Khat Consumption Research Articles

Acute coronary syndrome and Khat consumption in Yemeni women admitted to Coronary Care and Intensive Care in major hospital in Yemen

Background: There is a significant percent of normal coronaries in patients with a history of documented myocardial infarction among Yemeni patients who have undergone diagnostic coronary angiogram, and they theoretically attributed that to the effect of Khat as a vasoconstrictor to the coronary artery. Also, unadjusted comparisons of mortality and major morbidity after acute myocardial infarction have generally indicated that women have a poorer outcome than men. Methods: Data was collected prospectively from 15 hospitals in 8 governorates with acute coronary syndrome registry in the Gulf countries. All female patients who were admitted in any monitored bed in Coronary Care Units (CCU) or Intensive Care Units (ICU) with a provisional diagnosis of acute coronary syndrome (ACS) were included in the study. The presentations with khat chewing were compared with all other known and documented risk factor outcomes among women using multiple logistic regressions. Results There were 50.5% regular khat chewers of female patients at presentations to the general emergency department with an attack of acute coronary syndrome; 14.4% of all female patients have no other risk factors except khat. These patients were relatively younger and had a lower body mass index (BMI) when compared with the incidence of acute events in other populations. They had no significantly worse outcome during hospitalization in comparison to the males of the same age group. Conclusions It seems likely that there is at most only an intermediate association between Khat and the development of acute coronary syndrome in females, with less mortality and morbidity after suspected acute myocardial infarction. However, a larger study is needed, with more complete adjustment for coexisting risk factors, to determine whether the female has a worse outcome, which increases with khat.

The Potential Health Risks of Catha edulis Forsk (Khat) Consumption on Some Vital Organs

Abstract Introduction/Objective Introduction: Catha edulis Forsk (Khat) leaves are widely chewed by adults in the Arabian Peninsula and the Horn of Africa for their mild stimulating properties. Objectives To investigate the impact of an aqueous extract of Catha edulis Forsk leaves on the proper functioning of vital organs. Methods/Case Report Methods: Materials and methods: Twenty-five female albino rats were divided into two groups: a control group and a treated group which received a daily gavage of 1 ml of aqueous Khat extract with a concentration of 700 mg/kg body weight for four weeks. The effects of this treatment on selected organs, including the brain, hippocampus, heart, and ovaries, were assessed using various measurements and analyses. Results (if a Case Study enter NA) Results: Results: The antioxidant evaluation showed a significant increase in MDA levels in the khat group and a significant decrease in GSH, SOD, and CAT levels compared to the control group. There was a significant decrease in IL-4 and a significant increase in TNF-α and TGF-β1 compared to the control group. In contrast, the cardiac enzymes; Troponin, CK, CPK, and GOT showed a significant increase compared to the control group. The results of the hormonal assay indicated a significant increase in LH, FSH, and testosterone levels, along with a significant decrease in estrogen in the khat group compared to the control group. Furthermore, the histological investigations revealed significant changes in tissue architecture in the studied organs. In the heart, the treated group exhibited an intact, thick pericardium, along with markedly apoptotic cardiac muscle fibers and others with pyknotic nuclei and mildly congested blood vessels and capillaries. The examination of brain tissues in the treated group showed thick meninges with mild inflammatory infiltrate, marked astrogliosis with degenerated neurons in the cerebral cortex, inflammatory infiltrate with abscess formation and mildly congested blood vessels and eosinophilic plaque-like area in the deep cortex, and scattered degenerated neurons and some neurons with nuclear vacuoles and average glial cells in the white matter. In the ovaries, sections showed primary, secondary, and antral follicles, scattered cystically dilated follicles with atrophied lining, and multiple corpora lutea in the edematous stroma with scattered apoptotic stromal cells. Conclusion Based on these findings, long-term use of khat as a chewing material may harm vital organs.

