Assessment of Health-Related Effects of Khat (Catha Edulis) Consumption Among Residents of Bushenyi-Ishaka Municipality, Bushenyi District Western Uganda

Assessment of Health-Related Effects of Khat (Catha Edulis) Consumption Among Residents of Bushenyi-Ishaka Municipality, Bushenyi District Western Uganda | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Assessment of Health-Related Effects of Khat (Catha Edulis) Consumption Among Residents of Bushenyi-Ishaka Municipality, Bushenyi District Western Uganda Ahumuza Nicholus Mavine, Matthew C. Igwe, Bot Yakubu Sunday, Idehen Iyore Charles, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6236664/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 9 You are reading this latest preprint version Abstract Background Despite local and national efforts against Khat use, the habit continues to escalate mainly among young people in Uganda; especially those in urban and peri-urban areas. This is compounded by limited understanding of health related effects of Khat use which could have detrimental effects to the users, their families and community as a whole. This study aimed at assessing the health-related effects of Khat ( Catha edulis Forsk) consumption among residents of Bushenyi-Ishaka Municipality, South western Uganda. Methodology A community based cross sectional study design was conducted on 384 study participants residing or working in Bushenyi-Ishaka Municipality. Using structured questionnaires and a cluster sampling method, data was obtained on Khat consumption; its patterns, health effects and associated factors. Data was analyzed using SPSS version 27.0 for both descriptive and inferential statistics. Statistical significant association was set at a p-value of ≤ 0.05. Results A 16.9% and 15.1% lifetime and current prevalence of Khat consumption respectively was observed among the participants. The most reported health related effects of Khat use were GUS effects with a mean of 2.0578 ± 0.442, however it was CVS health effects which showed a significant association to Khat use (β = 0.201, P < 0.001). This study also showed that Khat use was positively associated with age 18–43 years (β = 0.189, P = 0.001), age 31–43years (β = 0.205, P = 0.002), primary level of education (β = 0.221, 0.006), being a traditional believer (β = 0.221, P = 0.014), being a driver (β = 0.348, P < 0.001) or a merchant (β = 0.356, P = 0.006) as an occupation and living with people than one’s parents (P < 0.001). On the other hand, Khat use was negatively associated with being a student as occupation (β= - 0.934, P < 0.001), and earning a higher monthly income (P < 0.001). Conclusion Lifetime and current prevalence of Khat consumption was 16.9% and 15.1% respectively with CVS health effects as the only positively and significantly associated health effects with Khat chewing. Khat chewing was also significantly associated with age, education level, religion, occupation, income level and type of people someone lives with. Khat Consumption Health related Effects Youths and Adults Uganda Figures Figure 1 Introduction Khat, also known as Catha edulis Forsk, is a psychotropic herb that is widely grown & used as a stimulant, medicinal herb, good for trade, for dowry, and dispute resolution within Eastern Africa and the Arabian Peninsula [ 1 ]. The herb is commonly referred to as Mairungi in Uganda, Miraa in Kenya, khat in Ethiopia, Qaad/jaad in Somalia and qat or gat in Yemen [ 2 , 3 ]. Chronic Khat use has become a public health concern with many health related effects. Khat use among young people is escalating despite the rising public health concerns. Globally, Khat is reportedly regularly used by more than 20 million people (≈ 3/1000) [ 4 ]. This is expected to exponentially increase over time in low and middle income countries [ 5 ]. In Sub-Saharan Africa (SSA), Khat use ranges from 14.5% − 21.6% and is anticipated to rise over time [ 6 ]. This rate is similar to Khat use among the youths in Uganda (15.6%) but lower than level of Khat use among adult Uganda (22.4%) in adults [ 7 ]. Chewing Khat leaves exposes users to alkaloid Cathinone and Cathine the active ingredients that cause health effects among Khat users including euphoria, excitement, alertness, low appetite and improving social connection [ 8 , 9 ]. Further studies have also associated excessive Khat consumption to Cardiovascular (CVS) health-related effects (Tachycardia, Hypertension, stroke), Gastro-intestinal Tract (GIT) effects (constipation, liver disorders), Genito-urinary System (GUS) effects (urinary retention) and Central Nervous System (CNS) effects (anxiety, depression, psychosis and mental alterations), among others [ 8 , 10 , 11 12 ]. The Bushenyi district in western Uganda passed the Bushenyi District ' Mairungi' Trade and usage Control Ordinance, 2006 in response to the effects of Khat trade and usage. Despite these local interventions against Khat and substance use, Bushenyi District remains the axis and an important route of Khat supply to major towns and cities such as Mbarara City and there is no evidence showing that if khat use has decreased in the district [ 13 ]. This is compounded with paucity of published data on health-related effects of Khat consumption among residents of Bushenyi District Southwestern Uganda hence the need to conduct this study aimed at assessing the potential health effects of khat ( Catha edulis Forsk) use among Bushenyi-Ishaka municipality inhabitants. Methods and Materials 2.1 Study Setting and Population This study on Khat use was carried out among youths (18–30years) and adults (30–59years) men and women of different occupations who reside or work in Kizinda, Ishaka, St. Kagwa, Bushenyi and Nyakabirizi towns of Bushenyi-Ishaka municipality, in South western Uganda. 2.2 Study Design, Variables and Sampling A community based cross sectional study design was conducted between April to August, 2024 to assess self-reported level of Khat use (dependent variable), Self-reported health-related effects of Khat (dependent variable) among youths and adults and Self-reported associated factors of Khat use (independent variable). A study sample size of 384 participants (220 youths and 164 adults) was determined using Cochran’s formula (1977) i.e. \(\:n=\frac{{z}^{2}p\left(1-p\right)}{{e}^{2}}\) ; Where Z = 1.96, P = 50% and e = 0.05 (at 95% Confidence level); \(\:n=\frac{{1.96}^{2}\times\:0.5(1-0.5)}{{\left(0.05\right)}^{2}}=384\:\:\) youth and Adults. According to UBOS 2016, Bushenyi-Ishaka municipality’s population aged 18 to 30 years was 10,820 and the population aged 31 to 59 years was 8,096. Therefore to have a representative sample of 384 participants, \(\:n1=\frac{\text{10,820}}{18916}\:\times\:384\) = 220 of 384 participants were between 18 to 30 years of age while \(\:n2=\frac{8096}{18916}\:\times\:384=\) 164 of 384 participants were between the ages of 31 to 59 years. Cluster sampling technique was used to recruit eligible participants until a desired sample was reached. 2.3 Data Collection procedure The study used interviewer-administered structured questionnaires to obtain quantitative data on self-reported Khat consumption, Khat chewing patterns and the associated factors ( see attached Data tool 1 ) whereas the self-reported health effects of Khat use (among the Khat users) were obtained using a 5-point Likert scale as adopted from WHO steps instrument guide for NCDs 2020 ( see attached Data tool 2 ). Responses were collapsed dichotomously with agree/strongly agree responses coded as an endorsement and all other responses (neutral/disagree/strongly disagree) coded as not endorsing the proposed effect of Khat use on each specified health outcome. 2.4 Statistical Analysis The Statistical Package for Social Sciences (SPSS) version 27.0 was used for both descriptive statistical analysis to obtain prevalence of Khat use, self-reported health effects of Khat use and also inferential statistics to assess the associated factors of Khat chewing at bivariate and multivariate regression analysis. Statistical significant association was set at a p-value of ≤ 0.05. 2.5 Ethical Approval Ethical clearance was sought from Institutional Research Ethics Committee of Kampala International University (KIU-REC). Ethical approval and accreditation number: KIU-2024-295. Study Results 3.1 Socio-demographic characteristics of study participants The study showed that most (94.3%) of the participants were male, over half (57.3%) were aged 18–30 years and about (40.1%) had attained secondary level education. About 45.3% of participants were singles by marital status, over half (53.6%) were Moslems by religion and majority (52.6%) were living alone. Finally, about 44.3% of participants were commercial cyclists by occupation and most (47.7%) of them were earning a monthly salary of UGX 100,000–300,000 (See Fig. 01 below). 3.5. Factors Associated With Khat Consumption At bivariate analysis, it was age 18–30 (9.5%), age 31–43 (17.0%), primary education (14.4%), being divorced (19.0%), being a Moslem (24.6%), being a traditional believer (34.8%), being a driver (17.1%), being a commercial cyclist (14.9%), staying with your own family (61.6%), staying with relatives (72.3%), staying with friends (71.2%) or staying alone (76.6%) that increased the tendency to use Khat among the residents of Bushenyi-Ishaka municipality. On the contrary, having secondary education (14.1%), earning between UGX 100,000 - <300,000 (19.1%) or earning more than UGX 600,000 (31.9%) per month decreased the tendency to chew Khat among the resident of the municipality (see Table 05 below). At multivariate analysis, age 18–30 (18.9%), age 31–43 (20.5%), primary education (22.1%), being a traditional believer (22.1%), staying with own family (61.4%), staying with relatives (70.1%), staying with friends (78.3%), staying alone (70.5%), being a driver (34.8%) or merchant (35.6%) by occupation increased the tendency to chew Khat among the residents of the municipality whereas being a student (93.4%) and earning a monthly salary of UGX 100,000 and above (97.6% − 138.2%) decreased the tendency to chew Khat among the residents of Bushenyi-Ishaka municipality (see Table 05 below). 3.3 Pattern of Khat Consumption Amongst the participants who reported chewing Khat, majority reported supply of Khat from Khat vendors (78.5%); most had chewed Khat for a period of more than 6months to 3 years (64.6%); mainly chew one bundle per session (53.8%); chew 4–6 times a week (66.2%); use between UGX 5000–10,000 per single consumption (53.8%) with a monthly average ranging between UGX 100,000–150,000 (53.8%) whereas all those who reported Khat chewing mentioned taking a period of more than 2 hours during the chewing session. Regarding the other substances consumed alongside Khat, majority of the Khat users mentioned chewing gum (53.8%) and most mentioned reasons for Khat chewing was to be alert (76.9%) as portrayed ( See table 02 below ). 