of khat chewing [18, 19], need of concentration and relaxation [13, 20], smoking cigarette, alcohol drinking [6, 21], religious practice [13, 22], economical status [5], peer pressure [5, 19, 23], place of residence [19], and increased workload [22].

Globally, in different countries khat and its consumption has been regulated by the Government [24]. In Ethiopia, especially in the Amhara region, the regional government imposed policy and increased taxation. But the problem remains high and evidence that shows the determinants of khat chewing especially that entertain both individual level and community level factors are limited. Multilevel models can be used to draw individual-level inferences, but inferences can also be made regarding group-to-group variation, including whether it exists in the data, and the extent to which it is accounted for by group and individual-level characteristics [25]. Therefore, this study was aimed to assess the predisposing factors of khat chewing among male adults in Ethiopia.

Methods

Study design and setting

Data from EDHS 2016 was used. EDHS 2016 is a community-based cross-sectional study conducted from January 18, 2016, to June 27, 2016. Ethiopia is situated in the Horn of Africa between 3 and 15 degrees north latitude and 33 and 48 degrees east longitude. Administratively Ethiopia has nine regional states. Namely: Tigray, Afar, Amhara, Oromia, Somali, Benishangul-Gumuz, Southern Nations Nationalities and peoples Region (SNNPR), Gambella, and Harari. In addition, it has two city administrations, Addis Ababa and Dire-Dawa. More than 82% of the country’s total population lives in the regional states of Amhara, Oromia, and SNNPR [11].

Population, sample size, and sampling technique

All men from 15 to 59 years in Ethiopia were the source population. Whereas, all men age 15–59 years in the selected enumeration areas (EAs) were the study population. All men age 15–59 who were the members of the selected households and those who spent the night before the survey in the selected households were included in the study.

The 2016 EDHS used a two-stage stratified cluster sampling technique with regions and residence as strata were used. Primarily, all nine regions were stratified into urban and rural clusters. A total of 654 EAs (202 urban and 443 rural clusters) were selected proportional to EA size. In the second stage of selection, a fixed number of 28 households per cluster were selected from the newly updated listing of households. Altogether, 16,650 households and 12,688 men aged 15–59 years were interviewed in the survey.

Study variables

Current khat chewing status, the outcome variable in this study was defined khat chewing within 30 days prior to the data collection period. The independent variables were grossly classified into socio-demographic and economic factors: age, religion, marital status, educational status, place of residence, region, and behavioral factors: alcohol drinking and smoking, and source of information: reading news-paper, reading magazines, and watching television.

Wealth ranking was grossly categorized into 5 major quintiles based on household assets as lowest (poorest), second (poorer), middle (middle), fourth (richer), and highest (richest). Substance use: was defined as the use of one or more of the substance like khat, Alcohol, using any type of tobacco (shisha or Gaya).

Data collection tool and procedure

The data was taken from EDHS which is collected by trained data collectors using standardized, structured, and pre-tested questionnaires. The questionnaire, based on the DHS Program’s standard Demographic and Health Survey questionnaires, were adapted to reflect the population and health issues relevant to Ethiopia. The input was solicited from various stakeholders representing government ministries and agencies, nongovernmental organizations, and international donors. After all, questionnaires were finalized in English, they were translated into local languages. Raw data collected from all part of the country on Men whose age was between 15 and 59 were extracted for the analysis.

Data processing and analysis

STATA version 14 was used for data analysis. Both descriptive and analytical analysis was done and presented using tables and texts. Bi-variable and multivariable multi-level logistic regressions were performed to determine the existing association among individual and community factors. Initially, a bi-variable analysis was performed and variables with a p-value of less than 0.2 were used for further analysis in the multivariable multilevel logistic regression. At the same time, Crude Odds Ratio (COR) and Adjusted Odds Ratio (AOR) with their corresponding confidence intervals (CI) were determined for the bi-variate and multi-variable analysis, respectively. The presence or absence of multi-collinearity was checked using the Variance Inflation Factor (VIF). Finally, p-value < 0.05 was used to declare the significance of association in the multi-variable model. The need for multi-level multivariable analysis which considers community-level factors was tested using the intra-class correlation coefficient (ICC) and models were compared using the deviance tests. The model with the lowest deviance was selected as the best-fitted model. In addition, sensitivity and specificity tests were checked. The presence and absence of univariate and multivariate outliers were checked.

