Khat – Tradition and Addiction in the Horn of Africa

 

Sudhen Sumesh Kumar, Mahentesh. N, Sanjay. T, Bahubali. J.G

School of Nursing and Midwifery, College of Health and Medical Sciences (CHMS),

Haramaya University, Harar, Ethiopia

 

ABSTRACT:

Khat is a green leaved plant and stands the most important cash crop cultivated in the highlands of the horn of Africa and Gulf state. It belongs to plant family celastraceae and 44 different types of khat exist in the Arabian Peninsula. It has considerable social value as it is chewed by 44 million people worldwide. Khat the cash crop is considered holy and used to welcome and entertain guests, also controls soil erosion. Besides being positive it also constitutes much risky to the individuals. The medical and psychosocial effects of khat chewing depend on its capacity to lead to dependency (addiction) and to specific physical and behavioral effects. A link has also been shown to exist between khat use and increased exposure to HIV/AIDS. So the government should take necessary action to educate the public regarding the ill effects of the substance usage.

 

 

 

INTRODUCTION:

Khat is a green-leaved plant that has been chewed for its stimulant effect for centuries (1). Khat stands among the most important cash crops in Ethiopia, with strong markets domestically as well as in neighboring Somalia, Djibouti, Yemen and the Gulf State(2). Khat leaves are cultivated in the highlands of the Horn of Africa, Southern Arabia and along the East African coast. In parts of Ethiopia, Kenya, Somalia and Yemen, Khat leaves have been chewed for centuries for their mildly stimulating properties and are for many a regular part of social life, since the end of the 19th century, successive improvements to the transport infrastructure have opened up new khat markets.

 

More recently, the mass migration of people from the Horn of Africa has been associated with the spread of khat usage to neighboring countries, Europe and the rest of the world. Contemporary patterns of consumption tend to be less formal and can be more excessive (3).

 

About Khat:

Khat refers to the young and tender leaves and shoots of the khat tree (3) Catha edulis Forsk, a species belonging to the plant family Celastraceae (4) Khat has many names including ‘qat’ (Yemen), ‘jad’ or ‘chat’ (Ethiopia, Somalia), ‘miraa’ (Kenya) or ‘marungi’ (Uganda, Rwanda). (3) Khat usually grows up to 7 meters but occasionally reaches as high as 15 to 25 meters. Leaves are simple, elliptic, oblong and are glossy green above but lighter below, leathery and stiff tapering to both ends. The buds and leaves contain an alkaloid and are chewed in a fresh or dried condition as a stimulant. Flowers are small and white. The fruit is smooth and narrow splitting to release narrowly winged reddish seeds when matured. The stem is straight and slender; the bark has different colours depending on the variety and age of the stem and branches. The young branches are smooth and green to pinkish but grey and sometimes rougher and darker on older branches and stems. The root system can grow as deep and as long as 3 -5 m (2)

 

Fig 1: The Catha edulis shrub

 

Fig 2: A bundle of khat

 

Properties of khat:

The environment and climate conditions determine the chemical profile of khat leaves. In the Yemen Arab Republic, about 44 different types of khat exist originating from different geographic areas of the country (5, 6). Its taste varies from one kind to another and depends on the tannic acid content. Khat leaves have an astringent taste and have an aromatic odour. The young leaves are slightly sweet. Many different compounds are found in khat including alkaloids, terpenoids, flavonoids, sterols, glycosides, tannins, amino acids, vitamins and minerals[7-9]. The invigorating qualities of khat derive from two alkaloids, identified as cathine and cathinone, which resemble amphetamine. However, they are highly unstable and disintegrate within 72 hours (10). The leaves of khat are chewed by the people for its pleasurable stimulant action (11, 12)

 

 

EFFECTS OF KHAT:

Socio-Cultural Effects:

Khat has considerable social value (2) Worldwide, 10 million people chew khat daily (12).A further bit of early evidence of chat being first considered holy was the method of its harvest and status of its use by the people. It is said that people washed their bodies before harvesting the crop, moreover, the harvested chat was put in clean cloth (13) In Ethiopia, khat is commonly used for social recreation (14,15) It is served to welcome and entertain guests, in mourning, weddings and circumcision ceremonies and collective labor works. Khat chewing has its own associated ceremonies like smoking of incense, cigarettes and use of drinks (soft drinks, tea and milk).(2) Occupational groups such as motor vehicle drivers, truck drivers, who chew khat during long distance driving, to keep awake, also use it under a variety of other conditions. A significant number of students chew khat to be alert especially during examination periods. There is also specific usage of khat by the special sections of the community, craftsmen and farmers use khat to reduce physical fatigue and traditional healers to heal ailments (14, 15)

