Khat Use Research Articles

Phenotypic characterization of selected Kenyan Khat (Catha edulis) cultivars based on morphological traits

Khat (Catha edulis Vahl) is an evergreen shrub habitually ingested for its euphoric and stimulatory effects. The crop is grown in the Middle East, Somalia, East Africa and Ethiopia. It is referred to as Miraa in Kenya, while in Yemen it has several names like Qat, Kat, Kath, Gat, Chat and Tschat. It belongs to the sub-order Rosidae, family Celastraceae and characterized by astringent taste. Despite the daily use and consumption of khat by millions of people in Kenya, little is known about its phenotypic. Phenotypic characterization is an essential approach for assessment of khat diversity; however, it is limited by morphological plasticity and multiple lineage evolution. The study aimed at evaluating the phenotypic diversity of selected khat cultivars grown in Embu and Meru Counties. Ninety samples from 18 cultivars were collected for phenotypic characterization. MINITAB 17 Software was used for description of principal component and construction of dendrogram using the Euclidean distance tool where 58.7% variability was observed among 13 traits studied in 90 samples of khat. Phenotypes grouped into 2 clusters phenotypic diversity showed considerable variability based on 13 khat traits. This will be useful in breeding and characterization programmes of khat cultivars. Key words: Phenotypic, khat, diversity, cultivar.

Determinants of alcohol use among people living with HIV initiating isoniazid preventive therapy in Ethiopia

BackgroundHepatotoxicity, an adverse effect of isoniazid preventative therapy (IPT), is exacerbated by alcohol consumption. Although the WHO recommends IPT for people living with HIV (PLHIV), it is contraindicated in regular alcohol users. The objective of this study was to identify the prevalence and determinants of alcohol use among PLHIV initiating IPT in Ethiopia. MethodsBaseline data (July 2013-May 2015) from 316 participants in the Enhance Initiation and Retention in IPT Care for HIV (ENRICH) study were used to assess the prevalence of alcohol use. Multinomial logistic regression was used to identify determinants of non-hazardous and hazardous alcohol use, compared to no alcohol use. ResultsOverall, 41.8% of participants reported alcohol use, of which 45.5% reported hazardous use. Compared to non-alcohol users, hazardous users were younger (adjusted odds ratio [AOR]: 1.06; 95% confidence interval [95% CI]: 1.02, 1.11), more likely to be male (AOR: 6.40; 95% CI: 3.17, 12.93), Orthodox (AOR: 3.96; 95% CI: 1.74, 9.00), have larger support networks (AOR: 3.82; 95% CI: 1.61, 9.06), and report greater amount (AOR: 14.80; 95% CI: 5.76, 38.02) and frequency (AOR: 5.91; 95% CI: 2.75, 12.67) of khat use. ConclusionsAlcohol use was prevalent in this population, and current WHO guidelines would exclude a substantial proportion of the population from receiving IPT. PLHIV in this region would benefit from routine screening for alcohol and khat use, and from substance use education and counseling while receiving IPT until it can be determined whether alcohol users can safely receive IPT.

Khat Use and Its Impacts on Students’ Various Aspect in Higher Educational Institutions:The Case of Mizan -Tepi University, Ethiopia

Khat chewing is one of the many maniples of drop-adjure or drug addiction. It becomes one experiential aspect of some section of society especially, the youth. Khat chewing is not uncommon among students in higher educational institutions particularly among university students. Now days, it has become a habit of significant number of students in higher educational institutions . This research is aimed at assessing impacts of Khat use among students of higher educational institutions the case of Mizan- Tepi University, Ethiopia. The research is a cross-sectional study; aimed at collecting data at one point in time and describing the study population rather than showing the patterns of change which might be witnessed over time. Key informant interviews, focus group discussions, in-depth interviews and observation used as data collection techniques. The study subjects were selected purposively/ judgmental under non-probability sampling procedure. Qualitative information recorded on notebook from FGDs, conversations with key informants, and in-depth interviews were organized and constructed coherently, analyzed descriptively- word description / sentence form. Findings of this research show that Khat use has enormous impact on student’s various aspects. Although it is believed that Khat use plays a role in making students alerted and focused during long study hours, the overall result of this study shows Kaht use has negative impact on various aspects of students. The impacts can be categorized as Economic, Social, and health related, psychological impacts and impact on students’ educational performance. Khat, Khat use, impacts, educational performance DOI : 10.7176/RHSS/9-15-02 Publication date : August 31 st 2019