3.4 Health Related Effects of Khat Consumption The explored health related impacts ranged from CVS effects to GIT, GUS and CNS effects assessed using a standard five point likert scale of Agree, Strongly agree, Neutral, Disagree and Strongly Disagree respectively scored from 1–5. The most confirmed health related effects of Khat use were GUS effects with a mean of 2.0578 ± 0.442 followed by the CVS effects (1.9809 ± 0.270) while the least confirmed health related effects were CNS ones with a mean of 1.9297 ± 0.158. Generally, most participants confirmed (median = 2.000) the occurrence of the assessed health effects after Khat use. The mean health effects for CVS, GIT, and GUS were skewed to the right while that CNS ones was skewed to the left. Minimum mean score for the health related effects ranged between Agree and strongly agree (1.40) while the maximum mean score for the health related effects ranged from neutral to disagree (3.40) with variations between the type of health effects assessed ( see table 03 below ). However during the regression analysis, it was only CVS health related effects which portrayed a positive and significant association (ß =0.201; P < 0.001) to Khat use ( see table 04 below ). Discussion of Results 4.1 Prevalence of Khat consumption among study participants This study showed 16.9% Lifetime prevalence of Khat consumption. This was higher than the lifetime pooled prevalence of Khat use in SSA (14.5%) among the youth [ 6 ]. However, this was lower that a 44.6% lifetime prevalence of Khat use in Kenya [ 14 ], a 26.7% lifetime prevalence of Khat use in Ethiopia [ 15 ] and a 21.4% lifetime prevalence of Khat use in South Africa [ 16 ]. Further, the study indicated a 15.1% Current prevalence of Khat Chewing which was higher than a 12.5% current prevalence of Khat use in South Africa [ 16 ]. However, this was lower than a 24.5% current prevalence of Khat use in Kenya [ 14 ] and a 17.5% current prevalence of Khat use in Ethiopia [ 15 ]. By and large, the prevalence of Khat use were lower than in most of other areas of study, which could be because Ishaka – Municipality is a growing town as compared to where related studies have been conducted. We also noted a slight decline in Khat chewing by 1.8% (from 65 to 58 users in 384 study participants). This could be because of failure of users to sustain the expenses, discouraging health related effects and changes in social status. 4.2 Health related Effects of Khat Use among study participants This study showed that the most reported health related effects of Khat use were GUS effects with a mean of 2.0578 ± 0.442, followed by CVS effects with a mean of 1.9807 ± 0.270. While the least reported health related impacts were CNS effects with a mean of 1.9297 ± 0.158. A regression analysis with β-coefficient revealed that only CVS health related effects were positively associated to Khat use (β = 0.201, P < 0.001). This was Consistent with Studies in Ethiopia [ 12 ], Kenya [ 14 ], and Tanzania [ 17 ] where erectile dysfunction, decreased libido, urinary retention and sexual dysfunction among men were respectively reported GUS health effects of Khat use. Also, agreed with a study in Tanzania [ 17 ] where Khat use was significantly associated with CVS effects such as High Blood pressure and heart disease. However, This Contrasted with studies in Ethiopia [ 12 ] and Uganda [ 7 ] where CNS effects such as depression, anxiety & stress were most reported among Khat users. Also, deviated from findings of a study in Tanzania [ 17 ] where CVS effects were the least reported health related effects of Khat use. This disparity in results of reported health effects of Khat use could be due to difference in assessment tools and subjectivity in response. Also, the duration of Khat use among participants was relatively short to notice CNS effects which are usually long term in nature. 4.3 Factors associated with Khat Use among study participants This study revealed that Khat use was positively associated with Age 18–43 years, though there was a greater association for adults aged 31–43years. This was consistent with a systematic review [ 18 ] where there was a positive association between advancing age and Khat use globally. Also, agreed with results of a review in SSA [ 6 ] and findings from a cross sectional study in Uganda by [ 7 ]. This could be linked to socio-generational drive, ability to afford cost & sustain use of Khat. This study also indicated that Khat use was positively associated with primary level of education and negatively associated with secondary level of education. This was consistent with findings of a world Drug Report (2019) which revealed that lower education was positively associated with Khat Use and a study [ 17 ] in Tanzania that showed that Higher education level was negatively associated with Khat Use. This could be due to improved knowledge & awareness on health effects of Khat use with higher levels of education. Further, the study indicated that Divorced study participants had increased chances of Khat use compared to their married counterparts. This was consistent with results from a review in SSA [ 6 ] where Divorce was positively associated with Khat Use and findings of studies in Ethiopia [ 12 ]. However, this contrasted with a study [ 17 ] & [ 7 ] which indicated that there was No significant association between divorce and Khat Use. This could be connected to psychosocial frustration & coping mechanisms in divorced individuals. On religious affiliation, the study revealed that Khat use was positively associated with traditional beliefs. This was consistent with a systematic review [ 19 ] which indicated that traditional belief was positively associated with Khat Use globally and Findings in Tanzania [ 17 ]. However, this contrasted with a study [ 18 ] which indicated that there was No association between traditional belief & Khat use. This could be linked to a ritualistic activity or due to traditional belief in Khat as herbal remedy. Besides, Khat use was found to be positively associated with drivers. This was consistent with: Findings of a systematic review [ 19 ] and a study in Uganda where drivers had higher odds of Khat use [ 7 ]. However, this contrasted with a study in Uganda that indicated that there was no association between Driving and Khat Use [ 20 ]. Drivers, especially long distance drivers and those who drive day & night could be chewing Khat more to keep alert while driving. Finally, Khat use was negatively associated with high income level. This was consistent with studies in Ethiopia where users from High income had lower odds of Khat Use [ 12 , 21 ]. This also agreed with a cross sectional study in Uganda [ 11 ]. This could be linked to social stigma, occupational constraints and alternative leisure activities and coping mechanisms of persons with high income. Conclusion The study concludes that life time and current prevalence of Khat consumption was 16.9% and 15.1% respectively. Khat users mostly reported GUS and CVS health effects, and least reported CNS health effects. Only CVS Health effects were positively associated with Khat chewing. Khat chewing was significantly associated with advancing age, primary education level, divorce marital status, traditional beliefs, driving or merchant occupation as well as high monthly income earnings. Declarations Ethical Approval and Consent to participate Ethical clearance was sought from Institutional Research Ethics Committee of Kampala International University (KIU-REC). Ethical approval and study accreditation number: KIU-2024-295. Data collection and the entire research process proceeded with reference to the Helsinki guidelines were; respect for individuals (the residents of Bushenyi-Ishaka Municipality) and the right to make informed decisions (study participants) were strictly adhered to. Participation in study was voluntary with written informed consent obtained from all study participants. Consent of publication Not applicable since no images or patient’s information has been included in this manuscript. Availability of Data and Materials The dataset used to establish these findings can be availed on request. The corresponding author should be contacted via email and such request forwarded to his address as stated in the manuscript. Conflict of Interest The authors declare that there is no conflict of interest regarding the publication of this paper. Funding The study was funded by Kampala International University under the Staff Development Scheme Scholarship (Ref No. KIU/HR/APPT/01.04.21-034). Authors’ Contributions All Authors contributed to the study. The corresponding Author (Ahumuza Nicholus Mavine) conceptualized the study, proposed the study design, and was involved in data collection and analysis and writing of the manuscript with support from the listed co-authors. Co-authors include; Mathew C Igwe participated in conceptualization of study and design, results interpretation, manuscript drafting and review. Bot Yakubu Sunday participated in conceptualization of study and design, results interpretation and manuscript approval. Idehen Iyore Charles participated in conceptualization of study and design, results interpretation and manuscript approval. Malemo Herbert participated in data analysis and interpretation, manuscript drafting and review. Isa Asiimwe participated in data analysis and interpretation, manuscript drafting and review. Solomon A Mbina in conceptualization of study and design, results interpretation, manuscript drafting and review. Umar Ibrahim participated in conceptualization of study and design, results interpretation, manuscript drafting and review. All Authors participated in manuscript review and approval. Acknowledgments I acknowledge the Chairperson Board of Trustees (Al-haji Hassan Basajja Balaba) for Kampala International University for funding my study, Outstanding Member of Doctoral Committee of Public Health (Dr. Tamale Andrew, Dr. Glory Nja and Dr. Nicholas Ngomi), Departmental Members of academia, my family and Colleagues for their respective support in this study. References Al-Motarreb A, Al-Habori M, Broadley KJ. Khat chewing, cardiovascular diseases and other internal medical problems: The current situation and directions for future research. J Ethnopharmacol. 2010;132(3):540–8. Odenwald M, Klein A, Warfa N. Introduction to the special issue: the changing use and misuse of khat (Catha edulis)–tradition, trade and tragedy. J Ethnopharmacol. 2010;132(3):537–9. 