Background: khat chewing has been practiced from ancient by people in the Eastern part of Africa, the Arabian, Peninsula and other parts of the world. In Ethiopia, khat chewing is becoming habitual and the proportion of people chewing khat has significantly risen over the years and chewers’ population in Ethiopia is now 16% from the country’s population.

The main aim of this study was to provide national data on life time prevalence of khat chewing and associated factors that will serve as evidence for policy and planning and as baseline data for further studies.

Methods: The data for this study was extracted from the 2016 EDHS. The 2016 EDHS is the fourth and most recent in the Demographic and Health Survey series in Ethiopia. Socio demographic variables were selected based on their availability in the dataset Our analysis included all men and women age 15-49 years which resulted in a total weighted sample of 27,289 Descriptive statistics were employed to show the distribution of socio-demographic characteristics Logistic regression model was used to determine the true association between chat chewing and basic socio-demographic factors

Results: Of the total sample of 27289 of men and women age 15-49 years at the time of survey, 18.3% (n = 5006) have life time that chewing in Ethiopia, About 71.7% of the variation in the outcome variable (that chewing) is explained by the independent variables included in model Men and women in the 15-19 age group 9.952 (AOR9.952 95% CI 6.156- 16.091) and Men and women age 15-49 years in urban areas 34.040 (AOR 34.040; 95% CI: 21.028--55.105) were found to be major contributing factors to the that chewing.

Conclusions: Younger age and urban residence had a statistically significant association with that chewing. Therefore, to effectively control khat chewing in Ethiopia, Creating awareness and increasing knowledge on the harmful effects of that chewing are recommended. A particular attention should be given to young adolescent and urban areas

• Socio demographic
• Life time prevalence of that chewing
• EDHS

Tegegne ET, Tegegne KT, Assefa AA, Kassa Tessema AM (2020) LIFE TIME PREVALENCE OF KHAT CHEWING AND ITS SOCIO DEMO-GRAPHIC CORRELATES AMOND ADULTS AGE 15-49 YEARS IN ETHIOPIA. J Subst Abuse Alcohol 7(1): 1084.

AOR: Adjusted odds ratio; CI: Confidence interval; COR: crude odd ratio; DHS: Demographic health survey; EDHS: Ethiopian demographic and health survey; ICF: Inner city fund; UNICEF: United Nations International Children’s Emergency Fund

khat chewing has been practiced from ancient by people in the Eastern part of Africa, the Arabian, Peninsula and other parts of the world [1-4].

In Ethiopia the proportion of people chewing khat has significantly risen over the years and chewers’ population in Ethiopia is now 16% from the country’s population [5].

In Ethiopia, khat has started to rapidly replace the precious cereal, coffee, fruits and other crops found in the highlands of Ethiopia. Farmers prefer that due to different reasons including, it’s profitability as a cash crop than others, less vulnerability to drought, and less labor power cost required for its cultivation.

However, khat producing farmers in Ethiopia start consuming that and this culture is also continued expanding to the nearby secondary schools and urban dwellers [6].

The Magnitude of students’ that use in Ethiopia ranges from 13.4% to 41% for lifetime Youths’ substance use contributes to the creation of a community with; substance use dependence, juvenile delinquencies, crimes, socio-economic and other public health problems [7].

In Ethiopia, studies conducted among students of Jimma University showed that the current prevalence of khat chewing was 30.8% [8] Moreover, in Ethiopia, 42% of university instructors were lifetime khat chewers [9] Besides, other studies have also presented that the use of that was significantly associated with age, gender and place of residence [10].

Similarly, a study in Gondar town revealed that the prevalence of khat chewing was high with statistically significant associations with sex, religion, and monthly income [11].

A 2011 report from the Ethiopian Demographic and Health (EDHS) survey showed khat chewing was more common in the Eastern, Central and Northeastern parts of the country; the highest wealth index quintile, older age group, unskilled workforce, rural residents, exposure to mass media and administrative regions were factors statistically associated with khat chewing practice [12].