Result

Baseline characteristics of study participants

A total of 12,595 participants were included in the study. The mean age of the respondents was 30.7 (SD = 11.5). One-fifths, 2572 (20.4%) of participants were in the age of 15–19 years. The majority of the participants, 10,099 (80.2%) were from rural and 5876 (46.7%) had primary education. More than half, 6968 (55.3%), of participants, were married (Table 1).
Table 1

Socio-demographic and behavioral factors of adult men 15–59 years in Ethiopia

Variable

Frequency

Percentage

Age in 5 year groups

 15–19

2572

20.4

 20–24

1880

14.9

 25–29

1975

15.7

 30–34

1614

12.8

 35–39

1371

10.9

 40–44

1188

9.4

 45–49

933

6.4

 50–54

575

4.6

 55–59

487

3.9

Residence

 Urban

2496

19.8

 Rural

10,099

80.2

Usual resident or visitor

 Usual resident

12,316

97.78

 Visitor

279

2.22

Region

 Tigray

795

6.3

 Afar

82

0.65

 Amhara

3206

25.5

 Oromia

4714

37.43

 Somali

326

2.6

 Benishangul

123

0.98

 SNNPR

2586

20.5

 Gambella

37

0.29

 Harari

31

0.25

 Dire-Dawa

72

0.57

 Addis Ababa

621

4.9

Educational level

 No education

3773

29.96

 Primary education

5876

46.7

 Secondary education

1846

14.7

 Higher education

1099

8.7

Occupation

 Not working

944

9.5

 Professional/technical/managerial

630

5

 Clerical

97

0.8

 Sales

677

5.4

 Agriculture – employee

8336

66.2

 Services

210

1.7

 Skilled manual

824

6.5

 Unskilled manual

279

2.2

 Others

598

4.8

Religion

  

 Orthodox

5677

45.1

 Catholic

90

0.7

 Protestant

2745

21.8

 Muslin

3916

31.1

 Traditional + other

166

1.3

Sex of household head

 Male

11,034

87.6

 Female

1561

12.4

Wealth Index

 Poorest

1979

15.7

 Poorer

2294

18.2

 Middle

2427

19.3

 Richer

2712

21.5

 Richest

3183

25.3

Current marital status

 Never in union

4890

38.8

 Married

6968

55.3

 Living with partner

421

3.3

 Widowed

44

0.4

 Divorced

226

1.8

 No longer living together/separated

46

0.4

Media Exposure

 Yes

8154

64.7

 No

4441

35.3

Alcohol drinking in the last 30 days

 Yes

5428

43.1

 No

7167

56.9

Smoking cigarette in the last 30 days

 Yes

655

5.2

 No

11,940

94.8

Prevalence of current khat chewing

A total number of 2974 participants chewed khat in the last 30 days prior to the survey. This makes the prevalence of current khat chewing 23.61% (95% CI: 22.87, 24.36).

The multilevel mixed-effects binary logistic regression model

The need for the multilevel model was confirmed by ICC of 66% with 95% CI (61.8, 70%). We have also compared the four models (Null model, Individual-level, community level and a model with both individual and community-level factors) and we have found the last model with the lowest deviance to be the best-fitted model (Table 2).
Table 2

Model comparison for identifying factors affecting khat chewing among male adults 15–59 years in Ethiopia, 2016

Model

Deviance

Model I (Null Model)

3869.58

Model II (individual level factors)

2944.39

Model III (community-level factors)

3745.34

Model IV (both individual and community-level factors)

2858.58

Factors affecting current khat chewing among male adults in Ethiopia

In the bi-variable multilevel logistic regression analysis; age, sex of household head, residence, educational status, occupation, religion, wealth Index, current marital status, alcohol drinking history in the last 30 days, cigarette smoking history in the last 30 days, and region were associated factors with khat chewing with a p-value < 0.2. In the multivariable analysis Age, educational status, occupation, religion, wealth index, current marital status, alcohol drinking history in the last 30 days, cigarette smoking history in the last 30 days, and region were significantly associated with current khat chewing at a p-value < 0.05.

