A Narrative Review of the Toxic Effects on Male Reproductive and Sexual Health of Chewing the Psychostimulant, Catha edulis (Khat).

Khat (Catha edulis Forsk) is a stimulating narcotic grown mainly in East and Southern Africa. The plant has a long history as a popular social behavior within these regions, and its active ingredient, cathinone, has been thought to cause an array of physical, psychological, and mental health complications. In 1980, the World Health Organization (WHO) classified it as an illicit substance due to the potential for psychological dependence. Subsequent investigations have found that its regular consumption can negatively impact the human central nervous system (CNS), systemic blood pressure, genitourinary system, and psychological health. This narrative review aims to discuss the reproductive toxicity and sexual dysfunction (SD) caused by regular khat usage in humans and experimental animals. Animal studies found dose-dependent impacts on male reproductive health: low levels increased testosterone production, whereas high levels had the opposite effects. Moderate intake was associated with reduced luteinizing hormone (LH) levels and heightened cortisol in blood plasma. In human studies, chronic users had dramatically lower semen volume, sperm motility, and count, as well as reduced libido or erectile dysfunction (ED). Khat can have serious implications for male fertility and sexual health: therefore, better understanding of its effects is paramount. This article aims to review the toxic effects on the male reproductive and sexual health of chewing the psychostimulant, Catha edulis (khat).

Prevalence and risk factors for tobacco, khat, and alcohol consumption among high school students in Ethiopia.

BACKGROUND: Tobacco, khat, alcohol, and marijuana are the main risk factors for non-communicable diseases. There are limited studies on substance use in Ethiopia, especially among secondary school students. This study aims to determine the epidemiology of substance use among secondary school students in Ethiopia. METHODS: This cross-sectional study was conducted in March 2020 in four large regions of Ethiopia and the capital Addis Ababa. We collected data from 3,355 grade 9 and grade 10 students in 36 randomly selected high schools. Data were collected on tobacco, khat, alcohol and other substances. Mixed effect logistic regression models were fitted to determine the predictors of cigarette smoking. RESULTS: 157 (4.7%) of the participants ever smoked cigarettes and 81 (2.4%) were current smokers. 106 (3.2%) ever used smokeless tobacco, 1,342 (41.8%) had ever drunk alcohol, 290 (8.7%) ever used khat, 137 (4.8%) chewed khat regularly and 76 (2.3%) ever used marijuana. There was a significant regional variation in substance use patterns; cigarette and khat use was the highest in southern regions, whereas alcohol use was highest in the northern areas. Availability of cigarette and khat shops within a 100-meter radius of the school compound was reported by 1,229 (37.5%) and 816 (25%) students, respectively. Three hundred fifty-four (10.9%) students had ever seen someone smoking a cigarette in the school compound. Ever use of smokeless tobacco (Adjusted Odds Ratio (AOR) = 9.4, 95%CI: 4.9-17.9), ever use of shisha (AOR = 8, 95% CI: 3.9-16.3), ever use of khat (AOR = 4.1, 95%CI: 2.5-6.8), ever use of alcohol (AOR = 2.3, 95%CI: 1.4-3.7), having a friend who smoked a cigarette (AOR = 2, 95%CI: 1.2-3.5), and ever seen someone smoking a cigarette in the school compound (AOR = 1.9, 95%CI: 1.1-3.4) were associated with ever use of cigarettes. CONCLUSION: Substance use prevalence in Ethiopia has regional variations and prevention strategies should be tailored to the needs of the regions. Although this study reported a lower prevalence of cigarette smoking, students could access cigarettes and khat in nearby school areas. The existing tobacco control laws that prohibit selling tobacco products to children and adolescents under 21 years of age and ban establishing tobacco shops close to school compounds should be enforced.

The effects of khat use during pregnancy on perinatal and maternal outcomes: a meta-analysis.

Chewing khat during pregnancy adversely affects maternal and fetal health, but available studies are scarce and inconsistent, and it is difficult to conclude the relationship between khat consumption and perinatal outcomes. We aimed to investigate the available studies on the effect of khat use during pregnancy on perinatal and maternal outcomes. For this meta-analysis, we conducted a thorough search of articles published in PubMed, Embase, Scopus, and Web of Science up to the date this search was undertaken (03.01.2022). We used random effect model with the Mantel-Haenszel method to calculate the pooled odds ratio and mean difference. We found that khat use during pregnancy was significantly associated with increased odds of low birth weight (OR:2.51; 95% CI: 1.60 to 3.94), congenital anomalies (OR:3.17; 95% CI: 1.30 to 7.73), premature rupture of membrane (OR: 1.99; 95% CI: 1.59 to 2.50), perinatal mortality (OR: 1.95; 95% CI: 1.26 to 3.03), and lower APGAR scores at the fifth minute (MD: -1.7; 95% CI: -2.32 to -1.07). Also, increased odds for developing maternal psychological stress and anemia were reported in women using khat during pregnancy. There were no statistically significant differences in stillbirth and preterm birth between women using khat during pregnancy and their counterparts. Since prenatal khat use is associated with adverse perinatal and maternal outcomes, we strongly recommend equitable and easily accessible health services through the implementation of integrated addiction treatment with maternity services to address khat use during pregnancy and encourage the practice of healthy behavior of women.

