Upload
ifriqiyah
View
219
Download
0
Embed Size (px)
Citation preview
8/13/2019 The Prevalence of Chat Chewing in Butajira
http://slidepdf.com/reader/full/the-prevalence-of-chat-chewing-in-butajira 1/8
r l oP.syrhiutr Scund 999: 100. 84-91Printed in UK. AN rights resrrse
A C T A P S Y C H I A T R I C A
SC NDIN VIC
ISSN 0902 4441
The prevalence and socio-demographiccorrelates of khat chewing in Butajira,Ethiopia
Alem A, Kebede D, Kullgren G. The prevalence and socio-demographic
correlates of khat chewing in Butajira, Ethiopia.
Acta Psychiatrica Scand 1999: 100: 84-91. Munksgaard 1999
A house-to-house survey was carried out in a rural Ethiopian communityto determine the prevalence and socio-demographic correlates of khatuse. A total of 10 468 adults were interviewed. Of these, 58% were female,
and 740/0were Muslim. More than half of the study population (55.7%)reported lifetime khat chewing experience and the prevalence of currentuse was 50 . Among current chewers, 17.40/0 eported taking khat on adaily basis; 16.1% of these were male and 3.4% were female. Various
reasons were given for chewing khat; 80% of the chewers used it to gain agood level of concentration for prayer. Muslim religion, smoking andhigh educational level showed strong association with daily khatchewing.
Introduction
Khat (Catha edulis) is an evergreen plant that
grows mainly in Ethiopia, Kenya, Yemen, and at
high altitudes in South Africa and Madagascar. T he
plant is known by different names in different
countries: chat in Ethiopia, qat in Yemen, mirra in
Kenya and qaad or ja ad in Somalia, but in most of
the literature it is known as khat. In khat-growing
countries, the chewing of khat leaves for social and
psychological reasons has been practised for many
centuries. I ts use has gradually expanded to
neighbouring countries and beyond through com-
mercial routes. Recently, increasing numbers of
immigrants have spread the practice to Europe and
the United States (1). There is an indication that
immigrants might be using more khat in Europethan in their country of origin (2).
The origin of khat is not clear, but it is generally
agreed that khat is native to Ethiopia and was first
used there (3). Between the first and sixth centuries
(AD), khat was introduced to Yemen where later
the Danish botanist and physician Forsskal
(1736-1763) gave the name Catha edulis to the
plant growing on the mountain of A1.-Yaman (3).
Terms such as ‘Tea of the Arabs’ or ‘Abyssinian
Tea’ formerly used for khat indicate that dried
A. Alem’, D. Kebede , G Kullgren3’Amanu el Psychiatr ic Hospi tal . Addis Ababa,
’Department of Communi ty Heal th, Facul ty of
M ed ic ine , U n i vers i ty o f Addis Ababa, E thiopia, and
3Depa rtment of Psych iatry. Ume3 Universi ty, UmeB,
S w eden
Key word s khat chewing, prevalence, ethnict ty.
E thiopia
Atalay A lem, Arnanuel Psychiatr ic Hospi tal. P 0 Box
1971, Addis Ababa. E thiopia
leaves of khat were boiled and used as modern tea is
now (4). The Harar region of Ethiopia is universally
believed to be the origin of khat use and, not
surprisingly, people of Harar consider khat a
treatment for all kinds of different ailments (5 ) .
The medical use of khat goes back to the time of
Alexander the Great, who used khat to treat his
soldiers for an unknown ‘epidemic disease’ ( 5 ) .
Historically, khat has also been used as medicine to
alleviate symptoms of melancholia and depression.
Modern users report that chewing khat gives
increased energy levels and alertness, improves
self-esteem, creates a sensation of elation, enhances
imaginative ability and the capacity to associate
ideas, and improves the ability to communicate (6).
For some, chewing khat is a method of increasingenergy and elevating mood in order to improve their
work performance. Khat is also considered a
dietary requirement by some. It may also be used
to suppress hunger when there is shortage of food.