Factors affecting tobacco smoking in Ethiopia: evidence from the demographic and health surveys

BackgroundTobacco smoking is growing at an alarming rate in the developing world and sub-Saharan Africa. Although Ethiopia has a relatively low rate in the region, it is not immune to the tobacco epidemic. The government of Ethiopia passed an anti-tobacco bill in 2015 that includes measures governing tobacco consumption, advertising, packaging, and labeling. To effectively address the challenge of tobacco control, the government should consider a number of aspects of tobacco production and consumption, such as local production in rural areas, as well as the complementarity nature of tobacco and khat use.MethodsUsing the World Bank’s Demographic and Health Surveys (2011 and 2016), this paper analyzes the key determinants of tobacco smoking in Ethiopia, emphasizing possible differences in various social contexts, across regions. More specifically, we assess the association between khat use and tobacco smoking while controlling for various observed individual-level, household-level, and community-level covariates. Using GPS data, we are able to capture the neighboring effects of smoking behavior in community clusters bordering other administrative regions as well as differences in smoking patterns between lowland and highland residents. We utilize a multilevel modeling framework and use a two-stage residual inclusion estimation method that accounts for the endogeneity of khat and tobacco use.ResultsThe results suggest that chewing khat and geographic regions are statistically significant determinants of tobacco smoking even after controlling for various socioeconomic and demographic factors. Altitude information analysis suggests that people living in lowlands are more likely to smoke compared to those living in highland areas. Additional analysis including interactions between regions and khat use indicate wide inter-regional variations in tobacco smoking by khat users. We also extend our analysis by interacting khat use with religious adherence. Results indicate a wide variation in tobacco smoking by khat chewers across different religious groups.ConclusionsTo effectively control tobacco smoking of the diverse communities in Ethiopia, policymakers should consider a multi-pronged policy approach that combines various policy tools that account for regional variation, the local social contexts, as well as the complementary nature of smoking and khat chewing practices.

Khat use and psychotic symptoms in a rural Khat growing population in Kenya: a household survey

BackgroundKhat is an amphetamine like psychostimulant chewed by over 10 million people globally. Khat use is thought to increase the risk of psychosis among its chewers. The evidence around this however remains inconclusive stemming from the scanty number of studies in this area and small study sample sizes. We undertook a large household survey to determine the association between psychotic symptoms and khat chewing in a rural khat growing and chewing population in Kenya.MethodsFor this cross-sectional household survey, we randomly selected 831 participants aged 10 years and above residing in the Eastern region of Kenya. We used the psychosis screening questionnaire (PSQ) to collect information on psychotic symptoms and a researcher designed sociodemographic and clinical questionnaire to collect information on its risk factors. We used descriptive analysis to describe the burden of khat chewing and other substance use as well as rates and types of psychotic symptoms. Using a univariate and multivariate analyses with 95% confidence interval, we estimated the association between khat chewing and specific psychotic symptoms.ResultsThe prevalence of current khat chewing in the region was at 36.8% (n = 306) with a male gender predominance (54.8%). At least one psychotic symptom was reported by 16.8% (n = 168) of the study population. Interestingly, psychotic symptoms in general were significantly prevalent in women (19.5%) compared to men (13.6%) (p = 0.023). Khat chewing was significantly associated with reported strange experiences (p = 0.024) and hallucinations (p = 0.0017), the two predominantly reported psychotic symptoms. In multivariate analysis controlling for age, gender, alcohol use and cigarette smoking, there was a positive association of strange experiences (OR, 2.45; 95%CI, 1.13–5.34) and hallucination (OR, 2.08; 95% C.I, 1.06–4.08) with khat chewing. Of note was the high concurrent polysubstance use among khat chewers specifically alcohol use (78.4%) and cigarette smoking (64.5%).ConclusionsPsychotic symptoms were significantly elevated in khat users in this population. Future prospective studies examining dose effect and age of first use may establish causality.

