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Hanlon C, Roberts T, Misganaw E, Malla A, Cohen A, Shibre T, Fekadu W, Teferra S, Kebede D, Mulushoa A, Girma Z, Tsehay M, Kiross D, Lund C, Fekadu A, Morgan C, Alem A. Studying the context of psychoses to improve outcomes in Ethiopia (SCOPE): Protocol paper. PLoS One 2024; 19:e0293232. [PMID: 38722946 PMCID: PMC11081395 DOI: 10.1371/journal.pone.0293232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 04/08/2024] [Indexed: 05/13/2024] Open
Abstract
BACKGROUND Global evidence on psychosis is dominated by studies conducted in Western, high-income countries. The objectives of the Study of Context Of Psychoses to improve outcomes in Ethiopia (SCOPE) are (1) to generate rigorous evidence of psychosis experience, epidemiology and impacts in Ethiopia that will illuminate aetiological understanding and (2) inform development and testing of interventions for earlier identification and improved first contact care that are scalable, inclusive of difficult-to-reach populations and optimise recovery. METHODS The setting is sub-cities of Addis Ababa and rural districts in south-central Ethiopia covering 1.1 million people and including rural, urban and homeless populations. SCOPE comprises (1) formative work to understand care pathways and community resources (resource mapping); examine family context and communication (ethnography); develop valid measures of family communication and personal recovery; and establish platforms for community engagement and involvement of people with lived experience; (2a) a population-based incidence study, (2b) a case-control study and (2c) a cohort study with 12 months follow-up involving 440 people with psychosis (390 rural/Addis Ababa; 50 who are homeless), 390 relatives and 390 controls. We will test hypotheses about incidence rates in rural vs. urban populations and men vs. women; potential aetiological role of khat (a commonly chewed plant with amphetamine-like properties) and traumatic exposures in psychosis; determine profiles of needs at first contact and predictors of outcome; (3) participatory workshops to develop programme theory and inform co-development of interventions, and (4) evaluation of the impact of early identification strategies on engagement with care (interrupted time series study). Findings will inform development of (5) a protocol for (5a) a feasibility cluster randomised controlled trial of interventions for people with recent-onset psychosis in rural settings and (5b) two uncontrolled pilot studies to test acceptability, feasibility of co-developed interventions in urban and homeless populations.
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Affiliation(s)
- Charlotte Hanlon
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, Centre for Global Mental Health, King’s College London, London, United Kingdom
- Department of Psychiatry and WHO Collaborating Centre in Mental Health Research and Capacity Building, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Tessa Roberts
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, Centre for Global Mental Health, King’s College London, London, United Kingdom
- ESRC Centre for Society & Mental Health, King’s College London, London, United Kingdom
| | - Eleni Misganaw
- Mental Health Service User Association, Addis Ababa, Ethiopia
| | - Ashok Malla
- Department of Psychiatry and Douglas Mental Health Institute, McGill University, Montreal, Canada
| | - Alex Cohen
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Wubalem Fekadu
- Department of Psychiatry and WHO Collaborating Centre in Mental Health Research and Capacity Building, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Solomon Teferra
- Department of Psychiatry and WHO Collaborating Centre in Mental Health Research and Capacity Building, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Derege Kebede
- Department of Preventive Medicine, School of Public Health, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Adiyam Mulushoa
- Department of Psychiatry and WHO Collaborating Centre in Mental Health Research and Capacity Building, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Zerihun Girma
- Department of Psychiatry and WHO Collaborating Centre in Mental Health Research and Capacity Building, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Mekonnen Tsehay
- Department of Psychiatry and WHO Collaborating Centre in Mental Health Research and Capacity Building, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Dessalegn Kiross
- Victoria University of Wellington, School of Nursing, Midwifery and Health Practice, Wellington, New Zealand
| | - Crick Lund
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, Centre for Global Mental Health, King’s College London, London, United Kingdom
- Department of Psychiatry and Mental Health, Alan J Flisher Centre for Public Mental Health, University of Cape Town, Cape Town, South Africa
| | - Abebaw Fekadu
- Department of Psychiatry and WHO Collaborating Centre in Mental Health Research and Capacity Building, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Craig Morgan
- ESRC Centre for Society & Mental Health, King’s College London, London, United Kingdom
| | - Atalay Alem
- Department of Psychiatry and WHO Collaborating Centre in Mental Health Research and Capacity Building, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Gosadi IM, Makeen AM, Alqassim AY, Aqeeli AA, Ryani MA, Bahri AA, Suwaydi HA, Najmi AA, Abualgasem MM. Khat chewing among parents and their children: A potential transgenerational effect. J Family Med Prim Care 2024; 13:903-910. [PMID: 38736817 PMCID: PMC11086802 DOI: 10.4103/jfmpc.jfmpc_1415_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 09/26/2023] [Accepted: 10/03/2023] [Indexed: 05/14/2024] Open
Abstract
Background Khat has a stimulating and addictive effect and can induce consequences on the health and socioeconomic status of khat chewers. Objectives This study aims to assess knowledge, attitude, and practice of khat chewing among parents in Jazan and its consequential effect on their children. Methods This cross-sectional investigation was conducted in the Jazan region of Saudi Arabia. Data was collected via a web-based, self-administered questionnaire measuring demographics, knowledge, attitudes, and practices concerning khat chewing. The Chi-square test or Fisher's exact test was used to assess factors associated with khat chewing among parents and its consequential effect on their children. Results A total of 724 parents were included. The sample had an overall good knowledge about the health hazards of khat chewing and an attitude against khat chewing. Nonetheless, the number of parents who reported that they had ever tried khat chewing was 200 (27.6%) and 106 parents (14.6%) confirmed that their children were khat chewers. Additionally, 98 (13.5%) parents declared that they practiced khat chewing in front of their children. Higher frequencies of parents who reported providing khat to their children were identified among parents with higher attitude levels that favor khat chewing (P value = 0.04). Conclusions Efforts should be made to develop targeted preventive and educational strategies to reduce khat chewing among parents who have favorable attitudes toward khat chewing.
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Affiliation(s)
- Ibrahim M. Gosadi
- Department of Family and Community Medicine, College of Medicine, Jazan University, Jazan, Saudi Arabia
| | - Anwar M. Makeen
- Department of Family and Community Medicine, College of Medicine, Jazan University, Jazan, Saudi Arabia
| | - Ahmad Y. Alqassim
- Department of Family and Community Medicine, College of Medicine, Jazan University, Jazan, Saudi Arabia
| | - Abdulwahab A. Aqeeli
- Department of Family and Community Medicine, College of Medicine, Jazan University, Jazan, Saudi Arabia
| | - Majed A. Ryani
- Department of Family and Community Medicine, College of Medicine, Jazan University, Jazan, Saudi Arabia
| | - Ahmed A. Bahri
- Department of Family and Community Medicine, College of Medicine, Jazan University, Jazan, Saudi Arabia
| | - Hassan A. Suwaydi
- Department of Public Health in Jazan, Ministry of Health, Saudi Arabia, Jazan, Saudi Arabia
| | - Abdullah A. Najmi
- Department of Obstetrics and Gynecology, King Fahad Central Hospital, Jazan, Saudi Arabia
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Ssenyonjo J, Mistler C, Adler T, Shrestha R, Kyambadde P, Copenhaver M. Examining HIV Knowledge and Sexually Risky Behaviors among Female Sex Workers in Kampala, Uganda. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:163. [PMID: 38397654 PMCID: PMC10888220 DOI: 10.3390/ijerph21020163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 01/26/2024] [Accepted: 01/30/2024] [Indexed: 02/25/2024]
Abstract
HIV incidence remains alarmingly high among female sex workers (FSWs) in Uganda, necessitating targeted interventions. This study aimed to identify individual and provider-level barriers and facilitators to primary HIV prevention among FSWs in an urban setting. Focus groups involving FSWs and healthcare providers (HCPs) were conducted to inform the development of tailored prevention interventions. Results revealed that all participants had mobile phones, recent sexual activity, and a history of HIV testing, with high rates of sexually transmitted infections and varying HIV test results. FSWs displayed a well-informed awareness of HIV transmission risks, emphasizing the threat for those not testing positive. They unanimously recognized the crucial role of HIV testing in informing, mitigating risks, promoting ART use, and endorsing consistent condom usage. Despite heightened awareness, HCPs noted potential underestimation of vulnerability. Various challenges, including inadequate condom usage, substance abuse, and client dynamics, underscored the complexity of safeguarding against HIV transmission among FSWs. Widespread alcohol and drug use, including marijuana, kuber, and khat, served as coping mechanisms and social facilitators. Some FSWs successfully reduced alcohol intake, highlighting challenges in addressing substance use. FSWs preferred group discussions in health education programs, emphasizing peer interactions and the effectiveness of visual aids in HIV prevention education. This study provides comprehensive insights to guide the development of targeted interventions addressing the multi-faceted challenges FSWs face in HIV prevention.
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Affiliation(s)
- Jude Ssenyonjo
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT 06269, USA
| | - Colleen Mistler
- Division of Prevention and Community Research, Department of Psychiatry, School of Medicine, Yale University, New Haven, CT 06520, USA
| | - Tanya Adler
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT 06269, USA
| | - Roman Shrestha
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT 06269, USA
| | - Peter Kyambadde
- Most At-Risk Populations Initiative-MARPI, Department of Allied Health Sciences, University of Connecticut, Storrs, CT 06269, USA
| | - Michael Copenhaver
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT 06269, USA
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Olani AB, Decorte T. Perceived harms and protective behavioural strategies among khat chewers: a qualitative study in Jimma, Ethiopia. Harm Reduct J 2023; 20:155. [PMID: 37875920 PMCID: PMC10594897 DOI: 10.1186/s12954-023-00890-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 10/11/2023] [Indexed: 10/26/2023] Open
Abstract
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.
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Affiliation(s)
- Amanti Baru Olani
- Institute for Social Drug Research, Department of Criminology, Criminal Law and Social Law, Ghent University, Universiteitstraat 4, 9000, Ghent, Belgium.
- Department of Sociology, Jimma University, Jimma, Ethiopia.
| | - Tom Decorte
- Institute for Social Drug Research, Department of Criminology, Criminal Law and Social Law, Ghent University, Universiteitstraat 4, 9000, Ghent, Belgium
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Nigussie K, Negash A, Sertsu A, Mulugeta A, Tamire A, Kassa O, Abdeta T, Dereje J. Khat chewing and associated factors among public secondary school students in Harar town, Eastern Ethiopia: a multicenter cross-sectional study. Front Psychiatry 2023; 14:1198851. [PMID: 37720900 PMCID: PMC10499630 DOI: 10.3389/fpsyt.2023.1198851] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 07/31/2023] [Indexed: 09/19/2023] Open
Abstract
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.
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Affiliation(s)
- Kabtamu Nigussie
- Department of Psychiatry, School of Nursing and Midwifery, College of Health and Medical Science, Haramaya University, Harar, Ethiopia
| | - Abraham Negash
- Department of Midwifery, School of Nursing and Midwifery, College of Health and Medical Science, Haramaya University, Harar, Ethiopia
| | - Addisu Sertsu
- Department of Nursing, School of Nursing and Midwifery, College of Health and Medical Science, Haramaya University, Harar, Ethiopia
| | - Abiy Mulugeta
- Department of Psychiatry, School of Nursing and Midwifery, College of Health and Medical Science, Haramaya University, Harar, Ethiopia
| | - Aklilu Tamire
- School of Public Health, College of Health and Medical Science, Haramaya University, Harar, Ethiopia
| | - Obsan Kassa
- School of Public Health, College of Health and Medical Science, Haramaya University, Harar, Ethiopia
| | - Tilahun Abdeta
- Department of Psychiatry, School of Nursing and Midwifery, College of Health and Medical Science, Haramaya University, Harar, Ethiopia
| | - Jerman Dereje
- Department of Psychiatry, School of Nursing and Midwifery, College of Health and Medical Science, Haramaya University, Harar, Ethiopia
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Olani AB, Gerbaba M, Getnet M, Soboka M, Decorte T. Is chewing khat associated with mental health disorders? A scoping review of the content and quality of the current evidence base. Subst Abuse Treat Prev Policy 2023; 18:39. [PMID: 37370160 DOI: 10.1186/s13011-023-00545-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 06/05/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Khat (Catha edulis) is a plant commonly found in the horn of Africa whose leaves are chewed for their psycho-stimulant effects. Several studies have demonstrated the association between khat use and mental health problems. Nevertheless, evidence is mixed and inconsistent, warranting further review of available studies. This scoping review is aimed at investigating the content and quality of evidence base on the associations between khat use and mental health disorders and suggesting avenues for further research. METHODS We used a scoping review methodology to map the existing evidence using PubMed, SCOPUS, Embase, and CINAHL databases. Primary studies focusing on the association between any pattern of khat use and any form of mental health disorders are included. The review focused on all age groups, any study design, all geographical locations, and any publication year. The terms used for searching eligible studies include khat, mental disorders, and various alternative terminologies. Narrative review is employed to present findings. RESULTS 7,121 articles were found, of which 108 were eligible, conducted across 12 different countries. The majority of the studies was done during the last ten years and the studies mostly employed cross-sectional design. About 10 different categories of mental health disorders have been identified as showing associations with khat use. Despite many contradictory findings between the studies, most of the evidence base suggests that khat use is associated with mental health disorders. Non-specific psychological distress is the most frequently mentioned mental health problem (reported in 26.9% of the studies). Khat use as a predictor variable is mostly assessed using a 'yes/no' category, and as a result, dose-dependent effects of khat use on mental health are not given much consideration. CONCLUSION Although most of the studies associate khat use with mental health disorders, the causal relationships are inconclusive given the cross-sectional design of the studies, and the presence of potential confounders and several forms of biases. Available studies also report contradictory findings. Further studies are recommended using prospective designs, standardized and valid measures of khat use, and focusing on specific types of mental health disorders.
