The effect of possible mediators on the association between chewing khat during pregnancy and fetal growth and newborn size at birth in Eastern Ethiopia.

INTRODUCTION: Restriction in the growth of the fetus is a leading cause of stillbirth, neonatal mortality, and short- and long-term morbidity. Documented existing scientific evidence have shown the effects of maternal drugs use, alcohol drinking, tobacco smoking, cocaine use and heroin use on fetal growth restriction. However, data is lacking on the effects of khat chewing during pregnancy on fetal growth status and newborn size at birth. Therefore, the aim of the present study was to measure the effect of chewing khat during pregnancy on fetal growth and size at birth in eastern Ethiopia. METHOD: A cohort study was conducted in selected health institutions in eastern Ethiopia. All pregnant women fulfilled the eligibility criteria in the selected health institutions was the source population. The calculated sample size of exposed and unexposed groups included in the study, in total, was 344. Data collection was performed prospectively by interviewers administered questionnaires, and anthropometric, clinical and ultrasound measurements. Data was analyzed using SPSS version 27 and STATA version 16 software. The survival analysis (cox proportional hazards model) and generalized linear model (GLM) for the binomial family analysis were performed to estimate the crude and adjusted relative risk and attributable risk (AR) with corresponding 95% CI of chewing khat on fetal growth restriction. The mediation effect has been examined through Generalized Structural Equation Modeling (GSEM) analysis using the Stata 'gsem' command. Statistically significant association was declared at p-value less than 5%. RESULTS: In the present study, the incidence of fetal growth restriction (FGR) among the study cohorts was 95 (29.7%); of this, 81 (85.3%) were among khat chewer cohorts. The relative risk of fetal growth restriction among khat chewer cohort mothers was significantly higher (aRR = 4.32; 95%CI 2.62-7.12). Moreover, the incidence of small for gestational age at birth among the present study cohorts was 100 (31.3%); 84 (84%) were from khat chewer cohorts' deliveries. More importantly, in the present study, 98.95% of the ultrasound-identified fetuses with FGR were found to be SGA at birth. Hence, in the current study, FGR was highly associated with SGA at birth. In additional analysis, the regression coefficient of khat chewing during pregnancy on fetal growth restriction has been decreased in size from path o, ß = 0.43, p < 0.001 to path o', ß = 0.32, p < 0.001, after adjusting for gestational hypertension and maternal anemia. CONCLUSION: In sum, the present study showed khat chewing during pregnancy is not simply affected the mothers, but it also affected the unborn fetuses. Therefore, the health workers as well as the local community and religious leaders should give high emphasis on provision of health education regarding the damage of chewing khat by pregnant mothers, with especial focus of the effects on their fetuses.

Tobacco use and khat chewing among adolescents in Yemen: a large-scale school-based cross-sectional study.

OBJECTIVE: The present study sought to assess the prevalence and determinants of tobacco use (cigarette smoking and shisha use) and khat chewing among Yemeni adolescents, and to evaluate their knowledge and attitudes toward these habits. METHODS: This school-based cross-sectional study was conducted among 13 to 19-year-old students attending middle/high schools (both private and public) across five main cities in Yemen. Data were collected using self-administered questionnaires comprising questions/items related to sociodemographic data, cigarette smoking, shisha use, khat chewing, and knowledge on and attitudes toward these habits. Bivariate and multivariate analyses were used to explore the most determinant factors. RESULTS: A total of 7505 students were recruited from 42 schools across five major cities in Yemen. The prevalence rates of khat chewing, cigarette smoking, and shisha use were 42.4%, 6.8%, and 19.3%, respectively. Compared to females, male subjects reported significantly higher prevalence of khat chewing (51.4% vs. 23.5%, p < 0.001), shisha use (20.3% vs. 17.2%, p < 0.01), and cigarette smoking (8.8% vs. 2.6%, p < 0.001). Male gender, older age, poor knowledge, khat chewing, parents' low education level, and parents' and peers' smoking habits were significant determinants of adolescents' cigarette smoking status. Private education, male gender, older age, poor knowledge, parents' low education level, and parents' and peers' khat chewing habits were significant determinants of adolescents' khat chewing status. The participant's knowledge of and attitudes toward tobacco use and khat chewing were inadequate. CONCLUSION: The prevalence of khat chewing, shisha use, and to lesser extent cigarette smoking among Yemeni adolescents is high that needs immediate intervention. The results highlight the urgent need to implement prevention strategies to tackle these habits among the youth in Yemen.

Clinical presentation and angiographic findings of acute myocardial infarction in young adults in Jazan region.