Reducing Khat use among Somalis living in Kenya: a controlled pilot study on the modified ASSIST-linked brief intervention delivered in the community.

BACKGROUND: During recent decades, the consumption of the stimulant khat (catha edulis) has profoundly changed in countries around the Horn of Africa, and excessive use patterns have emerged-especially evident among displaced Somalis. This is related to the development of severe somatic and psychiatric disorders. There are currently no preventive or interventional studies targeting khat use. This study's aim was to test screening and brief intervention (SBI) to reduce khat use among urban Somali refugees living in Kenya with limited access to public healthcare. METHODS: In this controlled study, 330 male Somali khat users from the community were either assigned to SBI (161) or an assessment-only control condition (AC; 169); due to field conditions a rigorous experimental design could not be implemented. The World Health Organization's (WHO) Alcohol, Smoking and Substance Involvement Screening Test (ASSIST)-linked brief intervention was adapted to khat and Somali culture. Trained local counselors administered the intervention. The amount and frequency of khat use was assessed using the time-line-follow-back method. We compared the month before the intervention (t1) to the two months after it (t2, t3). Baseline differences in khat use frequency were corrected by partial matching and mixed effect models used to evaluate intervention effects. RESULTS: SBI was well accepted and feasible for khat users. Over the complete observation period and from t1 to t2, khat use amount and frequency decreased (p < .001) and the intervention group showed a greater reduction (group x time effects with p ≤ .030). From t2 to t3, no further reduction and no group differences emerged. CONCLUSION: The results provide preliminary evidence that khat use amount and frequency can be reduced in community settings by SBI, requiring little resources. Thorough assessment alone might have intervention-like effects. The non-treatment-seeking community sample and the non-professional counselors are distinct from SBI studies with other substances in other countries, but support the feasibility of this approach in khat use countries and especially in Somali populations with limited access to healthcare. Future studies that employ rigorous experimental design are needed. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT02253589. Date of first registration 01/10/2014, retrospectively registered https://clinicaltrials.gov/ct2/show/NCT02253589 . First participant 16/09/2014.

Work-related stress and associated factors among garment workers in Bole Lemi Industrial Park of Addis Ababa, Ethiopia: a multi-center institution-based cross-sectional study.

BACKGROUND: Work-related stress (WRS) is a growing problem around the world that affects the health and well-being of employees. However, evidence of work-related stress in Ethiopia, particularly among garment industry employees, is scarce. This study aimed to assess the prevalence and associated factors of work-related stress among garment workers in the Bole Lemi industrial park in Addis Ababa, Ethiopia. METHODS: A multi-center institutional-based cross-sectional study was conducted from February 01 to March 31, 2021. A total of 605 study participants were selected using a stratified random sampling technique. A pre-tested, interviewer-administered standardized questionnaire was used to collect data. The logistic regression model was employed to identify determinant factors for work-related stress, and statistical significance was declared at a p-value < 0.05. RESULTS: The magnitude of work-related stress in garment workers was 44.1% (95% CI: 40.0, 48.0). Being within the age group of 25 - 34 years (AOR = 0.57, 95% CI: 0.36, 0.90) and receiving induction training (AOR = 0.35, CI: 0.20, 0.62) were protective factors with stress. Whereas lack of family support (AOR = 2.72, CI: 1.60, 4.64), lack of job satisfaction (AOR = 4.26, CI: 2.77, 6.57), and khat chewing (AOR = 3.14, CI: 1.35, 7.32) were positively associated with work-related stress. CONCLUSION: Work-related stress is prevalent among garment workers in the study setting. Being between the ages of 25-34 years and receiving induction training were protective factors against stress, while a lack of family support, a lack of job satisfaction, and khat chewing practices were positively associated with work-related stress. Therefore, improving family support and job satisfaction, providing induction training during employment, and providing psychological support for substance users to bring about changes are mandatory in Bole Lemi Industrial Park, Ethiopia.

The impact of khat chewing on heart activity and rehabilitation therapy from khat addiction in healthy khat chewers.