Drug Abuse and Mental Illness in Erigavo Mental Hostiptal, Erigavo, Somalia

Mental illness is an international health crisis that puts the lives of over three hundred million people (Four percent of the world’s population) at risk. The study was conducted at the Erigavo Mental Hospital in Somaliland and its main focus was the bond between substance abuse and mental illness. The research was to check the influence of the different drugs, screen mental health problems, and draw a link between drugs and mental illness. The sources of the quantitative data were a total of 27 employees and managers. This study is cross-sectional. We employed the measure of the magnitude and direction of a linear relationship between two variables with the Pearson correlation coefficient. The outcomes that were acquired show that there was use and particularly abuse of khat, substance smoking, and alcohol consumption, the score means of which were quite high. The investigation results, however, imply that through drug use and other forms of alcohol drug abuse, one of them counter various mental health problems. Furthermore, the addicted people demonstrated the tendency to use force in their attempt to solve the conflicts and to experience the highest degree of tension, with the mean score of the former giving 4.11 while the standard deviation of the latter giving 1.086, thus this shows the mental impact of drug use on the inhabitants of Erigavo. The main result of the study was the strong, positive relationship between drug addiction and mental illness, which became evident through an r - value of 0.509 and a p - value of 0.559. It means that those people who are involved in drug misuse are the ones who are likely to have mental health disorders. Based on the findings of the study, we suggest a combination of measures to recover drug addiction and mental illness. This consists in strengthening prevention. The study that lays the groundwork for suggestions, involves an approach that is holistic in nature. The main ideas of preventing drug usage, psychological health care, enhancing mental health services, and working towards certified professionals are key integrated activities of the whole concept. The hospital, thus, will be in a better position to eliminate the two major disease components namely; drug abuse and mental ailment. Thus, in this way, with the help of the new treatment approaches, a hospital provides and their patients who are quite likely to recover and lead healthy.

The analysis of the essential metal contents in khat (Catha edulis Forsk) from Meru County, Kenya

BackgroundChemical composition of plants has attracted considerable interest in recent years with considerable research tailored into determining metal contents in food substances. Particularly, essential elements which are necessary for normal human body functioning and are strongly recommended in optimal proportions for better health. This study determined the levels of essential elements; calcium (Ca), magnesium (Mg), sodium (Na), potassium (K) and manganese (Mn) in eleven khat (Catha edulis Forsk) samples collected from Meru County. Methodology1.0 g of dry ground khat samples were wet-digested in a solvent mixture of 10 mL of HCl, HNO3 and 20 vol of H2O2 for 3 h at variable temperature of 50–90 °C and later reconstituted in 25 mL 0.05 molL−1 HCl before analysis. The samples were analyzed using inductively coupled plasma atomic emission spectrometry (ICP AES) after acid digestion whereas Hierarchical cluster analysis (HCA) and principal component analysis (PCA) were used to investigate elemental characteristics and determine the sources of essential metals in khat. In addition, Pearson correlation coefficient (PCC) was used to evaluate the relationships between the essential metals. ResultsSpinach leaves certified reference material (CRM 1750a) was analyzed and the percentage recoveries (%) of 98.4 and 101.7 determined showing that the digestion method employed in this work had adequate accuracy. The validated method was employed for the analysis of all the khat samples. The analyzed metal concentration ranges (mg100g−1) in fresh-weight basis per day of five metals were 160.9–267.3, 44.6–81.7, 2.0–3.0, 237.6–393.6, and 220.3 -349.0 for Ca, Mg, Mn, K, and Na, respectively. Both HCA and PCA results showed that these elements could be linked to natural soils and anthropogenic sources. PCC reported significant correlations between Na and K indicating they may have been derived from the same source. The daily metal intakes were below the World Health Organization (WHO) permissible limits implying no associated health risks for khat users. ConclusionBased on the findings of this study, the consumption of khat from regions of Meru County may be a potential source for essential elements required for human biological processes.

From traditional to transactional: exploration of khat use in Ethiopia through an interpretative phenomenological analysis

