Prevalence of Khat Chewing and its Effects on Academic Performance among Wollega University Students

Table of Contents

DECLARATION

APPROVAL OF BOARD EXAMINERS

Acknowledgement

List of Tables

List of Figure

Abbreviations and Acronyms

Abstract

CHAPTER ONE
1. INTRODUCTION
1.1. Background
1.2. Statement of the Problem
1.3. Objectives of the Study
1.4. Research Questions
1.5. Significance of the Study
1.6. Scope and Limitations of the Study
1.7. Conceptual and operational definitions of terms
1.8. Organization of the Paper

CHAPTER TWO
2. LITRETURE REVIEW
2.1. INTRODUCTION
2.2. THEORETICAL LITRETURE REVIEW
2.1.1. The Social Development Strategy Model(SDS)
2.3. EMPERICAL LITRETURE
2.2.1. Social development strategy model Related empirical literatures
2.2.2. Reasons for khat chewing
2.2.3. Prevalence of khat chewing
2.2.4. Patterns of khat Chewing
2.2.5. Socio-demographic factors and Khat Chewing Behavior
2.2.6. Socio-Economic Factors and Khat Chewing Behavior
2.2.7. Psychological Factors and khat chewing behavior
2.2.8. Impacts of khat chewing
2.4. Conceptual Frame Work

CHAPTER THREE
3. RESEARCH METHODOLOGY
3.1. General description of the study area
3.2. Research design, Data Types, Sources and Method of Collection
3.2.1. Research design
3.3. Sampling technique and Sample Size
3.4. The Data Collection Instrument and Procedure
3.5. Method of Data Analysis
3.5.2. Econometric Models
3.6. Description of dependent and independent variables
3.7. Multiple Imputation of Survey data
3.8. Model Evaluation

CHAPTER FOUR
4. RESULT AND DISCUSSIONS
4.1 INTRODUCTION
4.2. RESULTS
4.2.1. PHASE ONE: QUANTITATIVE RESULTS
4.2.1.1. Socio-demographic characteristics Respondents
4.2.2.2. Prevalence of khat chewing
4.2.3. Determinants of Current regular Khat chewing Behavior
4.2.2.4. Predicted Value of Chained Logit Model
4.2.2.5. Effect of current regular khat chewing on academic performance
4.2.2.5.1. Discription of Students academic performance
4.2.2.5.2.Two-limit tobit model for predictors of academic Performance
4.2.2. PHASE TWO: QUALITATIVE FINDINGS
4.2.2.1. Focus Group Discussions Result
4.3. DISCUSSIONS
4.3.1. Prevalence of khat chewing
4.3.2. Determinants of current regular khat chewing behavior
4.3.3. Effect of Current regular khat chewing on academic performance.
4.4. Theory Confirmation

CHAPTER FIVE
CONCLUSSION AND RECOMMENDATION
5.1. CONCLUSSION
5.3. RECOMMENDATIONS
5.4. Policy implication

6. List of References

7. Appendices

Acknowledgement

All eulogize is due to the lord of the worlds, the all-knowing, who thought man with the use of the pen, and thought man what he knew not. Completing this thesis would not have been possible without the help and support of many people. First and foremost I am grateful to my Advisor, Dr. Anagaw Derseh for his indispensable advice and constructive suggestions starting from proposal development to final thesis. I am indebted for Ministry of Federal Affairs for supplying me a chance to learn, financial and material support throughout the study years. I am also thankful to Ethiopian Civil Service University for the partial financial support of my thesis which helped me to cover some parts of my expenses. I would like to extend my heartfelt appreciation to my research participant students and respondent farmers for agreeing to take part in the research and provided me all the necessary and relevant information, without whom this paper could have not been written. I appreciate the honest cooperation of Dr. Zelalem Abdisa the under graduate program directorate director of Wollega University. I really also appreciate the excited behavior and the good manner that he show me in creating conducive environment for data collection in all colleges of three campuses. Thanks!.My appreciation also goes to my best friend Dessalegn Iticha(Msc) department head of political and international relation at Wollega University, for his early advice on whatever academic issues and ongoing encouragement whenever I doubted myself. Without his involvement data collection from Gimbi campus was impossible, also he deserves many thanks. I have a great thanks for my friend Waktole Feyisa (Msc) economics post graduate department head he was a best reason for my success in data collection from Nekemte campus. So, he ought to have thanks! for what he have done for me. Also I have a grateful to Fiqiru Waqoya dean faculty of agriculture at Shambu campus for his swift cooperation that made challenging data collection process earlier. I would like also to express my best regards to Mr. Nigatu Hambissa, Mr. Ayele Geleta , Mr . Eliyas Feyissa, staff of Guto Gida Woreda Agriculture Office for their absolute support in facilitating in-depth interview program with farmers nearby university. Also I have a special thanks for facilitators of focus group discussion part: Desta, Mandella, Geme, Latera and Dessalegn, without their involvement identification of participant student for khat chewer group discussion was impossible. Finally, I would like to thank my family, friends and all people involved directly or indirectly for the accomplishment of this thesis.

List of Tables

Table 3.1.Variable names and labels used during analysis

Table.3.2: Variance information of MICE Model for 20 imputation

Table 4.1 :Description of Socio-demographic characteristics of respondents

Table 4.2: Prevalence of khat chewing, Wollega University, Feb. 2017

Table.4.3. Summary of responses of chewer students on frequency of khat use, amount and time consumed per each chewing session.

Table 4.5: Determinants of Current regular khat chewing behavior

Table.4.6. Descriptive summary of academic performance

Table. 4.7:Two-limit tobit model for determinants of Academic performance (CGPA)64

Table 4.8:Determinants of academic performance(SGPA) (Two-limit Tobit Model)

List of Figure

Figure 2.1 Conceptual framework

Figure 3.1.Wollega University Map

Figure3.2:Sampling procedure

Figure 4.2.Reasons for chewing khat

Figure 4.3:Time at chewing started

Figure 4.4.Initiators for khat use

Figure 4.7: Relationship between academic performance and frequency of khat use , amount and time consumed per each chewing session