Khat is a flowering plant whose leaves and stems are chewed for excitement purposes in most of east African and Arabian countries. Khat can cause mood changes, increased alertness, hyperactivity, anxiety, elevated blood pressure, and heart diseases. However, the effect of khat on the heart has not been studied exclusively. The purpose of this study was to investigate the impact of khat chewing on heart activity and rehabilitation therapy from khat addiction in healthy khat chewers. ECG signals were recorded from 50 subjects (25 chewers and 25 controls) before and after chewing session to investigate the effect of khat on heart activity. In addition, ECG signals from 5 subjects were recorded on the first and eightieth day of rehabilitation therapy for investigating the effect of rehabilitation from khat addiction. All the collected signals were annotated, denoised and features were extracted and analysed. After chewing khat, the average heart rate of the chewers was increased by 5.85%, with 3 subjects out of 25 were prone to tachycardia. 1.66% QRS duration and 23.56% R-peak amplitude reduction were observed after chewing session. Moreover, heart rate variability was reduced by 19.74% indicating the effect of khat on suppressing sympathetic and parasympathetic nerve actions. After rehabilitation therapy, the average heart rate was reduced by 11.66%, while heart rate variability (HRV), QRS duration, and RR interval were increased by 25%, 3.49%, and 12.53%, respectively. Statistical analysis results also confirmed that there is a significance change (p < 0.05) in ECG feature among pre- and post-chewing session. Our findings demonstrate that, khat chewing raises heart rate, lowers heart rate variability, or puts the heart under stress by lowering R-peak amplitude and QRS duration, which in turn increases the risk of premature ventricular contraction and arrhythmia. The results also show that rehabilitation therapy from khat addiction has a major impact on restoring cardiac activity to normal levels.

Prevalence and associated factors of depression, anxiety, and stress among high school students in, Northwest Ethiopia, 2021.

BACKGROUND: Many studies have revealed that students' performance in school, is affected by symptoms of depression, anxiety, and stress, which may impair their academic achievement, and lead to school dropout. However, to date, no studies have evaluated these three disorders among high school students in Africa. Therefore, in this study, we aimed to assess the prevalence of depression, anxiety, stress, and their associated factors among high school students in Northwest Ethiopia. METHODS: An institution-based cross-sectional study was conducted. A simple random sampling technique was used to select 849 participants from six high schools in Northwest Ethiopia. A self-administered Depression, Anxiety, and Stress Scale (DASS-21) questionnaire was used to collect the data. Data were analyzed using SPSS Version 25.0 software to identify factors associated with DAS, and bi-variable and multi-variable analyses were performed. RESULTS: The prevalence of depression, anxiety, and stress was 41.4, 66.7, and 52.2% respectively. Being female (AOR = 1.304, 95% CI = 1.006-1.849), higher risky khat chewers (AOR = 5.595, 95% CI = 2.357-11.132), having social phobia (AOR = 1.416, 95% CI = 1.045-1.919) were associated with depression. Being higher risky cigarette smokers (AOR = 4.777, 95% CI = 1.407-7304), having a history of chronic medical illness (AOR = 2.099, 95% CI = 1.045-4.218), and having a family history of mental illness (AOR = 1.777, 95% CI = 1.028-3.073) associated with anxiety. Stress was associated with high-risk alcohol drinkers (AOR = 1.828, 95% CI = 1.012-3.303), rural residency (AOR = 1.395, 95%CI = 1.010-1.925), and low social support (AOR 1.7391, 95% CI = 1.203-2.515). CONCLUSION: The burden of DAS among high school students was found to be high. Female sex, chewing khat, and having social phobia are associated with depression. Conversely, smoking cigarettes, having a chronic medical illness, and having a family history of mental illness are all linked to anxiety. Being a highly risky alcoholic drinker, having poor social support, and being a rural resident are positively associated with stress. Therefore, extending mental health services to all high schools, and strengthening the existing counseling services, are recommended.

Drug-related problems and its predictors among hospitalized heart failure patients at Jimma Medical Center, South West Ethiopia: prospective interventional study.

BACKGROUND: Drug-related problems are associated with high mortality, complications, prolonged hospital stay, compromised quality of life, and increased healthcare costs. This problem is high in patients hospitalized with chronic conditions such as heart failure. However, there are limited studies conducted on this area, particularly in Ethiopia. OBJECTIVE: To evaluate drug-related problems, their predictors, and clinical pharmacist intervention among hospitalized heart failure patients at Jimma Medical Center, Ethiopia. METHODS AND PARTICIPANTS: A prospective interventional study was conducted among hospitalized heart failure patients from September 30, 2020, to May 28, 2021, at Jimma Medical Center. Drug-related problems were sorted based on the Pharmaceutical Care Network Europe drug classification tool version 9.0. Patient's specific data were collected using a structured questionnaire. Data was analyzed using statistical software package version 23.0. Multivariate logistic regression analysis was used to identify independent predictors of drug-related problems occurrence and statistical significance was considered at a p value < 0.05. RESULTS: A total of 237 heart failure patients were included in this study. The mean (SD) age was 49.06 + 17.79. About two-thirds (66.2%) of study patients had at least one drug-related problem during their hospital stay. A total of 283 drug-related problems were identified among 157 patients. Treatment effectiveness-related problem (55.48%) was the most common observed drug-related problem. The independent predictors of drug-related problems were khat chewing [AOR = 3.25, 95% CI = (1.46-7.23)], hospital stay > 18 days [AOR = 3.77, 95% CI = (1.93-7.37)]; presence of comorbid condition [AOR = 2.59, 95% CI = (1.35-4.96)] and polypharmacy [AOR = 2.94, 95% CI = (1.54-5.61)]. CONCLUSION: The prevalence of drug-related problems was high among hospitalized heart failure patients in the study area. Chewing khat, prolonged hospital stay, comorbidity, and polypharmacy were the predictors of drug-related problems. Hence, to overcome these problems, clinical pharmacists, physicians, and other health professionals have to work in collaboration.