Khat, a naturally growing stimulant, has seen a significant increase in both consumption and cultivation in eastern Ethiopia. This reliance on khat in the region comes despite its known physiological complications, with users unable to restrict khat use due to its pervasive impact on their livelihood. This qualitative study sought to understand the meaning that those in eastern Ethiopia attribute to khat and explore their firsthand experiences with the substance. In June and July of 2023, six unstructured interviews were conducted among residents of the Haramaya District in Ethiopia. To promote a holistic comprehension of the participants’ lived experiences, an interpretative phenomenological analysis approach was employed when collecting and analyzing the data. Participant responses were coded independently from one another by two different researchers identifying superordinate and corresponding subordinate themes. Among the participants, six superordinate themes were captured: economic backbone of the region, market disruption & fluctuation, pesticide use, societal relationships around khat, applications of khat, and access to healthcare. The participants’ responses indicated that the normalization of khat use, coupled with the downplaying of its addictive potential, has established a framework where khat consumption is not only allowed but, in some cases, even encouraged. The unique interplay between communal practice and individual preservation creates a cyclical effect of using khat to supplement energy to farm khat and then sell or stimulate further work on their farm. This study illuminates the transitionfrom what was once the traditional or spiritual use of khat, to a more practical use for ensuring economic livelihood.

Prevalence and Factors Associated with Regular Khat Chewing Among College and University Students in Harar Town 2024

Background: Khat (Catha edulis) is an evergreen shrub that is a natural stimulant native, planted and chewed in eastern through southern parts of Africa and the Arabian Peninsula with distribution in parts of the Middle East and on the island of Madagascar. Khat chewing is becoming a common practice and great concern in university and college students because they think that it helps increase their academic performance especially during exams and for recreational purposes. It is widely understood that the consumption of Khat creates a remarkable problem for today’s youth which is not limited to individual users; rather its adverse negative consequence is believed to be challenging to a family, the community as a whole, economy and political arena of a given nation. Objective of the Study: To assess Prevalence and factors associated with regular khat chewing among college and university students in Harar town 2024. Methodology: Facility based cross sectional study was conducted in Harar Town from December 13 up to 29, 2023 on selected university and colleges. A total sample of 371 students was including on the study. Data was collected through structured questioner. Training was given for data collectors and data evaluation done on daily based. Cleaned data were entered to SPSS version 20 and multiple logistic regression analysis was used for better prediction of determinants and to reduce bias due to confounders. Those variables with P-value < 0.20 was entered in to multiple logistic regression analysis. Associations with P - value less than 0.05 was declared as statistically significant. Result: The Prevalence of khat chewing on this study was 57.4%. In multivariable analysis marital status, religion, Peers who chew khat, peers who smoke cigarette, students whose lives in rented house, Smoke cigarette while chewing chat, currently drink alcohol were associated with outcome variables. Conclusion and Recommendation: Majority of students was khat chewers for a long period of time and there also start chewing before their joining university and or college. Peer pressure, living condition and alcohol usage were significant predictors of khat chewing therefore to alleviate this problem effort on preventive measure is need by all stake holders at different levels.

Khat use and related determinants among pregnant women within Haramaya, Ethiopia: a mixed methods study.

Khat, a green leafy plant grown in East Africa and throughout the Arabian Peninsula, is chewed for its psychoactive and amphetamine-like effects, serving as a significant aspect of culture, economic livelihood, and global trade. Khat consumption during pregnancy has been associated with adverse effects, including anemia, premature rupture of membranes, and low birth weight, among others. This cross-sectional, explanatory sequential mixed methods study was conducted in the Haramaya District of eastern Ethiopia using a questionnaire and focus group discussions. Questionnaires assessed socio-demographic information, pregnancy history, and diet, including khat use. Data were analyzed using SPSS v28 to include descriptive statistics, proportions, odds ratios, binary logistic regression, and chi-square analysis. FGDs expanded on the knowledge, attitudes, and practices of khat in the region, including pregnant or lactating women from two different kebeles. Two independent reviewers conducted a qualitative content analysis to examine the qualitative findings from the FGDs. Transcripts from the focus groups were entered into NVivo 14 to aid in capturing salient themes. A total of 444 pregnant women with a median age of 25 years completed the questionnaire. Two-thirds of the women, 66.9%, reported currently consuming khat while pregnant, and 72.7% of them reported daily consumption. The FGD analysis resulted in the discovery of five themes: Economic Livelihood, Maternal Significance, Medicinal Implications of Khat, Pesticide Use, and Social and Cultural Applications. This study revealed an alarming high prevalence of khat consumption among pregnant women in the Haramaya District, highlighting the pressing need for long-term studies to assess the health consequences. The role of khat as both an economic staple and an energy source for daily activities underscores the challenges in curbing its use. The documented health risks associated with the chemicals used in khat cultivation, including cancer, call for interventions to enhance safe agricultural practices in households involved in khat farming.

