Prevalence of Khat Chewing and Its Associated Factors among Debre Markos University Regular Students, North West Ethiopia.
SamuelSemahgne1✉Emailsamuelsemahgne2222@gmail.com
AlehgneAderaw1
YeneworkEndalarf1
EndeshawZemenu2
DemekeShumuNegesse3
TemesgenBaylie4
TilahunBitew4
TemechewMunawAbebe5
1Department of Human Nutrition, College of Medicine and Health ScienceDebre Markos UniversityDebre MarkosEthiopia
2Department of Environmental Health, College of Medicine and Health ScienceDebre Markos UniversityDebre MarkosEthiopia
3Department of Pediatrics and Child Health Nursing, College of Medicine and Health ScienceDebre Markos UniversityDebre MarkosEthiopia
4Department of Biomedical Sciences, College of Medicine and Health ScienceDebre Markos UniversityDebre MarkosEthiopia
5Department of Biomedical Sciences, College of Medicine and Health ScienceInjibara UniversityInjibaraEthiopia
Samuel Semahgne1*, Alehgne Aderaw1, Yenework Endalarf1, Endeshaw Zemenu2, Demeke Shumu Negesse3, Temesgen Baylie4, Tilahun Bitew4, Temechew Munaw Abebe 5
1Department of Human Nutrition, College of Medicine and Health Science, Debre Markos University, Debre Markos, Ethiopia.
2Department of Environmental Health, College of Medicine and Health Science, Debre Markos University, Debre Markos, Ethiopia.
3Department of Pediatrics and Child Health Nursing, College of Medicine and Health Science, Debre Markos University, Debre Markos, Ethiopia.
4Department of Biomedical Sciences, College of Medicine and Health Science, Debre Markos University, Debre Markos, Ethiopia.
5Department of Biomedical Sciences, College of Medicine and Health Science, Injibara University, Injibara, Ethiopia.
*Corresponding author
Email address: samuelsemahgne2222@gmail.com
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Author Contribution
Samuel Semahgne Tilahun Bitew and Alehgne Aderaw made the conceptualization, wrote the original draft, and performed the formal analysis. Samuel Semahgne, Alehgne Aderaw, and Yenework Endalarf made data curation; Demeke Shumu Negesse, Temesgen Baylie and Alehgne Aderaw made Investigation and Methodology. Endeshaw Zemenu and Temechew Munaw found resources, and Demeke Shumu Negesse, Tilahun Bitew, Endeshaw Zemenu, Temechew Munaw, and Yenework Endalarf wrote the review & Editing.
Abstract
Introduction: Educational institutions consider khat use part of the adult age groups' experiential aspect; globally, studies have been conducted and reported in its multi-dimensional aspect.
Objective
This study aimed to assess the prevalence of khat chewing and its associated factors among Debre Markos University undergraduate regular students, northwest Ethiopia, 2024.
Method
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An institution-based cross-sectional study was conducted among 672 regular students using a self-administered questionnaire from July 15 to 24, 2024. Multi-stage sampling technique was used to select the respondents. The completed data were coded and then entered and analyzed by SPSS version 25. Prevalence with a 95% confidence interval was estimated for khat chewing practice among university students. Binary logistic regression analysis was fitted and odds ratios with 95% confidence intervals were computed to identify factors associated with khat chewing. Those variables with p-value < 0.05 in the multivariable analysis were considered statistically significant.Result
A total of 672 students participated giving a response rate of 96.1%. The lifetime, one-year and current prevalence of khat chewing were 23.1%, 20.7%, and 19.0 respectively. Factors like being sex male (AOR = 2.64; 95%CI: 1.33, 5.22), family member chewing khat (AOR = 10.79; 95%CI: 4.71, 24.73), having friends who chewed khat (AOR = 9.50; 95%CI: (4.63, 19.47) and self-reported mental disorder (AOR = 2.04; 95%CI: 1.06, 3.93) were factors significantly associated with khat chewing among regular university students. Among participants who chew khat currently, 34.1% of students chew khat for enjoyment, while 33.3% of students were due to peer pressure.