Literature has revealed that a number of factors cause the increased khat consumption in different regions of Ethiopia. Among them are normalization in the community, social mobility to most khat chewing community, perceived non -side effect, affordability, type of occupation and availability of khat leaf in the whole year [12,13].

To assist policy formation for coping with all forms of drug abuse in specific risk groups and the general population of Ethiopia, epidemiological studies are needed to identify risk groups and patterns of drug use behavior [14].

The consumption of khat leaves is mostly practiced by adults in all regions and ethnic groups. Hence, most khat chewers are adults and exist in the active production stage, country labor force economic production, and chewers’ livelihood situation remains questionable. This implies reducing number of chewers through identifying and reducing determinants is essential.

The main aim of this study was to provide national data on life time prevalence of that chewing and socio demographic factors associated with it and the findings of this study will serve as evidence for policy and planning, and as baseline data for further studies.

Data source, sampling and data collection

The data for this study was extracted from the 2016 EDHS. The 2016 EDHS is the fourth and most recent in the Demographic and Health Survey series in Ethiopia [15]. The survey was conducted in nine regional states and two city administrations of Ethiopia [15]. Further details on sampling strategy can be found in the DHS manual [15].

A total of 16,583 eligible women and 11,606 eligible men between 15 and 49 years were approached to be interviewed. A response rate of 95% was observed with 15,683 women completing the interviews and response rate 86% among 11,606 men interviewed. The interviews included several standard questionnaires recording information ranging from basic socio-demographic information to detailed bio-medical information.

Our analysis included all men and women age 15-49 years which resulted in a total weighted sample of 27,289 Outcome variable.

Life time prevalence of Khat chewing: The proportion of men and women age 15-49 years who had ever chewed Khat in their life time

According to EDHS all men and women age 15-49 years asked whether they ever chewed chat or not (1 if they ever chew chat, 0 otherwise)

Co-variates

The basic socio-demographic variables were selected based on their availability in the dataset The included basic sociodemographic factors are highest education level (categorized as “no education”, “primary”, “secondary ” ,“more than secondary ”)and working status in the past 12 months (“not working” or “working and occupation status (“not working”, “nonagriculture” and “agriculture”), marital status (“never married”, “currently married”, “Living together”, “Divorced/separated” and “Widowed”) age (“15–19 years”, “20– 24 years”, “25–29 years” 30– 34 years” “35– 39 years” “40– 45 years” and “45– 49 years”) and mothers exposure to mass media (“no” or “yes”).

Number of living children (“1”, “1-2”, “3-4” and “5+”), Literacy (“Cannot read at all”, “Can read part/whole sentence” and “Other”)

Household factors included household wealth index (categorized as “poorest”, “poorer”, “middle”, “richer” and “richest”),

The household wealth index was calculated using scores based on household assets with analyses conducted by the National Population Commission and Inner-City Fund (ICF) International based on a methodology developed from previous DHSs [16, 17] and using methods recommended by the World Bank Poverty Network and United Nations International Children’s Emergency Fund (UNICEF) [18].

Community level factors recorded were the place of residence (“rural” or “urban”) and geographical region.

The geographical regions were grouped into nine regional states of Ethiopia; namely Afar, Amhara, Benishangul-Gumuz, Gambella, Harari, Oromia, Somali, Southern Nations Nationalities and Peoples’ Region (SNNP), and Tigray, and two city administrations named Addis Ababa and Dire Dawa [15].

Statistical analysis

Sampling weights provided with the EDHS dataset were used during analysis Further details on sample weights can be found in the EDHS report [15].

Descriptive statistics were employed to show the distribution of background characteristics. We used logistic regression model to determine the true association between chat chewing and basic socio-demographic factors. Both unadjusted and adjusted odds\ ratios (ORs) were reported with 95% confidence intervals (95% CI). Besides, diagnostic tests were done, particularly goodness of fit of the model by the Hosmer and Lemeshow test; (where p-value of 0.875 was found), The Cronbach’s alpha result of the variables is 0.900 The Nagelkerke R Square shows that about 71.7% of the variation in the outcome variable (chat chewing ) is explained by this logistic model The overall accuracy of this model to predict subjects who ever chew chat (with a predicted probability of 0.5 or greater) is 89.4% All analyses were performed using statistical software SPSS (Version 16.0).

