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Exploring the concept of problematic khat use in the Gurage community, South Central Ethiopia: a qualitative study.

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.

SUBMITTER: Mihretu A

PROVIDER: S-EPMC7552831 | biostudies-literature | 2020 Oct

REPOSITORIES: biostudies-literature

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Exploring the concept of problematic khat use in the Gurage community, South Central Ethiopia: a qualitative study.

Mihretu Awoke A Fekadu Abebaw A Habtamu Kassahun K Nhunzvi Clement C Norton Sam S Teferra Solomon S

BMJ open 20201012 10

<h4>Objective</h4>This study aimed to explore how problematic khat use is characterised in the Gurage community in South Central Ethiopia.<h4>Design</h4>Qualitative study.<h4>Setting</h4>Gurage community in South Central Ethiopia.<h4>Participants</h4>We conducted indepth interviews with 14 khat users and 5 non-khat users, and three focus group discussions with khat users.<h4>Methods</h4>All participants were selected purposively based on their exposure to khat or khat use. We used an interview g ...[more]

PMID: 33046468

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Project description:BACKGROUND:The use of excessive caffeine and consumption of alcohol, cigarette, and khat during pregnancy can result in adverse health effects on the fetus. The World Health Organization (WHO) recommends a daily caffeine intake not exceeding 300 mg. Likewise, pregnant women are recommended to avoid alcohol, khat and tobacco use. However, the prevalence's of the use of substances among pregnant women were not well studied in developing countries such as Ethiopia. Therefore, the study aimed to estimate the prevalence of caffeine and alcohol consumption, khat chewing, and tobacco use during pregnancy and identify key factors associated with excess caffeine consumption. METHODS:We conducted a community based cross-sectional study and used a random sampling technique to recruit 352 pregnant women. We adapted a questionnaire from Caffeine Consumption Questionnaire-Revised (CCQ-R), Alcohol Use Disorder Identification Test (AUDIT), Global Adult Tobacco Survey (GATS), and Ethiopian Demographic Health Survey 2016 for caffeine, alcohol consumption, tobacco use, and khat chewing assessment, respectively. We conducted non-consecutive two days 24-hour recall to determine the habitual intake of caffeine from caffeinated beverages and foods. Prevalence with 95% confidence interval was estimated for excess caffeine intake per day, alcohol consumption, khat chewing, and passive tobacco smoking. We ran a multivariable binary logistic regression model to identify factors associated with excess caffeine intake. RESULTS:Almost all pregnant women (98.2%) consumed caffeine as estimated using the 2 days 24-hour average. The median daily caffeine intake was 170.5 mg and ranged from 0.00 mg to 549.8 mg per day. In addition, 17.6% (95% CI: 13.9%, 22.0%) of them had a daily caffeine consumption of 300 mg and above exceeding the WHO recommended daily caffeine intake during pregnancy. The prevalence of alcohol consumption and Khat chewing were 10.0% (95% CI: 7.2%, 13.7%) and 35.8% (95% CI: 30.8, 41.0%) respectively. None of the pregnant women were active tobacco smokers. However, 23.2% (95% CI: 19.0, 28.0%) were passive tobacco smokers. We found that pregnant women in the richest wealth quintile (AOR = 3.66; 95% CI: 1.13, 11.88), and the first trimester of pregnancy (AOR = 4.04; 95% CI: 1.26, 13.05) had higher odds of consuming excessive caffeine. CONCLUSIONS:The study showed a considerable magnitude of substance use among pregnant women in the study area. Given this findings, we recommend, programs and services focusing on pregnant women to consider addressing substance use.

Project description:BACKGROUND:Ethnic groups throughout the world have developed their own cultures expressed in the form of customs, taboos, and traditional healthcare systems. Traditional medicine system is one of the widespread cultures known throughout the world which is very much tied to cultural practices of the community or ethnic group. Medicinal plant treasure found in Gurage and Silti zones remained poorly characterized and understood. Therefore, this study was conducted in four ethnic groups: three from Gurage zone (Gurage, Qebena, and Mareqo) and one from Silti zone (Silti) which have lived in close proximity and contact for many centuries in the respective zones. In the present study, unique and shared cultural elements in connection to traditional herbal medicine were examined through investigation of the diversity of medicinal plants. Moreover, attempts have been made to determine similarities among the society in the medicinal plants they have used in general and in medicinal plant species considered culturally most important. METHODS:In a study that involved 320 randomly sampled informants, semi-structured interviews, focus group discussions, and participant observation were used and qualitative and quantitative data were collected. Descriptive statistics, rank order priority (ROP), informant consensus factor, Jaccard similarity coefficient, and clustering were used for data analysis. RESULTS:A total of 244 medicinal plant species and a fungal species used to treat human and/or livestock ailments were documented. The number of plants (80 plants, 33 %) with ROP value greater than 50% were considerably fewer than that of plants with ROP < 50% (164, 67 %). Jaccard similarity index and clustering analysis for all cited plants, among the respective studied districts, indicated that grouping generally followed the existing ethnic origin. On the contrary, clustering based on culturally important medicinal plant species (80 plant species, score ROP ? 50%) showed the influence of proximity and geographical orientation rather than ethnic relation. CONCLUSIONS:Culturally, most important plants (80 spp.) are widely used and best shared with nearby communities and this could imply current (new) knowledge being practiced in the communities. This knowledge must be documented and better utilized in a modern way including modernized use of traditional medicinal plants.