10.1016/j. jep.2010.11.012. Feyissa AM, Kelly JP. A review of the neuropharmacological properties of khat. Progress Neuro-psychopharmacol Biol Psychiatry. 2008;32:1147–66. Patel NB. Khat (Catha edulis Forsk) – And now there are three. Brain Res Bull. 2019;145:92–6. World Health Organization (WHO). (2014). Khat chewing in Yemen:turning over a new leaf 86(10): 737–816. World Health Organization. (2018). Khat Use in Subsaharan Africa: A review of Prevalence, pattern and factors associated to Khat use. Nakimuli A, et al. Khat use and associated factors among youth and adults in Uganda. J Subst Use. 2018;23(5):462–8. World Health Organization (WHO) Expert Committee on Drug Dependence. Assessment of Khat (Catha edulis Forsk). 2006. Available from: http://www.who.int/medicines/areas/quality_safety/4.4KhatCritReview.pdf . [Last cited on 2014 Aug 20]. Borelli S. Social aspects of drug use in Djibouti: the case of the leaf of Allah. J Afr Econ. 2009;18(4):555–91. Basker GV. A review on hazards of khat chewing. Int J Pharm Sci. 2013;5(3):74–7. Nakajima M, Jebena MG, Taha M, Tesfaye M, Gudina E, Lemieux A, al'Absi M. Correlates of khat use during pregnancy: A cross-sectional study. Addict Behav. 2017;73:178–84. Tesfaye E, Krahl W, Alemayehu S. (2020). Khat induced psychotic disorder: case report. Substance Abuse Treatment, Prevention, and Policy, 15, 1–5. Beckerleg S. Idle and disorderly’ khat users in Western Uganda. Drugs: Educ Prev Policy. 2010;17(4):303–14. Ochieng A, Muthuri SK, Oyugi R. Khat Chewing Habits and associated Socio-demographic Factor among Kenyan Children. 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Tables Table 01 showing Khat Consumption among the participants Variable Frequency % Ever Chewed Khat Yes 65 16.9 No 319 83.1 Currently Chewing Khat Yes 58 15.1 No N/A 7 319 10.8 83.1 Who Introduced You to Khat Chewing Friend 51 78.5 Workmate 14 21.5 Nobody 0 .0 Table 02 Khat Chewing Patterns among the Khat users Variable Frequency (N = 65) % Means of Khat Supply Friends 14 21.5 Khat vendor 51 78.5 How long been chewing Khat > 6 months − 3 years 42 64.6 4–6 years 15 23.1 Over 6 years 8 12.3 Quantity Chewed in single session One bundle 35 53.8 > 2 bundles 30 46.2 Khat Chewing Frequency Daily 22 33.8 4-6times a week 43 66.2 Time spent chewing > 120 minutes 65 100.0 Amount spent on single consumption > UGX 5000 - UGX 10000 35 53.8 > UGX 10000 30 46.2 Average amount spent per month >UGX 100000 - UGX 150000 35 53.8 > UGX 150000 30 46.2 Substance used together with Khat Alcohol 22 33.8 Chewing gum 35 53.8 Cigarette 8 12.3 Reason for chewing Khat To be alert 50 76.9 To be accepted by peers 15 23.1 Table 03 Descriptive Statistics of health Effects of Khat consumption CVS Effects GIT Effects GUS Effects CNS Effects N = 65 65 65 65 65 Mean 1.9807 1.9560 2.0578 1.9297 Median 2.0000 1.9000 2.0000 2.0000 Std. Deviation .26989 .20043 .44204 .15833 Skewness .061 .571 .758 − .207 Std. Error of Skewness .125 .125 .125 .125 Minimum 1.40 1.60 1.40 1.50 Maximum 2.60 2.50 3.40 2.50 N = 65participants who have ever used Khat were used to assess Health effects of Khat consumption Table 04: Linear regression analysis of health-related effects of Khat use and Khat use Variable Unstandardized Coefficients Standardized Coefficients t Sig. B Std. Error Beta CVS EFFECTS 0.280 0.071 0.201 3.949 < 0.001 GIT EFFECTS -0.023 0.095 -0.012 -0.242 0.809 GUS EFFECTS -0.042 0.043 -0.049 -0.958 0.339 CNS EFFECTS 0.001 0.120 0.000 0.005 0.996 Table 05 showing regression analysis of socio-demographic factors and Khat chewing Variable EVER CHEWED KHAT Bivariate Analysis Multivariate Analysis Coefficients (ß) P-value Coefficients (ß) P-value Gender Male 0.158 0.055 Female Ref. Age (years) 18–30 0.095 0.046 0.189 0.001 31–43 0.170 0.004 0.205 0.002 44–56 Ref. Ref. Education Level No formal 0.044 0.435 0.124 0.240 Primary 0.144 0.014 0.221 0.006 Secondary -0.141 0.003 -0.057 0.363 Tertiary Ref. Ref. Marital Status Married Ref. Ref. Single 0.029 0.522 0.142 0.126 Separated -0.022 0.702 0.052 0.562 Divorced 0.190 0.027 0.200 0.063 Religion Christian 0.037 0.647 0.089 0.254 Moslem 0.246 0.002 0.142 0.088 Traditional 0.348 < 0.001 0.221 0.014 Others Ref. Ref. Lives with….. Family 0.616 < 0.001 0.614 < 0.001 Relatives 0.723 < 0.001 0.701 < 0.001 Friends 0.712 < 0.001 0.783 < 0.001 Parents Ref. Ref. Alone 0.766 < 0.001 0.705 < 0.001 Occupation Civil servant Ref. Ref. Student 0.110 0.142 -0.934 < 0.001 Driver 0.171 0.008 0.348 < 0.001 Commercial cyclist 0.149 0.009 -0.030 0.703 Peasant -0.045 0.624 -0.069 0.526 Merchant -0.194 0.070 0.356 0.006 Monthly income (UGX) <100,000 Ref. Ref. 100,000 - <300,000 -0.191 0.004 -0.976 < 0.001 300,000–600,000 -0.083 0.243 -1.057 600,000 -0.319 < 0.001 -1.382 < 0.001 Entry into Multivariate model was P ≤ 0.05 at Bivariate. Thus, Age, Education, Marital status, Religion, Occupation, Monthly income and People stayed with, were taken to the multivariate model. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6236664","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":458282705,"identity":"f9457da9-fb78-4b55-bc3b-bf4b5df961a5","order_by":0,"name":"Ahumuza Nicholus Mavine","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA+klEQVRIiWNgGAWjYDACCWROAoONARupWtJI1cLAcNiAoA7+2T2mm3n+2DHotp99JvFwx3ljPokExg8/GA7bNeCy5M4Zs9s8PMkMZmfSzSQSz9w2Y5NIYJbsYTicjEsLw40coBYJZgazA2nMBoltt22AWhikgS5MxqVDHqzFoJ7B7PwzkJZzIC3Mv/FpMQBrSTjMYHYjjfFBYtsBkMPYQLbY4dJieCOt7OacA8d5zG48A2lJNmbjedhm2WOQnoBLi9yN5G033vypljM7n8Zw8GebneH89uTDN35UWNvj0gIDPEhsxgaggxkSGwjpwQAEbRkFo2AUjIIRAwAaXVGU6TB1awAAAABJRU5ErkJggg==","orcid":"","institution":"Kampala International University","correspondingAuthor":true,"prefix":"","firstName":"Ahumuza","middleName":"Nicholus","lastName":"Mavine","suffix":""},{"id":458282706,"identity":"58a00358-5964-440c-ab23-a8ee5728a21f","order_by":1,"name":"Matthew C. Igwe","email":"","orcid":"","institution":"Kampala International University","correspondingAuthor":false,"prefix":"","firstName":"Matthew","middleName":"C.","lastName":"Igwe","suffix":""},{"id":458282707,"identity":"78b786f0-626a-4dc6-b39d-3f41b8cb1b8d","order_by":2,"name":"Bot Yakubu Sunday","email":"","orcid":"","institution":"Kampala International University Western Campus","correspondingAuthor":false,"prefix":"","firstName":"Bot","middleName":"Yakubu","lastName":"Sunday","suffix":""},{"id":458282708,"identity":"38d3fca3-dc5f-4434-8cf2-c93eefdf44ca","order_by":3,"name":"Idehen Iyore Charles","email":"","orcid":"","institution":"Kampala International University Western Campus","correspondingAuthor":false,"prefix":"","firstName":"Idehen","middleName":"Iyore","lastName":"Charles","suffix":""},{"id":458282709,"identity":"0cd0694e-90fd-4310-8b8e-af7e569ce705","order_by":4,"name":"Herbert Malemo","email":"","orcid":"","institution":"Kampala International University","correspondingAuthor":false,"prefix":"","firstName":"Herbert","middleName":"","lastName":"Malemo","suffix":""},{"id":458282710,"identity":"25698eb4-9c42-42fc-9393-ae7ae7c738d7","order_by":5,"name":"Isa Asiimwe","email":"","orcid":"","institution":"Kampala International University","correspondingAuthor":false,"prefix":"","firstName":"Isa","middleName":"","lastName":"Asiimwe","suffix":""},{"id":458282711,"identity":"89cdfc74-2310-4467-8f4f-dad9c568e0c4","order_by":6,"name":"Solomon A. Mbina","email":"","orcid":"","institution":"Kampala International University","correspondingAuthor":false,"prefix":"","firstName":"Solomon","middleName":"A.","lastName":"Mbina","suffix":""},{"id":458282712,"identity":"76b70ad4-aec9-44c6-8ca9-ba9c96cb5e87","order_by":7,"name":"Umar Ibrahim","email":"","orcid":"","institution":"Federal University Dutse","correspondingAuthor":false,"prefix":"","firstName":"Umar","middleName":"","lastName":"Ibrahim","suffix":""}],"badges":[],"createdAt":"2025-03-16 09:08:03","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6236664/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6236664/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":83143951,"identity":"4feabb8d-2dc3-485d-aa82-e47e35c7c5fd","added_by":"auto","created_at":"2025-05-20 12:41:33","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":45342,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003e\u003cstrong\u003eSocio-demographic characteristics of study participants\u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6236664/v1/79047d1075359fdc5a582df4.png"},{"id":83144208,"identity":"ad7c61c8-adc1-4583-8862-8d9d452beded","added_by":"auto","created_at":"2025-05-20 12:49:34","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1076212,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6236664/v1/14f03a2e-9443-45ca-85cf-e451457be9aa.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eAssessment of Health-Related Effects of Khat (Catha Edulis) Consumption Among Residents of Bushenyi-Ishaka Municipality, Bushenyi District Western Uganda\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eKhat, also known as \u003cem\u003eCatha edulis\u003c/em\u003e Forsk, is a psychotropic herb that is widely grown \u0026amp; used as a stimulant, medicinal herb, good for trade, for dowry, and dispute resolution within Eastern Africa and the Arabian Peninsula [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. The herb is commonly referred to as Mairungi in Uganda, Miraa in Kenya, khat in Ethiopia, Qaad/jaad in Somalia and qat or gat in Yemen [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eChronic Khat use has become a public health concern with many health related effects. Khat use among young people is escalating despite the rising public health concerns. Globally, Khat is reportedly regularly used by more than 20\u0026nbsp;million people (\u0026asymp;\u0026thinsp;3/1000) [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. This is expected to exponentially increase over time in low and middle income countries [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. In Sub-Saharan Africa (SSA), Khat use ranges from 14.5% \u0026minus;\u0026thinsp;21.6% and is anticipated to rise over time [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. This rate is similar to Khat use among the youths in Uganda (15.6%) but lower than level of Khat use among adult Uganda (22.4%) in adults [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eChewing Khat leaves exposes users to alkaloid Cathinone and Cathine the active ingredients that cause health effects among Khat users including euphoria, excitement, alertness, low appetite and improving social connection [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Further studies have also associated excessive Khat consumption to Cardiovascular (CVS) health-related effects (Tachycardia, Hypertension, stroke), Gastro-intestinal Tract (GIT) effects (constipation, liver disorders), Genito-urinary System (GUS) effects (urinary retention) and Central Nervous System (CNS) effects (anxiety, depression, psychosis and mental alterations), among others [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe Bushenyi district in western Uganda passed the Bushenyi District '\u003cem\u003eMairungi'\u003c/em\u003e Trade and usage Control Ordinance, 2006 in response to the effects of Khat trade and usage. Despite these local interventions against Khat and substance use, Bushenyi District remains the axis and an important route of Khat supply to major towns and cities such as Mbarara City and there is no evidence showing that if khat use has decreased in the district [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. This is compounded with paucity of published data on health-related effects of Khat consumption among residents of Bushenyi District Southwestern Uganda hence the need to conduct this study aimed at assessing the potential health effects of khat (\u003cem\u003eCatha edulis\u003c/em\u003e Forsk) use among Bushenyi-Ishaka municipality inhabitants.