Khat abusing: Effect of Educational Program about Khat Abusing on Self-Care Adherence for Diabetic Patients in Sana'a, Yemen Republic

Yemeni diabetic patients believe that khat chewing helps to lower their blood glucose. Different studies suggested that substance use especially khat chewing in diabetic patients is associated with poor adherence to treatment and outcomes, resulting in mortality and morbidity. Health professionals require greater awareness of khat use and related health problems. The aim of the study was to explore the effect of educational program about khat abusing on Self-Care Adherence for diabetic patients in Sana'a, Yemen Republic. Subjects and Methods: The total number of selected adults diabetic patients abusing khat both male and female attending to educational program in outpatient diabetic center of Al Thawra Modern General Hospital at Sana'a, Yemen Republic from September 2014 until the end of July 2015 were 116. Tools: Patient Assessment Questionnaire, Adherence to Self-care scale and Severity of Dependence Scale-Khat were utilized for data collection. Results: There was a strong improvement in Self-Care Adherence p<0.001** and there was negative statistically significant correlation between self-care adherence level and Severity of Dependence Scale-khat score (Pearson coefficient r = -.251*, p< 0.012). Conclusion: there was improvement of Self-Care Adherence for less addicted and there was negative relation between the level of khat abusing dependence and self-care adherence.

Epidemiology of khat (Catha edulis) consumption among university students: a meta-analysis

BackgroundKhat is amphetamine-like substance commonly consumed by students when they wish to study for long hours especially during examination periods. Khat consumption is associated with increased rates of cardiovascular problems, stroke, myocardial infarction, cardiomyopathy, periodontal disease, gastritis, poor oral hygiene, psychosis, decreased quality of life, and poor academic performance.MethodsPubMed, EMBASE, and SCOPUS were systematically searched without restriction by publication status. Publications were screened according to predefined inclusion criteria. Twenty-five articles were included. Random effect model was used to calculate weighted prevalence, odds ratio (OR) and corresponding 95% confidence interval (CI). We assessed the risk of publication bias by using funnel plot and Eggers’s regression tests.ResultsThe pooled prevalence of current khat use among university students was 14.16% (95% CI; 11.87–16.81). The pooled prevalence of current khat use was highest in Saudi Arabia 18.85% and it was 13.59% in Ethiopia and 13.04% in Yemen. In addition, the current pooled prevalence of khat use was higher in men at 19.26% than in women 6.41%. Regarding lifetime khat use, in this study, the pooled prevalence of lifetime khat use was 27.31%. The lifetime prevalence was higher in men at 31.47% than in women 11.79%. Moreover, the lifetime prevalence of khat use was 43.27% in Yemen, 37.32% in Saudi Arabia, and 24.82% in Ethiopia. We found significantly increased odds of current (OR 3.59; 95%CI 2.01–6.41) as well as lifetime (OR 3.48; 95%CI 2.09–5.78) khat chewing in men as compared to women.ConclusionThe pooled prevalence of current and lifetime khat consumption was 14.16 and 27.31%, respectively. Both the current and lifetime prevalence of khat use was higher in men than in women. In addition, both the current and lifetime prevalence estimates of khat consumption were low in Ethiopia than in Saudi Arabia. Moreover, the odds of both current and lifetime khat consumption were higher in male students than in female students. Programmes that specifically aim at increasing awareness and that most motivate reduced khat consumption among university students were recommended.

Co-occurring medical and substance use disorders in patients with schizophrenia: a systematic review

Comorbid medical and substance use disorders are common in people with schizophrenia. The aim of this systematic review was to summarize evidences on co-occurring medical and substance use disorders (SUDs) in patients with schizophrenia. A Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) review was conducted. Medline, CinAHL, Embase, PsycINFO, and the Cochrane Library were searched to August 31, 2016 without restriction by publication status. Publications were screened according to predefined inclusion criteria. Qualitative analysis was undertaken for this systematic review. Twenty-six materials published from 1990 to 2015 were included in a qualitative analysis. From a total of 202 articles identified, 26 articles were eligible for systemic review. The evidence shows that 18.5 to 90% of people with schizophrenia develop any SUDs at some point in their lives including nicotine and 18.5% to 61.5% excluding nicotine. Nicotine use disorders are particularly common in people with schizophrenia, with a lifetime prevalence of roughly 58–90% followed by alcohol, khat, and cannabis use disorders, respectively. In addition, up to 80% of people with schizophrenia have recognizable medical disorders of which approximately up to 50% remain undetected and medical problems may explain or exacerbate their condition in about 20% of people with schizophrenia. This systematic review indicates that comorbid medical disorders and SUD are common in people with schizophrenia. Routine screening and integrated management of medical and substance use disorders is implicated in persons with schizophrenia.