For many centuries the active ingredient in khat
was not known. Now it has been discovered that the
psycho-stimulant effect of khat is due to the
alkaloid chemical ingredient cathinone present in
the fresh leaves of the plant. Cathinone’s chemical
structure is similar to amphetamine. The results of
8
8/13/2019 The Prevalence of Chat Chewing in Butajira
http://slidepdf.com/reader/full/the-prevalence-of-chat-chewing-in-butajira 2/8
Khat chewing in Butajira
various rz vivo and in vitro experiments indicate thatthe substance could be considered a ‘naturalamphetamine’ (7, 8). The effects of cathinone inanimals correspond to those observed in khat-usinghumans. The pattern of dependence cathinoneproduces is also similar to that of amphetamine.Consequently, WHO has recommended that cath-inone be put under international control and it isnow included in the list of controlled drugs. Becauseof cathinone’s similarity to amphetamine, there isreason to believe that the effect of khat on healthmay be similar to that of amphetamine. Thediffering effects on health are mainly due todifferences in dosage and mode of application (9).
Compared to amphetamine, khat is less likely to
cause tolerance perhaps because there are physicallimits to the amount that can be chewed. Khat issaid to cause persistent psychic dependence rather
than physical dependence (10, 11). However, truewithdrawal symptoms, such as profound lassitude,anergia, difficulty in initiating normal activity, andslight trembling, several days after ceasing to chewhave been reported. Nightmares, often paranoid innature of being attacked, strangled or followed, arealso other symptoms of withdrawal.
Most people chew khat in groups during specialceremonies intended to enhance social interactionor facilitate contact with Allah by Muslims. In fact,in some localities buildings and homes are archi-tecturally designed to include rooms that comfor-tably accommodate khat ceremonies. Morghem andRufat 12) describe khat chewing ceremonies as
follows: the khat ceremonies conform to a specificpattern. Friends gather in the allocated room. Theyspread mattresses on the floor upon which theyrecline leaning against the wall with their elbowsresting on pillows. Some prefer to keep a blaze ofcharcoal in the centre of the room to burn incense.Only tender khat leaves and stems are chewed, andthe juice is swallowed. The residue accumulates inthe mouth until the end of the session and the bolusmakes a characteristic bulge in the cheek of thechewer. During the session, fluids like tea and softdrinks are consumed; often music is played. In suchsessions a high level of social interaction is achievedand most important topics for discussion are
reserved for such sessions, Individuals who reg-ularly hold the ceremony strive to get the best out ofevery session. An average of two to three hours isspent on the khat ceremony every day by someregular users. Such parties are mostly attended bymen and mixed parties with women are rare.
Many observers have reported a negative impacton health and socio-economic conditions in com-munities where khat is used regularly (13). Almostall classes of people use khat in places where its useis endemic. However, the urban poor are believed to
be most negatively affected. Some estimate that asmuch as 85 of men’s monthly income may bespent on khat in some communities (13). Somereports indicate that khat consumption has adverse
consequences for married life. Spending money tomaintain the habit and wasting time at the khatceremonies lead to family neglect and, conse-quently, to divorce. In some cases deterioration ofsexual activities and estrangement between spousesis also reported. In a Somali study, 18.8 of themale respondents reported improvement of sexualperformance after khat chewing, but 61Yn reportedthat it caused impairment (13). Regular use of khatcan reduce working hours and capacity for workwhen the substance is not used. This is believed toreduce the economic growth of a country (4). On theother hand, the economic benefit from the sale of
khat is said to be high. A considerable amount of
revenue is generated from khat export by countriesthat grow khat.
There are several reports on unwanted physicaland psychological effects among regular chewers ofthe substance. More cases of low birth weight andstill birth among khat chewing mothers than amongnon-users has been reported (14) . It has also beenreported that khat addiction has a deleterious effecton semen parameters and deforms sperm cells 15).Gastritis, malnutrition, constipation, anorexia,spermatorrhea, arrhythmias, impotence, elevationof blood pressure, are among other physical effectsreported in khat users (16, 17). Insomnia, anxiety,depression on cessation, tension, and variouspsychotic symptoms are also reported by differentinvestigators (11). Until 1995, 16 cases of khat-induced psychoses have been reported in Europeand America among African and Arab immigrants18). Paranoid state, schizophreniform psychosis,
Capgras Fregoli syndrome, acute schizophrenia-likepsychotic syndrome, and mania were the primarydiagnoses given to the cases until relationshipsbetween the onsets or recurrences of symptoms andkhat consumption were discovered 1 8-22). In twoof the cases, homicide and combined homicide andsuicide following consumption of khat werereported (19). In most of those cases, heavy khat
consumption preceded the psychotic episodes. Werecently reported a khat-related case that wasadmitted to Amanuel Mental Hospital from thecentral prison in Addis Ababa by court order for asanity evaluation. He had repeatedly displayedviolent behaviour following heavy khat consump-tion with spontaneous remission in a couple of daysor weeks. During one such episode, he had violentlykilled his wife and his daughter and injured hiscattle (23). It is also a familiar experience of theprimary author of this paper to observe a high
85
8/13/2019 The Prevalence of Chat Chewing in Butajira
http://slidepdf.com/reader/full/the-prevalence-of-chat-chewing-in-butajira 3/8
Alem t al.
proportion of khat chewers among inpatients at
Amanuel Mental Hospital.