BACKGROUND: There is a paucity of information about the clinical features and angiographic findings in young patients with acute myocardial infarction (MI), especially in the Arab Peninsula countries. OBJECTIVE: The aim of this study was to assess the proposed risk factors, clinical presentation, and angiographic findings of acute myocardial infarction in young adults. METHODS: This prospective study included young (range, 18 to 45 years) patients who presented with acute MI based on clinical evaluation, laboratory investigation, and electrocardiogram, and they underwent a coronary angiography procedure. KEY FINDINGS: Data of 109 patients with a diagnosis of acute MI were collected. Patients' mean age was 39.98 ± 7.52 years (range, 31 to 45 years), and 92.7% (101) were male. Smoking was the highest risk factor in 67% of patients, obesity and overweight in 66%, sedentary lifestyle in 64%, dyslipidaemia in 33%, and hypertension in 28%. Smoking was the most common risk factor for acute MI in males (p = 0.009), whereas sedentary lifestyle was the most common risk factor in females (p = 0.028). Chest pain typical of acute MI was the most common presenting symptom in 96% of patients (p < 0.001). On admission, 96% of patients were conscious, and 95% were oriented. On angiography, the left anterior descending artery (LAD) was affected in 57%, the right coronary artery (RCA) was affected in 42%, and the left circumflex artery (LCX) was affected in 32% of patients. The LAD was severely affected in 44%, the RCA was severely affected in 25.7%, and the LCX was severely affected in 19.26% of patients (p < 0.001). CONCLUSION: Smoking, obesity, sedentary lifestyle, dyslipidaemia, and hypertension were the most common risk factors for acute MI. Smoking was the most common risk factor in males and sedentary lifestyle in females. The LAD was the most commonly affected coronary artery, followed by the RCA and LCX arteries, with the same order for severity of stenosis.

Magnitude of Khat use and associated factors among women attending antenatal care in Gedeo zone health centers, southern Ethiopia: a facility based cross sectional study.

BACKGROUND: Khat (Catha edulis) is a fresh green leave commonly chewed for recreational purpose and its euphoric effect as a result of dopamine activities stimulation effect of Khat. Women may use Khat during their pregnancy to tolerate their pregnancy related distress. Khat has biological, social or psychological complications; adverse pregnancy outcomes and negatively affects the health of the mother and the fetus. However, magnitude, pattern and associated factors of Khat use are not well addressed among pregnant women in Ethiopia. The aim of this study was to address this gap by assessing the magnitude and associated factors of Khat use among women attending antenatal care service at Gedeo zone rural health centers. METHODS: This was a facility based cross-sectional study conducted at rural health centers in Gedeo zone from June 1st to August 1st, 2017. The data were collected through structured interview using an interview guide developed from different literatures. A total of 718 pregnant women attending antenatal care service participated in the study using multi stage sampling technique. Bivariable and multivariable analysis were used to identify associated factors of Khat use among women during their current pregnancy period. In the multivariable analysis, variables with P-Values of less than 0.05 were considered as statistically significant correlates of Khat use. The strength of the association was also measured with adjusted odds ratio at a corresponding 95% confidence interval. RESULTS: The lifetime and current prevalence of khat use among pregnant women were 11.0% (95%CI: 8.8-13.2) and 9.9% (95% CI: 7.7-12), respectively. The odds of being khat user was higher among those who had khat user partner [AOR = 3.450, 95% C.I (1.907-6.244)], respondents with alcohol use behavior [AOR = 3.235, 95% C.I (1.573-6.659)] and mental distress [AOR = 3.575, 95% C.I (2.067-6.189)]. CONCLUSION: Significant proportions of pregnant women were experiencing khat chewing during pregnancy. Having khat user partner, alcohol use behavior and metal distress were significantly associated with khat use of pregnant women. This demonstrates a need to integrate the prevention, early identification and intervention of Khat use as a component of treatment modality for pregnant women during their antenatal visit.

Prevalence and risk factors for khat use among youth students in Ethiopia: systematic review and meta-analysis, 2018.

