Tessema Zemenu Tadesse, Zeleke Tadele Amare
Department of Epidemiology and Biostatics, Institute of Public Health College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
Department of Psychiatry, School of Medicine, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia.
Psychiatry J. 2020 Apr 20;2020:8369693. doi: 10.1155/2020/8369693. eCollection 2020.
Khat chewing has become prevalent in the world due to the improvement of road and air transportation. In Ethiopia, khat chewing is more prevalent and widely practiced by men. Khat has a negative effect on social, economic, and mental health. There is variation in khat cultivation, use, and factors that associated with khat chewing in the Ethiopian regions. Therefore, this study is aimed at showing spatial distribution and factors associated with khat chewing among male adults 15-59 years in Ethiopia.
A total of 12,594 men were included in this study. ArcGIS version 10.7 software was used to show the spatial distribution of chewing khat among adult men in Ethiopia. The Bernoulli model was applied using Kilduff SaTScan version 9.6 software to identify significant purely spatial clusters for chewing khat in Ethiopia. A multilevel logistic regression model was fitted to identify factors associated with khat chewing. A value < 0.05 was taken to declare statistically significant predictors.
The EDHS 2016 survey showed that the high proportion of chewing khat was found in Dire Dawa, Harari, Southern Oromia, Somali, and Benishangul Gumuz regions. In spatial scan statistics analysis, a total of 126 clusters (LLR = 946.60, value < 0.001) were identified. Age group 30-44 years old (AOR = 1.60, 95% CI: 1.37, 1.86) and 45-59 years old (AOR = 1.33, 95% CI: 1.09, 1.61), being single (AOR = 1.86, 95% CI: 1.64, 2.12), Muslim religion followers (AOR = 15.03, 95% CI: 11.90, 18.90), media exposed (AOR = 0.77, 95% CI: 0.68, 0.86), had work (AOR = 2.48, 95% CI: 2.08, 2.95), alcohol drinker (AOR = 3.75, 95% CI: 3.10, 4.53), and region (Afar, Amhara, Benishangul Gumuz, Gambela, Harari, Oromia, Somali, Southern Nations, Nationalities, and People's Region (SNNPR), and Tigray) and two cities (Addis Ababa and Dire Dawa) were statistically significant factors affecting chewing khat in Ethiopia.
In Ethiopia, the spatial distribution of khat chewing among adult men was nonrandom. A high proportion of khat chewing was observed in Dire Dawa, Harari, Southern Oromia, Somali, and Benishangul Gumuz regions. Older age group, being single marital status, alcohol drinker, media unexposed, had no work, and Muslim religion follower were factors affecting khat chewing. Policymakers should be given spatial attention in reducing the prevalence of chewing khat by teaching the health impact of khat chewing through media in the identified regions.
由于公路和航空运输的改善，恰特草咀嚼在全球范围内变得普遍。在埃塞俄比亚，恰特草咀嚼更为普遍，且男性中更为盛行。恰特草对社会、经济和心理健康有负面影响。埃塞俄比亚各地区在恰特草种植、使用以及与恰特草咀嚼相关的因素方面存在差异。因此，本研究旨在展示埃塞俄比亚15至59岁成年男性中恰特草咀嚼的空间分布及相关因素。
本研究共纳入12594名男性。使用ArcGIS 10.7版本软件展示埃塞俄比亚成年男性中咀嚼恰特草的空间分布。应用Kilduff SaTScan 9.6版本软件中的伯努利模型来识别埃塞俄比亚咀嚼恰特草的显著纯空间聚集区。拟合多级逻辑回归模型以识别与恰特草咀嚼相关的因素。采用P值<0.05来判定具有统计学意义的预测因素。
2016年埃塞俄比亚人口与健康调查显示，在迪雷达瓦、哈勒尔、奥罗米亚南部、索马里以及本尚古勒-古穆兹等地区，咀嚼恰特草的比例较高。在空间扫描统计分析中，共识别出126个聚集区（对数似然比=946.60，P值<0.001）。30至44岁年龄组（调整后比值比=1.60，95%置信区间：1.37，1.86）和45至59岁年龄组（调整后比值比=1.33，95%置信区间：1.09，1.61）、单身（调整后比值比=1.86，95%置信区间：1.64，2.12）、穆斯林信徒（调整后比值比=15.03，95%置信区间：11.90，18.90）、接触媒体（调整后比值比=0.77，95%置信区间：0.68，0.86）、有工作（调整后比值比=2.48，95%置信区间：2.08，2.95）、饮酒者（调整后比值比=3.75，95%置信区间：3.10，4.53）以及地区（阿法尔、阿姆哈拉、本尚古勒-古穆兹、甘贝拉、哈勒尔、奥罗米亚、索马里、南方各族州和人民地区（SNNPR）以及提格雷）和两个城市（亚的斯亚贝巴和迪雷达瓦）是影响埃塞俄比亚咀嚼恰特草的具有统计学意义的因素。
在埃塞俄比亚，成年男性中恰特草咀嚼的空间分布并非随机。在迪雷达瓦、哈勒尔、奥罗米亚南部、索马里以及本尚古勒-古穆兹等地区观察到较高比例的恰特草咀嚼现象。年龄较大、单身婚姻状况、饮酒者、未接触媒体、无工作以及穆斯林信徒是影响恰特草咀嚼的因素。政策制定者应在已确定的地区通过媒体宣传恰特草咀嚼对健康的影响，从而在降低恰特草咀嚼流行率方面给予空间上的关注。