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

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. 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. 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%. 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.

Understanding Khat: Its Sociocultural and Health Implications in Saudi Arabia.

This review offers an insight into the historical background, utilization, chemical composition, health impacts, processes, and cultural aspects associated with the usage of khat, a psychoactive, mind-altering plantindigenous to the Arabian Peninsula and the Horn of Africa. It further explores the cultural importance of khat in nations such as Saudi Arabia, Yemen, Ethiopia, and Somalia, detailing its chemical makeup containing alkaloids and other compounds, its physiological impact on the body, and its potential health risks like cardiovascular complications, mental health disorders, and dental problems. The cultural, economic, and religious aspects that affect perceptions and consumption of khat were also considered while emphasizing its usage despite legal bans in many nations.

Maternal and household factors affecting the dietary diversity of preschool children in eastern Ethiopia: a cross-sectional study

ObjectiveInvestigate the association between the dietary diversity of preschool children and proximate factors including household food insecurity, maternal food choice, preferences, khat use, and levels of depressive symptoms.DesignCross-sectional survey of...

An investigation of the Catholic Church’s viewpoint on miraa production and consumption in Igembe Deanery, Meru Diocese

The study sought to investigate the Catholic Church’s viewpoint on miraa production and consumption in Igembe Deanery, Meru Diocese, Kenya. The study employed a descriptive research design. Data were obtained from oral interviews, focus group discussions, questionnaires, primary and secondary sources, and participant observation to ensure the study's validity and reliability. The study was based on the Structural-Functionalism and Social Conflict theory in order to establish the viewpoint of the Catholic Church on miraa production and usage in Igembe Deanery despite the CC policies on drugs of all kinds except on therapeutic grounds. A sample of 348 of the 3614 church members in Igembe Deanery was chosen for the study. Ten (10) priests, eight (8) catechists, ten (10) elders, ten (10) farmers, ten (10) traders and three hundred (300) church members from sampled parishes of Igembe Deanery were used as key informants. Descriptive statistics such as frequency, percentages, tables and the mean were used in analysing data. The Statistical Package for Social Sciences (SPSS) 27.0 was used to analyse the data. This study’s findings were that the Catholic Church in Igembe Deanery, Diocese of Meru, views miraa as the main source of livelihood for Christians, and miraa's economic, socio-cultural, religious, and educational functions are the main reasons for the Catholic Church in Igembe Deanery to accept Khat's production and consumption. This study recommends that the church in Africa needs to enhance efficient and effective Christianity by enhancing the inculturation of Christianity in Africa.

Khat consumption as a modifiable risk factor for chewing dystonia

Abstract Chewing dystonia, a variant of focal task-specific dystonia, is a rarely reported condition that causes remarkable decrement in quality-of-life, social embarrassment, and associated mental stress. In this article, we present two case studies that extend previous observations, which indicate a putative association between khat (Catha edulis) consumption and chewing dystonia. While pharmacological treatments such as botulinum toxin injections may be an option, a substantial proportion of affected individuals do not achieve optimal outcomes. If preventable, a medical condition ought to be prevented. The observations presented in the two case studies discussed indicate that khat consumption may be a modifiable risk factor for chewing dystonia.

Changes in Glial Fibrillary Acidic Protein-Immunoreactive Astrocytes in the Prefrontal Cortex of the Male Rat following Chronic Khat Use.

