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Widmann M, Apondi B, Musau A, Warsame AH, Isse M, Mutiso V, Veltrup C, Schalinski I, Ndetei D, Odenwald M. Reducing Khat use among Somalis living in Kenya: a controlled pilot study on the modified ASSIST-linked brief intervention delivered in the community. BMC Public Health 2022; 22:2271. [PMID: 36471268 PMCID: PMC9721075 DOI: 10.1186/s12889-022-14681-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 11/21/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND During recent decades, the consumption of the stimulant khat (catha edulis) has profoundly changed in countries around the Horn of Africa, and excessive use patterns have emerged-especially evident among displaced Somalis. This is related to the development of severe somatic and psychiatric disorders. There are currently no preventive or interventional studies targeting khat use. This study's aim was to test screening and brief intervention (SBI) to reduce khat use among urban Somali refugees living in Kenya with limited access to public healthcare. METHODS In this controlled study, 330 male Somali khat users from the community were either assigned to SBI (161) or an assessment-only control condition (AC; 169); due to field conditions a rigorous experimental design could not be implemented. The World Health Organization's (WHO) Alcohol, Smoking and Substance Involvement Screening Test (ASSIST)-linked brief intervention was adapted to khat and Somali culture. Trained local counselors administered the intervention. The amount and frequency of khat use was assessed using the time-line-follow-back method. We compared the month before the intervention (t1) to the two months after it (t2, t3). Baseline differences in khat use frequency were corrected by partial matching and mixed effect models used to evaluate intervention effects. RESULTS SBI was well accepted and feasible for khat users. Over the complete observation period and from t1 to t2, khat use amount and frequency decreased (p < .001) and the intervention group showed a greater reduction (group x time effects with p ≤ .030). From t2 to t3, no further reduction and no group differences emerged. CONCLUSION The results provide preliminary evidence that khat use amount and frequency can be reduced in community settings by SBI, requiring little resources. Thorough assessment alone might have intervention-like effects. The non-treatment-seeking community sample and the non-professional counselors are distinct from SBI studies with other substances in other countries, but support the feasibility of this approach in khat use countries and especially in Somali populations with limited access to healthcare. Future studies that employ rigorous experimental design are needed. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT02253589. Date of first registration 01/10/2014, retrospectively registered https://clinicaltrials.gov/ct2/show/NCT02253589 . First participant 16/09/2014.
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Affiliation(s)
- Marina Widmann
- grid.9811.10000 0001 0658 7699University of Konstanz, Feursteinstrasse 55, 78479 Konstanz, Germany ,vivo international e.V, Konstanz, Germany
| | - Bernice Apondi
- Voices of Community Action & Leadership, Beverly Court, Marcus Garvey Rd, Nairobi, Kenya
| | - Abednego Musau
- grid.4830.f0000 0004 0407 1981University of Groningen, PO Box 72, 9700 Groningen, AB Netherlands ,grid.490737.eAfrica Mental Health Research and Training Foundation, Box 48423-00100, Matumbato Road, Nairobi, PO Kenya
| | | | - Maimuna Isse
- Tawakal Medical Clinic, 5th street, Eastleigh, Nairobi, Kenya
| | - Victoria Mutiso
- grid.490737.eAfrica Mental Health Research and Training Foundation, Box 48423-00100, Matumbato Road, Nairobi, PO Kenya
| | - Clemens Veltrup
- Fachklinik Freudenholm-Ruhleben, Postfach 5, 24301, Plön, Germany
| | - Inga Schalinski
- vivo international e.V, Konstanz, Germany ,grid.7752.70000 0000 8801 1556Universität der Bundeswehr München, München, Germany
| | - David Ndetei
- grid.490737.eAfrica Mental Health Research and Training Foundation, Box 48423-00100, Matumbato Road, Nairobi, PO Kenya ,grid.10604.330000 0001 2019 0495University of Nairobi, Nairobi, Kenya
| | - Michael Odenwald
- grid.9811.10000 0001 0658 7699University of Konstanz, Feursteinstrasse 55, 78479 Konstanz, Germany ,vivo international e.V, Konstanz, Germany