Abbreviations and Acronyms

Abbildung in dieser Leseprobe nicht enthalten

Abstract

Khat is a psycho stimulant basil globally consumed by millions, regardless of gender, religion, education, profession, philosophy and occupation. A significant number of educated group of Ethiopian society engaged in chewing, mainly for intellectual stimulation and recreation. Past studies revealed that khat chewing was associated with poor academic performance among students. While khat has harmful penalty, little is known about effect of khat chewing among university students in Ethiopia. This thesis aimed to explore the prevalence, determinants and effect of khat chewing on academic performance among Wollega University students. Methodologically the study used an explanatory sequential research design. Quantitative data was gathered through University based cross-sectional survey conducted in Feb 2017 among randomly selected 358 students using multi-stage sampling technique. Moreover, the in-depth interviews (N=4)and focus group discussions (N=10) was done using semi-structured questionnaires. Binary logistic regression model was employed to identify determinants of khat chewing behavior with in a framework of imputed data and survey design analysis. Two-limit tobit regression model was used to evaluate predictors of academic performance. The study reveals that prevalence of current regular, lifetime and last semester khat chewing were 24.3%,29%and 27.4%respectively.Students who comes from khat growing area(AOR=20[0.04-0.17]),who have chewer friends(AOR=5.3[5-8.8]),who lives out of campus with friends(AOR=9.2 (3.3-5.01]), whose year of study was third year(AOR=7.4( 0.04-1.27]),students from Nekemte campus (AOR=17.8[1.6-4.8]) and students who perceived khat enhances performance(AOR=2.9[1.4-7.8]) were more likely to chew khat. It is also found that khat chewing(p<0.01) is negatively associated with academic performance of students. To hinder the problems associated with khat chewing integrated prevention approach involving students, the university officials, the surrounding community, and regulatory bodies is required.

Keywords: khat chewing, predictors, prevalence, academic performance, university students

CHAPTER ONE

1. INTRODUCTION

1.1. Background

The term Khat defines the leaves and shoots of a flowering evergreen plant species which is known as Catha edulis. It is native to eastern Africa and southern Arabia known by various names in different countries such as qat in Yemen, chat in Ethiopia, and miraa in Kenya. Khat originated in Ethiopia and spread out to Kenya, Somalia, Djibouti, Uganda, Tanzania, Zimbabwe, Zambia, South Africa, and Yemen. Although khat is not illegal in these countries, its use has been restricted recently in the Western countries such as the UK, Canada, and the United States, and it is now classified as a controlled substance (Gebissa 2010).

Compounds such as alkaloids, terpenoids, flavonoids, sterols, glycosides, tannins, amino acids, vitamins, and minerals among others are found in Khat. The principal alkaloids found in the plant are phenylalkylamines and the cathedulins (WHO 2006). It is a substance categorized with the broader class of psycho stimulants like caffeine, cocoa leaves, cocaine and other substances used for their stimulating properties such as increased movement, arousal, vigor, wakefulness, and attention (Wood, D. 2005).

The use of khat has a long history in Ethiopia, there has been dramatic increase in khat consumption after the adoption of the free market economic system in the 1990s. Although the use of khat is widespread, until recently it has remained mostly confined to the region where the plant is grown since only the fresh leaves have the potency to produce the desired effects

Millions of Ethiopians, regardless of gender, religion, education, profession, philosophy and occupation, consume khat .As Gessesse (2013) indicated an educated bracket of Ethiopian society is exposed to chewing during the high school and university years. A significant number of them engaged in chewing, mainly for intellectual stimulation and recreation.

The use of addictive substances like khat is becoming increasingly widespread in recent years especially among the youth in general and university students in particular (Tesfaye et al. 2008; Belew et al. 2000). Many argue that the use of khat is both a social and a cultural activity (Al-Mutarreb etal.2010; Manghi et al. 2009). It is widely believed to enhance social interaction, playing a role in ceremonies such as weddings.

In general, there is lack of consensus on the production and consumption of khat. Some argue that khat is an essential crop as it stimulates people to work for long hours through increased concentration (Gebissa 2010). They also emphasize the importance of khat in generating foreign exchange and creating employment opportunities (Gebissa 2004 ; Klein 2010). On the contrary, Beckerleg (2010) and Branko (2008 ) argues that khat is an addictive substance with possible negative consequences. They believe that khat use makes users careless, less accountable and irresponsible, thereby increasing social crime. In addition they indicates that khat takes a significant share of the daily expenditure of regular users and hence diverts money away from productive activities. For this reason they favor strict government control on the production and distribution of the khat plant.

"Despite the fact that khat is used by 5-10 million people daily and its importance as cash crop among producers, there has been little interest among social scientists and other researchers regarding its effect on academic performance" (Numan 2012, cited in Abafita et al. 2015 pp. 2086).

A few studies have addressed the health effects of substances like cigarettes and khat in Ethiopia, focusing on psychiatric morbidity and psychosocial problems and their association with unsafe sexual behavior (Tesfaye et al. 2008; Kebede 2002). However, there is little empirical evidence regarding prevalence and extent of khat use among students and its likely effect on academic performance. This thesis is, therefore, attempted to bridge such gaps regarding khat and its use, with specific emphasis on identifying the prevalence of khat chewing and its potential effect on students’ academic performance based on a sample of undergraduate students at Wollega University Nekemte Campus. The study examined whether khat use had an effect on students’ academic performance.

1.2. Statement of the Problem

Khat which was previously known to grow mainly in the eastern part of Ethiopia, was cultivated in all parts of the country. The main centers of production and export in the world today are in Ethiopia and Kenya ( Gezon, L.L. 2012). No khat is produced in Djibouti and little in Somalia, but, they import huge amount from Ethiopia and Kenya to meet their high consumption demand. Khat utilization, traditionally confined to a certain segment of the population become popular among all sections and khat chewing often led to abuse of illicit drugs (Kebede 2002).

The case of this plant is a confusing one and international law on this issue is unclear (Drake 1998). In Ethiopia, it is accepted as non-controllable substance and the view of the government, as some suggests, is interacting with its huge and highly growing contribution towards the Gross Domestic Product of the nation (Gessesse 2013). The natural stimulant considered to be kindly addictive and the leaf has become the country's number-two export behind coffee and become a highly valued export commodity, being marketed widely in Ethiopia. As a result the production, marketing and export of khat become more profitable, khat use seems to gain social respectability and it becomes more difficult for Governments to deal with the problem.

In relation with academic case, the habit of chewing Khat is spreading at an alarming rate among the younger generation, especially in high schools and higher institutions, where academic activity is intense (Gelaw and Haile-Amlak 2004; Mossie 2002). Khat chewer youths indifferent settings, including in colleges and universities, holding a positive view about the practice of khat use. They are usually witnessed stating the benefits of khat as: a feeling of well-being, a sense of excitement, increase energy levels, improve alertness, enhance the ability to concentrate, increase imaginative ability and capacity to associate ideas, advances social-skill and make better in work performance. Students in colleges and universities usually use Khat, claiming that it improves their academic performance.

