Prevalence of khat chewing and its effect on academic performance in

Sidama zone, Southern Ethiopia.

Andargachew Kassa1, Eskindir Loha2, Atkilt Esaiyas3

1. School of Nursing and Midwifery, College of Medicine and Health Sciences, Hawassa University, Hawassa,
Ethiopia
2. School of Public and Environmental Health, College of Medicine and Health Sciences, Hawassa University,
Hawassa, Ethiopia
3. School of Medicine, Physiology Unit, College of Medicine and Health Sciences, Hawassa University,
Hawassa, Ethiopia

Abstract
Background: Khat use is a well-established public health problem in Yemen, Arabian Peninsula, and Ethiopia. Along with its
large scale production, the magnitude of khat use is increasing among students.
Objective: This study was intended to assess the prevalence, determinants, and effect of khat use on academic performance of
high school students in Sidama Ethiopia.
Methodology: A cross-sectional study was conducted from April to June 2015. We used a stratified sampling technique to draw
a total of 1,577students. The data was collected using self-administered questionnaires and analyzed using SPSS version 20.
Descriptive statistics and logistic regression models were used to determine the prevalence, effects, and predictors of khat use.
Result: The life time and current prevalence of khat use were 14.6% and 13%, respectively. Smoking cigarette (AOR=5.1, 95%
C.I: 2.3-14.3), drinking alcohol (AOR=3.0, 95% C.I: 1.4-6.3), having a family growing khat (AOR=2.0, 95% C.I: 1.1-2.5), having
friend chewing khat (AOR=3. 95% C.I: 2.0-4.6), were some of factors that increased the odds of students’ khat use. Student’s
khat use increased the odds of student’s poor academic performance (AOR=2.1, 95% C.I: 1.1-3.9).
Conclusion: The prevalence of khat use in high khat producing districts of Sidama and its contribution to poor academic per-
formance demand prompt intervention.
Keywords: Khat, high school student, academic performance, Ethiopia.
DOI: https://dx.doi.org/10.4314/ahs.v17i1.22
Cite as: Kassa A, Loha E, Esaiyas A. Prevalence of khat chewing and its effect on academic performance in Sidama zone, Southern Ethiopia.
Afri Health Sci. 2017;17(1): 175-185. https://dx.doi.org/10.4314/ahs.v17i1.22

Introduction factor for poor oral health5, psychosis6, mental distress7,

Khat is known for its adverse health effects1,2. The grow- anemia8, poor quality of life9, disturbed sleep pattern10-12,
ing research evidence shows that khat is a risk factor for and duodenal ulcer13.
different cardio-vascular disorders such as hypertension,
ischemic heart diseases, and stroke3,4. Khat is also a risk The adverse effect of khat on reproductive health in-
cludes genotoxic and teratogenic effects on the fetus,
Corresponding author: causing low birth weight14,15. Moreover, khat also affects
Andargachew Kassa, the potency of male sexuality by affecting spermatogen-
School of Nursing and Midwifery, esis and plasma testosterone concentration14,16. Growing
College of Medicine and Health Sciences, evidence shows that khat use is one of the risk factors for
Hawassa University, Hawassa, Ethiopia taking risky sexual behaviors which fuel the widespread
Telephone: +2519-1133-8895 effect of sexually transmitted infections (STIs)especially
Fax number: +251-46-220-8755 Human Immunodeficiency Virus (HIV) infection17-19.
P.O. Box: 1650,
Hawassa, Ethiopia Besides khat’s effect on mental, physical, and reproduc-
E-mail address: akandkassa@gmail.com, tive health, it is one of the factors causing socio-econom-
andkassa@hu.edu.et ic problems. These include; social isolation, family break-
down, neglect of social responsibilities20 and spending