Khat use is legal in Ethiopia. Khat chewing has
been a daily practice in many Ethiopian commu-
nities for many generations. The practice, with itsalleged ill effects, is currently spreading throughout
the country (24).
In general, there is only a limited amount of data
on khat chewing in Ethiopia. The two epidemiolo-
gical studies available thus far are based on small
samples of students (25, 26), which may not reflect
the situation in communities. So far, no commu-
nity-based study has been conducted in the country.
We feel that such data are essential for policy issues,
further studies and planning in health. We report
here on the results of a survey conducted in a rural
community as one of the important components of
the general mental health survey.
Materi al and methods
Study area
The study was conducted in Butajira, one of the
rural districts of Ethiopia. It is located 130 km
south of Addis Ababa and is one of the most
densely populated districts in the country. Although
the area’s major ethnic group is Gurage and the
population is predominantly Muslim, there is also a
minority of persons from diverse ethnic groups, and
there is a substantial Orthodox Christian commu-
nity. Butajira is the only major town in the area. The
district’s health needs are served by one health
centre inside the town and two health stations and
four health posts outside the town. The mainstay of
the district’s economy is farming; peppers and khat
are the main cash crops. Kocho, a fibrous bread
prepared from the stem of the false banana plant, is
the staple diet.
A rural health project was started in this district
in 1986 as a collaborative research undertaking
between the Department of Community Health,
Faculty of Medicine, Addis Ababa University,
Ethiopia, and the Department of Epidemiology
and Public Health, Ume& University, Sweden. The
objectives of the project were to establish a
demographic study base for research on essentialhealth problems in a rural area and to develop and
strengthen the research capacity and infrastructure
for this purpose. Detailed descriptions of the base
are reported elsewhere (27).
Ins t rument
This study was combined with a general mental
health survey in the study base that used the Self
Reporting Questionnaire (SRQ) to assess mental
distress (28). Nine questions for this study and other
86
questions on problem drinking and suicide attempt
were added to the SRQ. A few questions to enquire
about income and cigarette smoking were included
as well.
The questions used for this study were the
following:
(i) Have you ever chewed khat? (no/yes)
(ii) If yes, how long have you chewed? (in years)
(iii) Do you chew now? (no/yes)(iv) If yes, how often?
(v) If you are chewing daily, what time of day?(morning/day time/evening/if more than once,
specify)
(vi) What is the reason for you to chew khat? (forpleasure/to socialize/to prevent the withdrawal
effect/to pass time/for prayer/other, specify)
(vii) Do your small children also chew khat? (no/
(viii) If yes, at what age (in years) do they start? (lessthan 5/5-9/10-15)
ix) How do you get khat? (own fardbuy it/ownfarm and buying/other, specify)
Yes)
Des ign
The design of the study is described elsewhere in
detail (28). Briefly, 21 high school graduates were
recruited from the town of Butajira to collect data.
They were given three days’ training in interview
techniques and how to complete the questionnaire.
Initially, the questionnaire was pretested on 40people from villages not included in the study. None
of these individuals had any negative reactions to
any of these questions. The survey was performed
between November 1994 and January 1995.
St a t i s t i ca l a na lys i s
The EPI-INFO version 5 computer program was
used for data entry and preliminary analysis. Chi-
square analysis was employed to compare inter-
group distribution using SPSS version 7.