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Affiliation(s)
- Amanti Baru Olani
- Institute for Social Drug Research, Department of Criminology, Criminal Law and Social Law, Ghent University, Universiteitstraat 4, Ghent, 9000, Belgium.
- Department of Sociology, Jimma University, Jimma, P.O.Box 378, Ethiopia.
| | - Mulusew Gerbaba
- Department of Epidemiology, Institute of Health, Jimma University, Jimma, P.O.Box 378, Ethiopia
| | - Masrie Getnet
- Department of Epidemiology, Institute of Health, Jimma University, Jimma, P.O.Box 378, Ethiopia
| | - Matiwos Soboka
- Department of Psychiatry, Institute of Health, Jimma University, Jimma, P.O.Box 378, Ethiopia
| | - Tom Decorte
- Institute for Social Drug Research, Department of Criminology, Criminal Law and Social Law, Ghent University, Universiteitstraat 4, Ghent, 9000, Belgium
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Shaikhain G, Gaballah M, Alhazmi A, Khardali I, Hakami A, Oraiby M, Alharbi S, Tobaigi M, Ghalibi M, Fageeh M, Albeishy M, Attafi I. Fatalities Involving Khat in Jazan, Saudi Arabia, 2018 to 2021. TOXICS 2023; 11:506. [PMID: 37368606 DOI: 10.3390/toxics11060506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 05/30/2023] [Accepted: 05/31/2023] [Indexed: 06/29/2023]
Abstract
Interpreting fatalities involving khat is challenging due to a lack of data on cathinone and cathine reference concentrations in postmortem tissues. This study investigated the autopsy findings and toxicological results of fatalities involving khat in Saudi Arabia's Jazan region from 1 January 2018 to 31 December 2021. All confirmed cathine and cathinone results in postmortem blood, urine, brain, liver, kidney, and stomach samples were recorded and analyzed. Autopsy findings and the manner and cause of death of the deceased were assessed. Saudi Arabia's Forensic Medicine Center investigated 651 fatality cases over four years. Thirty postmortem samples were positive for khat's active constituents, cathinone and cathine. The percentage of fatalities involving khat was 3% in 2018 and 2019 and increased from 4% in 2020 to 9% in 2021, when compared with all fatal cases. They were all males ranging in age from 23 to 45. Firearm injuries (10 cases), hanging (7 cases), road traffic accident (2 cases), head injury (2 cases), stab wounds (2 cases), poisoning (2 cases), unknown (2 cases), ischemic heart disease (1 case), brain tumor (1 case), and choking (1 case) were responsible for the deaths. In total, 57% of the postmortem samples tested positive for khat only, while 43% tested positive for khat with other drugs. Amphetamine is the drug most frequently involved. The average cathinone and cathine concentrations were 85 and 486 ng/mL in the blood, 69 and 682 ng/mL in the brain, 64 and 635 ng/mL in the liver, and 43 and 758 ng/mL in the kidneys, respectively. The 10th-90th percentiles of blood concentrations of cathinone and cathine were 18-218 ng/mL and 222-843 ng/mL, respectively. These findings show that 90% of fatalities involving khat had cathinone concentrations greater than 18 ng/mL and cathine concentrations greater than 222 ng/mL. According to the cause of death, homicide was the most common fatality involving khat alone (77%). More research is required, especially toxicological and autopsy findings, to determine the involvement of khat in crimes and fatalities. This study may help forensic scientists and toxicologists investigate fatalities involving khat.
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Affiliation(s)
- Ghassan Shaikhain
- Forensic Toxicology Services, Forensic Medical Center, Ministry of Health, Jazan 45142, Saudi Arabia
| | - Mohammed Gaballah
- Forensic Medicine Services, Forensic Medical Center, Ministry of Health, Jazan 45142, Saudi Arabia
| | - Ahmad Alhazmi
- Forensic Medicine Services, Forensic Medical Center, Ministry of Health, Jazan 45142, Saudi Arabia
| | - Ibrahim Khardali
- Forensic Toxicology Services, Forensic Medical Center, Ministry of Health, Jazan 45142, Saudi Arabia
| | - Ahmad Hakami
- Forensic Medicine Services, Forensic Medical Center, Ministry of Health, Jazan 45142, Saudi Arabia
| | - Magbool Oraiby
- Forensic Toxicology Services, Forensic Medical Center, Ministry of Health, Jazan 45142, Saudi Arabia
| | - Sultan Alharbi
- Forensic Toxicology Services, Forensic Medical Center, Ministry of Health, Jazan 45142, Saudi Arabia
| | - Mohammad Tobaigi
- Forensic Medicine Services, Forensic Medical Center, Ministry of Health, Jazan 45142, Saudi Arabia
| | - Mohammed Ghalibi
- Forensic Medicine Services, Forensic Medical Center, Ministry of Health, Jazan 45142, Saudi Arabia
| | - Mohsen Fageeh
- Forensic Toxicology Services, Forensic Medical Center, Ministry of Health, Jazan 45142, Saudi Arabia
| | - Mohammed Albeishy
- Forensic Toxicology Services, Forensic Medical Center, Ministry of Health, Jazan 45142, Saudi Arabia
| | - Ibraheem Attafi
- Forensic Toxicology Services, Forensic Medical Center, Ministry of Health, Jazan 45142, Saudi Arabia
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Abdulrahman H, Bousleiman S, Mumin M, Caqli I, Hijaz BA, Gelaye B, Fricchione G, Chemali Z. A retrospective data analysis of psychiatric cases in Hargeisa, Somaliland between 2019 and 2020. S Afr J Psychiatr 2023; 29:1946. [PMID: 36876033 PMCID: PMC9982481 DOI: 10.4102/sajpsychiatry.v29i0.1946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 09/28/2022] [Indexed: 03/06/2023] Open
Abstract
Background In Somaliland, an estimated one person in every two households suffers from psychiatric disorders. Despite this, access to mental health care is limited because of shortages in facilities, human resources, funding and stigma. Aim To present the proportion of psychiatric disorders encountered in outpatient psychiatry clinics. Setting The University if Hargeisa (UoH), Hargesisa, Somaliland. Methods De-identified data on patients accessing psychiatric care from doctor trainees in the dual psychiatry-neurology residency program at UoH from January 2019 to June 2020 were included in the analysis. The Institutional Review Board from UoH approved data collection and analysis. The most common psychiatric diagnoses were summarised overall and by sex and age. Results A total of 752 patients were included in the analysis. Most were male (54.7%), with an average age of 34.9 years. The most common psychiatric diagnoses were schizophrenia (28.0%), major depressive disorder (MDD) (14.3%) and bipolar disorder type 1 (BD1) (10.5%). When stratified by sex, patients with schizophrenia and BD1 were more likely to be male (73.5% and 53.3%, respectively), and those with MDD were more likely to be female (58.8%). Trauma- and stressor-related disorders accounted for 0.4% of cases, while 0.8% of patients presented with substance use disorders (alcohol and khat), which is an underestimate of the widespread use in Somaliland. Conclusion Additional research using structured clinical interviews is needed to determine the epidemiology of psychiatric disorders and promote policies aiming to decrease neuropsychiatric mortality and morbidity. Contribution This work presents the first data collection related to neuropsychiatric disorders in Somaliland.
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Affiliation(s)
- Hassan Abdulrahman
- College of Medicine and Health Science, University of Hargeisa, Hargeisa, Somaliland
| | - Stephanie Bousleiman
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Mustafe Mumin
- College of Medicine and Health Science, University of Hargeisa, Hargeisa, Somaliland
| | - Ibrahim Caqli
- College of Medicine and Health Science, University of Hargeisa, Hargeisa, Somaliland
| | - Baraa A Hijaz
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Bizu Gelaye
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States.,The Chester M. Pierce, MD Division of Global Psychiatry, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Gregory Fricchione
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States.,The Chester M. Pierce, MD Division of Global Psychiatry, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Zeina Chemali
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States.,The Chester M. Pierce, MD Division of Global Psychiatry, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States.,Department of Neurology, Massachusetts General Hospital, Boston, MA, United States
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Dachew BA, Bifftu BB, Tiruneh BT, Anlay DZ, Wassie MA. Prevalence of mental distress and associated factors among university students in Ethiopia: a meta-analysis. J Ment Health 2022; 31:851-858. [PMID: 31250685 DOI: 10.1080/09638237.2019.1630717] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Mental distress is an important public health problem and is becoming common health problems among university students. AIMS This study aimed to provide a pooled prevalence of mental distress and associated factors among university students in Ethiopia. METHOD We systematically searched PubMed, EMBASE and PsycINFO databases. A further search was performed at Google Scholar search engine for additional studies. All observational studies reporting the prevalence of mental distress and/or associated factors among university students in Ethiopia were included. Pooled prevalence with 95% confidence interval (95% CI) were calculated using random effects and quality effects models. Subgroup and sensitivity analyses were performed. Heterogeneity between studies and evidence of publication bias were assessed. RESULTS The pooled prevalence of mental distress was 35% (95% CI; 28%-43%). Being female, participating in religious programmes, having close friends, experiencing financial distress, alcohol use, khat use, conflict with friends, lack of interest in their field of study and a family history of mental illness were factors associated with mental distress among students. We found significant heterogeneity, but no evidence of publication bias. CONCLUSIONS More than one third of university students in Ethiopia have suffered with mental distress. The finding provides evidence that university students are at risk population for mental health problems and suggests the need for early intervention to prevent severe mental illness.
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Affiliation(s)
- Berihun Assefa Dachew
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Brhanu Boru Bifftu
- School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Bewket Tadesse Tiruneh
- School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Degefaye Zelalem Anlay
- School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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10
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Im H, Swan LET. Trauma exposure, social functioning, and common mental health disorders in Somali refugee male and female youth: An SEM analysis. Int J Soc Psychiatry 2022; 68:1539-1551. [DOI: https:/doi.org/10.1177/00207640211037726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/22/2023]
Abstract
Background: Refugee youth often face numerous adversities before and during forced migration. Although experiences vary across settings and subpopulations, common mental disorders are prevalent among refugee youth who are displaced in low- and middle-income countries. It is important to examine how risk factors are intricately linked and contribute to common mental health issues to inform clinical practice and social policy. Aims: This study aims to test the pathways from risk factors previously identified as determinants of Somali refugee youth mental health (i.e. trauma exposure, substance use, social functioning, aggression) to symptoms of PTSD, depression, anxiety, and somatic pains. Method: We collected survey data in 2013, using snowball sampling to recruit Somali refugee youth (15–35 years old) living in Eastleigh, Kenya. We ran three structural equation models to assess paths from trauma exposure to mental health symptoms, through psychosocial factors including substance use, aggression, and functional impairment. We first conducted this analysis with a mixed-gender sample ( N = 305) and then assessed gender differences by running one model for male participants ( n = 124) and another for female participants ( n = 181). Results: In the mixed-gender sample, trauma exposure directly predicted substance use and both directly and indirectly predicted aggression, functional impairment, and mental health symptoms. Substance use directly predicted aggression and functional impairment, and substance use both directly and indirectly predicted mental health symptoms. The split-gender models revealed gender differences, with only functional impairment directly predicting mental health symptoms in the male sample and with many significant direct and indirect pathways in the female sample. Conclusions: This study shows the role of trauma exposure, substance use, aggression, and social functioning in determining mental health outcomes among refugee youth and how CMD symptoms are differently manifested across genders in this population.
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Affiliation(s)
- Hyojin Im
- Virginia Commonwealth University, Richmond, USA
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11
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Ermansons G. ‘If there was no
jaad
’: poetics of khat and remembering the future in a London Somali community. JOURNAL OF THE ROYAL ANTHROPOLOGICAL INSTITUTE 2022. [DOI: 10.1111/1467-9655.13825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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12
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Edwards B, Atkins N. Exploring the association between khat use and psychiatric symptoms: a systematic review. BMJ Open 2022; 12:e061865. [PMID: 35879018 PMCID: PMC9328084 DOI: 10.1136/bmjopen-2022-061865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
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.
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Affiliation(s)
- Betsy Edwards
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Naomi Atkins
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
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13
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Nakajima M, Jama S, Noor N, Albee R, Ali SA, Ali SF, Pratt R, al’Absi M. Attitudes Toward Mental Health, Addiction, and Biobehavioral Research in the Somali Community in Minnesota, United States. Int J Ment Health Addict 2022. [DOI: 10.1007/s11469-022-00851-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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14
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Beksinska A, Nyariki E, Kabuti R, Kungu M, Babu H, Shah P, Nyabuto C, Okumu M, Mahero A, Ngurukiri P, Jama Z, Irungu E, Adhiambo W, Muthoga P, Kaul R, Seeley J, Weiss HA, Kimani J, Beattie TS. Harmful Alcohol and Drug Use Is Associated with Syndemic Risk Factors among Female Sex Workers in Nairobi, Kenya. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:7294. [PMID: 35742558 PMCID: PMC9223659 DOI: 10.3390/ijerph19127294] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 05/31/2022] [Accepted: 06/08/2022] [Indexed: 02/04/2023]
Abstract
Background: Female Sex Workers (FSWs) are at high risk of harmful alcohol and other drug use. We use quantitative data to describe the prevalence of alcohol and other drug use and identify associated occupational and socio-economic risk factors, and aim to elucidate patterns of alcohol and drug use through information drawn from qualitative data. Methods: Maisha Fiti was a mixed-method longitudinal study conducted in 2019 among a random sample of FSWs in Nairobi, Kenya. We used baseline date from the behavioural−biological survey, which included the WHO Alcohol, Smoking and Substance Involvement Screening Test that measures harmful alcohol and other drug use in the past three months (moderate/high risk score: >11 for alcohol; >4 for other drugs). In-depth interviews were conducted with 40 randomly selected FSWs. Findings: Of 1003 participants, 29.9% (95%CI 27.0−32.6%) reported harmful (moderate/high risk) alcohol use, 21.5% harmful amphetamine use (95%CI 19.1−24.1%) and 16.9% harmful cannabis use (95%CI 14.7−19.2%). Quantitative analysis found that harmful alcohol, cannabis and amphetamine use were associated with differing risk factors including higher Adverse Childhood Experience (ACE) scores, street homelessness, food insecurity (recent hunger), recent violence from clients, reduced condom use, depression/anxiety and police arrest. Qualitative interviews found that childhood neglect and violence were drivers of entry into sex work and alcohol use, and that alcohol and cannabis helped women cope with sex work. Conclusions: There is a need for individual and structural-level interventions, tailored for FSWs, to address harmful alcohol and other drug use and associated syndemic risks including ACEs, violence and sexual risk behaviours.
