Association of Chronic Khat Chewing with Blood Pressure and Predictors of Hypertension Among Adults in Gurage Zone, Southern Ethiopia: A Comparative Study

Levels and Health Risk Assessments of Heavy Metals in Khat and Its Support Soil in Algesachi, Ilu Ababor, Ethiopia

Background

Khat (Catha edulis Forsk) is a stimulant plant grown in East Africa and the Arabian Peninsula. Heavy metal pollution has been a global concern due to its acute and chronic health effects and the major route of exposure is the consumption of contaminated foods. In this study, the determination and health risk assessment of heavy metals (Mn, Cu, Zn, Ni, Cr, Cd, and Pb) in khat and its support soil samples was carried out.

Materials and Methods

Khat and its support soil were analyzed for the levels of 7 toxic heavy metals by Atomic Absorption Spectrophotometer. Samples were randomly collected from 3 districts of khat farming kebeles and digested using mixture of strong acids.

Results

The concentrations (mg/kg) of analytes in soil and khat samples were: Cu (6.78-35.80); Zn (24.30-199.02); Mn (7.59-1855.40); Ni (6.37-64.80); Cr (0.82-169.20); Cd (14.2-38.8), and Pb (ND). Among the analyzed heavy metals in soil, Mn was with the highest concentration, followed by Zn, Cr, Cu, Ni, and Cd while that of Zn was the maximum followed by Cu, Mn, and Cr in khat. The levels of Zn, Cr, and Cd in soil samples from all study sites and detected concentrations of Cr in khat samples exceeded the recommended FAO/WHO levels.

Conclusion

The hazard index (HI) of metals in khat from study areas was less than 1 indicating a less likelihood of non-carcinogenic toxicological health effects. However, the presence of these toxic chemicals in soil and khat indicates product contamination and needs extensive further investigation involving other heavy metals.

Cardiotoxicity After Synthetic Cathinone Use; Two Cases, A Case Series and Scoping Review

The cardiotoxic effects of synthetic cathinones remain largely unknown. In this study, we present two cases, a case series and a scoping review, to explore synthetic cathinone associated cardiotoxicity. Case 1 involved a 28-year-old male with non-ST-elevation myocardial infarction after ingesting a substance containing 4-methylmethcathinone (4-MMC), 3-methylmethcathinon (3-MMC), and methcathinone. Case 2 involved a 49-year-old male with ventricular fibrillation after 4-methylmethcathinone ingestion, who was diagnosed with severe three-vessel disease. A retrospective analysis was performed on self-reported synthetic cathinone poisonings reported to the Dutch Poisons Information Centre from 2012 to 2022. A total of 222 mono-intoxications with cardiotoxicity were included, mostly involving 3-methylmethcathinon (63%). Often tachycardia, hypertension, palpitations, and chest pain were reported. A comprehensive literature search was performed on PubMed to identify the studies reporting cardiac arrest, myocardial infarction, cardiac inflammation, cardiomyopathy, and life-threatening arrhythmias following synthetic cathinone use. A total of 30 articles reporting 40 cases were included. The reported complications included cardiac arrest (n = 28), ventricular tachycardia (n = 4), supraventricular tachycardia (n = 1), ST-elevation myocardial infarction (n = 2), non-ST-elevation myocardial infarction (n = 2), cardiomyopathy (n = 1), and myocarditis (n = 2). A total of ten different associated synthetic cathinones were identified. Cardiac arrest, myocardial infarction, and ventricular arrhythmias have been reported following the use of synthetic cathinones, underscoring the importance of obtaining a detailed recreational drug use history from patients presenting with syncope, chest pain, or palpitations.

Apparent Khat chewers exposure to DDT in Ethiopia and its potential toxic effects: A scoping review

Dichlorodiphenyltrichloroethane (DDT) is an insecticide, a member of dirty dozen persistent organic pollutants, used widely in the world until it was banned in the 1970s.The banning of DDT was strengthened by the Stockholm Convention in 2001. DDT is allowed only for malaria control in Ethiopia. However, farmers are misusing DDT and applying it to Khat (Catha edulis) farming. So, this review analyzes available data in the literature on the current trend, application, occurrence, fate and effects of DDT and its metabolites, dichlorodiphenyldichloroethane (DDD), dichlorodiphenyldichloroethylene (DDE), in the chewable parts of Khat. Generally, the concentration level of DDT, DDD, and DDE, designated as DDTs, is detected in different farmlands of Ethiopia. Some of the DDTs concentrations detected are very high (141.2-973 μg/kg (Gelemso), 194.4-999 μg/kg (Aseno) and 6253-8413.3 μg/kg (Gurage), and these concentrations may indicate increasing recent unmonitored application of DDT on Khat leaves. Some of the detected concentrations of DDT in the literature were above the maximum residue limit (MRL) set by FAO/WHO (100 μg/kg) and the European Commission 10 μg/kg in vegetables and 50 μg/kg in cereals. DDT exposure of Khat chewers linked to the concentration of DDT on Khat leaves and the amount of Khat consumed. DDT might pose health risks to chewers due to chronic toxicity, bioaccumulation, persistent and endocrine disruption properties.

