American Journal of Biomedical and Life Sciences
Volume 2, Issue 4, August 2014, Pages: 89-97

Effects of khat chewing behaviours on health outcomes among male khat chewers in Bahir Dar, North West Ethiopia

Bizuayehu Walle Birhane1, *, Muluken Walle Birhane1, Kidest Reba Lebeta2

1Medical physiology, Bahir Dar University, Bahir Dar, Ethiopia

2Adult Nursing, Bahir Dar University, Bahir Dar, Ethiopia

Email address:

(B. W. Birhane)
(M. W. Birhane)
(K. R. Lebeta)

To cite this article:

Bizuayehu Walle Birhane, Muluken Walle Birhane, Kidest Reba Lebeta. Effects of Khat Chewing Behaviours on Health Outcomes among Male Khat Chewers in Bahir Dar, North West Ethiopia. American Journal of Biomedical and Life Sciences. Vol. 2, No. 4, 2014, pp. 89-97. doi: 10.11648/j.ajbls.20140204.15


Abstract: Khat is found in the evergreen tree or large shrub, consists of whole fresh leaves and buds of a plant known as Catha edulis. It is an indigenous tree to Ethiopia, Kenya, and Yemen and more than 20 different compounds are fund in khat. Cathinone, which is the main active ingredient in Khat leave, is responsible for the pharmacological properties of Khat. Bahir Dar is a city that three percent of Ethiopia’s total production of khat is originated from. There is no community based study that has been done in Bahir Dar city to determine effects of khat chewing behaviours on self rated oral health status and risk on elevated blood pressure. Therefore, this study aimed to determine the effects of Khat chewing behaviors on oral health status and blood pressure on chewers. A community based cross-sectional study was conducted from January to September 2013 among chewers of Bahir Dar city. A total of 422 male khat chewers were included in study, 422 respond to the questioners, giving a response rate of 100%. The study found that the mean age of participants with standard deviation was 30.31 ± 1.39 years old. Sixty two percent of participants reported oral health problems and started khat chewing at early age. Started khat chewing at early age was found to be statistically significantly associated with self rated oral health problem (AOR: 2.85, CI 95%:1.26-6.45). Frequent chewers were 7.58 times more likely to be affected by self rated oral health problem compared to those who chewed less frequently (AOR: 7.58,95%CI:3.53-16.27). Chewers who chewed more than or equal to 100gms of khat per session were 4.33 times more likely to be affected by oral health problem compared to those who chewed less amount (AOR: 4.33, 95%CI: 2.49-7.53). As for the time period spent for Khat session, those who spent more than 6 hours in a khat session were 7.25 times more likely to have elevated systolic blood pressure compared to those who spent less than 6 hours, (AOR :7.25; 95%CI: 4.03-13.05). It was also found that those who spent more than 6 hours in a khat session were almost 9 times more likely to have elevated diastolic blood pressure compared to who spent less than 6 hours (AOR:8.99,95%CI:4.85-16.66).The risk of elevated systolic blood pressure was more than 5.26 times more likely among male chewers who reported increase amount of khat chewing compared to who reported decrease the amount in last 12 months, (AOR:5.26:95% CI: 2.76-10.15) and the risk of elevated diastolic blood pressure was more than 7 times more likely among chewers who reported increase amount of khat chewing in the last 12 months (AOR:7.25,95%CI:3.66-14.38).

Keywords: Khat Chewing, Health Outcomes, Bahir Dar, North West Ethiopia


1. Introduction

Khat (Catha edulis) is a large green shrub that grows at high altitudes in the region extending from eastern to southern Africa, as well as on the Arabian Peninsula [1]. Khat leaves are crimson-brown and chewing of khat leaves (Catha edulis Forsk) is widely practised in East Africa and parts of the Middle East, such as Yemen where it forms a deep-rooted social and cultural function [2,3]. The pleasure derived from khat chewing is attributed to the euphoric actions of its content of (-)-S-cathinone, a sympathomimetic amine with properties described as similar to those of amphetamine [3-5]. Cathinone enhances the releases of catecholamines from their storage areas resulting in CNS stimulation. Cathinone has also a variety of peripheral sympathomimetic activities [6,7]. Users of khat report increased levels of energy, alertness and self-esteem, a sensation of euphoria, enhanced imaginative ability and a higher capacity to associate ideas and these effects have been attributed to the khat’s content in cathinone, a sympathomimetic amine with properties similar to those of amphetamine [8]. In Ethiopia khat is used for direct consumption, local sale and for export. It is estimated that 85 to 90% of khat production is for sell; the rest is used for local consumption [9].