In sight of an existence of strong synergy between human capital and economic development, it has a great importance to understand factors that affect students’ educational achievement, because academic attainment is a key determinant of human capital accumulation.

Despite the positive attitude for the practice of using khat and lack of perfect scientific evidence (Gebissa, E. 2010) on the problems related to khat use, it is certain to observe multidimensional difficulties of using khat from different groups of the community as a result of high prevalence in the practice of khat chewing. Among different groups, higher institution students are highly vulnerable groups in Ethiopia. More specifically, students in Wollega University are highly vulnerable as a result of very high widespread of Khat production and consumption in the area, and the prevalence of khat chewing centers in the nearby villages of the University campus.

A little attempt made by few scholars in Ethiopia indicated an existence of negative relationship between khat chewing and academic achievement (Abafita et al. 2015;Adugna,F.1994; Ayana, M. and Mekonnen, Z. 2004).The methodology(sampling technique, model choice) they employed lacks appropriateness, comprehensiveness and shallow. Additionally the most important variables were excluded from their analysis. In current study area until now no one investigated where a culture of khat production and consumption is a recent phenomenon. So that little is understood in detail on its prevalence and effect on academic performance.

This thesis was designed to fill this gap by examining the prevalence of khat chewing and its effect on academic performance among Wollega University students. The finding of this study had its own contribution to this less investigated issue and bridges the gap in the literature by empirically analyzing an issue through following sequential explanatory mixed research design approach, by using cross-sectional data gathered from undergraduate students.

1.3. Objectives of the Study

General Objective

This study aimed at determining the prevalence of khat chewing and its effect on academic performance among Wollega University Under graduate students.

Specific Objectives

1. To determine the prevalence of khat chewing among Wollega University students.
2. To identify the demographic and socio-economic factors responsible for Khat use among students.
3. To examine effect of khat chewing on academic performance of Wollega University students.

Hypothesis

Based on the objectives listed above, three hypotheses was developed and tasted. These are:

Null hypothesis:-

Ho: Khats chewing behavior and academic performance of students have no significant relation.

Ho: Demographic backgrounds of students and khat chewing behavior have no significant relation

Ho: Socio-economic conditions and khat chewing behavior of students have no significant relation

Alternative hypothesis:-

H1:The khat chewing behavior has a significant effect on academic performance of students.
H2: Demographic background of the students has a significant influence on khat chewing behavior of students
H3: socio-economic conditions has a significant effect on khat chewing behavior of students

1.4. Research Questions

- What is the extent of prevalence of khat chewing?
- What are determinants of current khat chewing behavior of students?
- Does khat chewing affect academic performance?

1.5. Significance of the Study

The consequence of Khat chewing is becoming beyond an individual ethical and minor health problems, rather it also affects family and cultural and development issues. Abuse of Khat has been labeled as a high cost for socio-economic development associated with unproductive and wrong behavior (NIDA 2010). It is also becoming the major reason for decreased academic performance and incompetence of the students. This will make it difficult to achieve social and economic development in the country without considering its cost on human capital formation.

This particular study is therefore important as baseline information to help stakeholders know the magnitude of the problem, and examine strategies for intervention towards control and preventions of Khat abuse and for designing a treatment and rehabilitation program. It will also be used as a basis for future studies on drug abuse studies by scholars. The findings of this study may also be useful for policy makers and contribute to source of knowledge to scholars and stakeholders in related areas. The study included producer farmers to capture the full image of factors influencing prevalence of khat chewing.

1.6. Scope and Limitations of the Study

1.6.1. Scope of the study

Wollega University has three campuses the scope of (Nekemte, Gimbi and Shambu campuses) this study was covered all three campus.

1.6.2. Limitations of the Study

During the study there might be occurrence of recall bias because respondents were required to remember events that had occurred many years ago and under reporting of khat chewing related behaviors for fear of shame and action resulting from disclosure which hinder to get pure information.

Even if, assurance of confidentiality is given to reduce personal information biased regarding experiences of pattern of khat chewing there is no full guarantee for absence of bias.

The restriction of study to regular under graduate students, can ignores extension students who are enrolled at the time of data collection and outside University youths.

Since the study design is cross-sectional, a one-time observation is difficult to determine the temporal relationships between Khat chewing behavior and academic performance.

The study was not assessed the overall socio-economic impacts ofkhat chewing; rather, the research will focus specifically on prevalence and effectof khat chewing on academic performance in the study area.

These findings of this study have a limitation in identifying possible causal relationship between khat chewing and academic performance of students. Because data collected at a point in time can only reflect association between khat chewing and academic performance. Therefore, further longitudinal research is important to identify causal relation between chat chewing and academic performance.

There was time limitation, financial problem and skill gap during data collection and analysis.

1.7. Conceptual and operational definitions of terms

Conceptual definitions

Khat - It is a stimulant drug derived from a shrub known as Catha edulis .

Licit drug: a drug that is legally available by medical prescription in the jurisdiction in question or, sometimes, a drug legally available without medical prescription (like Khat).

Marijuana: a usually illegal drug made from the dried leaves and flowers of the hemp plant which produces a feeling of pleasant relaxation if smoked or eaten.

Current user: Consumption of Khat at least once in the past 30 days prior to study.

Dependence: Increasing tolerance and the onset of withdrawal symptom .

Ever user: an individual or a student is considered as ever user even if he/she had consumed only once in his/her life time.

Prevalence: is the proportion of the students that has participated in khat chewing at a specific point in time.

Life time prevalence of khat chewing: the proportion of youth who had ever chewed khat

Current prevalence of khat chewing: proportion of youth who chew currently and have chewed in the month of data collection

Health effects: All illnesses associated with substance abuse to any person using Khat.

Regular University students: excluding students attending extension, and summer program .

The substance considered in this study is Khat.

Substance abuse: it refers to a destructive pattern of substance use, leading to significant social, occupational or medical impairments.

Substance or drug: all psychoactive substances which when taken by living organisms may modify its perception, mood, cognition, behavior or motor function.

Stickro: only khat leaf that marketed in grams(without stem).

Bar-ok: Hotel which foud in Nekemte town around board .

