Scaling up Surgical Capacity in Kenya: The Kenya Hospital Assessment Tool (K-HAT).

INTRODUCTION: Although substantial progress has been achieved to bring surgical care to the forefront of global health discussions, a number of low-and middle-income countries are still in the process of developing a National Surgical, Obstetric, and Anesthesia Plan (NSOAP). This paper describes the initial step toward the development of the NSOAP through the creation of the Kenya National Hospital Assessment Tool (K-HAT). METHODS: A study protocol was developed by a multisectoral collaborative group that represented the pillars of surgical capacity development in Kenya. The K-HAT was adapted from two World Health Organization (WHO) tools: the Service Availability and Readiness Assessment tool and the Situational Analysis Tool. The survey tool was deployed on Open Data Kit, an open-source electronic encrypted database. This new locally adapted tool was pilot tested in three hospitals in Kenya and subsequently deployed in Level 4 facilities. RESULTS: Eighty-nine questions representing over 800 data points divided into six WHO Health Systems Strengthening sections comprised the K-HAT which was deployed to over 95% of Level 4 hospitals in Kenya. When compared to the WHO Service Availability and Readiness Assessment tool, the K-HAT collected more detailed information. The pilot test team reported that K-HAT was easy to administer, easily understood by the respondents, and that it took approximately 1 hour to collect data from each facility. CONCLUSIONS: The K-HAT collected comprehensive information that can be used to develop Kenya's NSOAP.

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.

From traditional to transactional: exploration of khat use in Ethiopia through an interpretative phenomenological analysis.

Khat, a naturally growing stimulant, has seen a significant increase in both consumption and cultivation in eastern Ethiopia. This reliance on khat in the region comes despite its known physiological complications, with users unable to restrict khat use due to its pervasive impact on their livelihood. This qualitative study sought to understand the meaning that those in eastern Ethiopia attribute to khat and explore their firsthand experiences with the substance. In June and July of 2023, six unstructured interviews were conducted among residents of the Haramaya District in Ethiopia. To promote a holistic comprehension of the participants' lived experiences, an interpretative phenomenological analysis approach was employed when collecting and analyzing the data. Participant responses were coded independently from one another by two different researchers identifying superordinate and corresponding subordinate themes. Among the participants, six superordinate themes were captured: economic backbone of the region, market disruption & fluctuation, pesticide use, societal relationships around khat, applications of khat, and access to healthcare. The participants' responses indicated that the normalization of khat use, coupled with the downplaying of its addictive potential, has established a framework where khat consumption is not only allowed but, in some cases, even encouraged. The unique interplay between communal practice and individual preservation creates a cyclical effect of using khat to supplement energy to farm khat and then sell or stimulate further work on their farm. This study illuminates the transitionfrom what was once the traditional or spiritual use of khat, to a more practical use for ensuring economic livelihood.

Apparent Khat chewers exposure to DDT in Ethiopia and its potential toxic effects: A scoping review.

Dichlorodiphenyltrichloroethane (DDT) is an insecticide, a member of dirty dozen persistent organic pollutants, used widely in the world until it was banned in the 1970s.The banning of DDT was strengthened by the Stockholm Convention in 2001. DDT is allowed only for malaria control in Ethiopia. However, farmers are misusing DDT and applying it to Khat (Catha edulis) farming. So, this review analyzes available data in the literature on the current trend, application, occurrence, fate and effects of DDT and its metabolites, dichlorodiphenyldichloroethane (DDD), dichlorodiphenyldichloroethylene (DDE), in the chewable parts of Khat. Generally, the concentration level of DDT, DDD, and DDE, designated as DDTs, is detected in different farmlands of Ethiopia. Some of the DDTs concentrations detected are very high (141.2-973 µg/kg (Gelemso), 194.4-999 µg/kg (Aseno) and 6253-8413.3 µg/kg (Gurage), and these concentrations may indicate increasing recent unmonitored application of DDT on Khat leaves. Some of the detected concentrations of DDT in the literature were above the maximum residue limit (MRL) set by FAO/WHO (100 µg/kg) and the European Commission 10 µg/kg in vegetables and 50 µg/kg in cereals. DDT exposure of Khat chewers linked to the concentration of DDT on Khat leaves and the amount of Khat consumed. DDT might pose health risks to chewers due to chronic toxicity, bioaccumulation, persistent and endocrine disruption properties.

The effects of khat (Catha edulis) use on the genitourinary system: A systematic review and meta-analysis.