Conclusion and recommendation: The prevalence was considerable compared to other studies done in the university. Peer pressure to khat chewing should be reduced through creating good understanding to each individual by theatres, drama and others.
Key words:
Euphoria
Psychoactive
Spermatogenesis
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Introduction
East African countries traditionally used khat leaves as a recreational drug for elevation of mood or as euphoriant (1). Khat leaves can be green, yellow, and red depending upon the growth stage of the plant and the soil where it is grown. It is used traditionally for diabetes, muscle strength, to lower appetite, and rest, and other Anecdotal uses (2–5). The plant parts contain cathine, which acts on the autonomic sympathetic nervous system, commonly called as the ‘fear-flight’ response and can cross the blood–brain barrier to enter and stimulate the brain (6). More than 20 different compounds have been isolated from khat, among them cathinone is the major psychoactive compound which affects the CNS (7, 8).
The critical periods of life cycle, adolescence, push needs in services and information carefully tailored to meet their need due to changes in physical, psychological, and sexual behavior, make them explanatory impose themselves in the addiction of substance use (9). Although it has not caused a serious problem, the World Health Organization (WHO) indicates that khat creates dependency or it needs continued usage (10). It is illegal in countries like Canada and the United States, but it is normal in Europe(11). It is a traditional practice in different parts of Africa and the Arabian countries where the plant is available.
Globally, it is estimated that from 5 to 10 million people chewed khat for different purpose most of them are Arabian and Africans including Ethiopia. There are different studies conducted about the prevalence’s, pattern, reason, impact and perception of khat chewing in the world (9).
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Many psychological and physical problems have been mentioned, making it a public health concern. It includes hemorrhoids, anemia, low-birth-weight babies, and elevation of blood pressure, myocardial infarction, and ulcer, and spermatogenesis slowness in physically. Neurocognitive impairments, euphoria, excitability, anxiety, insomnia, stress are some listed psychological problems (12). Higher risk in-hospital mortality and stroke can be seen in a large prospective multicenter study of patients with acute coronary disease (13).The most reported reasons for khat usage by university/college students are to relieve stress, and relaxation(14, 15) be able to concentrate in their education (16) stay awake. Other mentioned reasons in youth population include peer pressure, the need for enjoyment and the socialization and these reasons are the need to enjoy and follow their mood. Several factors were shown to be associated with khat chewing among university/college students.
Being Muslim by religion, family history of khat chewing, being sex male (17) and having friends who chew khat (18) are major factors reported that increase the odds of chewing khat. Chewing khat had a history and continued in a common usage for social and religious matter in Ethiopia (19). 27% of men and 12% of women have ever chewed chat According to the report of EDHS 2016 (20).
Studies have documented the number of khat chewers in different institutions of Ethiopia has significantly increased over time and it has become popular in all segments of the Ethiopian population, and currently it has become a significant practice in youth, especially university students and staff (21, 22)
In Ethiopia, khat is mostly used for stimulation and social recreation, especially in the young population. There have been few studies of khat chewing among university students, and the studies did not include self-reported mental disorder as a factor. Therefore, this study was conducted to identify the prevalence of khat chewing and associated factors among Debre Markos university regular students in the current context of university setups using a representative sample size.
Material and Methods
Study design, period and setting
An institution-based cross-sectional study was conducted to assess the prevalence of khat chewing and its associated factors among regular students in Debre Markos University, Debre Markos, East Gojjam, Amhara Ethiopia from July 15 to 24, 2024.
Inclusion and Exclusion criteria
Those who were registered and continued their education as regular students, second year and above for undergraduate classes, were included. Critically ill and students who were absent during data collection time were excluded from the study.