The odds of khat chewing among older adults were higher than that of teenagers aged between 15 and 19 years. When compared to adults who had higher educational status those who had no education (AOR = 1.62, 95% CI: 1.10, 2.39) and primary education (AOR = 1.85, 95% CI: .30, 2.62) had higher odds of chewing khat. When compared to participants who have no job those with jobs have higher odds of Khat chewing. Muslim study participants had higher odds of chat chewing (AOR = 18.30, 95% CI: 13.54, 24.74) when compared to Orthodox Christians whereas Catholics (AOR = 0.16, 95% CI: 0.05, 0.48) and Protestants (AOR = 0.20, 95% CI: 0.13, 0.31) had lower odds of khat chewing. Participants who have poorer wealth index had 33% lower odds of Khat chewing (AOR = 0.67, 95% CI: 0.51, 0.89) when compared to the poorest. The odds of being current khat chewer among divorced men were reduced by 62% (AOR = 0.38, 95% CI: 0.21, 0.69) as compared to singles. Participants who drink alcohol in the last 30 days had 2.15 (AOR = 2.15, 95% CI: 1.69, 2.73) times higher odds of being current khat chewer than their counterparts likewise those who smoke cigarette in the last 30 days had 14.92 (AOR = 14.92, 95% CI: 10.88, 20.47) times higher odds of being current khat chewer than those who do not. The odds of khat chewing had also a significant difference among regions of Ethiopia (Table 3).
Table 3

Multivariable logistic regression analysis among adult males in Ethiopia, 2016

Variable

Khat chewing

COR(95% CI)

AOR(95% CI)

AOR(95% CI)

Yes

No

Individual-level factors

Age

 15–19

331

2241

1.00

1.00

1.00

 20–24

394

1486

3.0 (2.35, 3.83)

2.66 (2.00, 3.52)

2.68 (2.02, 3.56)*

 25–29

577

1398

6.11 (4.84, 7.72)

6.27 (4.58, 8.59)

6.24 (4.55, 8.56)*

 30–34

500

1114

6.72 (5.26, 8.57)

6.74 (4.75, 9.56)

6.59 (4.64, 9.36)*

 35–39

375

996

5.77 (4.43, 7.51)

5.19 (3.56, 7.57)

4.92 (3.37, 7.18)*

 40–44

317

871

5.94 (4.57, 7.73)

5.05 (3.45, 7.42)

4.99 (3.40, 7.34)*

 45–49

222

711

4.01 (2.98, 5.39)

2.91 (1.92, 4.39)

2.89 (1.91, 4.37)*

 50–54

141

434

4.60 (3.25, 6.49)

3.91 (2.45, 6.24)

3.81 (2.38, 6.10)*

 55–59

116

371

4.49 (3.15, 6.40)

4.74 (2.94, 7.65)

4.66 (2.89, 7.57)*

Educational level

 No education

1078

2695

2.09 (1.59, 2.75)

1.43 (0.97, 2.11)

1.62 (1.10, 2.39)*

 Primary education

1419

4457

1.39 (1.09, 1.79)

1.72 (1.21, 2.43)

1.85 (1.30, 2.62)*

 Secondary education

302

1544

0.95 (0.74, 1.24)

1.28 (0.91, 1.18)

1.32 (0.94, 1.87)

 Higher education

176

923

1.00

1.00

1.00

Occupation

 Not working

86

858

1.00

1.00

1.00

 Professional/technical/managerial

114

517

5.54 (3.74, 8.19)

3.44 (2.10, 5.65)

3.59 (2.18, 5.91)*

 Clerical

17

80

7.09 (3.54, 14.19)

8.21 (3.59, 18.77)

8.49(3.68, 19.55)*

 Sales

152

525

5.20 (3.55, 7.60)

2.47 (1.58, 3.86)

2.53 (1.61, 3.97)*

 Agriculture – employee

2168

6168

4.66 (3.43, 6.34)

2.50 (1.74, 3.59)

2.57 (1.78, 3.72)*

 Services

48

162

6.17 (3.68, 10.33)

3.23 (1.74, 5.98)

3.16 (1.70, 5.89)*

 Skilled manual

205

619

9.92 (6.88, 14.32)

5.48 (3.57, 8.40)

5.68 (3.68, 8.76)*

 Unskilled manual

52

227

5.27 (3.14, 8.83)

3.75(2.02, 6.98)

4.01 (2.14, 7.54)*

 Others

132

466

5.11 (3.40, 7.68)

3.69 (2.31, 5.89)

3.70 (2.30, 5.96)*

Religion

 Orthodox

325

5352

1.00

1.00

1.00

 Catholic

11

79

0.15 (0.06, 0.38)