\u003c/p\u003e"},{"header":"Methods and Materials","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Study Setting and Population\u003c/h2\u003e \u003cp\u003eThis study on Khat use was carried out among youths (18\u0026ndash;30years) and adults (30\u0026ndash;59years) men and women of different occupations who reside or work in Kizinda, Ishaka, St. Kagwa, Bushenyi and Nyakabirizi towns of Bushenyi-Ishaka municipality, in South western Uganda.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003e2.2 Study Design, Variables and Sampling\u003c/h3\u003e\n\u003cp\u003eA community based cross sectional study design was conducted between April to August, 2024 to assess self-reported level of Khat use (dependent variable), Self-reported health-related effects of Khat (dependent variable) among youths and adults and Self-reported associated factors of Khat use (independent variable).\u003c/p\u003e \u003cp\u003eA study sample size of 384 participants (220 youths and 164 adults) was determined using Cochran\u0026rsquo;s formula (1977) i.e. \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:n=\\frac{{z}^{2}p\\left(1-p\\right)}{{e}^{2}}\\)\u003c/span\u003e\u003c/span\u003e; Where Z\u0026thinsp;=\u0026thinsp;1.96, P\u0026thinsp;=\u0026thinsp;50% and e\u0026thinsp;=\u0026thinsp;0.05 (at 95% Confidence level); \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:n=\\frac{{1.96}^{2}\\times\\:0.5(1-0.5)}{{\\left(0.05\\right)}^{2}}=384\\:\\:\\)\u003c/span\u003e\u003c/span\u003eyouth and Adults.\u003c/p\u003e \u003cp\u003eAccording to UBOS 2016, Bushenyi-Ishaka municipality\u0026rsquo;s population aged 18 to 30 years was 10,820 and the population aged 31 to 59 years was 8,096. Therefore to have a representative sample of 384 participants, \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:n1=\\frac{\\text{10,820}}{18916}\\:\\times\\:384\\)\u003c/span\u003e\u003c/span\u003e = 220 of 384 participants were between 18 to 30 years of age while \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:n2=\\frac{8096}{18916}\\:\\times\\:384=\\)\u003c/span\u003e\u003c/span\u003e 164 of 384 participants were between the ages of 31 to 59 years.\u003c/p\u003e \u003cp\u003e Cluster sampling technique was used to recruit eligible participants until a desired sample was reached.\u003c/p\u003e\n\u003ch3\u003e2.3 Data Collection procedure\u003c/h3\u003e\n\u003cp\u003eThe study used interviewer-administered structured questionnaires to obtain quantitative data on self-reported Khat consumption, Khat chewing patterns and the associated factors (\u003cb\u003esee attached Data tool 1\u003c/b\u003e) whereas the self-reported health effects of Khat use (among the Khat users) were obtained using a 5-point Likert scale as adopted from WHO steps instrument guide for NCDs 2020 (\u003cb\u003esee attached Data tool 2\u003c/b\u003e). Responses were collapsed dichotomously with agree/strongly agree responses coded as an endorsement and all other responses (neutral/disagree/strongly disagree) coded as not endorsing the proposed effect of Khat use on each specified health outcome.\u003c/p\u003e\n\u003ch3\u003e2.4 Statistical Analysis\u003c/h3\u003e\n\u003cp\u003eThe Statistical Package for Social Sciences (SPSS) version 27.0 was used for both descriptive statistical analysis to obtain prevalence of Khat use, self-reported health effects of Khat use and also inferential statistics to assess the associated factors of Khat chewing at bivariate and multivariate regression analysis. Statistical significant association was set at a p-value of \u0026le;\u0026thinsp;0.05.\u003c/p\u003e\n\u003ch2\u003e2.5 Ethical Approval\u003c/h2\u003e\n\u003cp\u003eEthical clearance was sought from Institutional Research Ethics Committee of Kampala International University (KIU-REC). Ethical approval and accreditation number: KIU-2024-295.\u003c/p\u003e"},{"header":"Study Results","content":"\u003cp\u003e\u003cb\u003e3.1 Socio-demographic characteristics of study participants\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe study showed that most (94.3%) of the participants were male, over half (57.3%) were aged 18\u0026ndash;30 years and about (40.1%) had attained secondary level education. About 45.3% of participants were singles by marital status, over half (53.6%) were Moslems by religion and majority (52.6%) were living alone. Finally, about 44.3% of participants were commercial cyclists by occupation and most (47.7%) of them were earning a monthly salary of UGX 100,000\u0026ndash;300,000 \u003cb\u003e(See Fig.\u0026nbsp;01 below).\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e3.5. Factors Associated With Khat Consumption\u003c/b\u003e\u003c/p\u003e\u003cp\u003eAt bivariate analysis, it was age 18\u0026ndash;30 (9.5%), age 31\u0026ndash;43 (17.0%), primary education (14.4%), being divorced (19.0%), being a Moslem (24.6%), being a traditional believer (34.8%), being a driver (17.1%), being a commercial cyclist (14.9%), staying with your own family (61.6%), staying with relatives (72.3%), staying with friends (71.2%) or staying alone (76.6%) that increased the tendency to use Khat among the residents of Bushenyi-Ishaka municipality. On the contrary, having secondary education (14.1%), earning between UGX 100,000 - \u0026lt;300,000 (19.1%) or earning more than UGX 600,000 (31.9%) per month decreased the tendency to chew Khat among the resident of the municipality \u003cb\u003e(see Table\u0026nbsp;05 below).\u003c/b\u003e\u003c/p\u003e\u003cp\u003eAt multivariate analysis, age 18\u0026ndash;30 (18.9%), age 31\u0026ndash;43 (20.5%), primary education (22.1%), being a traditional believer (22.1%), staying with own family (61.4%), staying with relatives (70.1%), staying with friends (78.3%), staying alone (70.5%), being a driver (34.8%) or merchant (35.6%) by occupation increased the tendency to chew Khat among the residents of the municipality whereas being a student (93.4%) and earning a monthly salary of UGX 100,000 and above (97.6% \u0026minus;\u0026thinsp;138.2%) decreased the tendency to chew Khat among the residents of Bushenyi-Ishaka municipality \u003cb\u003e(see Table\u0026nbsp;05 below).\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e3.3 Pattern of Khat Consumption\u003c/b\u003e\u003c/p\u003e\u003cp\u003eAmongst the participants who reported chewing Khat, majority reported supply of Khat from Khat vendors (78.5%); most had chewed Khat for a period of more than 6months to 3 years (64.6%); mainly chew one bundle per session (53.8%); chew 4\u0026ndash;6 times a week (66.2%); use between UGX 5000\u0026ndash;10,000 per single consumption (53.8%) with a monthly average ranging between UGX 100,000\u0026ndash;150,000 (53.8%) whereas all those who reported Khat chewing mentioned taking a period of more than 2 hours during the chewing session. Regarding the other substances consumed alongside Khat, majority of the Khat users mentioned chewing gum (53.8%) and most mentioned reasons for Khat chewing was to be alert (76.9%) as portrayed (\u003cb\u003eSee table 02 below\u003c/b\u003e).\u003c/p\u003e\u003cp\u003e\u003cb\u003e3.4 Health Related Effects of Khat Consumption\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe explored health related impacts ranged from CVS effects to GIT, GUS and CNS effects assessed using a standard five point likert scale of Agree, Strongly agree, Neutral, Disagree and Strongly Disagree respectively scored from 1\u0026ndash;5. The most confirmed health related effects of Khat use were GUS effects with a mean of 2.0578\u0026thinsp;\u0026plusmn;\u0026thinsp;0.442 followed by the CVS effects (1.9809\u0026thinsp;\u0026plusmn;\u0026thinsp;0.270) while the least confirmed health related effects were CNS ones with a mean of 1.9297\u0026thinsp;\u0026plusmn;\u0026thinsp;0.158. Generally, most participants confirmed (median\u0026thinsp;=\u0026thinsp;2.000) the occurrence of the assessed health effects after Khat use. The mean health effects for CVS, GIT, and GUS were skewed to the right while that CNS ones was skewed to the left. Minimum mean score for the health related effects ranged between Agree and strongly agree (1.40) while the maximum mean score for the health related effects ranged from neutral to disagree (3.40) with variations between the type of health effects assessed (\u003cb\u003esee table 03 below\u003c/b\u003e). However during the regression analysis, it was only CVS health related effects which portrayed a positive and significant association (\u0026szlig; =0.201; P\u0026thinsp;\u0026lt;\u0026thinsp;0.001) to Khat use (\u003cb\u003esee table 04 below\u003c/b\u003e).\u003c/p\u003e"},{"header":"Discussion of Results","content":"\u003cp\u003e\u003cb\u003e4.1 Prevalence of Khat consumption among study participants\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThis study showed 16.9% Lifetime prevalence of Khat consumption. This was higher than the lifetime pooled prevalence of Khat use in SSA (14.5%) among the youth [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. However, this was lower that a 44.6% lifetime prevalence of Khat use in Kenya [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e], a 26.7% lifetime prevalence of Khat use in Ethiopia [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e] and a 21.4% lifetime prevalence of Khat use in South Africa [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eFurther, the study indicated a 15.1% Current prevalence of Khat Chewing which was higher than a 12.5% current prevalence of Khat use in South Africa [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. However, this was lower than a 24.5% current prevalence of Khat use in Kenya [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] and a 17.5% current prevalence of Khat use in Ethiopia [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. By and large, the prevalence of Khat use were lower than in most of other areas of study, which could be because Ishaka \u0026ndash; Municipality is a growing town as compared to where related studies have been conducted. We also noted a slight decline in Khat chewing by 1.8% (from 65 to 58 users in 384 study participants). This could be because of failure of users to sustain the expenses, discouraging health related effects and changes in social status.