Arsema: khat chewing shop nearby Wollega University

Operational Definitions

A student is considered an ever chewer if he/she respond "yes" to the question "Have you chewed Khat previously?‟ Then following questions were employed to collect information such as whether or not he/she is current chewer, frequency, amount and time of starting of chewing Khat for current chewers, etc.

1.8. Organization of the Paper

This research paper was organized into five chapters. The first chapter consisted introduction, statement of the problem, objectives of the study, hypothesis, the research questions, scope and limitation of the study, conceptual & operational definitions and significance of the study. Chapter two consisted of both theoretical and empirical literature reviews and the third chapter describes the methodology which contains a description of the study area, data sources, data types and sampling techniques and the analytical tools were presented.

Fourth chapter consisted two components: the first component described the results from quantitative phase study using descriptive and econometric models and, the second component consisted qualitative phase study results . Chapter five comprised integrated discussions of quantitative and qualitative phase results, conclusion, Recommendation and policy implications of the study.

CHAPTER TWO

2. LITRETURE REVIEW

2.1. INTRODUCTION

There is a massive literature on Khat related information focusing on its history, botany, production, geographic distribution, chemistry and pharmacological, and exploring the social, economic, medical, psychological and oral aspects related to its use (Gebissa 2004, Kalix 1992 and Meampel 1992). Literatures regarding the prevalence, responsible factors, and perceived socio-economic and academic effects of Khat chewing are relatively insufficient in Ethiopian higher education institutions in general and almost unavailable in current study area. In this chapter theoretical and empirical literature that are believed to have relevance with the current study were examined according to variables of the study.

2.2. THEORETICAL LITRETURE REVIEW

2.1.1. The Social Development Strategy Model(SDS)

The Model was used for understanding youth drug use and abuse. This model is developed by scholars Hawkins and Catalano mostly helps to understand youth drugs issues through addressing risk and protective factors. According to Catalano et al. (1996) the social development model is a mixture of social learning, social control and differential association theory .The SDS identified risk factors that contribute to the development of the five most common adolescent behavioral problems, including: substance abuse, delinquency, teen pregnancy, school drop-out, and violence. According to this model, risk factors are conditions that increase the risk or likelihood that the abovementioned problems to emerge in adolescence and young maturity.

On another hand, protective factors safeguard them from exposure to risks, and hence reduce the likelihood in displaying such behavior. Both risk and protective factors encompass four spheres where young people grow up: peer and individual ( friends who engage in problem behavior, constitutional factors, etc.), school (lack of commitment in school), family ( family history of problem behavior, etc.), and community availability of drugs, etc. (Hawkins and Catalano 2005).

From the above statement factors which are predictors of the problems, the presence of protective factors can neutralize the harm that are associated with risk factors. These protective factors include: Healthy beliefs and clear standards for behavior as linked by families, schools, communities, and peer groups; strong attached bonding and relationships with at least one adult (can be parents, relative, etc.), who has healthy beliefs and clear standards for young people; individual characteristic of the young person, such as a positive social orientation, high intelligence, and resilient temperament (Ibid).

The model is concerned with the socializing processes of the children, and the process involving the following constructs: giving opportunities for children's positive and meaningful engagement, providing the skills for children to participate in these involvements, and giving recognition and corrective feedback to them as reinforcement for pro-social involvement (Ibid). From this model, it is important to note that these common risk factors would predict diverse problem behaviors, such as the five listed above. They can be present across development, with some factors becoming more striking than others depending on the course of human development. More importantly, the number of risk factors is proportional to the chance of demonstrating problem behaviors, and the presence of protective factors would neutralize such effects (Harachi, Ayers, Hawkins and Catalano 1996).

According to this model therefore, addressing these underlying problems shown in the risk factors, finding ways to minimize them, and increasing the protective factors are the most effective ways to tackle any adolescent issues including substance abuse. Furthermore, if these various factors are tackled effectively, the result would also mean that the range of adolescent problem behaviors can be reduced (Hawkins and Catalano 2005). Although SDM could explain why the youth in schools do or do not abuse drugs. Integrating all findings from literature related to the basis of youth drug abuse, it is not a single factor but a combined effect of several risk factors predisposing young people to use drugs, which can be divided into five levels in accordance with bio-psychosocial perspectives: biological determinations, youth psychological development characteristics, interpersonal elements, community variables, and societal factors.

Therefore, this thesis utilized Social development strategy model and an explained theoretical literature above as a base to identify the prevalence of khat chewing and its effect on academic performance among Wollega University students.

2.3. EMPERICAL LITRETURE

2.2.1. Social development strategy model Related empirical literatures

Research in the field of prevention science has found that the most effective methods for promoting positive youth development and preventing problem behaviors involve addressing both risk and protective factors (Hawkins, Arthur, & Catalano, 1995; Pollard, Hawkins, & Arthur, 1999) as cited in Sameroff et al. ( 1998 pp.575-576).Their study found that, at the highest levels of risk, students reporting elevated levels of protection were less likely to engage in problem behaviors than students reporting the lowest level of protection. This study also found that focusing on protective factors alone is not enough. Although students exposed to several protective factors were less likely to engage in problem behaviors than students exposed to few or no protective factors, prevalence rates of problem behaviors increased for all students as their exposure to risk increased.

The study by et al.(1998) supports the finding that youth become more likely to engage in problem behaviors as their exposure to risk increases , even when they experience high levels of protection. His work shows that flexible youth with strong problem-solving skills who lived in high-risk environments were more likely to engage in problem behaviors than youth without these protective characteristics who lived in low-risk environments.

A study by Hawkins et al. ( 1997) underlines the importance of addressing both risk and protective factors. From a sample of over 60,000 children, the study found fewer than 100 children in high-risk environments who also had high levels of protection. Furthermore, close to 0% of the children in low-risk environments had used marijuana or other illicit drugs within the past 30 days even when they were exposed to very few protective factors .From this we can understand that focusing on protective factors alone is usually not enough, because it is difficult to develop high levels of protection in the face of high levels of risk and even when children are exposed to few protective factors, risk-reduction strategies can decrease problem behaviors.

2.2.2. Reasons for khat chewing

Different studies revealed that there are various factors influencing substances abuse among students. The factors of drug taking generally have been regarded as determined by a combination of the personal characteristics of the user and the nature of the person's environment and other socio-economic factors. Among them are personal factors, family related factors, peer influence, accessibility and afford-ability of substances (in this context Khat).