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.

Factors Associated with Anxiety During COVID-19 Pandemic and Its Association with Hypertension in Saudi Arabia

Objective

Patients with chronic diseases such as hypertension (HTN) are considered a vulnerable group, and they are prone to anxiety and other psychological conditions during pandemics. Very few reports discussed factors related to anxiety and how it is associated with HTN during COVID-19 pandemic. In this project, we aimed to identify the prevalence of anxiety among hypertensive patients in Saudi Arabia during the COVID-19 pandemic.

Methods

A cross-sectional study was conducted, and data were collected using an electronic self-administered pretested questionnaire distributed via trained data collectors. Data were analyzed using t-test and chi-test.

Results

A total of 2135 participants were enrolled in this study. Anxiety was reported in 5% of all participants and 8% of the hypertensive participants. Older age, marital status, higher body mass index (BMI), smoking, and Khat chewing were strongly associated with anxiety among the general population. In addition, less adherence to medication made participants with HTN significantly more anxious.

Conclusion

The prevalence of anxiety among hypertensive individuals is higher compared to the general population. Moreover, anxiety is significantly associated with some sociodemographic in the general population, and with less adherence to medications in hypertensive patients. Further studies with data from medical record including more variables are needed to highlight this association.

Adverse Effects of Chewing Khat (Catha edulis): A Community-based Study in Ethiopia

Objectives

The purpose of this study was to assess the effects of habitual chewing of khat (Catha edulis) on blood pressure, body mass index, and physiological aspects of sexuality among residents of an Ethiopian town.

Methods

A statistically determined and randomly selected sample of khat-chewing individuals in the town of Hosanna in Southern Ethiopia were included in the study. We used physical measurements and a self-administered questionnaire to collect the data, which was statistically analyzed.

Results

The participants comprised a total of 420 with mean age = 28.7±5.7 years; 336 (80.0%) were male. Nearly half (201; 47.9%) were in the age-group 30-34 years. The adverse effects of khat use were assessed from the median score of each outcome, namely, physical problems, abuse potential, and social effects. Having a score above the median on each of the three target outcomes was equated with the presence of adverse effects. Adverse effects were reported among 341 of 420 (81.2%) participants, of whom 277 of 341 (81.2%) were male and 64 of 341 (18.8%) were female. The reported adverse effects were significantly higher among those who co-used tobacco, coffee, or tea with khat, with adjusted odds ratio = 4.8; CI: 2.86-8.22.

Conclusions

Khat chewing was found to have a significant adverse effect on the health of individuals who indulged in it. This finding implies the need for urgent intervention from health authorities.

The impact of khat chewing on heart activity and rehabilitation therapy from khat addiction in healthy khat chewers

Khat is a flowering plant whose leaves and stems are chewed for excitement purposes in most of east African and Arabian countries. Khat can cause mood changes, increased alertness, hyperactivity, anxiety, elevated blood pressure, and heart diseases. However, the effect of khat on the heart has not been studied exclusively. The purpose of this study was to investigate the impact of khat chewing on heart activity and rehabilitation therapy from khat addiction in healthy khat chewers. ECG signals were recorded from 50 subjects (25 chewers and 25 controls) before and after chewing session to investigate the effect of khat on heart activity. In addition, ECG signals from 5 subjects were recorded on the first and eightieth day of rehabilitation therapy for investigating the effect of rehabilitation from khat addiction. All the collected signals were annotated, denoised and features were extracted and analysed. After chewing khat, the average heart rate of the chewers was increased by 5.85%, with 3 subjects out of 25 were prone to tachycardia. 1.66% QRS duration and 23.56% R-peak amplitude reduction were observed after chewing session. Moreover, heart rate variability was reduced by 19.74% indicating the effect of khat on suppressing sympathetic and parasympathetic nerve actions. After rehabilitation therapy, the average heart rate was reduced by 11.66%, while heart rate variability (HRV), QRS duration, and RR interval were increased by 25%, 3.49%, and 12.53%, respectively. Statistical analysis results also confirmed that there is a significance change (p < 0.05) in ECG feature among pre- and post-chewing session. Our findings demonstrate that, khat chewing raises heart rate, lowers heart rate variability, or puts the heart under stress by lowering R-peak amplitude and QRS duration, which in turn increases the risk of premature ventricular contraction and arrhythmia. The results also show that rehabilitation therapy from khat addiction has a major impact on restoring cardiac activity to normal levels.