Sample size determination and procedure
Sample size calculation
Sample size (n) required for this study was calculated by using the single population proportion (p) formula as follows,
n =
Then n =
= 426
Sample size = 426+ (5%*426) = 448
Total sample will be 1.5*448 = 672
Where n is sample size, p is the proportion of students who chew khat
is the margin of error, which is 4%, and 95% confidence interval. The meta-analysis of 24 studies, which found the pooled prevalence of khat chewing among university students in Ethiopia, 23.22% were used (17). The non-response rate and design effect were 5% and 1.5 respectively.
Sampling procedures
Multi-stage sampling technique was used to select the respondents of the study. First, among the eight schools, colleges and institutes in Debre Markos University, one department was selected by using simple random sampling (SRS) method. Sample size was proportionally allocated for the selected departments based on their class size and academic years of the study.
Secondly, from the selected eight departments, by using the students’ name list from the registrar and department office as a sampling frame, the respondents were selected by a simple random sampling method.
SRS
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Fig. 2
Schematic Presentation of sampling procedure
Variable of the study
Dependent variable
Khat chewing
Independent variables
Age, sex, ethnicity, religion, department/school, year of study, income source of family, the student’s monthly pocket money and source, living area (off campus and campus), peer pressure, family history of khat chewing, self-reported mental disorder.
Operational definition
Current prevalence of khat chewing: the proportion of students who are chewing khat within a month (30 days) preceding the study.
Lifetime prevalence of khat chewing
the proportion of students who had ever chewed khat in their lifetime.
One year prevalence of khat chewing
the proportion of students who were chewing khat within a year preceding the study.
Current prevalence of khat chewing
the proportion of students who were chewing khat during the period of data collection.
Self-reported mental disorder
From 20 SRQ who scored greater than or equal to six for males and greater than or equal to eight for females are considered as mentally disordered (23).
Data collection tool
The final English version of the questionnaire was developed by extensive revision of relevant literature on the subject and the WHO student drug-use questionnaire to ensure reliability. Data were collected from sample students using a structured self-administered questionnaire having two parts. The first part contains general information, including socio demographic characteristics of the students and their family, whereas the second part contains the questionnaire which assesses khat chewing condition of the students and their family’s history of khat chewing. Two versions of the questionnaire were used, an English version and an Amharic language version, Amharic version was made available to students.
Data collection procedures and collectors
The data collection was facilitated by five Debre Markos university Postgraduate Nutrition students. The sample size for each randomly selected department was predetermined proportionally. Therefore, the number of students in the study sample was known for each class. The ID numbers of the students in the sample were considered in the class. Then the data collectors informed the students about the objective of the study and administered the questionnaire by cross-checking their ID number. Finally, the data collectors went to collect the questionnaire, and finally the supervisors took the questionnaire by checking the completeness.
Data quality assurance
To assure the data quality, high emphasis was given in designing the data collection instrument (tool). For its simplicity, the translation of the questionnaire into the Amharic language were performed and orientation was given for data collectors (including class representatives) on the overall procedure of data collection. Proper instructions were given before the survey as to the importance of the study for the students. Pre-test was done in Injibara University, before a month days of the actual data collection day, on 15 students, followed by modification.
Data analysis techniques
The collected data were reviewed and checked for completeness before data entry, and the incomplete data were discarded. Complete data were coded and analyses were composed of two parts, descriptive and analytical statistics. Descriptive analysis, such as frequency, percentage, mean, median, and standard deviation, were applied for general characteristics, prevalence of khat chewing. Binary logistic regression models were fitted to identify factors significantly associated with khat chewing practice. Odds ratio was used to show the strength of association. Those variables with a p-value of less than 0.05 in the multivariable analysis were considered as statistically significant. Finally, the data were presented using statements, tables, and charts.
Ethical consideration
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An ethical clearance letter was obtained from Debre Markos University, College of Medicine and Health Sciences, Research, Community Service and Technology transfer Directorate, before starting the data collection process. A
All procedures were conducted in accordance with relevant guidelines and regulations. A
An informed consent was obtained from all participants. Permission to study was secured from university administration. The students were told that they had the right to refuse or join this study without any effects on their education and no need to explain the reason. Participation to the study was voluntary and confidentiality of information was assured throughout the study.Results
General characteristics of respondents
From the total of 672 questionnaires administered, 646 were filled and returned making the response rate 96.1%.