Prevalence, types, patterns and risk factors associated with drugs and substances of use and abuse: A cross-sectional study of selected counties in Kenya.

BACKGROUND: The increasing trend of drugs and substances abuse (DSA) by different age groups and gender in parts of Kenya is not only a socio-economic problem but a public health concern. There is a need to determine prevalence, types and patterns of DSA by age and gender in order to develop all-inclusive and long-term strategies to prevent and manage the DSA within different communities. In this study we determined the prevalence of DSA, types and patterns of drugs and substances being abused and risk factors associated with this abuse. METHODS: A descriptive cross-sectional mixed methods study was conducted in four counties; Isiolo, Kajiado, Murang'a and Nyamira, all purposively selected from the 47 counties of Kenya based on the review reports of the Kenya Medical Research Institute's County Cluster Coordinators which indicated that DSA was a priority health concern in the selected counties. From each county, two sub-locations each from two locations in one sub-county were purposively selected. In each sub-location, 225 households were systematically selected. Hence, a total of 3,600 participants were systematically sampled for quantitative data collection using an interviewer-based questionnaire to gather information on magnitude and causes of DSA. Additionally, in each county, qualitative data through in-depth interviews (IDIs) with 16 opinion leaders, 16 healthcare personnel, 16 previous DSAs, at least 5 county personnel, 32 current DSAs; and through 16 focus group discussions (FGDs) were concurrently collected to elicit more information on types, patterns and causes of DSA. The observed overall prevalence of DSA was calculated using binomial logistic regression model and factors associated with DSA analyzed using multilevel logistic regression model. Qualitative data was analyzed using QSR NVIVO version 10, thematically by types, patterns and causes of DSA by age and gender. RESULTS: Prevalence of DSA was 86.0% (95%CI: 84.9-87.2) with the highest prevalence being observed in Nyamira County, 89.8% (95%CI: 87.9-91.7). Age-wise, the highest prevalence was observed in persons aged between 45 to 53 years, 89.4% (95%CI: 86.9-92.0), followed by those aged 36 to 44 years, 88.0% (95%CI: 85.4-90.6). Majority of those who abuse drugs and substances were males; 94.5% (95%CI: 93.6-95.4). The most abused drugs or substances were packaged/legal alcohol at 25.2% (745), cigarettes 20.3% (600), local brew (chang'aa) 16.3% (482), and khat (miraa) 10.5% (311). Risk factors analysis revealed that DSA was significantly higher among males (adjusted odds ratio (aOR) = 7.02 (95%CI: 5.21-9.45), p<0.001), government employees (aOR = 2.27 (95%CI: 1.05-4.91), p = 0.036) and unmarried (aOR = 1.71 (95%CI: 1.06-2.77), p = 0.028). CONCLUSIONS: These study findings are useful in informing development of specific control programmes which will address age, gender and county needs of DSA in Kenya in order to comprehensively respond to this public health problem. This study was conducted in line with the Kenya National Authority for the Campaign against Alcohol and Drug Abuse (NACADA) mandate to promote use of research on drugs and substances abuse.

Reduced Tissue Response with Topical Khat Leaves after Eyelid Surgery: Preliminary Findings.

BACKGROUND: Upper eyelid blepharoplasty surgery is one of the most common plastic surgeries. Khat is used topically to reduce tissue edema. OBJECTIVES: To evaluate the effect of topical khat administration after eyelid surgery on postoperative healing. METHODS: Our prospective comparative study included 24 patients who underwent upper eyelid blepharoplasty or ptosis surgery between 2019 and 2020. Patients were randomly assigned to 48 hours of cold dressing with frozen khat leaves and frozen peas dressing (common practice). Postoperative photographs of the eyes were evaluated for the degree of ecchymosis and edema on postoperative days (PODs) 1, 3, and 7 by three blinded observers. Measures included tissue swelling and hemorrhage on PODs 1, 3, and 7. RESULTS: The mean age of the cohort was 67 ± 7 years; 17 females (71%). Khat application was associated with lower postoperative ecchymosis at each time point. Females had lower levels of postoperative ecchymosis on POD 7 (P = 0.07). Eyelid edema was more pronounced in the khat group on PODs 1 and 3, but this was reversed on POD 7. There was good agreement among all three observers in grading ecchymosis and edema (P < 0.001). CONCLUSIONS: The use of khat was associated with less tissue ecchymosis after oculoplastic surgery, although this was not statistically significant even following sub-population analysis. The outcome can be attributed to the active ingredients of cathinone and cathine, which cause vasoconstriction and lipolysis, and to the anti-inflammatory and anti-oxidative flavonoids and phenolic compounds. These encouraging preliminary findings warrant additional studies on a biochemical/cellular level.