African Health Sciences Vol 17 Issue 1, March, 2017 175

more than half of the domestic budget on khat21. In line best systematic and rigorous literature search, there is no
with this, one study reported that khat use is associated published research report revealing the effects of khat
with specific impairments in behavioral control which production and marketing activities particularly on high
triggers conflict amongst human22,23. Moreover, khat is school students of Sidama-zone. Therefore, this study
also reported as a risk factor for poor working memo- was conducted to establish prevalence of khat use, fac-
ry24-26, poor academic performance27,28, reduced produc- tors affecting students’ khat use, and also the effect of
tivity and increased daily financial expenditure29. Despite students’ khat use on their academic performance.
these harmful consequences, the cultivation and use of
khat is on arise especially in Yemen, Arabian peninsula, Method
East Africa, and Ethiopia in particular30,31. This study is institution-based and cross-sectional in de-
sign. It was conducted from April to June 2015 to assess
In Ethiopia, khat has started to rapidly replace the pre- the prevalence and factors determining khat chewing
cious cereal, coffee, fruits and other crops found in the among high school students of Sidama zone, Southern
highlands of Ethiopia. Farmers prefer khat due to differ- Ethiopia. This study was conducted in Sidama zone. Si-
ent reasons including, it’s profitability as a cash crop than dama zone is one of the khat producing zones of Ethi-
others, less vulnerability to drought, and less labor power opia located at the Southern Nations Nationalities and
cost required for its cultivation. However, khat producing Peoples Region (SNNPR). The capital of the region is
farmers in Ethiopia start consuming khat and this cul- Hawassa town located 275 km south of Addis Ababa, the
ture is also continued expanding to the nearby secondary capital city of Ethiopia.
schools and urban dwellers29. There are 21 districts in Sidama zone among which sev-
en of them are top khat producing areas, according to
Khat or other psycho-active substance use at an early the zonal agricultural office (personal communication).
age leads to a complicated type of substance use in the Considering the proportion of farmers growing khat, the
remaining adulthood period of an individual. Youths’ first four high khat producing areas of the Zone were
substance use, therefore, contributes to the creation of included: Shebedino District, Aleta Chuko District, Dara
a community with; substance use dependence, juvenile District and Wondo Genet District. During the study
delinquencies, crimes, socio-economic and other public period, Sidama zone had 70,000 students enrolled in 40
health problems. The Magnitude of students’ khat use high schools, of which 11 high schools were in the four
in Ethiopia ranges from 13.4% to 41% for lifetime and selected districts. In total, there were 17.863 students en-
6.3%–33.1% for current (past 30 days)32. Among the top rolled in these high schools of which 8,645 were females.
students’ expressed reasons for khat use are; to get en- All districts had four high schools, except the three high
ergized for study, to stay awake or avoid sleep and to in- schools in Wondogenet. Two in each district, a total of
crease academic performance32,33. Factors increasing the eight high schools, were selected by using simple random
odds of students’ khat use include; male gender, having sampling technique.
friend chewing khat, having family members chewing
khat, Muslim religion, pocket money, living alone during Minimum sample size was determined using open EPI
school age, cigarette smoking, financial freedom, parents’ Software version 3.03. After calculating for all possible
educational levels, living in rural area, and others32,34,35. sample sizes, we selected the bigger sample size sufficient
enough to address all research objectives. The bigger
As one of the highlands of Ethiopia growing khat, Sid- sample size obtained in this study was calculated using the
amazone has a lion’s share of khat production and mar- reported proportions of khat chewing for urban(8.73%)
keting. Almost most of the districts in the zone are khat and rural (4.52%) at 95% confidence level and power of
producing. Especially, Aleta Chuko, Dale, Shebedino, 90%37. The study from which we took the proportion
and Wendo Genet districts are among the top of the list36. showed that, living in an urban area was an exposure vari-
As a result, the trend which was observed in previously able than living in rural. Thus, the calculated minimum
khat producing regions seems to happen in newly khat sample size was 1,558 high school students. Considering
producing zones29. Nevertheless, as per the investigators 6% non response, the final minimum size was determined
to be 1,655 students.