The age of respondents ranged from 19 to 42 years, with the highest (81.1%) being below 25 years old. The majority of the respondents were males (70.0%), from third-year (38.4%), Orthodox religion followers (79.6%), Amhara ethnic group (50.8%), and Law students (33.7%), (Table 1)
Regarding their source of income, the majority (83.0%) of students obtained it from their family. The monthly pocket money of more than half (56.3%) of students were 500 ETB and above. Student’s family sources of income were covered by agriculture, government employee, business man and daily laborer with the percentage of 57.9%, 17.3%, 18.6% and 5.6%, respectively. (Table 1)
Variables | Frequency | % | |
|---|---|---|---|
Sex | Male | 452 | 70.0 |
Female | 194 | 30.0 | |
Age | Below 25 | 524 | 81.1 |
25–30 | 120 | 18.6 | |
Above 30 | 2 | 0.3 | |
Department | Anesthesia | 45 | 7.0 |
Environmental health | 57 | 8.8 | |
Amharic | 30 | 4.6 | |
Law | 218 | 33.7 | |
Chemistry | 41 | 6.3 | |
Horticulture | 32 | 5.0 | |
Software engineering | 122 | 18.9 | |
Economics | 101 | 15.6 | |
Year of study | Second year | 218 | 33.7 |
Third year | 248 | 38.4 | |
Fourth year | 149 | 23.1 | |
Fifth year | 31 | 4.8 | |
Religion | Orthodox | 514 | 79.6 |
Muslims | 102 | 15.8 | |
Protestant | 20 | 3.1 | |
Others | 10 | 1.5 | |
Personal monthly income source | Family | 536 | 83.0 |
Friends | 40 | 6.2 | |
Relatives | 34 | 5.3 | |
My self | 36 | 5.6 | |
Monthly pocket money | Below 500 ETB | 282 | 43.7 |
500 ETB and above | 364 | 56.3 | |
Family source of income | Agriculture | 374 | 57.9 |
Government employee | 112 | 17.3 | |
Business man | 120 | 18.6 | |
Daily laborer | 36 | 5.6 | |
Others | 4 | 0.6 | |
Ethnic group | Amhara | 328 | 50.8 |
Oromo | 165 | 25.5 | |
SNNP | 78 | 12.1 | |
Others | 75 | 11.6 | |
Prevalence of khat chewing
The life time prevalence of khat chewing among Debre Markos university undergraduate regular students was 23.1% (95%CI: 19.5, 26.2%). One year prevalence was 20.7% (95%CI: 18.1, 23.8%). In addition, the current prevalence of khat chewing was 19.0% (95%CI: 18.0, 21.4%). the life time prevalence’s of khat chewing among males (24.5%) were greater than females (19.5%). Similarly, the current prevalence of khat chewing among male 21.0%) was greater than female students 14.4% (Table 2).
Prevalence of khat chewing | Khat chewers | Total (n = 646) | ||||
|---|---|---|---|---|---|---|
Male | Female | No | % | |||
No | % | No | % | |||
Life time prevalence | 111 | 24.5 | 38 | 19.5 | 149 | 23.1 |
One year prevalence | 104 | 23.0 | 30 | 15.5 | 134 | 20.7 |
Current prevalence | 95 | 21.0 | 28 | 14.4 | 123 | 19.0 |
Fifth year students were the most exposed group for khat chewing (29.0%) than with in any other year of study. Third year students followed by 22.2%, second year students 17.0% and fourth year students 14.8%. There was highest prevalence of khat chewing in third year (44.7%) students among all year of study and khat were chewed least by fifth year (7.3%) students. Among 514 orthodox Christian’s regular students 85 were chewed khat making the prevalence 16.5%, among 102 Muslim students 28 were chewed khat making the prevalence 27.5%, among 20 protestant 4 students were chewed khat making the prevalence 20.0% and 6 students were chewed khat from other religion.
