The impact of khat use on East African communities in Melbourne: a preliminary investigation

Khat consumption and undernutrition among adult population in Ethiopia: A systematic review and meta-analysis

BACKGROUND

In Ethiopia, malnutrition is a public health threat causing a significant burden of morbidity, mortality, and economic crisis. Simultaneously, khat consumption is alarmingly increasing among adults, yet it might contribute to the existing burden of malnutrition, where the current evidence is inconclusive. Hence, this review was to estimate the association between khat consumption and undernutrition among adults in Ethiopia.

METHODS

A comprehensive search for Google, Google Scholar, and PubMed, coupled with a thorough manual search of the literature, was done up to date, October 18, 2023, using relevant search terms: "impact," "effects," "khat chewing," "khat consumption," "Ethiopia," "nutritional status," and "undernutrition." An updated PRISMA guideline was used to select relevant literature. The extracted data was summarized in narrative summaries, descriptions, and meta-analyses. The risk of bias was assessed. The results are presented in forest plots and funnel plots to assess publication bias. A pooled effect size (odds ratio) with a 95% certainty level was reported.

RESULTS

While a total of 17 articles (n = 45,679) were included in the narrative review, only 15 articles were included in the quantitative meta-analysis. The majority of studies had a low and moderate risk of bias (based on risk of bias assessment tool), mainly due to unclear exposure assessment and high study heterogeneity. A total of 11 studies were cross-sectional studies (71%), three were comparative studies (17.4%), and three were case control studies (17.4%). There is a higher risk of publication bias as evidenced by the funnel plot. Overall, five studies were from the Oromia region, and three studies were conducted at the national level. Overall, chewing had been shown to significantly increase the risk of undernutrition by 53% (pooled OR = 1.53; 95% CI: 1.09-2.16) under a random effect model. Under the fixed effect model, higher weight was given to national-level studies with higher samples, where chewing contributed to a 12% increased risk of undernutrition (AOR = 1.12; 95% CI: 1.01-2.23). Hence, khat chewing could raise the odds of undernutrition by 12-53%.

CONCLUSION

There is evidence of an association between khat chewing and an increased risk of undernutrition among adults in Ethiopia, which highlights the need for public health interventions to address the potential adverse effects of khat chewing on nutritional status.

Correlates of Concurrent Khat and Tobacco Use in Yemen

BACKGROUND

Habitual substance use poses public health threat. This is a growing concern in countries where one or more substances are commonly used. Many individuals in Middle Eastern and East African countries use khat (Catha edulis), a stimulant often accompanied by smoking. However, few systematic attempts have been made to characterize patterns of concurrent khat and tobacco use.

OBJECTIVES

To examine correlates such as gender and patterns of khat and tobacco use in concurrent users and khat-only users.

METHODS

This study used a cross-sectional design with a face-to-face interview method including 151 (74 women) concurrent users of khat and tobacco and 141 (76 women) khat-only users in Yemen. Data collection was completed in 2012. Analysis of variance (ANOVA) and logistic regressions were conducted to examine gender and khat use group differences in use patterns.

RESULTS

Reported frequency and intensity of khat use were greater in men than in women. Men and women khat users used different tobacco products and beverages while using khat. Khat use was more frequent in concurrent users relative to khat-only users. Earlier age of onset of khat use was associated with greater number of cigarettes smoked during a typical khat session. Approximately 70% of concurrent users reported initiating khat use prior to tobacco use. Conclusions/Importance: The results provide support for gender differences in khat and tobacco use, differences in khat use pattern between concurrent users of khat and tobacco and khat-only users, and positive associations between khat and tobacco use.

Experiences of and attitudes toward injecting drug use among marginalized African migrant and refugee youth in Melbourne, Australia

Little is known about injecting drug use (IDU) among people from culturally and linguistically diverse backgrounds in Australia. We interviewed 18 young people of African ethnicity (6 current/former injectors, 12 never injectors) about exposure and attitudes to IDU. Exposure to IDU was common, with IDU characterized as unnatural, risky and immoral. IDU was highly stigmatized and hidden from family and friends. There is a need for culturally appropriate programs to promote open dialogue about substance use to reduce stigma and prevent African youth who may use illicit drugs from becoming further marginalized.

Before the ban--an exploratory study of a local khat market in East London, U.K

BACKGROUND

Khat is a green leaf with amphetamine-like effects. It is primarily used among people in Africa, the Middle East and in the diaspora communities from these countries. Prior to the prohibition of khat in the UK on 24 June 2014, there was almost no information available on key aspects of the local khat market.