176 African Health Sciences Vol 17 Issue 1, March, 2017

The study participants were selected using stratified sam- ban” and “Rural”), father’s educational status, student’s
pling technique. participation in khat production and marketing activities,
Considering the relative size of students in each school, and student’s current khat chewing status were all com-
the sample size was distributed proportionately. Specific puted to see their effect on student’s academic status.
sections in each grade were selected by using simple ran- On the outcome variables logistic regression model was
dom sampling technique. The stratification considered fitted. Odds ratio with their 95% confidence intervals
sex and grade levels of students to allocate students pro- were computed to identify the presence and strength
portionally and on the assumption that student’s grade of association and statistical significance was affirmed if
level and sex would affect student’s khat chewing behav- p < 0.05. To minimize the effect of confounding strat-
ior. The total sample size was distributed proportion- ification was done by variables, which were assumed to
ally to the selected grades and sections based on total have a confounding effect. In addition, multivariate anal-
number of students in each year of study according ysis was used to control confounding variables. Variables
to sex. Finally, individual students fulfilling the inclusion that showed statistically significant association and main
criterion were randomly selected to be study participants. variables which could have an effect on the outcome were
The questionnaire was prepared by reviewing relevant lit- also included in the multivariate model. Those variables
eratures34,35,38. It was customized to fit the context and with P value ≤ 0.20 were all considered in the multivariate
translated to the local language Amharic and Afo-Sidamu analysis step.
so that the students could understand the questions. A
pre-test was performed on 10% of the sampled The operational definitions given to the most important
subjects at Tula High School found in Tula sub-city of variables were defined as follows. “lifetime khat use’ de-
Hawassa town. The questionnaires were distributed by fined as respondents who admitted to having ever used
trained data collectors. khat. “Current khat use” implying the proportion of stu-
dents who used khat within 30 days preceeding the date
The collected data was cleaned, coded, entered and an- of the study. ‘Poor academic performance’ denoted those
alyzed using SPSS version 20.0 statistical software. De- students who scored, in their recent past semester exam,
scriptive and summary statistics were done. Both bivar- below 50% or failed in the previous semester.
iate and multivariate logistic regression analysis was Ethical clearance was obtained from Institutional Re-
used to determine the association of each independent view Board of College of Medicine and Health Sci-
variables with the dependent variable. The outcome vari- ences, Hawassa University. To ensure voluntary par-
able ‘Students’ khat use’ was a categorical variable with ticipation of each participant, a written and signed
“Yes”/”No” re+sponse which follows a binomial distri- informed consent (assent) was obtained from each
bution. Thus we checked the effects of the co-variates student. Additionally, the confidentiality of the in-
against this outcome variable. The list of co-variates in- formation was assured by using anonymous question-
clude sex, student’s grade level, living status during school naires and by maintenance of the data in a safe and
age, parents educational level, family substance use his- protected place.
tory, peer influence, family pressure, other substance use
history, having family growing khat, participating in khat Result
production and marketing activities, amount of monthly Socio-demographic characteristics of study partici-
pocket money, and living in urban or rural area. pants.
This study included 1,577 high school students out of
We also assessed the effects of factors contributing for 1,655 sampled study participants making the response
students’ academic performance. This outcome variable rate 95.3%. The majority 479 (54.5%) of the study sub-
is a categorical variable with possible responses such as jects were male and 1,290 (79.9%) of them were 15-19
“poor academic performance” and “better academic per- years of age. The mean age of the respondents was 16.7
formance”. Student past semester grades were used to years (SD=2.3). One thousand seventy eight (68.4%) of
classify student academic performance as “Poor” if he/ the respondents were protestant Christians, followed
she scored < 50 percent and “better” if it was ≥ 50%. by orthodox (11.6%). With regard to the ethnic group
Covariates such as, sex, living area (with responses “Ur- distribution the largest proportion belongs to Sidama

African Health Sciences Vol 17 Issue 1, March, 2017 177

(85.7%). The vast majority (86.6%) students were unmar- ried where as very few (6.7%) reported currently living in
formal marital engagement (Table-1).
Table-1: Socio demographic characteristics of high school students in high khat producing
areas of Sidama Zone, Southern Ethiopia 2015

Socio demographic variables (n=1577) Frequency Percent (%)

Woreda
Wendo Genet District 198 12.6%
Aleta Chuko District 582 36.9%
Shebedino District
Grade
Grade 9 928 58.8%
Grade 10 501 31.8%
Grade 11 87 5.5%
Grade 12 61 3.9%
Sex
Male 860 54.5%
Female 717 45.5%
Age
10-14 148 9.4%
15-19 1290 81.8%
20-24 118 7.5%
> 24 21 1.3%
Religion
Orthodox 183 11.6%
Protestant 1078 68.4%
Catholic 120 7.6%
Muslim 55 3.5%
Other 109 6.9%
Marital Status
Unmarried 1366 86.6%
Married 106 6.7%
Living together 88 5.6%
Divorced or separated 11 0.7%
Widower 6 0.4%
Ethnicity
Sidama 1352 85.7%
Non ethnic Sidama 225 14.3%