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Fig. 3
Prevalence of current khat chewing among Debre Markos University regular students, Debre Markos Ethiopia, 2024.
Reasons of khat chewing
Among khat chewers twenty two students started before grade six making the percentage 16.4% and from khat chewers the greatest number 30 (22.4%) of students start during there were grade nine to ten. Next to grade nine to ten starting time of khat chewing were during first year (20.9%) in their university life. Only two (1.5%) students started chewing khat when they were third year university student.
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Fig. 4
Time of starting khat chewing among Debre Markos University, Debre Markos, Ethiopia 2024.
Seventy four (11.5%) students spent below 100 ETB per ceremony of chewing khat and sixty (9.3%) students spent 100 ETB and above. Most of the students who chew the khat had source of khat tree from city (9.3%) followed by in front of university (6.5%), from friends (4.3%) and other places(0.6%). While they were chewing khat fifty students used water (7.7%), fourth students used soft drink (6.2%), sixteen students used coffee (2.5%), eight students used tea (1.2%), ten students used nut (1.5%) and ten students used other thing (1.5%). From khat chewers about 38.8% of students chew khat daily bases and 16.4% were chewed khat during exam. Forty six students chew khat in frequency of one to three days per week and fourteen students were chewed khat beyond these days of frequency.
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Fig. 5
Source of khat tree among Debre Markos university khat users, Debre Markos Ethiopia 2024
Greater than half of students (52.2%) chewed khat with friends from university from current khat chewer students. The students who chewed khat with their other friends among khat chewers were 29.9%, with their family 1.5%, with others 4.5%. From current khat chewers 44.3% have faced negative effect due to chewing khat and 49.3% were mental problem due to khat chewing. Four hundred ten (63.5%) students from total sampling population have awareness about negative effect of substance use.
reasons | Frequency | % from total sample population | % from students who chewed khat | |
|---|---|---|---|---|
Peer pressure | 44 | 7.0 | 33.3 | |
Enjoyment | 45 | 7.1 | 34.1 | |
Culture | 18 | 2.8 | 13.3 | |
To get concentration on reading | 16 | 2.5 | 11.9 | |
To be free from anxiety | 2 | 0.3 | 1.5 | |
To stimulate sexual behavior | 6 | 0.9 | 4.4 | |
Due to their family members chew | 2 | 0.3 | 1.5 | |
Total | 133 | 20.9 | 100.0 | |
Forty six (34.1%) students were chewed khat for enjoyment while 33.3% of students who chewed khat currently were due to peer pressure. Reasons for chewing khat were due to culture (13.3%), to get concentration on reading (11.9%), to stimulate sexual behavior (4.4%) to be free from anxiety (1.5%) and due to their family members chewed (1.5%).