0.19 (0.06, 0.60)

0.16 (0.05, 0.48)*

 Protestant

98

2648

0.13 (0.09, 0.19)

0.26 (0.17, 0.40)

0.2 (0.13, 0.31)*

 Muslin

2505

1411

8.78 (7.04, 10.94)

21.59 (16.00, 9.19)

18.30 (13.54, 4.74)*

 Traditional+other

37

129

0.50 (0.06, 0.09)

0.60 (0.20, 1.85)

0.43 (0.14, 1.31)

Sex of household head

 Male

2658

8376

1.56 (1.30, 1.88)

1.01 (0.81, 1.27)

1.03 (0.82, 1.30)

 Female

317

1244

1.00

1.00

 

Wealth Index

 Poorest

621

1358

1.00

1.00

1.00

 Poorer

660

1634

0.64 (0.50, 0.81)

0.71(0.54, 0.93)

0.67(0.51, 0.89)*

 Middle

616

1811

0.69(0.54, 0.88)

0.84(0.63, 1.12)

0.80(0.60, 1.08)

 Richer

495

2217

0.56(0.43, 0.72)

0.81(0.60, 1.10)

0.76(0.56, 1.03)

 Richest

582

2600

0.74(0.55, 1.00)

1.18(0.83, 1.68)

0.94(0.63, 1.39)

Current marital status

 Never in union

854

4036

1.00

1.00

1.00

 Married

1814

5154

2.40 (2.09, 2.75)

0.81 (0.63, 1.04)

0.83 (0.64, 1.06)

 Living with partner

245

176

2.98 (1.89, 4.70)

1.44 (0.83, 2.50)

1.27 (0.74, 2.19)

 Widowed

12

32

4.69 (1.75, 12.58)

1.20 (0.36, 4.020

1.17 (0.34, 3.94)

 Divorced

36

189

1.29 (0.76, 2.19)

0.35 (0.19, 0.65)

0.38 (0.21, 0.69)*

 No longer living together/separated

13

33

3.17 (1.27, 7.88)

1.86 (0.64, 5.37)

1.88 (0.62, 5.65)

Alcohol drinking in the last 30 days

 Yes

478

4949

1.12(0.95, 1.33)

1.91(1.50, 2.43)

2.15(1.69, 2.73)*

 No

2496

4671

1.00

1.00

1.00

Smoking cigarette in the last 30 days

 Yes

526

129

21.62 (16.01, 29.18)

16.87 (12.30, 23.14)

10.79 (8.61,13.51)*

 No

2449

9491

1.00

1.00

1.00

Community-level factors

Residence

 Urban

482

2014

2.13(1.31, 3.45)

1.01(0.58, 1.75)

1.17(0.66, 2.07)

 Rural

2493

7606

1.00

  

Region

 Oromia

1875

2839

1.00

1.00

1.00

 Tigray

19

776

0.01 (0.01,0.03)

0.01 (0.01,0.03)

0.03 (0.01, 0.07)*

 Afar

28

54

0.93 (0.35, 2.45)

0.93 (0.35, 2.45)

0.28 (0.11, 0.68)*

 Amhara

304

2902

0.04 (0.02, 0.09)

0.04 (0.02, 0.09)

0.07 (0.04, 0.14)*

 Somali

142

184

1.60 (0.76, 3.39)

1.60 (0.76, 3.39)

0.36 (0.18, 0.70)*

 Benishangul

22

102

0.26 (0.10, 0.68)

0.26 (0.10, 0.68)

0.14 (0.06, 0.35)*

 SNNPR

392

2194

0.10 (0.05, 0.21)

0.10 (0.05, 0.21)

0.53 (0.29, 0.99)*

 Gambella

8

29

0.30 (0.08, 1.10)

0.30 (0.08, 1.11)

0.78 (0.21, 2.94)

 Harari

23

8

11.04 (3.11,39.16)

10.99 (3.02, 40.00)

6.97 (1.91, 25.43)*

 Addis Ababa

118

503

0.41 (0.19, 0.87)

0.41(0.17, 0.99)

0.30 (0.14, 0.66)*

 Dire Dawa

45

27

4.65 (1.74, 12.37)

4.62 (1.64, 13.02)

2.77 (1.05, 7.30)*

* P-value < 0.05

Discussion

The study determined the prevalence of current khat chewing status and factors affecting it among male adults of Ethiopia. A range of different socio-demographic and economic factors affecting current khat chewing was identified, these include Older age, being uneducated, Muslim religion follower, poorest wealth index, being divorce, history of alcohol drinking for the last 30 days, history of cigarette smoking for the last 1 month, and regions of Harari and Dire Dawa had statistically significant association with khat chewing.

