Skip to main content

Prevalence and risk factors for khat use among youth students in Ethiopia: systematic review and meta-analysis, 2018



Khat use is a widely spreading public health problem affecting the most economically productive population areas in Ethiopia. Khat use among students has been linked with mental, physical, social, and psychological problems. Reliable prevalence has not been recognized because of varying published rates. The objective of this systematic review and meta-analysis is to synthesize evidence on the prevalence and potential risk factors of khat use in Ethiopia.


We found 284 studies of which 266 were removed due to duplication, irrelevant topics, and other reasons, respectively. All studies conducted in Ethiopia on khat chewing among students irrespective of time frame were included. Subsequently, 18 studies were used for synthesis of prevalence. Figures were extracted from published reports, and any lost information was requested from investigators. The quality of the included literature was evaluated by using the Newcastle–Ottawa Scale (NOS). Prevalence was pooled using random-effects meta-analyses. The presence of association was declared using P-values and an odds ratio with a corresponding 95% CI.


The pooled prevalence of khat use among students was 16.7% (13.7–19.7%). In the subgroup analysis, the highest prevalence was observed in the Oromia region, at 21.1% (15.5%, 26.7%), and an almost equal prevalence of 14.8% (10.6, 18.9) and 14.3% (10.3, 18.3) was observed in Amhara and the Southern Nation, Nationalities, and People’s Region of Ethiopia, respectively. Being male (OR: 2.43 (1.73, 3.13)), being a Muslim religion follower (OR: 2.22 (1.6, 2.8)), being an alcohol user (OR: 2.3 (1.5, 3.0)), khat use by a family member (OR: 1.8 (1.4, 2.2)), peer pressure (OR: 4.4 (3.1, 5.6)), and being a cigarette smoker (OR: 8.5 (5.3, 11.7)) were found to be risk factors for khat chewing.


Khat use is a common problem among students. Health promotion, awareness on effect of khat, set policy on khat and substance use on the male sex, Muslim religion, alcohol user, having a family-member khat user, peer pressure, and being a cigarette smoker as possible risk factors for khat use among students.


Irrespective of time restriction, all studies conducted in Ethiopia are included and cross-sectional in nature. Protocol no. CRD-42017081886.


Khat is a plant containing a natural psychoactive substance which is cultivated in East African as well as Arab lands [1]. Khat has different names in different countries, but “khat” remains the name widely used in studies [2]. The origin of khat is not known, but it is believed to be native to Ethiopia and was originally used there [3]. Khat contains the amphetamine-like substances cathine, cathinone, and methcathinone [4].

Khat has a stimulant effect on the body [5, 6]. The fresh green leaves and young buds are chewed [7]. This stimulates both the peripheral and vital nervous system, causing, for instance, insomnia, alertness, anorexia, and increased respiration, body temperature, blood pressure, and heart rate [8]. The stimulant effect is mutually enhanced by caffeine use and cigarette smoking [9]. Khat use has appeared to be a male habit, but women practise it as well [10]. Users start chewing at an early age and develop an uncontrollable habit lasting throughout the lifespan [11]. It is practised based on local customs and traditions [12] and carried out in religious ceremonies [13, 14].

The World Health Organization report has shown that khat use causes dependency [15,16,17,18,19], predisposes the individual to myocardial infarction [20], ischemic heart disease [21], psychosis [22, 23], distress [24], premature ejaculation [25], unprotected sex [26], manic episodes [27, 28], oesophageal cancer [29], low birth weight and lactation problems [30], structural and functional brain changes [31, 32], and criminal activity [33].

Khat chewing is a familiar habit among students for staying alert, achieving higher concentration at work, socializing, and providing relaxation, relief from stress, and a desire to study for long hours [34,35,36,37].

Moreover, being male, having chewer friend(s), believing that chewing khat will boost performance, drinking alcohol, and having a family that cultivates khat were found to considerably increase the chewing practice [34, 38,39,40].

The literature includes studies conducted in Ethiopia among students. However, the literature shows a difference in prevalence and associated factors. Therefore, this systematic review and meta-analysis aim to estimate the pooled prevalence and associated factors of current use of khat chewing among students in Ethiopia.