Ethics approval

This study is a secondary analysis of publicly available dataset where permission was obtained through registering with the DHS website and therefore no ethics approval was required.

Baseline characteristics

Of the total sample of 27289 of men and women 15-49 years at the time of survey, 18.3% (n = 5006) had life time prevalence of khat chewing

As summarized in Table 1, majority (57.5%) of the respondents were female and a predominant percentage of the men and women 15-49 years lived in rural areas (78.8%), respondatns in the regions of Oromiya were (37.1%) and Amhara (24.3%).

Table 1. Individual, household and community level characteristics of men and women 15-49 years, Ethiopia 2016.

32.1% of men and women 15-49 years reported not working in the past 12 months at the time of survey, and 39.2% did not have any formal education. In addition to education status, around 45.9% of men and women 15-49 years reported having poor literacy skills and could not read at all.

Majorities (39.8%) of the respondent’s occupation were agriculture, 28.1% were non-agriculture employee in addition, and 43.8% of the respondents were orthodox religion followers

In terms of men and women 15- 49 years age, overall 21.8% of men and women were between 15 and 19 years of age

Most men and women 15- 49 years (58.9%) reported as currently married at the time of the survey. Of the total, only 16.4% were in lowest wealth quintile and 26.0 % were in the highest wealth quintile

In terms of the number of living children, about 39.7 % of men and women 15- 49 years reported to have one living children and 20.7 % had more than 5 number of living children during survey.

Regarding exposure to mass media, 6.2% read newsletter, 18.1% watch to TV and 21.7% listen to radio (Table 1).

Bi-variable analysis

An increase in one-year in age (COR = 0.174; 95% CI: 0.165-- 0.183) were less likely to chew chat

Odds of chat chewing among men and women age 15-49 years in urban areas were 9.709 (COR19.709; 95% CI: 18.303-- 21.223) times higher than rural areas

Men and women age 15-49 years in afar are 0.799 (COR 0.799; 95% CI: 0 719-- 0.888) times less likely to chew khat than Tigray region of Ethiopia

Men and women age 15-49 years in Amhara are 0 .002 (COR 0 .002; 95% CI: 0.002--0.003) times less likely to chew khat than Tigray region of Ethiopia

Men and women age 15-49 years in poorest category are 0 649 (COR 0 649; 95% CI: 0.598- 0.704) less likely to chew khat than poorer categories

Men and women age 15-49 years who were never married 0 .078 (COR 0 .078; 95% CI: 0.072-0-084) less likely to chew khat than married

Multivariable analysis

residence they live had significant association with men and women 15-49 years living in urban areas were 34.040 times higher odds of chat chewing (AOR 34.040; 95% CI: 21.028-- 55.105) compared to men and women 15-49 years who had live in rural areas

Demographically, since age is a quantitative numerical variable, an increase in one-year in age has 9.952 (AOR9.952 95% CI 6.156- 16.091) times decrease in odds of khat chewing

Table 2 shows unadjusted and adjusted odds ratios (AOR) that were calculated to determine the strength of association between the co-variates and life time prevalence of khat chewing (Table 2).

Table 2: Unadjusted and adjusted Odds Ratio for life time prevalence of khat chewing in Ethiopia 2016.

Backward stepwise model with dichotomous outcome of (0 = no life time prevalence of chat chewing, 1= life time prevalence of chat chewing) (Table 3).

Table 3: socio demographic characteristics of men and women age 15-49 years according to life time prevalence of khat chewing in Ethiopia 2016

Life Time Prevalence of Khat Chewing

Of the total sample of 27289 of men and women 15-49 years at the time of survey, 18.3% (n = 5006) have life time prevalence of chat chewing which is comparable to previous studies 13.4% to 41%,17.5% ,17.9% , 18.3% respectively [7,9,19,20] and higher compared to 15.3%, 16%.,15.36% , 14% 7.5%, 15.8%, 15.3%, 9.6% respectively [12,21-27].and lower compared to 46%., 23.0%, 19%, 19.9 % , 48.6%., 50% ,30.6%, 19.6%, 24.7%, 74.55%, 22.3% , 23.61% , 29.6% , 27.14%, 37.1%, 65.6% respectively (8.24,25,28,29,30-34,36-41 ) and Study by (35).is also higher compared to this finding

Furthermore, the possible explanations for the observed differences in that chewing could be due to differences in sample characteristics, in the definitions used by studies. In our study life time prevalence of that use was measured by asking whether they ever chew chat in their previous life and others used define that use as “using of that for the previous one year or one month” and methodological differences.