Study done by Gebresilus et al.(2014) on khat use prevalence, causes and its effect on mental health at Bahirdar shows that that the majority of khat chewer students reasoned out as they use it to keep alert and to maintain concentration while reading (71.4%), the rest khat user participants reason out to maintain relaxation with friends (38.4%). Only 17.9 % of study participants used khat to minimize sleep time for their reading. In addition, other reasons of substance abuse have been highlighted as disturbance due to unemployment, academic failure, sexual failure, sexual victimization, physical abuse, poverty, lack of money for educational opportunities, homelessness, lack of food, lack of proper medical care, adolescence experimentation, keeping contact with drug addicts, and absence of parents at home due to working, incarceration, separation or divorce (Bry, Cataglano and EMCDDA 2010;Behrman and Wolfe 2006).

2.2.3. Prevalence of khat chewing

According to evidences from different studies, the prevalence of Khat chewing varies from country to country. Many studies were identified with different study samples like community and national samples; clinical samples; and homogenous samples. Accordingly, the recent national study carried out by World Bank (2007) in seven Governments of Yemen among 4027 Yemeni showed that the prevalence of Khat chewing, among age group 12 years and above, was 54.6%.

Khawaja et al. (2008) work in random national survey that recruited 11435 female age 15-49 years from the data of Yemen Demographic and Mental and Health Survey reported the prevalence of Khat chewing as 40.7%.The national survey prevalence for Kenya and Somalia were 4.1% and 36.4%, respectively (Odenwald et al. 2007a ; Mwenesi 1996).

Regarding clinical samples of all age groups in a study carried out in four different establishments in Yemen for assessing the periodontal status of Yemenis, a prevalence of Khat chewing was estimated as 35.8% (Mengel et al. 1996). However, Ali et al (2004) in a recent survey among 2500 Dental School at tenders in the capital of Yemen (Sanaa), the prevalence of Khat chewing was reported as 61.1%. But, the figures reported by Othieno et al. (2000) from different Kenyan rural and urban Health Center attenders were 10.7%.

The study done by Teni et al.(2016) among students of a college in Gondar shows the lifetime prevalence of Khat chewing among the respondents was 42.0% (168/400) with the current prevalence being 32.5% (130/400).

The assessment done by Gadissa,M. (2014 ) at Ambo University Weliso campus among under graduate students shows that the prevalence of khat chewing was higher as regardless of sex, age ,academic status and year of study ,students highly chew khat. A study carried out by Dayessa et al. (2009) in Butajira district in Ethiopia among 15-49 years 3016 female samples revealed that the prevalence of Khat chewing as 52.5%. The result for Khat chewing for the whole population of the capital Addis Ababa was reported as 8.7% (Tesfaye et al. 2008). Research by Kebede et al. (2005) among in-school and out-of school 20434 youth age 15-24 years in different region of Ethiopia, showed prevalence of Khat chewing at 15.3%.

The study by Ayana et al. (2004) in Ethiopia among University students of 472 revealed that the prevalence of chewing Khat as 24%. In line with this, the prevalence has been estimated among a random sample of 1258 respondents of somalia. This difference may be seen because of the difference in subjects and geographical location of the study area. On the other hand, a study college of Gonder Medical science in North West students aged 17-24 years of 1103 samples as 17.5% (Kebede 2002).

On the other hand for the community studies, Belew et al. (2000), in a nine months community based study in Ethiopia south Addis Ababa rural and urban district, among random samples of 1200, reported that the current prevalence of Khat chewing as 31.7% (18.5% for urban and 37.9% for rural respectively). Alem et al. (1999) in house to house study in rural area of Butajira, mostly populated with Muslims, found that the prevalence of current Khat chewing was 50%. A study by Ayana et al (2002) showed the prevalence of Khat chewing in the town of Jimma was 31.6%.

In Ethiopia the estimates of Khat chewing among younger age group either at university, schools or out of school was reported as 5.6%-64.9% (Maru et al. 2003; Adugna et al. 1994).The national survey prevalence for Ethiopia is 30.5 % (Selassie and Gebre 1996). Adugna et al. (1994) among 248 secondary schools students grade 9-12 in Agaro South Western Ethiopia reported high prevalence (64.9%) of Khat chewing.

2.2.4. Patterns of khat Chewing

The explanation of Khat chewing frequency in the literature is varied. World Bank (2007) survey in Yemen reported that Khat chewing more than three days per week as addictive (total 38.7% and 10% for female) and balanced chewing as 1-2 days or less (15.3%). Numan (2004) reported Khat chewing as once a week or less as occasional (16.2%), 2-3 days as light (29.9%), 4-6 days frequent (19.1%) and every day as heavy (34.8%). Patel et al. (2005) and Griffiths et al.(1997) reported as 10% and 6% Somalis chewed currently Khat on daily basis in four cities in the UK and East London-UK. Griffiths et al. (1997) reported less than seven days chewing as less frequent.

The details of Khat chewing frequency in the literature is mixed for Ethiopia. Abafita et al.(2015) define heavy users as those who use khat more than 4 days a week, who use 2-3day per week as medium users, while light users are those who use khat one day a week. Finding shows both medium users and heavy users had significantly lower grades in terms of Cumulative GPA, with the magnitude for heavy use being larger. For semester GPA, medium users were found to perform better (on average attaining 0.437 points higher) compared to light users; however there was no statistically significant difference among heavy users and light users.

Teni et al.(2016) found that the the pattern of khat chewing among students of college in Gondar town, of the total 130 respondents who chewed Khat 59.2% (77/130),who accounted for the majority, started the practice in college. As to the frequency of Khat chewing, the most common was once a day, reported by 33.1% (43/130) of the Khat chewers. The substances used together with or associated to Khat included alcohol, 40.8% (53/130) and cigarette 40% (52/130)as the most common ones reported by the respondents. A considerable proportion of respondents also reported they used Hashish, 13.1% (17/130) in relation to their Khat chewing practices.

As to the time spent on a typical Khat chewing activity session, most of the chewers, 53.8% (70/130) reported they spent duration of 1-4 h followed by those who reported they spent 5-8 h.

Kebede et al. (2005) investigated the use of Khat among in school and out of school children through using the less than once a week (2.1%), once a week (11%) and every day Khat chewing (7.7%). Ayana and Mekonen (2004) defined the pattern of Khat chewing every day as regular (44%) and once a week (29.9%) occasional (25.6%). Belew et al. (2000) reported current habitual Khat chewing as daily (the prevalence as 17.9%), and more frequently as occasional (82.1%).