Magnitude & patterns of khat chewing, substance 43(21.0%) were female students. Among those students
use, and sexual practices currently chewing khat, 64(31.2%) reported that they al-
The lifetime and current prevalence of khat use among ready developed an addiction to khat. But the vast major-
high school students of Sidama zone were 230(14.6%) ity of all students using khat, 164 (80%) reported their
and 205(13%) respectively. Out of current khat chewers desire to stop chewing khat (Table-2).

178 African Health Sciences Vol 17 Issue 1, March, 2017

Among those students currently using khat, 32(18.5%) and also when khat prices get cheaper (17.6%). Moreover
reported that they were chewing khat on a daily basis, the vast majority (63.3%) of students chewed khat for
whereas 12(5.9%) reported chewing khat 2-3 days per greater than six months. Out of this 44.1% chewed khat
week. The proportion of students who chew khat once in for greater than one year.
a week was 62 (30.2%). This makes the overall proportion This study further assessed the types of other substances
of students who chew khat on a regular basis 112(54.6%). used by high school students of Sidama zone. The find-
The remaining 93(45.4%) of students reported that they ings of this study reveal that 59(3.7%) of students report-
chew khat occasionally. The reported students’ average ed to have ever used alcohol whereas 38(2.4%) had been
financial expense for buying khat was 16.00 birr with an smoking cigarettes in their life time. The shocking finding
amount ranging from 1.00 -100.00 birr. These students with respect to cigarettes is the information that almost
also reported that they increase the amount of their khat all students who participated in this study (80%) reported
use during times of an increased khat production (20.0%) being exposed to second hand cigarette smoke (Table-2).

Table-2: Magnitudes and patterns of Sidama Zone highs school student’s khat use, alcohol
use, cigarette smoking, and sexual practices. Sidama, Ethiopia 2015.

Questions Frequency Proportion (%)

Life time khat use Yes 230 14.6%
Current khat use Yes 205 13.0%
Developed an addiction to khat Yes 64 31.2%
Want to stop chewing khat Yes 164 80.0%
Current cigarette smoking Yes 38 2.4%
Current alcohol use Yes 59 3.7%
Ever practiced sex* Yes 280 17.8%
Commit sex due to khat use Yes 56 24.4 %
Exposure to 2nd hand tobacco smoke Yes 1261 80.0%
Ever practiced sex*=> sex outside of formal marital engagement or premarital sex

The findings of this study also depicted the relationship Association of khat use with academic performance
between substance use and students’ sexual practice. In This study also examined whether students’ khat use his-
light of this 56(24.4%) reported that they have sex as tory had an influence on students’ academic performance
a result of their khat use. The overall students’ sexual or not. The multivariate logistic regression analysis re-
practice history, which was committed outside of formal vealed that there is a statistically significant association
marital engagement, was 280 (17.8%). The proportion of (AOR=2.0, 95%CI: 1.1-3.9). As per this analysis the like-
students who commit casual and unprotected sex outside lihood of performing poorly or failing in academics is
of formal marital engagement was 126(8.0%) (Table-2). two times higher for those students who were using khat
currently than those who were not chewing khat. Oth-
Reasons for khat use er factors found increasing the odds of students’ poor
The reported reasons for Sidama high school students’ academic performance include, being female (AOR=2.1,
khat use were as follows. In accordance with their rank 95%CI: 1.3-3.6), living in urban area (AOR=1.7, 95%
order the first reason mentioned was “to stay awake and CI: 1.1-2.7), and also having a father with academic status
get energized for study” (52.4%). The remaining were; of elementary education and below (AOR=1.8, 95% CI:
‘peer influence’ (27.2%), ‘ to avoid stress’ (8.4%), ‘for get- 1.1-3.1) (Table-3).
ting happiness or pleasure’ (7.9%), and ‘ due to an addic-
tion’ (4.2%).