Older people had higher odds of being a khat chewer as compared to teenagers. This finding is in line with other studies conducted in different institutions in Ethiopia [1, 2] and a community-based study on EDHS 2011 [26]. The possible reason could be young people tend to be under family control which reduces their risk of exposure. As a result, their probability of chewing will be less.

Lower educational status was found to be a significant independent predictor of current khat chewing. This finding is in contrast with a study conducted in Butajira, Ethiopia [13]. But, the current study was in agreement with a study conducted from the Jazan region, Saudi Arabia, which showed that illiterates were at higher odds of chewing khat [23]. The reason could be uneducated men would have a lack of information on the negative consequences of khat on their health [27]. Therefore, they would continue khat chewing.

The type of occupation was associated with khat chewing. Accordingly, professionals, clerical, sales, agricultural, service, skilled manual, and unskilled manual workers were at higher odds of being khat chewer. This finding is in line with a study conducted in Ethiopia [26]. This could be due to the fact that jobless individuals cannot afford to buy khat and also they have relatively less work which will stress them so as to need such stimulants.

In this study, Muslims were at higher risk of being khat chewer when compared to Orthodox Christians whereas being Catholic and Protestant was found to decrease the odds of chewing khat. This finding is in line with other studies from Ethiopia [1, 12, 13, 28]. This could be traditionally Muslim religious followers have good acceptance to gain maximum concentration while doing their work and prayer [27, 29].

The odds of khat chewing among poor people were reduced by 33% compared to those with the poorest wealth index. This finding is in agreement with a community-based study from EDHS 2011 [26]. This could be because the poorest people could not even afford basic necessities like food and unable to cover the expense of khat [30].

Divorced men were associated with lower odds of Khat chewing than their single counterparts. This finding is in contrast with a study conducted in Ethiopia [26]. The lower odds of khat chewing among divorced people could be their tendency to modify their lifestyle after divorce as this khat chewing could be also a reason for the divorce. Single individuals usually are also young people who are under family control.

In this study, alcohol drinking is associated with an increased risk of khat chewing as compared to their counterparts. This result is consistent with a systematic review and meta-analysis [31]. A similar association was found from the study conducted in Butajira [13], Saudi Arabia [6], and Uganda [32]. This could be due to the fact that khat chewing causes sleep disturbance [33] as a result, chewers would use alcohol for better sleep. However, different studies showed concurrent use of khat, cigarette, and alcohol would result in sleep deprivation [32, 34, 35]. Therefore, giving due attention is needed to minimize the concurrent effect of khat, alcohol, and cigarette smoking.

Community-level factors of khat chewing were also determined and the region was significantly associated with khat chewing. Men living in the regions of Harari and Dire Dawa were at higher odds of khat chewing. This finding is in line with a study conducted in Ethiopia [26]. This due to the cultural difference across the regions and especially khat chewing in the Eastern part of Ethiopia is culturally acceptable and is considered as a good practice.

This study has a significant implication for the public and policymakers. Khat chewing in the community could affect social life [24], the economy [27], and result in poor health outcomes [35, 36, 37, 38]. Currently, in Ethiopia farmers in the rural area are expanding the cultivation of khat and the landmass covered by cereals and fruits is decreasing from time to time. However, the negative effect of khat on health outweighs the income earned from khat production and sale. In addition, khat chewers are prone to poor appetite and resulted in malnutrition. Khat chewing is also a growing concern among Ethiopian universities [39] associated with low academic performance in Ethiopian students [40, 41, 42]. Khat chewing contributes to the high burden of non-communicable diseases like cardiovascular disorders [43, 44]. Khat increases the concurrent use of cigarettes and increases risky sexual behavior [9] which further increases the burden of the Human Immune Deficiency Virus (HIV). Khat mainly affects the productive population of a country like university students, youths, and employers this will affect the country’s economy at large in the long run. Therefore, policymakers should design strategies on khat sale and production including high taxation or banning to minimize the burden.