PubMed/MEDLINE, Scopus, HINARI and EMBASE were searched for published studies. In addition, 10 pages were accessed using Google Scholar. All references in the relevant articles were reviewed in order to obtain other studies. Furthermore, for partial articles or those missing necessary information, the authors of the articles were contacted via email or other means of communication. For the PubMed search, the following terms were applied: ‘khat chewing’, ‘khat use’, ‘chewing habit’, ‘determinant factors*’, ‘student’, ‘college students’ and ‘Ethiopia’. An advanced search was conducted using these terms with the options ‘MeSH terms’ and ‘all fields’ selected and including ‘AND’ and ‘OR’ Boolean operators as appropriate. The rest of the electronic databases were searched using database-specific subject headings linked with the terms and keywords used in PubMed. “Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)” guidelines used [41]. To show the procedures used for the screening and selection processes, a PRISMA flow diagram was used. The findings of this meta-analysis are presented here in with the aid of figures.

Review and meta-analysis registration

This systematic review and meta-analysis were registered at the International Prospective Register of Systematic Reviews. The following represents the registration number: CRD-42017081886.

Eligibility criteria

Three investigators (WG, TA and WW) independently screened the selected articles using their titles and abstracts before retrieving the full-text papers. We use pre-specified inclusion criteria to screen the full-text articles. Disagreements between the investigators were discussed during a consensus meeting with a fourth reviewer (SS) in order to select the studies to be included in the systematic review and meta-analysis.

Inclusion criteria

  • Cross-sectional studies.

  • Studies on khat chewing among students.

  • Studies published in English.

  • Studies reporting on the prevalence and/or determinants of khat chewing.

  • Studies conducted in Ethiopia.

Exclusion criteria

  • Editorials, letters, reviews, commentaries and interventional studies.

  • Studies without access to the full data even after contacting the author(s).

  • Duplicate studies.

Data extraction

All the articles accessed using the databases and search engines were exported to EndNote (version 6), and we excluded duplicate articles. The remaining articles were evaluated based on the topic, language and study area. Next, studies conducted outside of Ethiopia, those not published in English and those on irrelevant topics were excluded. There were no time restrictions among the included studies. Finally, the abstracts and full text of the remaining articles were reviewed.

Outcome variable

Current khat use is defined as the proportion of students who are chewing for different purposes within 3 months of prior to data collection.

Data synthesis and quality assessment

After extracting and documenting the data in a Microsoft Excel spreadsheet, we exported it to Stata (version 14) for further analysis. All the analyses were conducted using Comprehensive Meta analysis software (version 3) [42]. The overall pooled prevalence of khat chewing was estimated using a random-effects meta-analysis [43]. First, using a fixed-effects model, heterogeneity among the studies was determined. A Q test and an I2 heterogeneity test [43] were used to declare heterogeneity at p < 0.05. The prevalence of statistical heterogeneity between the studies was assessed using I2 statistics, with 25%, 50% and 75% representing low, medium and high heterogeneity, respectively [44]. The quality of the included studies was evaluated using the Newcastle–Ottawa Scale [45] and tested based on sample size and representativeness, comparability between participants, ascertainment of khat chewing and statistical quality. To test the agreement between the three reviewers, the actual agreement and agreement beyond chance (unweighted kappa) were used. The values of reviewers’ result 0, 0.01–0.20, 0.21–0.40, 0.41–0.60, 0.61–0.80, and 0.81–1.00 were used to represent poor, slight, fair, moderate, substantial, and almost perfect agreements, respectively [46]. A random-effects model was used in the analysis. Meta-regression was conducted to explore the probable source of heterogeneity. A leave-one-out sensitivity analysis was also conducted to assess which studies majorly impacted between-study heterogeneity. A funnel plot and Egger’s regression test were used to measure publication bias.


Search outcomes

The systematic literature search generated a total of 284 articles. In total, 55 were duplicated and 167 were irrelevant, and, as such, these were excluded. In addition, 44 were excluded (not measure outcome, measure not current use). The remaining 18 articles were used to determine the pooled prevalence of khat chewing in Ethiopia. All 18 articles were cross-sectional studies (Fig. 1).