The objective of the current study is to conduct a meta-analysis of the existing literature concerning the potential impact of khat on the reproductive systems. Five international databases, Embase, Medline/PubMed, Scopus, Web of Knowledge (ISI), and ProQuest, were searched from inception up to the end of January 2024. The Joanna Briggs Institute (JBI) Critical Appraisal Checklist was used for quality assessment of included studies. After several screening phases,10 articles were included in the final analysis. The pooled meta-analysis showed that women who use khat during pregnancy had a significantly higher chance of having low birth weight (LBW) (OR= 2.51, 95% CI: 1.61-3.95, p-value < 0.001) and congenital anomalies (OR= 3.17, 95% CI: 1.31-7.73, p-value = 0.011) compared to nonusers. The obtained results of the meta-analysis showed that the consumption of khat significantly reduces semen volume (standardized mean difference = -0.903, 95% CI: -1.801 to -0.007, p = 0.048). In conclusion, our study show that significant associations with LBW, congenital anomalies, and reduced semen volume underscores the necessity for additional research to delve deeper into the intricate complexities of how khat affects reproductive health in both women and men.

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.

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.

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.

Exploring the perception of key stakeholders toward khat policy approaches in Ethiopia: a qualitative study.

BACKGROUND: Khat is an amphetamine-like plant, produced and commonly chewed in Ethiopia by a large group of the population. Although significant multidimensional harms of khat use have been reported, currently, there are no policies or organized activities against khat use in Ethiopia. Therefore, the current study aimed to explore the perception of key stakeholders toward khat policy approaches for Ethiopia. METHODS: A qualitative study was conducted using focus group discussion (FGD) and in-depth interview (IDI). Ten stakeholders participated in the IDIs, and another 15 individuals participated in the FGDs. Key stakeholders were appropriately mapped and purposively selected based on their experience related to khat use and khat harm reduction. Interviews and FGDs were led by the study authors and were audio-recorded. The audio-recorded data were transcribed verbatim and then translated into English language. The data were analyzed using thematic analysis approach. RESULTS: Participants preferred prevention and law regulation measures for khat policy approaches for Ethiopia. Proposed prevention and law regulation measures included regulating the transportation of khat, limiting the minimum age to buy and sell khat, prohibiting khat use at some public places, banning khat advertising and promotion, and imposing excise tax. Individual level khat harm reduction strategies were also proposed to be useful. However, the participants asserted that total khat ban in Ethiopia is not likely to be feasible and acceptable. CONCLUSION: Prevention, treatment or care for individuals with problematic khat use, law regulation, and harm reduction were preferred approaches by stakeholders for khat policy in Ethiopia instead of total banning.

Perceived harms and protective behavioural strategies among khat chewers: a qualitative study in Jimma, Ethiopia.

BACKGROUND: While there have been many previous studies focusing on the adverse effects of khat chewing, attempts to investigate the protective behavioural strategies (PBS) employed by the khat using population are rare. PBS are strategies that substance users employ to minimize or alleviate the possible negative consequences related to the behaviour. This study focuses on the harms that chewers associate with khat use, and the behavioural strategies they practise to prevent or minimize these harms. METHODS: A community-based qualitative study was conducted using a snowball sampling technique to recruit a diverse sample of khat chewing participants (N = 102) in Jimma city, Ethiopia. Face-to-face in-depth interviews were carried out with the participants. RESULTS: Participants identified a variety of harms likely to result from chewing khat. These include impacts on their finances, work, social life and health. The PBS that participants employed to avoid or minimize the risks were classified into four themes based on their temporal sequence with khat chewing sessions: prior to chewing, during chewing, after chewing and general PBS covering the whole of their khat chewing career. The PBS enable khat chewers to prevent or minimize the adverse health consequences of chewing, socialize and work without or with fewer difficulties and manage their economy successfully. CONCLUSION: The study participants believe that khat-related harms are avoidable if khat users implement appropriate strategies prior to, during and after chewing, and if they apply PBS to khat-related factors (e.g. type, amount and frequency), set factors (e.g. reason for using and health behaviour) and setting factors (e.g. place of use, when used, with whom used and social norms) covering the whole of their khat chewing career.

Parental khat use and early childhood growth status in Eastern Ethiopia.

BACKGROUND: Adult chewing of the stimulant plant khat (Catha edulis) has an unclear relationship with child growth outcomes. Contradictory study conclusions because habitual khat chewing covary with increased household income from khat production. AIM: Disentangling the association of parental khat use, household khat production, and child nutritional status and growth markers. METHODS: Bayesian analysis was applied to survey data for 2340 households containing 2760 children aged 24-60 months in a population-representative geographic sampling of two districts in Eastern Ethiopia, a khat chewing and producing region. RESULTS: Stunting effects were more evident than wasting; the negative child growth effect of khat chewing persisted regardless of household khat production; maternal chewing particularly mattered for child growth delays. CONCLUSIONS: This exploratory analysis suggests that future studies should target the interactions of khat chewing practices with gendered performances of child care/feeding responsibilities.