2.2.5. Socio-demographic factors and Khat Chewing Behavior

Literatures showed that the prevalence of Khat chewing is different across socio-demographic factors (gender, age, religion, occupation status, and place of residence). The studies of prevalence of Khat chewing in the Diaspora and Khat producing countries like Ethiopia and Yemen showed that Khat chewing prevalence among males is higher than among females. World Bank (2007) report showed that men reported 14% of their wives chew khat and the survey itself among females reported 33% of Yemeni females chewed khat.

In Diaspora, Wood (2005) reported that 64% males to 6% women chew Khat among adults community sample of 220 Somalis who resided in Sheffield. Patel et al. (2005) reported among Somali community in four cities of UK, the prevalence of Khat chewing for males was 51% compared to 14 % for females. Findings of some studies (Patel et al. 2005; Straus et al. 2005;Elmi 1983; Griffiths et al.1997) shows that khat chewing is culturally disapproved for Somali women while the study done by Al-Motarreb et al.( 2002) approved only for married and older Yemeni women. This result shows the prevalence figures of khat chewing reported in some studies is inconclusive.

Numan (2004) reported that in khat producing countries, among adults community groups such as in Yemen the prevalence among males was 81.6% and 43.3% for females. Bhui et al. (2003) showed among a sample of Somali community adults, significant association between Khat chewing and being male. Zein (1988) among university students found higher prevalence of khat chewing among male students than females, 25.1% to 10.2% respectively.

In rural Ethiopia, Alem et al (1999) reported that 70% males chew khat compared to 35% females and the figures were 61.13% for males and 23.9% for females respectively, in Jimma town, W. Ethiopia (Ayana et al. 2002). Among a random sample of 1200 of rural adults‟ community in Ethiopia, Belew et al (2000) reported that 18.2% of females currently chew khat compared to 40% males. Khawaja et al (2008) in a survey recruited randomly females only; the prevalence figure of khat chewing was reported as 40%. But, Adugna et al. (1994) reported among secondary school children the percentages of khat chewing were for males and females as 71.6% and 55% respectively.

In rural Ethiopia khat Chewing and link of Socio-demographic factors findings shows that it is higher for males than female, Alem et al. (1999) reported that 70% males chew Khat compared to 35% females and the figures were 61.13% for males and 23.9% for females respectively. Among a random sample of 1200 of rural community in Ethiopia, Belew et al. (2000) reported that 18.2% of females currently chew Khat compared to 40% males. Adugna et al.(1994) reported among secondary school children the percentages of Khat chewing was as 71.6% and 55% for males and females, respectively showing Khat chewing seems male culture than for females.

Age wise, reported that 50% of the secondary school students started Khat chewing at the age between 11-14 years (Ibid). Similarly, Gelaw and Haile-Amlak (2004) among the staff of Jimma University reported the beginning of Khat chewing as 10-15 years. Among a community population Belew et al.(2000) reported the mean age of starting Khat chewing was at 21 years age and Alem et al (1999) reported the beginning of Khat chewing as 10 to 15 years. However, Patel et al. (2005) and Adugna et al. (1994) reported small percent (6% and 1.3%) of Khat chewing initiation among Ethiopians and Somalis below the age of 10 years old. The prevalence of Khat chewing was reported to increase with age as indicated by Belew et al. (2000) among 15-24 years old Ethiopians that the prevalence was 22.7% and increased to 69 % between the ages of 25-44 years.

With respect to religion Khat chewing is reported to be mostly associated with the Muslim religion. Studies showed that in areas where many followers live side by side, khat chewing percentage is higher among Muslim than other beliefs. Gelaw and Haile-Amlak (2004) reported that among a sample of Ethiopian staff in Jimma University, Muslim Khat chewers comprised of higher percentage (49%) than chewers from other different faith backgrounds. Ayana et al. (2002) reported significant associations between being a Muslim and chewing Khat.

2.2.6. Socio-Economic Factors and Khat Chewing Behavior

The evidence shows that the use of Khat is associated with several socio-economic effects- both positively and negative. On the positive side, it serves as an employment opportunity and source of income for the involved in the production and in the chain of the marketing process (Ayalew and Yemane 2013). According to the authors it also serves as an export commodity for countries in which it is cultivated. On the negative side, it has been shown to be damaging in terms of being a factor in family conflict and breakdown, diverting household and individual income, resulting in delay and absenteeism from work and threatening food security.

In Somalia, Khat is perceived as a considerable drain of resources (money and time) and as decline in productivity when working at both household and macro levels (Feyisa and Aune 2003 Green 1999) and is perceived to be the largest cause of non-support of families by men. Men abandon their families or abuse their spouses, leading to the high incidence of female instituted divorce. According to Klein (2004), there is a large number of people who chew Khat all night long, becoming increasingly aggressive, go home in the morning, beat up their wives and go to sleep throughout the day. It also argued that, many users of Khat secure daily portion at the expense of vital needs, indicating dependence (Odenwald 2007).

Regarding economic impacts of Khat chewing, evidences show that it also has a major reason for economic crisis to the user, family, and to the nation. According to Pantelis et al. (1999), study the recent sharp increase in Khat consumption has serious socio-economic consequences for the countries involved.

The potential adverse effect is diversion of income for the purchase of Khat, resulting in neglect of the needs of the one's self and the family. Furthermore, in countries where its use is substantial, it may negatively affect the economy since productivity is reduced in quantity and quality as the result of absenteeism and after-effects of the drug.

As Herboid (1999) suggested, Khat chewing sessions are time consuming so on the productivity output, Khat can be both weakening and is time wasting. Study by Patel (2004), among Somali people indicate that, habitual Khat use per individual costs to the tune of $1,500 a year yet a significant majority of Somali households live in absolute poverty. It is also reported that gaining of moneys to pay for Khat may lead to criminal behavior and even prostitution (Ishraq and Jiri 2004).

In Ethiopia, Khat chewing is both a social and cultural activity in some parts of the country like East and Western Hararghe, Somali Region, Dire Dawa, Jimma and others. Researchers found that proponents of Khat chewing said that they chewed Khat to enhance their social interaction, playing a role in ceremonies and important business transactions. Occupational groups such as motor vehicle drivers, who chew Khat during long distance driving to keep awake.

