Problematic khat use as a possible risk factor for harmful use of other psychoactive substances: a mixed method study in Ethiopia

Exploring the perception of key stakeholders toward khat policy approaches in Ethiopia: a qualitative study

BACKGROUND

Khat is an amphetamine-like plant, produced and commonly chewed in Ethiopia by a large group of the population. Although significant multidimensional harms of khat use have been reported, currently, there are no policies or organized activities against khat use in Ethiopia. Therefore, the current study aimed to explore the perception of key stakeholders toward khat policy approaches for Ethiopia.

METHODS

A qualitative study was conducted using focus group discussion (FGD) and in-depth interview (IDI). Ten stakeholders participated in the IDIs, and another 15 individuals participated in the FGDs. Key stakeholders were appropriately mapped and purposively selected based on their experience related to khat use and khat harm reduction. Interviews and FGDs were led by the study authors and were audio-recorded. The audio-recorded data were transcribed verbatim and then translated into English language. The data were analyzed using thematic analysis approach.

RESULTS

Participants preferred prevention and law regulation measures for khat policy approaches for Ethiopia. Proposed prevention and law regulation measures included regulating the transportation of khat, limiting the minimum age to buy and sell khat, prohibiting khat use at some public places, banning khat advertising and promotion, and imposing excise tax. Individual level khat harm reduction strategies were also proposed to be useful. However, the participants asserted that total khat ban in Ethiopia is not likely to be feasible and acceptable.

CONCLUSION

Prevention, treatment or care for individuals with problematic khat use, law regulation, and harm reduction were preferred approaches by stakeholders for khat policy in Ethiopia instead of total banning.

Current alcohol, tobacco, and khat use and associated factors among adults living in Harari regional state, eastern Ethiopia: A community-based cross-sectional study

Background

Psychoactive substance use becomes a major public health and socioeconomic problem worldwide. Despite its burden and consequences, there is no community-based study conducted on psychoactive substance use and associated factors in eastern Ethiopia. Therefore, this study aimed to assess the magnitude and determinants of current alcohol, tobacco, and khat among adults living in Harari regional state, eastern Ethiopia.

Methods

A community-based cross-sectional study was conducted on 955 adults living in Harari regional state. Participants were randomly recruited using a simple random sampling technique. Data were collected by interviewer-administered structured and semi-structured questionnaires. Data were entered into Epi Data version 3.1 and exported to Stata version 14.0 for analysis. Logistic regression analysis was performed to determine the association between the outcome and independent variables, and the statistical significance was declared at a p < 0.5.

Results

Of 955 eligible participants, 95.29% participated in the study. The overall prevalence of current alcohol use, tobacco use, and khat use in this study was 8.24, 14.5, and 63.30%, respectively. The availability of alcohol, being unemployed, and being a current khat user were significantly associated with current alcohol use. Being male, having a low level of education, having peer pressure, having a common mental disorder, being a current alcohol user, and being a khat user were identified as significant predictors for current tobacco use. The age between 31 and 40 years, being a Muslim religion follower, being a farmer, being a current tobacco user, and availability of khat were significantly associated with current khat use.

Conclusion and recommendations

The prevalence of psychoactive substance use in the study area was relatively high compared with that of previous studies. By considering these determinants, screening, early identification, and developing appropriate intervention strategies to prevent and tackle current alcohol, tobacco, and khat use in the community should be of great concern.