Fig. 1
figure 1

Flowchart describes the selection of studies for the systematic review and meta-analysis of prevalence and risk factors of khat chewing among students in Ethiopia, 2018

All the included studies were conducted in Ethiopia (Table 1). Finally, the levels of agreements between the reviewers about the levels of bias for studies included in this meta-analysis we got from moderate to almost perfect (Kappa statistic range 0.60–1) (Table 2).

Table 1 Descriptive summary of 18 studies reporting the prevalence and associated factors of khat chewing among students in Ethiopia included in the systematic review and meta-analysis, 2018
Table 2 The quality and agreed level of bias and level of agreement on the methodological qualities of included studies in a meta-analysis based on sampling, outcome, response rate and method of analysis

Pooled prevalence of khat chewing among students

The pooled prevalence of khat chewing in Ethiopia was 16.7% (13.7–19.7: I2 = 63.8%, p ≤ 0.001) (Fig. 2).

Fig. 2
figure 2

Forest plot of pooled prevalence of khat chewing in Ethiopian students 2018 (n = 18)

In the random-effects model, the subgroup analysis by setting on high school and university is different which is 14.61% (11.09, 18.13:I2 = 11.9%, p = 0.338) and 17.56% (13.52, 21.61:I2 = 71.6%, p = 0.001), respectively (Fig. 3).

Fig. 3
figure 3

Subgroup analysis on prevalence of khat chewing among high school and university students 2018 (n = 18)

By region showed that the highest prevalence of khat chewing was observed in the Oromia Region (OR: 21.1 (15.5, 26.7)). A comparable prevalence was observed in the Amhara Region (OR: 14.8 (10.6, 18.9)) and the southern Nation Nationality people of Ethiopia (OR: 14.3 (10.3, 18.3)) (Fig. 4).

Fig. 4
figure 4

Subgroup prevalence of khat chewing in Ethiopian students, 2018 (n = 18)

Publication bias

There was no evidence of bias, as observed in the funnel plot. An Egger’s regression test confirmed this (p = 0.53) (Fig. 5).

Fig. 5
figure 5

Funnel plot showing publication bias of prevalence studies among students, a systematic review and meta-analysis, Ethiopia, 2018

Factors associated with khat use

Khat use is common among high school, college and university students. There are many risk factors, but just we include those reported in more than one study. Being male is more likely to chew khat than females (OR: 2.43 (1.73, 3.13). In addition, khat chewing is predominantly practised by Muslims (OR: 2.22 (1.6, 2.8). Students with a family member who had a history of khat use or who currently uses khat are more likely to chew khat than students without such a family member (OR: 1.8 (1.4, 2.2).


The objectives of this systematic review and meta-analysis were to assess the prevalence and associated factors of khat use among young students in Ethiopia. Young students who are habitual khat users believe that its use boosts alertness, concentration, imaginative abilities, and improves communication skills. To the best of our knowledge, this systematic review and meta-analysis is the first of its kind, assessing the pooled prevalence and factors that have an effect on the habitual use of khat among young students in Ethiopia. The overall pooled prevalence of khat use was found to be 16.7% (13.7–19.7). The pooled prevalence of Khat use was found to be different across regions; it was highest in the Oromia region, 21.10% (15.52, 26.68), and we found a similar prevalence in the Amhara and SNNPs regions, 14.78 (10.6, 18.9) and 14.3 (10.3, 18.3), respectively (figure-3). Clearly illustrated above, the subgroup analysis demonstrated that the pooled prevalence of khat use among young students is slightly different across different regions of Ethiopia. The possible reason for these variations could be environmental, religious, and/or cultural differences across the regions. For example, people residing in the Oromia region are Muslim followers. In addition to this, the higher prevalence of khat chewing in this region could be explained by the differences in settings across regions, such as access to khat and factors outside the university and high school environment.