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From total of 646 students, 76 (11.8%) were family who chewed khat and 304 (47.1%) students had friends who chewed khat. Almost half (49.8%) of students had exposure with alcohol and followed by cigarette smoking and hashish with percent of 9.3% and 8.7% respectively. When students asked 36.2% had awareness about the importance of khat chewing for education and among 646 students 522 (80.8%) were passed their time mostly in compound, 92 (14.2%) were passed their time mostly out of compound, 22 (3.4%) were passed their time mostly in pension and 10 (1.5%) were other places.Factors associated with Khat chewing
Table 4 shows the result of a bivariate and multivariable logistic regression analysis that were fitted to identify factors associated with khat chewing practice among undergraduate regular university students. Age, department, and year of study, main monthly source of income, monthly pocket money, family source of income, geographic location, religion, having a family member chewing khat, having friends chewing khat, place for passing time and self-reported mental disorder were the variables entered in to the multivariable binary logistic regression model. After adjusting the possible confounders,
Being male, being student in department of software engineering, having family member’s chewed khat, having friend’s chewed khat and self-reported mental disorder were factors significantly associated with khat chewing practice. The association between these factors and khat chewing were observed. Male students were 2.64 times chewed khat than female students (AOR (95%CI) = 2.64(1.33, 5.22), department of software engineering student chewed khat 6.61 times economics students (AOR (95%CI) = 6.61(2.7, 19.2). (Table 4)
Families’ member chewed khat was significantly associated with chewing khat among students. It showed that students who had family member of chewed khat were approximately 11 times practiced chewing khat than students who had not family member of chewed khat (AOR = 10.79; 95%CI: 4.71, 24.73). Similarly, students who have friends chewing khat significantly associated with khat chewing among students. Students who had friends of chewing khat were chewed khat 9.5 times than students who had not friends chewing khat. (AOR = 9.50; 95%CI: 4.63, 19.47) Students who reported as mentally disordered were also 2.04 times chewed khat than students who were not reported as mentally disordered. (AOR (95%CI) = 2.04(1.06, 3.93)) (Table 4)
Variables | Khat chewing | COR (95% CI) | +AOR (95% CI) | |
|---|---|---|---|---|
Yes count (%) | No count (%) | |||
Sex | ||||
Male | 95(21.0) | 357(79.0) | 1.58(1.00,2.50) | 2.64(1.33,5.22)** |
Female | 28(14.4) | 166(85.6) | 1 | 1 |
Department | ||||
Anesthesia | 4(8.9) | 41(91.1) | 0.56(0.18,1.79) | 2.58(0.55,12.12) |
Env’tal health | 11(19.3) | 46(80.7) | 1.37(0.58,3.23) | 1.28(0.4,4.18) |
Amharic | 4(13.3) | 26(86.7) | 0.88(0.27,2.89) | 5.80(1.01,33.29) |
Chemistry | 8(19.5) | 33(80.5) | 1.39(0.54,3.58) | 3.66(1.04,12.94) |
Law | 40(18.3) | 178(81.7) | 1.29(0.68,2.46) | 9.36(3.14,27.90) |
Horticulture | 8(25.0) | 24(75.0) | 1.91(0.72,5.04) | 1.59(0.33,7.57) |
Software Eng. | 33(27.0) | 89(73.0) | 2.13(1.08,4.19)* | 6.61(2.27,19.21)** |
Economics | 15(14.9) | 86(85.5) | 1 | 1 |
Year of study | ||||
2nd year | 37(17.0) | 181(83.0) | 0.50(0.21,1.17) | 0.75(0.24,2.36) |
3rd year | 55(22.2) | 193(77.8) | 0.70(0.30,1.6) | 0.81(0.25,2.63) |
4th year | 22(14.8) | 127(85.2) | 0.42(0.17,1.04) | 0.34(0.10,1.17) |
5th year | 9(29.0) | 22(71.0) | 1 | 1 |
Religion | ||||
Orthodox | 85(16.5) | 429(83.5) | 0.40(0.32,1.82)* | 0.35(0.10,1.17) |
Muslims | 28(27.5) | 74(72.5) | 0.76(0.32,1.82) | 0.97(0.26,3.71) |
Protestant and others | 10(33.3) | 20(66.7) | 1 | 1 |
Ethnic group | ||||
Amhara | 59(18.0) | 269(82.0) | 0.88(0.45,1.65) | 0.97(0.39,2.45) |
Oromo | 21(12.7) | 144(87.3) | 0.58(0.28,1.21) | 0.93(0.32,2.68) |
SNNP | 28(35.9) | 50(64.1) | 2.24(1.08,4.65)* | 3.88(1.36,11.10) |