Protein-Ligand Identification and In Vitro Inhibitory Effects of Cathine on 11 Major Human Drug Metabolizing Cytochrome P450s

Cathine is the stable form of cathinone, the major active compound found in khat (Catha edulis Forsk) plant. Khat was found to inhibit major phase I drug metabolizing cytochrome P450 (CYP) enzyme activities in vitro and in vivo. With the upsurge of khat consumption and the potential use of cathine to combat obesity, efforts should be channelled into understanding potential cathine-drug interactions, which have been rather limited. The present study aimed to assess CYPs activity and inhibition by cathine in a high-throughput in vitro fluorescence-based enzyme assay and molecular docking analysis to identify how cathine interacts within various CYPs’ active sites. The half maximal inhibitory concentration (IC₅₀) values of cathine determined for CYP2A6 and CYP3A4 were 80 and 90 μM, while CYP1A2, CYP2B6, CYP2C8, CYP2C9, CYP2C19, CYP2D6, CYP2E1, CYP2J2 and CYP3A5 showed no significant inhibition. Furthermore, in K_i analysis, the Lineweaver-Burk plots depicted non-competitive mixed inhibition of cathine on both CYP2A6 and CYP3A4 with K_i value of 63 and 100 μM, respectively. Cathine showed negligible time-dependent inhibition on CYPs. Further, molecular docking studies showed that cathine was bound to CYP2A6 via hydrophobic, hydrogen and π-stacking interactions and formed hydrophobic and hydrogen bonds with active site residues in CYP3A4. Both molecular docking prediction and in vitro outcome are in agreement, granting more detailed insights for predicting CYPs metabolism besides the possible cathine-drug interactions. Cathine-drug interactions may occur with concomitant consumption of khat or cathine-containing products with medications metabolized by CYP2A6 and CYP3A4.

Alcohol and illicit drug use among young people living with HIV compared to their uninfected peers from the Kenyan coast: prevalence and risk indicators

BACKGROUND

In sub-Saharan Africa, there is paucity of research on substance use patterns among young people living with HIV (YLWH). To address the gap, we sought to: i) determine the prevalence of substance use, specifically alcohol and illicit drug use, among YLWH compared to their HIV-uninfected peers; ii) investigate the independent association between young people's HIV infection status and substance use; iii) investigate the risk indicators for substance use among these young people.

METHODS

Between November 2018 and September 2019, a cross-sectional study was conducted at the Kenyan coast recruiting 819 young people aged 18-24 years (407 HIV-positive). Alcohol and drug use disorders identification tests (AUDIT and DUDIT) were administered via audio computer-assisted self-interview alongside other measures. Logistic regression was used to determine substance use risk indicators.

RESULTS

The point prevalence of current substance use was significantly lower among YLWH than HIV-uninfected youths: current alcohol use, 13% vs. 24%, p <  0.01; current illicit drug use, 7% vs. 15%, p <  0.01; current alcohol and illicit drug use comorbidity, 4 vs. 11%, p <  0.01. Past-year prevalence estimates for hazardous substance use were generally low among young people in this setting (< 10%) with no significant group differences observed. Being HIV-positive independently predicted lower odds of current substance use, but not hazardous substance use. There was overlap of some risk indicators for current substance use between young people with and without HIV including male sex, khat use and an experience of multiple negative life events, but risk indicators unique to either group were also identified. Among YLWH, none of the HIV-related factors was significantly associated with current substance use.

CONCLUSIONS

At the Kenyan coast, substance use is a reality among young people. The frequency of use generally appears to be low among YLWH compared to the HIV-uninfected peers. Substance use prevention initiatives targeting young people, regardless of HIV infection status, are warranted in this setting to avert their potential risk for developing substance use disorders, including dependence. The multifaceted intrapersonal and interpersonal factors that place young people at risk of substance use need to be addressed as part of the substance use awareness and prevention initiatives.

Current Substances Use Among Students in Ethiopia: A Systematic Review and Meta-Analysis of 20-Years Evidence

BACKGROUND

The use of psychoactive substances is one of the main public health issues worldwide. However, there is a lack of evidence on the magnitude of current substance use among students in Ethiopia. Therefore, this study aimed to provide comprehensive views of the current prevalence of substance use among students in Ethiopia.

METHODS

We searched PubMed/Medline, Health InterNetwork Access to Research Initiative (HINARI), Google Scholar, and gray literature sources between 2000 and 2019. The prevalence of current substances with a 95% confidence interval (CI) was estimated using the random-effects model. The results were presented using forest plots, and Cochrane Q-test and I 2 were used to measure the extents of between-study variations.