BACKGROUND: Khat use is a widely spreading public health problem affecting the most economically productive population areas in Ethiopia. Khat use among students has been linked with mental, physical, social, and psychological problems. Reliable prevalence has not been recognized because of varying published rates. The objective of this systematic review and meta-analysis is to synthesize evidence on the prevalence and potential risk factors of khat use in Ethiopia. METHODS: We found 284 studies of which 266 were removed due to duplication, irrelevant topics, and other reasons, respectively. All studies conducted in Ethiopia on khat chewing among students irrespective of time frame were included. Subsequently, 18 studies were used for synthesis of prevalence. Figures were extracted from published reports, and any lost information was requested from investigators. The quality of the included literature was evaluated by using the Newcastle-Ottawa Scale (NOS). Prevalence was pooled using random-effects meta-analyses. The presence of association was declared using P-values and an odds ratio with a corresponding 95% CI. RESULTS: The pooled prevalence of khat use among students was 16.7% (13.7-19.7%). In the subgroup analysis, the highest prevalence was observed in the Oromia region, at 21.1% (15.5%, 26.7%), and an almost equal prevalence of 14.8% (10.6, 18.9) and 14.3% (10.3, 18.3) was observed in Amhara and the Southern Nation, Nationalities, and People's Region of Ethiopia, respectively. Being male (OR: 2.43 (1.73, 3.13)), being a Muslim religion follower (OR: 2.22 (1.6, 2.8)), being an alcohol user (OR: 2.3 (1.5, 3.0)), khat use by a family member (OR: 1.8 (1.4, 2.2)), peer pressure (OR: 4.4 (3.1, 5.6)), and being a cigarette smoker (OR: 8.5 (5.3, 11.7)) were found to be risk factors for khat chewing. CONCLUSIONS: Khat use is a common problem among students. Health promotion, awareness on effect of khat, set policy on khat and substance use on the male sex, Muslim religion, alcohol user, having a family-member khat user, peer pressure, and being a cigarette smoker as possible risk factors for khat use among students. LIMITATIONS: Irrespective of time restriction, all studies conducted in Ethiopia are included and cross-sectional in nature. Protocol no. CRD-42017081886.

Knowledge and Attitudes on Khat Use among Yemeni Health Sciences Students.

Background: Khat chewing has a negative impact on an individual's life. Objectives: The study was execute to assess health sciences students' knowledge and attitudes regarding khat use in Yemen. Methods: This survey involved health sciences students from Aden University. Approximately 500 participants were selected through convenience sampling. The data were collected using a structured and validated self-administered questionnaire. The data were tabulated and descriptively analyzed. Results: The total number of respondents was 500. Almost half of the students reported that they chewed khat (n = 239, 48%). Approximately 66% (n = 330) of the students spent 2000 Yemeni riyals or less (USD1 = YER249.9) per day on khat. The main reasons for chewing khat were 'it is a social habit' (n = 155, 31%), followed by 'it improves my concentration when studying or working' (n = 140, 28%). Students knew that the effects of khat are similar to those of amphetamines (n = 210, 42.0%) and that khat is addictive (n = 254, 50.8%). Additionally, they knew that cathinone is the dependence-producing constituent of khat leaves (n = 269, 53.8%). The students agreed with the following statements: 'I will advise people to cease khat use'; 'Khat chewing is harmful to health'; 'Children and adolescents should not chew khat'; 'Khat chewing helps people stay awake'; and 'Health professionals serve as role models for patients and the public'. Conclusions: Khat chewing is prevalent among Yemeni university health sciences students. Only about half of the students recognized health risks associated with khat use. Also, among those who used khat, students endorsed positive benefits such as improved concentration.

Prevalence, associated factors and consequences of substance use among health and medical science students of Haramaya University, eastern Ethiopia, 2018: a cross-sectional study.

BACKGROUND: Substance use has a terrible impact on health, behavior and country's economy because the number of people particularly the youngsters being involved in this practice is increasing rapidly. However, the prevalence, determinants and consequence of substance use in the study area has been overlooked. METHODS: A descriptive quantitative cross-sectional study was conducted among 254 health science students of Haramaya University. The respondents were selected randomly after double stratification based on their department and batch respectively. A pre-tested self-administrable anonymous questionnaire was used. The collected data were entered into epidata version 3.1 and exported to SPSS version 23. Descriptive statistical analysis was done to examine findings. Besides, chi-square (X2) test was considered to examine the nonparametric association of factors with ever substance use. RESULTS: Prevalence of ever substance use for at least one substance was found to be 114(45.4%). Ever khat chewers take the highest percentage [107(93.9%)] followed by ever smokers 45(39.5%) and ever drinkers 44(38.6%). Among these ever substance users, 80(70.2%) were found to be current substance users. Being a preparatory student (26.3%) and freshman at university (57.9%) were critical times to initiate substance use. Sex, monthly income, sexual risk behavior and family history of substance use were found to be significantly associated with being ever substance user as witnessed by their respective X2 values of 19.67, 72.28, 28.99 and 139.72 at P-value = 0.05 and degree of freedom (df = 1). From the overall ever substance users, 31.6% had undesirable health consequences. Among these consequences, anorexia [40 (35.1%)] accounted for the highest percentage followed by insomnia [29 (25.4%)], depression [25 (22%)], gastritis [25 (22%)], dental caries [23 (20.2%)] and increased sexual activity [12 (10.5%)]. CONCLUSION: Prevalence of ever substance use in the study area was relatively high. Therefore attention should be given to the major reasons for substance use mainly orientation of freshman students about better stress coping mechanisms and expansion of adequate recreational activities.

Factors affecting tobacco smoking in Ethiopia: evidence from the demographic and health surveys.

