Journal of Medical and Clinical Nursing Studies

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

Gosaye Tekelehaymanot Zewde

Department of Midwifery, Harar Health Science College, Harar, Ethiopia 

Corresponding author
Gosaye Tekelehaymanot Zewde, Department of Midwifery, Harar Health Science College, Harar, Ethiopia.

ABSTRACT
Background: Khat (Catha edulis) is an evergreen shrub that is a natural stimulant native, planted and chewed in eastern through southern parts of Africa and the Arabian Peninsula with distribution in parts of the Middle East and on the island of Madagascar. Khat chewing is becoming a common practice and great concern in university and college students because they think that it helps increase their academic performance especially during exams and for recreational purposes. It is widely understood that the consumption of Khat creates a remarkable problem for today’s youth which is not limited to individual users; rather its adverse negative consequence is believed to be challenging to a family, the community as a whole, economy and political arena of a given nation.

Objective of the Study: To assess Prevalence and factors associated with regular khat chewing among college and university students in Harar town 2024.

Methodology: Facility based cross sectional study was conducted in Harar Town from December 13 up to 29, 2023 on selected university and colleges. A total sample of 371 students was including on the study. Data was collected through structured questioner.  Training was given for data collectors and data evaluation done on daily based. Cleaned data were entered to SPSS version 20 and multiple logistic regression analysis was used for better prediction of determinants and to reduce bias due to confounders. Those variables with P-value < 0.20 was entered in to multiple logistic regression analysis. Associations with P - value less than 0.05 was declared as statistically significant.

Result: The Prevalence of khat chewing on this study was 57.4%. In multivariable analysis marital status, religion, Peers who chew khat, peers who smoke cigarette, students whose lives in rented house, Smoke cigarette while chewing chat, currently drink alcohol were associated with outcome variables. 

Conclusion and Recommendation: Majority of students was khat chewers for a long period of time and there also start chewing before their joining university and or college. Peer pressure, living condition and alcohol usage were significant predictors of khat chewing therefore to alleviate this problem effort on preventive measure is need by all stake holders at different levels.

Keywords: Khat, University, College Students, Khat Chewing, Effects of Chewing, Pear Pressure

Introduction 
Khat (Catha edulis) is an evergreen shrub that is a natural stimulant native, planted which chewed across the globe [1]. It is believed that khat cultivation originated in Ethiopia, and was imported to Djibouti, Somalia, Kenya, Uganda, Tanzania, Zimbabwe, Zambia, South Africa and Yemen. In some of these countries, khat chewing goes far back in history and has always been a kind of tradition [2]. It is evident that khat chewing by users is intended to increase concentration, self-confidence, creativity and imagination as well as communication abilities to associate as by virtue of its amphetamine like activity with euphoric and stimulant effects [3,4]. Khat chewing is becoming a common practice and great concern in university students because they think that it helps increase their academic performance especially during exams as well for recreational purposes [5,6].

Statement of the Problem
Globally an estimated 5 to 10 million people chewing khat most of which are in the horn of Africa and Arabian Peninsula, specifically Ethiopia, Somalia and yemen. In Ethiopia, different studies have showed that the prevalence of khat chewing ranges from 20 % up to more than 60% current khat chewing habit [7].

It is widely understood that the consumption of Khat creates a remarkable problem for today’s youth which is not limited to individual users; rather its adverse negative consequence is believed to be challenging to a family, the community as a whole, economy and political arena of a given nation [8]. Prolonged usage of khat exposes the user to thrombocytosis, which predisposes to myocardial infarction, ischemic heart disease, manic like schizophrenia and distress secondary to withdrawal. Likewise, its use has multiple deleterious effects, including erectile dysfunction, unsafe sex, psychotic experience, esophageal tumor, low birth weight and lactation problem and anatomical as well as functional brain changes. Moreover, behavioral impairment associated with its use might lead to a variety of criminal deeds of the young segment of the Ethiopian population, college and university students are the most at risk of using alcohol and other drugs such as khat and tobacco [9]. The use of alcohol, khat among adolescents can be harmful, leading to decreased academic performance, increased risk of contracting HIV and other sexually transmitted diseases, or other psychiatric disorders such as lethargy, hopelessness and insomnia [10]. Even if few studies conducted on khat chewing in Ethiopia, there is no sufficient information in our study area there for this study will try to fill the information gap which was not address by other researchers. And the main aim of this study was contributing to describing Khat chewing through comprehensively assessing the prevalence among college and university students, reasons for its use and its perceived effects on health as well as socioeconomic status of chewers.