Exploring the association between khat use and psychiatric symptoms: a systematic review.

OBJECTIVES: Consumption of the drug khat is high across East Africa and the South-Western Arabian Peninsula despite evidence for its adverse psychiatric effects. This systematic review aims to explore cross-sectional research in the field to determine the strength of the association between khat use and psychiatric symptoms METHODS: Six databases were searched in October 2021-Ovid Medline, Embase, APA PsycINFO, CINAHL, Scopus and Proquest-using the following search terms: "khat" OR "qat" OR "qaad" OR "catha" OR "miraa" OR "mairungi" AND "depression" OR "anxiety" OR "mania" OR "psych*" OR "schiz*" OR "mental" OR "hallucinations" OR "delusions" OR "bipolar". Eligible studies were cross-sectional studies of any population or setting comparing the prevalence of psychiatric symptoms in long term or dependent khat users with non-users. The quality of each study was appraised by the Newcastle-Ottawa scale. A meta-analysis was planned using a random effects model to produce an OR with 95% CIs-using the Mantel-Haenszel method-alongside an I2 statistic to represent heterogeneity. The quality of this meta-analysis was appraised using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) scoring system. RESULTS: 35 studies were eligible for inclusion (total participants=31 893), spanning 5 countries (Ethiopia, Somalia, Kenya, Saudi Arabia, UK). Meta-analysis suggests that khat use is associated with an 122% increased prevalence of psychiatric symptoms (OR 2.22, 95% CIs 1.76 to 2.79, p<0.00001, GRADE score: 'very low'). CONCLUSIONS: The high heterogeneity of the meta-analysis is likely due to the wide variation between the studies within the evidence base. To perform a more accurate systematic review, further primary studies are needed with standardised measurements of variables, particularly khat consumption. PROSPERO REGISTRATION NUMBER: CRD42020224510.

Non Ischemic Cardiomyopathy in a 54-Year-Old Khat Consuming Yemeni Male Presenting with Worsening Exertional Dyspnea, T Wave Inversions in V5-V6 and Normal Coronary Artery Angiography.

BACKGROUND Khat (Catha edulis) is a plant cultivated in Ethiopia, East African, and the Arabian Peninsula. Long-term khat consumption has been associated with increased rates of periodontal diseases, esophagitis, psychosis, and cardiovascular issues such as cerebrovascular accidents, myocardial ischemia, and ischemic cardiomyopathy (CM). We report a case of khat-induced non-ischemic CM in a patient with no other known cardiovascular risk factors and highlight a cardiovascular effect of chronic khat consumption. CASE REPORT A 54-year-old Yemeni man with no known medical history but a chronic khat chewer presented with worsening exertional dyspnea for 6 months and associated pedal edema. Laboratory studies were remarkable for elevated B-type natriuretic peptide (BNP). Electrocardiogram (EKG) revealed normal sinus rhythm with non-specific T wave inversions (TWI) in V5-V6. A computed tomography (CT) scan of the chest showed bilateral pleural effusions with interlobular septal thickening. Transthoracic echocardiogram (TTE) showed a left ventricular ejection fraction (LVEF) of 16-20% and global CM. Coronary angiography revealed normal coronaries. CONCLUSIONS Chronic khat consumption is being recognized as a dangerous habit with serious health consequences and its association with ischemic CM is well documented. The findings of ischemic cardiac changes of acute coronary syndrome in a patient with normal coronary arteries raises the possibility that khat toxicity was associated with coronary artery spasm due to its amphetamine-like stimulatory effects. Although further research is required to substantiate this relationship, it is imperative that khat consumption be considered a risk factor when assessing for CM.

Work-related stress and associated factors among employees of Hawassa industrial park, southern Ethiopia: an institutional based cross-sectional study.