Socio demographic factors associated with life time prevalence of that chewing

In our study the life time prevalence of that chewing was not statistically significantly higher in males compared with females similar to findings from 2015 national Noncommunicable diseases STEPS survey (25).

According to our findings life time prevalence of that chewing in the general population of Ethiopia was 26.7 % among men and 12.1 % among women of 15–49 years which is similar with EDHS 2011 27.3% among men and 11.0% among women of 15–49 years [26.].

In our study age and area of residence significantly associated with that chewing contrarily with study in Southwestern Saudi Arabia (41).

In this study an increase in one-year in age has 9.952 (AOR9.952 95% CI 6.156- 16.091) times decrease in odds of chat chewing which is similar to previous studies [8-9,21,27,38,41- 43].

This study is contrarily with study [12,48,21,39].

Many factors increase the risk of that chewing during adolescence, including socioeconomic status, neighborhood, cultural context, peer influence, teachers’ influence and perhaps most importantly, family influences [44].

It is reported that social acceptability of that chewing and socialization of this habit increase the likelihood of adolescents adopting the behavior in Jazan Region [45]. For Yemenis, that may be less of a drug than a medium for socialization [4].

This fall in the age of initiation of that chewing indicates the failure of prevention strategies (46).

Teenagers who want to try new things and can be convinced by their friends and may try to chew that for the purpose of relaxation (28).

This indicates that the more educated groups who represent the most productive sections of the society are affected by the that chewing habit (8), This showed that the above ages are in the age group called teenage in which those who are in this period want to try everything by themselves and can be exposed to different kinds of substances (9,43). The most frequent reasons for continuing chewing that were promoting dialogue and social discussion, making the chewer feel refreshed, more energetic, alert and attentive (41).

Similar claims of positive physiological aspects to that chewing and strong energizing effect of workers have been reported elsewhere (47).

It implies older individuals may be deciding to wait for not chewing in order to deal with their family cases unlike younger that may be sensitive to do what they observe in their life and that chew 

In this study residence they live had significant association with men and women 15-49 years living in urban areas were 34.040 times higher odds of chat chewing AOR 34.040; 95% CI: 21.028--55.105) compared to men and women 15-49 years who had live in rural areas which is similar to previous studies (25,32,42,49) and contrarily to studies (12, 33).

In this study Higher prevalence in urban observed because from no educated respondents (10701) majority of 54.0% (5779) respondents in urban residence have no education

According to previous study education is a protective factor for current that chewing. Participants who are in the no education group are more likely to chew khat than those who are educated (25) Lower educational status was found to be a significant independent predictor of current that chewing (37).

The study conducted from the Jazan region, Saudi Arabia, which showed that illiterates were at higher odds of chewing that [50].

The reason could be uneducated men would have a lack of information on the negative consequences of that on their health [51].

In our study age and residence significantly associated with life time prevalence of that chewing and this is similar with the previous study that reported that chewing was associated with age and residence [52].

Limitations of the study

The cross-sectional nature of the study design might not show the cause and effect relationships between the explanatory variables and that use. Furthermore, that use has a social taboo, in which participants might under report their experience and this may introduce social desirability bias.

Younger age (15-19) and urban residence had a statistically significant association with life time prevalence of that chewing.

Therefore, to effectively control that chewing in Ethiopia, creating awareness and increasing knowledge on the harmful effects of that chewing are recommended. A particular attention should be given to young adolescent and urban areas

We are grateful to Measure DHS, ICF International Rockville, Maryland, USA for providing the 2016 EDHS data for this analysis.

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