Limitations

Since the study was cross-sectional it does not show the temporal relationship between the outcome status and the risk factors. Important variables like peer pressure and perceptions/attitude on benefit, consequence, duration of chewing, dosage and frequency were not addressed in this study. So, the long term implications of khat were not studied in this study. However, the authors tried to determine the causes of khat chewing in Ethiopia among the men population.

Conclusion

Older age, being uneducated, Muslim religion follower, poorest wealth index, being divorce, history of alcohol drinking for the last 30 days, history of cigarette smoking for the last 1 month, and regions of Harari and Dire Dawa had a statistically significant association with khat chewing. Therefore, to effectively control khat chewing among the diverse communities in Ethiopia, policymakers should consider a multi-faceted policy approach that accounts for regional variation, the local social contexts, as well as the complementary nature of smoking and khat chewing practices.

Notes

Acknowledgments

The authors forward their gratitude to DHS for providing the data.

Authors’ contributions

Conceptualization: TYA, AGB, KAG, HFW, and AML. Data curator: TYA, AGB, KAG, HFW, and AML. Formal analysis: TYA, AGB, KAG, HFW, and AML. Investigation: TYA, AGB, KAG, HFW, and AML. Methodology: TYA, AGB, KAG, HFW, and AML. Resources: TYA, AGB, KAG, HFW, and AML. Software: TYA, AGB, KAG, HFW, and AML. Validation: TYA, AGB, KAG, HFW, and AML. Visualization: TYA, AGB, KAG, HFW, and AML. Writing – original draft: TYA, AGB, KAG, HFW, and AML. Writing – review & editing: TYA, AGB, KAG, HFW, and AML. Finally, all authors have read and approved the manuscript.

Funding

No funding was obtained for this study.

Ethics approval and consent to participate

Permission to use the EDHS data was obtained from the Measure DHS international program. The data is publicly available and has no personal identifiers.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