African Health Sciences Vol 17 Issue 1, March, 2017 179

 Table 3: Binary & multiple logistic regression analysis showing factors determining
student’s poor academic performance. Sidama Zone, Southern Ethiopia 2015

Variables Academic COR (95.0%C.I.) AOR (95.0% C.I.)

Performance
Poor Better
Sex Female 40 647 1.8(1.1-2.9) 2.1(1.3- 3.6)*
Male 28 832 1 1
Living Area Urban 40 693 1.7(1.0-2.8) 1.7(1.1-2.7)*
Rural 28 816 1 1
Father’s Elementary 48 867 1.8(1.1-3.0) 1.8(1.1-3.1)*
educational & below
status High school 20 642 1 1
& above
Currently Yes 15 190 2.0(1.1-3.6) 2.1(1.1-3.9)*
chewing khat No 53 1319 1 1
Involvement in Yes 15 199 1.9(1.0-3.4) 1.7(0.9-3.1)
khat production
& marketing No 53 1310 1 1

Determinants of students khat use Those students who a had family history of khat use were
During the bivariate analysis, factors found to be signifi- two times more likely to have khat chewing than their
cantly associated with alcohol use were: sex, living alone counterparts (AOR=2.0, 95% CI: 1.2-3.0). Similarly, hav-
during school age, place of residence, having a family ing a friend who used khat increased the odds of stu-
member chewing khat, having a family member smoking dents chewing khat by three times more than those who
cigarettes, having a family growing khat, participating in didn’t have a friends chewing khat (AOR = 3.1, 95% CI:
khat production and marketing activities, drinking alco- 2.0-4.6). Most importantly, in contrast to students who
hol, smoking cigarettes, practicing sex, and having khat had never smoked (AOR=5.7, 95% CI: 2.3-14.3), smok-
user friend/s. However, during the multiple logistic re- ing cigarettes increased the risk of students’ khat chewing
gression analysis: sex, having a family member chewing by about six fold.
khat, having family member smoking cigarettes, having Similarly, students’ alcohol use also increased the risk of
a family growing khat, drinking alcohol, smoking ciga- khat chewing by three fold, as compared to the students
rettes, practicing sex, and having khat user friend/s were who did not drink alcohol (AOR=3.0, 95% CI: 1.4-6.3). In
factors associated with khat chewing at statistically signif- addition, having family growing khat was another factor
icant levels. Male students were 2.5 times more likely to that increased the risk of students’ khat use by twofold.
have a khat chewing habit than females (AOR=2.5, 95% (AOR=2.0, 95% CI: 1.1-2.5). Lastly, practicing sex was
CI: 1.6-3.8) (Table 4). another factor which increased the odds of students khat
use by two fold (AOR=2.0, 95%CI: 1.3-3.0) (Table-4).

180 African Health Sciences Vol 17 Issue 1, March, 2017

 Table 4: Bivariate and multivariate logistic regression analysis showing socio-demographic
and behavioral correlates of current khat use among high school Students of Sidama Zone
Ethiopia, June /July 2015

Variables Used khat COR AOR (95.0%

Yes No (95.0%C.I.) C.I.)
Sex Male 162 43 3.6(2.6-5.2) 2.5(1.6-3.8)*
Female 698 674 1§ 1
Living Area Urban 115 618 1.6(1.2-2.1) 1.4(0.9-2.0)
Rural 90 754 1 1
Lived alone during school age: Yes 55 150 1.6(1.2-2.3) 1.5(0.9-2.3)
No 252 1120 1 1
Family cigarette use history Yes 18 187 3.9(2.5-6.1) 1.8(0.9-3.4)
No 42 1330 1 1
Family khat use Yes 64 141 3.9(2.8-5.5) 2.0(1.2-3.0)*
history: No 142 1230 1 1
Having khat chewing Yes 85 141 6.2(4.5-8.6) 3.1(2.0-4.6)*
friend No 120 1231 1 1
Do your family grow khat Yes 151 836 1.8(1.3-2.5) 2.0(1.1-2.5)*
No 54 536 1 1
Involvement in khat production Yes 63 151 3.6(2.6-5.1) 1.6(0.9-2.4)
and marketing No 142 1221 1 1
Smoking cigarette Yes 24 14 14.2(7.2-28.1) 5.7(2.3-14.3)*
No 157 1303 1 1
Drinking alcohol Yes 32 27 9.2(5.4-15.8) 3.0(1.4-6.3)*
No 173 1344 1 1
Ever practiced sex Yes 85 195 4.5(3.3-6.2) 2.0 (1.3-3.0)*
No 110 1134 1 1
1§=Reference
*P<0.05