ResultsThe survey included 5259 houses where 12531
persons above the age of 15 resided. Fifteen per cent
of these persons (n=1873) did not respond to the
questionnaire. Individuals who were not found at
home on three consecutive visits accounted for 91%
of the non-respondent group. Nine per cent (n= 173)
of the non-respondents failed to participate because
of various personal reasons. Some of these indivi-
duals were prevented from responding because of
physical or mental illnesses. From those who did
8/13/2019 The Prevalence of Chat Chewing in Butajira
http://slidepdf.com/reader/full/the-prevalence-of-chat-chewing-in-butajira 4/8
Khat chewing in Butajira
Table 1 Distribution of daily khat chewing according to socio demographic factors, stratified for sex
Male FemaleKhat
chewers chewers StatisticsPopulation chewers ~~
Variable n n n n Chi square df P-value
Age
15-24
25-44
45-59
60+
Religion
Christian
Muslim
Marital status
Single
Married
Divorced
Widowed
Illiterate
Elementary
Secondary+
Ethnicity
Gurage
Others
Income 1
Income 2
Income 3
Problem drinking
No
Yes
Smoking
No
Mi ld
Moderate
Heavy
Mental distress
No
Yes
Total
Education
Income
2997
4669
1732
1089
2668
7800
2527
681 1
254
876
8295
1514
651
8668
1800
7948
1047
196
10 083
385
10088
186
132
141
8642
1826
10 468
195
496
159
64
86
825
212
636
21
42
603
122
136
838
73
697
112
21
853
58
773
46
47
59
756
155
911
158
381
120
47
76
630
189
494
14
9
430
153
123
648
58
539
97
17
650
56
573
46
45
56
596
110
706
12 0
21 5
15 3
9 0
6 9
1 9 2
13 5
17 2
21 2
13 2
14 8
14 7
28 6
17 6
8 4
15 6
1 9 4
18 3
16 0
17 0
1 4 3
25 4
35 2
42 7
16 0
17 0
16 1
37
115
36
17
10
195
23
142
7
33
173
19
13
190
15
158
15
4
203
2
200
0
2
3
160
45
205
2 2
4 0
3 9
3 0
0 6
4 3
2 0
3 6
3 4
4 1
3 2
4 0
5 7
3 8
1 4
3 5
2 5
3 9
3 4
3 6
3 3
0 0
50 0
30 0
3 3
3 8
3 4
M+F=51 24
M=73 48
F = l l 40
M+F=13530
M=92 19
F=48 34
M+F=20 67
M = 1 6 0 2
F=8 08
M+F=148 34
M=55 10
F=4 70
M+F=59 09
M=36 12
F=1644
M+F=4 88
M=4 93
F=O 93
M+F=20 36
M=O 22
F = O 01
M+F=386 27
M=125 65
F=48 77
M+F=3 10
M=O 42
F=O 91
o 001
o 001
o 01
o 001
o 001
o 001
o 001
o 001
O 05
o 001
o 001
n s
o 001
(0 001
o 001
n s
n s
o 001
n s
n s
n s
o 001
<o 001
o 001
n s
n s
n s
not respond because of personal reasons, 13%
(n-22) were severely mentally ill. One hundred and
ninety questionnaires were found to be incomplete
and were excluded from the analyses.
The study population thus consisted of 10468
individuals. Over 50 were female, and there were
more respondents between the ages of 25 and 44
than in the other age categories. The majority of the
respondents belonged to the Gurage ethnic group,were Muslim, and had no formal education. Most
were married.
Income was divided into three levels based on
the annual income of families in birr as follows:
Income 1<1200, Income 2= 1200-6000, Income
3=6000+ (1 US =6.5 birr). There were 1277
(1 2.2'%1) ndividuals who were not able to specify
their income. Seventy-six per cent had an
estimated annual income equivalent to or less
than US 190.
More than half of the study population reported
lifetime khat chewing experiences. Among these, the
majority was male. The prevalence for current
chewing in both sexes was 50 with a higher
frequency among men (70%) compared to women
(35%). The duration of khat use ranged from less
than a year to 70 years. The median duration was 12years. Among the current chewers, 17.4% (n=911)
reported using the substance on a daily basis. Agreat majority (97%) of daily users reported
chewing only once a day, and the rest reported
chewing twice daily. Around noon is the preferred
time of day for chewing. Most consumers (57.3%)
buy their khat, and only 27% obtained the plant
from their own farms.
Various reasons for chewing khat were given. The
majority (80.0%) reported that they used khat to
obtain maximum concentration levels during
prayer. Of these, 96% were Muslim.
8/13/2019 The Prevalence of Chat Chewing in Butajira
http://slidepdf.com/reader/full/the-prevalence-of-chat-chewing-in-butajira 5/8
Alem t al.
Socializing or conformity with the norm was
given as the main reason for khat use by 25% of
the respondents, 12.1% used it to stabilize their
emotions, 0.6% took it because of dependence and
I .3%1 for concentration when studying, and for
efficiency at work.
Ten per cent (n=541) of the khat users reported
that their small children also chewed khat. Of these,
the majority (88.2%) reported that 10-15 years is the
age at which children start chewing. Twelve people
reported that even children under five chew khat.