The habit of khat chewing is believed to affect a large segment of the Ethiopian population, especially the productive age group i.e., it has negative impact on health, socioeconomic and political matters [10].

The description of khat chewing frequency in the literature is varied. For example; a study [11] reported current habitual khat chewing as daily, and more frequently as occasional. Another study also [12] reported khat chewing as once a week or less as occasional (16.2%), 2-3 days as light, 4-6 days frequent and every day as heavy. World Bank survey study result in Yemen [13] reported that khat chewing three and more days per week as ‘addictive’. A study also [14] defined the pattern of khat chewing every day as regular and other patterns as once a week and occasional.

Study results shown the effect of khat chewing on body organ systems. For instance, the effect that accounts for the popularity of khat is its central nervous system stimulation, believed to be induced by cathinone; an active ingredient of khat leaves [15]. Several studies showed that the psycho stimulant effects induced by chewing khat include a moderate degree of euphoria and mild excitement resulting in promotion of social interaction and loquacity and these effects were found to be a maximum between 1.5-3.5 hours after starting to chew and they were progressively replaced by mild dysphonic, anxiety, reactive depression, insomnia and anorexia (loss of appetite) [16,17]. In recent years khat induced psychosis (serious mental illness) including mania, paranoia and schizophrenia has become more common [18]. Furthermore khat chewing seems to complicate the management of pre-existing serious mental illness [19]. Recent work on Yemeni healthy adult volunteers provided evidence that khat chewing produced a significant rise in pulse rate and these changes run parallel with the changes in plasma cathinone levels during and after khat chewing [20]. It could be expected, therefore, that khat chewing carries a potential cardiovascular risk especially in patients with hypertension and heart disease, and might precipitate the occurrence of cardiovascular accidents (stroke) and myocardial infarction in susceptible individuals [21].

The study had shown that khat chewing delays gastric emptying of a semi-solid meal, probably as a result of the sympathomimetic action of cathinone in khat [22]. A common complaint of khat chewers is constipation, probably caused by a combination of the astringent properties of the chemical in khat, called tannins and the sympathomimetic properties of cathinone [23].

Studies again reported about the effect of both khat and nicotine dependence on trouble experiencing mouth infection after khat chewing and oral cancer (squamous cell carcinoma) [24-26].

Self rated health has been identified as an important indicator of the multi– dimensional construct, health [27]. The evaluation of health or subjective health is considered a legitimate/lawful indicator of overall health status, providing a valid reliable and cost effective means of health assessment particularly in studies in which other forms of health information are lacking, where questionnaire resources are limited and it is often used as a proxy measure of disease risk instead of more formal, but both invasive and costly, measures of physiological parameters [28-30].

Studies reported that self rated health condition (s) were found reliable and valid when compared with physician-reported medical histories [31-35]. Self reported oral health problem (s) such as periodontal diseases as alternative to the primary collection of clinical data has been reported in the current literature and this approach has been appraised as less time consuming, less expensive, consistent and complete, accessing a more representative sample including respondents who don’t access care or don’t have insurance [36].

Medical investigations have proven that the most important parameters are those that specify the work of heart and respiratory system. They best describe the human heath state. Designing the overall monitoring system of health outcomes, it is necessary to assess not only importance of measured parameters but also techniques of their measurement and potentiality of implication in to practical system [37].

2. Methods and Materials

A study was conducted in Bahir Dar town, North West Ethiopia, from January to September 2013, using a cross-sectional design. The source population of this study was all Bahir Dar town khat chewers and the study population was sampled khat chewers of the town. Systematic random sampling technique was employed to select samples of khat sellers and cluster sampling technique was used to select study participants.