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Affiliation(s)
- Alicja Beksinska
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London WC1H 9SH, UK; (P.S.); (J.S.); (T.S.B.)
| | - Emily Nyariki
- Partners for Health and Development in Africa (PHDA), UNITID, College of Health Sciences, Nairobi P.O. Box 30197-00100, Kenya; (E.N.); (R.K.); (M.K.); (H.B.); (C.N.); (M.O.); (A.M.); (P.N.); (Z.J.); (E.I.); (W.A.); (P.M.); (J.K.)
| | - Rhoda Kabuti
- Partners for Health and Development in Africa (PHDA), UNITID, College of Health Sciences, Nairobi P.O. Box 30197-00100, Kenya; (E.N.); (R.K.); (M.K.); (H.B.); (C.N.); (M.O.); (A.M.); (P.N.); (Z.J.); (E.I.); (W.A.); (P.M.); (J.K.)
| | - Mary Kungu
- Partners for Health and Development in Africa (PHDA), UNITID, College of Health Sciences, Nairobi P.O. Box 30197-00100, Kenya; (E.N.); (R.K.); (M.K.); (H.B.); (C.N.); (M.O.); (A.M.); (P.N.); (Z.J.); (E.I.); (W.A.); (P.M.); (J.K.)
| | - Hellen Babu
- Partners for Health and Development in Africa (PHDA), UNITID, College of Health Sciences, Nairobi P.O. Box 30197-00100, Kenya; (E.N.); (R.K.); (M.K.); (H.B.); (C.N.); (M.O.); (A.M.); (P.N.); (Z.J.); (E.I.); (W.A.); (P.M.); (J.K.)
| | - Pooja Shah
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London WC1H 9SH, UK; (P.S.); (J.S.); (T.S.B.)
| | - The Maisha Fiti Study Champions
- Partners for Health and Development in Africa (PHDA), UNITID, College of Health Sciences, Nairobi P.O. Box 30197-00100, Kenya; (E.N.); (R.K.); (M.K.); (H.B.); (C.N.); (M.O.); (A.M.); (P.N.); (Z.J.); (E.I.); (W.A.); (P.M.); (J.K.)
| | - Chrispo Nyabuto
- Partners for Health and Development in Africa (PHDA), UNITID, College of Health Sciences, Nairobi P.O. Box 30197-00100, Kenya; (E.N.); (R.K.); (M.K.); (H.B.); (C.N.); (M.O.); (A.M.); (P.N.); (Z.J.); (E.I.); (W.A.); (P.M.); (J.K.)
| | - Monica Okumu
- Partners for Health and Development in Africa (PHDA), UNITID, College of Health Sciences, Nairobi P.O. Box 30197-00100, Kenya; (E.N.); (R.K.); (M.K.); (H.B.); (C.N.); (M.O.); (A.M.); (P.N.); (Z.J.); (E.I.); (W.A.); (P.M.); (J.K.)
| | - Anne Mahero
- Partners for Health and Development in Africa (PHDA), UNITID, College of Health Sciences, Nairobi P.O. Box 30197-00100, Kenya; (E.N.); (R.K.); (M.K.); (H.B.); (C.N.); (M.O.); (A.M.); (P.N.); (Z.J.); (E.I.); (W.A.); (P.M.); (J.K.)
| | - Pauline Ngurukiri
- Partners for Health and Development in Africa (PHDA), UNITID, College of Health Sciences, Nairobi P.O. Box 30197-00100, Kenya; (E.N.); (R.K.); (M.K.); (H.B.); (C.N.); (M.O.); (A.M.); (P.N.); (Z.J.); (E.I.); (W.A.); (P.M.); (J.K.)
| | - Zaina Jama
- Partners for Health and Development in Africa (PHDA), UNITID, College of Health Sciences, Nairobi P.O. Box 30197-00100, Kenya; (E.N.); (R.K.); (M.K.); (H.B.); (C.N.); (M.O.); (A.M.); (P.N.); (Z.J.); (E.I.); (W.A.); (P.M.); (J.K.)
| | - Erastus Irungu
- Partners for Health and Development in Africa (PHDA), UNITID, College of Health Sciences, Nairobi P.O. Box 30197-00100, Kenya; (E.N.); (R.K.); (M.K.); (H.B.); (C.N.); (M.O.); (A.M.); (P.N.); (Z.J.); (E.I.); (W.A.); (P.M.); (J.K.)
| | - Wendy Adhiambo
- Partners for Health and Development in Africa (PHDA), UNITID, College of Health Sciences, Nairobi P.O. Box 30197-00100, Kenya; (E.N.); (R.K.); (M.K.); (H.B.); (C.N.); (M.O.); (A.M.); (P.N.); (Z.J.); (E.I.); (W.A.); (P.M.); (J.K.)
| | - Peter Muthoga
- Partners for Health and Development in Africa (PHDA), UNITID, College of Health Sciences, Nairobi P.O. Box 30197-00100, Kenya; (E.N.); (R.K.); (M.K.); (H.B.); (C.N.); (M.O.); (A.M.); (P.N.); (Z.J.); (E.I.); (W.A.); (P.M.); (J.K.)
| | - Rupert Kaul
- Department of Medicine, University of Toronto, Toronto, ON M5S 1A1, Canada;
| | - Janet Seeley
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London WC1H 9SH, UK; (P.S.); (J.S.); (T.S.B.)
| | - Helen A. Weiss
- MRC International Statistics & Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK;
| | - Joshua Kimani
- Partners for Health and Development in Africa (PHDA), UNITID, College of Health Sciences, Nairobi P.O. Box 30197-00100, Kenya; (E.N.); (R.K.); (M.K.); (H.B.); (C.N.); (M.O.); (A.M.); (P.N.); (Z.J.); (E.I.); (W.A.); (P.M.); (J.K.)
| | - Tara S. Beattie
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London WC1H 9SH, UK; (P.S.); (J.S.); (T.S.B.)
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“It hurts so much to live for nothing”: Lived Experiences of Substance Use Among Refugee Youth in Displacement. Int J Ment Health Addict 2022. [DOI: 10.1007/s11469-020-00472-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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16
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Mohamed AA, Lantz K, Ahmed YA, Osman A, Nur MA, Nur O, Njeru JW, Sia IG, Wieland ML. An Assessment of Health Priorities Among a Community Sample of Somali Adults. J Immigr Minor Health 2022; 24:455-460. [PMID: 33740189 PMCID: PMC7975235 DOI: 10.1007/s10903-021-01166-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2021] [Indexed: 11/30/2022]
Abstract
Somali immigrants are one of the largest African populations to resettle in the United States since 1990. There is an emerging literature base of disease-specific studies among Somali immigrants. However, we are aware of no studies on the health priorities for Somalis from the community's perspective. Somali adults in Minnesota completed a survey conducted by a community-based participatory research partnership on individual and community health priorities. Data were reported as counts and frequencies. 646 participants completed the survey. The most important health issues for individuals and their families were health behaviors (22.7%), diabetes (18.2%), and hypertension (14.4%), while those of the community were diabetes (22.5%), hypertension (18.8%) and weight (15.9%). This study found a significant overlap of health priorities among Somali individuals and their families compared to the community. These health priorities underscore the need to focus on non-communicable diseases among Somali immigrants.
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Affiliation(s)
- Ahmed A Mohamed
- Department of Medicine, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA.
| | - Kiley Lantz
- Department of Medicine, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA
| | - Yahye A Ahmed
- Department of Medicine, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA
| | - Ahmed Osman
- Intercultural Mutual Assistance Association, Rochester, MN, USA
| | - Mohamud A Nur
- Department of Medicine, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA
| | - Omar Nur
- Somali American Social Service Association, Rochester, MN, USA
| | - Jane W Njeru
- Department of Medicine, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA
| | - Irene G Sia
- Department of Medicine, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA
| | - Mark L Wieland
- Department of Medicine, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA
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Hakami T. Clinical characteristics and treatment outcomes of patients with newly diagnosed schizophrenia: A 4-year single-center experience in Saudi Arabia. Neuropsychopharmacol Rep 2022; 42:199-204. [PMID: 35318823 PMCID: PMC9216363 DOI: 10.1002/npr2.12247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 02/25/2022] [Accepted: 03/02/2022] [Indexed: 11/10/2022] Open
Abstract
Objectives Understanding how local “psychiatry clinic” characteristics shape research findings is essential for applying research into evolution, outcomes, and costs of mental health. However, a paucity of “psychiatry clinics” details has implications for the interpretation and utilization of this research. Methods We reviewed data of 746 patients with new‐onset schizophrenia on antipsychotic monotherapy seen over four years in an “adult psychiatry clinic” at Jazan Health, Saudi Arabia. Protocol‐driven interviews and investigations were recorded prospectively and extracted from the medical records for the study. Summary statistics and logistic regression analyses were applied to assess patients' characteristics and outcomes. Results The median patient age was 32 (IQR 27‐39) years. Of patients, 589 (79.0%) were male, and 679 (91.0%) had a low‐level education. The median follow‐up duration was 51.4 (IQR 27.4‐96.3) weeks. The most used initial antipsychotic drugs were olanzapine (48.8%), haloperidol (13.9%), and aripiprazole (11.3%). The numbers of patients who retained the initial drug at 24 and 52 weeks were 539 (72.3%) and 325 (43.6%), respectively. The initial drug was changed in 246 (33.0%) patients. The median time to initial drug change was 43.9 (IQR 14.8‐85.0) weeks. The logistic regression demonstrated that male sex (P < 0.004), young adult age group (P < 0.027), predominant positive symptoms (P < 0.021), treatment with haloperidol (P < 0.024), and khat use (P < 0.006) were significant factors for drug change. Conclusions This clinical records study demonstrated substantial individual variations in characteristics and in responding to initial antipsychotic medication. Insight into these findings will facilitate the planning for comprehensive research programs.
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Affiliation(s)
- Tahir Hakami
- The Department of Clinical Pharmacology, The Faculty of Medicine, Jazan University, Jazan, Saudi Arabia
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18
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Ye S, Hu J, Liu Z, Liang M. Progress and Research Trends on Catha edulis (Vahl) Endl. ( Catha edulis): A Review and Bibliometric Analysis. Front Pharmacol 2021; 12:705376. [PMID: 34867319 PMCID: PMC8632648 DOI: 10.3389/fphar.2021.705376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 10/06/2021] [Indexed: 11/13/2022] Open
Abstract
Catha edulis (Vahl) Endl., known as Catha edulis or Khat is a traditional and regional plant for chewing, smoking and drinking, that has posed a worldwide public health problem due to its recent emerging abused consumption. In the face of the massive use of Catha edulis, we reviewed related publications to analyze the progress and research trends through bibliometric methods. After screening, a total of 514 scientific publications published from 1997 to 2020 were included by systematic retrieval from the Web of Science (WoS) database. According to further scientometric analysis, the annual number of publications output kept rising in most of the years. Ethiopia and the United States of America (USA) have been devoting significant contributions to the field. Though the research emphasis had been the chemical composition and pharmacological and toxicological effects for several years, the hot spots were transferred; the mechanism investigations of Catha edulis have been the focus in recent years, which might be continued in the future. Furthermore, co-operations of multi-disciplinary researchers are needed to minimize abuse harms and maximize the medicinal benefits of Catha edulis to human beings.
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Affiliation(s)
- Shuang Ye
- Department of Forensic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jin Hu
- Department of Otolaryngology-Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zilong Liu
- Department of Forensic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Man Liang
- Department of Forensic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Rojanaworarit C, Claudio L, Howteerakul N, Siramahamongkol A, Ngernthong P, Kongtip P, Woskie S. Hydrogeogenic fluoride in groundwater and dental fluorosis in Thai agrarian communities: a prevalence survey and case-control study. BMC Oral Health 2021; 21:545. [PMID: 34686164 PMCID: PMC8532340 DOI: 10.1186/s12903-021-01902-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 10/12/2021] [Indexed: 11/19/2022] Open
Abstract
Background Dental fluorosis can be a disease of social inequity in access to safe drinking water. This dental public health issue becomes prominent in socially disadvantaged agrarian communities in fluoride endemic areas where the standard irrigation system is unavailable and groundwater containing natural fluoride is the major drinking water source. This study aimed to determine the prevalence and severity of dental fluorosis in children and to evaluate its association with fluoride in groundwater in the aforementioned setting in Thailand. Methods A cross-sectional survey of 289 children in Nakhon Pathom Province was conducted in 2015. Children with very mild to severe fluorosis were regarded as ‘cases’ while their counterparts were ‘controls’ for a subsequent case–control study. Records of fluoride concentrations in groundwater used for household supply corresponding to resident and number of years by age of each child during 2008–2015 were retrieved. Other exposure variables were measured using a questionnaire. Prevalence ratio (PR), a measure indicating the relative effect of different levels of fluoride on dental fluorosis, was obtained from Poisson regression with robust standard error. Result There were 157 children with very mild to moderate dental fluorosis (54.3% prevalence). The univariable analysis revealed that the prevalence of dental fluorosis among children with fluoride concentrations in water sources of 0.7–1.49 (index category 1) and ≥ 1.5 ppm (index category 2) was 1.62 (95% CI; 0.78, 3.34) and 2.75 (95% CI; 1.42, 5.31) times the prevalence among those with fluoride < 0.7 ppm (referent category). After adjusting for all covariates, the adjusted prevalence ratios in both index categories were 1.64 (95% CI; 0.24, 11.24) and 2.85 (95% CI; 0.44, 18.52) which were close to their corresponding crude estimates. Since the magnitude of confounding, measured by (PRcrude–PRadjusted)/PRadjusted, were less than 10% for both index categories; this indicated the limited confounding effect of all covariates. Conclusions In fluoride endemic areas, groundwater containing natural fluoride utilized for household consumption resulted in high dental fluorosis prevalence, particularly in the groundwater with fluoride concentrations of ≥ 1.5 ppm. Supplementary Information The online version contains supplementary material available at 10.1186/s12903-021-01902-8.