RESULTS

A total of 1543 study articles were identified from electronic databases, and 32 cross-sectional studies were included in the meta-analysis. The prevalence of current use of at least 1 substance was 37.63% (95% CI: 33.66, 41.69), alcohol 27.61% (95% CI: 22.10, 33.48), khat 17.20% (95% CI: 14.03, 20.62), and smoking 9.74% (95% CI: 7.17, 12.64). The prevalence of any substance use in high school students versus university/college students was 41.55% (95% CI: 38.83, 44.29) versus 36.24% (95% CI: 32.37, 40.20), alcohol 24.21% (95% CI: 14.05, 36.11) versus 25.27% (95% CI: 19.76, 31.20), khat 13.82% (95% CI: 8.61, 20.02) versus 17.30% (95% CI:13.75, 21.16), and cigarette 8.30% (95% CI: 1.89, 18.60) versus 9.80% (95% CI: 7.32, 12.58). Meta-regression analysis revealed publication year, sample size, female proportion, and age were not significantly associated with the current use of substances.

CONCLUSION

Overall, the current substance use of any substance, alcohol, chewing khat, and smoking cigarettes was relatively high. A significant proportion of high school students were already using substances at an early age. Policymakers should formulate and implement regulations to control the pervasive use of substances by young people around educational institutions at all levels.

PROTOCOL REGISTRATION

The protocol has been registered on 19 August 2019 on the International Prospective Register of Systematic Reviews (PROSPERO) with ID: CDR42019130560.

Determinants and consequences of heavy episodic drinking among female sex workers in Ethiopia: A respondent-driven sampling study

Background

Female sex workers (FSW), due to their working conditions, have an increased likelihood of heavy episodic drinking (HED), which is associated with risky sexual behavior. Nevertheless the specific contribution of HED to risky sexual behavior among FSWs in Ethiopia is not well documented for prevention activities.

Objective

The purpose of this study was to explore the determinants and consequences of HED among FSWs in Ethiopia.

Methods

A cross-sectional study using respondent-driven sampling was conducted among 4886 FSWs in 11 major towns in Ethiopia in 2014. A structured interview was performed, and data were examined using descriptive statistics and multiple logistic regression analyses.

Results

Most (66%) FSWs consumed alcohol, and the prevalence of HED was 29.1%. Compared to street-based FSWs, those who worked in bars/hotels and local drinking houses had 2.19 and 1.29 times higher odds of HED, respectively. FSWs who started selling sex when younger than 18 years (compared to those who started when older than 25 years) and those who were forced into selling sex had 1.48 and 2.91 times higher odds of HED, respectively. FSWs with more income from selling sex and FSWs who chewed khat reported increased odds of HED. Moreover, FSWs with experience of HED reported 1.27 and 1.44 times higher odds of physical beating and condom breakage/slippage, respectively. Furthermore, the population attributable risk fraction of HED among FSWs showed that 6.2% of physical beating and 8.9% of condom breakage/slippage could be attributed to HED.

Conclusion

In general, several factors increase the experience of HED, and HED in turn increases the likelihood of violence and condom breakage. These factors could inform programs and intervention activities among FSWs populations.

Alcohol use disorder and associated factors among University of Gondar undergraduate students: A cross-sectional study

BACKGROUND

Alcohol use disorder among health science students is a problem throughout the world. Alcohol is accountable for many diseases, injury-related health conditions, poor academic performance, and dropout; and it is the fifth leading risk factor for premature death in the world. Despite this, we know little about the magnitude of alcohol use disorder among health science students in Ethiopia. Assessing alcohol use disorder and associated factors among this population will be paramount for future interventions.

OBJECTIVE

To assess alcohol use disorder and associated factors among University of Gondar undergraduate students.