\u003c/p\u003e\u003cp\u003e\u003cb\u003e4.2 Health related Effects of Khat Use among study participants\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThis study showed that the most reported health related effects of Khat use were GUS effects with a mean of 2.0578\u0026thinsp;\u0026plusmn;\u0026thinsp;0.442, followed by CVS effects with a mean of 1.9807\u0026thinsp;\u0026plusmn;\u0026thinsp;0.270. While the least reported health related impacts were CNS effects with a mean of 1.9297\u0026thinsp;\u0026plusmn;\u0026thinsp;0.158. A regression analysis with β-coefficient revealed that only CVS health related effects were positively associated to Khat use (β\u0026thinsp;=\u0026thinsp;0.201, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). This was Consistent with Studies in Ethiopia [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e], Kenya [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e], and Tanzania [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e] where erectile dysfunction, decreased libido, urinary retention and sexual dysfunction among men were respectively reported GUS health effects of Khat use. Also, agreed with a study in Tanzania [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e] where Khat use was significantly associated with CVS effects such as High Blood pressure and heart disease. However, This Contrasted with studies in Ethiopia [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] and Uganda [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e] where CNS effects such as depression, anxiety \u0026amp; stress were most reported among Khat users. Also, deviated from findings of a study in Tanzania [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e] where CVS effects were the least reported health related effects of Khat use. This disparity in results of reported health effects of Khat use could be due to difference in assessment tools and subjectivity in response. Also, the duration of Khat use among participants was relatively short to notice CNS effects which are usually long term in nature.\u003c/p\u003e\u003cp\u003e\u003cb\u003e4.3 Factors associated with Khat Use among study participants\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThis study revealed that Khat use was positively associated with Age 18\u0026ndash;43 years, though there was a greater association for adults aged 31\u0026ndash;43years. This was consistent with a systematic review [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] where there was a positive association between advancing age and Khat use globally. Also, agreed with results of a review in SSA [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e] and findings from a cross sectional study in Uganda by [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. This could be linked to socio-generational drive, ability to afford cost \u0026amp; sustain use of Khat.\u003c/p\u003e\u003cp\u003eThis study also indicated that Khat use was positively associated with primary level of education and negatively associated with secondary level of education. This was consistent with findings of a world Drug Report (2019) which revealed that lower education was positively associated with Khat Use and a study [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e] in Tanzania that showed that Higher education level was negatively associated with Khat Use. This could be due to improved knowledge \u0026amp; awareness on health effects of Khat use with higher levels of education.\u003c/p\u003e\u003cp\u003eFurther, the study indicated that Divorced study participants had increased chances of Khat use compared to their married counterparts. This was consistent with results from a review in SSA [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e] where Divorce was positively associated with Khat Use and findings of studies in Ethiopia [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. However, this contrasted with a study [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e] \u0026amp; [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e] which indicated that there was No significant association between divorce and Khat Use. This could be connected to psychosocial frustration \u0026amp; coping mechanisms in divorced individuals.\u003c/p\u003e\u003cp\u003eOn religious affiliation, the study revealed that Khat use was positively associated with traditional beliefs. This was consistent with a systematic review [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e] which indicated that traditional belief was positively associated with Khat Use globally and Findings in Tanzania [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. However, this contrasted with a study [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] which indicated that there was No association between traditional belief \u0026amp; Khat use. This could be linked to a ritualistic activity or due to traditional belief in Khat as herbal remedy.\u003c/p\u003e\u003cp\u003eBesides, Khat use was found to be positively associated with drivers. This was consistent with: Findings of a systematic review [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e] and a study in Uganda where drivers had higher odds of Khat use [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. However, this contrasted with a study in Uganda that indicated that there was no association between Driving and Khat Use [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Drivers, especially long distance drivers and those who drive day \u0026amp; night could be chewing Khat more to keep alert while driving.\u003c/p\u003e\u003cp\u003eFinally, Khat use was negatively associated with high income level. This was consistent with studies in Ethiopia where users from High income had lower odds of Khat Use [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. This also agreed with a cross sectional study in Uganda [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. This could be linked to social stigma, occupational constraints and alternative leisure activities and coping mechanisms of persons with high income.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe study concludes that life time and current prevalence of Khat consumption was 16.9% and 15.1% respectively. Khat users mostly reported GUS and CVS health effects, and least reported CNS health effects. Only CVS Health effects were positively associated with Khat chewing. Khat chewing was significantly associated with advancing age, primary education level, divorce marital status, traditional beliefs, driving or merchant occupation as well as high monthly income earnings.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical Approval and Consent to participate\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical clearance was sought from Institutional Research Ethics Committee of Kampala International University (KIU-REC). Ethical approval and study accreditation number: KIU-2024-295. Data collection and the entire research process proceeded with reference to the Helsinki guidelines were; respect for individuals (the residents of Bushenyi-Ishaka Municipality) and the right to make informed decisions (study participants) were strictly adhered to. Participation in study was voluntary with written informed consent obtained from all study participants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent of publication\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable since no images or patient\u0026rsquo;s information has been included in this manuscript.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of Data and Materials\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe dataset used to establish these findings can be availed on request. The corresponding author should be contacted via email and such request forwarded to his address as stated in the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of Interest\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that there is no conflict of interest regarding the publication of this paper.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was funded by Kampala International University under the Staff Development Scheme Scholarship (Ref No. KIU/HR/APPT/01.04.21-034).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll Authors contributed to the study. The corresponding Author (Ahumuza Nicholus Mavine) conceptualized the study, proposed the study design, and was involved in data collection and analysis and writing of the manuscript with support from the listed co-authors. Co-authors include; Mathew C Igwe participated in conceptualization of study and design, results interpretation, manuscript drafting and review. Bot Yakubu Sunday participated in conceptualization of study and design, results interpretation and manuscript approval. Idehen Iyore Charles participated in conceptualization of study and design, results interpretation and manuscript approval. Malemo Herbert participated in data analysis and interpretation, manuscript drafting and review. \u0026nbsp; Isa Asiimwe participated in data analysis and interpretation, manuscript drafting and review. Solomon A Mbina in conceptualization of study and design, results interpretation, manuscript drafting and review. Umar Ibrahim participated in conceptualization of study and design, results interpretation, manuscript drafting and review. All Authors participated in manuscript review and approval.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eI acknowledge the Chairperson Board of Trustees (Al-haji Hassan Basajja Balaba) for Kampala International University for funding my study, Outstanding Member of Doctoral Committee of Public Health (Dr. Tamale Andrew, Dr. Glory Nja and Dr. Nicholas Ngomi), Departmental Members of academia, my family and Colleagues for their respective support in this study.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAl-Motarreb A, Al-Habori M, Broadley KJ. Khat chewing, cardiovascular diseases and other internal medical problems: The current situation and directions for future research. J Ethnopharmacol. 2010;132(3):540\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOdenwald M, Klein A, Warfa N. Introduction to the special issue: the changing use and misuse of khat (Catha edulis)\u0026ndash;tradition, trade and tragedy. J Ethnopharmacol. 