BACKGROUND: Work-related stress (WRS) is becoming an alarmingly growing public health concern worldwide. Due to globalization and changes in working conditions, people in low-income countries face growing work-relates stress. However, despite high prevalence globally, work-related stress among industrial park workers is not well studied in Ethiopia.Thus; the aim of this study was to assess work-related stress and associated factors among employees of Hawassa industrial park, southern Ethiopia. METHODS: An institutional-based cross-sectional study was employed among 419 employees of Hawassa industrial park using an interviewer-administered structured questionnaire. Study participants were selected using simple random sampling technique. Data was collected by face-to-face interview. A workplace stress scale (WPSS) was used to assess work-related stress. The collected data were coded and entered into EPI data 4.6 and exported to SPSS version 26 for analysis. Multivariable logistic regression analysis was conducted to identify associated factors. The statistical significance was considered at P-value < 0.05. RESULT: The Overall prevalence of work-related stress was 47.5, 95% CI (43.2, 52.1). Variables such as temporary employment [AOR = 0.41, 95% CI (0.26-0.64)], poor working condition [AOR = 2.12, 95% CI (1.32-3.43)], work experience less than two and half years [AOR = 3.11, 95% CI (1.95-4.96)], poor learning opportunity [AOR = 1.82, 95% CI (1.10-2.30)], poor organizational support [AOR = 1.70, 95% CI (1.10-2.62)], current use of khat [AOR = 2.52, 95% CI (1.28-4.99)] and current use of alcohol [AOR = 2.27, 95% CI (1.44-3.58)] were significantly associated with work-related stress. CONCLUSION AND RECOMMENDATION: The study found high prevalence of work-related stress among employees of Hawassa industrial park. Temporary employment, poor working conditions, work experience < 21/2 years, poor learning opportunities, poor organizational support, current khat use, and current use of alcohol were significantly associated with work-related stress. Our study finding is recommending enhancing stress management skills and primary prevention on identified risk factors to industry employees.

Consumption of animal source food and associated factors among pregnant women in eastern Ethiopia: A community-based study.

INTRODUCTION: Animal source foods contain quality nutrients, immunity, and behavioral outcome and are important for growth, and development. However, evidence on the level of animal source food consumption frequency and associated factors among pregnant women in Ethiopia, particularly rural residents are limited. Therefore, this study aimed to assess the consumption frequency of animal source food and to identify associated factors among pregnant women in the Haramaya district. METHODS: A community-based cross-sectional study was conducted among 448 pregnant women. Data were collected through face-to-face interviews by trained research assistants, using a validated frequency questionnaire. Consumption of animal food sources was assessed by counting the frequency of each food from animal sources that pregnant women ate over a seven-day reference period. The highest tertile for animal source food consumption was considered as the high frequency of animal source food consumption; whereas the two lower tertiles were taken as the low frequency of animal source food consumption. A binary logistic regression model was used to investigate the association of the independent variables with the animal source food consumption. An adjusted odds ratio with a 95% confidence interval was reported to show an association using a p-value <0.05. RESULTS: The high frequency of animal source food consumption among the study participants was 24.78% (95% CI = 21%-29%). High animal source food consumption was more likely higher among respondents who were literate (AOR = 1.80; 95% CI = 1.048-3.095), and those who owned milk cows (ARO = 1.70; 95% CI = 1.003-2.863). However, respondent who reported chewing khat (AOR = 0.51; 95% CI = 0.313-0.805) (AOR = 0.56; 95% CI = 0.349-0.903), were less likely experienced animal source food consumption. CONCLUSION: We found low animal source food consumption among pregnant women in this predominantly rural setting. Women's educational level and milk cow ownership were positively associated with animal source food consumption. Additionally, a lower frequency of animal source food consumption was observed among women who reported chewing khat. Therefore, nutrition policy programs and interventions aimed at encouraging maternal nutritional guidance and counseling are recommended.

Is latent Toxoplasma gondii infection associated with the occurrence of schizophrenia? A case-control study.

INTRODUCTION: Neurotropic pathogens such as Toxoplasma gondii (T. gondii) which result in chronic infections in the brain are associated with mental illnesses. In view of this, a growing body of literature has revealed the possible interaction of schizophrenia and T. gondii infection. METHOD: A case-control study was conducted from February 2018 to January 2019 among 47 Schizophrenia patients and 47 age and sex-matched controls. Data was collected using a structured questionnaire. Serum was used for serological analysis of anti-T. gondii IgG and IgM antibodies through chemiluminescent immunoassay. Proportions and mean with standard deviations (SD) were used as descriptive measures and variables with p-values <0.05 were considered as statistically significant and independently associated with schizophrenia. RESULT: The mean ages of schizophrenia patients and controls were 29.64 ± 5.8 yrs and 30.98 ± 7.3 yrs, respectively. We found that 81.9% (77/94) of the study subjects had a positive anti-T. gondii IgG antibody. While the difference is statistically insignificant, schizophrenic patients have a marginally higher seroprevalence of toxoplasmosis than controls (87.2% vs 80.9%; p = 0.398). Schizophrenia cases who live in homes with soil floors have a significantly higher T. gondii infection as compared to those who live in homes with cement/ceramic floors (90.9% vs 33.3%; p = 0.004). Furthermore, there was a significantly lower T. gondii infection among schizophrenic cases who were taking antipsychotic medication for more than three yrs (79.3% vs 100.0%, p = 0.039). On the other hand, among all study subjects who have T. gondii infection, subjects who are addicted to khat and alcohol were about seven times more likely to develop schizophrenia (71.4% vs 47.7%, OR = 7.13, p = 0.024). CONCLUSION: Our data is not sufficient to show a significant positive correlation between T. gondii infection and schizophrenia. For study subjects with T. gondii infection, addiction to khat and alcohol is one of the risk factors for schizophrenia.