The sample size (n) was calculated by considering 95% confidence level, p = 0.5, margin error (d) 5% (0.05) and the estimated sample size of the study were 422. All voluntary khat chewers in the sampled khat sellers were included in the study.

The sample for this study was drawn from places of khat sales and systematic procedures were carried out to select the eligible khat chewers for the study, these were; identifying the kebeles/villages which sellers were highly populated, identifying or recruitment of khat sellers from a given kebele/village and selection of khat chewers from the recruited khat sellers. Sampling was conducted through sellers to sellers survey in which, every second khat sellers was selected through systematic random sampling and all khat chewers in selected sellers were included as the study participants. All volunteers in the sampled sellers were included in the study.

For data collection, a pretested questionnaire pertinent to the study objectives were developed and used. The questionnaire was translated into Amharic and distributed to all sampled khat chewers. Medical equipments and materials such as sphygmomanometer with stethoscope, digital thermometer and others were used to measure the level of physiological parameters. Four trained nurses were involved in data collection, and supervision was carried out by the principal investigator.

Data entry, clearing and analysis were made using SPSS. To assess the effects of khat chewing

khat chewing on self rated oral health and physiological parameters, p-value, chi-square test, adjusted odds ratio (AOR) and confidence interval (95%CI) were calculated. A bivariate and multivariate logistic regression analysis were made to determine the statistically significant effects of khat chewing behaviours on self rated health status and its risk of elevated blood pressure.

Ethical clearance and permission were first obtained from the Ethical Review Boards of Bahir Dar University. The study participants were informed about the objective of the study and asked their consent to be involved in the study.

Confidentiality was also maintained.

The following operational definitions were used in this study:

Grams of khat: the amount of khat leafs sold by sellers to chewers in the study area during khat session.

Frequent chewers: those who chew khat for three and more days a week.

Less frequent khat chewers: those who chew khat less than three days a week.

Physiological parameters: are those that specify the work of heart and respiratory system.

Levels of physiological parameters: physiology books state the level of physiological parameters for systolic and diastolic pressure is 120 and 80mmHg respectively; breathing rate:12-16breath/minute; body temperature: 37°C; body mass index: <18 kg/m2 under weight, 18-25 kg/m2 normal and26-30 kg/m2 overweight; heart rate: 60-100 beat/minute.

Self rated health status: is a reliable and valid way of diagnosing patients when compared with physician-reported medical histories.

Oral health problems: including gum bleeding, tooth decay, decolourization of teeth, dental abscess, and soon.

Khat sellers: those who earning money from chewers by prepared a special place and setup for chewers and sold grams of khat for chewers during khat session.

Khat chewing behaviours: frequency of khat chewing per week and grams of khat chewed during khat session.

3. Results

3.1. Socio Demographic Characteristics

A total of 422 male khat chewers were included in this study, 422 of them were responded to the questioners, giving a response rate of 100%. The study found that the mean age of participants with standard deviation was 30.31 ± 1.39 years old. More than half of the male chewers (58.1) were in age between 30-40 years old. Majority (71.6%) of participants were born in Bahir Dar city. Regarding educational status, 160(37.9%) 65 (15.4%) and 158 (37.4%) participants had completed high school, college diploma and university degree and above respectively. Out of the total male khat chewers, 59.2% were unemployed. With regard to marital status more than half of male khat chewers (62.8%) were single. Three hundred thirty (78.2%) of participant had no children (Table 1).

Table 1. Socio-demographic characteristics among male khat chewers in Bahir Dar city, 2013.

Variable Frequency (N) Percentage (%)
Age in years    
18-29 187 44.3
30-40 201 47.6
41-64 34 8.1
Place of birth    
Bahir Dar 302 71.6
Outside Bahir Dar 120 28.4
Educational status    
Illiterate 10 2.4
Primary school 29 6.9
Higher School 160 37.9
College diploma 65 15.4
University degree and above 158 37.4
Job title    
Employed 172 40.8
unemployed 250 59.2
Marital status    
Married 141 33.4
Single 265 62.8
Divorced 14 3.3
Widowed 2 0.5
Number of children    
None 330 78.2
One 42 10.0
Two 28 6.6
Three 10 2.4
More than 3 12 2.8

3.2. Khat Chewing Behavior among Chewers

This section describes the social and behavioral backgrounds of khat chewing, frequency of khat chewing, amount of khat chewing, any attempts to stop khat chewing, the reasons for re-starting chewing, education/information on khat impacts and a validation of self-reported khat chewing.