Khat and Alcohol Use Disorders Predict Poorer Adherence to Anti-Tuberculosis Medications in Southwest Ethiopia: A Prospective Cohort Study

Introduction: Tuberculosis is one of the infectious diseases causing public health crisis in low income countries and it remained among the top ten causes of mortality. Non-adherence to anti tuberculosis (anti-TB) medication greatly contributes to the rise in multi-drug resistance tuberculosis which is associated with high rates of mortality. Substance use is frequently seen among patients with poor adherence, however, little is known about the effect of substance use on adherence to anti-TB medications in Ethiopia. Therefore, we aimed to assess the effect of substance use disorders on adherence to anti-TB medications in Southwest Ethiopia. Methods: A prospective cohort study was conducted among 268 patients with tuberculosis attending services at 26 health institutions in Southwest Ethiopia between October 2017 and October 2018. A structured questionnaire translated to local language was used to assess substance use disorders, adherence and other potential risk factors for non-adherence. Patients were followed for six months and data were collected on three occasions during the follow-up. Generalized linear mixed model was used to identify the effect of substance use disorder on adherence to anti-TB medications. The model fitting was checked using Bayesian Information Criterion (BIC) while the covariate selection was based on a directed acyclic graph (DAG). Results: The overall prevalence of non-adherence among patients with substance use disorders was 16⋅4% (n=22), 41⋅7 % (n=48), and 45⋅7% (n=59) at baseline, two month, and six month respectively. The odds of non-adherence to anti-TB medications among patients with khat use disorder was nearly four times that of patients who did not use khat (aOR 3⋅8, 95%CI=1⋅8-8⋅0). Also patients who have alcohol use disorder were 3⋅2 times likely to have poor adherence compared to their counterparts (aOR=3⋅2, 95%CI=1⋅6-6⋅6). In addition, being educated (aOR =4⋅4, 95%CI=1⋅7-11⋅3), and being merchant (aOR=6⋅1, 95%CI=1⋅2-3⋅0) were associated with non-adherence to anti-TB medications. Interpretation: Khat and alcohol use disorders predict greater likelihood of non-adherence to anti-TB medication. This implies that there is a need to integrate management for substance use disorders into the existing tuberculosis treatment services. Funding Statement: Jimma University and IPPG. Declaration of Interests: All authors declare that they have no conflict of interests. Ethics Approval Statement: Ethical clearance was obtained from the Ethical Review Board of Jimma University (IHRPGC1095/2017) and LMU (Nr: 18-017). The study was discussed in detail and written informed consent was obtained from each participants. The anonymity of the study participants was kept at all stages of data processing and write-up of the manuscript.

SU117POLYGENIC RISK SCORE AND CNV BURDEN INFLUENCES ON BROADLY AND NARROWLY DEFINED PSYCHOSIS

For centuries, a large number of people living in the southwestern part of the Arabian Peninsula and eastern Africa have chewed the fresh leaves and twigs of the plant Catha edulis Forsk, more commonly known as khat, for its psychostimulatory effect. The main active compound in khat is cathinone, whose synthetic derivatives form a part of the new psychoactive substances list. This review summaries the prevalence of khat use, its harvesting and consumption, the biosynthetic pathway in khat, the mechanism of action, the results from animal and human studies, and its dependence potential. It is unlikely that khat use will be prohibited in countries where it is traditionally consumed and socially acceptable unlike in other countries of the world where both the importation and the consumption of khat and cathinone is banned. Khat users being mainly Muslims prohibited from using alcohol or other drugs probably represent the largest global number of mono-drug users of an amphetamine-like stimulant. Thus, khat use represents a unique situation and a neglected area of research in Africa.