Impact of khat leaves on glycosylated haemoglobin and lipid profile in healthy individuals in Dire Dawa, Ethiopia

Objective:

The objective of this study is to determine the effect of Catha edulis leaves on glycosylated haemoglobin and lipid profiles in healthy individuals in Dire Dawa, Ethiopia.

Method:

A cross-sectional study was conducted to evaluate the effect of khat leaves on the glycated haemoglobin and lipid profile in the Dire Dawa population. For the study, 100 male subjects (aged ⩾20–⩽40 years) were recruited and divided into two groups, each consisting of 50 subjects: the first group was khat chewing people while the other group was non-khat chewing individuals. Blood samples were collected and tested to evaluate the glycated haemoglobin and lipid profiles.

Results:

The mean glycated haemoglobin value of khat chewers was 5.33% and for non-chewers, it was 5.48%, respectively. Since p value is less than the significance value, the t-test supports the reduction in glycated haemoglobin values in khat chewers. The mean values of total cholesterol, and triglycerides in khat chewers are 175.2 and 172.92, and for non-chewers they are 168.7 and 164.56, respectively.

Conclusion:

From this study, we concluded that Catha edulis leaves have a significant effect on glycosylated haemoglobin levels. Mean glycated haemoglobin values of long-term healthy khat chewers are comparatively less than healthy non-chewers. Long-term khat chewing increases total cholesterol levels and triglycerides levels but there is no significant effect on the high-density lipoprotein and low-density lipoprotein levels.

Risks of khat chewing on the cardiovascular, nervous, gastrointestinal, and genitourinary systems: A narrative review

Khat is an evergreen plant and its fresh green leaves and buds are chewed for several hours a day for its psychostimulant response. This study aimed to review the effects of khat chewing on the body. PubMed was searched for literature on the different aspects of khat chewing to summarize its effects on different body systems. The major effects of khat chewing are those on the cardiovascular system including increased blood pressure, increased heart rate, and increased risk of myocardial infarction. It causes insomnia, stress, depression, hallucination, and increased risk of brain stroke. It causes dental caries, bad oral hygiene, periodontitis, increased oral mucosal ulcers, and increased gingival bleeding and recession. Khat chewing causes loss of appetite, gastritis, constipation, and hemorrhoids, and increased risk of hepatotoxicity and liver cirrhosis. Ultimately, it causes weak micturition, decreased sperm motility and count, and low birth-weight offspring in khat chewing mothers. The published articles about khat chewing in journals indexed in the PubMed was reviewed. Inclusion criteria involved each article available with English language and have a reported new effect of khat chewing.

Heavy khat (Catha edulis) chewing and dyslipidemia as modifiable hypertensive risk factors among patients in Southwest, Ethiopia: Unmatched case-control study

BACKGROUND

The burden of hypertension is more devastating in low-and middle-income countries, including sub-Saharan Africa than in high-income countries. Among the modifiable risk factors, dyslipidemia and khat chewing were expanding at an alarming rate in Ethiopia but were still underestimated. Thus, this study aimed to assess heavy khat (Catha edulis) chewing and dyslipidemia as modifiable hypertensive risk factors among patients in the southwest, Ethiopia.

METHODS

A facility-based case-control study was conducted among 136 cases and 270 controls from May 15 to July 30, 2017. A consecutive sampling technique was used in this study. Epi data version 3.1.1 and SPSS version 21 were used for data entry and analysis. Descriptive statistics and bivariate and multivariate logistic regression analyses were performed. Both crude and adjusted odds ratios and 95% confidence intervals were reported.