In this study found that thirty seven percent (37.2%) of the participants had already started khat chewing at the age of between 19 to 21 years old. Majority of the respondents (80.6%) started khat chewing in Bahir Dar.

Around 326 (77.3%) of them were initiated chewing for the first time by their own close friends. Many reasons were reported for khat chewing; most commonly help pass time (29.4%) and dependence (24.2%). Family khat chewing history was also explored; Thirty eight percent and 1.9% of participants’ fathers and mothers were khat chewers. Fifty four percent of participant chewed khat in groups (with friends). Most 375 (88.9%) of participants reported chewing khat for three days or more and only 3.6% chewed less than three days per week. With regarding to khat chewing cost 36% of khat chewers were coasted 101 Ethiopian birr and more during a khat session. The most commonly reported time for starting khat chewing was between 1.00 pm - 3.00 pm while a small percentage (3.6%) preferred between 4 pm-6 pm. Thrifty eight percent of the participants reported chewing 100 and more grams of khat per day during khat session. Fifty four percent of chewers had spent greater than or equal to six hours during a khat session.

Different aspects of khat chewing behaviours, including frequency and dose were also assessed. Out of the total participant majority (64.0%) of them were reported increases their khat chewing desire in the last 12 months while smallest percentage (10.4%) of participant decreases their desire (Table 2)

Table 2. Social and behavioral background of khat chewing among male khat chewers in Bahir Dar city, 2013.

Variable Frequency (N) Percentage (%)
Age of starting khat chewing    
From 7-15 years 56 13.3
From 16-18 years 106 25.1
From 19-21 years 157 37.2
22 years to older 103 24.4
Initiators of khat chewing    
Close friends 326 77.3
Family 24 5.7
By yourself 72 17.1
Reasons for chewing khat    
A habit 83 19.7
Need Social interaction 77 18.2
Help pass the time 124 29.4
Dependence 102 24.2
Increase concentration during study and work  28 6.6
Khat chewing setting    
Alone 6 1.4
With others 228 54.0
sometimes with others sometimes alone 188 44.5
Number of Days Chewing khat per Week    
< 3 days 47 11.1
≥3 days 375 88.9
Amount of money (in birr) coasted for a khat session    
From lowest up to 50 birr 135 32.0
51-100 birr 135 32.0
From 101 birr to above 152 36.0
Time Preferred for Starting Chewing    
4-6 local time 73 17.3
7-9 local time 334 79.1
10-12 local time 15 3.6
Amount of khat chewed    
25gm-50gm 118 28.0
51gm-100gm 143 33.9
>=100gm 161 38.2
Time period spend during a Khat Session    
Up to 6 hours 192 45.5
More than or equal to 6 hours 230 54.5

3.3. Health Outcomes and Related Behaviors

Almost all (96.7%) study participants had no history of illness. Amongst the participant who self reported a history of illness, 50% of them reported GI conditions (Gastritis) and 21.4%, 14.3%, 14% reported hypertension, diabetics and hemorrhoid respectively. With regard to self rated health condition, twenty four percent of participants self-rated very good and good health and sixty six percent rated fair, bad and very bad general health state.

Sixty two percent of participants reported oral health problems. Of the 262 self-reported oral problems; 78.6% had dental decay or tooth discoloration, 21.4% gum problems (inflammation, bleeding).

Table 3. Self rated health outcomes among male khat chewers in Bahir Dar city, 2014.

Variables Frequency (N) Percentage (%)
Illness history
Yes 14 3.3
No 408 96.7
Self-rated health status
V.good 71 16.8
Good 30 7.1
Fair 133 31.5
Bad 92 21.8
V. bad 96 22.7
Oral and dental health problem
Tooth decay 206 48.8
Gum bleeding 56 13.3
No problem on both 160 37.9
Visit dentist before
yes 14 3.3
No 408 96.7

3.4. The Levels of Physiologic Parameters

Table 4. Levels of physiological parameters among male khat chewers, Bahir Dar City, 2013.