Social Habits and Other Risk Factors that Cause Tooth Loss: An Associative Study Conducted in Taiz Governorate, Yemen

To investigate the relationship between tooth loss, age, gender, and its correlation with several local habits that affect oral health, especially the khat, and Shammah use. The current study included 580 participants. They were divided into five age groups15-24, 25-34, 35-44, 45-54, and 55-64-years-old. Clinical and radiographic examinations were done for each subject. Reasons for teeth loss, age, gender, khat chewing, Shammah use, smoking, and use of oral hygiene aids were recorded. The data were statically analyzed using Chi-square tests of the statistical package for social sciences (SPSS) program. The p value < 0.05 were considered statistically significant. Caries was the most cause of tooth loss in the young age groups 15-34 years-old and was significantly more common compared to the older groups (p < 0.001). The periodontal diseases increased with age and progressively became the main cause of tooth loss of 100% in the 55-64 years-old group. Orthodontic reasons for tooth extractions were limited to the young age group 15-24 years old. Third molars were the highest extracted teeth in the maxillary arch, while the first molars were the highest in the mandibular arch. Anterior teeth were the lowest extracted teeth ranging from 9; 1.6% in maxillary teeth and 9-29; 1.6-5% in the mandibular teeth. This study highlights the importance of local habitual use of khat 52.9% and Shammah 8.1% besides smoking in tooth loss. Caries was the main cause of tooth loss in the young age groups, followed by the periodontal disease in the older age. Molars were frequently extracted followed by maxillary first premolars. Limited number of epidemiological surveys were carried out in Taiz Governorate to investigate the reasons of tooth loss and its relationship with social habits like Khat chewing, Shammah use, smoking, using of Miswake and toothbrush. The results of this study will guide us to develop a preventive program which may minimize tooth loss and its adverse effects.

PERSONALITY TRAITS, INTERPERSONAL DIFFICULTIES AND MENTAL HEALTH PROBLEMS OF KHAT USERS AND NON-KHAT USERS: A COMPARATIVE STUDY

ABSTRACTOBJECTIVE: To find the differences between Khat users and non-Khat users on the basis of personality traits, interpersonal difficulties and mental health problems.METHODS: A cross-sectional research design was used, and the sample was selected from undergraduate university students through a mixed sample technique. There was an approximately equal number of all four years of undergraduate students in the sample out of which 247 of the sample were Khat users and 94 were non-Khat users (control variable). All the participants were male and aged between 18 to 25 years. The scales used were Eysenck Personality Questionnaire (EPQ), newly developed Khat Interpersonal Difficulties Scale (KIDS), and the Depression Anxiety Stress Scale (DASS). A debriefing session was carried out at the end of each testing and participants were asked for any inquiry, question and feedback. SPSS version 21.0 was used to analyze the data.RESULTS: Results revealed mean age of Khat users as 23.03±2.01, while non-Khat users had 21.44±1.71. Khat user students scored higher on neuroticism (t[339]=4.45, p<0.001), psychoticism (t[339]=2.92, p<0.001) and tend to experience more interpersonal difficulties (t[339]=11.83, p<0.001) and more mental health problems (t[339]=11.67, p<0.001) as compared to non-Khat users. Multiple regression analysis found a strong positive relationship between personality traits (neuroticism and psychoticism) with interpersonal difficulties (β=31, 28, respectively p<0.001) and mental health problems (β=28, 35, respectively p<0.001) as well. CONCLUSION: Khat use is related to a high score on neuroticism and psychoticism and the experience of more interpersonal difficulties and mental health problems.KEY WORDS: Extroversion (MeSH); Neuroticism (MeSH); Psychoticism (Non-MeSH); Personality (MeSH); Interpersonal difficulties (Non-MeSH); Depression (MeSH); Catha (MeSH); Khat (MeSH); Mental Health (MeSH); Depression Anxiety Stress Scale (Non-MeSH); Eysenck Personality Questionnaire (Non-MeSH); Khat Interpersonal Difficulties Scale (Non-MeSH)

High Seroprevalence of Autoantibodies Typical of Autoimmune Liver Disease in Eastern Ethiopia: Is Chewing of Khat (Catha edulis) a Triggering Factor?