Detailed analysis of socio-demographic correlates
was carried out only on those individuals who
chewed khat on a daily basis (Table 1). Chi-square
statistics are presented for both sexes combined and
after stratification. Daily khat chewing yielded
a significantly higher association with male than
with female sex (chi-square 520.37; P<O.OOl). All
variables were stratified for sex. Young adults andthe middle-aged showed higher associations for
daily chewing compared to adolescents. The highest
percentage of daily chewers were between the ages
of 25 and 44 years. Being Muslim was a significant
predictor of daily khat chewing in both sexes. There
is a significant association between high level of
education and khat chewing among men only. The
Gurage people were more likely to chew khat daily.
This difference was statistically significant. There
was an association between marital status and daily
khat chewing; among men it was the divorced and
among women, it was the widowed who were most
likely to be khat chewers.
People who smoked cigarettes were operationallyclassified into three groups based on the number of
cigarettes they smoked daily, as follows: 1-3=mild,
4-9=moderate, and >9=heavy. Cigarette smoking
showed a significantly higher association with khat
chewing than non-smoking. Heavy smokers showed
over a three-fold greater association than non-
smokers. Problem drinking was also associated with
khat chewing, but not so when stratified for sex.
There was no significant association between khat
chewing and general mental distress.
DiscussionEpidemiological studies on khat use are rare.
Baasher and Sadoun (4) reviewed the epidemiology
of khat chewing in their paper presented at the
International Conference on khat in Madagascar in
1983. According to their review, in 1972, a WHO-
sponsored mission to Yemen estimated that
approximately 80% of the adult men in major
cities and 90% of the men in khat-producing villages
were regular khat chewers. The prevalence was
estimated to be lower among women. Another
report on a study of 468 high school students in
Yemen showed that 12% of the students were khat
users. Ninety per cent of the students’ fathers and
60 ) of their mothers were khat users. In the
Democratic Republic of Yemen, in 1976, a group ofhealth workers estimated that 50 of the adult male
population indulged in khat chewing. In Somalia, in
1981 , it was estimated that about 75% of the men
and 7710% of the women chewed khat regularly,
and that khat use was increasing. In 1982, it was
estimated by WHO visitors that 90% of the men and
10% of the women regularly chewed khat in
Djibouti. In a randomly selected sample of general
outpatient clinic attenders in Kenya, it was found
that 29% were khat chewers and that only one of
them was female (29).
Our study indicates a lower prevalence of khat
use than previous general estimates from Yemen,
Djibouti and Somalia. However, there were fewerwomen who chewed khat reported in those
countries than in our population. The 1981 estimate
of 75% for men who chewed khat in Somalia is
comparable to the results of our study. The
differences between these estimates and our findings
may be that figures from those countries were mere
educated guesses rather than based on scientific
studies. If our study had been done in the 1970s and
the early 1980s, we may have obtained results
similar to the estimates in those countries, particu-
larly that of khat use by women. The emancipation
of women, which has been one of the movements in
Ethiopia for the last 20 years, may have increased
the number of khat chewing women in Butajira.
However, the prevalence of khat chewing among
men is still twice as high as that of women in this
study. This may be explained by the persisting
cultural restriction on women against the use of
such substances.
The prevalence of khat chewing in Butajira isclose to the prevalence (54.9%) reported among
the Hargeisa community in Somalia (7), but lower
than the prevalence of 64.9% among the Agaro
Secondary School students (26) in south-western
Ethiopia. The higher prevalence among the Agaro
students may be due to a population composition
that does not represent the general population. Thestudent population in our study was very low (3%)
and would not have a great impact on the results
when seen together with the rest of the population.
Similar studies among Mogadishu inhabitants in
Somalia (7) and among students at Gondar College
of Medical Sciences, Ethiopia (25) found a pre-
valence of 18.26% and 22.3%, respectively. The
lower prevalence in these studies might be explained
by relatively greater distances between those places
and khat-growing areas.
88
8/13/2019 The Prevalence of Chat Chewing in Butajira
http://slidepdf.com/reader/full/the-prevalence-of-chat-chewing-in-butajira 6/8
Khat chewing in Butajira
The significantly positive association between the
Muslim religion and daily khat chewing is similar to
the finding among Agaro students and to reports
from elsewhere (30). Khat growing and the practice
of chewing has traditionally been confined to the
lowlands of Ethiopia where the Muslim population
predominates and the habit could easily be passed
from generation to generation, as evidently shown
by the positive association of daily chewing and the
Gurage ethnic group in this study. The custom ofkhat chewing in group prayer sessions by Muslims
can also be one of the possible explanations for the
difference.