Magnitude and predictors of common mental disorders among residents in south Gondar Zone, Northwest Ethiopia: a community-based, cross-sectional study.

BACKGROUND: Common mental disorders such as depression, anxiety, and somatic symptoms are a major public health concern because it is prevalent and chronic, and its impact on physical health, psychological and economic consequences is very serious. Evidence on the prevalence and predictors of common mental disorders is very limited in Ethiopia. This study aims to determine the prevalence and associated factors with common mental disorders. METHODS: A community-based cross-sectional study was conducted among 731 south Gondar zone residents recruited with a multistage sampling method. Data were collected by face-to-face interviews on socio-demographic, clinical, and psychosocial factors. Common mental disorders (CMD) were assessed using a self-reporting questionnaire (SRQ-20). A-List of Threatening Experiences and the Oslo social support instruments were used to identify the factors. We used bivariate and multivariable binary logistic regressions to identify factors associated with common mental disorders. Statistical significance was declared at P-value < 0.05. RESULTS: The prevalence of common mental disorders over the last four weeks was found to be 29.7% with 95% of confidence interval (CI) (26.4-33.1). After adjusting possible confounders, female sex, [AOR = 2.47, 95% CI (1.68, 3.62)], poor social support [AOR = 2.34, 95% CI (1.50, 3.64)], family history of mental illness [AOR = 2.15, (1.32-3.51)], rural resident [AOR = 2.01, 95% CI (1.35, 3.01)], current use of khat [AOR = 1.69, 95% CI (1 0.07, 2.64)] current use of tobacco (AOR = 1.71, 95% CI (1.04-2.84) and unemployment [AOR = 1.762, 95% CI; 1.193, 2.602)] were significantly associated with common mental disorders. CONCLUSION: The prevalence of common mental disorders was high, especially in Female sex, current substance use (khat chewing (leaves) and tobacco smoking), unemployment, rural residence, family history mental illness, and poor social support are the main determinants of common mental disorders. Early detection and appropriate intervention for common mental disorders in the community level should be promoted. Governmental strategies should be focused on implementing substance rehabilitation centers to treat Khat and tobacco might be helpful to minimize the burden of CMD in Ethiopia.

Towards a better understanding of the psychosocial determinants associated with adults' use of smokeless tobacco in the Jazan Region of Saudi Arabia: a qualitative study.

BACKGROUND: Most diagnosed oral cancer cases in Saudi Arabia are in the Jazan region. A common type of smokeless tobacco "Shammah" is prevalent in this region. This study aimed to gain an in-depth understanding of the possible psychosocial determinants of Shammah consumption among adult Shammah users in Jazan region. METHODS: A qualitative study was conducted by means of one-on-one interviews among thirty adult Shammah users. Participants were recruited by means of a purposive sampling technique. Data were collected using a semi-structured interview guide utilizing face-to-face and phone-call interviews. Thematic analysis with hybrid approach was used to analyze the dataset. RESULTS: Twenty-four sub-codes within four overarching themes were generated. Participants revealed uncertainty related to Shammah composition, how to quit knowledge and Shammah prevention/cessation programs. Shammah use identified as a normal phenomenon in society. Its use was frequently reported in participants' close network but most users faced family and peers' disapproval. Some users expressed joy, happiness and focused when using Shammah. Others were disgusted or neutral. Many users believed Shammah causes cancer and tears oral tissues. Others believed it relieves toothache or has no effect. Majority of users were confident to quit and recalled some quitting aids. Toothache, craving, drinking tea and chewing Khat (leaves of Catha edulis plant that causes moderate euphoria) perceived to be triggers to use Shammah. Availability of Shammah, withdrawal symptoms, stress, lack of support, seeing others using Shammah, losing part of routine and toothache were barriers to quit. CONCLUSIONS: Shammah use was associated with uncertainty about Shammah composition and quitting knowledge, social acceptability, influence from family/friends, a range of positive and negative attitudinal beliefs toward its use and high quitting efficacy beliefs. Future interventions targeting Shammah should address the acknowledged triggers and barriers in the present study including the dual use of Shammah and Khat.

Validation of the Problematic Khat Use Screening Test: A Cross-Sectional Study.