Discussion prevalence from this nearby khat producing district called

This study determined the prevalence, determinants and Gurage Zone, were 15.36 % and 13.25% respectively37.
effects of khat use among high school students of Sid- Compared to Ethiopian university based khat survey re-
ama zone. The study tries to prevent anticipated social ports, the prevalence for students of Sidama seems to
desirability bias by using a pre-tested self-administered fall within the documented khat use prevalence range but
questionnaire and giving adequate privacy to students lesser than the community based reports. For instance
while collecting the data using an anonymous question- university based prevalence studies conducted in Ethiopia
naire. reported khat use prevalence ranging from 13.4% to 41%
The overall life time and current prevalence of khat use for lifetime, 7% to 20.3% for past 12 months, and 6.3%
among high school students of Sidama zone were 14.6% to 33.1% current or past 30 days32. Much bigger prev-
and 13 % respectively. In contrast to other study reports alence reports noticed in Ethiopia are from one school
from outside of Ethiopia, the magnitude of khat use for survey report and other community based surveys7,34.
Sidama zone high school students seems lesser. For in-
stance the overall khat use prevalence registered in Saudi In contrast to population based research reports of Ethi-
Arabia was 24%35. opia, khat use prevalence findings from our study seem
Similarly reports from Eastern part of Ethiopia docu- lesser. To compare this, one can see the documented
mented a 25 % for life time khat use prevalence34. Other community based reports of Ethiopia which range from
school, university, and community based studies conduct- 31.7%-55.7%34,39. The differences noticed in these re-
ed in Ethiopia also reported a much higher figure than search reports may better be explained with the follow-
the reports we found among Sidama students32,34,38. For ing possible rationales. These may include, study time
instance the reported overall khat use prevalence among differences, methodological differences, availability or
Agaro high school students was 64%. This is nearly five production of khat in the studied areas, the surrounding
times bigger (64%) than the Sidama high school stu- community socio-cultural and religious context, the time
dents38. However, our finding was similar with one re- period in which khat got introduced to the local commu-
search conducted on Ataye high school students of nity, and the working legal and policy issues in the sur-
Ethiopia. The documented life time and current khat use rounding regions.