2010;132(3):537\u0026ndash;9. 10.1016/j. jep.2010.11.012.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFeyissa AM, Kelly JP. A review of the neuropharmacological properties of khat. Progress Neuro-psychopharmacol Biol Psychiatry. 2008;32:1147\u0026ndash;66.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePatel NB. Khat (Catha edulis Forsk) \u0026ndash; And now there are three. Brain Res Bull. 2019;145:92\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWorld Health Organization (WHO). (2014). Khat chewing in Yemen:turning over a new leaf 86(10): 737\u0026ndash;816.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWorld Health Organization. (2018). Khat Use in Subsaharan Africa: A review of Prevalence, pattern and factors associated to Khat use.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNakimuli A, et al. Khat use and associated factors among youth and adults in Uganda. J Subst Use. 2018;23(5):462\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWorld Health Organization (WHO) Expert Committee on Drug Dependence. Assessment of Khat (Catha edulis Forsk). 2006. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://www.who.int/medicines/areas/quality_safety/4.4KhatCritReview.pdf\u003c/span\u003e\u003cspan address=\"http://www.who.int/medicines/areas/quality_safety/4.4KhatCritReview.pdf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. [Last cited on 2014 Aug 20].\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBorelli S. Social aspects of drug use in Djibouti: the case of the leaf of Allah. J Afr Econ. 2009;18(4):555\u0026ndash;91.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBasker GV. A review on hazards of khat chewing. Int J Pharm Sci. 2013;5(3):74\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNakajima M, Jebena MG, Taha M, Tesfaye M, Gudina E, Lemieux A, al'Absi M. Correlates of khat use during pregnancy: A cross-sectional study. Addict Behav. 2017;73:178\u0026ndash;84.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTesfaye E, Krahl W, Alemayehu S. (2020). Khat induced psychotic disorder: case report. Substance Abuse Treatment, Prevention, and Policy, 15, 1\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBeckerleg S. Idle and disorderly\u0026rsquo; khat users in Western Uganda. Drugs: Educ Prev Policy. 2010;17(4):303\u0026ndash;14.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOchieng A, Muthuri SK, Oyugi R. Khat Chewing Habits and associated Socio-demographic Factor among Kenyan Children. J Orthod Orthognathic Surg. 2020/;4(2):1\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLakew A, et al. Prevalence of catha edulis (khat) chewing and its associated factors among ataye secondary school students in northern shoa, Ethiopia. Adv Appl Sociol. 2014;4(10):225.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePatel NB. Natural Amphetamine Khat: A Cultural Tradition or a Drug of Abuse? Int Rev Neurobiol. 2015;120:235\u0026ndash;55.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMbwambo JS, et al. Khat Use and Associated factors among youth and adults in Tanzania. J Subst use. 2018;24(2):154\u0026ndash;60.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBennett R, et al. Khat Use ans Associated Factors among adults in Kenya. J Subst Use. 2019;25(1):34\u0026ndash;41.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAl-Mamum A, et al. Khat Use and Tranditional beliefs among Adults: A systematic Review. J Subst Use. 2019;24(2):147\u0026ndash;53.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eUganda Bureau of Statistics. 2019, The National Population and Housing Census 2014 \u0026ndash; Main Report, Kampala, Uganda.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKinyanda E, Owoaje ET, Odejide OA. Khat Use and Its associated factors among University Students in Ethiopia. Subst Abuse Rehabilitation. 2018;9:1\u0026ndash;8. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.4137/SART.s34071\u003c/span\u003e\u003cspan address=\"10.4137/SART.s34071\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 01\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eshowing Khat Consumption among the participants\u003c/div\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eVariable\u003c/div\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eFrequency\u003c/div\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e%\u003c/div\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eEver Chewed Khat\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eYes\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e65\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e16.9\u003c/span\u003e\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eNo\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e319\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e83.1\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eCurrently Chewing Khat\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eYes\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e58\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e15.1\u003c/span\u003e\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eNo\u003c/div\u003e\n \u003cdiv class=\"SimplePara\"\u003eN/A\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e7\u003c/div\u003e\n \u003cdiv class=\"SimplePara\"\u003e319\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e10.8\u003c/div\u003e\n \u003cdiv class=\"SimplePara\"\u003e83.1\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eWho Introduced You to Khat Chewing\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eFriend\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e51\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e78.5\u003c/span\u003e\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eWorkmate\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e14\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e21.5\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eNobody\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e.0\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cdiv id=\"10\" class=\"btn-xs-small Annotation tooltipped\" data-position=\"top\" data-tooltip=\"\"\u003e\u003cbr\u003e\u003c/div\u003e\n\u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u0026nbsp;\u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 02\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eKhat Chewing Patterns among the Khat users\u003c/div\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eVariable\u003c/div\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eFrequency (N\u0026thinsp;=\u0026thinsp;65)\u003c/div\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e%\u003c/div\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eMeans of Khat Supply\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eFriends\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e14\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e21.5\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eKhat vendor\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e51\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e78.5\u003c/span\u003e\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eHow long been chewing Khat\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u0026gt;\u0026thinsp;6 months \u0026minus;\u0026thinsp;3 years\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e42\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e64.6\u003c/span\u003e\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e4\u0026ndash;6 years\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e15\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e23.1\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eOver 6 years\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e8\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e12.3\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eQuantity Chewed in single session\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eOne bundle\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e35\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e53.8\u003c/span\u003e\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u0026gt;\u0026thinsp;2 bundles\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e30\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e46.2\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eKhat Chewing Frequency\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eDaily\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e22\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e33.8\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e4-6times a week\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e43\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e66.2\u003c/span\u003e\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eTime spent chewing\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u0026gt;\u0026thinsp;120 minutes\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e65\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e100.0\u003c/span\u003e\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eAmount spent on single consumption\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u0026gt; UGX 5000 - UGX 10000\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e35\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e53.8\u003c/span\u003e\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u0026gt; UGX 10000\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e30\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e46.2\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eAverage amount spent per month\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u0026gt;UGX 100000 - UGX 150000\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e35\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e53.8\u003c/span\u003e\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u0026gt; UGX 150000\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e30\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e46.2\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eSubstance used together with Khat\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eAlcohol\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e22\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e33.8\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eChewing gum\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e35\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e53.8\u003c/span\u003e\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eCigarette\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e8\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e12.3\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eReason