BACKGROUND: Tobacco smoking is growing at an alarming rate in the developing world and sub-Saharan Africa. Although Ethiopia has a relatively low rate in the region, it is not immune to the tobacco epidemic. The government of Ethiopia passed an anti-tobacco bill in 2015 that includes measures governing tobacco consumption, advertising, packaging, and labeling. To effectively address the challenge of tobacco control, the government should consider a number of aspects of tobacco production and consumption, such as local production in rural areas, as well as the complementarity nature of tobacco and khat use. METHODS: Using the World Bank's Demographic and Health Surveys (2011 and 2016), this paper analyzes the key determinants of tobacco smoking in Ethiopia, emphasizing possible differences in various social contexts, across regions. More specifically, we assess the association between khat use and tobacco smoking while controlling for various observed individual-level, household-level, and community-level covariates. Using GPS data, we are able to capture the neighboring effects of smoking behavior in community clusters bordering other administrative regions as well as differences in smoking patterns between lowland and highland residents. We utilize a multilevel modeling framework and use a two-stage residual inclusion estimation method that accounts for the endogeneity of khat and tobacco use. RESULTS: The results suggest that chewing khat and geographic regions are statistically significant determinants of tobacco smoking even after controlling for various socioeconomic and demographic factors. Altitude information analysis suggests that people living in lowlands are more likely to smoke compared to those living in highland areas. Additional analysis including interactions between regions and khat use indicate wide inter-regional variations in tobacco smoking by khat users. We also extend our analysis by interacting khat use with religious adherence. Results indicate a wide variation in tobacco smoking by khat chewers across different religious groups. CONCLUSIONS: To effectively control tobacco smoking of the diverse communities in Ethiopia, policymakers should consider a multi-pronged policy approach that combines various policy tools that account for regional variation, the local social contexts, as well as the complementary nature of smoking and khat chewing practices.

Successful Management of Khat Chewing-induced Gingival Recession by Using Tunnel Technique Utilizing Subepithelial Connective Tissue Graft: A Case Report.

AIM: Treatment of an unusual gingival recession induced by khat chewing habit. BACKGROUND: Gingival recession induced by khat chewing was confirmed by many authors. However, there is no proposal for treatment of gingival recession induced by chewing khat. CASE DESCRIPTION: A systemically healthy nonsmoking male khat chewer aged 38 years presented with class III gingival recession around the lower right incisor. The treatment approach involved a subepithelial connective tissue graft with a tunnel procedure. CONCLUSION: A full coverage of khat-induced recession was achieved by using tunnel technique utilizing subepithelial connective tissue graft at 1-year follow-up. CLINICAL SIGNIFICANCE: Treatment of gingival recession, including those induced by mechanical trauma such as chewing habits is considered as an esthetic demand and it is the responsibility of the clinician to determine the proper treatment plan for the correcting esthetic and functional defects of the periodontal tissues. How to cite this article: Al-Akhali MS, Successful Management of Khat Chewing-induced Gingival Recession by Using Tunnel Technique Utilizing Subepithelial Connective Tissue Graft: A Case Report. J Contemp Dent Pract 2019;20(10):1235-1238.

Disparities in risky sexual behavior among khat chewer and non- chewer college students in Southern Ethiopia: a comparative cross-sectional study.

BACKGROUND: Risky sexual behavior (RSB) and its consequence among school adolescents and youths have been well understood. It is still a common practice among college and university students living away from their controlling families compounded with the ever-worsening khat chewing habits. However, the relation between khat chewing and RSB is not well studied particularly among college students in Ethiopia. Hence, this study contributes to the literature by examining disparities of RSB among khat chewer and non-chewer students in Southern Ethiopia with the purpose of improving adolescent and youth health. METHODS: An institution-based comparative cross-sectional study was conducted among 1211 college students at Arba Minch town in March 2015. Respondents were selected by employing a simple random sampling technique. Data was collected by using a pre-tested, structured, self- administered questionnaire. The data was entered into Epidata version 3.1 and analyzed using IBM SPSS statistics version 21. Level of statistical significance was declared at a p- value of < 0.05. RESULTS: The prevalence of lifetime and current RSB among college students was 40.8 and 36.5% respectively. The lifetime and current prevalence of RSB among khat chewers (82.2 and 30.9%) was significantly higher than non-chewers (74.2 and 27.6%) respectively (P-value = 0.001). Male sex (AOR = 1.82; 95% CI = 1.28, 2.6), urban residence (AOR = 1.63,95% CI = 1.17, 2.28), age of students (AOR = 1.18; 95% CI = 1.09,1.28), living away from family (AOR = 2.45, 95% CI = 1.62,3.7), having high peer pressure (AOR = 2.58, 95% CI = 1.85-3.59), an increase in average grade point (AOR = 0.98, 95% CI = 0.96-0.99), regular attendance of religious institutions (AOR = 0.24, 95%CI = 0.12, 0.42), watching pornographic movies (AOR = 2.51, 95% CI = 1.79,3.51), khat chewing (AOR = 3.02, 95% CI:=1.91,4.76) and alcohol drinking (AOR = 2.26, 95% CI = 1.54,3.35) were factors associated with RSB. CONCLUSIONS: Considerable proportions of students were engaged in khat chewing and RSB. RSB was significantly higher among khat chewers as compared to non- chewers. Comprehensive sexuality education was recommended to college communities and by extension to the ministry of health and education to address the identified factors so that RSB can be reshaped.