Clavulanic Acid Improves Memory Dysfunction and Anxiety Behaviors through Upregulating Glutamatergic Transporters in the Nucleus Accumbens of Mice Repeatedly Exposed to Khat Extract.

Khat (Catha edulis) is an evergreen shrub whose buds and leaves give a state of delight and euphoria when chewed. Cathinone, an amphetamine-like stimulant that is among the active ingredients in khat, is able to downregulate glutamate transporter subtype I (GLT-1). Neurobehavioral dysfunctions such as altered locomotor activity, anorexia, and nociception have been observed in animals exposed to cathinone. Interestingly, treatment with a ß-lactam antibiotic such as ceftriaxone, which upregulates GLT-1, normalizes cathinone-induced conditioned place preference, and alters repetitive movements in rats. However, little is known about the role of the glutamatergic system in memory dysfunction and anxiety-like behaviors in mice exposed to khat. We found here that clavulanic acid, a ß-lactam-containing compound and GLT-1 upregulator, would modulate the neurobehavioral changes, including memory impairment and anxiety-like behaviors, associated with repeated exposure of mice to khat. Our data supported that clavulanic acid could improve memory impairment and anxiety-like behaviors through upregulating GLT-1 in the nucleus accumbens (NAc), an effect abolished with a selective GLT-1 blocker. This upregulation was associated with restored glutamate/cystine antiporter expression in the NAc using a Western blotting assay. Cathine and cathinone were identified in khat extract using the gas chromatography technique. Our work provides preclinical insight into the efficacy of ß-lactam-containing compounds for the attenuation of neurobehavioral changes induced by khat exposure.

Effect of khat extract on color stability of digitally and manually fabricated provisional restorations: an in vitro comparative study.

BACKGROUND: The aim of this in vitro study was to evaluate the effect of khat extract on the color stability of five different provisional restorative materials (PRMs). METHODS: In this study, 50 specimens were fabricated from five different PRMs with different techniques. Twenty specimens were digitally fabricated of poly-methyl methacrylate (PMMA) CAD/CAM milling and 3D printing PRMs, while the other thirty specimens were manually fabricated of three different PRMs: PMMA self-cured (SC) acrylic resin, light-cured (LC) composite, and Bis-acrylic SC composite. Milling and 3D printing machines were used to fabricate the digital specimens, while the manual specimens were fabricated using a metallic mold. The material was placed in the mold, covered by a polyester stripe, and held between two glass slabs with a constant load for 30 s. After setting, the specimens were removed and checked. Ten disc-shaped specimens with 2 ± 0.3 mm thickness and 10 ± 0.3 mm diameter were prepared from each of the tested PRM. Then all the specimens were polished. Five specimens of each PRM were immersed in khat extract, while the other five were immersed in distilled water medium as a control group. The color measurements were recorded before and after 1 and 7 days of immersion using a spectrophotometer. The immersion media were renewed every 24 h and kept along with the specimens at 37 °C. The T test, paired T test, and ANOVA analysis of variance were used to analyze the results. The Bonferroni test was used for post-hoc multiple comparisons. RESULTS: The interaction between the tested PRMs, the media, and the duration of immersion time was statistically significant (p < 0.05). PMMA CAD/CAM milling PRM was the most stable in color, and this was statistically significant (p < 0.05). The LC composite PRM composite was the least stable in color and was statistically insignificant (p > 0.05) when compared to the 3D printing and Bis-acrylic SC composite PRMs, respectively. CONCLUSIONS: This study demonstrated that khat extract medium has a high staining ability on the tested PRMs. CAD/CAM milling PRM was the most stable in color and could therefore be used as a long-term provisional. The increase in immersion time was a significant factor in the color change of the tested PRMs. The color of the 3D-printed PRM was the most affected over time.

The effect of khat cultivation on rural households' income in Bahir Dar Zuria District, Northwest Ethiopia.

The study was conducted to evaluate the effect of khat cultivation on rural households' income in the Bahir Dar Zuria district using cross-sectional data collected from 180 randomly selected respondents, and supported by focus group discussions in two districts of northwest Ethiopia. The data were analyzed by simple descriptive statistics and beta regression. Results from descriptive statistics show that khat contributes the largest (51%) of farmers' income, followed by crop sale (33%), sale of livestock and their products (9%), and off-farm and non-farm activities (7%), Empirical findings from the Beta regression model also show that farming experience, education status, the proportion of land allocated for khat cultivation, total working capital of the household, the density of khat trees planted per hectare, and participation in off-farm and non-farm activity have a significant and positive effect on the proportion of khat income of the households. On the contrary, livestock holding, total asset ownership, and access to mobile phones have a significant and negative influence on the proportion of annual khat income of the households. Hence, the cultivation of khat can have a significant effect on the improvement of rural households' income and standard of living in the districts. However, increased khat production have also serious implications on the market, water resources, and human health. Thus, policymakers need to come up together to understand and devise proper running mechanisms for these controversies of khat production in association with economic, social, and health implications.