 

Some of the farmers consulted said that khat gives them energy and strength to accomplish a great deal of agricultural and other hard work, which they say, would otherwise be impossible. According to farmers in Hararghe where hand cultivation is extensively used in seedbed preparation and cultivation, khat chewing enables them to accomplish the work without fatigue. They also cited the additional advantage of a reduced appetite in food shortage periods. The crop also has prestige value for people who grow large quantities. Farmers in eastern Ethiopia often start chewing khat right after breakfast and work for about 3 hours without any feeling of fatigue. After lunch, they resume chewing and work through the remaining afternoon with intermittent chewing. It is evident that khat chewing competes for active working time in that the actual working hours do not exceed 6-8 hours a day. Furthermore, in areas where khat chewing is common, such as in Afar, Somali regions and Hararghe zones of Oromia Region, punctuality of business appointments is a frequent problem, as the time after lunch is usually spent in chewing Khat.(2)

 

Environmental effect:

In Hararghe khat is grown in an intensive production system. It is planted in rows on hillsides along terraces in association with different food crops, mainly annuals, and oriented against slopes. As such, khat cultivation plays key role in controlling soil erosion, which is a major threat in the area due to the undulated topography and intensive deforestation for farmland expansion and hence khat culture is considered to be the best agro forestry system practiced by farmers. Had it not been for the cultivation of khat, the erosion of topsoil would have been severe and possibly disastrous in midland areas of East and West Hararghe zones (2)

 

Economic Effect:

Khat is an important and potentially lucrative cash crop. Khat producers in Ethiopia, Kenya and Yemen have experienced a dramatic expansion of domestic and export markets over recent years. In 2003/4, khat exports are estimated to have constituted some 15 % of Ethiopia’s export earnings (3) The employment opportunity created through the cultivation of khat is very high in that large numbers of people are involved in growing, harvesting, sorting, packing, transporting, loading and unloading the commodity. The wood of the plant is commonly used for fuel and due to its resistance to termite is used in the construction of houses and fencing. It is also used for making rafters, handles of farm tools (hammers and chisels) and handles of household articles such as pots and pans, rolling pins, and to make forks, combs, spoons and for rulers.(2) Khat producers in Ethiopia, Kenya and Yemen have experienced a dramatic expansion of domestic and export markets over recent years. In 2003/4, khat exports are estimated to have constituted some 15 % of Ethiopia’s export earnings (3)

 

Medical and psychosocial effects:

The medical and psychosocial effects of khat chewing depend on its capacity to lead to dependency (addiction) and to specific physical and behavioral effects, (16) Khat use affects cardiovascular, digestive, respiratory, endocrine, and genito-urinary systems. In addition, it affects the nervous system and can induce paranoid psychosis and hypomanic illness with grandiose delusions (17).  The main toxic effects include increased blood pressure, tachycardia, insomnia, anorexia, constipation, general malaise, irritability, migraine and impaired sexual potency in men (8)

 

Table 1. Body system and suggested adverse effects of khat in Human (18)

HUMAN BODY SYSTEM	ADVERSE EFFECTS
Cardiovascular system	Tachycardia, Palpitations, Hypertension, Arrhythmias, Vasoconstriction, Myocardial Infarction, Cerebral Hemorrhage, Pulmonary Edema
Respiratory system	Tachypnoea, Bronchitis
Gastro-intestinal system	Dry Mouth, Polydipsia, Dental Caries, Periodontal Disease, Chronic Gastritis, Constipation, Hemorrhoids, Paralytic Ileus, Weight Loss, Duodenal Ulcer, Upper Gastro-Intestinal Malignancy, Oral Carcinoma,
Hepatobiliary system	Fibrosis, Cirrhosis
Genito-urinary system	Urinary Retention, Spermatorrhoea, Spermatozoa Malformations, Impotence, Libido Change
Obstetric effects	Low Birth Weight, Stillbirths, Impaired Lactation
Metabolic and endocrine effects	Hyperthermia, Perspiration, Hyperglycaemia
Ocular effects	Blurred Vision, Mydriasis
Central nervous system	Dizziness, Impaired Cognitive Functioning, Fine Tremor, Insomnia, Headaches
Psychiatric effects	Lethargy, Irritability, Anorexia, Psychotic Reactions, Depressive Reactions, Hypnagogic Hallucinations, Khat Psychosis