Objectives 
General Objective: To assess Prevalence and factors associated with regular khat chewing among college and university students in Harar town 2020.

Specific Objective
To determine prevalence of khat chewing among college and university students in Harar town. 

To asses factor associated with chewing among college and university students in Harar town. 

Methodology
Study Area & Period: The study was conducted in Harar Town Selected College and University. Harar town is located in the eastern part at a distance of 526 km away from Addis Ababa, the capital city of Ethiopia. In the town 3 governmental and 4 private college as well as 1 Governmental and 1 private university college were found. They provide teaching and education on social, Natural as well as health related fields. The Study was conducted from December 13 up to 29, 2023. Institutional based cross sectional study design was used. Randomly selected consented university and college student were incorporate on the study.

Eligibility Criteria: Student who are volunteer to participate as well as Students whose age greater than 18 was include on the study and those Student who are absent during study time or students who are sick at the time of data collection was exclude. 

Sample Size Determination: sample was determined by using single population proportion formula with Prevalence of khat chewing 32.5 % study conducted on Gonder (38) [7] and after adding 10% non-response rate the final sample size will be come 371.

Sampling Technique and Procedure: In the town a total of 7 colleges and 2 universities were found among those three colleges and 1 university namely; Harar Teacher Teaching College, Afran Qallo, Lucy and Rift Valley University was selected by SRS method. Sample was proportionally allocated based on the total number of active students. Study participant was selected by systematic random sampling method.

Study Variables: was categorized in two Dependent and independent Variable therefore Depend variables of this study was khat chewing while the independent variables were Sex, Age, Religion, Monthly income, Residents, Exposure to mass media, Peer influence, living in rent house, Ethnicity. 

Data Collection Tool and Procedure: Data collection instrument was developed after critical review of literature. The questionnaire contains socio- demographic characteristics, khat chewing practice and variables that help to study prevalence and associated factors. Data was collected by 8 Bsc pharmacy professionals through self-administered questioner after informed consent was obtained. 

Data Processing and Analysis: Data checking and cleaning was done by principal investigators on daily basis during collection before actual analysis. Analysis was done by using SPSS version 20.0. The uni-variate analysis such as proportions, percentages, ratios, frequency distributions and appropriate graphic presentations as well as measures of central tendency and measures of dispersion were made. Multiple logistic regression analysis was used for better prediction of determinants and to reduce bias due to confounders. Those variables with P-valueless than 0.20 were entered in to multiple logistic regression analysis. Associations with P - value less than 0.05 was declared as statistically significant at 95% confidence level.

Data Quality Assurance: Data quality assurance mechanisms were instituted at several points to ensure the quality of the data. Pretest was conducted on 5% of the total sample at Horn international college. The questionnaires were translated into local language and back translated to English by people who have proficiency in translation to ensure its consistency. Training was given for data collectors and supervisor.

Ethical Consideration: Before beginning of data collection, ethical clearance letter was obtained from Harar Health Science College Research Ethics Review Committee and it was submitted to the study organization and consent was obtained from organization administrators and Permission was obtained from study institution. All the participants were informed the purpose, advantages and disadvantages and there have the right to be involved or not as well as they can withdraw from the study any time they want.  Informed verbal consent was obtained from all participants. Confidentiality was maintained by avoiding names and other personal identification.

Result
Socio Demographic Characteristics of the Respondents
From 371 Study population, all students were interviewed which makes response rate 100 %. Majority 174 (46.9%) of respondents were between the age group 25 - 29 years with mean age of 25.17 and standard deviation of (SD ± 3.341) and ranges from 19 to 35 years. Regarding sex and marital status majority were 195 (52.6%) female and 241 (65%) singles. Most of respondents 134 (36.1%) were Muslim religion followers followed by orthodox 130 (35.0%). Regarding year, field and program of study majority 209 (56.3%), 106 (28.6%) and 233 (62.8%) of respondents were year 2-year, Natural science study and regular program students respectively. Average monthly income ranges from 500 up to 9506 birrs with mean of 1089.59 and standard deviation of (SD ±1359.49) (Table 1)

Regarding reason for khat chewing majority 50 (13.5%) respond that their chew khat to get energy for work followed by 44 (11.9%) to avoid unpleasant felling and stress of life. (Figure 1)