Variable Frequency (N) Percentage (%)
SBP( mmHg)    
<120 142 33.6
≥120 280 66.4
DBP( mmHg)    
<80 139 32.9
≥80 283 67.1
Pulse pressure( mmHg)    
<40 mmHg 21 5.0
≥40 mmHg 401 95
Respiratory rate    
12-15 breath/minute 64 15.2
>15breath/minute 358 84.8
Heart rate    
60-100 beat/min 340 80.6
>100 beat/minute 82 19.4
Temperature(oc )    
<37 416 98.6
≥37 6 1.4
Body mass index (kg/m2)    
< 18 84 19.9
18-25 306 72.5
26-30 32 7.6

Out of the total respondents, majority, 85.3% and 67.1% of the participant were their systolic and diastolic blood pressure greater than 120 and 80mmHg respectively.

3.5. Factors Associated with Self Rated Oral Health Problem

Bivariate and multivariate logistic regressions were done to asses effects of khat chewing behaviors on self rated oral health problem. First all factor were analyzed by bivariate analysis, of them only three factors that had significant effects on self rated oral health problem, which had a P-value ≤0.2, then those significant variables entered into multi variety logistic regression analysis. All three predictors were found to be statistically significant in multivariate logistic regression.

The multivariate analysis indicated that those male chewers who started khat chewing at age from 7-15 years old were 2.85 times more likely to be affected by oral health problem compared to those who started khat chewing at age 22 years old and above (AOR:2.85,CI 95%:1.26-6.45). With regard to frequency of khat chewing; those male chewers who chewed frequently (more than or equal to 3 days per week) were 7.58 times more likely to be affected by oral health heath problem compared to those who chewed less frequently (less than 3 days per week) (AOR: 7.58, 95%CI: 3.53-16.27).

Those male chewers who chewed 51gm-100gm and more than or equal to 100gm per khat session were 1.95 and 4.33 times more likely to be affected by oral health problem compared to those male chewers who chewed 25gm-50gm per session (AOR:1.95,95% CI:1.16-3.30), (AOR: 4.33,95% CI:2.49-7.53) respectively (Table 5)

Table 5. Factors associated with oral health problem among male khat chewers, in Bahir Dar city, 2013.

Variable Oral health problem COR(95%CI) AOR(95%CI) P-value
Yes No
Age of starting khat chewing          
From 7-15 years 45 11 2.93(1.36-6.31) 2.85(1.26-6.45)* 0.04*
From 16-18 years 62 44 1.01(0.58-1.75) 0.96(0.53-1.76)
From 19-21 years 95 62 1.01(0.66-1.82) 0.95(0.55-1.64)
22 years to older 60 43 1.00 1.0
Khat chewing frequency per week          
< 3 days 12 35 1.00 1.0 0.001**
≥3 days 250 125 5.83(2.93-11.63) 7.58(3.53-16.27)**
Amount of khat chewed          
25gm-50 gm 52 66 1.00 1.00 0.001**
51gm-100gm 91 52 2.22(1.35-3.66) 1.95(1.16-3.30)**
≥100gm 119 42 3.59(2.17-5.96) 4.33(2.49-7.53)**

3.6. Factors Associated with Self Reported Health Status

Bivariate and multivariate logistic regression was done to assess factors and self reported health status. First all factor were analyzed by bivariate analysis, of them only three factors that had significant effects on self rated oral health problem, which had a P-value ≤0.2,then those significant variables entered into multi variety logistic regression analysis. Among these, two predictors were found to be statistically significant.

With regard to number of children; those male chewers’ who has one to three children 0.4 times less likely to be compromised in their health status compared to those who has no children(AOR:0.40,95%CI:0.24-.69).

Those male khat chewers who had oral health problems 1.67 times more likely to be compromised on their health status compared to those who had no oral health problems(AOR:1.67,95%CI:1.03-2.69)(Table 6).

Table 6. Factors associated with self reported health status among male khat chewers, in Bahir Dar city, 2013.