METHODS

The research team conducted an institution-based cross-sectional study from April 18 to June 15, 2019. First, the study screened all students in the health science campus for alcohol use. To further study alcohol use disorder, the research team selected 424 students from alcohol users using a simple random sampling method. The team collected data through self-administered questionnaires. The study used an alcohol use disorders identification test to assess alcohol use disorder. The study team conducted bivariate and multivariate logistic regression analyses and used an adjusted odds ratio (AOR) at a 95% confidence interval (CI) to determine the independently associated factors of alcohol use disorder.

RESULTS

The overall prevalence of alcohol use disorder among the students was 61.8%. Chewing khat (AOR = 3.26, CI (1.30, 8.15)), male sex (AOR = 1.65, 95 CI (1.02, 2.67)), and having intimate friends who use alcohol (AOR = 1.603, CI (1.03, 2.50)) were significant factors associated with increased alcohol use disorder. Being a 2nd year student (AOR = 0.39, CI (0.17, 0.94)), 3rd year student (AOR = 0.30 CI (0.14, 0.66)), 4th year student (AOR = 0.39, CI (0.18, 0.85)) were significantly associated with decreased alcohol use disorder.

CONCLUSION

The prevalence of alcohol use disorder was high among students. Interventions should be made available to students who use alcohol and khat to reduce use-related problems, and thereby improve their health, and functional and social well-being.

Glycemic Control of Diabetes Mellitus Patients in Referral Hospitals of Amhara Region, Ethiopia: A Cross-Sectional Study

Background

Glycemic control is the level of glucose in diabetes patient. Evidence regarding glycemic control is scarce in resource-limited settings, and this study was conducted to generate information regarding the prevalence and predictors of glycemic control among diabetes mellitus patients attending their care from the referral hospitals of the Amhara region, Ethiopia.

Methods

A cross-sectional study design was implemented. A simple random sampling technique was used. Data were collected from March 2018 to January 2020. The data were collected using interviews, chart review, and blood samples. Hemoglobin A1c was measured using high-performance liquid chromatography. Data were entered into Epi-info software and analyzed by SPSS software. Descriptive statistics were used to estimate the prevalence of glycemic control; linear regression was used to identify the predictors of HbA1c.

Results

A total of 2554 diabetes patients were included giving for the response rate of 95.83%. The mean age of the study participants was 54.08 years [SD (standard deviation) ± 8.38 years]. The mean HbA1c of the study participants was 7.31% [SD ± 0.94%]. Glycemic control was poor in 55.32% [95% CI: 53.4%-57.25%] of diabetes patients. The glycemic control of diabetes patients was determined by BMI (β 0.1; [95% CI: 0.09-0.1]), type 2 diabetes (β -0.14; [95% CI: -0.11-0.16]), age (β 0.22; [95% CI: 0.02-0.024]), duration of the disease (β 0.04; [95% CI: 0.037-0.042]), the presence of hypertension (β 0.12; [95% CI:0.09-0.16]), regular physical exercise (β -0.06; [95% CI: -0.03-0.09]), medication adherence (β -0.16; [95% CI: -0.14-0.18]), and male (β 0.34; [95% CI: 0.31-.037]).

Conclusion

The glycemic control of diabetes patients was poor, and it needs the attention of decision-makers.

Current alcohol consumption and associated factors among school adolescents and youths in Ethiopia: A systematic review and meta-analysis

BACKGROUND

The use of alcohol is an alarmingly growing public health concern worldwide, and it has an impact on younger generations. There are a few large scale and comprehensive nation-wise surveys conducted on the subject matter and study groups. Hence, the purpose of this study was to render strong evidence for policymakers and researchers on the prevalence of alcohol consumption and its associated factors among school adolescents and youths in Ethiopia.