In this study, khat chewing was more frequent
between the ages of 25 and 44 and less common
after the age of 59. This finding is closer to the
results of a study in Mogadishu (7) that reported a
peak age of 2 04 0 and to a survey in Kenya 31 that
reported a peak age of 2 1 4 0 . In our study, 10% ofthe respondents reported that small children chew
khat with their parents. Most of these people
(88.2 ) reported that the age of onset of khat
chewing is 10-15 years. The median age of onset
reported by Agaro students was 14.6 years, and 16.4
years by Gondar students. This indicates that khat
consumption starts during the teenage years, peaks
during early adulthood, and declines after middle
age. The young adult and middle-aged and the more
educated groups who represent the most productive
sections of the society are most affected by the khat
chewing habit.
Kalix authoritatively reviewed the negative
health, socio-economic, and political effects ofkhat chewing in countries where the habit is
widespread (6). His argument for the negative
socio-economic effect was based on observations
regarding time and money spent to maintain the
habit. On the other hand, one might argue that
moderate use of khat might improve performance
and increase output of work because of its stimulant
and fatigue-postponing effects. The increased asso-
ciation of its use with those who have higher
educational attainment in this study and previous
studies (7,25,26 )might lead one to hypothesize that
prior khat use might have enabled these individuals
to progress in their education better than non-users.
Therefore, simple observation may not allow us todiscuss the negative or positive socio-economic
impact of khat chewing on those societies where
khat chewing is a common practice. However,
taking all the evidence together one is inclined to say
the negative effects of khat chewing outweigh
possible positive effects.
All users of khat in the Somali and Ethiopian
studies mentioned above obtain it by purchasing.
This includes students of the Agaro Secondary
School. which is located in an area where khat is
commonly grown. Most chewers among our study
population obtain the substance by buying it,
whereas 27% of the chewers grew it themselves.
This suggests that khat is a cash crop grown mainly
for economic reasons. In fact, because khat is a
drought-resistant plant, it does not require much
effort to cultivate, and generates more income than
other cash crops; farmers in khat-growing areas
destroy other cash crops, such as coffee, and replace
them with khat. In a study that compared the
income levels of two khat-growing and non-khat-
growing communities in a district of Hararghe
region in Ethiopia, it was shown that the mean
income per family in the khat-growing community
was 2704 birr compared to 875 birr in the non-khat-
growing community (32). The study also reported a
greater ownership of modern commodities and
facilities by the khat-growing community than
by the non-khat-growing community. Khat wasassessed as the source of 76.8% of income in the
khat-growing community, while crops, milk, and
fire-wood were the sources for 100% of the income
in the non-khat-growing community. That study
has also indicated the relative reluctance to grow
essential crops and breed cattle in the khat-growing
community. Such findings tempt one to compare
khat growers with those who invest relatively little
to grow and sell illicit drugs in order to make more
money than those who work harder to produce
essential products that contribute to their country’s
development and the well-being of its citizens.
The reasons given by our population for chewing
khat were to enhance concentration during prayerand study, to improve social interaction, to elevate
mood, and to avoid withdrawal symptoms. This
finding is similar to previous reports (6). This
indicates that khat has similar effects on users to
that of amphetamine and other psycho-stimulants.
Amongst our population, khat seems to be used
more when people engage in higher level mental
exercises, where alertness, concentration, high
imaginative capacity and social interaction are
required. Prayer and study are among the activities
that require high concentration and imagination.
The increase in khat use with increasing educational
level could be explained in the same way. People
with a high level of education are likely to beengaged with tasks that require imaginative think-
ing to a greater extent than those who are less
educated. It might also be that the immense pressure
of academic success at all levels (owing to fierce
competition) tempts young people to use khat in the
hope that it might increase their chances of being
successful. However, there are no studies to show
that khat increases intellectual performance. Many
drivers in Ethiopia, long distance truck drivers in
particular, are regular khat consumers. This group
9
8/13/2019 The Prevalence of Chat Chewing in Butajira
http://slidepdf.com/reader/full/the-prevalence-of-chat-chewing-in-butajira 7/8
Alem t al
of people chew khat to gain the maximum alertnessand concentration for their demanding job . Themost frequently stated reason for chewing khat wasto increase concentration during prayer. This maybe explained by the predominance of Muslimsamong the study population, reflected in the factthat 96% of those who gave this reason areMuslims.