Project description:BackgroundCommunity-based Health Insurance (CBHI) is a voluntary prepayment mechanism that guarantees the provision of basic healthcare services without financial barriers to underserved segments of the population in developing countries. The Government of Ethiopia launched the CBHI program to protect the community from high out-of-pocket health expenditure and improve health service utilization a decade ago. However, to improve the quality of healthcare services delivery in health facilities and cover the changing costs of healthcare, the government should revise the contribution of the CBHI scheme. Therefore, we determined the willingness to pay for a CBHI scheme and associated factors among rural households of Lemu and Bilbilo district, South Central Ethiopia.MethodsWe conducted a community-based cross-sectional study design to assess willingness to pay for the CBHI scheme and its associated factors among households in Lemu and Bilbilo districts, South Central Ethiopia. We used a double bounded contingent valuation method to elicit households' willingness to pay for the CBHI scheme. Data were coded, cleaned, entered into Statistical Package for Social Science (SPSS) version 25, and exported to STATA 16 for analysis. A logistic regression analysis was conducted to determine the presence of statistically significant associations between the willingness to pay for the CBHI scheme and independent variables at a p-value <0.05 and Adjusted odds ratio (AOR) values with 95% CI. Finally, we checked the fitness of the model using Hosmer and Lemeshow's goodness-of-fit test.ResultsOf the 476 study participants, 82.9% (95% CI: 79.2%, 86.01%) were willing to pay for the CBHI scheme and only 62% of them can afford the average amount of 358.32ETB ($7.68) per household per annum. Primary education (AOR = 3.17; 95% CI: 1.74-5.80), secondary and above education (AOR = 4.13; 95% CI: 1.86-9.18), large family size (AOR = 2.75; 95% CI: 1.26-5.97), monthly income of 500-1000ETB (AOR = 3.75; 95% CI: 1.97-7.13) and distance to public health facilities (AOR = 2.14, 95% CI: 1.04-4.39 were significantly associated with willingness to pay for the CBHI scheme.ConclusionIn this study, around 83% of respondents were willing to pay for the CBHI and meet the government expectation for 2020. The study also revealed that educational status, family size, monthly income, and distance from the health facilities were significant factors associated with WTP for the CBHI scheme. In addition, we found that a large number of the respondents couldn't afford the average amount of money that the participants were willing to pay for the CBHI scheme. So, the government should consider the economic status of the communities while revising the CBHI scheme premium not to miss those who cannot afford the contribution.

Project description:INTRODUCTION:A decline in malaria morbidity and mortality has been documented in Ethiopia since 2005 following a scale-up of the distribution of long-lasting insecticidal nets (LLINs). However, universal access to LLINs ownership and use has not yet been achieved. This study aimed to determine ownership and use of LLINs over time in south-central Ethiopia. METHODS:A cohort of 17,142 individuals residing in 3,006 households was followed-up from October 2014 to January 2017 (121 weeks). New PermaNet2.0 LLINs were given to households in October 2014. Once per week, the LLIN use status was documented for each individual. A survey was conducted after 110 weeks of LLIN distribution to determine LLIN ownership. A multilevel negative binomial regression model was fitted to identify significant predictors of LLIN use. RESULTS:At baseline, the LLIN ownership was 100%. After 110 weeks only 233 (8%) of the households owned at least one LLIN. The median proportion of LLIN use per individuals during the study period was only 14%. During the first year (week 1-52) the average LLIN use per individuals was 36% and during the second year (week 53-104) it was 4.6%. More frequent LLIN use was reported among age group [5-14 years (adjusted IRR = 1.13, 95% CI 1.04-1.22), 15-24 years (adjusted IRR = 1.33, 95% CI 1.23-1.45), ?25 years (adjusted IRR = 1.99, 95% CI 1.83-2.17)] compared to <5 years, and household head educational status [read and write (adjusted IRR = 1.17, 95% CI 1.09-1.26), primary (adjusted IRR = 1.20, 95% CI 1.12-1.27), secondary or above (adjusted IRR = 1.20, 95% CI (1.11-1.30)] compared to illiterate. Having a family size of over five persons (adjusted IRR = 0.78, 95% CI 0.73-0.84) was associated with less frequent use of LLINs compared to a family size of ?5 persons. CONCLUSIONS:The study showed a low LLIN ownership after 110 weeks and a low LLIN use during 121 weeks of follow-up, despite 100% LLIN coverage at baseline. The study highlights the need to design strategies to increase LLIN ownership and use for setting similar to those studied here.

Project description: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.

Dataset Information

Exploring the concept of problematic khat use in the Gurage community, South Central Ethiopia: a qualitative study.

Publications

Exploring the concept of problematic khat use in the Gurage community, South Central Ethiopia: a qualitative study.

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