Socio-economic factor has also been incorporated into the literature as studies done by Leong Yin Ching et al.(1990 ) shows that there is a correlation between poverty and cognitive development. Socio-economic factors play an important role in influencing academic achievement of students through influencing student’s target, motivation, self-efficacy and involvement in educational activities.

A past research has examined the relationship between family income and schooling performance which the findings indicate that students from well provided for families perform better academically (Basil, B. 2007). Some studies (Gebissa 2010 and 2008; Klein and Metaal 2010) tried to indicate the lack of perfect scientific evidence on the harm associated with khat use as it can destroy the livelihood of many dependent on it and economically significant crop in another way , particularly in the absence of appropriate alternative policy.

With regard to the socioeconomic impact of khat consumption, they argue that regular use of khat has adverse socioeconomic effects. Loss of work hours, lower production, malnutrition, and misuse of money are some of the effects documented in the literature. This is indirectly related to unemployment that in turn leads to reduction in overall economic activity. Moreover, it is reported that habitual khat chewing has led to decreased productivity in Ethiopia, Somalia, Uganda and Kenya.

According to Cox and Rampes (2003) and Kalix (1984) Khat is a stimulant used to improve performance, stay alert and increase work capacity. Night-shift workers use it to stay awake and postpone tiredness. Yemeni khat users believe that khat is beneficial for minor illnesses such as headaches, colds, body pains, fevers, arthritis and depression (Kennedy et al. 1983).

On another perspective, Some studies confirm that the adverse effects of khat use are dose dependent (Alem and Shibre 1997). In contrary, Giannini and Castellani (1986) argue that moderately using khat improves performance and increases work output, owing to the stimulant and fatigue-postponing effects. Consequently, working hours and possibly productivity can decrease when khat is not used, because of reduced motivation.

2.2.6.1. Family Related Factors

Families affect children's substance use behavior in a number of ways. Different researches have discussed some of the family factors which more predictive of youth drug abuse such as: for instance parental history of chewing behavior puts the child at risk for drug abuse. Study in Kenya by Otieno and Ofulla (2009) in Kisumu town showed many of the secondary students who abused drugs came from families where other family members abuse drug. These included immediate family members like parents and siblings and other members of the extended family staying with them.

Furthermore, Needle et al. (1990) have shown that youths from disrupted families tend to get involved in substance abuse. Lack of parental supervision is also another family related factor. Many parents have no time and far away from their children to supervise their sons and daughters. Some parents have little or no interaction with family members, because their children are far away for education and for other reasons. These phenomena initialize and increases drug abuse among students.

The parents support as an importance role in order to develop the students positive self-concept which affects the way they see learning, to create a conducive climate, provide adequate necessities and ensure happiness at home . The study by Sumari et al.( 2010) shows that factors like parent's expectations, home environment, discipline and parent involvement do affect student's academic achievement . A well-function family could create a positive climate in the family institution which the dynamic communication and effective relationship could determine the educational climate in the family, and in turn influence the academic results.

Demographic factors that have impact on academic achievement of the rural school students include family advantage, home environment and parents’ academic support. Poor rural parents generally do not take a great interest and much value in education (Tengku, A. 1989). Study by Awang, H.S (1983) indicates that due to illiteracy and low education level, they are not able to help with their children’s homework.

2.2.6.2. Peer Influence

Peer pressure plays a significant role in influencing many adolescents into drug abuse. This is because peer pressure is a fact of adolescent and youth life. As they try to depend less on parents, they show more dependency on their friends. Friends reinforce other's drug habit through driving them into this group activity, encouraging them to carry on drug using, and fostering their denial of drug problem (Shilts 1991).

Wills et al. (2001) have conducted a study on 1700 adolescents and assessed them yearly from the seventh to the ninth grade and found that there is a good correlation between the level of alcohol and other drug use in the respondents and the number of the peers who used the drugs. In addition, when children of drinking parents lose parental tie, they tend to be strongly influenced by peers who could also be heavy drinkers.

Another study assessing parental and peer influences on the risk of adolescent substance use also revealed findings which are in consistence with social development theory. Using a probability sample of 4230 adolescents from grades 7-12, the researchers used regression to estimate the effects of peer and six family variables on the risk of adolescent substance use. Peer substance use had relatively strong effects on adolescent drug use. Parental substance attitudes, sibling substance use, and adult substance use had significant direct effects net of peer influences. In addition, they had significant indirect effects that were mediated by peer substance use (Bahr, Hoffmann, and Yang 2005).

2.2.6.3. Accessibility and Afford-ability

In many countries, drugs have dropped in prices as supplies have increased which means they are everywhere with low cost. In Ethiopia Khat plant grown everywhere and consumers get it with in a close vicinity to where they live. It is also accessible and affordable. Its open use and the powerful drug culture where drug use is considered normal by communities is also another factor.

2.2.6.4.Money (pocket money)

Pocket money enables them to buy all they need, drugs included. Those not given involve themselves in criminal acts like robbery and prostitution to get money. Further studies indicate that there are a number of social, economic and political factors associated with the global spread and use of drugs.

2.2.7. Psychological Factors and khat chewing behavior

Psychological factors refer to patterns of thought, behavior, personality traits, self-esteem and coping skills among others (Swadi 1999). When negative psychological characteristics, personality and personal experiences work together, young individuals will certainly have ability of resiliency weaken. Such non-pathological factors may cause a youth to develop Khat and drug abuse problems. In other words, they will lack coping skills in case of environmental challenges, and lean to drugs either voluntarily or passively. Due to a lot of mental stress in academic courses and an unachievable expectation from teachers and parents, some youths go round to drugs (Nasibi 2003). It is known that adolescents who witness or experience physical and/or sexual assault are at a great danger of developing alcohol and other drug use disorders.

As what has been discussed above, youth is such a time highly initiated to enjoy any pleasure of independence. So, it is understandable that young people consider taking drug as an approach to show recreation, to alleviate boredom, to feel confident, and to be hard (Home Office 2007). Experimental curiosity is among the personal factors influencing students for substance use cited in different literature. An interest to experiment the unknown facts about drugs thus motivates adolescents into drug use. The first experience in drug abuse produces a state of stimulation such as happiness and pleasure which in turn motivate them to continue.