Variable State of health COR(95%CI) AOR(95%CI) P-value
Compromise Not compromise
Number of children          
None 262 68 1.00 1.0 .003*
1 to 3 children 49 31 0.41(0.24-0.69) .40(.24-.69)*
More than 3 children 10 2 1.29(0.28-6.09) 1.16(.24-5.58)
Oral health problem          
No 111 49 1.00 1.0 .036*
Yes 210 52 1.78(1.13-2.80) 1.67(1.03-2.69)*
Amount of khat chewed          
25gm-50 gm 85 33 1.00 1.0 .072
51gm-100gm 102 41 0.97(0.56-1.66) 0.89(0.51-1.57)
≥100gm 34 27 1.93(1.08-3.43) 1.69(.92-3.08)

3.7. Factors Associated with Systolic Blood Pressure

The multivariate analysis result (Table-7) indicated that frequency of khat chewing, time period spend during a khat session, amount of khat chewing the last 12 month and difficulty to stop/ go without khat chewing were statistically significant with systolic blood pressure.

The multivariate analysis result revealed that the figure of having elevated systolic blood pressure among male chewers who chewed frequently was fourteen times more compared to who chewed less frequently (AOR:14.95,95% CI:5.49-40.66). There is statistically significant association between time period spend during a khat session and having elevated systolic blood pressure, it was found that those who spent more than 6 hours in a khat session were 7.24 times more likely to have elevated systolic blood pressure compared to those who spent less than 6 hours, (AOR :7.24; 95%CI: 4.03-13.05). The risk of elevated systolic blood pressure was more than 5.26 times more likely among male chewers who reported increase amount of khat chewing compared to who reported decrease amount of khat chewing in last 12 months, (AOR:5.26:95% CI: 2.76-10.15).

With regard to difficulty to stop or go without khat chewing; those male chewers who reported impossible and very difficult to stop or go without khat chewing 3.83 and 9.91times more likely to have elevated blood pressure compared to those male chewers who reported not difficult to stop or go without khat (AOR: 3.83, 95%CI: 1.87-7.88) and (AOR: 9.91, 95% CI: 4.70-20.88) respectively.

Table 7. Factors associated with systolic blood pressure among male khat chewers, in Bahir Dar city, 2013.

Variable SBP COR(95%CI) AOR(95%CI) P-value
≥120 mmHg <120 mmHg      
Frequency of khat chewing
< 3 days 12 35 1.00 1.00 0.001  
≥3 days 268 107 7.31(3.65-14.61) 14.95(5.49-40.66)
Time period spend during a khat session
Up to 6 hours 78 114 1.00 1.00   0.001
More than or equal to 6 hours 202 28 10.54(6.47-17.19) 7.25(4.03-13.05)
Amount of khat chewing the last 12 month
Increase 218 52 5.52(2.83-10.77) 5.29(2.76-10.15) 0.001
Remain the same 43 65 0.87(0.43-1.77) 0.98(0.40-2.39)
Decrease 19 25 1.00 1.00
Difficult to stop or go without khat chewing
Not difficult 76 102 1.00 1.00 0.001
Very difficult 57 23 3.29(1.87-5.81) 3.83(1.87-7.88)
Impossible 147 18 10.85(6.12-19.25) 9.91(4.70-20.88)

3.8. Factors Associated with Diastolic Blood Pressure

The multivariate analysis result, revealed that having elevated diastolic blood pressure among male chewers who chewed frequently was five times more compared to who chewed less frequently (AOR:5.43.95%CI:2.05-14.38). It was also found that those who spent more than 6 hours in a khat session were almost 9 times more likely to have elevated diastolic blood pressure compared to who spent less than 6 hours (AOR:8.99,95%CI:4.85-16.66). The risk of elevated diastolic blood pressure was more than 7 times more likely among male chewers who reported increase amount of khat chewing compared to who reported decrease amount of khat chewing in last 12 months (AOR:7.25,95%CI:3.66-14.38). With regard to difficulty to stop or go without khat chewing; those male chewers who reported impossible and very difficult to stop or go without khat chewing 3.43 and 14.74 times more likely to have elevated diastolic blood pressure compared to those male chewers who reported not difficult to stop or go without khat (AOR: 3.43, 95%CI: 1.67-7.03) and (AOR: 14.74, 95%CI: 6.61-32.85) respectively. (Table 8)

Table 8. Factors associated with diastolic blood pressure among male khat chewers, in Bahir Dar city, 2013.