for chewing Khat\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eTo be alert\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e50\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e76.9\u003c/span\u003e\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eTo be accepted by peers\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e15\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e23.1\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable id=\"Tab3\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 03\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eDescriptive Statistics of health Effects of Khat consumption\u003c/div\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eCVS Effects\u003c/div\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eGIT Effects\u003c/div\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eGUS Effects\u003c/div\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eCNS Effects\u003c/div\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eN\u0026thinsp;=\u0026thinsp;65\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e65\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e65\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e65\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e65\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eMean\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e1.9807\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e1.9560\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e2.0578\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e1.9297\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eMedian\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e2.0000\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e1.9000\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e2.0000\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e2.0000\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eStd. Deviation\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e.26989\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e.20043\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e.44204\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e.15833\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eSkewness\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e.061\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e.571\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e.758\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u0026minus;\u0026thinsp;.207\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eStd. Error of Skewness\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e.125\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e.125\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e.125\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e.125\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eMinimum\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e1.40\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e1.60\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e1.40\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e1.50\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eMaximum\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e2.60\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e2.50\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e3.40\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e2.50\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\"\u003e\u003cspan type=\"Italic\" class=\"Italic\" name=\"Emphasis\"\u003eN\u0026thinsp;=\u0026thinsp;65participants who have ever used Khat were used to assess Health effects of Khat consumption\u003c/span\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003cdiv align=\"left\" class=\"colspec\"\u003e\u003cbr\u003e\u003c/div\u003e\u003cbr\u003e\n\u003c/div\u003e\n\u003cdiv\u003e\u003cspan type=\"Italic\" name=\"Emphasis\"\u003eTable 04: Linear regression analysis of health-related effects of Khat use and Khat use\u003c/span\u003e\u003c/div\u003e\n\u003ctable border=\"1\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"3\" rowspan=\"2\"\u003e\n \u003cdiv\u003eVariable\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cdiv\u003eUnstandardized Coefficients\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv\u003eStandardized Coefficients\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cdiv\u003et\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cdiv\u003eSig.\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv\u003eB\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv\u003eStd. Error\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv\u003eBeta\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\" rowspan=\"4\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv\u003eCVS EFFECTS\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv\u003e0.280\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv\u003e0.071\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv\u003e0.201\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv\u003e3.949\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv\u003e\u003cspan type=\"Bold\" name=\"Emphasis\"\u003e\u0026lt;\u0026thinsp;0.001\u003c/span\u003e\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv\u003eGIT EFFECTS\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv\u003e-0.023\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv\u003e0.095\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv\u003e-0.012\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv\u003e-0.242\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv\u003e0.809\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv\u003eGUS EFFECTS\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv\u003e-0.042\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv\u003e0.043\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv\u003e-0.049\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv\u003e-0.958\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv\u003e0.339\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv\u003eCNS EFFECTS\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv\u003e0.001\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv\u003e0.120\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv\u003e0.000\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv\u003e0.005\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv\u003e0.996\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable id=\"Tab4\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 05\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eshowing regression analysis of socio-demographic factors and Khat chewing\u003c/div\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eVariable\u003c/div\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"4\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eEVER CHEWED KHAT\u003c/div\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eBivariate Analysis\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eMultivariate Analysis\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eCoefficients (\u0026szlig;)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eP-value\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eCoefficients (\u0026szlig;)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eP-value\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eGender Male\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.158\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.055\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eFemale\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eRef.\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eAge (years) 18\u0026ndash;30\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.095\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e0.046\u003c/span\u003e\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.189\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e0.001\u003c/span\u003e\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e31\u0026ndash;43\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.170\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e0.004\u003c/span\u003e\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.205\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e0.002\u003c/span\u003e\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e44\u0026ndash;56\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eRef.\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eRef.\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eEducation Level No formal\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.044\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.435\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.124\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.240\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003ePrimary\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.144\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e0.014\u003c/span\u003e\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.221\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e0.006\u003c/span\u003e\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eSecondary\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e-0.141\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e0.003\u003c/span\u003e\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e-0.057\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.363\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eTertiary\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eRef.\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eRef.\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eMarital Status Married\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eRef.\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eRef.