Research findings from Education Planning and Research Division ( 1994) suggest that negative attitudes toward learning are attributed to lack of basic skills in learning, weak mastery of language skills and poor self-efficacy that influence the success or failure of the students. Self-efficacy is the belief that one possesses the capabilities to organize, plan and carry out the courses of action required to manage situations at hand (Bandura, A. 1995). Therefore, a many of research findings indicate that self-efficacy influences academic achievement and motivation. Findings from studies indicate that many students suffer from psychological problems like depression, anxiety and stress, which could have an effect on their academic achievement.

2.2.8. Impacts of khat chewing

The literature suggests a variety of health, health risk behaviors (khat chewing association with tobacco smoking and dependency creating substances), socioeconomic and environmental impacts associated with khat chewing and khat cultivation. Some of available literatures will be presented here under.

2.2.8.1. Effect of Khat Chewing on Health

The growing literature suggests that a variety of harmful physical health, psychological and socio-economic problems were associated with Khat chewing. The health, psychological and oral aspects are given a greater attention in the existing literatures. Evident from different studies that the medical and psychosocial effects of Khat chewing are harmful both to the individual chewer and the community (Klein 2004 and Kalix 1992). Yemen Khat chewers believe that it is beneficial for mild sicknesses like headache, fevers and depression (Glenice and Rampes 2003).Despite these functional effects believed by the proponents, the use of Khat is believed to be associated with several public health problems.

Health Effects of Khat abuse Growing research evidences revealed that Khat use poses a public health challenges to countries in the Horn of Africa and the Arabian Peninsula. According to Ahmed et al. (2013) though culturally acceptable, Khat chewing is associated with many health and psychiatric complications. A common effect of Khat use is insomnia, a condition that the users sometimes try to overcome with sedatives or alcohol. The withdrawal symptoms after prolonged Khat use seem to be limited, however, tiredness, minor depression, slight trembling and recurrent bad dreams. An important consideration is that, Khat use may endanger health in that the resulting anorexia leads to malnutrition and thereby to increased vulnerability to infectious diseases (Kalix 1992).

Community surveys and hospital based studies indicate an increase in drug related health problems, an indication of increase in the drug abuse (NIDA 2010). The drug is a stimulant and produces sleeplessness, gastritis, constipation and a depressive mood. Other health effects include: tooth decay, irregular heartbeat, decreased blood flow, myocardial infarction and may worsen per-existing mental disorders. It also causes increased libido, infertility, decreased lactation. Prolonged use of Khat can lead to impotence and causes low birth weight in mothers who chew Khat during pregnancy (Dalu 2008, NIDA 2007 and Ihunwo et al. 2004).

The effect of Khat chewing can be short-time or long-term. Chewing Khat makes people feel more alert and talkative and suppresses the appetite though users describe ensuing calming effects when used over a few hours. In some cases it may make people feel more irritable and angry and possibly violent.

There is also evidence to suggest that Khat chewing increases the risk of cardiovascular diseases such as high blood pressure and acute myocardial infarction through its main constituent cathinone (Halket et al. 1995 and Brenneisen et al. 1990). In a cross-sectional random sample of 1000 community subjects in Ethiopia, Ayana et al. (2002) reported that among 306 regular (daily) Khat chewers 23% were found to be hypertensive. Other vascular complications associated with Khat chewing were reported. In a case control study of Mujlli et al. (2005) in bivariate analysis, acute cerebral infarction (ACI) was found to be associated with an increase of high blood pressure and Khat chewing amongst patient than control groups.

Dawit et al. (2005) stated that Khat chewing leads to tension on family relations either through increased sexual awakening and most likely multiple sexual practices. It is also reported that chronic use of Khat results in increased risk for several diseases. In a recent case-control study among 425 HIV positive cases and controls, gave more insight into the impacts of Khat chewing on the spread of HIV in Ethiopia through multiple sexual practices (Ibid). Furthermore, insomnia is a common problem associated with the use of Khat which prompts the chewer to abuse tranquilizers and to indulge in alcohol as a means of overcoming the side effect.

Khat chewing in combination with alcohol intake and casual sex was observed more in people with HIV than in the control group. Khat chewing was significantly associated with multiple sexual practices among cases, which in turn were strongly linked to HIV cases. It seems that Khat chewing may induce a moderate but often persistent psychological dependence (Kalix 1994).

Some of the psychological impacts cited in literatures are poor self-esteem, poor self-control, inadequate social coping skills, sensation seeking, depression, anxiety, being stressed, tension, restlessness, aggressive behavior or psychosis (Yousef et al. 1995 and Pantelis et al. 1989). In addition a group of experts in WHO (2006) has concluded that Khat consumption may induce moderate but often persistent dependence, the withdrawal symptoms after prolonged Khat use seem to be limited, however, to lethargy, mild depression, slight trembling and recurrent bad dreams.

2.2.8.2. Impact of Khat Chewing on Academic Performance

Regarding the associated effects of Khat chewing and academic performance, researchers suggested that Khat affects the brain, this results in major decline in the functions carried out by the brain (Stemberg 2003).

Empirical studies (World Bank 2007 ; Zein 1988) shows, khat chewing was reported to be used among students, drivers and workers in the belief of enhancing their performance. On the other hand finding of Aden et al.(2006) 40% of mirra chewers in Kenya blamed khat for their low productivity and inefficiency at work and 32% associated their khat chewing with absenteeism. According to World Bank ( 2007) report 60% of female and 40% of male Yemeni khat chewers reported day-after effects (tiredness, absenteeism) of khat chewing.

The study done by Al-Sanosy RM.(2009) on pattern of khat abuse and academic performance among secondary school and college students in Jazan region, kingdom of Saudi Arabia revealed that the risk of poor academic performance was high among khat chewers: 39.4% had poor grades, 40.9% were frequently absent from class and 39.6% were on experimentation as a result of poor grades with strong negative association Odds Ratio (2.8%). Similar findings were also reported in two other Ethiopian studies (Abafita et al.2015; Ayana and Mekonen 2004) where khat chewing among university students and secondary school was studied and the mean cumulative grade point average (CGPA) of non-chewers was found to be significantly higher (p < 0.001) than that of chewers.

This revealed a clear negative association between Khat chewing and academic performance. This could be due to the long time wasted in Khat sessions, insomnia, absence from school, and impaired activity on the morning following the khat session.

Gelaw and Haile-Amlak (2004) reported among 123 khat chewers of 400 university staff 50.4% of khat chewers have one or more times missed their regular work because of chewing, and 54.5% of the chewers used to come late because of chewing khat or leave their work early to chew khat and Late wake-up time next morning low work performance next day.

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