RESULTS

The majority of the cases had a total cholesterol to high-density lipoprotein ratio of >5 (72.1%). The odds of hypertension increased among participants who had attended no formal education [AOR = 2.25, 95% CI: (1.05-4.82)], history of alcohol consumption [AOR = 5.93,95% CI:(3.11-11.30)], moderate khat chewing [AOR = 3.68, 95% CI:(1.69,8.01)], heavy khat chewing [AOR = 18.18, 95% CI: (3.56-92.89)], mild intensity physical activity [AOR = 3.01, 95% CI: (1.66-5.47)], type of oil used for food preparation [AOR = 2.81, 95% CI: (1.49-5.28)], and dyslipidemia [AOR = 6.68, 95% CI: (2.93-15.23)].

CONCLUSION

The study showed that modifiable risk factors were the major factors associated with the development of hypertension. The findings of this study highlighted that health education is needed to focus on physical exercise, quitting excess alcohol consumption, quitting khat chewing by giving special emphasis to those who had no formal education. In addition, consideration should be given to a healthy diet free of cholesterol and unhealthy behavior.

The Impact of Khat (Catha edulis) on Hemodynamics of the Common Carotid Arteries in Regular Khat Chewers: A Case-control Study Using Doppler Ultrasound

Background:

To evaluate the effect of chewing khat on the hemodynamics of the common carotid arteries (CCAs) using Doppler ultrasound imaging.

Methods:

This is a cross-sectional case–control study. Fifty volunteers who were chronic regular khat chewers were selected and compared with healthy nonkhat chewers. They were examined using Doppler imaging with a 7–10 MHz linear transducer. The resistivity index (RI), pulsatility index (PI), peak systolic velocity (PSV), and end-diastolic velocity of the CCAs were determined according to the standard protocol of carotid Doppler ultrasound.

Results:

The RI and PI of the right and left CCAs were significantly higher in khat chewers compared to controls (P < 0.001). The PSV of the right and left CCAs was considerably higher in khat chewers compared to controls (P < 0.001 and 0.04, respectively).

Conclusion:

The Doppler values of blood flow velocity, resistivity, and pulsatility were significantly higher in chronic regular khat chewers compared to nonkhat chewers. Khat is a significant contributory factor for increasing the hemodynamics of the CCAs.

Prevalence of Hypertension and Associated Factors Among Adults in Debre Berhan Town, North Shoa Zone, Ethiopia, 2020

INTRODUCTION

Hypertension is a serious medical condition that significantly increases the risks of heart, brain, kidney, and other diseases. The prevalence is highest in Africa (27%) and lowest in America (18%). Hypertension is a major reason for premature death worldwide; this is why it will become a targeted non-communicable disease by 2025.

OBJECTIVE

To assess the prevalence of hypertension and associated factors among adults in Debre Berhan town, Amhara region, Ethiopia.

METHODS

A community-based cross-sectional study was conducted among 680 participants who were selected by a systematic sampling technique. Data were checked, cleaned, and entered into Epi-data then exported to SPSS-23 for analysis. Hosmer-Lemeshow test was used to check the model fitness. Binary logistic regression analysis was used to see the association between dependent and independent variables. All variables with p <0.25 were taken into the multivariable model to minimize the possible confounders. The multi collinearity test was carried out to see the correlation between independent variables by using a variance inflation factor (VIF). The odds ratio along with 95% CI were estimated to measure the strength of association and to identify factors associated with hypertension using multivariable logistic regression. Descriptive statistics in the form of tables, figures, percent with measure of central tendency and dispersion with multivariable analysis were used to report the findings and to identify the factors associated with the outcome variable at a p<0.05.

RESULTS

Among 680 participants, the prevalence of hypertension was 27.5%. Sex, being male (AOR: 1.77, 95% CI: 1.12-2.81), alcohol consumption (AOR: 2.76: 95% CI: 1.87-4.05), physical exercise (AOR: 2.17, 95% CI: 1.28-3.71), being overweight (AOR: 1.99, 95% CI: 1.11-3.58), and family history of hypertension (AOR: 2.10, 95% CI: 1.43-3.08) were found to be significantly associated with hypertension.

CONCLUSION AND RECOMMENDATION

Prevalence of hypertension in Debre Berhan town was relatively high compared with other studies. So, it is necessary to emphasize intervention in the community for behavioral change, in order to minimize alcohol consumption and to encourage adoption of regular physical exercise, with the existing health system and partners working on hypertension.

The Prevalence of Hypertension and Associated Risk Factors among Secondary School Teachers in Bahir Dar City Administration, Northwest Ethiopia

Background

Hypertension is one of the noncommunicable cardiovascular diseases (CVDs), and its prevalence is rising in middle- and low-income countries. It is not given enough attention in the developing countries like Ethiopia. Not enough data and studies about hypertension are available in Ethiopia. This study aimed to determine the prevalence of hypertension and its associated risk factors among secondary school teachers in Bahir Dar city administration.