In this study, 0.6% (n=29) reported that theycontinue to chew khat because of withdrawalsymptoms. This suggests that khat hardly causesphysical dependence.
The strong association of daily khat chewing withcigarette smoking in this study is in line withfindings from other studies 3 3 ) . Khat chewers arebelieved to take alcohol to break the stimulanteffect of khat after long hours of stimulation. Theexpression used for such a practice in one of the
Ethiopian languages, ‘mirkana chahsi’, connotesbreaking the effect. Contrary to findings in thatstudy, however, there was no association betweendaily khat chewing and problem drinking in ourstudy. There seemed to be an overall difference inproblem drinking between daily chewers and non-chewers, but when stratified for sex this was nolonger the case. The fact that the study by Omoloand Dhadphale was not a community sample andthat almost all of their subjects were male mightexplain the difference in the results.
There was no significant difference in the habi t ofkhat chewing between high and low scorers on a
mental distress scale measured by the SRQ.
Dhadphale and Omolo (34), in Kenya, reportedthat the prevalence of psychiatric morbidity was thesame among moderate chewers and non-chewers.However, they found a higher prevalence ofpsychiatric morbidity among excessive chewersthan among non-chewers. Since the attempt toquantify the amount of consumption was notsuccessful in our study, it was not possible toshow the dose-related effect of khat consumptionon mental health.
In conclusion, this study has shown that the khatchewing habit affects a majority of the adultpopulation in the Butajira district. The section
most affected by khat chewing seems to comprisethe most educated and the most productive agegroup of the community. Although the methodsemployed in measuring mental disorders in thissurvey were not very specific, general mentaldistress, as measured by the SRQ, has not beenshown to be associated with khat chewing. We
recommend an appropriately designed study to lookinto the effect of khat chewing on the socio-economy and health of a community where its use isvery common.
Acknowledgements
The study was financed by the Swedish Medical ResearchCouncil and the Swedish Agency for Research Co-operationwith Developing Countries through the Department ofPsychiatry, Umei University. Material assistance obtained
from the Department of Community Health, Addis AbabaUniversity and Amanuel Hospital is also acknowledged.
We would like to thank Drs. Ayana Yen eabat, Abeba Bekeleand Ato Teferi Gedif for assisting us in supervising the datacollection process.
We thank Professor R. Giel, Drs. Barbara Singleton, RobertKohn and Matthew Hotopf for their comments on an earlierdraft of this manuscript.
We also thank all the data collectors and the studyparticipants who kindly gave us the necessary information.
References
1.
2.
3.
4.
5 .
6.
7.
8.
9.
10
11.
12.
13.
14.
15.
N E N C I N I, GRASSSIC, BOTAN A, AS S EYR F , P A OLI.Khat chewing spread to the Somali community inRom e. Drug Alcohol Depend 1988: 23: 255-258.
GRIFFITHS, GOSSIP, W I C I K E N D E N, D U N W O K H, H A R R I SK, LLOYD . A transcultural pattern of drug use: qat(khat) in the U K. B r J Psychiatry 1997: 170: 281 284.AS EF F AM . Socio-economic aspects of khat in theHarrarghe administrative region, Ethiopia.Proceedings of the International Conference on Khat,Janua ry 17-21 1983, Antananarivo, Madagascar .BAASHERT, S ADOUNR. Epidemiology of khat.Proceedings of the International Conference on Khat,Janua ry 17-21 1983, Antananarivo, Madagascar .B A L I N TA , GEBREKIDAN, B A L I N TE . uthu edulis, a ninternational socio-medical problem with considerablepharmacological implications. East Afr Med J 1991 68:555-561.K A L I X. Kh at: scientific knowl edge and policy issues. BrJ Addict 1987: 82: 47-53.
EL M I S. Khat consumption and problems in Somalia .Proceedings of the International Conference on Khat,Jan uar y 17-21 1983, Ant anana rivo, Mada gascar.KA LIX . The pharmacology of kha t . Gen Pharmacol1984: 15: 179-187.