METHODS

Systematic searching was conducted using electronic (Medline, EMBASE, PubMed, CINAHL, Web of Science, Scopus, PsycINFO, and Science direct), and grey literature sources. Cross-sectional studies conducted among adolescents and youths (12-24 years old) were included. Joanna Briggs Institute critical appraisal tool was used to assess the quality of studies. Heterogeneity was examined by using forest plot and I2 heterogeneity tests. Publication bias was also assessed by inspecting the funnel plot and Egger's regression test. Stata/M16.0 for windows was used for the analysis.

RESULTS

A total of 26 studies were included in the final analysis with a total of 17,880 participants. The pooled prevalence of current alcohol consumption was 27.0% (95% CI = 22.0-32.0). In the subgroups, the prevalence of current alcohol consumption among high school, college, and university students was 23%, 27%, and 29%, respectively. The pooled data revealed that being a male (odds ratio = 1.93; 95% CI = 1.24-2.99), khat chewing (odds ratio = 6.65; 95% CI = 2.52-17.52), family members alcohol consumption behavior (odds ratio = 3.20; 95% CI = 2.08-5.17), and peer pressure (odds ratio = 3.79; 95% CI = 2.64-5.42) were significantly associated with alcohol consumption.

CONCLUSION

The pooled analysis of 26 studies indicate that over a quarter of school adolescents and youths consume alcohol in Ethiopia. Hence, we recommend designing and implementing community and school-based intervention programs to tackle the growing problems of alcohol consumption and its multifaceted impacts.

Magnitude and predictors of khat use among patients with tuberculosis in Southwest Ethiopia: A longitudinal study

INTRODUCTION

Tuberculosis (TB) is a leading cause of morbidity and mortality in low and middle-income countries. Substance use negatively affects TB treatment outcomes. Our recent study has found that khat use predicted poorer adherence to anti-TB medications. However, there is scarce longitudinal study on predictors of khat use among outpatients with TB, and this study aimed at addressing this research gap.

METHODS

From October 2017 to October 2018, 268 outpatients with tuberculosis on DOTs were enrolled in a longitudinal study from 26 health institutions in Southwest Ethiopia. Structured questionnaires translated into local languages (Afaan Oromoo and Amharic) were used to assess khat use. Patients were followed for six months, and data were collected on three occasions during the follow-up. A generalized linear mixed model was used to identify the relation between khat use and predictors. Model fitness was checked using the Bayesian Information Criterion (BIC). Odds ratio (OR) and 95% CI were used to describe the strength of association between the outcome variable and predictors.

RESULTS

The overall prevalence of khat use at baseline and first follow up was 39.2% while it was 37.3% at second follow up. Of this, 77.1% and 96.2% of them believed that khat use reduces the side effects of anti-TB medications and symptoms of tuberculosis respectively. In the final model, being male (aOR = 7.0, p-value = 0.001), being government employee (aOR = 0.03, p-value≤0.001) and presence of alcohol use disorders (AUD) (aOR = 2.0, p-value≤0.001) predicted khat use among outpatients with tuberculosis.

CONCLUSION

A considerable proportion of patients with TB used khat throughout DOTs and wrongly perceived that it had health benefits. The finding implies that all patients diagnosed with TB should be screened for khat use, and a particular emphasis should be given to males and individuals with a history of alcohol use. Moreover, further studies are needed to assess patients' beliefs regarding the benefits of khat use so that interventions can be developed.

Spatial Distribution and Factors Associated with Khat Chewing among Adult Males 15-59 Years in Ethiopia Using a Secondary Analysis of Ethiopian Demographic and Health Survey 2016: Spatial and Multilevel Analysis

Background

Khat chewing has become prevalent in the world due to the improvement of road and air transportation. In Ethiopia, khat chewing is more prevalent and widely practiced by men. Khat has a negative effect on social, economic, and mental health. There is variation in khat cultivation, use, and factors that associated with khat chewing in the Ethiopian regions. Therefore, this study is aimed at showing spatial distribution and factors associated with khat chewing among male adults 15-59 years in Ethiopia.