Chewing khat and risky sexual behavior among residents of Bahir Dar City administration, Northwest Ethiopia.

INTRODUCTION: Khat is a well-known natural stimulant and is widely used in Ethiopia, particularly in Bahir Dar city. Khat chewing is linked with risky sexual behaviors. OBJECTIVE: The study was aimed to determine the prevalence of chewing khat and its relation with risky sexual behaviors among residents of Bahir Dar City administration, Northwest Ethiopia. METHODS: A community based cross-sectional study was conducted from January to February, 2016. The data were collected using an interviewer administered structured questionnaire. Logistic regression analysis was applied to assess association between dependent and explanatory variables. RESULTS: The proportion of lifetime and current chewing khat among the study participants were 25.7 and 19.5%, respectively. Males (AOR 5.0; 95% CI 3.0-8.2) than females, merchants (AOR 4.9; 95% CI 2.6-9.3) than government employees, and those with average monthly income of ≥ 3001 Ethiopian birr (AOR 2.4; 95% CI 1.2-4.8) than ≤ 1000 had an increased current chewing khat prevalence. Having lifetime history of chewing khat was significantly associated with ever had sexual intercourse, having extra sexual partners, watching pornographic film and self-reported sexually transmitted infections. CONCLUSION: Chewing khat is associated with increment of having risky sexual behaviors and self-reported sexually transmitted infections. Harm reduction measures are needed to prevent the community from engaging in khat use and risky sexual behaviors.

The Physiological and Ergogenic Effects of Khat (Catha edulis Forsk) Extract.

BACKGROUND: Khat (Catha edulis Forsk) is a natural psychoactive substance which contains two main addictive substances; Cathine and Cathinone. Khat is widely used in east Africa and southern Arabian Peninsula. Khat chewers believe that it improves work capacity and increases energy level and alertness. That is why we aimed in this study to investigate the physiological and ergogenic effects of khat extract. METHODS: This study is an experimental study conducted at the Substance Abuse Research Centre in Jazan University, Saudi Arabia. Thirty healthy young volunteers were randomly assigned into two experimental groups. The first group ingested 45 g of grounded khat leaves extract mixed with juice in the first session then placebo (juice only) in the second session. While the second group ingested the placebo in the first session and the grounded khat leaves with juice in the second session. Experiments were done between December 2012 and March 2013. We recorded the blood pressure, heart rate, grip strength, and reaction time every 15 min for 75 min after each ingestion. The study proposal was reviewed and approved by Research Ethics Committee (REC) of the Medical Research Centre in Jazan University. RESULTS: The results showed the consumption of 45 g of grounded khat leaves contributed to the increase in blood pressure (SBP & DBP) and reaction time (p < 0.05); but had no significant effect on heart rate and grip strength (p > 0.05). CONCLUSIONS: The findings of this study showed that Khat has an acute effect on some physiological parameters. These findings support the prohibition of cathinone and cathine by the World Anti-Doping Agency (WADA, 2016).

Khat chewing habit produces a significant adverse effect on periodontal, oral health: A systematic review and meta-analysis.

Although there is a general agreement that a khat chewing habit produces clinicopathological changes in the oral mucosa. However there is no reliable evidence of the effects of a khat chewing habit on the periodontal tissues. Thus, authors aimed to investigate the influence of khat chewing habits on periodontal, oral health, by comparing khat chewers to non-chewers in respect of gingival recession, periodontal pocketing depth and loss of attachment. A systematic review and meta-analysis were conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched PubMed, the Cochrane Library, Web of Science, Scopus and grey literature. The inclusion criteria were all studies with aims of comparing khat chewers and/or sides to non-chewers and/or sides in respect of gingival recession, periodontal pocketing depth and loss of attachment. For continuous data, we computed weighted mean difference or standard mean difference analyses. An odds ratio using a random effect model was used if heterogeneity was detected; otherwise, a fixed effects model with a 95% confidence interval was used for continuous data. Two subgroups were analysed: khat chewers vs non-chewers and khat chewer sides vs non-chewer sides of the chewer's individuals. A total of 6373 participants were enrolled in 12 studies (khat chewers=3812, non-chewers=2561). There were statistically significant differences between khat and non-chewers in both subgroup analyses regarding gingival recession, periodontal pocketing depth and loss of attachment (P<.05). The odds ratios for khat chewers compared to non-chewers, in respect of depth of periodontal pocket and gingival recession were 4.797 and 6.853 respectively. The results of this meta-analysis have shown that the khat chewing habit produces a destructive and adverse effect on periodontal, oral health.