Variable DBP COR(95%CI) AOR(95%CI) P-value
≥80 mmHg <80 mmHg      
Frequency of khat chewing
< 3 days 18 29 1.00 1.00 0.01*
≥3 days 265 110 3.88(2.07-7.28) 5.43(2.05-14.38)
Time period spend during a Khat Session
Up to 6 hours 77 115 1.00 1.00 0.001*
> 6 hours 206 24 12.82(7.68-21.38) 8.99(4.85-16.66)
Amount of khat chewing the last 12 month
Increase 223 47 6.24(3.18-12.25) 7.25(3.66-14.38) 0.001*
Remain the same 41 67 .805 (.39-1.64) 1.13(0.45-2.84
Decrease 19 25 1.00 1.00
Difficult to stop or go without khat chewing
Not difficult 75 102 1.000 1.00 0.001*
Very difficult 55 25 2.99(1.71-5.23) 3.43(1.67-7.03)
Impossible 153 12 17.34(8.97-33.51) 14.74(6.61-32.85)

4. Discussion

Studies on the effect of substance abuse and their health effects are scarce despite the ever-growing rate of substance use behaviours. Previous studies shown that, khat chewing had effects on the physical wellbeing of the society; therefore this study aims to investigate the association between health effects (oral health problems and the risk of elevated blood pressure) and that of khat chewing frequency, amount of khat chewed during khat session among male chewers. In this study the mean age of participants with standard deviation was 30.31 + 1.39 years old.

According to this study 37.9%, 15.4% and 37.4% of khat chewers were completed a high school, college diploma and university degree and above respectively this is higher than study conducted in Jimma which was 8.5 % of the respondents were completed the high school and higher education programs.

The habit of khat chewing is more frequently in the age group between 16 and 21 years and less common above the age of 41. This is supported by study conducted in UK-resident Male Yemeni Khat chewers indicated that majority of khat chewers’ age were in the productive age groups and more than half of the respondents were started chewing at the age of 18 [38,40]

The probable difference might be due the presence of certain behavioral, lifestyle and personality variation.

In the present study showed that, majorities (77.3%) of chewers were initiated khat chewing for the first time by their own close friends, and their reason for khat chewing most commonly was for helping pass time and dependency. This study is in line with the study in Jimma University students reported that, khat chewing initiated for the first time by friends and family [41].

This study result showed that 38.2% of the respondents reported chewing 100 and more grams of khat per day during a khat session. 54.5% of chewers had spent six and more hours during a khat session and around 64% of the participants were reported increases their khat chewing desire in the last 12 months. This may due to lack of job opportunities in the city and absence of concerned bodies that tried to band khat chewing in the country.

In this study, 62.1% of participants reported oral health problem, 78.6% had dental decay or tooth discoloration and 22.4% gum problem (inflammation, bleeding). Similar study conducted in Yemen [22] reported that khat chewers were often complained inflammation of the mouth. These effects may be due to the presence of harsher chemical called tannins in khat and using sugar during khat session to minimize the bitterness of khat juice [42,43]

In this study, multivariate analysis was done to determine the association of khat chewing and oral health status. The result shown that, starting khat chewing at early age were 2.85 times more likely to be affected by oral health problems compared to those who starte chewing lately (AOR: 285, 95% CI: 1.26-6.45), this is consistent study conducted in Yemen indicated that In the gastrointestinal tract, the astringent characteristics of the tannins account for periodontal disease, stomatitis, oesophagitis and gastritis [86]. This might be the presence of harshest chemical called tannins in khat juice.