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Affiliation(s)
- Chanapong Rojanaworarit
- Department of Health Professions, School of Health Professions and Human Services, Hofstra University, Hempstead, NY, USA.
| | - Luz Claudio
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Nopporn Howteerakul
- Department of Epidemiology, Faculty of Public Health, Mahidol University, Bangkok, Thailand
| | | | | | - Pornpimol Kongtip
- Department of Occupational Health and Safety, Faculty of Public Health, Mahidol University, Bangkok, Thailand
| | - Susan Woskie
- Department of Public Health, University of Massachusetts Lowell, Lowell, MA, USA
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Leminie AA, Dugul TT, Eshetu EM, Melka DS. Catha edulis Forsk and Ascorbic Acid Effects on Hematological Indices in Rat. J Blood Med 2021; 12:855-862. [PMID: 34602828 PMCID: PMC8480916 DOI: 10.2147/jbm.s328703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 09/15/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The prevalence of chewing Catha edulis Forsk and the use of ascorbic acid is increasing from time to time. Their subchronic effects on hematological indices are not well examined. The present study was aimed to investigate their subchronic effects on hematological indices in rats. MATERIALS AND METHODS A total of 36 adult (7-8 weeks) wild-type rats weighing between 213 and 229g were used in this study. They received Catha edulis Forsk extract (Ce) (100 milligrams/kilogram, 200 milligram/kilogram and 300 milligram/kilogram b.w), Catha edulis Forsk juice (2.5 mL/kg), ascorbic acid (AA 200 milligram/kilogram), and 2% tween 80 in distilled water (T80W- v/v) for twelve weeks. Hematological indices were measured with Sysmex KX-21. Data were analyzed by SPSS version 21.0 and Microsoft Excel. RESULTS Neutrocytes (p < 0.01), lymphocytes (p < 0.05), plateletcrit (p < 0.05), average size of platelets (p < 0.05), platelet size variability (p < 0.01), platelet-large cell ratio (p < 0.05) and neutrocytes/lymphocytes ratio (p < 0.001) were significantly greater, while hemoglobin concentration per red blood cell (p < 0.05) and hemoglobin concentration per volume of red blood cells were significantly reduced (p < 0.05) in rats received khat. The red cell distribution width (p < 0.05), platelet size variability (p < 0.05) and platelet-large cell ratio (p < 0.01) were significantly greater in rats received ascorbic acid. CONCLUSION Crude Catha edulis Forsk extract and juice changed some hematological indices and increased platelet activities. The platelet activity was also increased by ascorbic acid. The mechanisms for these changes need to be investigated.
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Affiliation(s)
- Abebaye Aragaw Leminie
- Department of Physiology, Addis Ababa University, College of Health Sciences, Addis Ababa, Ethiopia
| | - Tesfaye Tolessa Dugul
- Department of Physiology, Addis Ababa University, College of Health Sciences, Addis Ababa, Ethiopia
| | - Eyasu Makonnen Eshetu
- Department of Pharmacology, Addis Ababa University, College of Health Sciences, Addis Ababa, Ethiopia
| | - Daniel Seyifu Melka
- Department of Biochemistry, Addis Ababa University, College of Health Sciences, Addis Ababa, Ethiopia
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21
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Hassen MT, Soboka M, Widmann M, Keller L, Zeller AC, Büchele N, Barnewitz E, Yitayih Y, Schiller S, Senger J, Adorjan K, Odenwald M. Khat Use Patterns, Associated Features, and Psychological Problems in a Khat-Treatment-Seeking Student Sample of Jimma University, Southwestern Ethiopia. Front Public Health 2021; 9:645980. [PMID: 34490174 PMCID: PMC8416611 DOI: 10.3389/fpubh.2021.645980] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 07/27/2021] [Indexed: 11/25/2022] Open
Abstract
Background: Khat (Catha edulis) is a traditionally used substance in African and Arab countries that contains the amphetamine-like alkaloid cathinone. Khat use among Ethiopian students is a growing concern. This study aims to describe khat use, psychological problems, and motivation to change and to determine associated factors of khat use among students from Jimma University seeking psychological assistance. Methods: In a cross-sectional study, a sample of 717 students from Jimma University, southwestern Ethiopia, who seek assistance to reduce khat use were recruited. The study used Amharic and Afaan Oromoo language versions of common psychological instruments and employed them as part of a comprehensive tablet computer-delivered self-report assessment battery, comprising the SRQ-20, the PCL-5, the LEC-5, the AUDIT, and the SOCRATES-khat. In addition, socio-demographic, economic variables, and functioning problems due to severe mental disorders were assessed. The analysis relied on the data of the 575 included participants and used clinical cut-off values to describe this treatment-seeking sample and hierarchical regression models to determine variables associated with khat use. Results: The sample showed high khat use in the past month (M = 31.55 bundles, SD = 28.53, on M = 15.11 days, SD = 8.54); 17.0% showed highly problematic use. The sample was extremely burdened with comorbid psychiatric problems: 21.6% reported functioning problems due to past mental disorders, 60.2% scored above the cut-off for current common mental disorders, 37.9% screened positive for PTSD, and 47.1% reported hazardous alcohol use. Small to medium intercorrelations between variables were detected, and in hierarchical regression models, higher motivation to change khat use was associated with higher use of the substance. Conclusions: This study clearly shows the need to develop research instruments, screening methods, and assistance services for khat-using students at Jimma University. Study participants' high mental health burden shows the need for targeted intervention programs that go beyond brief interventions for khat use. Furthermore, the study highlights challenges for implementing such services: the barriers to utilization for females and khat users without comorbid mental health problems.
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Affiliation(s)
| | - Matiwos Soboka
- Department of Psychiatry, Medical Faculty, Jimma University, Jimma, Ethiopia
| | - Marina Widmann
- Department of Psychology, University of Konstanz, Konstanz, Germany.,Vivo International e.V., Konstanz, Germany
| | - Lucas Keller
- Department of Psychology, University of Konstanz, Konstanz, Germany
| | - Anja C Zeller
- Department of Psychology, University of Konstanz, Konstanz, Germany.,Vivo International e.V., Konstanz, Germany
| | - Natascha Büchele
- Department of Psychology, University of Konstanz, Konstanz, Germany
| | - Eva Barnewitz
- Department of Psychology, University of Konstanz, Konstanz, Germany.,Vivo International e.V., Konstanz, Germany
| | - Yimenu Yitayih
- Department of Psychiatry, Medical Faculty, Jimma University, Jimma, Ethiopia
| | - Sabine Schiller
- Department of Psychology, University of Konstanz, Konstanz, Germany
| | - Jael Senger
- Department of Psychology, University of Konstanz, Konstanz, Germany
| | - Kristina Adorjan
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilians-Universität Munich, Munich, Germany.,Institute of Psychiatric Phenomics and Genomics, University Hospital, Ludwig-Maximilians-Universität Munich, Munich, Germany.,Center for International Health (CIHLMU), Ludwig-Maximilians-Universität Munich, Munich, Germany
| | - Michael Odenwald
- Department of Psychology, University of Konstanz, Konstanz, Germany.,Vivo International e.V., Konstanz, Germany
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22
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Greene MC, Yangchen T, Lehner T, Sullivan PF, Pato CN, McIntosh A, Walters J, Gouveia LC, Msefula CL, Fumo W, Sheikh TL, Stockton MA, Wainberg ML, Weissman MM. The epidemiology of psychiatric disorders in Africa: a scoping review. Lancet Psychiatry 2021; 8:717-731. [PMID: 34115983 PMCID: PMC9113063 DOI: 10.1016/s2215-0366(21)00009-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 01/07/2021] [Accepted: 01/08/2021] [Indexed: 01/12/2023]
Abstract
This scoping review of population-based epidemiological studies was done to provide background information on the prevalences and distribution of psychiatric disorders in Africa for calls to broaden diversity in psychiatric genetic studies. We searched PubMed, EMBASE, and Web of Science to retrieve relevant literature in English, French, and Portuguese from Jan 1, 1984, to Aug 18, 2020. In 36 studies from 12 African countries, the lifetime prevalence ranged from 3·3% to 9·8% for mood disorders, from 5·7% to 15·8% for anxiety disorders, from 3·7% to 13·3% for substance use disorders, and from 1·0% to 4·4% for psychotic disorders. Although the prevalence of mood and anxiety disorders appears to be lower than that observed in research outside the continent, we identified similar distributions by gender, although not by age or urbanicity. This review reveals gaps in epidemiological research on psychiatric disorders and opportunities to leverage existing epidemiological and genetic research within Africa to advance our understanding of psychiatric disorders. Studies that are methodologically comparable but diverse in geographical context are needed to advance psychiatric epidemiology and provide a foundation for understanding environmental risk in genetic studies of diverse populations globally.
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Affiliation(s)
- M Claire Greene
- Program on Forced Migration and Health, Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Tenzin Yangchen
- Division of Translational Epidemiology, Department of Psychiatry, New York State Psychiatric Institute, New York, NY, USA
| | - Thomas Lehner
- New York Genome Center, New York, NY, USA; Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, New York, NY, USA
| | - Patrick F Sullivan
- Center for Psychiatric Genomics, Department of Genetics, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Carlos N Pato
- Institute for Genomic Health, SUNY Downstate, Health Science University, Brooklyn, NY, USA
| | - Andrew McIntosh
- Division of Psychiatry, University of Edinburgh, Royal Edinburgh Hospital, Edinburgh, UK
| | - James Walters
- MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | - Lidia C Gouveia
- Department of Mental Health, Ministry of Health-Mozambique, Maputo, Mozambique
| | - Chisomo L Msefula
- Pathology Department, College of Medicine, University of Malawi, Chichiri, Blantyre, Malawi
| | - Wilza Fumo
- Department of Mental Health, Ministry of Health-Mozambique, Maputo, Mozambique
| | - Taiwo L Sheikh
- Department of Psychiatry, College of Medical Sciences, Ahmadu Bello University, Zaria, Nigeria
| | - Melissa A Stockton
- Division of Translational Epidemiology, Department of Psychiatry, New York State Psychiatric Institute, New York, NY, USA; Columbia University Vagelos College of Physicians and Surgeons; New York State Psychiatric Institute, New York, NY, USA
| | - Milton L Wainberg
- Division of Translational Epidemiology, Department of Psychiatry, New York State Psychiatric Institute, New York, NY, USA; Columbia University Vagelos College of Physicians and Surgeons; New York State Psychiatric Institute, New York, NY, USA
| | - Myrna M Weissman
- Division of Translational Epidemiology, Department of Psychiatry, New York State Psychiatric Institute, New York, NY, USA; Columbia University Vagelos College of Physicians and Surgeons; New York State Psychiatric Institute, New York, NY, USA.
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23
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Soares J, Costa VM, Bastos MDL, Carvalho F, Capela JP. An updated review on synthetic cathinones. Arch Toxicol 2021; 95:2895-2940. [PMID: 34100120 DOI: 10.1007/s00204-021-03083-3] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 05/17/2021] [Indexed: 02/06/2023]
Abstract
Cathinone, the main psychoactive compound found in the plant Catha edulis Forsk. (khat), is a β-keto analogue of amphetamine, sharing not only the phenethylamine structure, but also the amphetamine-like stimulant effects. Synthetic cathinones are derivatives of the naturally occurring cathinone that largely entered the recreational drug market at the end of 2000s. The former "legal status", impressive marketing strategies and their commercial availability, either in the so-called "smartshops" or via the Internet, prompted their large spread, contributing to their increasing popularity in the following years. As their popularity increased, the risks posed for public health became clear, with several reports of intoxications and deaths involving these substances appearing both in the social media and scientific literature. The regulatory measures introduced thereafter to halt these trending drugs of abuse have proved to be of low impact, as a continuous emergence of new non-controlled derivatives keep appearing to replace those prohibited. Users resort to synthetic cathinones due to their psychostimulant properties but are often unaware of the dangers they may incur when using these substances. Therefore, studies aimed at unveiling the pharmacological and toxicological properties of these substances are imperative, as they will provide increased expertise to the clinicians that face this problem on a daily basis. The present work provides a comprehensive review on history and legal status, chemistry, pharmacokinetics, pharmacodynamics, adverse effects and lethality in humans, as well as on the current knowledge of the neurotoxic mechanisms of synthetic cathinones.
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Affiliation(s)
- Jorge Soares
- UCIBIO, REQUIMTE, Laboratory of Toxicology, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, Porto, Portugal.
| | - Vera Marisa Costa
- UCIBIO, REQUIMTE, Laboratory of Toxicology, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, Porto, Portugal
| | - Maria de Lourdes Bastos
- UCIBIO, REQUIMTE, Laboratory of Toxicology, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, Porto, Portugal
| | - Félix Carvalho
- UCIBIO, REQUIMTE, Laboratory of Toxicology, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, Porto, Portugal
| | - João Paulo Capela
- UCIBIO, REQUIMTE, Laboratory of Toxicology, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, Porto, Portugal.