Others | 15(20.0) | 60(80.0) | 1 | 1 |
Personal monthly income source | ||||
Family | 94(17.5) | 442(82.5) | 0.99(0.40,2.46) | 0.40(0.10,1.58) |
Friends | 8(20.0) | 32(80.0) | 1.17(0.36,3.77) | 0.33(0.06,1.89) |
My self | 15(41.7) | 21(58.3) | 3.33(1.11,10.04)* | 1.83(0.38,8.86) |
Relatives | 6(17.6) | 28(82.4) | 1 | 1 |
Monthly pocket money | ||||
500ETB and above | 81(22.3) | 283(77.7) | 1.64(1.09,2.47)* | 1.66(0.93,2.98) |
Below 500ETB | 42(14.9) | 240(85.1) | 1 | 1 |
Family source of income | ||||
Agriculture | 63(16.8) | 311(83.2) | 0.96(0.40,2.26) | 4.50(1.11,18.23) |
Government employee | 13(11.6) | 99(88.4) | 0.62(0.23,1.68) | 4.01(0.83,19.32) |
Business | 40(33.3) | 80(66.7) | 2.36(0.96,5.80) | |
Daily laborer | 7(17.5) | 33(82.5) | 1 | 1 |
Family member chew khat | ||||
Yes | 48(63.2) | 28(36.8) | 11.31(6.69,19.14)*** | 10.79(4.71,24.73)*** |
No | 75(13.2) | 495(86.8) | 1 | 1 |
Friends who chew khat | ||||
Yes | 104(34.2) | 200(65.8) | 8.84(5.27,14.87)*** | 9.50(4.63,19.47)*** |
No | 19(5.6) | 323(94.4) | 1 | 1 |
Mostly passing time | ||||
In the compound | 70(13.4) | 452(86.6) | 0.34(0.16,0.75) | 1.89(0.45,7.96) |
Outside the compound | 43(46.7) | 49(53.3) | 1.93(0.82,4.53) | 13.80(2.80,68.00) |
Pension and other | 10(31.3) | 22(68.8) | 1 | 1 |
Self-reported mental disorder | ||||
Yes | 65(26.0) | 185(74.0) | 2.05(1.38,3.05)*** | 2.04(1.06,3.93)* |
No | 58(14.6) | 338(85.4) | 1 | 1 |
*=p-value < 0.05, **p-value < 0.01 ***=p-value < 0.001
COR = Crude Odds Ratio + AOR = Adjusted Odds Ratio
Discussion
This study was conducted to determine the prevalence and associated factors of khat chewing among Debre Markos university undergraduate regular students. In the study the life time, one year and current prevalence’s of khat chewing among Debre Markos university undergraduate regular students were 23.1%, 20.7% and 19.0% respectively. The result of this study was lower compared to study done in Haramaya University, Oromia Ethiopia in 2014 among 1040 students which reported almost one in three (30.3%) students chewed khat in life time (24).
According to the study conducted in Jimma University, Oromia, Ethiopia among 248 medical and health officer students the result of this study was low 33.1%(14) and higher 10.5%(25) according to study conducted in all campus of Hawassa University, southern Ethiopia among 1,255 regular students. An institution based cross sectional study conducted using quantitative method on 161 students of Adigrat University, North Ethiopia revealed that the life time prevalence of khat chewing were 6.7% and too low compared to this study(26). Current prevalence of khat chewing practice among community was 17.0% in Dera woreda, North West Ethiopia and it was nearly similar result(27). Other studies conducted on the prevalence of khat chewing in a sample of 248 high school students in south –western Ethiopia which was 64.9%(28) and it was high compared to this finding.
Another cross-sectional study conducted on 422 Gonder University medical students revealed that the current prevalence of khat chewing was 21.5% (22)and another similar study in this town indicated lifetime and current prevalence of khat chewing among the regular students were 42% and 32.5% respectively which was higher compared to this finding(29). Institution based cross-sectional study was conducted in 2013 in Aste Fasil campus, University of Gondar in total of 310 students revealed that life time and current prevalence rate of khat chewing was found to be 9.6% and 6.95% respectively and it were lower compared to this study(30). Similar study conducted in Jazan Region, Saudi Arabia the overall or life time prevalence of khat chewing among students of Higher Education was 23.1% and nearly similar with this finding(31). The study conducted in Hawassa University, southern Ethiopia revealed that the prevalence of current khat chewing among all campus students was 10.5% and it was lower as compared to this study.
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.