AIM: The study aimed to evaluate the psychometric properties of the Problematic Khat Use Screening Test (PKUST-17) in Ethiopia. METHODS: A validation study of PKUST-17 was carried out among 510 khat users, using a house-to-house survey. Confirmatory factor analysis and 2-parametric item response theory (IRT) were used to evaluate the construct validity of PKUST-17. We also used Spearman's rank-order correlation coefficient and other test statistics to assess the convergent validity of PKUST-17 with depression symptoms, functional impairment, and other characteristics of participants. We generated latent classes of problematic khat use using latent profile analysis (LPA) and validated the classes using multinomial logistic regression. RESULTS: The data confirm the unidimensional model of the PKUST-17. The internal consistency of PKUST-17 was excellent (Cronbach's alpha = 0.93). IRT discrimination parameters indicated that each item had a strong ability to distinguish participants across the spectrum of problematic khat use (α thresholds range from 1.02 to 2.9). The items were fairly or moderately severe to be endorsed by participants (ß thresholds vary from 1.43 to 5.57). The LPA identified three latent classes which have severity differences: mild (34%), moderate (34%), and severe (32%) problematic khat use. Depression symptoms, functional impairment, and other khat use patterns were also associated with moderate and severe problematic khat use class membership compared to mild problematic khat use class. CONCLUSION: We found that the PKUST-17 is a culturally appropriate, brief, easy to use, and psychometrically sound screening test. PKUST-17 can be used to screen khat users with different levels of risk for providing stepped care at different healthcare levels, including integration of services in primary care. Future studies need to test the predictive capacity of the PKUST-17 for khat-related harms.

Effects of Catha Edulis Forsk on spatial learning, memory and correlation with serum electrolytes in wild-type male white albino rats.

BACKGROUND: The burdens of psychostimulant use disorders are becoming a worldwide problem. One of the psychostimulants widely consumed in Ethiopia and East African countries is Catha edulis Forsk (khat). However, no studies have been conducted on the cognitive effects of khat and its correlation with serum electrolytes. The present study was aimed to evaluate the effects of khat on spatial learning and memory and their correlation with serum electrolytes. MATERIALS AND METHODS: Diethyl ether and chloroform (3:1v/v ratio) were solvents used to obtain the crude khat extract in this study. T80W was used to prepare the khat juice, fresh khat leave extract. The rats were received crude khat extract subchronically (KESC) (100 mg/kg, 200 mg/kg and 300 mg/kg b.w), khat juice (KHJ 2.5 mL/kg), 2% tween 80 in distilled water (T80W- v/v, vehicle) and khat extract subacutely (KESA) (300 mg/kg). For subchronic treatment, each rat was administered for twelve weeks before Morris water maze experiment has been started, while it was administered for a week for acute treatment. Spatial learning and memory were measured using the Morris water maze model and serum sodium, calcium, potassium, and chloride were evaluated using Cobas 6000. RESULTS: Spatial learning was improved with trials across the groups, while average escape latency (s) of rats received KESC 200 mg/kg (p<0.001), KESC 300 mg/kg (p<0.01) and KHJ 2.5 mL/kg (p<0.05) was significantly greater than rats that received vehicle. There was no significant difference in the latency between rats that received KESA 300mg/kg and vehicle (p>0.05). Thigmotaxis was significantly higher in rats that received all doses of khat extract (p<0.001). The time spent in the target quadrant in rats that received KESC 300 mg/kg was significantly reduced (p<0.05). Serum calcium level was inversely correlated with the escape latency (R = -0.417, p<0.05) in rats that received khat. CONCLUSIONS: Khat extract and juice administered subchronically, but not subacutely, impaired learning and memory and was associated with serum calcium reduction. The neuronal basis for such alteration should be investigated.

Khat, a Cultural Chewing Drug: A Toxicokinetic and Toxicodynamic Summary.

Khat (Catha edulis) is a recreational, chewed herbal drug that has been used as a psychostimulant for centuries in East Africa and the Arabian Peninsula, namely in Somalia, Ethiopia, and Yemen. However, the growing worldwide availability of khat has produced widespread concern. The plant comprises a large number of active substances, among which cathinone, cathine, and norephedrine are the main constituents, which can be included in the group of sympathomimetics of natural origin. In fact, these compounds are amphetamine analogues, and, as such, they have amphetamine-like nervous system stimulant effects. Chewing the leaves gives people a sensation of well-being and increases energy, alertness, and self-confidence. The chronic use of khat is, however, associated with severe cardiac, neurological, psychological, and gastrointestinal complications. The psychological dependence and withdrawal symptoms of khat are the reasons for its prolonged use. The aim of this paper is to review current knowledge on the khat plant with toxicokinetic and toxicodynamic perspectives. Namely, this review paper addresses in vitro, in vivo, and human studies. The models used, as well as the concentrations and doses with the respective biological effects, are discussed. Additionally, the main drug interactions involved with khat are described.