- FP-ENAS (Fernando Pessoa Energy, Environment and Health Research Unit), CEBIMED (Biomedical Research Centre), Faculty of Health Sciences, University of Fernando Pessoa, Porto, Portugal.
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24
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Abou-Elhamd AS, Kalamegam G, Ahmed F, Assidi M, Alrefaei AF, Pushparaj PN, Abu-Elmagd M. Unraveling the Catha edulis Extract Effects on the Cellular and Molecular Signaling in SKOV3 Cells. Front Pharmacol 2021; 12:666885. [PMID: 34040530 PMCID: PMC8141790 DOI: 10.3389/fphar.2021.666885] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 03/30/2021] [Indexed: 12/29/2022] Open
Abstract
Khat (Catha edulis (Vahl) Endl.) is an evergreen flowering shrub used as a stimulant in many regions worldwide including East Africa, the Arabian Peninsula, Europe, and the United States. Chewing leaves of khat induces excitement and euphoria, which are primarily attributed to two major constituents, cathinone and cathine. Khat also contains other important constituents such as cathedulins. A considerable number of studies reported side effects induced by the khat extracts to both embryos and adults. These include teratogenicity and developmental retardation, oral cancer and ulcers, high blood pressure, and myocardial infarction. So far, little attention has been paid to the effects of khat extracts on the molecular signaling interactions. We aimed in this study to investigate this through evaluating the effects of khat extracts on SKOV3, a human ovarian adenocarcinoma cell line. We show, by in vitro assays, that khat induces several cellular defects including reduced cell size, cell membrane damage, and apoptosis. At high khat extract concentrations, the cell metabolic activity, cell cycle, and cellular proliferation were affected. RT-qPCR analysis showed an increase in the gene expression of the apoptotic marker BAX, the tumor suppressor p53, and the inflammatory cytokine IL-6. Protein expression analysis by immunostaining showed downregulation of β-catenin, E-cadherin, and Ki-67 and upregulation of FZD8 and SPRY2, suggesting that Wnt and FGF signaling were implicated. SwissTargetPrediction in silico analysis showed that khat constituents cathine, cathinone, catheduline K2, and catheduline E5 bind to family A G-protein-coupled receptor, cause many neurological diseases and disorders such as Alzheimer's, schizophrenia, depression, and anxiety, and induce many ovarian cancer-related diseases. The analysis also showed that important signaling pathways such as CREB, Wnt, FGF, IL-6, and ERK/MAPK, and that of the endometrial cancer, and cell cycle were implicated. Upstream regulators of cathine and cathinone were found to potentially target several molecules including interleukin-8, MMP2, PLAU, and micro-RNAs. In conclusion, khat induces significant cellular and molecular changes that could potentially cause a wide range of serious diseases and syndromes. Such an impact could have a heavy burden on the health care system in the countries where khat is consumed.
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Affiliation(s)
- Alaa Sayed Abou-Elhamd
- Department of Anatomy and Histology, Faculty of Veterinary Medicine, Assiut University, Assiut, Egypt.,Department of Respiratory Therapy, College of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia
| | - Gauthaman Kalamegam
- Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia.,Center of Excellence in Genomic Medicine Research, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Farid Ahmed
- Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia.,Center of Excellence in Genomic Medicine Research, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Mourad Assidi
- Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia.,Center of Excellence in Genomic Medicine Research, King Abdulaziz University, Jeddah, Saudi Arabia
| | | | - Peter Natesan Pushparaj
- Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia.,Center of Excellence in Genomic Medicine Research, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Muhammad Abu-Elmagd
- Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia.,Center of Excellence in Genomic Medicine Research, King Abdulaziz University, Jeddah, Saudi Arabia
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25
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Pesticide Residue Analysis of Khat Leaves and Health Risks among Khat Chewers in the Amhara Region, Northwestern Ethiopia. JOURNAL OF ENVIRONMENTAL AND PUBLIC HEALTH 2021; 2021:4680573. [PMID: 33833811 PMCID: PMC8016596 DOI: 10.1155/2021/4680573] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 03/09/2021] [Accepted: 03/15/2021] [Indexed: 11/18/2022]
Abstract
Introduction Farmers use a large number of pesticides to increase the productivity of Khat cultivation. Since Khat is consumed by many Ethiopians as a habit, there may be a significant concentration of pesticide residues in Khat leaves which result in adverse effects among the exposed population. Excess use of pesticides in Khat causes cancer, genotoxicity, and endocrine disturbances. The current study aimed to determine the concentration of selected pesticide residues on Khat leaves samples and to estimate the possible health risk on consumers. Methods Thirty Khat samples were collected from Khat cultivators in the Amhara region, Ethiopia. Pesticide residue extraction and cleanup of Khat samples were performed using the QuEChERS method. Data were also collected about personal variables and Khat consumption habits. The pesticide concentrations were determined and the health risks were estimated. Results Profenofos, dimethoate, and chlorpyrifos were detected in 6 (20%), 24 (80%), and 28 (93.3%) Khat samples, respectively. However, diazinon was detected in two samples and endosulfan I was not detected. The average concentration of chlorpyrifos, dimethoate, profenofos, and diazinon in Khat samples was 75.39 ± 20.26, 130 ± 48.94, 242.45 ± 119.79, and 81.5 ± 21.0 μg/kg, respectively. The HQ for diazinon was greater than 1 which shows the chronic health risks associated with intake of diazinon among Khat chewers. The acute health risks associated with intake of profenofos and diazinon were minimal. Discussion. Pesticide residue exposure is a risk factor for cardiac complications, reduction in antioxidant defense system, and developing neurological symptoms. All the pesticides were higher than the European Union Maximum Residue Levels (EU-MRL). Diazinon has the potential to cause higher chronic health risks. Chronic Khat chewers in the region may face potential health risks from pesticide residues. Awareness creation among people in the study area is necessary to avoid the adverse health effects of pesticide residues.
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26
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Adorjan K, Schulze TG, Budde M, Heilbronner U, Tessema F, Mekonnen Z, Falkai P. [Neurogenetics of schizophrenia: findings from studies based on data sharing and global partnerships]. DER NERVENARZT 2021; 92:199-207. [PMID: 33439287 DOI: 10.1007/s00115-020-01052-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/07/2020] [Indexed: 11/25/2022]
Abstract
Schizophrenic psychoses are the result of a multifactorial process in which not only environmental influences but also genetic factors play an important role. These factors are based on a complex mode of inheritance that involves a large number of genetic variants. In the last three decades, biological psychiatric research has focused closely on molecular genetic aspects of the hereditary basis of schizophrenic psychoses. In particular, international consortia are combining cohorts from individual researchers, creating continuously increasing sample sizes and thus increased statistical power. As part of the Psychiatric Genomics Consortium (PGC), genome-wide association studies with tens of thousands of patients and controls have for the first time found robustly replicable markers for schizophrenic psychoses. Through intensive phenotyping, first approaches to a transdiagnostic clinical reclassification of severe mental illnesses have been established in the longitudinal PsyCourse study of the UMG Göttingen and the LMU Munich, allowing new biologically validated disease subgroups with prognostic value to be identified. For the first time environmental factors could even be examined in an African cohort that contribute to the development of the psychosis. In the coming years, the enormous technical progress in the area of genomic high-throughput technologies (next-generation sequencing) is expected to provide new knowledge not only about the influence of frequently occurring single nucleotide polymorphisms but also about rare variants. For the successful use of this technological revolution an exchange of data between research groups is essential.
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Affiliation(s)
- K Adorjan
- Klinik für Psychiatrie und Psychotherapie, LMU Klinikum, Nussbaumstr. 7, 80336, München, Deutschland.
- Institute of Psychiatric Phenomics and Genomics (IPPG), University Hospital, LMU Munich, München, Deutschland.
- Center for International Health (CIH), LMU Munich, München, Deutschland.
| | - T G Schulze
- Institute of Psychiatric Phenomics and Genomics (IPPG), University Hospital, LMU Munich, München, Deutschland
| | - M Budde
- Institute of Psychiatric Phenomics and Genomics (IPPG), University Hospital, LMU Munich, München, Deutschland
| | - U Heilbronner
- Institute of Psychiatric Phenomics and Genomics (IPPG), University Hospital, LMU Munich, München, Deutschland
| | - F Tessema
- Department of Epidemiology, Faculty of Public Health, Gilgel Gibe Filed Research Center, Jimma University, Jimma, Äthiopien
| | - Z Mekonnen
- School of Medical Laboratory Sciences, Institute of Health, Jimma University, Jimma, Äthiopien
| | - P Falkai
- Klinik für Psychiatrie und Psychotherapie, LMU Klinikum, Nussbaumstr. 7, 80336, München, Deutschland
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27
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Nakajima M, al'Absi M. Influences of Fasting on Stress Response and Withdrawal Symptoms in Habitual Khat Users. Eur Addict Res 2021; 27:49-57. [PMID: 33202407 PMCID: PMC7785579 DOI: 10.1159/000506737] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 02/21/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Fasting changes mood and physiological states. Substance use, such as khat use, is prohibited during fasting during Ramadan, a traditional practice among Muslims. Habitual khat use is associated with increased negative affect and altered psychobiological stress responses. Effects of fasting on stress responses, mood, and withdrawal symptoms among khat users have not been examined. METHODS In this study, 80 individuals completed an ambulatory monitoring period and a laboratory assessment session. Participants who completed the study while fasting during Ramadan were matched by gender and khat use status with participants who completed the study while not fasting. This resulted in 40 participants (12 females and 28 males; 25 khat users and 15 nonusers) in each fasting group. Cardiovascular (blood pressure and heart rate) and subjective measures were collected throughout the laboratory stress session. A mental arithmetic challenge was used to induce stress. In addition, self-reported mood and withdrawal measures were collected multiple times during the ambulatory assessment. RESULTS Khat users reported greater negative affect than nonusers. Results from the ambulatory study indicated that withdrawal symptoms were lower during evening hours in the fasting group than in the no-fasting group. Stress-related changes in positive and negative affects were flattened in the fasting group relative to the no-fasting group. Khat users reported reduced blood pressure responses relative to nonusers. CONCLUSION These preliminary results demonstrate that fasting is associated with reduced negative affect and withdrawal symptoms in khat users. Khat use was related to blunted blood pressure stress responses, but this was independent of fasting. Due to the small sample size, these results should be replicated with a large sample and comprehensive stress tasks.
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Affiliation(s)
- Motohiro Nakajima
- Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School, Duluth, Minnesota, USA,
| | - Mustafa al'Absi
- Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School, Duluth, Minnesota, USA
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28
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Malasevskaia I, Al-Awadhi AA, Mohammed L. Tea in the Morning and Khat Afternoon: Health Threats Due to Khat Chewing. Cureus 2020; 12:e12363. [PMID: 33527046 PMCID: PMC7842844 DOI: 10.7759/cureus.12363] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2020] [Indexed: 12/13/2022] Open
Abstract
Khat or qat (Catha edulis) is a flowering plant with an Arabic name قات, regularly named as qāt, also is known by various descriptive names, such as Abyssinian tea, Somali tea, Arabian tea, Miraa, Jima, and Kafta in its endemic regions of the Horn of Africa and the Arabian Peninsula. Fresh leaves and tops of khat are chewed or dried and consumed as a tea to attain a state of euphoria and excitement; it also has appetite-reducing effects. Traditionally, khat is used as a socializing habit in Yemen and is also widely cultivated because of its high income. However, in recent years the plant has been reported in England, Wales, Rome, Amsterdam, Canada, Israel, Australia, New Zealand, and the United States. Although it is believed that khat is a relatively low-risk drug, it's associated with an increased risk for various medical complications, including dental and oropharyngeal disease, gastrointestinal, cardiovascular, neuropsychiatric, obstetric, and even can be the cause of cancer. Our goal in this review article is to revise and determine the relationship between chewing khat and its health issues. Additionally, we tried to determine the mechanism involved in health hazards due to consuming the khat.
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Affiliation(s)
- Iana Malasevskaia
- Obstetrics and Gynecology, Obstetrics/Gynecology Private Clinic, Sana'a, YEM
- Obstetrics and Gynecology, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | | | - Lubna Mohammed
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
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29
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Kassim S. The impact of protective psychosocial factors on khat chewing among male medical and dental future health-care providers in Yemen. J Dent Sci 2020; 15:451-456. [PMID: 33505616 PMCID: PMC7816017 DOI: 10.1016/j.jds.2019.08.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 08/15/2019] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND/PURPOSE Khat chewing, a green leaf with amphetamine effects, is a public health concern. Yet, it is prevalent and evident, in the khat belt region, among male students in health faculties. This study aimed to examine whether psychosocial factors have a protective impact on khat chewing among male dental and medical students. MATERIALS AND METHODS A cross-sectional study included all students (1457) in second year and above at a Yemeni university. A self-administered questionnaire was used to obtain sociodemographic data and to assess students' psychosocial characteristics namely, depression, resilience and social support (perceived or received [living with or away from family]). Data analysis included descriptive statistics and multivariable logistic regression modelling. RESULTS The response rate was 61% (male = 334, female = 547) and the responding students' mean ± SD age was 22.95 ± 1.56 years. Of the respondents 185 (21% [95%CI = 18%-24%]) were current khat chewers (7 [4%] females and 178 [96%] males respectively). In the adjusted model, among male students living away from family was significantly associated with khat chewing (adjusted odd ratio [AOR] = 3.15,95%CI = 1.96-5.07, p < 0.001) and perceived social support was inversely significantly related to khat chewing (AOR = 0.98; 95%CI = 0.96-1.00; p = 0.019). CONCLUSION Within the limitation of the study of a single institute, social support whether received (living with family) or perceived appeared to be a protective factor from khat chewing among male medical and dental students. Social support should be enhanced and targeted to discourage khat chewing during the preparation of this future health care force.