References

  1. 1.
    Reda AA, et al. Prevalence and determinants of khat (Catha edulis) chewing among high school students in eastern Ethiopia: a cross-sectional study. PLoS One. 2012;7(3):e33946.PubMedPubMedCentralCrossRefGoogle Scholar
  2. 2.
    Dires E, et al. Factors associated with khat chewing among high school students in Jimma town Southwest Ethiopia. J Psychiatry. 2016;19(4):372.CrossRefGoogle Scholar
  3. 3.
    Teni F, et al. Prevalence, reasons, and perceived effects of khat chewing among students of a college in Gondar town, northwestern Ethiopia: a cross-sectional study. Ann Med Health Sci Res. 2015;5(6):454–60.PubMedPubMedCentralCrossRefGoogle Scholar
  4. 4.
    Wendy Sykes, et al., Perceptions of the social harms associated with khat use. Home office, 2010.Google Scholar
  5. 5.
    Mulugeta Y. Khat chewing and its associated factor among college students in Bahir Dar town, Ethiopia. Sci J Public Health. 2013;1(5):209–14.CrossRefGoogle Scholar
  6. 6.
    Alsanosy RM, Mahfouz MS, Gaffar AM. Khat chewing among students of higher education in Jazan region, Saudi Arabia: prevalence, pattern, and related factors. Biomed Res Int. 2013;2013:1–7.CrossRefGoogle Scholar
  7. 7.
    Balint EE, Falkay G, Balint GA. Khat–a controversial plant. Wien Klin Wochenschr. 2009;121(19–20):604.PubMedCrossRefPubMedCentralGoogle Scholar
  8. 8.
    Woldeamanuel GG, Geta TG. Impact of chronic khat (Catha edulis Forsk) chewing on pulmonary function test and oxygen saturation in humans: a comparative study. SAGE Open Med. 2019;7:2050312118824616.PubMedPubMedCentralGoogle Scholar
  9. 9.
    Abate A, et al. Chewing khat and risky sexual behavior among residents of Bahir Dar City administration, Northwest Ethiopia. Ann Gen Psychiatry. 2018;17:26.PubMedPubMedCentralCrossRefGoogle Scholar
  10. 10.
    Ware E, et al. Disparities in risky sexual behavior among khat chewer and non- chewer college students in southern Ethiopia: a comparative cross-sectional study. BMC Public Health. 2018;18(1):558.PubMedPubMedCentralCrossRefGoogle Scholar
  11. 11.
    Adorjan K, et al. Khat use and occurrence of psychotic symptoms in the general male population in southwestern Ethiopia: evidence for sensitization by traumatic experiences. World Psychiatry. 2017;16(3):323.PubMedPubMedCentralCrossRefGoogle Scholar
  12. 12.
    Manzar MD, et al. Poor sleep in concurrent users of alcohol, khat, and tobacco smoking in community-dwelling Ethiopian adults. Ann Thorac Med. 2018;13(4):220–5.PubMedPubMedCentralCrossRefGoogle Scholar
  13. 13.
    Alem A, Kebede D, Kullgren G. The prevalence and socio-demographic correlates of khat chewing in Butajira, Ethiopia. Acta Psychiatrica Scandinavica. 1999;100:84–91.CrossRefGoogle Scholar
  14. 14.
    Sinshaw AE. Prevalence and associated factors of khat chewing among Atse Fasil campus student in University of Gondar, North West Ethiopia. Malays J Med Biol Res. 2014;1(2):53–64.Google Scholar
  15. 15.
    Wazema DH, Madhavi K. Prevalence of Khat abuse and associated factors among undergraduate students of Jimma University, Ethiopia. Int J Res Med Sci. 2017;3(7):1751–7.Google Scholar
  16. 16.
    Gelaw Y, Haile-Amlak A. Khat chewing and its socio-demographic correlates among the staff of Jimma University. Ethiop J Health Dev. 2004;18(3):179–84.Google Scholar
  17. 17.
    Ethiopian Demographic and Health Survey 2016. Central statistical agency Addis Ababa, Ethiopia The DHS Program ICF Rockville, Maryland, USA, 2017.Google Scholar
  18. 18.
    Reda AA, Moges A, Biadgilign S, Wondmagegn BY. Prevalence and determinants of khat (Catha edulis) chewing among high school students in eastern Ethiopia: a cross-sectional study. PLoS one. 2012;7(3):e33946.PubMedPubMedCentralCrossRefGoogle Scholar
  19. 19.
    Lakew A, et al. Prevalence of catha edulis (khat) chewing and its associated factors among ataye secondary school students in northern shoa, Ethiopia. Adv Appl Sociol. 2014;4(10):225.CrossRefGoogle Scholar
  20. 20.
    Deribachew Hailemariam Wazema and Kanchi. Madhavi, Prevalence of Khat abuse and associated factors among undergraduate students of Jimma University, Ethiopia. Int J Res Med Sci  https://doi.org/10.18203/2320-6012.ijrms20150264, 2015. 3(7): p. 1751–1757.
  21. 21.
    Jima SB, Tefera TB, Ahmed MB. Prevalence of tobacco consumption, alcohol, Khat (Catha Edulis) use and high blood pressure among adults in Jimma town, South West Ethiopia. Science. 2015;3(5):650–4.Google Scholar
  22. 22.
    Dachew BA, Bifftu BB, Tiruneh BT. Khat use and its determinants among university students in Northwest Ethiopia: a multivariable analysis. Int J Med Sci Public Health. 2015;4(3):319–23.CrossRefGoogle Scholar
  23. 23.
    Alsanosy RM, Mahfouz MS, Gaffar AM. Khat chewing habit among school students of Jazan region, Saudi Arabia. Plos one. 2013;8(6):e65504.PubMedPubMedCentralCrossRefGoogle Scholar