Comparison of behavioural effects of cathinone,amphetamine and apomorphine. Pharmacol BiochemBehav 1984: 20: 181-184.K A LI X . Kh at: a pl ant with am phetamine effects. JSubst Abuse Tre at 1988: 5: 163-169.H A L B A C H. Medical aspects of chewing khat leaves.Bull World Health Organ 1972: 47: 21L29.M O R G H E MM , RU FAT I . Cul t iva tion and chewing ofkhat in the Yemen Arab Republic. Proceedings of theInternational Conference on Kh at, Janua ry 17-21 1983,
Antananarivo, Madagascar .GETAJIUN, K R I K O R I A ND. The economic and socialimportance of khat and suggested research and services.Proceedings of the International Conference on Khat,Jan uar y 17-21 1983, Ant anana rivo, Madag ascar.E R I K S S O NM , GHANI A, KRISTIANSSON. K h a tchewing during pregnancy: effect upon the off-springand some characteristics of the chewers. East Afr Med J1991: 68: 106-110.E L - S H O U R AM , A B D ~ L ZIL M, AL I ME, e t a l .Deleter ious effects of khat addiction on sperm para-meters and sperm ultra-structure. H u m Reprod 1995:
SCHECHTER M D , RO SE C R A N SA , G L E N N O N A .
10: 2295-2300.
90
8/13/2019 The Prevalence of Chat Chewing in Butajira
http://slidepdf.com/reader/full/the-prevalence-of-chat-chewing-in-butajira 8/8
Khat chewing in Butajira
16. KENNEDY, TEAGUE, RROKAW, COONEY. A medicalevaluation of the use of qat in North Yemen. SOCSciMed 1983: 17: 783-793.
17. MEKASHA. The clinical effects of khat Catha edulisForsk): Proceedings of the International Symposium on
Khat, December 15 1984, Addis Ababa, Ethiopia.18. YOUSEF, HUQZ, LAMBERT. Khat chewing as a causeof psychosis. Br J Hosp Med 1995: 99: 322-326.
19. PANTELIS, HINDLERG, TAYLORC. Use and abuse of
khat Catha edulis): a review of the distribution,pharmacology, side effects and a description ofpsychosis attributed to khat chewing. Pharmacol Med1989: 19: 657-668.
20. GIANNINIJ, CASTELANIS. A manic like psychosis dueto khat Catha edulis Forsk.). J Toxicol Clin Toxicol1982: 19: 455459 .
21. GOUGHP, COOKSONB. Khat induced schizophreniformpsychosis in the UK (letter). Lancet 1984: 1: 455.
22. DHADPHPALE, MENGECH NK, CHEGE W. Miraa(Catha edulis) as a cause of psychosis. East Afr Med J1981: 58: 130--135.
23. ALEMA, SHIBBE . Khat induced psychosis and itsmedico-legal implication: a case report. Ethiop Med J1997: 35: 137-141.
24. GEBREELASSIE GE BRE . Rapid assessment of thesituation of drug and substance abuse in selected urbanareas in Ethiopia. Addis Ababa: Ministry of Health,1995.
25. ZEINAZ. Poly drug abuse among Ethiopian Universitystudents with particular reference to khat Catha edulis).Am J Trop Med Hyg 1988: 91: 1-5.
26. ADUGNA, JIRAC, MOILAT. Khat chewing amongAgaro Secondary School students, South WesternEthiopia. Ethiop Med J 1994: 32: 161 166.
27. ALEM , JACOBSSON, ARA YA , KEBEDE, KULLGRENG. How are mental disorders seen and where is help
sought in a rural Ethiopian community? A keyinformant study in Butajira, Ethiopia. Acta PsychiatrScand 1999: 100 (Suppl): 4 047 .
28. ALEMA, KEBEDE , WOLDESEMIAT, JACOBSSON,KULLGREN. The prevalence and socio-demographiccorrelates of mental distress in Butajira, Ethiopia. ActaPsychiatr Scand 1999: 100 (Suppl): 48-55.
29. OMOLO E, DHADPHALE. Alcohol use among khatCatha edulis) chewers in Kenya. Br J Addiction 1987:
82: 97-99.30. MIATAI CK . Epidemiology. Proceedings of the
International Conference on Khat, January 17-211983, Antananarivo, Madagascar.
31. MIATAI K. Country report; Kenya. Proceedings of theInterna tional Conference on Khat, January 17--21 1983,Antananarivo, Madagascar.
32. SEYOUM , KID ANE , GER RUH, SEVENHUSEN.Preliminary study of income and nutritional statusindicators in two Ethiopian communities. Food NutrBull 1986: 8: 3741 .
33. OMOLO E, DHADPHALE. Prevalence of khat chewers
among primary health clinic attenders in Kenya. ActaPsychiatr Scand 1987: 75: 318-320.
34. DHADPHALE, OMOLOE. Psychiatric morbidity amongkhat chewers. East Afr Med J 1988: 65: 355-359.
91