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Affiliation(s)
- Saba Kassim
- Department of Preventive Dental Sciences, Taibah University Dental College & Hospital, Naif Ibn Abdulaziz Road, Al-Madinah Al-Munawwarah, 42353, Saudi Arabia
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Tesfaye E, Krahl W, Alemayehu S. Khat induced psychotic disorder: case report. Subst Abuse Treat Prev Policy 2020; 15:27. [PMID: 32245382 PMCID: PMC7119018 DOI: 10.1186/s13011-020-00268-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Accepted: 03/23/2020] [Indexed: 01/22/2023] Open
Abstract
Background Khat (Catha edulis) is a stimulant leaf khat comes from a tree which grows in countries bordering the Red Sea which are along the east coast of Africa and in west Asia. The psycho- active component within these leaves is cathinone. In Ethiopia, Khat is chewed routinely by users for its euphoric effects and as a recreational drug, and chewing khat has an important role as well in both traditional and religious ceremonies. In this case report, we describe the case of a 33-year-old male patient presented with psychotic symptoms after prolonged and heavy khat chewing. Case presentation Findings on psychiatric evaluation encompassing detailed history and mental state examination suggest khat induced psychotic disorder severe in full remission; khat use disorder, severe, in early remission. Conclusions This case demonstrates that the use of excess khat above 2 bundles for prolonged duration can manifest with psychotic episodes. A small number of case studies had supported a causal relationship between heavy khat use and psychosis or psychotic symptoms. There have been suicidal attempts and homicidal acts in those who used excess and prolonged use of khat. In our case, the improvement attributed to stopping the khat rather than taking antipsychotics. Therefore, we recommend an urgent social intervention to change the community norms regarding Khat use through psycho-education in media, institution and in person about the relationship between khat use and mental illness. In addition, we suggest the role of religious institutions on the management of khat use not be overlooked. Finally, this study makes a powerful argument for researchers and policy makers to do clinical study to settle a causal effect relation of khat on mental health.
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Mihretu A, Fekadu A, Habtamu K, Nhunzvi C, Norton S, Teferra S. Exploring the concept of problematic khat use in the Gurage community, South Central Ethiopia: a qualitative study. BMJ Open 2020; 10:e037907. [PMID: 33046468 PMCID: PMC7552831 DOI: 10.1136/bmjopen-2020-037907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE This study aimed to explore how problematic khat use is characterised in the Gurage community in South Central Ethiopia. DESIGN Qualitative study. SETTING Gurage community in South Central Ethiopia. PARTICIPANTS We conducted indepth interviews with 14 khat users and 5 non-khat users, and three focus group discussions with khat users. METHODS All participants were selected purposively based on their exposure to khat or khat use. We used an interview guide to explore the perceptions of participants about khat use and problematic khat use. We analysed the data thematically using OpenCode V.4.03 software. We used iterative data collection and analysis, triangulation of methods, and respondent validation to ensure scientific rigour. FINDINGS We identified three major themes: sociocultural khat use, khat suse (khat addiction) and negative consequences of khat use. Sociocultural khat use included a broad range of contexts and patterns, including use of khat for functional, social, cultural and religious reasons. Khat addiction was mainly explained in terms of associated khat withdrawal experiences, including harara/craving and inability to quit. We identified mental health, sexual life, physical health, social and financial negative consequences of khat use. The local idiom jezba was used to label a subgroup of individuals with khat suse (khat addiction). CONCLUSION The study has identified what constitutes normative and problematic khat use in the Gurage community in South Central Ethiopia. Problematic khat use is a broad concept which includes frequency, reasons, contexts, negative consequences and addiction to khat. Insights generated can be used to inform future studies on the development of tools to measure problematic khat use.
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Affiliation(s)
- Awoke Mihretu
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Department of Social Sciences, College of Natural and Social Sciences, Addis Ababa Science and Technology University, Addis Ababa, Ethiopia
| | - Abebaw Fekadu
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Kassahun Habtamu
- School of Psychology, College of Education and Behavioral Studies, Addis Ababa University, Addis Ababa, Ethiopia
| | - Clement Nhunzvi
- Department of Rehabilitation, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Sam Norton
- Psychology Department, Institute of Psychiatry, King's College London, London, UK
| | - Solomon Teferra
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
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Abstract
Background: Georgia is leading one of the world’s first hepatitis C (HCV) elimination programs alongside interventions to combat a HIV epidemic concentrated among high-risk groups. Although progress has been substantial, neither strategy accounts for the nearly 150,000 internally displaced persons residing in collective centers (CC-IDPs) who are susceptible to deeply integrated risk environments that could promote infection. Achieving dedicated goals for HCV elimination and HIV suppression requires a clear understanding of the risks facing CC-IDPs. Objectives: This literature review aims to consolidate what is known about the socio-economic and physical/mental health status of IDPs living in collective centers in Georgia, and to assess their vulnerability to HIV and HCV in light of local and global epidemiological trends. Methods: Sources were compiled from journal publications, reports by government ministries and transnational organizations, and the Integrated Household Survey database (2009–2018; updated annually by the National Statistics Office of Georgia) through manual searches in PUBMED, Google Scholar and Search, ProQuest, and digital repositories of government offices. Findings: Reports indicate that CC-IDPs are more susceptible to poverty, poor living conditions, mental illness, disability, substance use, and in some cases infectious disease; although, the correlation is not always present and subject to variability. These factors were linked to increased transmission and acquisition of HIV/HCV in both displacement and non-displacement contexts abroad. The geographic concentration of HIV/HCV in areas with greater clusters of CC-IDPs, and shared characteristics with local high-risk groups, indicate the possibility of inordinate transmission among CC-IDPs in Georgia. Conclusions: The disproportionate prevalence of psychosocial and clinical harms among CC-IDPs testifies to the serious potential of a greater burden of HIV and hepatitis C. Going forward, targeted research is needed to inform interventions and clarify the health status of CC-IDPs in Georgia.
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Sharma V, Papaefstathiou S, Tewolde S, Amobi A, Deyessa N, Relyea B, Scott J. Khat use and intimate partner violence in a refugee population: a qualitative study in Dollo Ado, Ethiopia. BMC Public Health 2020; 20:670. [PMID: 32398069 PMCID: PMC7216323 DOI: 10.1186/s12889-020-08837-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 05/03/2020] [Indexed: 11/12/2022] Open
Abstract
Background Intimate partner violence (IPV) is the most common form of gender-based violence affecting women and girls worldwide and is exacerbated in humanitarian crises. There is evidence that substance use is associated with male perpetration of IPV. Consumption of khat —a plant containing amphetamines traditionally chewed in the horn of Africa and legal in some countries including Ethiopia—may increase risk of IPV toward women. This analysis aimed to assess perceptions on khat use among Somali refugees in Dollo Ado, Ethiopia and its association with IPV to inform an IPV and HIV prevention intervention. Methods A descriptive qualitative study comprising individual interviews (n = 30) and focus group discussions (n = 10) was conducted in Bokolmayo refugee camp in Dollo Ado, Ethiopia in October 2016. A purposive sample of male and female Somali refugees, religious and community leaders, and service providers (n = 110 individuals; 44 women and 66 men) was included. Trained interviewers from the camp conducted the interviews and discussion, which were audio recorded, transcribed and translated. A content analysis was conducted on coded excerpts from the transcripts to identify factors contributing to IPV toward women, including khat use. Results Participants reported that displacement has resulted in limited employment opportunities for men and increased idle time, which has led to increased khat use among men as a coping mechanism. Male khat use was perceived to be associated with perpetration of physical and sexual IPV through several mechanisms including increased anger and aggression and enhanced sexual desire. Khat use also contributes to intra-marital conflict as money allocated for a household is spent on purchasing khat. Conclusion Khat use should be addressed as part of IPV prevention programming in this context. Livelihood interventions and other strategies to improve economic conditions, should be explored in collaboration with refugee camp authorities and community leaders as a potential avenue to mitigate the impact of khat use on women and families.
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Affiliation(s)
- Vandana Sharma
- Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA.
| | | | - Samuel Tewolde
- Women and Health Alliance International Addis Ababa, Ethiopia and Paris, Paris, France
| | - Adaugo Amobi
- Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, USA
| | - Negussie Deyessa
- Addis Ababa University School of Public Health, Addis Ababa, Ethiopia
| | - Bridget Relyea
- Women and Health Alliance International Addis Ababa, Ethiopia and Paris, Paris, France
| | - Jennifer Scott
- Women and Health Alliance International Addis Ababa, Ethiopia and Paris, Paris, France.,Harvard Medical School, Boston, USA.,Beth Israel Deaconess Medical Center, Boston, USA
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Alemu WG, Zeleke TA, Takele WW, Mekonnen SS. Prevalence and risk factors for khat use among youth students in Ethiopia: systematic review and meta-analysis, 2018. Ann Gen Psychiatry 2020; 19:16. [PMID: 32165908 PMCID: PMC7061479 DOI: 10.1186/s12991-020-00265-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 02/21/2020] [Indexed: 01/11/2023] Open
Abstract
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.
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Affiliation(s)
- Wondale Getinet Alemu
- Department of Psychiatry, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Tadele Amare Zeleke
- Department of Psychiatry, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Wubet Worku Takele
- Department of Community Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Shegaye Shumet Mekonnen
- Department of Psychiatry, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
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Abstract
Khat, a psychostimulant cultivated and commonly used in Eastern Africa and the Arabian penin-sula, has a longstanding history of use embedded within the cultures of these regions. Due to changing patterns of use and the adverse effects of dependence, khat has become a growing pub- lic health concern. Despite extensive findings regarding the detrimental psychiatric, physical, and social consequences of khat dependence, research on interventions in this area is glaringly sparse. The present paper aims to summarize the consequences of chronic khat use and review existing research on interventions.
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Affiliation(s)
- Sagal Ahmed
- Department of Psychology, Fordham University, Bronx, New York, USA
| | - Haruka Minami
- Department of Psychology, Fordham University, Bronx, New York, USA
| | - Andrew Rasmussen
- Department of Psychology, Fordham University, Bronx, New York, USA
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Abstract
Substance abuse is one of the most threatening public health issues of contemporary society. Traditionally, it was considered as an urban problem despite its spread touching every corner of the globe including the pastoral communities. Against this background, the current study intended to examine the prevalence of substance abuse among the Afar pastoral community of Dubti district primarily to estimate the prevalence of the most frequently abused substances. To this end, a cross-sectional survey design that used a combination of both quantitative and qualitative methods was employed. The study pointed out Khat, Cigarette, and Mada'a (a type of locally produced flavored tobacco) as the most commonly abused substances. Besides, it highlighted that concomitant use of substances (poly-drug use behavior) is a rapidly growing problem. Addressing such problems needs a consensus-based approach that recognizes the contribution of both abusers and non-users of substances together.
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Berihu BA, Asfeha GG, Welderufael AL, Debeb YG, Zelelow YB, Beyene HA. Toxic effect of khat ( Catha edulis) on memory: Systematic review and meta-analysis. J Neurosci Rural Pract 2019; 8:30-37. [PMID: 28149078 PMCID: PMC5225718 DOI: 10.4103/0976-3147.193524] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND People use khat (Catha edulis) for its pleasant stimulant effect of physical activity, consciousness, motor, and mental functions. Although there are reports assessing the effect of khat on memory, there was no study based on formal systematic review and meta-analysis. OBJECTIVE We have therefore conducted this meta-analysis to determine the level of evidence for the effect of khat (C. edulis Forsk) on memory discrepancy. METHODS MEDLINE, Cochrane Library, PubMed, Academic Search Complete, SPORTDiscus, ScienceDirect, Scopus, Web of Science, and Google Scholar were searched to retrieve the papers for this review. Keywords utilized across database search were khat, cat, chat, long-term memory, short-term memory, memory deficit, randomized control trial, and cross-sectional survey. The search was limited to studies in humans and rodents; published in English language. RESULT Finding of various studies included in our meta-analysis showed that the effect of acute, and subchronic exposure to khat showed that short-term memory appears to be affected depending on the duration of exposure. However, does not have any effect on long-term memory. CONCLUSION Although a number of studies regarding the current topic are limited, the evidenced showed that khat (C. edulis) induced memory discrepancy.
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Affiliation(s)
- Birhane Alem Berihu
- Department of Anatomy and Histology, Institute of Bio-Medical Sciences, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Gebrekidan Gebregzabher Asfeha
- Department of Biochemistry and Molecular Biology, Institute of Bio-Medical Sciences, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Abadi Leul Welderufael
- Department of Pediatrics and Gynecology, School of Medicine, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Yared Godefa Debeb
- Department of Physiology, Institute of Bio-Medical Sciences, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Yibrah Berhe Zelelow
- Department of Pediatrics and Gynecology, School of Medicine, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Hafte Assefa Beyene
- Department of Anatomy and Histology, Institute of Bio-Medical Sciences, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
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Khat use and psychotic symptoms in a rural Khat growing population in Kenya: a household survey. BMC Psychiatry 2019; 19:137. [PMID: 31064338 PMCID: PMC6505064 DOI: 10.1186/s12888-019-2118-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 04/15/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Khat is an amphetamine like psychostimulant chewed by over 10 million people globally. Khat use is thought to increase the risk of psychosis among its chewers. The evidence around this however remains inconclusive stemming from the scanty number of studies in this area and small study sample sizes. We undertook a large household survey to determine the association between psychotic symptoms and khat chewing in a rural khat growing and chewing population in Kenya. METHODS For this cross-sectional household survey, we randomly selected 831 participants aged 10 years and above residing in the Eastern region of Kenya. We used the psychosis screening questionnaire (PSQ) to collect information on psychotic symptoms and a researcher designed sociodemographic and clinical questionnaire to collect information on its risk factors. We used descriptive analysis to describe the burden of khat chewing and other substance use as well as rates and types of psychotic symptoms. Using a univariate and multivariate analyses with 95% confidence interval, we estimated the association between khat chewing and specific psychotic symptoms. RESULTS The prevalence of current khat chewing in the region was at 36.8% (n = 306) with a male gender predominance (54.8%). At least one psychotic symptom was reported by 16.8% (n = 168) of the study population. Interestingly, psychotic symptoms in general were significantly prevalent in women (19.5%) compared to men (13.6%) (p = 0.023). Khat chewing was significantly associated with reported strange experiences (p = 0.024) and hallucinations (p = 0.0017), the two predominantly reported psychotic symptoms. In multivariate analysis controlling for age, gender, alcohol use and cigarette smoking, there was a positive association of strange experiences (OR, 2.45; 95%CI, 1.13-5.34) and hallucination (OR, 2.08; 95% C.I, 1.06-4.08) with khat chewing. Of note was the high concurrent polysubstance use among khat chewers specifically alcohol use (78.4%) and cigarette smoking (64.5%). CONCLUSIONS Psychotic symptoms were significantly elevated in khat users in this population. Future prospective studies examining dose effect and age of first use may establish causality.