Long-term khat consumption is associated with significant neurocognitive changes, which have been elucidated in behavioral studies. With current research showing the centrality of astrocytes and other glial cells in neuronal signaling, there is possibility that these cells are also affected by chronic khat use. There is little literature on the structural changes in the prefrontal cortex neuronal and astrocytic cytoarchitecture and morphometry in chronic khat users. The objective of this study was to describe the changes in astrocyte morphometry and structure in rats after long-term use of khat (miraa). Adult male Wistar rats, aged 2-3 months, weighing 200-300 g were randomized into four groups of 10 each (control, Group 1, Group 2, and Group 3) to correspond with those used as controls and those that received 500 mg/kg, 1000 mg/kg, and 2000 mg/kg body weight khat extracts, respectively. Fresh khat leaves were purchased from Maua market in Meru, and crude extract was prepared using lyophilization. The control rats were fed on normal diet, while the experimental groups were fed on normal diet and khat extracts using oral gavage for 6 weeks. The animals were sacrificed and their brains were removed. We performed immunohistochemical visualization of astrocytes using glial fibrillary acidic protein. Photomicrographs of the stained sections were transferred to ImageJ Fiji software to study the astrocyte density and astrocytic processes. We used Kruskal-Wallis test to correlate the four animal groups in terms of astrocyte densities. We observed an increase in the average number of astrocytes with increasing doses of khat compared to controls, with those in Group 3 (2000 mg/kg) having an exuberant reactive astrocytosis. Further, escalating khat doses resulted in increased glial fibrillary acidic protein immunoreactivity in the nuclei and astrocytic processes, gliotic changes, and increased complexity of astrocytic processes. Chronic khat use, especially at high doses, results in reactive astrocytosis and astrogliosis, which may be part of the mechanisms involved in the cognitive changes associated with its use.

Prevalence and risk factors for tobacco, khat, and alcohol consumption among high school students in Ethiopia

BackgroundTobacco, khat, alcohol, and marijuana are the main risk factors for non-communicable diseases. There are limited studies on substance use in Ethiopia, especially among secondary school students. This study aims to determine the epidemiology of substance use among secondary school students in Ethiopia.MethodsThis cross-sectional study was conducted in March 2020 in four large regions of Ethiopia and the capital Addis Ababa. We collected data from 3,355 grade 9 and grade 10 students in 36 randomly selected high schools. Data were collected on tobacco, khat, alcohol and other substances. Mixed effect logistic regression models were fitted to determine the predictors of cigarette smoking.Results157 (4.7%) of the participants ever smoked cigarettes and 81 (2.4%) were current smokers. 106 (3.2%) ever used smokeless tobacco, 1,342 (41.8%) had ever drunk alcohol, 290 (8.7%) ever used khat, 137 (4.8%) chewed khat regularly and 76 (2.3%) ever used marijuana. There was a significant regional variation in substance use patterns; cigarette and khat use was the highest in southern regions, whereas alcohol use was highest in the northern areas. Availability of cigarette and khat shops within a 100-meter radius of the school compound was reported by 1,229 (37.5%) and 816 (25%) students, respectively. Three hundred fifty-four (10.9%) students had ever seen someone smoking a cigarette in the school compound. Ever use of smokeless tobacco (Adjusted Odds Ratio (AOR) = 9.4, 95%CI: 4.9–17.9), ever use of shisha (AOR = 8, 95% CI: 3.9–16.3), ever use of khat (AOR = 4.1, 95%CI: 2.5–6.8), ever use of alcohol (AOR = 2.3, 95%CI: 1.4–3.7), having a friend who smoked a cigarette (AOR = 2, 95%CI: 1.2–3.5), and ever seen someone smoking a cigarette in the school compound (AOR = 1.9, 95%CI: 1.1–3.4) were associated with ever use of cigarettes.ConclusionSubstance use prevalence in Ethiopia has regional variations and prevention strategies should be tailored to the needs of the regions. Although this study reported a lower prevalence of cigarette smoking, students could access cigarettes and khat in nearby school areas. The existing tobacco control laws that prohibit selling tobacco products to children and adolescents under 21 years of age and ban establishing tobacco shops close to school compounds should be enforced.

The effects of khat use during pregnancy on perinatal and maternal outcomes: a meta-analysis.