 

 

The khat chewing also induces excessive sexual arousal, impotence or spermatorrhoea, the end result of the habit is believed to lead to strained relations between spouses or married couples and most likely to precipitate family fragmentation and/or multiple sexual practices. Khat chewing habit may thus be postulated as one of those risky behaviors that could fuel the spread of HIV. In this regard, a link has been shown to exist between khat use and increased exposure to HIV/AIDS among prostitutes in Djibouti (19) Therefore like many other drugs of abuse could also constitute risky behavior contributing to the spread of HIV infection (20)

 

Therapeutic effect: 

In the Kenyan region where the plant originates from, the use is reported among the Meru tribe for the treatment of erectile dysfunction, malaria, influenza, vomiting and headache (4)

CONCLUSION:

The above article on Khat “The natural amphetamine” highlights the Traditional as well the addictive effect of its usuage to the individual and to the community, It also states that the various factors contributes to the underlying use of khat, Khat is a  relevant source of income for farmers and marketers in east Africa and Arabian peninsula, besides the cultural influences it also reinforces the developments of other habits leading to unnecessary expenses and waste of time among the citizens, so it is highly recommended for the government to stimulate the initiation and adoption of pragmatic actions thereby levying high taxes on the substances so the economic factor is not affected and the chewing habit of khat is reduced, It also constitutes much risky to the individuals, so the government should take necessary action to educate the public regarding the ill effects of the substance usage.

 

REFERENCES:

1.        Assessment of risk to the individuals and community in the UK; Khat (qat) Page 4.

2.        Dechassa Lemessa, UN emergencies unit for Ethiopia , Addis Ababa, June 2011 Page 2

3.        Micheal Odenwald et al, Drugs in Focus, European monitoring centre for drugs and drug addiction 2011

4.        Expert Committee on Addiction-Producing Drugs (ECDD). World Health Organ Report 34/2006/4.4.

5.        Geisshusler S, Brenneisen R. The content of psychoactive phenylpropyl and phenylpentenyl khatamines in Catha edulis Forsk. of different origin. J Ethnopharmacol 1987; 19:269-277.

6.         Al Motarreb A, Baker K, Broadley KJ. Khat: pharmacological and medical aspects and its social use in Yemen. Phytother Res 2002; 16:403-413.

7.         Cox G, Rampes H. Adverse effects of khat: A review. Adv Psychiatric Treatmt 2003; 9:456-463.

8.        Nencini P, Ahmed AM. Khat consumption: a pharmacological review. Drug Alcohol Depend 1989; 23:19-29.

9.        Kalix P, Braenden O. Pharmacological aspects of the chewing of khat leaves. Pharmacol Rev 1985; 37:149-164.

10.     Axel klein, Khat and the creation of tradition in the Somali diaspora , Drugs in society Page 56

11.     Nasir TW. Chemistry, Pharmacology, and Toxicology of Khat (Catha Edulis Forsk): A Review. Addict and Health. 2011; 3(3-4):137-49.

12.      Magdum SS. An Overview of Khat. Addictive disorders and their treatment. 2011; 10(2):72-83.

13.     Amare Getahun and A. D. Krikorian. Chat: Coffee's Rival from Harar, Ethiopia. I. Botany, Cultivation and Use, Economic Botany, Vol. 27, No. 4 (Oct. - Dec., 1973), pp. 353-377

14.     Kalix P. The pharmacology of khat. International symposium, Addis Ababa, 1984:69-73.

15.     Mekasha A. Clinical aspects of khat (Catha edulis forsk): In: Proceedings of the International Symposium on khat 1983; 77-83.

16.     Zein A. Polydrug abuse among Ethiopian university students with particular reference to khat. In: International symposium on khat 1984: 85-89.

17.     Kalix P. Khat: a plant with amphetamine effects. J Subst Abuse Treat 1988;5:163-169.

18.     Cox G, Rampes H. Adverse effects of khat: A review. Adv Psychiatr Treatm 2003;9:456-463.

19.     Ted Case Studies. Qat trade in Africa, 2000. http/www.somaliawatch.org/archive/000410201.htm

20.     World Bank, 1997. Confronting AIDS. Oxford University Press

 

 

 

Received on 16.12.2016          Modified on 25.12.2016

Accepted on 13.01.2017          © A&V Publications all right reserved