A meta-analysis study previously completed on University students found that 23.22% (95% CI 19.5, 27.0%) of these students were chewers, which is a bit higher than our findings [43]. This discrepancy might be due to differences in study population, while ours considered young students on high school and university, the former one focused on university students, these students couldn’t afford to buy the khat and they might not use.

Multiple factors have contributed to young students to be khat users. Being male, younger age, religion, ethnicity, khat use by family, family history of other substances use, living condition, peer pressure, other psychoactive substance use, having a family that cultivates khat, perceive khat use boosts performance, increased class workload, residency, having suicidal ideation, having ever had a sexual contact were found to be the most important associated factors.

Gender of students continued to be a significant factor affecting students' behaviour. Being male sex had a significant role to be user as compared to females. This finding is line with studies conducted in Ethiopia [2, 36, 47,48,49,50,51]. This significant difference between male and female may be justified as; females are less exposed to chewing practice than males. Moreover, we found that being Muslim by religion had a significant role to be user than others [2, 36, 41, 43, 51, 52].

Having chewer friends was strong predictor of chewing which is similar to other studies [2, 41, 43, 45, 49, 50, 53], khat use by family member was associated with increased odds of use among participants. This finding was similar with studies conducted on substance abuse [2, 36, 48, 49]. The possible cause for the association may be because of shared influence and peer pressure.

Furthermore, in this review, it has been observed that other substance use is common among study participants. Who had ever drunk alcohol and ever smoked cigarette were more likely to practise chewing as compared to no alcohol and cigarette users. This finding is supported by r studies conducted, ever drunk alcohol [52, 54], and smoking cigarette [43, 48, 50, 52, 54]. These studies reported that history of alcohol consumptions and cigarette smoking was positively associated with chewing. This finding provides evidence on the prevalence of khat use on Ethiopian students with relevant data. Measures to reduce the use of khat should be taken and these should be considered as priority areas: awareness, family contribution, prevention and early intervention.


Khat use is prevalent among high school, college and university students. The prevalence of khat use appeared to be high. Particular attention should be given to male gender, Muslims religion follower, alcohol users, having family member khat user, peer pressure, being cigarette smoker. There is a need for early intervention that targets high school, college, and university students to reduce the health, financial and social consequences of khat use.

Limitations of the study

The limitation was that only English articles were considered to conduct this review. In addition, all of the studies included in this review were cross-sectional in nature, as a result the outcome variable might be affected by confounding variables.

Availability of data and materials

Not applicable.



Adjusted odds ratio


World Health Organization


Crude odds ratio


Confidence interval




Statistical Package for Social Science


Meta-analysis of observational studies


  1. Berhanu M, Aregash E, Alyi M. Socio-economic impact of Khat in Mana District, Jimma Zone, South Western Ethiopia. Discourse J Agric Food Sci. 2014;2(2):21–322.

    Google Scholar 

  2. Reda AA, Moges A, Biadgilign S, Wondmagegn BY. Prevalence and determinants of khat (Catha edulis) chewing among high school students in eastern Ethiopia: a cross-sectional study. PLoS ONE. 2012;7(3):e33946.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Nencinp I, Rassmsci G, Botana A, Asseyar F. Khat chewing spread to the Somali community in Rome. Drug Alcohol Depend. 1988;23(4):255.

    Google Scholar 

  4. Aseffa M. Socio-economic aspects of khat in the Harrarghe administrative region. Antananarivo, Madagascar: Ethiopia. In: Proceedings of the international conference on Khat. 1983.

  5. Brenneisen RFH, Koelbing U, Geisshusler S, Kalix P. Amphetamine-like effects in humans of the khat alkaloid cathinone. Br J Clin Pharmacol. 1990;30(6):825–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Cox G, Rampes H. Adverse effects of Khat chewing: a review. Journal of continuing professional development. Adv Psychiatr Treat. 2003;9:456–63.

    Article  Google Scholar 

  7. Ezekiel G. Khat in the Horn of Africa: Historical perspectives and current trends. J Ethno Pharmacol. 2010;132(3):607–14.

    Article  Google Scholar 

  8. Kalix P. Catha edulis, a plant that has amphetamine effects. Pharm World Sci. 1996;18:69–73.

    Article  CAS  PubMed  Google Scholar 

  9. Dhaifalah I, Santavy J. Khat habit and its health effect. A natural amphetamine. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2004;148(1):11–5.