Background Recent studies have identified chewing of khat (Catha edulis) as an independent risk factor for liver injury; however, the pathogenetic mechanism remains poorly understood. Case series have found markers of autoimmune hepatitis in patients with khat-related liver disease, suggesting that khat chewing might trigger an autoimmune response. The aims of the present study were (i) to assess the prevalence of autoantibodies typical for autoimmune liver diseases in a healthy population in Ethiopia and (ii) to explore the hypothesis that khat usage triggers autoimmunity. Methods Consenting adults (≥18 years) without known autoimmune disease or manifest liver disease were included. One-hundred-and-sixty-nine individuals with current khat use were compared to 104 individuals who never used khat. Seroprevalence of antinuclear (ANA), antismooth muscle (SMA), and antimitochondrial antibodies (AMA) were determined and compared between the groups using logistic regression models to adjust for age and sex. Results Overall, 2.6% of the study subjects were positive for ANA, 15.4% for SMA, and 25.6% for AMA. When comparing khat users to nonusers, ANA was detected in 4.1% vs. 0% (p=0.047), SMA in 16.0% vs. 14.4% (p=0.730), and AMA in 24.9% vs. 26.9% (p=0.704). ANA was excluded from multivariable analysis since there was no seropositive in the reference group. After adjusting for sex and age, no significant association between khat use and SMA or AMA was found. Conclusions No association between khat usage and the seropresence of SMA or AMA was found, weakening the hypothesis that khat-related liver injury is mediated through autoimmune mechanisms. However, the seroprevalences of AMA and SMA were strikingly high in this Ethiopian population compared to global estimates, suggesting that diagnostic algorithms for autoimmune liver diseases developed in Europe and North America might lead to misdiagnosis of patients on the African continent.

Depression, anxiety, and stress and their association with khat use: a cross-sectional study among Jazan University students, Saudi Arabia.

BackgroundDepression, anxiety, and stress levels are considered important indicators for mental health. Khat chewing habit is prevalent among all segments of Jazan population in Saudi Arabia. Few studies have been conducted to evaluate depression, anxiety, and stress among Jazan University students, and information about the correlation between khat use and these disorders is scarce. Thus, this study aims to evaluate the prevalence of depression, anxiety, and stress and their correlation with khat chewing and other risk factors among Jazan University students.MethodsA cross-sectional study was conducted on 642 students from Jazan University. Multistage sampling was used, with probability proportional to size-sampling technique. The Depression, Anxiety, and Stress Scale 21 questionnaire was used to collect the data, which were analyzed using SPSS Version 20.0 software.ResultsModerate depression was prevalent among 53.6% of the sample, anxiety was found among 65.7%, while 34.3% of the students suffered from stress. Female gender was strongly associated with higher mean scores for symptoms of depression, anxiety, and stress, with P-values <0.05 for all. Moreover, anxiety symptoms scores were statistically associated with grade point average and caffeine consumption. Khat use was statistically associated with higher mean scores of anxiety among males and a higher mean score of depression and anxiety among females.ConclusionThe results indicate a high rate of symptoms of depression, anxiety, and stress among Jazan University students. Khat use was associated with anxiety, and a higher rate of symptoms of depression, anxiety, and stress was indicated among female students. Therefore, strategy for the prevention and management of depression, anxiety, and stress is highly recommended to minimize the impact of these serious disorders.

Caught Smoking Khat! A Case of Drug-Induced Autoimmune Hepatitis

Khat (pronounced “cot”) leaves come from the Catha edulis plant grown mainly in Yemen and are smoked throughout Middle Eastern countries and Africa due to natural stimulant effects. Khat has been associated with direct liver injury and has less commonly been associated with autoimmune hepatitis. We present a case of a Yemeni immigrant male with Khat-induced autoimmune hepatitis. A 29-year-old Yemeni male presented with fatigue, general malaise, scleral icterus and dark-colored urine. He denied alcohol or drug use. He had no right upper quadrant tenderness. Liver function tests revealed ALT>3000 and AST>1400 with total bilirubin of 10.9 and alkaline phosphatase of 181. Radiologic imaging revealed no evidence of cholecystitis. Acetaminophen level, and Epstein-Barr virus, Cytomegalovirus, and autoimmune serologies were negative. At this time, his liver enzymes began to improve slowly. Patient underwent liver biopsy which revealed acute hepatitis and cholestasis with predominantly lobular lymphocytic inflammation with individual hepatocyte necrosis. The pattern of injury was nonspecific. As an outpatient he admitted that he smoked Khat and it was suspected that his liver enzymes had improved during admission due to cessation of Khat. He was started on prednisone and mycophenolate for presumed Khat-induced autoimmune hepatitis and his liver functions normalized. Khat-induced direct liver injury is a recognized entity and can be so severe as to lead to fulminant liver failure. Rarely, khat leaves can lead to an autoimmune-type picture with positive autoimmune markers and liver biopsy suggestive of autoimmune hepatitis. While our patient had negative serologic autoimmune markers and his liver biopsy revealed nonspecific inflammation, his liver function returned to normal with prednisone and mycophenolate. Few cases of khat-induced autoimmune hepatitis have been reported in the United States. History-taking in patients presenting with acute hepatitis who have emigrated from the Middle East or Africa should include asking about use of khat as cessation can lead to rapid improvement.

