A Systematic Review of Treatments for Problematic Khat Use

Mental health crisis in Somalia: a review and a way forward

Background

Somalia has been without an effective government since the collapse of the military regime in 1991. Years of conflict, disasters, and insecurity have all contributed to very low scores for most health indicators due to poor governance, protracted conflict, underdevelopment, economic decline, poverty, social and gender inequality, and environmental degradation. The three-decade long protracted conflict has led to widespread psychosocial trauma, social deprivation and substance abuse with devastating consequences on mental health. A WHO study showed Somalia has one of the highest rates of mental illness in the world. The main aim of this study is to assist policy makers in setting priorities for the design and delivery of interventions to promote mental health and psychosocial wellbeing in Somalia.

Methods

The study uses a systematic mapping technique (from January 1991 to May 2020) and data collected from public domain, to collect, collate, and present mental health data mainly from WHO’s Global Health Observatory. Since there is no primary database for Somalia’s public health research, the bibliographic databases used for mental health in this study included Medline, PubMed, CINAHL, PsycINFO, and Google Scholar. Data were extracted using techniques for web data mining for public health.

Results

Systematic mapping of mental health-related issues in Somalia showed that policy-related determinants and mental health services dominated (74.4%), followed by the disaster-related determinants and women’s health consequences (39.3%). The ratio of the number of beds for mental health in general hospitals (per 100,000 population) in Somalia in 2017 is 0.5 compared to the Eastern Mediterranean region (EMR) at 6.4 and globally at 24. One of the biggest casualties of the civil war was loss of essential human resources in healthcare as most either fled the country or were part of the victims of the war.

Conclusions

The vast scale of the mental health problems in Somalia and the priority setting guidelines for interventions to address the issues outlined in this paper, prompt a dire need that the Somali government and its national/international partners should prioritize and emphasize the need to invest in the prevention and the treatment of mental illness across the country.

Exposure to DDT and HCH congeners and associated potential health risks through khat (Catha edulis) consumption among adults in South Wollo, Ethiopia

Khat (Catha edulis) chewing is widespread in the region of East Africa. Even low levels of organochlorine pesticides (OCPs) in khat could induce public health concern. In a market-based study, from five popular khat varieties, a total of 35 composite khat samples were analyzed for dichlorodiphenyltrichloroethane (DDT) and its main transformation products, and four hexachlorocyclohexane (HCH) isomers. Extraction was carried out by quick, easy, cheap, effective, rugged and safe method (QuEChERS). OCP concentrations were determined by head space solid phase microextraction coupled to gas chromatography-mass spectrometry (HS-SPME-GC-MS). Every sample contained β-HCH above the maximum residue limit set by the European Commission. For total DDT, this was the case for 25.7% of the samples. The ratios of (p,p'-DDD + p,p'-DDE) to p,p'-DDT were less than one for 85% of khat samples, demonstrating recent use of DDT in khat farmlands. Conversely, the ratio of β-HCH to total HCH varied from 0.56 to 0.96, implying historical input of technical HCH. Assuming a daily chewable portion of 100 g, dietary intakes of p,p'-DDT, total DDT and total HCH by adults ranged from 3.12 to 57.9, 6.49 to 80.2 and 39.2 to 51.9 ng (kg body weight)^-1 day^-1, respectively. These levels are below acceptable levels suggested by international organizations. Chewing khat showed lower non-cancer health risk, but showed relatively higher cancer risk in terms of OCPs. Because khat is chewed without being subjected to any treatment, uncertainties associated with estimated intakes and health risks should be low. Therefore, this practice is of great concern.

Prevalence and determinants of chewing khat among women in Ethiopia: data from Ethiopian demographic and health survey 2016

BACKGROUND

In Ethiopia and other countries in eastern Africa, khat abuse is an increasing public health problem. Levels of use appear to be increasing in women, who are more vulnerable to khat-related problems. However, population-based data are lacking as studies have been small and related to specific settings. This study aimed to contribute to current knowledge on the prevalence of chewing khat and associated factors among women in Ethiopia, using data from the 2016 Ethiopian national demographic and health survey.

METHODS

The 2016 EDHS used a two-stage stratified sampling design to select households. A total of 645 enumeration areas (202 urban and 443 rural) were selected, based on the 2007 Ethiopia Population and Housing Census. In these, 18,008 households were considered, from which 15,683 women were included from individual households. The women were interviewed by trained lay interviewers. Data were tabulated and logistic regression was used to examine mutually adjusted associations, expressed as adjusted odds ratios.

RESULTS

The lifetime prevalence of chewing khat among women was 9.9%. Current khat use was 8.4%, with a mean of 14.2 days of use in the last month. Khat use increased with increasing age, remaining constant after age 35 years, having one child, lower educational level, being Muslim by religion and not pertaining to the lowest wealth index category. Not being in a marital relationship with the most recent sex partner and Protestant religion were protective factors.

CONCLUSION

Lifetime prevalence of chewing khat among women in Ethiopia is substantial and associated with specific sociodemographic risks. These can be used in targeted public health efforts to control the use of khat and reduce the associated health and economic burden.

Exploring the concept of problematic khat use in the Gurage community, South Central Ethiopia: a qualitative study

OBJECTIVE

This study aimed to explore how problematic khat use is characterised in the Gurage community in South Central Ethiopia.

DESIGN

Qualitative study.

SETTING

Gurage community in South Central Ethiopia.

PARTICIPANTS

We conducted indepth interviews with 14 khat users and 5 non-khat users, and three focus group discussions with khat users.

METHODS

All participants were selected purposively based on their exposure to khat or khat use. We used an interview guide to explore the perceptions of participants about khat use and problematic khat use. We analysed the data thematically using OpenCode V.4.03 software. We used iterative data collection and analysis, triangulation of methods, and respondent validation to ensure scientific rigour.

FINDINGS

We identified three major themes: sociocultural khat use, khat suse (khat addiction) and negative consequences of khat use. Sociocultural khat use included a broad range of contexts and patterns, including use of khat for functional, social, cultural and religious reasons. Khat addiction was mainly explained in terms of associated khat withdrawal experiences, including harara/craving and inability to quit. We identified mental health, sexual life, physical health, social and financial negative consequences of khat use. The local idiom jezba was used to label a subgroup of individuals with khat suse (khat addiction).

CONCLUSION

The study has identified what constitutes normative and problematic khat use in the Gurage community in South Central Ethiopia. Problematic khat use is a broad concept which includes frequency, reasons, contexts, negative consequences and addiction to khat. Insights generated can be used to inform future studies on the development of tools to measure problematic khat use.