Methods

A total of 12,594 men were included in this study. ArcGIS version 10.7 software was used to show the spatial distribution of chewing khat among adult men in Ethiopia. The Bernoulli model was applied using Kilduff SaTScan version 9.6 software to identify significant purely spatial clusters for chewing khat in Ethiopia. A multilevel logistic regression model was fitted to identify factors associated with khat chewing. A P value < 0.05 was taken to declare statistically significant predictors.

Results

The EDHS 2016 survey showed that the high proportion of chewing khat was found in Dire Dawa, Harari, Southern Oromia, Somali, and Benishangul Gumuz regions. In spatial scan statistics analysis, a total of 126 clusters (LLR = 946.60, P value < 0.001) were identified. Age group 30-44 years old (AOR = 1.60, 95% CI: 1.37, 1.86) and 45-59 years old (AOR = 1.33, 95% CI: 1.09, 1.61), being single (AOR = 1.86, 95% CI: 1.64, 2.12), Muslim religion followers (AOR = 15.03, 95% CI: 11.90, 18.90), media exposed (AOR = 0.77, 95% CI: 0.68, 0.86), had work (AOR = 2.48, 95% CI: 2.08, 2.95), alcohol drinker (AOR = 3.75, 95% CI: 3.10, 4.53), and region (Afar, Amhara, Benishangul Gumuz, Gambela, Harari, Oromia, Somali, Southern Nations, Nationalities, and People's Region (SNNPR), and Tigray) and two cities (Addis Ababa and Dire Dawa) were statistically significant factors affecting chewing khat in Ethiopia.

Conclusions

In Ethiopia, the spatial distribution of khat chewing among adult men was nonrandom. A high proportion of khat chewing was observed in Dire Dawa, Harari, Southern Oromia, Somali, and Benishangul Gumuz regions. Older age group, being single marital status, alcohol drinker, media unexposed, had no work, and Muslim religion follower were factors affecting khat chewing. Policymakers should be given spatial attention in reducing the prevalence of chewing khat by teaching the health impact of khat chewing through media in the identified regions.

Predictors of substance use among Jimma University instructors, Southwest Ethiopia

BACKGROUND

Use of substances such as alcohol, khat leaves (Catha edulis) and tobacco has become one of the rising major public health and socioeconomic problems worldwide and dramatically increased in developing countries. The aim of this study was to assess the predictors of substance use among Jimma University instructors.

METHOD

Institutional based cross-sectional study design was conducted in 2018 among Jimma University instructors. A two-stage cluster sampling procedure was employed to select study participants by their departments and data was collected using structured, self-administered questionnaire with severity assessed by the standardized fifth version of a diagnostic statistical manual of mental health criteria for substance use disorder. Multivariate logistic regression was used to identify independent predictors of substance use. Variables with a P-value < 0.05 in the final fitting model were declared to be associated with the outcome variable.

RESULTS

A total of 330 instructors were involved in this study, with a response rate of 96.2%. About 225 of the respondents have ever used the substance in life (khat, alcohol, or cigarette or all) making the lifetime prevalence of substance use 68.2%. The lifetime prevalence of khat chewing, alcohol use, and smoking cigarette was 51.6, 81.3, and 17.3% respectively. The prevalence of substance uses disorder among users was 36.9%. Living with family (AOR = 0.220 [2.004-8.536] 95%CI), no family substance use history (AOR = 0.220 [0.098-0.495] 95% CI), friends substance use (AOR = 9.047 [4.645-17.620] 95% CI), Social norm favors substance use, (AOR = 1.123 [1.020-1.238] 95% CI), perceived benefit of substance use (AOR = 1.077 [1.008-1.151] 95% CI) were predictors of substance use.

CONCLUSION

Perception toward substance, the influence of family and peer were associated with substance use. Therefore, designing a multifaceted approach directed to an individual, interpersonal and community-level intervention targeted to substance misperception and social norms contributing to substance use.