Withdrawal Symptom & its Measure Taken: Majority of study participant 208 (56.1%) had faced withdrawal symptom and measure taken to have relief was having slept reported by 82 (22.1%) respondents. The most frequently reported problem face due to khat chewing was weight loss 101 (27.2%). Near to half 189 (50.9%) of respondent had live with khat chewer. One hundred fifty-two 152 (41.0%) respondent father and 131 (35.3%) mothers as well as 189 (50.9%) respondent peers were chews khat. Regarding living arrangements majority 189 (50.9%) was live on rented house. (Table 2)

Among current khat chewers, 208 (56.1%) reported that they had had experienced various withdrawal symptoms. The most frequently reported withdrawal symptoms were feeling depressed 62 (16.7%), craving 55 (14.8%), and increased appetite 34 (9.2%).( Figure 2)

Factors associated with khat Chewing
In multivariable analysis after controlling of confounders marital status, religion, Peers who chew khat, peers who smoke cigarette, students whose lives in rented house, Smoke cigarette while chewing chat, currently drink alcohol were associated with outcome variables.

Those students who were single were 14 times more likely chew khat than their encounter (AOR = 14.11, 95% CI:  0.920 -216.517) and students whose Peers chew khat were 33 times more like chew khat than their encounters (AOR = 33.960, 95% CI: 7.910 -145.798).  The odds of chew khat were 5 times (AOR = 5.043, 95% CI:  1.396 -18.215) higher on those students whose peers smoke cigarette than those who did not.

Discussion 
The current prevalence of khat chewing on this study was 57.4% was higher than study conducted in Gonder 32.5% Butajira 50.3%, Jimma (30.8%) South western Ethiopia 31.4% [7,10-12]. Hawassa University 10.5% Jimma university 23.9% and Haramaya University 23.6% [13,14,17].  This discrepancy and higher prevalence in our study might be due to difference in Socio - demography, study population as well as accessibility of khat. 

The life time prevalence rate of khat chewing on this study was 58.5% which was higher than among study conducted in Gonder 42.0%, Jimma university 26.3% Hawassa University 22.8%, and Addis Ababa University 14% [7,11,13,15]. This discrepancy might be due to easily accessible of Khat in our study area as well as difference on study area and population.

In this study cigarette smoking had statistically significant associated with khat chewing while Age and marital status were not statistically significant on multivariate analysis this finding was similar with study conducted in Jima [11].

In our study having peers who chew khat, Cigarette smoking, live off-campus in rented houses was significantly associated with khat chewing which was in line with study conducted in Hawassa University. In contrast year of study and having a father who chews khat were not associates in our study which was different from study conducted in Hawassa study [13].

In this study age, sex, family members currently chewing khat were not statistically significant on multivariate analysis this finding different from study conducted in Harar town secondary school [16]. 
In our study sex, marital status and year of study were not statistically significant on multivariate analysis this finding is not in line with study conducted in Haromay University [17]. This difference might be due to variation in sample size as well as reference population.

Conclusion
Majority of students was khat chewers for a long period of time and there were also start chewing before their joining university or college. Most of study participants were develops addiction as well as different withdrawal symptoms. Peer pressure had a major contributing factor for khat chewing. Those students who drink alcohols as well as leaving in rent house with not having their families around them were more prone for khat chewing therefore to alleviate this problem effort need by all stake holders at different levels like MOH, MOE study institutions.

Recommendation: Based on my major findings the following recommendation will provide 
For Harar Regional Health Office

Those students whose lives in rented house were 4 times more likely chew khat than their encounter (AOR = 4.905, 95% CI:  1.684 -14.287) and students whose currently drink alcohol were 5 times more likely chew khat than their encounter (AOR = 5.869, 95% CI:  2.006 -17.174). (Table 2)

For Harar Regional Health Office

• Behavioral change communication skill development training needs to be offer at high school level
• Provision of health education about substance abuse need to provide at high school level

For Harar Region Education Office

• Better to provide education regarding substance abuse at each class level
• Incorporate on curriculum and providing teaching about substance use and its effect
• Provision of health education in collaboration with HRHO
• Provision of life skill training at each level 

For Study Organization 

• Provide more emphasis about substance use while teaching
• Provision of live skill training
• Provision of supportive therapy 
• Student counsel service should be strengthened 
• Established as well as strengthen ant substance use club 

For Another Researcher
It will be more valuable if studies will be conducted on this subject matter on large scale by incorporating other college and university  

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