An exploratory study of knowledge, attitudes, and beliefs related to tobacco use and secondhand smoke among women in Aleta Wondo, Ethiopia

BackgroundBy 2030, the Sub-Saharan African region is projected to be the epicenter of the tobacco epidemic. While smoking prevalence is currently low among women (< 2%), the prevalence among men (7.7% overall and up to 27% depending on region) makes exposure to secondhand smoke a pressing concern for women and children. To prevent the uptake of smoking among women and address tobacco-related risks, including secondhand smoke exposure, a greater understanding of women’s related perceptions is needed. The purpose of this study was to explore Ethiopian women’s knowledge, attitudes, and beliefs related to tobacco use and secondhand smoke exposure, and the potential influence of contextual factors including; khat use, exposure to pro- and anti-tobacco messaging, and religious affiliation.MethodsA cross-sectional study using a systematic household sampling technique and an adapted interviewer-administered survey was conducted in Southern Ethiopia. The survey was administered to 353 women, 18–55 years of age, in Aleta Wondo town and surrounding districts between August–October 2014 (95.2% cooperation rate).ResultsGeneral awareness of harm associated with personal tobacco use and exposure to secondhand smoke was high (> 94%); however, specific knowledge of associated health-risks was limited. More than 96% perceived female tobacco use as socially unacceptable. At the same time, more than 70% were able to name potential benefits of using tobacco for both personal consumption and non-personal use. Respondents reported greater experimentation with khat versus tobacco and 73% reported that their religion significantly influenced their tobacco-related attitudes. Overall, there were higher reports of exposure to anti-tobacco (70%) versus pro-tobacco (49%) messaging, in the last 30 days.ConclusionsThe high level of awareness of health risks associated with tobacco use and SHS exposure and the high exposure to anti-tobacco messaging are community-level strengths that can proactively be built on to prevent the projected disease burden associated with tobacco. Findings have implications for the development of contextualized gender-specific tobacco control interventions, particularly in relation to the promotion of smoke-free homes.

User Experiences of Prescription and Over-The-Counter Drug Abuse in Aden City, Yemen.

Khat chewing is commonplace in Yemen, but little else is known about the misuse of other drugs, especially how such misuse may intersect with Khat use. The aim of this study was to investigate misuse of prescription and over-the-counter (OTC) drugs in community pharmacies in Aden city, from the users’ perspective. A qualitative in-depth-interview study was undertaken with fifteen known or suspected drug misusers, recruited through community pharmacies. Thematic analysis was used to identify the main emergent themes around experience of prescription and OTC drug misuse. The majority of interviewees were male (n = 11/15) with an age range of 21–40 years. Benzodiazepines, Tramadol, and Ketoprofen were the most commonly misused drugs. Four main themes were identified: Experience sought with drugs; awareness of problematic drug use; pattern and methods of misuse; and the role of healthcare professionals in responding to misuse. The study highlighted different issues, such as the practice of mixing different OTC and prescription drugs with Khat to heighten the effects or manage associated pain, and drug misuse by females and by health care professionals. The study also suggested that physicians and pharmacists fear counselling such people, probably with the risk of violence as a contributory factor.

Effects of Khat (Catha edulis) use on catalytic activities of major drug-metabolizing cytochrome P450 enzymes and implication of pharmacogenetic variations