  24. 24.
    Sykes W, et al. Perceptions of the social harms associated with khat use. Home Office Online Report. London: Home Office; 2010.Google Scholar
  25. 25.
    Diez-Roux AV. Multilevel analysis in public health research. Annu Rev Public Health. 2000;21(1):171–92.PubMedCrossRefPubMedCentralGoogle Scholar
  26. 26.
    Haile D, Lakew Y. Khat chewing practice and associated factors among adults in Ethiopia: further analysis using the 2011 demographic and health survey. PLoS One. 2015;10(6):e0130460.PubMedPubMedCentralCrossRefGoogle Scholar
  27. 27.
    Aden A, et al. Socio-economic effects of khat chewing in north eastern Kenya. East Afr Med J. 2006;83(3):69–73.PubMedPubMedCentralGoogle Scholar
  28. 28.
    Ethiopia Demographic and Health Survey. 2011 central statistical agency Addis Ababa. Maryland: Ethiopia ICF International Calverton; 2012.Google Scholar
  29. 29.
    Zeleke A, Awoke W, Gebeyehu E, Ambaw F. Khat chewing practice and its perceived health effects among communities of Dera Woreda, Amhara region, Ethiopia. Open J Epidemiol. 2013;3:160–8.CrossRefGoogle Scholar
  30. 30.
    Andualem M. The prevalence and socio- demo-graphic characteristics of khat chewing in Jimma town, South Western Ethiopia. Ethiopian J Health Sci. 2002;12:69–80.Google Scholar
  31. 31.
    Gebrie A, et al. Prevalence and predictors of khat chewing among Ethiopian university students: a systematic review and meta-analysis. PLoS One. 2018;13(4):e0195718.PubMedPubMedCentralCrossRefGoogle Scholar
  32. 32.
    Ihunwo AO, Kayanja FI, Amadi-Ihunwo UB. Use and perception of the psychostimulant, khat (catha edulis) among three occupational groups in south western Uganda. East Afr Med J. 2004;81(9):468–73.PubMedCrossRefPubMedCentralGoogle Scholar
  33. 33.
    Wabe NT. Chemistry, pharmacology, and toxicology of khat (catha edulis forsk): a review. Addict Health. 2011;3(3–4):137–49.PubMedPubMedCentralGoogle Scholar
  34. 34.
    Nakajima M, et al. Habitual khat and concurrent khat and tobacco use are associated with subjective sleep quality. Prev Chronic Dis. 2014;11:E86.PubMedPubMedCentralCrossRefGoogle Scholar
  35. 35.
    Manzar MD, et al. Psychometric properties of the Insomnia Severity Index in Ethiopian adults with substance use problems. J Ethn Subst Abus. 2018:1–15.Google Scholar
  36. 36.
    Odenwald, M. and M. al’Absi, Khat use and related addiction, mental health and physical disorders: the need to address a growing risk. East Mediterr Health J, 2017. 23(3): p. 236–244.PubMedCrossRefPubMedCentralGoogle Scholar
  37. 37.
    Mihretu A, Teferra S, Fekadu A. What constitutes problematic khat use? An exploratory mixed methods study in Ethiopia. Subst Abuse Treat Prev Policy. 2017;12(1):17.PubMedPubMedCentralCrossRefGoogle Scholar
  38. 38.
    Hassan NA, Gunaid AA, Murray-Lyon IM. Khat (Catha edulis): health aspects of khat chewing. East Mediterr Health J. 2007;13(3):706–18.PubMedPubMedCentralGoogle Scholar
  39. 39.
    Gebrehanna E, Berhane Y, Worku A. Khat chewing among Ethiopian University Students--a growing concern. BMC Public Health. 2014;14:1198.PubMedPubMedCentralCrossRefGoogle Scholar
  40. 40.
    Kassa A, Loha E, Esaiyas A. Prevalence of khat chewing and its effect on academic performance in Sidama zone, Southern Ethiopia. Afr Health Sci. 2017;17(1):175–85.PubMedPubMedCentralCrossRefGoogle Scholar
  41. 41.
    Mekonen T, et al. Substance Use as a Strong Predictor of Poor Academic Achievement among University Students. Psychiatry J. 2017;2017:7517450.PubMedPubMedCentralCrossRefGoogle Scholar
  42. 42.
    Al-Sanosy RM. Pattern of khat abuse and academic performance among secondary school and college students in jazan region, Kingdom of Saudi Arabia (ksa). J Family Community Med. 2009;16(3):89–95.PubMedPubMedCentralGoogle Scholar
  43. 43.
    Ahmed SH, et al. The prevalence of selected risk factors for non-communicable diseases in Hargeisa, Somaliland: a cross-sectional study. BMC Public Health. 2019;19(1):878.PubMedPubMedCentralCrossRefGoogle Scholar
  44. 44.
    Ageely HM. Health and socio-economic hazards associated with khat consumption. J Family Community Med. 2008;15(1):3–11.PubMedPubMedCentralGoogle Scholar

Copyright information

© The Author(s). 2020

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

Authors and Affiliations

  • Temesgen Yihunie Akalu
    • 1
  • Adhanom Gebreegziabher Baraki
    • 1
    Email author
  • Haileab Fekadu Wolde
    • 1
  • Ayenew Molla Lakew
    • 1
  • Kedir Abdela Gonete
    • 2
  1. 1.Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health SciencesUniversity of GondarGondarEthiopia
  2. 2.Department of Human Nutrition, Institute of Public Health, College of Medicine and Health SciencesUniversity of GondarGondarEthiopia

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