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.

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.

Effect of the Prenatal Exposure of Khat on the Skeleton of Developing Rabbit Embryo: Morphometric and Gross Anatomical Study.

Background: Khat leaves are chewed by many people worldwide, mainly in Africa and the southwest Arabian peninsula. Materials and methods: 27 apparently healthy adult New Zealand rabbits (3 males & 24 females) of 2.5 ± 0.5 kg body weight were used in this work. The animals were divided into 4 groups (control, low, medium and high doses groups). The khat extract was administered orally during (8th -18th) day of gestation. The mothers were sacrificed on the 29th day of gestation. The skeletons of the fetuses were stained with Alizarin Red S and Alcian Blue. Results: Skeletal examination of the fetuses of treated dams showed several types of malformations and variations in all treated groups such as unossified phalanges, deformed sternum, completely unossified vertebral lamina and opened anterior and posterior fontanelles, and reduced length of limb long bones. Conclusion: These findings support the teratogenic effect of the khat on the developing rabbit fetus.

Study of influence of Catha edulis (Khat) chewing on oral pharmacokinetics of irbesartan in rats using a newly developed HPLC-UV method.

Khat consumers might use a number of drugs for underlying conditions; however the potential drug-herb interaction between khat and other drugs including Irbesartan (IRB) is unknown. The present study was conducted to evaluate the effects of khat chewing on pharmacokinetic profile of IRB, a commonly available antihypertensive agent. The pharmacokinetic profile of orally administered IRB (15.5 mg/kg) with and without pre-administration of khat (12.4 mg/kg) were determined in Sprague-Dawley rats. IRB was estimated in rat plasma samples using a newly developed HPLC method. The chromatographic separation of the drug and internal standard (IS) was performed on a C-18 column (Raptor C-18, 100 mm × 4.6 mm id.; 5 µm) using a mobile phase consisting of 10 mM ammonium acetate buffer (pH 4.0) and acetonitrile in a ratio 60:40 v/v. Acceptable linearity for IRB was recorded at 1 - 12 µg/mL concentration range (R2 > 0.99). Intra-day and inter-day precision (%RSD = 0.44% - 3.27% and 0.39-1.98% respectively) and accuracy (% recovery = 98.3 - 104.3%) in rat plasma was within the acceptable limit according to USFDA guidelines. The AUC0-t was found to be significantly increased in IRB-khat co-administered rats as compared to rats receiving IRB only; whereas, the Tmax (0.5 h) value remained unchanged. Results of this study revealed that the IRB level considerably increased in rat plasma upon co-administration of khat. This might be due to the inhibition of CYP2D9 by khat which is the principal cytochrome P450 isoform responsible for IRB metabolism.

Prevalence and determinants of chewing khat among women in Ethiopia: data from Ethiopian demographic and health survey 2016.

BACKGROUND: In Ethiopia and other countries in eastern Africa, khat abuse is an increasing public health problem. Levels of use appear to be increasing in women, who are more vulnerable to khat-related problems. However, population-based data are lacking as studies have been small and related to specific settings. This study aimed to contribute to current knowledge on the prevalence of chewing khat and associated factors among women in Ethiopia, using data from the 2016 Ethiopian national demographic and health survey. METHODS: The 2016 EDHS used a two-stage stratified sampling design to select households. A total of 645 enumeration areas (202 urban and 443 rural) were selected, based on the 2007 Ethiopia Population and Housing Census. In these, 18,008 households were considered, from which 15,683 women were included from individual households. The women were interviewed by trained lay interviewers. Data were tabulated and logistic regression was used to examine mutually adjusted associations, expressed as adjusted odds ratios. RESULTS: The lifetime prevalence of chewing khat among women was 9.9%. Current khat use was 8.4%, with a mean of 14.2 days of use in the last month. Khat use increased with increasing age, remaining constant after age 35 years, having one child, lower educational level, being Muslim by religion and not pertaining to the lowest wealth index category. Not being in a marital relationship with the most recent sex partner and Protestant religion were protective factors. CONCLUSION: Lifetime prevalence of chewing khat among women in Ethiopia is substantial and associated with specific sociodemographic risks. These can be used in targeted public health efforts to control the use of khat and reduce the associated health and economic burden.