\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eSingle\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.029\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.522\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.142\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.126\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eSeparated\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e-0.022\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.702\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.052\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.562\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eDivorced\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.190\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e0.027\u003c/span\u003e\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.200\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.063\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eReligion Christian\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.037\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.647\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.089\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.254\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eMoslem\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.246\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e0.002\u003c/span\u003e\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.142\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.088\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eTraditional\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.348\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e\u0026lt;\u0026thinsp;0.001\u003c/span\u003e\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.221\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e0.014\u003c/span\u003e\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eOthers\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eRef.\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eRef.\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eLives with\u0026hellip;.. Family\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.616\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e\u0026lt;\u0026thinsp;0.001\u003c/span\u003e\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.614\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e\u0026lt;\u0026thinsp;0.001\u003c/span\u003e\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eRelatives\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.723\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e\u0026lt;\u0026thinsp;0.001\u003c/span\u003e\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.701\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e\u0026lt;\u0026thinsp;0.001\u003c/span\u003e\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eFriends\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.712\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e\u0026lt;\u0026thinsp;0.001\u003c/span\u003e\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.783\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e\u0026lt;\u0026thinsp;0.001\u003c/span\u003e\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eParents\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eRef.\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eRef.\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eAlone\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.766\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e\u0026lt;\u0026thinsp;0.001\u003c/span\u003e\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.705\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e\u0026lt;\u0026thinsp;0.001\u003c/span\u003e\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eOccupation Civil servant\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eRef.\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eRef.\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eStudent\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.110\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.142\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e-0.934\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e\u0026lt;\u0026thinsp;0.001\u003c/span\u003e\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eDriver\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.171\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e0.008\u003c/span\u003e\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.348\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e\u0026lt;\u0026thinsp;0.001\u003c/span\u003e\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eCommercial cyclist\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.149\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e0.009\u003c/span\u003e\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e-0.030\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.703\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003ePeasant\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e-0.045\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.624\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e-0.069\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.526\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eMerchant\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e-0.194\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.070\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.356\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e0.006\u003c/span\u003e\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eMonthly income (UGX) \u0026lt;100,000\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eRef.\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eRef.\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e100,000 - \u0026lt;300,000\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e-0.191\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e0.004\u003c/span\u003e\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e-0.976\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e\u0026lt;\u0026thinsp;0.001\u003c/span\u003e\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e300,000\u0026ndash;600,000\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e-0.083\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.243\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e-1.057\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e\u0026lt;\u0026thinsp;0.001\u003c/span\u003e\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u0026gt;\u0026thinsp;600,000\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e-0.319\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e\u0026lt;\u0026thinsp;0.001\u003c/span\u003e\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e-1.382\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e\u0026lt;\u0026thinsp;0.001\u003c/span\u003e\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\"\u003eEntry into Multivariate model was P\u0026thinsp;\u0026le;\u0026thinsp;0.05 at Bivariate. Thus, Age, Education, Marital status, Religion, Occupation, Monthly income and People stayed with, were taken to the multivariate model.\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n\u003c/div\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Khat Consumption, Health related Effects, Youths and Adults, Uganda","lastPublishedDoi":"10.21203/rs.3.rs-6236664/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6236664/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDespite local and national efforts against Khat use, the habit continues to escalate mainly among young people in Uganda; especially those in urban and peri-urban areas. This is compounded by limited understanding of health related effects of Khat use which could have detrimental effects to the users, their families and community as a whole. This study aimed at assessing the health-related effects of Khat (\u003cem\u003eCatha edulis\u003c/em\u003e Forsk) consumption among residents of Bushenyi-Ishaka Municipality, South western Uganda.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethodology\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA community based cross sectional study design was conducted on 384 study participants residing or working in Bushenyi-Ishaka Municipality. Using structured questionnaires and a cluster sampling method, data was obtained on Khat consumption; its patterns, health effects and associated factors. Data was analyzed using SPSS version 27.0 for both descriptive and inferential statistics. Statistical significant association was set at a p-value of ≤ 0.05.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA 16.9% and 15.1% lifetime and current prevalence of Khat consumption respectively was observed among the participants. The most reported health related effects of Khat use were GUS effects with a mean of 2.0578 ± 0.442, however it was CVS health effects which showed a significant association to Khat use (β = 0.201, P \u0026lt; 0.001). This study also showed that Khat use was positively associated with age 18–43 years (β = 0.189, P = 0.001), age 31–43years (β = 0.205, P = 0.002), primary level of education (β = 0.221, 0.006), being a traditional believer (β = 0.221, P = 0.014), being a driver (β = 0.348, P \u0026lt; 0.001) or a merchant (β = 0.356, P = 0.006) as an occupation and living with people than one’s parents (P \u0026lt; 0.001). On the other hand, Khat use was negatively associated with being a student as occupation (β= \u003csup\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/sup\u003e0.934, P \u0026lt; 0.001), and earning a higher monthly income (P \u0026lt; 0.001).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eLifetime and current prevalence of Khat consumption was 16.9% and 15.1% respectively with CVS health effects as the only positively and significantly associated health effects with Khat chewing. Khat chewing was also significantly associated with age, education level, religion, occupation, income level and type of people someone lives with.\u003c/p\u003e","manuscriptTitle":"Assessment of Health-Related Effects of Khat (Catha Edulis) Consumption Among Residents of Bushenyi-Ishaka Municipality, Bushenyi District Western Uganda","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-20 12:33:28","doi":"10.21203/rs.3.rs-6236664/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2025-05-27T14:15:29+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"108093301850405543082016817493124068696","date":"2025-05-24T13:26:19+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"129380440018442182779742384301008980665","date":"2025-05-17T07:42:28+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"48265892200830885559202132262456843671","date":"2025-05-15T07:46:54+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-05-15T07:33:32+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-05-13T08:04:48+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-03-28T11:53:20+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-03-26T16:19:09+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Public Health","date":"2025-03-26T16:18:00+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"b877fe8d-4026-4035-a89e-6e060bdb2b11","owner":[],"postedDate":"May 20th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-05-20T12:33:28+00:00","versionOfRecord":[],"versionCreatedAt":"2025-05-20 12:33:28","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6236664","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6236664","identity":"rs-6236664","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}