Conceptualizing problematic khat use in the Gurage community, central Ethiopia: A qualitative study

Khat leaves are chewed for their stimulant effect in many communities in East Africa and the Middle East. We aimed to understand how a range of people from a community of central Ethiopia describe problematic khat use so that we can develop a screening tool. We interviewed 40 individuals. The participants explained how they categorise khat use in terms of traditional, normal and problematic patterns. In terms of traditional use, Muslim elders were reported to chew khat for concentration during prayer .  Normal khat use was described as chewing khat to get concentration and energy to avoid being tired, to socialize and for leisure. Khat users from rural areas did not consider it to be acceptable to chew khat in public places. Problematic khat use was described by daily khat use, chewing too much, chewing before meals, experiencing craving and needing to chew khat to avoid distressing experiences. Participants also identified harmful effects of problematic khat use on the individual, including sexual problems, mental illness, and time wastage. Community-level harms of khat included work absenteeism, food insecurity, unemployment, conflicts and violence. Conclusions: The current study will inform future studies on measurement of the impact of problematic khat use and development of potential interventions to reduce problematic khat use