Determinants of undernutrition among khat chewing and non-khat chewing male adults in Addis Ababa, Ethiopia: a comparative cross-sectional study.

Khat chewing is a deep-rooted socio-cultural tradition that affects appetite, gastric emptying, and food intake, ultimately influencing nutritional status. Moreover, there is significant variation in lifestyles and ways of living among khat chewing and non-chewing people. However, there is limited evidence on the disaggregated determinants of undernutrition among khat chewers and non-chewers in Ethiopia. A community-based comparative cross-sectional study was conducted with 253 Khat-chewing and 249 non-chewing male adults in Addis Ababa, Ethiopia. Weight and height were measured under standard procedure and used to calculate the body mass index (BMI < 18.5 kg/m2 indicates undernutrition). Variables with p-values below 0.25 in the bi-variable analysis were entered into a multivariable logistic regression model to identify factors associated with undernutrition and to control confounding respectively. An adjusted odds ratio with 95% confidence interval was used to declare the presence and the strength of association between the independent and outcome variable. Statistical significance was declared at a p value of 0.05. In this study, a total of 138 (27.5%: 23.6-31.6%) adult males were undernourished; among them, 78 (32.0%) were khat chewers and 60 (23.9%) were non chewers. Christian religion (AOR = 1.49; 1.02-2.30), vegetable consumption (AOR = 1.69; 95% CI 1.12-2.55) and khat chewing (AOR = 1.60; 1.04-2.45) were independent risk factors for undernutrition. However, none of the above factors showed a statistically significant association among non-khat chewer male adults. In conclusion, undernutrition was a public health concern in male adults in the study area. Frequent consumption of fruits, vegetables and family size of the households were the independent predictors of undernutrition. The practical implication of identifying risk factors of undernutrition among chewers and non-chewers could be helpful in depicting the relevant risk factors by exposure category and helping to further refine intervention packages. In addition, focusing on interventions which can increase the availability and accessibility of fruits and vegetables are important to improve the nutritional status of adult male populations.

Risk of acute coronary syndrome and relationship with the use of khat and tobacco products in the Jazan region, Saudi Arabia: A prospective case-control study.

INTRODUCTION: Previous studies have identified several risk factors for acute coronary syndrome (ACS). This study was intended to examine the potential risk of ACS associated with khat and tobacco use. METHODS: A case-control study of 344 people (172 cases and 172 controls) was conducted at Prince Mohammed Bin Nasser Hospital in Jazan, Saudi Arabia, from April to September 2019. The cases and controls were matched for age (±5 years) and gender. Data were analyzed using descriptive, inferential, and modeling analyses. We utilized the adjusted odds ratio (AOR) to express the results. RESULTS: The prevalence of ever khat chewing among all study participants was 29.1%, significantly higher for the cases with ACS than for the control group (43.6% vs 14.5%, p<0.001). Cigarette smokers accounted for 33.4% of the study participants, and 22.1% were ACS cases, which is a significantly higher percentage than the control group. The prevalence of smokeless tobacco was 20.3% among ACS cases and 14.5% among controls, with no statistically significant differences (p>0.05). In the final model, tobacco use was more likely to be reported among cases with myocardial infarction (MI) (AOR=4.58; 95% CI: 1.01-4.73, p<0.05) as was khat chewing (AOR=3.4; 95% CI: 1.55-7.46, p<0.05), after controlling for other traditional risk factors. CONCLUSIONS: Khat chewing was reported more by those who reported ACS. ACS cases were more likely to be frequent khat users with chewing sessions of five or more days per week. Regular tobacco use was also reported in those who reported ACS, and this increases with the amount of tobacco used. Implementing early intervention strategies can help mitigate the impact of khat chewing and smoking on the development of ACS.

Khat chewing and associated factors among public secondary school students in Harar town, Eastern Ethiopia: a multicenter cross-sectional study.