Frequent khat chewers were 7.58 times more likely to be affected by oral health problem compared to less frequent chewers (AOR: 7.58, 95% CI: 3.53-16.27) and those who chewed large amount of grams of khat during khat session were 4.33 times more likely to be affected by oral health problem compared to those who chewed less amounts (AOR: 4.33, 95% CI: 2.49-7.53). The probable reason may be due to the fact that chewing large amount of khat in gram during khat session and chewing frequently may increase the incidence of exposing chewers with chemicals that are found in khat called tannins and the pharmacological effects of these chemicals will be dominantly seen on frequent chewers and on chewers who chewed large amount during khat session than the rest.

Previous study that conducted in Yemen reported that khat chewing produced a significant rise in arterial systolic and diastolic blood pressure [20,21]. In the present study also the risk of having elevated systolic blood pressure among frequent khat chewers was 14 times more compared to less frequent chewers (AOR: 14, 95%CI: 5.49-40.66).

Those chewers who spent more time on khat chewing during khat session were 7.24 times more likely to have elevated systolic blood pressure compared to chewers who spent less time (AOR: 7.24, 95% CI: 4.03-13.05).

The risk of elevated systolic blood pressure was also more than 5.26 times more likely among chewers who reportedly increases the amount of khat chewing for the last 12 months (AOR: 5.26, 95%: 2.76-10.15).

As for difficulty to stop or go without khat chewing, chewers who respond impossible and very difficult to stop or go without khat chewing were 3.83 and 9.91 times more likely to have elevated systolic blood pressure compared to those who reported not difficult to stop or go without khat.

The diastolic blood pressure is also significantly associated with that of the above chewing habits that affected the systolic blood pressure.

According to this study result, amount, frequency and chronic khat chewing was statistically significantly associated with that of the risk of elevation of arterial blood pressure. This may be due to the result of sympathetic like action of an active ingredient of khat known as cathinone [44].

5. Conclusion

This work and previous studies demonstrated that khat intake causes risks on cardiovascular problems such as hypertension and oral health problem. In addition to the cardiovascular effect, khat has influence on the respiratory center, which is expressed as quick breathing, marked hyperthermia and finally death.

Chronic khat chewing also produces direct effect on the gastrointestinal system resulting in such disorders as osophagitis, stomatitis, gastritis, gastric and duodenal ulcer, entercolitis, hepatitis, and pancreatitis.

Currently, the habit of khat chewing affects a large segment of the population, especially the productive age group and its negative impact on health; socioeconomic and political matters are reported enormously by different study findings. This is because the habit of khat chewing reinforces the development of other habits such as cigarette smoking, alcohol intake and addiction with narcotics.

This study had strengths and weaknesses. As strength, data were intensively collected from study populations by convincing the sampled khat sellers and scientific medical equipments were used to measure physiological parameters. It was better if the study covers many areas of the country and incorporates large sample sizes for better inference. However, due to the limitations of resources, this study was focused only on Bahir Dar city and this will be counted as a weakness for this article.

Recommendation

To sum up, using this as a preliminary study, further investigation should be continued to explain exhaustively the effect of chronic khat chewing on the mental health and detailed experimental work on the cardiovascular effect of khat. Khat chewing is also suspected to be the risk factor of peptic ulcer disease. This again needs careful observation. Health education about the adverse effect of khat chewing should be delivered to the community and health institutions. Based on this recommendation, policy makers should design strategies to control the production, usage and distribution of khat in Ethiopia.

Abbreviations

ABP= Arterial Blood Pressure

AOR=Adjusted Odds ratio,

CI=Confidence Interval

COR=Crude Odds Ratio;

UK=United Kingdom

PP= pulse pressure

Competing Interests

The authors declare that they have no competing interests.

Authors’ Contributions

Bizuayehu Walle Birhane designed the study, conducted field work, analyzed data, interpreted findings, and wrote the manuscript. Muluken Walle Birhane and Kidest Reba Lebeta involved in the design, development of the proposal, assisted field work, in data analysis and manuscript writing. All authors of the manuscript have read and agreed to its content.

Acknowledgement

I would like to thank the Research and Publication Office of the Bahir Dar university college of medicine and health science for funding this study. I also thank Mr. Bekele (MSc. in general public health) for carefully revising this manuscript and forwarding constructive and timely comments for the success of this work. Finally this research would not have been realized without the strong commitment of the data collectors and khat sellers.


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