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Hassen MT, Soboka M, Widmann M, Keller L, Zeller AC, Büchele N, Barnewitz E, Yitayih Y, Schiller S, Senger J, Adorjan K, Odenwald M. Khat Use Patterns, Associated Features, and Psychological Problems in a Khat-Treatment-Seeking Student Sample of Jimma University, Southwestern Ethiopia. Front Public Health 2021; 9:645980. [PMID: 34490174 PMCID: PMC8416611 DOI: 10.3389/fpubh.2021.645980] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 07/27/2021] [Indexed: 11/25/2022] Open
Abstract
Background: Khat (Catha edulis) is a traditionally used substance in African and Arab countries that contains the amphetamine-like alkaloid cathinone. Khat use among Ethiopian students is a growing concern. This study aims to describe khat use, psychological problems, and motivation to change and to determine associated factors of khat use among students from Jimma University seeking psychological assistance. Methods: In a cross-sectional study, a sample of 717 students from Jimma University, southwestern Ethiopia, who seek assistance to reduce khat use were recruited. The study used Amharic and Afaan Oromoo language versions of common psychological instruments and employed them as part of a comprehensive tablet computer-delivered self-report assessment battery, comprising the SRQ-20, the PCL-5, the LEC-5, the AUDIT, and the SOCRATES-khat. In addition, socio-demographic, economic variables, and functioning problems due to severe mental disorders were assessed. The analysis relied on the data of the 575 included participants and used clinical cut-off values to describe this treatment-seeking sample and hierarchical regression models to determine variables associated with khat use. Results: The sample showed high khat use in the past month (M = 31.55 bundles, SD = 28.53, on M = 15.11 days, SD = 8.54); 17.0% showed highly problematic use. The sample was extremely burdened with comorbid psychiatric problems: 21.6% reported functioning problems due to past mental disorders, 60.2% scored above the cut-off for current common mental disorders, 37.9% screened positive for PTSD, and 47.1% reported hazardous alcohol use. Small to medium intercorrelations between variables were detected, and in hierarchical regression models, higher motivation to change khat use was associated with higher use of the substance. Conclusions: This study clearly shows the need to develop research instruments, screening methods, and assistance services for khat-using students at Jimma University. Study participants' high mental health burden shows the need for targeted intervention programs that go beyond brief interventions for khat use. Furthermore, the study highlights challenges for implementing such services: the barriers to utilization for females and khat users without comorbid mental health problems.
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Affiliation(s)
| | - Matiwos Soboka
- Department of Psychiatry, Medical Faculty, Jimma University, Jimma, Ethiopia
| | - Marina Widmann
- Department of Psychology, University of Konstanz, Konstanz, Germany.,Vivo International e.V., Konstanz, Germany
| | - Lucas Keller
- Department of Psychology, University of Konstanz, Konstanz, Germany
| | - Anja C Zeller
- Department of Psychology, University of Konstanz, Konstanz, Germany.,Vivo International e.V., Konstanz, Germany
| | - Natascha Büchele
- Department of Psychology, University of Konstanz, Konstanz, Germany
| | - Eva Barnewitz
- Department of Psychology, University of Konstanz, Konstanz, Germany.,Vivo International e.V., Konstanz, Germany
| | - Yimenu Yitayih
- Department of Psychiatry, Medical Faculty, Jimma University, Jimma, Ethiopia
| | - Sabine Schiller
- Department of Psychology, University of Konstanz, Konstanz, Germany
| | - Jael Senger
- Department of Psychology, University of Konstanz, Konstanz, Germany
| | - Kristina Adorjan
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilians-Universität Munich, Munich, Germany.,Institute of Psychiatric Phenomics and Genomics, University Hospital, Ludwig-Maximilians-Universität Munich, Munich, Germany.,Center for International Health (CIHLMU), Ludwig-Maximilians-Universität Munich, Munich, Germany
| | - Michael Odenwald
- Department of Psychology, University of Konstanz, Konstanz, Germany.,Vivo International e.V., Konstanz, Germany
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