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Attention Deficit Hyperactivity Disorder (ADHD) among Children Aged 6 to 17 Years Old Living in Girja District, Rural Ethiopia. Behav Neurol 2019; 2019:1753580. [PMID: 31110594 PMCID: PMC6487158 DOI: 10.1155/2019/1753580] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 02/05/2019] [Indexed: 11/18/2022] Open
Abstract
Objective Attention deficit hyperactivity disorder (ADHD) is one of the most common behavioral disorders in childhood with long-term outcomes. Although ADHD is the most studied behavioral disorders of childhood in developed countries, few studies have been conducted in Ethiopia. The aim of this study was to determine the prevalence of ADHD in rural parts of Ethiopia. Method A cross-sectional study was conducted from May to June 2015 among children aged 6 to 17 years living in rural areas. A multistage cluster sampling technique was used to select 1302 participants. The Disruptive Behavior Disorder Rating Scale was used to collect the data. Logistic regression analysis was used to see statistically significant variables. Result The prevalence rate of attention deficit hyperactivity disorder (ADHD) among children was 7.3%. Being male (Adjusted Odds Ratio (AOR) = 1.81, 95% CI: (1.13, 2.91)); living with a single parent (AOR = 5.0, 95% CI: (2.35, 10.65)); child birth order/rank (AOR = 2.35, 95% CI: (1.30, 4.25)); and low family socioeconomic status (AOR = 2.43, 95% CI: (1.29, 4.59)) were significantly associated with ADHD. Conclusion The ADHD prevalence rate was found to be similar with global reports. Prevention and early management of maternal complications is important to reduce the prevalence of ADHD among children.
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Adorjan K, Mulugeta S, Odenwald M, Ndetei DM, Osman AH, Hautzinger M, Wolf S, Othman M, Kizilhan JI, Pogarell O, Schulze TG. [Psychiatric care of refugees in Africa and the Middle East : Challenges and solutions]. DER NERVENARZT 2019. [PMID: 28646248 DOI: 10.1007/s00115-017-0365-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Violence, flight, famine, and natural disasters as well as the absence of a psychosocial healthcare system are major psychological burdens for refugees. The level of provision of mental healthcare is particularly low in developing countries. Internally displaced people and refugees place high demands on the healthcare system because they often suffer from psychiatric disorders, such as depression, posttraumatic stress disorder, and substance use disorders. We present first initiatives to improve psychiatric care in refugee camps in Ethiopia, Kenya, and Sudan. Moreover, we provide first insights into a project based in Northern Iraq and Germany aimed at the treatment of people who were severely traumatized by the terror regime of the so-called Islamic State (IS).
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Affiliation(s)
- K Adorjan
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Klinikum der Universität München, LMU, Nußbaumstraße 7, 80336, München, Deutschland. .,Institut für Psychiatrische Phänomik und Genomik, Klinikum der Universität München, LMU, München, Deutschland. .,Center for International Health, Ludwig Maximilians Universität München, München, Deutschland.
| | - S Mulugeta
- International Medical Corps, Mental Health and Psychosocial Support Program, (UNHCR and ARRA) Dolo Ado Refugee Camps, Dolo Ado, Äthiopien
| | - M Odenwald
- Klinische Psychologie und klinische Neuropsychologie, Universität Konstanz, Konstanz, Deutschland.,vivo international e. V., Konstanz, Deutschland
| | - D M Ndetei
- Department of Psychiatry, University of Nairobi and Africa Mental Health Foundation, Nairobi, Kenia
| | - A H Osman
- Department of Psychiatry, University of Khartoum, Khartoum, Sudan
| | - M Hautzinger
- Klinische Psychologie und Psychotherapie, Universität Tübingen, Tübingen, Deutschland
| | - S Wolf
- Klinische Psychologie und Psychotherapie, Universität Tübingen, Tübingen, Deutschland
| | - M Othman
- Institut für Psychotherapie und Psychotraumatologie, Universität Dohuk, Dohuk, Nordirak, Irak
| | - J I Kizilhan
- Institut für Psychotherapie und Psychotraumatologie, Universität Dohuk, Dohuk, Nordirak, Irak.,Fakultät für Sozialwesen, Duale Hochschule Baden Württemberg, Villingen-Schwenningen, Deutschland
| | - O Pogarell
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Klinikum der Universität München, LMU, Nußbaumstraße 7, 80336, München, Deutschland.,Klinik und Poliklinik für Psychiatrie und Psychotherapie, Migrationsambulanz, Klinikum der Universität München, LMU, München, Deutschland
| | - T G Schulze
- Institut für Psychiatrische Phänomik und Genomik, Klinikum der Universität München, LMU, München, Deutschland
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Mohan S, Shaheen E, El-Amir Y, Khadashi H, Ncibi S, Farasani A, Abdelwahab S. Catha edulis-induced skeletal muscle toxicity in experimental rats via regulation of rhabdomyolysis biomarkers. Pharmacogn Mag 2019. [DOI: 10.4103/pm.pm_142_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Alemu WG, Amare Zeleke T, Takele WW. Prevalence and associated factors of khat chewing among students in Ethiopia: a protocol for systematic review and meta-analysis. BMJ Open 2018; 8:e021157. [PMID: 30478104 PMCID: PMC6254418 DOI: 10.1136/bmjopen-2017-021157] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
INTRODUCTION These days, in Ethiopia, khat chewing is one of the widely spreading public health problems affecting the most productive segment of the population. The health implications of khat chewing among students are strongly linked with poor mental, physical and social performances. However, the national magnitude of khat chewing and the associated factors among Ethiopian students are unknown. Therefore, this systematic review and meta-analysis will answer the national prevalence of khat chewing and the associated factors among students in Ethiopia. METHODS Published primary relevant articles will be accessed using various databases, such as Medline, PubMed, EMBASE and Scopus. Other electronic search engines, for instance, Google Scholar and Google, will be used. Furthermore, additional studies will be collected by communicating with the author(s) and following the references of relevant articles. To select eligible studies, the Joanna Briggs Institute quality appraisal checklist will be used. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist will be followed to keep the scientific rigour of the study. Heterogeneity between studies will be examined through forest plot and I2 heterogeneity tests. To identify influential studies, sensitivity analysis will be done. For substantial heterogeneity (I2>50%), the DerSimonian and Laird random-effects model will be employed. Subgroup analyses will be conducted using the random-effect model. Moreover, small studies' publication bias will be checked by funnel plots and objectively by Egger's regression test. If in case Egger's test was found to be statistically significant (p<0.05), trim and fill (Duval and Tweedie) analysis will be performed. The presence of association will be declared using p≤0.05 and OR with corresponding 95% CI. ETHICS AND DISSEMINATION Since the intention of the study is to describe earlier primary studies qualitatively and pool the results of those articles, ethical clearance will not be a concern. The results of the study will be published in a reputable peer-reviewed journal and presented at different scientific research conferences. It will also be disseminated to academic as well as other concerned institutions. PROSPERO REGISTRATION NUMBER CRD-42,017,081,886.
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Affiliation(s)
- Wondale Getinet Alemu
- Department of Psychiatry, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tadele Amare Zeleke
- Department of Psychiatry, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Wubet Worku Takele
- Department of Community Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Bahhawi TA, Albasheer OB, Makeen AM, Arishi AM, Hakami OM, Maashi SM, Al-Khairat HK, Alganmy OM, Sahal YA, Sharif AA, Mahfouz MS. Depression, anxiety, and stress and their association with khat use: a cross-sectional study among Jazan University students, Saudi Arabia. Neuropsychiatr Dis Treat 2018; 14:2755-2761. [PMID: 30425493 PMCID: PMC6200432 DOI: 10.2147/ndt.s182744] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Depression, anxiety, and stress levels are considered important indicators for mental health. Khat chewing habit is prevalent among all segments of Jazan population in Saudi Arabia. Few studies have been conducted to evaluate depression, anxiety, and stress among Jazan University students, and information about the correlation between khat use and these disorders is scarce. Thus, this study aims to evaluate the prevalence of depression, anxiety, and stress and their correlation with khat chewing and other risk factors among Jazan University students. METHODS A cross-sectional study was conducted on 642 students from Jazan University. Multistage sampling was used, with probability proportional to size-sampling technique. The Depression, Anxiety, and Stress Scale 21 questionnaire was used to collect the data, which were analyzed using SPSS Version 20.0 software. RESULTS Moderate depression was prevalent among 53.6% of the sample, anxiety was found among 65.7%, while 34.3% of the students suffered from stress. Female gender was strongly associated with higher mean scores for symptoms of depression, anxiety, and stress, with P-values <0.05 for all. Moreover, anxiety symptoms scores were statistically associated with grade point average and caffeine consumption. Khat use was statistically associated with higher mean scores of anxiety among males and a higher mean score of depression and anxiety among females. CONCLUSION The results indicate a high rate of symptoms of depression, anxiety, and stress among Jazan University students. Khat use was associated with anxiety, and a higher rate of symptoms of depression, anxiety, and stress was indicated among female students. Therefore, strategy for the prevention and management of depression, anxiety, and stress is highly recommended to minimize the impact of these serious disorders.
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Affiliation(s)
- Tariq Al Bahhawi
- Department of Community Medicine, Faculty of Medicine, Jazan University, Jazan, Kingdom of Saudi Arabia,
| | - Osama B Albasheer
- Department of Community Medicine, Faculty of Medicine, Jazan University, Jazan, Kingdom of Saudi Arabia,
| | - Anwar M Makeen
- Department of Community Medicine, Faculty of Medicine, Jazan University, Jazan, Kingdom of Saudi Arabia,
| | | | | | | | | | | | - Yasir Adnan Sahal
- Faculty of Medicine, Jazan University, Jazan, Kingdom of Saudi Arabia
| | | | - Mohamed Salih Mahfouz
- Department of Community Medicine, Faculty of Medicine, Jazan University, Jazan, Kingdom of Saudi Arabia,
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Orlien SMS, Sandven I, Berhe NB, Ismael NY, Ahmed TA, Stene-Johansen K, Gundersen SG, Morgan MY, Johannessen A. Khat chewing increases the risk for developing chronic liver disease: A hospital-based case-control study. Hepatology 2018; 68:248-257. [PMID: 29369368 DOI: 10.1002/hep.29809] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 12/15/2017] [Accepted: 01/18/2018] [Indexed: 12/20/2022]
Abstract
UNLABELLED The chewing of the leaves of Catha edulis (khat) has been implicated in the development of liver disease, but no controlled observations have been undertaken. The objective of the present study was to determine whether khat chewing is associated with development of chronic liver disease (CLD). A case-control study was conducted at two public hospitals in Harar, Ethiopia, between April 2015 and April 2016. A consecutive sample of 150 adult hospital attendees with CLD were included as cases, and 300 adult hospital attendees without clinical or laboratory evidence of CLD were included as controls. Khat consumption was quantified in "khat years"; 1 khat year was defined as daily use of 200 g of fresh khat for 1 year. A logistic regression model was used to control for confounders. There was a significant association between chewing khat and the risk for developing CLD (crude odds ratio, 2.64; 95% confidence interval [CI], 1.56-4.58). In men, this risk, following adjustment for age, alcohol use, and chronic hepatitis B/C infection, increased with increasing khat exposure; thus, compared to never users the adjusted odds ratios were for low khat exposure 3.58 (95% CI 1.05-12.21), moderate khat exposure 5.90 (95% CI 1.79-19.44), and high khat exposure 13.03 (95% CI 3.61-47.02). The findings were robust in a post hoc sensitivity analysis in which individuals with identifiable risk factors for CLD were excluded. CONCLUSION A significant association was observed between chewing khat and the risk for developing CLD, and in men the association was strong and dose-dependent, suggesting a causal relationship; as the prevalence of khat chewing is increasing worldwide, these findings have major public health implications. (Hepatology 2018;68:248-257).