Background: Khat is a huge, evergreen tree that grows at high altitudes throughout the Arabian Peninsula and in the region stretching from eastern to southern Africa. Cathinone, cathine, and norephedrine are psychoactive ingredients contained in khat. Ethiopian teenagers, especially those in secondary school, frequently use khat. This use of khat may lead to students frequently missing class and experiencing subpar academic performance. However, the study area lacks information regarding the prevalence of khat use and the factors associated with it. Objective: This study's primary goal is to determine the prevalence of khat chewing and related factors among secondary school students in public schools in Harar, Eastern Ethiopia, in 2022. Methods: A multicenter cross-sectional study design was employed from June 01-June 30, 2022, in three public secondary schools in Harar town in a sample of 485 students. Systematic random sampling was used to choose the study sample. Data were gathered using self-administered questionnaires, and the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) was used to assess khat chewing. Epidata version 4.6 was used to enter the data, while STATA version 14 was used to analyze them. To determine the factors related to khat chewing, bivariate and multivariate logistic regression analysis was conducted, and statistical significance was determined at a 95% confidence level with a P-value under 0.05. Results: Out of 485 eligible participants, 455 responded to this survey, giving a response rate of 93.8%. Overall, 33.2% (95% CI: 29.2%-37.6%) of the sample's participants reported currently chewing khat. Age ranged from 20 to 25 years (AOR = 2.04; 95% CI: 1.19-3.48), male students (AOR = 7.03; 95% CI: 4.35-12.57), current alcohol user (AOR 6.48; 95% CI: 2.30-18.28), presence of chewer friends (AOR 3.86; 95% CI: 2.38-6.24), and depression (AOR 1.84, 95%CI: 1.02-3.30), were strongly associated with khat chewing at a p-value of < 0.05. Conclusion: Khat chewing was very common among students in Eastern Ethiopia's public secondary schools. Ages between 20 and 25 years, being a male, being current alcohol users, having chewer buddies, and depression are all significantly linked to khat use. Thus, schools should create and implement audience-specific behavioral change communication to deter and stop students from chewing khat. Additionally, it is important to ban the sale of khat to young adults and adolescents, promote medical care for khat users, and foster peer advocacy for support services.

Khat chewing and its associated factors among pregnant women in Chiro district, eastern Ethiopia: a community-based study.

Introduction: Despite its deleterious consequences, khat chewing is escalating worldwide. However, there is a lack of evidence about the extent of khat chewing among pregnant women in Ethiopia, particularly in the current study area. Therefore, this study aimed to assess the prevalence of current khat chewing and its associated factors among pregnant women in Chiro district, eastern Ethiopia. Methods: This community-based cross-sectional study was conducted in Chiro district from November 1 to 30, 2022 G.C. Study participants were selected using the systematic random sampling technique. An interview-administered structured questionnaire was used to collect data through a house-to-house survey. The data were entered into EpiData version 3.1 and analyzed in STATA 14 software. Characteristics of study participants were summarized using descriptive analysis, and binary logistic regression was used to identify determinants of khat chewing. Results: A total of 409 pregnant women participated in this study, with a response rate of 99%. The overall prevalence of khat chewing was 60.4% (95% CI: 55.5%, 65.2%). Religion (AOR: 2.08; 95% CI: 1.13, 3.82), khat cultivation (AOR: 0.43; 95% CI: 0.25, 0.77), partner khat use (AOR: 5.54; 95% CI: 3.11, 9.88), pre-pregnancy khat use (AOR: 9.95; 95% CI: 5.55, 17.81), antenatal care (ANC) visit (AOR: 2.71; 95% CI: 1.41, 5.21), and mental distress (AOR: 4.89; 95% CI: 2.38, 10.02) were significantly associated with current khat chewing. Conclusion: The majority of pregnant women in the study area practice khat chewing. Thus, accessible and comprehensive pre-conception and pre-natal care incorporating the prevention and management of antenatal khat chewing is crucial to overcome this problem. Provision of mental healthcare involving partners of pregnant women is also important to reduce the extent and impacts of khat chewing during pregnancy. Further longitudinal studies triangulated with qualitative designs are recommended.

Magnitude and associated factors of chewing khat during pregnancy in Eastern Ethiopia, 2022: a mixed method cross-sectional study.