The pooled prevalence of khat use revealed that prevalence of current khat use among university students was 14.16% and prevalence of current khat use was highest in Saudi Arabia 18.85% and it was 13.59% in Ethiopia and 13.04% in Yemen and this finding was highest as compared to this meta-analysis and systematic review (21). The study conducted in Addis Ababa University Sellalie campus revealed that the life time prevalence of khat chewing among students was 21.9%(32) and it was almost similar as compared to this study. The life time prevalence of khat chewing among pharmacy and technology students of Addis Ababa University was 31.9%(33) and it was higher as compared to this finding but the current prevalence was 14.4% and it was lower as compared to this study. Study conducted in Sidama zone among high school students indicated that the life time and current prevalence of khat use were 14.6% and 13% respectively and it was lower as compared to this study(34). The reason might be due to the study time difference, accessibility of khat to the universities, characteristics of schools, absence of involving all school or faculties even in one college or university and its students.
In this study, prevalence of khat chewing was higher among male students when measured across different time periods. This is consistent with several studies conducted among higher learning institutions in Ethiopia and elsewhere (16, 23, 35–37). The study in Bahir Dar University assessed students in sex ever use of khat in males and females were 27.3% and 12.5%(38) as compared to this study higher with in males (24.5%) and lower with in females (19.5%). Compared to another study conducted in Aste Fasil campus, University of Gondar of khat chewing among males (11.7%) and females (6.72%) were higher in prevalence(30). According to the department and year of study the prevalence of overall khat chewing were assessed as: In Debre Berhan University the students who study law, economics, engineering and health sciences were 1.5%, 4.2%, 4.5% and 5.7% respectively(39). As compared to this study the prevalence was higher in law (8.3%), lower in economics (2.9%), higher in software engineering (5.8%) and lower in environmental health (2.0%).
Some of reasons reported for khat chewing in this study were due to culture (13.3%), to get concentration on reading (11.9%) and to be free from anxiety (1.5%). As compared to study conducted in Hawassa University, southern Ethiopia higher due to habit (5.6%), lower to get concentration for studying/reading (38.9%) and nearly the same to avoid unpleasant feeling, stress of life and anxiety (12.9%) (25).
The result of this study indicated high prevalence khat chewing with factors such as sex (males 2.64 times females), being law department (9.36 times economics), being ethnic group of SNNP (3.88 times others), family members chewing khat (10.79 times who had no family member chewed), friends chewing khat (9.5 times who had no friend chewed) and self-reported mental disorder (2.04 times self-reported mentally normal). (P-value < 0.05)
According to sex this was consistent with study conducted in hosanna, Ethiopia males chewed khat 3.48 times that of females(6). It was also consistent with study conducted among medical students in other studies conducted in Ethiopia and abroad (22, 23, 31, 38). The possible reason might be male students consider chewing khat as indicator of civilization and females toward khat chewing affected by cultural and social restriction.
According to having family member of student chewing khat this study was also consistent with study conducted in Jazan region of Saudi Arabia (31), Sidama zone southern Ethiopia (34) and other studies (18, 36, 39). The possible reason might be students followed the behavior of their family. Another factor having friend who chew khat on current regular khat chewing is also consistent with previous studies which reported higher odds of khat chewing among students who had khat chewing friends (11, 31, 40, 41). Mental disorder can also be factor of khat chewing and it is consisted with study conducted in Amhara Region, Northwest Ethiopia stress and khat chewing was positively associated (42).
Limitation of this study
The limitations included the collection of data was based on self-report of the students and may be subjected to recall bias. It is related to sensitive issues so that may not be genuine response even if the confidentiality of respondent was kept. .
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Competing of Interest.
The authors declare. that they have no competing of interest.
Human & Experiment.
Non available.
A
Funding
No funding.
A
Acknowledgement
We are grateful to Debre Markos University for coordinating and giving any information concerned from office of registrar to department offices.
A
Data Availability
All relevant datasets used and/or analyzed during the current study are within the paper.