Methods

An institutional-based cross-sectional survey was conducted among secondary school teachers in Bahir Dar. Two hundred twenty-two randomly selected teachers were interviewed, and data related to the demographic, behavioral, health, and dietary characteristics of the individuals were recorded. Blood pressure data were taken. Logistic regression analysis had been used to assess independent risk factors for hypertension. p-values of less than 0.05 were considered statistically significant.

Results

The overall prevalence of hypertension in the study was 29.28%. Age 41 to 50 (AOR: 2.506; 95% CI: 1.103–5.694; and p=0.028), having self-reported diabetes mellitus (AOR: 8.595; 95% CI: 2.795–26.424; and p < 0.0001), having a family history of hypertension (AOR: 3.387; 95% CI: 1.579–7.285; and p=0.002), khat chewing (AOR: 5.426; 95% CI: 1.811–16.256; and p=0.003), physical inactivity (AOR: 5.212; 95% CI: 1.974–13.763; and p=0.001), and presence of self-reported repeated stress (AOR: 3.027; 95% CI: 1.404–6.527; and p=0.005) were the risk factors associated with hypertension.

Conclusions

Different intervention measures with a particular emphasis on prevention by introducing lifestyle modifications are highly recommended to mitigate and control hypertension.

Tea in the Morning and Khat Afternoon: Health Threats Due to Khat Chewing

Khat or qat (Catha edulis) is a flowering plant with an Arabic name قات, regularly named as qāt, also is known by various descriptive names, such as Abyssinian tea, Somali tea, Arabian tea, Miraa, Jima, and Kafta in its endemic regions of the Horn of Africa and the Arabian Peninsula. Fresh leaves and tops of khat are chewed or dried and consumed as a tea to attain a state of euphoria and excitement; it also has appetite-reducing effects. Traditionally, khat is used as a socializing habit in Yemen and is also widely cultivated because of its high income. However, in recent years the plant has been reported in England, Wales, Rome, Amsterdam, Canada, Israel, Australia, New Zealand, and the United States. Although it is believed that khat is a relatively low-risk drug, it's associated with an increased risk for various medical complications, including dental and oropharyngeal disease, gastrointestinal, cardiovascular, neuropsychiatric, obstetric, and even can be the cause of cancer. Our goal in this review article is to revise and determine the relationship between chewing khat and its health issues. Additionally, we tried to determine the mechanism involved in health hazards due to consuming the khat.

Undiagnosed Hypertension and Associated Factors Among Adults in Hawela Tula Sub-City, Hawassa, Southern Ethiopia: A Community-Based Cross-Sectional Study

Background

Hypertension (HTN) is a major public health problem and often it is unnoticed. Undiagnosed HTN may lead to a high burden of cardiovascular diseases and complications such as stroke and heart attack. In this study, we aimed to assess the prevalence and associated factors of undiagnosed HTN.

Methods

From February to June 2019, a community-based cross-sectional study was conducted on 383 randomly selected adults in Hawela Tulla Sub-city, Hawassa, southern Ethiopia. Data were collected by pretested questionnaires, and physical measurements of weight, height and blood pressure were collected through standardized procedures adapted from WHO STEPS survey tools. Data entry and analysis were carried out using SPSS version 23 statistical software. Descriptive analysis and logistic regression models were used to describe the results. Logistic regression analysis results were declared statistically significant if the P-value was below 0.05 and the 95% CI did not cross the null value.

Results

The prevalence of undiagnosed HTN among the respondents was 12.3%. Only 152 (39.7%) of the study population knew the symptoms of HTN. Males (adjusted odds ratio [AOR] =2.5, 95% CI: 1.2, 5.2; P=0.016), people with a family history of HTN (AOR=2.7, 95% CI: 1.0, 7.0; P= 0.044), people who chewed khat (AOR=4.6, 95% CI: 2.0, 10.2; P<0.001), overweight or obese individuals (AOR=3.5, 95% CI: 1.7, 7.3; P=0.001) and people with diabetes mellitus (AOR=3.2, 95% CI: 1.1, 9.3; P=0.036) had a higher risk of undiagnosed HTN than their counterparts.

Conclusion

Identification of people with the risk factors of undiagnosed HTN and delivering health education to reduce the risky behaviors could reduce the burden and consequences of HTN. Integrating interventions at the community level may be important.