African Health Sciences Vol 17 Issue 1, March, 2017 181

One of the limitations of crosssectional surveys is their chews khat were all factors increasing the odds of stu-
inability to tell the pattern or trend of the subject under dents khat use. Most important of all these, smoking cig-
study40. In accordance with this fact, our study never tried arettes increased the risk of khat chewing by about six
to assess the pattern and the rate in which Sidama stu- folds as compared to the students who had never smoked
dents’ khat use raised from zero to 14%. Even though (AOR=6.0, 95% CI: 2.3-14.3).
further studies are required in this area, as khat is new to These study findings are in accordance with other study
the area, it is possible to understand that the prevalence reports. But unique to this study is that we considered
increased with in a short period. If this is the case, the additional factors such as having a family which grows
doubling and tripling time of the existing prevalence may khat, and students involvement in khat marketing activ-
be very soon. ities32,34,38. The result showed that both factors were sig-
nificant at the binary logistic regression analysis level.
The discovered prevalence in the area is at an alarming Especially students’ involvement in khat producing and
level and at more than sufficient level to establish khat marketing activities was significant with (COR=3.6, CI:
use as one of the public health problems of the area. 95% 2.6-5.1). However, only ‘having a family growing
As most of khat chewing students’ self-report depicted, khat’ passed the multivariate analysis. In addition, we also
most students already claimed developing an addiction to assessed the effects of ever practicing sex on students
khat. They also expressed their desire to stop chewing ‘khat use. The result denoted that students’ odd of khat
khat. Thus, this is time for action by all concerned parties. use is two times higher for those who ever practiced sex
As khat is a psycho-active substance, the reported prev- than those who didn’t. Therefore considering those mod-
alence is high enough to cause all the adverse outcomes ifiable risk factors among the list of determinants shown
mentioned in the introductory part of this article. It is above will help in designing khat use preventive programs.
also well known that using psycho-active substances in
early age leads to using various drugs and continued use Effect of khat use on student’s academic perfor-
of substances in latter life. mance
Most of studies conducted in Ethiopia and other coun-
In this study, we found only three types of substances tries reported that students are using khat for its stim-
currently used by the students. These were khat (13.0%), ulant effect. Among the self reported reasons given by
alcohol (3.7%), and cigarettes (2.4%). This finding is con- students; to wake up or avoid sleep, to get energized for
sistent with other studies. Most of the studies conduct- study, and to increase academic performance are includ-
ed in Ethiopia reported students using these three psy- ed32,34. In contrary to this, those khat chewing students in
cho-active substances32,34. Nevertheless, looking merely at our study had a poor chance of performing well in their
the size of the cigarette prevalence report is misleading. academics or in an other way had a likelihood of failing in
Because nearly all students in these districts (80%) are their academics. That means scoring below 50%.
passive cigarette smokers as a result of uncontrolled ex- Student’s poor performance as a result of khat use is
posure to second hand tobacco smoke. This report may also in accordance with other study findings. These stud-
be taken as an indicator for the communities’ exposure ies stated that khat use has an association with academic
to second hand smoke. Ethiopia has already developed a performance27,28,41. There are also other reports that doc-
policy and legal framework to safeguard citizens from ex- umented the fact that other psychoactive substance use
posure to second hand smoke. Our finding is, therefore, a also increases the odds of students’ poor academic per-
confirmation that the implementation of the policies and formance or failure in academics42.
reinforcement of the law are not to the expected level. The paradox between the emerging evidence ascertain-
ing khat’s effect for poor academic performance and the
Factors determining students’ khat use frequent motivational beliefs held by students might hap-
As the multivariate logistic regression analysis denoted, pen as a result of lack of information or getting distorted
being a male, having a family member chewing khat, information either from deeply embedded myths in the
drinking alcohol, smoking cigarettes, ever practicing sex, community or from formal or informal khat marketing
having a family growing khat, and having friend who promotional agencies.

182 African Health Sciences Vol 17 Issue 1, March, 2017

Other studies which assessed the association between alcohol ,ever practicing sex, and being male are all fac-
khat and academic performance tested to discover if tors increasing the odds of students’ khat use. Students’
there was any association and determined the level of khat use increased the odds of students’ poor academic
significance (P value) and chi squared testing28. But this performance or failing in their academics. Similarly being
study goes further to determine to what extent khat use female, living in an urban area & having a father with an
affect students ‘academic performance using the multiple academic status primary education and below are factors
logistic regression analysis and found that khat using stu- increasing students’ good academic performance.
dents had odds of failing in their academics or perform-
ing poorly by two folds more than the non-chewing stu- Recommendations
dents. But further studies like comparative cross-sectional Khat’s contribution to students’ poor academic perfor-
studies, case control, or other longitudinal studies can be mance demand prompt intervention. Formulation of
conducted to explain more about the issue and establish appropriate intervention which reduces the use of
either cause and effect or temporal relationship. As lim- khat should be everyone’s priority. Moreover, design-
itation of all cross-sectional surveys, this study didn’t in- ing an effective cessation strategy to help students with
tend to explain beyond determining the odds of students’ established khat addiction will remain the responsibility
poor academic performance due to khat use. of the students, the family, the health authorities, edu-
cation authorities, agricultural authorities and all other
This study also showed that being female, living in an stakeholders.
urban area, and having a father with educational status
of elementary and below showed students’ odds of fail- Acknowledgments
ing in their academics by about two fold more than their Primarily, we are grateful to Hawassa University for fund-
counterparts. This may be due to female students’ work ing this project and also all students participated in the
burden at domestic level, the availability of leisure centers study. We also would like to appreciate students partic-
and psycho-active substances in the urban area, and also ipated in this study and all the data collectors who tried
lack of parental mentorship and guidance from their un- their best to collect the data in difficult time and remote
educated or less educated fathers respectively. places.
Our primary research objectives were determining the
prevalence and factors affecting students’ khat use. As Conflict of interest
one of the limitations of this study we didn’t exhaustively None to declare
embrace all possible factors affecting students’ academic
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