In a one-way cross-over study, we investigated the effect of Khat, a natural amphetamine-like psychostimulant plant, on catalytic activities of five major drug-metabolizing cytochrome P450 (CYP) enzymes. After a one-week Khat abstinence, 63 Ethiopian male volunteers were phenotyped using cocktail probe drugs (caffeine, losartan, dextromethorphan, omeprazole). Phenotyping was repeated after a one-week daily use of 400 g fresh Khat leaves. Genotyping for CYP1A2, CYP2C9, CYP2C19, CYP2D6, CYP3A5 were done. Urinary cathinone and phenylpropanolamine, and plasma probe drugs and metabolites concentrations were quantified using LC-MS/MS. Effect of Khat on enzyme activities was evaluated by comparing caffeine/paraxanthine (CYP1A2), losartan/losartan carboxylic acid (CYP2C9), omeprazole/5-hydroxyomeprazole (CYP2C19), dextromethorphan/dextrorphan (CYP2D6) and dextromethorphan/3-methoxymorphinan (CYP3A4) metabolic ratios (MR) before and after Khat use. Wilcoxon-matched-pair-test indicated a significant increase in median CYP2D6 MR (41%, p < 0.0001), and a marginal increase in CYP3A4 and CYP2C19 MR by Khat. Repeated measure ANOVA indicated the impact of CYP1A2 and CYP2C19 genotype on Khat-CYP enzyme interactions. The median MR increased by 35% in CYP1A2*1/*1 (p = 0.07) and by 40% in carriers of defective CYP2C19 alleles (p = 0.03). Urinary log cathinone/phenylpropanolamine ratios significantly correlated with CYP2D6 genotype (p = 0.004) and CYP2D6 MR (P = 0.025). Khat significantly inhibits CYP2D6, marginally inhibits CYP3A4, and genotype-dependently inhibit CYP2C19 and CYP1A2 enzyme activities.

Antioxidant capacity and biomarkers of oxidative stress in saliva of khat-chewing patients: a case-control study

The aim of this study was to investigate the antioxidant levels and biomarkers of oxidative stress in saliva from khat-chewing patients compared with controls. Saliva samples were collected from 51 chronic khat chewers and 46 age- and sex-matched controls. Concentrations of oxidative stress biomarkers (malonyl-dialdehyde [MDA], protein carbonyl, and 8-hydroxy-2'-deoxyguanosine) and antioxidant defense (total antioxidant capacity [TAC], superoxide dismutase, glutathione peroxidase, and catalase [CAT) were analyzed. Salivary MDA level in the khat users group (45 ± 9.2 nmol/mL) was significantly increased in comparison with controls (13 ± 2.1 nmol/mL; P < .001), but there were no significant differences between the 2 groups regarding the levels of salivary protein carbonyl and oxidized guanine species. Salivary TAC was significantly reduced in khat users (0.25 ± 0.028 mmol/L) in comparison with controls (0.34 ± 0.037 mmol/L). Salivary CAT level was significantly reduced in khat users (6.0 ± 0.47 U/mL) in comparison with controls (7.7 ± 0.43 units/mL; P <.05), but no significant differences were observed between the 2 groups with regard to salivary superoxide dismutase or glutathione peroxidase levels. Chronic khat chewing is associated with increased levels of salivary MDA and reduced levels of TAC and CAT among a population of adult men in comparison with non-khat-chewing controls. These findings suggest that the pro-oxidative effect of khat chewing may be a contributing mechanism for various oral diseases associated with khat use, including cancer, periodontitis, and caries.

A survey of work-related injuries among building construction workers in southwestern Ethiopia

Construction sites are known to be one of the most dangerous areas for human health and safety. In developing countries, enforcement of safety rules are often negligible to minimize occupational injuries and illnesses. As the result, work related injuries are very rampant. Currently, Ethiopia is one of the developing countries where strong growth of construction industries are observed. However the prevalence of injuries in these industries could vary from place to place and even by company. The present study assessed the prevalence of injury and associated factors among building construction workers in southwestern Ethiopia. Institutional based cross-sectional study was conducted among workers of construction industries located in Jimma town. A stratified multi-stage sampling followed by simple random sampling was used to select the study participants. A pre-tested and structured questionnaire was used to collect data. Physical examination of the study subjects was done to complement self-reported information of occupational injury. Bivariate logistic regression analyses followed by multivariate analyses were employed to identify main causes of injury. The overall prevalence of work-related injuries in the preceding one year was 41.4% [95% CI: (37.8, 49.4)]. The top five injuries were injured by object (36.9%), followed by lower back pain (35.6%), falling injury (23.5%), skin disorder (20.1%), and eye problem (18.2%). Working without personal protective equipment (PPE), absence of vocational training, khat chewing, and working overtime were significantly raised the odds of having work-related injuries among construction workers. The finding revealed that provision of safety equipment and promoting its utilization, avoiding work overload, and controlling khat use in workplace could help to minimize work-related injuries and occupational diseases to ensure construction site safety.