METHODS

A cross-sectional study was conducted in 2012 using snowball sampling, Privileged Access Interviewing and area mapping in order to identify khat sale establishments. Data was collected via face-to-face interviews using mixed methods for data collection. This included information about the establishments selling khat, khat pricing and its use among different ethnic minority groups, in addition to the potential sale of khat to children and risk assessment (e.g., use of pesticides on khat).

RESULTS

Five out of seven sellers identified agreed to participate. Sellers described their khat sale establishments as 'community centres' which included, for example, a restaurant basement. The sellers' history of selling khat ranged between 1-15 years and khat's sale took place between 2pm-10pm. Miraa (e.g., Lara) from Kenya was the most popularly used khat variety, sold in pre-wrapped bundles of approximately 250 g costing £3 each and delivered four days a week. Harari (e.g., Owdi) from Ethiopia was sold in 200 g, 400 g and 1 kg bundles, priced between £5 and £20 and delivered two days a week. The primary benefit of khat use was reported to be social interaction. The customers were predominantly adult males of Somali origin. Most sellers claimed a self-imposed ban on sales to children under 18 years old. Khat bundles had no labelling describing variety or weight and sellers had no knowledge of the use of pesticides on khat and did not advertise the risks associated with khat use.

CONCLUSIONS

Khat selling establishments were businesses that did not adhere to trade standards regulations (e.g., labelling khat bundles). They claimed to provide a community service (facilitating social interaction) to their predominately Somali customers. Without a better understanding of the dynamics of the khat market there is a risk that both health and social needs of the vulnerable populations involved in the market continue to go unaddressed. Future research should track changes in the now illicit khat market in order to evaluate the social and public health implications following the recent changes to the current U.K. regulatory environment regarding khat.

Khat Use: What Is the Problem and What Can Be Done?

The chewing of khat leaves is an established tradition in East Africa but is much less prevalent in other areas of the world and is mostly limited to Somali communities. However, our understanding of what constitutes problematic khat use in the Somali community in Victoria, Australia, is limited. The objectives of this study were to better understand the views of Somali community representatives and primary care practitioners regarding problematic khat use, to consider relevant harm minimisation strategies, and to develop resources to assist individuals with problematic khat use and their families. Qualitative research methods were used to investigate the experiences and perceptions of khat use among Somalis and mainstream primary care practitioners. Six focus groups were conducted with 37 members of the Somali community and 11 primary care practitioners. Thematic analysis was used to analyse transcripts. Various indicators of the problematic use of khat were identified, including adverse physical and mental health effects, social isolation, family breakdown, and neglect of social responsibilities. Potential harm minimisation strategies were identified including the adoption of health promotion through education, outreach to the community, and the use of universal harm minimisation strategies specifically tailored to khat use.

Why would khat chewers quit? An in-depth, qualitative study on Saudi Khat quitters

Background: Khat chewing, which has many adverse health and social consequences, is highly prevalent and socially accepted in the Jazan region of the Kingdom of Saudi Arabia. Methods: A qualitative study was conducted with 47 adult male former khat users regarding their khat initiation, continuance, and cessation, the amounts of khat they had used, and the health and social consequences of their use and cessation of use. Results: Participants noted a desire to show maturity, ease of availability of khat, and peer pressure as reasons for initiating khat chewing. Many noted long leisure times with little to do as a reason for continuing use. Negative consequences of khat use were seen in economic, health, familial, and sexual areas of their lives. After quitting khat use, participants saw improvements in all of these areas. Conclusions: A comprehensive community development program (CCDP) tackling, among other issues, the normalization of khat use, substantial leisure times with few positive activities, and misinformation about the “benefits” of khat use, as well as developing peer and family training programs to help prevent or stop khat use, would be useful to reduce khat chewing in this community.

Khat (Catha edulis): A systematic review of evidence and literature pertaining to its harms to UK users and society

The use of khat ( Catha edulis) has been associated with a large number of physiological and societal harms, leading to calls for it to be controlled in the UK. The evidence of these harms is often equivocal, limited by confounding factors, or entirely anecdotal: high-powered, quality-controlled studies are lacking. Regardless, the body of relevant literature indicates that the once socially-regulated use of khat has been eroded. Some individuals have developed excessive consumption patterns, either using khat daily or in binge-sessions, though daily consumption is not necessarily problematic per se. The majority of users seem to use khat in moderation, where the associated harms appear low. For excessive users, harms associated with khat are greater, particularly relating to mental health. Social harms also seem to be largely related to excessive khat use rather than khat use itself. Even in cases of excessive khat use, however, causal relationships between chewing and harms have not been described. More research is required to establish the role of khat in liver disease, coronary problems, cancers of the digestive tract and incidents of domestic violence. Studies should consider the likeliness that certain users are more vulnerable to developing patterns of excessive khat use due to an interwoven set of factors such as social health determinants and pre- and post-migration experiences.