Chewing khat during pregnancy adversely affects maternal and fetal health, but available studies are scarce and inconsistent, and it is difficult to conclude the relationship between khat consumption and perinatal outcomes. We aimed to investigate the available studies on the effect of khat use during pregnancy on perinatal and maternal outcomes. For this meta-analysis, we conducted a thorough search of articles published in PubMed, Embase, Scopus, and Web of Science up to the date this search was undertaken (03.01.2022). We used random effect model with the Mantel-Haenszel method to calculate the pooled odds ratio and mean difference. We found that khat use during pregnancy was significantly associated with increased odds of low birth weight (OR:2.51; 95% CI: 1.60 to 3.94), congenital anomalies (OR:3.17; 95% CI: 1.30 to 7.73), premature rupture of membrane (OR: 1.99; 95% CI: 1.59 to 2.50), perinatal mortality (OR: 1.95; 95% CI: 1.26 to 3.03), and lower APGAR scores at the fifth minute (MD: -1.7; 95% CI: -2.32 to -1.07). Also, increased odds for developing maternal psychological stress and anemia were reported in women using khat during pregnancy. There were no statistically significant differences in stillbirth and preterm birth between women using khat during pregnancy and their counterparts. Since prenatal khat use is associated with adverse perinatal and maternal outcomes, we strongly recommend equitable and easily accessible health services through the implementation of integrated addiction treatment with maternity services to address khat use during pregnancy and encourage the practice of healthy behavior of women.

Socioeconomic, Health, and Missiological Implications of Khat in East Africa

Background: Khat is a stimulant plant widely cultivated in East Africa and Yemen. Millions of people chew khat habitually to satiate their cravings for it. The plant generates a very high income for millions of farmers and East African governments. This study explored the economic, social, and health implications of khat use and its missiological implications.
 Method: This study used a qualitative approach to explore the effects of khat consumption in East Africa. Secondary data and interviews were the main sources of data. The study participants comprised Seventh-day Adventist pastors and other church members from Kenya and Ethiopia. 
 Results: Khat chewing and production have significant socioeconomic and health implications in East African communities. Moreover, khat production and consumption negatively affect the mission of Seventh-day Adventists in the region.
 Conclusion: Based on the results, several suggestions are provided to address the dangers of khat cultivation and consumption.

Socioecological predictors of breastfeeding practices in rural eastern Ethiopia

BackgroundEstimates by the World Health Organization indicate that over 800,000 global neonatal deaths each year are attributed to deviations from recommended best practices in infant feeding. Identifying factors promoting ideal breastfeeding practices may facilitate efforts to decrease neonatal and infant death rates and progress towards achieving the Sustainable Development Goals set for 2030. Though numerous studies have identified the benefits of breastfeeding in reducing the risk of childhood undernutrition, infection and illness, and mortality in low- and middle-income countries, no studies have explored predictors of breastfeeding practices in rural eastern Ethiopia, where undernutrition is widespread.The aim of this study is to examine predictors of infant feeding practices in Haramaya, Ethiopia, using a multi-level conceptual framework.MethodsThis study uses data collected from household questionnaires during the Campylobacter Genomics and Environmental Enteric Dysfunction (CAGED) project among 102 households in the Haramaya woreda, Eastern Hararghe Zone, Eastern Ethiopia, and investigates factors influencing breastfeeding practices: early initiation, prelacteal feeding, and untimely complementary feeding.ResultsNearly half (47.9%) of infants in this study were non-exclusively breastfed (n = 96). Generalized liner mixed effects models of breastfeeding practices revealed that prelacteal feeding may be a common practice in the region (43.9%, n = 98) and characterized by gender differences (p = .03). No factors evaluated were statistically significantly predictive of early initiation and untimely complementary feeding (82% and 14%, respectively). Severely food insecure mothers had more than 72% lower odds of early breastfeeding initiation, and participants who self-reported as being illiterate had 1.53 times greater odds of untimely complementary feeding (95% CI, [0.30,7.69]) followed by male children having 1.45 greater odds of being untimely complementary fed compared to female (95% CI,[0.40,5.37]).ConclusionsThis study found high rates of prelacteal feeding and low prevalence of exclusive breastfeeding, with girls more likely to be exclusively breastfed. While no predictors evaluated in this multi-level framework were associated with prevalence of early initiation or complementary feeding, rates may be clinically meaningful in a region burdened by undernutrition. Findings raise questions about gendered breastfeeding norms, the under-examined role of khat consumption on infant feeding, and the complex factors that affect breastfeeding practices in this region. This information may be used to guide future research questions and inform intervention strategies.