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Affiliation(s)
| | - Irene Sandven
- Oslo Centre of Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
| | - Nega Belay Berhe
- Regional Centre for Imported and Tropical Diseases, Oslo University Hospital, Oslo, Norway.,Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Nejib Yusuf Ismael
- Department of Internal Medicine, Hiwot Fana Specialized University Hospital, Harar, Ethiopia.,School of Medicine, Haramaya University College of Health and Medical Sciences, Harar, Ethiopia
| | - Tekabe Abdosh Ahmed
- School of Medicine, Haramaya University College of Health and Medical Sciences, Harar, Ethiopia.,Department of Internal Medicine, Jugal Hospital, Harar, Ethiopia
| | | | - Svein Gunnar Gundersen
- Research Unit, Sørlandet Hospital HF, Kristiansand, Norway.,Department of Global Development and Planning, University of Agder, Kristiansand, Norway
| | - Marsha Yvonne Morgan
- UCL Institute for Liver & Digestive Health, University College London, London, UK
| | - Asgeir Johannessen
- Regional Centre for Imported and Tropical Diseases, Oslo University Hospital, Oslo, Norway
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45
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Nakajima M, Hoffman R, Alsameai A, Khalil NS, al'Absi M. Development of the Khat Knowledge, Attitudes and Perception Scale. Drug Alcohol Rev 2018; 37:802-809. [PMID: 29931779 DOI: 10.1111/dar.12828] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 05/09/2018] [Accepted: 05/22/2018] [Indexed: 01/28/2023]
Abstract
INTRODUCTION AND AIMS Khat (Catha edulis) is a stimulant plant widely used in East Africa and the Arabian Peninsula. Tobacco is often co-used with khat and its use has expanded to other parts of the world. Chronic khat use is associated with negative health consequences. There is a lack of research to develop a tool to assess attitudes toward khat use. This study aimed to develop a brief tool to assess attitude and perception related to khat (i.e. the Khat Knowledge, Attitudes and Perception Scale). DESIGN AND METHODS Four-hundred and three participants in Yemen (151 concurrent users of khat and tobacco, 141 khat-only users and 92 non-users of khat and tobacco) were asked about knowledge and attitudes related to khat. A principle component analysis with Promax rotation, Scree-plot and Cronbach's α coefficients was performed to examine psychometric properties of the Khat Knowledge, Attitudes and Perception Scale. RESULTS Principle component analysis revealed five factors: negative beliefs, positive beliefs, idleness, weight control and family issues. Internal consistency of items in negative beliefs, positive beliefs, idleness, weight control and family issues were 0.88, 0.62, 0.62, 0.72 and 0.53, respectively. Greater negative beliefs was inversely correlated with positive beliefs but positively associated with idleness, weight control and family issues. Concurrent users and khat-only users had lower scores on negative beliefs than non-users. Concurrent users had higher scores on positive beliefs than khat-only and non-users. DISCUSSION AND CONCLUSIONS These results provide initial support of the usefulness of the Khat Knowledge, Attitudes and Perception Scale.
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Affiliation(s)
- Motohiro Nakajima
- Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School, Duluth, USA
| | - Richard Hoffman
- Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School, Duluth, USA
| | - Abed Alsameai
- Department of Linguistics, Taiz University, Taiz, Yemen
| | | | - Mustafa al'Absi
- Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School, Duluth, USA
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46
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Sheriff RJS, Reggi M, Mohamed A, Haibe F, Whitwell S, Jenkins R. Mental health in Somalia. Int Psychiatry 2018. [DOI: 10.1192/s1749367600002757] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Somalia, in the Horn of Africa, suffers violence, political instability and high mortality rates. The recent major drought in Somalia led to what was termed the worst humanitarian disaster in the world. In July 2011 it was reported that nearly 60 000 people had entered into Kenya from Somalia already that year, including 1300 new arrivals every day to the Dadaab refugee camp, described as ‘the largest, most congested and one of the most remote refugee camps in the world’ (see http://www.unhcr.org/4e204b1e9.html). The drought along with mass migration into such poor conditions are likely to have significant short- and long-term mental health consequences for the populations involved.
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47
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Muthumbi E, Lowe BS, Muyodi C, Getambu E, Gleeson F, Scott JAG. Risk factors for community-acquired pneumonia among adults in Kenya: a case-control study. Pneumonia (Nathan) 2017; 9:17. [PMID: 29209590 PMCID: PMC5702239 DOI: 10.1186/s41479-017-0041-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 10/17/2017] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Pneumonia is a leading cause of morbidity and mortality among adults worldwide; however, the risk factors for community-acquired pneumonia in Africa are not well characterized. METHODS The authors recruited 281 cases of community-acquired pneumonia and 1202 hospital controls among patients aged ≥15 years who attended Kilifi District Hospital/Coast Provincial General Hospital in Kenya between 1994 and 6. Cases were admissions with an acute illness with ≥2 respiratory signs and evidence of consolidation on a chest radiograph. Controls were patients without signs of pneumonia, frequency matched by age, sex and hospital. Risk factors related to socio-demographic factors, drug use, clinical history, contact patterns and exposures to indoor air pollution were investigated by questionnaire, anthropometric measurements and laboratory assays. Associations were evaluated using a hierarchical logistic regression model. RESULTS Pneumonia was associated with human immunodeficiency virus (HIV) infection (Odds Ratio [OR] 2.06, 95% CI 1.44-3.08), anemia (OR 1.91, 1.31-2.74), splenomegaly (OR 2.04, 95% CI 1.14-3.41), recent history of pneumonia (OR 4.65, 95% CI 1.66-12.5), history of pneumonia >2 years previously (OR 17.13, 95% CI 5.01-60.26), coryza in the 2 weeks preceding hospitalization (OR 2.09, 95% CI 1.44-3.03), current smoking (2.19, 95% CI 1.39-3.70), use of khat (OR 3.44, 95% CI 1.72-7.15), use of snuff (OR 2.67, 95% CI 1.35-5.49) and contact with several animal species. Presence of a Bacillus Calmette-Guerin (BCG) scar was associated with protection (OR 0.51, 95% CI 0.32-0.82). The risk factors varied significantly by sex. CONCLUSION Pneumonia in Kenyan adults was associated with global risk factors, such as HIV and smoking, but also with specific local factors like drug use and contact with animals. Intervention strategies should account for sex-specific differences in risk factors.
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Affiliation(s)
- Esther Muthumbi
- KEMRI-Wellcome Trust Research Programme, Center for Geographical Medicine Research Coast, Kilifi, Kenya
| | - Brett S. Lowe
- KEMRI-Wellcome Trust Research Programme, Center for Geographical Medicine Research Coast, Kilifi, Kenya
- Centre for Tropical Medicine & Global Health, University of Oxford, Oxford, UK
| | | | | | - Fergus Gleeson
- Department of Radiology, Churchill Hospital, University of Oxford, Oxford, UK
| | - J. Anthony G. Scott
- KEMRI-Wellcome Trust Research Programme, Center for Geographical Medicine Research Coast, Kilifi, Kenya
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
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Mihretu A, Teferra S, Fekadu A. Problematic khat use as a possible risk factor for harmful use of other psychoactive substances: a mixed method study in Ethiopia. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2017; 12:47. [PMID: 29096691 PMCID: PMC5668959 DOI: 10.1186/s13011-017-0132-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 10/24/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND Substance use disorders along with neuropsychiatric disorders contributed about 14% of the global burden of disease. Harmful alcohol use, is a known contributor for many harms (accidents, suicide, violence, and complication of other psychiatric and medical disorders). In the Western countries, alcohol and nicotine are gateway drugs to cannabis use, and cannabis use is a risk factor for other illicit drugs such as cocaine and heroin. Khat use is another psychoactive substance which is common in East African and Arabian Peninsula. But there is a knowledge gap regarding the position of khat use or problematic khat use in sequential progression of different psychoactive substances. Therefore, we aimed to understand and investigate the relationship of problematic khat use and other psychoactive substances in Ethiopia. METHODS Exploratory mixed methods study was employed. Quantitative cross sectional survey was done among 102 khat users, and 4 focus group discussions and 11 in-depth interviews were conducted to understand the pathways between khat use and other psychoactive substances use in 2014. Non random sampling (purposive and snowballing) was employed for both quantitative and qualitative studies. Khat users from khat cafeterias, shops, and from other open markets of khat in Addis Ababa were invited to participate. RESULT Currently significant majorities of khat users (86.3%) used at least one other psychoactive substance after they started khat use. The prevalence of harmful drinking was 53.9% among khat users. Problematic khat use was a significant predictor of harmful drinking (p < 0.05). About one from ten respondents engaged to risky sexual behavior pushed by the effect of khat after chewing. CONCLUSION The proportion of psychoactive substances use especially harmful drinking among khat users was observed higher compared to other cross sectional surveys conducted among general population. In Ethiopia, intervention and policy on harmful alcohol use could consider problematic khat use as one possible risky factor. A rigorous methodology which could test gateway hypothesis of problematic psychoactive substances use could be warranted.
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Affiliation(s)
- Awoke Mihretu
- Department of Clinical Psychology, Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia. .,Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
| | - Solomon Teferra
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.,Harvard T.H. Chan School of public Health, Boston, USA
| | - Abebaw Fekadu
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.,Department of Psychological Medicine, Centre for Affective Disorders, King's College London, London, UK
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Widmann M, Apondi B, Musau A, Warsame AH, Isse M, Mutiso V, Veltrup C, Ndetei D, Odenwald M. Comorbid psychopathology and everyday functioning in a brief intervention study to reduce khat use among Somalis living in Kenya: description of baseline multimorbidity, its effects of intervention and its moderation effects on substance use. Soc Psychiatry Psychiatr Epidemiol 2017; 52:1425-1434. [PMID: 28321455 DOI: 10.1007/s00127-017-1368-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 02/22/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND AND AIMS Migration and khat use were found to correlate with high rates of psychopathology. In this paper we aimed for assessing baseline multimorbidity and its interactions with a Brief Intervention. METHODS In the RCT, 330 male Somali khat users were assigned to treatment conditions (khat use is a predominantly male habit). The ASSIST-linked BI for khat users was administered. Using the TLFB Calendar, the PHQ-9, a Somali short version of the PDS and parts from the CIDI, khat use and comorbidity was assessed. With a regression analysis we tested for the influence of comorbidity and with mixed effect models group differences over time in sleep duration, khat use-time and everyday functioning. RESULTS We found high rates of baseline multimorbidity: 51% (N = 168) for depression, 22% (N = 74) for PTSD and 23% (N = 73) for khat-psychotic symptoms. Depression and khat-psychotic symptoms, but not PTSD symptoms decreased without group differences. Khat use-time decreased and functional time increased with significant time × group interactions (p ≤ 0.046). Depression and PTSD did not influence therapy success but in participants without comorbid psychopathology, more khat use reduction after the intervention was found (p = 0.024). CONCLUSION Somali khat users in Kenya are highly burdened by multimorbidity of depression, PTSD and khat-psychotic symptoms. The main effects for time and differences in healthy vs. mentally ill khat users indicate potential of unspecific support and the specific need for mental health care in combination with substance abuse treatment. The increase of everyday functioning promises more options for alternative activities, preventing excessive use and addiction.
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Affiliation(s)
- Marina Widmann
- University of Konstanz, Box 23, 78457, Konstanz, Germany.,vivo international e.V., PO Box 5108, 78430, Konstanz, Germany
| | - Bernice Apondi
- Africa Mental Health Foundation, Mawensi Gardens, Upperhill Nairobi, Kenya
| | - Abednego Musau
- Africa Mental Health Foundation, Mawensi Gardens, Upperhill Nairobi, Kenya
| | | | - Maimuna Isse
- Tawakal Medical Clinic, 5th street, Eastleigh, Nairobi, Kenya
| | - Victoria Mutiso
- Africa Mental Health Foundation, Mawensi Gardens, Upperhill Nairobi, Kenya
| | - Clemens Veltrup
- Fachklinik Freudenholm-Ruhleben, Postfach 5, 24301, Plön, Germany
| | - David Ndetei
- Africa Mental Health Foundation, Mawensi Gardens, Upperhill Nairobi, Kenya.,University of Nairobi, Nairobi, Kenya
| | - Michael Odenwald
- University of Konstanz, Box 23, 78457, Konstanz, Germany. .,vivo international e.V., PO Box 5108, 78430, Konstanz, Germany.
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50
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Nakajima M, Jebena MG, Taha M, Tesfaye M, Gudina E, Lemieux A, Hoffman R, al'Absi M. Correlates of khat use during pregnancy: A cross-sectional study. Addict Behav 2017; 73:178-184. [PMID: 28531823 DOI: 10.1016/j.addbeh.2017.05.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 05/02/2017] [Accepted: 05/08/2017] [Indexed: 01/08/2023]
Abstract
OBJECTIVES Khat is widely used in East African countries including Ethiopia. A growing body of evidence indicates that long-term khat use is associated with various health consequences. The aim of this study was to examine the magnitude and correlates of khat use in pregnant women. METHODS This study used a cross-sectional, face-to-face interview design that included 642 pregnant women receiving antenatal care services at primary care centers in Ethiopia. A series of chi-square tests and regression models were conducted to examine whether khat use status (i.e., 123 current khat users, 41 former khat users, and 478 non-users) was associated with socio-demographic, mental distress, and substance use measures. RESULTS As compared with non-users, current and former khat users had higher levels of depressive symptoms and distress. Khat users minimized potential health risks associated with khat use. Social and motivational factors related to khat use were different between current and former khat users. CONCLUSIONS Findings of this study suggest a substantial prevalence of khat use among pregnant women in Ethiopia and highlight the role of socio-demographic and cultural influences on khat use during pregnancy. Health care professionals in the region where khat is available are encouraged to ask their female patients about khat use and encourage them to refrain from use while they are pregnant. The positive link between khat and mental distress warrants further research focusing on biological, psychological, and social mechanisms of this relationship.
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Affiliation(s)
- Motohiro Nakajima
- University of Minnesota Medical School, 1035 University Drive, Duluth, MN 55812, USA.
| | | | | | | | | | - Andrine Lemieux
- University of Minnesota Medical School, 1035 University Drive, Duluth, MN 55812, USA.
| | - Richard Hoffman
- University of Minnesota Medical School, 1035 University Drive, Duluth, MN 55812, USA.
| | - Mustafa al'Absi
- University of Minnesota Medical School, 1035 University Drive, Duluth, MN 55812, USA.
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