Introduction: khat (Catha edulis Forsk), is an evergreen flowering tree or shrub widely produced and consumed in East Africa and the Arabian Peninsula. In Ethiopia, it is largely produced, freely marketed and consumed by almost all segments of the population. This is more pronounced in the Eastern part of the country. However, there exists little scientific information on the level and associated factors of khat use among pregnant women in Ethiopia, despite a few available evidences indicated its adverse effect on pregnancy outcomes. Moreover, the perceived reasons for chewing khat during pregnancy were not yet explored qualitatively to triangulate the quantitative findings. Hence, the aim of the present study was to determine the magnitude and associated factors of chewing khat during pregnancy in Eastern Ethiopia, 2022, in a Mixed Method study approach. Methods: an institution-based cross-sectional study was conducted from August 1st to 14th, 2022 using both quantitative and qualitative methods. Two hundred forty-two pregnant mothers on Antenatal care (ANC) were included in the study. Moreover, 18 purposively selected pregnant mothers on ANC were also considered for qualitative data. Analysis of quantitative data was performed on Statistical Package for the Social Sciences (SPSS) version 27 and thematic framework analysis was performed for qualitative data. Univariable and multivariable logistic regression analysis was performed to identify variables which are significantly associated with khat chewing during pregnancy and to estimate the variable's crude and adjusted odds' ratio with corresponding 95% CI. The statistically significant association was declared at p-value of less than 5. Results: the overall magnitude of chewing khat during pregnancy in the present study was 27.4% (95% CI: 22.2-33.0). Variables which significantly associated with chewing khat during pregnancy in this study were being >26 years [adjusted odds' ratio (AOR)=2.81 95% CI: 1.19-6.59], being a rural resident (AOR=2.82 95% CI: 1.19-6.69), being illiterate (AOR=4.31 95% CI: 1.02-18.20), participants having chewer husbands (AOR=3.51 95% CI: 1.33-9.24) and respondents having other chewer family members (AOR=3.05 95% CI: 1.19-7.77). In addition, the perceived reasons for chewing khat explored through in-depth interviews were for socialization, to obey tradition, to be happy with friends, husbands and families, to be free from tensioned situations, to be effective in performing daily activities, and due to lack of knowledge of its harm. Conclusion: in the present study, a relatively higher proportion of mothers chewed khat during their current pregnancy. Being older age, living in rural areas, being illiterate, having khat chewer husbands and other family members were statistically significant variables associated with khat chewing during pregnancy. Moreover, pregnant mothers are practicing chewing of khat in the current study area due to deep-rooted sociocultural issues. Hence, creation of awareness on possible harm of chewing khat during pregnancy especially for those found to be at significantly increased risk of consumption in this study is highly recommended during their antenatal care visits. In addition, creation of awareness out of health institutions, at household and community level, is highly recommended, probably using community volunteers (health development armies) in the present study area. At last, we highly also recommend the local government and religious leaders to work on how to stop the chewing practice especially during pregnancy. For example, the local government and religious leaders can work on averting consideration of chewing by the community as culturally accepted practices.

Diabetic peripheral neuropathy and their associations with overweight/obesity and impaired blood glucose among diabetic patients in Eastern Ethiopia: Institutional-based study.

Objective: This study aimed to determine the burden of diabetic peripheral neuropathy and its associations with overweight/obesity and impaired blood glucose among diabetic patients in Eastern Ethiopia. Method: A total of 644 diabetic individuals were included in the study through systematic random sampling techniques. The Michigan neuropathy screening instrument was used to evaluate the presence of diabetic neuropathy. Data were presented using narrative, figures, and tables from the results of statistical analysis. The descriptive result was reported using frequency (percentage) for categorical variables and mean ± SD for continuous measures, respectively. Multivariable logistic regression was performed to identify factors associated with diabetic peripheral neuropathy. Results: The overall prevalence of diabetic peripheral neuropathy was 47.8% (95% CI: 43.9%-51.7%). Low monthly income (AOR: 2.02, 95% CI: 1.09, 3.73), history of khat chewing (AOR: 2.32, 95% CI: 1.04, 4.907), impaired blood glucose (AOR: 1.52, 95% CI: 1.63, 1.94), physical inactivity (AOR: 2.76, 95% CI: 1.74, 4.36), and raised body mass index (AOR: 2.45, 95% CI: 1.01, 4.99) were factors significantly associated with diabetic peripheral neuropathy. Conclusion: The study emphasizes the value of early diabetic peripheral neuropathy detection and the widespread presence of diabetic peripheral neuropathy risk factors in diabetes patients. Any initiative intended to lessen the burden of diabetic peripheral neuropathy-related morbidity and high health care costs must be implemented as a strategy.

Tongue Abscess: A Case Report.

Introduction: Abscess of the tongue is a very rare disease that potentially compromises the airway. Acute tongue abscess symptoms include swelling or a lump in the deep tissues of the tongue, throbbing local pain, a discomfort that radiates to the ears, fever, difficulty swallowing, deliberate fixation of the tongue due to pain, and eventually, difficulties breathing. Case: This is a 50-year-old male patient who presented with a complaint of severe tongue pain and swelling of three days duration. Associated with this, he had pain while swallowing, difficulty opening his mouth, shortness of breath, and drooling saliva. Likewise, he had a high-grade fever and a global type of headache. On physical examination, there was significant tongue swelling on the left anterolateral area, fluctuant on palpation, and had erythematous border. After informed consent was taken the patient was transferred to the operation room with the diagnosis of tongue abscess. Subsequently, incision and drainage were done under general anesthesia, and about 30mL of thick pus was drained. The pocket was washed with normal saline and 2% hydrogen peroxide. The patient was transferred to the surgical ward with stable vital signs and had been on antibiotics. He was discharged after two days of hospital stay. Conclusion: Abscesses in the tongue are quite uncommon due to its rich vascular supply, lymphatic drainage, and saliva's immunologic advantage. Thorough diagnosis and successful treatment of tongue abscess prevent potential airway compromise. Antibiotic treatment should cover gram-positive and gram-negative anaerobes.