Reducing Khat use among Somalis living in Kenya: a controlled pilot study on the modified ASSIST-linked brief intervention delivered in the community

BackgroundDuring 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.MethodsIn 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.ResultsSBI 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.ConclusionThe 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 registrationClinicalTrials.gov identifier: NCT02253589. Date of first registration 01/10/2014, retrospectively registered https://clinicaltrials.gov/ct2/show/NCT02253589. First participant 16/09/2014:

S1326 Characteristics of Individuals Receiving Hepatitis B Treatment in Ethiopia: 18-Month Follow-Up

Introduction: Hepatitis B virus (HBV) infection is a major risk factor for hepatocellular carcinoma (HCC) in Africa with higher morbidity and mortality. This is in part due to disparities in access to viral treatment. We aimed to identify characteristics of individuals who were treated versus untreated for HBV in Ethiopia. Methods: We identified HBsAg positive patients in a referral clinic in Addis Ababa, Ethiopia starting in January 2020. Clinical, laboratory and demographic data were obtained during clinic visits at baseline, 6, 12, 18 months, and recorded in REDCap. The study was approved by the institutional review board of Addis Ababa University. Analyses were performed using Chi-squared test, with p values < 0.05 considered significant. Results: 150 HBsAg-positive patients were included: 51 treated and 99 untreated for HBV. At baseline, the treated group was more likely to be male (86%, n=44), reported higher quantity of coffee use (p< 0.05), and had higher median AST (36 vs. 27 IU), ALT (32 vs. 26 IU), and HBV DNA (25,921 vs. 389 IU/ml) compared to the untreated group. Median age was similar between both groups (35 vs 34 years). Interestingly, the treated group reported a higher level of education (56% vs 42%, p=0.19). The treated group also had higher APRI (median 0.54 vs. 0.31) and FIB4 scores (median 1.79 vs 0.85), likely relating to treatment decision. Treated individuals were more likely to have baseline ascites (p< 0.01) and abnormalities on liver ultrasound (p< 0.01). Untreated individuals reported more alcohol (5% vs 0%, p=0.1) and khat use (9% vs 0%, p=0.08). At 6 and 12 months, those treated showed a decrease in AST, ALT, FIB4 and APRI scores, with 1 case of HCC reported in that group. HCC developed in 4% (n=4) of the untreated group during the same time. At 12 months (n=55 with follow up), 44% of the untreated group had initiated treatment, and 35% had abnormal ultrasound findings. Interestingly, at 18 months, 30 patients (30%) in the untreated group followed up, whereas only 1 patient (2%) of the treated group followed up. Median APRI and FIB4 at 18 months for those untreated were 0.56 and 1.06 respectively. Conclusion: Our data from Ethiopia show that individuals on HBV treatment were more likely to be male, and have higher baseline lab findings. Those untreated showed more liver-unhealthy habits such as alcohol and khat consumption and less coffee intake. Untreated individuals developed more HCC at follow up. Interestingly, they were more likely to follow up at 18 months.

Changes in normal and apoptotic pyramidal neuronal cell densities in prefrontal cortex of the male rat following chronic khat use

Long-term Khat consumption is associated with significant neuro-cognitive changes, which have been elucidated in behavioral studies. However, correlation of these neurophysiological changes with experimental structural changes in prefrontal neurons has not been described adequately. Young adult male Winstar rats, aged 2-3 months, weighing 200-300 grams were randomized into four groups of 11 each to correspond with those used as controls, those that received 500mg/kg, 1000mg/kg and 2000mg/kg body weight khat extracts respectively. The control rats were fed on normal diet, while experimental groups were fed on normal diet and khat extracts using oral gavage for 6 weeks. The animals were sacrificed, and their brains removed. Toluidine blue staining was used to elucidate the Nissl substance. Image-Fiji was used to analyse densities of normal and apoptotic pyramidal neuronal densities across the 4 experimental groups. Normal pyramidal neurons were identifiable by their characteristic uniform size and prominent nucleoli, while apoptotic cells displayed prominent eosinophilia and pyknotic nuclei. There was a statistically significant increase in apoptotic pyramidal neurons across the three khat-fed groups compared to controls, and a decrease in normal pyramidal neuronal population from controls with increasing doses of khat. This decrease in normal pyramidal neurons and increase in apoptosis could be a potential surrogate for neurocognitive perturbations associated with chronic khat use.