    Article  PubMed  Google Scholar 

  10. Zein ZA. Polydrug abuse among Ethiopian university students with particular reference to khat (Catha edulis). J Trop Med Hyg. 1988;91(2):71–5.

    CAS  PubMed  Google Scholar 

  11. Kennedy JG. The flower of paradise: the institutionalized use of the drug qat in North Yemen. Dordrecht: D Reidel Publications; 1987. p. 98–100.

    Book  Google Scholar 

  12. Kalix P, Braenden O. Pharmacological aspects of the chewing of khat leaves. Pharmacol Rev. 1985;37:149–64.

    CAS  PubMed  Google Scholar 

  13. Adam F, Hasselot N. Khat: from traditional usage to risk of drug addiction. Med Trop Adams Mars. 1994;25(2):141–4.

    Google Scholar 

  14. Banjaw M, Schmidt W. Behavioural sensitisation following repeated intermittent oral administration of Catha edulis in rats. Behav Brain Res. 2005;156:181–9.

    Article  CAS  PubMed  Google Scholar 

  15. Banjaw M, Schmidt W. Catha edulis extract and its active principle cathinone induce ipsilateral rotation in unilaterally lesioned rats. Behav Pharmacol. 2006;17:615–20.

    Article  CAS  PubMed  Google Scholar 

  16. Giannini AJ, Miller MS, Turner CE. Treatment of khat addition. J Subst Abuse Treat. 1992;9:379–82.

    Article  CAS  PubMed  Google Scholar 

  17. Kalix P. Khat: scientific knowledge and policy issues. Br J Addict. 1987;82:47–53.

    Article  CAS  PubMed  Google Scholar 

  18. Elmai. Khat consumption and problems in Somalia. In: Proceedings of the international conference on Khat, Antananarivo, Madagascar. 1983.

  19. Morghemm M, Rufatm I. Cultivation and chewing of khat in the Yemen Arab Republic. In: Proceedings of the international conference on Khat, Antananarivo, Madagascar. 1983.

  20. Getajiu A, Krikoriaand N. The economic and social importance of khat and suggested research and services. In: Proceedings of the international conference on Khat, Antananarivo, Madagascar. 1983.

  21. Alhegami MA. Effects of Khat (catha edulis) on some blood contents and the tissues of digestive system of rabbits. [dissertation] Sana’a (Yemen): Sana’a University. 2001.

  22. Singh BN. Newer concepts in pathogenesis of myocardial Ischemia: Implications for evaluation of antianginal therapy. Drugs. 1986;32:1–14.

    Article  CAS  PubMed  Google Scholar 

  23. Gough SP, Cookson IP. Khat-induced schizophreniform psychosis in UK. Lancet. 1984;8374:455.

    Article  Google Scholar 

  24. Giannini AJ, Castellani S. A manic-like psychosis due to khat (Catha edulis Forsk). Toxicol Clin Toxicol. 1982;19:455–9.

    Article  CAS  Google Scholar 

  25. Newton T, Kalechstein A, Duran S, Vansluis N, Ling W. Methamphetamine abstinence syndrome: Preliminary findings. Am J Addict. 2004;13(3):248–55.

    Article  PubMed  Google Scholar 

  26. Malaju MT, Asale GA. Association of Khat and alcohol use with HIV infection and age at first sexual initiation among youths visiting HIV testing and counseling centers in Gamo-Gofa Zone, South West Ethiopia. BMC Int Health Hum Rights. 2013;13:10.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Kebede D, Alem A, Mitike G, Enquselassie F, Berhane F, Abebe Y, et al. Khat and alcohol use and risky sex behaviour among in-school and out-of-school youth in Ethiopia. BMC Public Health. 2005;5:109.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Alem A, Shibre T. Khat induced psychosis and its medico-legal implication: A case report. Ethiop Med J. 1997;35(2):137–9.

    CAS  PubMed  Google Scholar 

  29. Odenwald M, Neuner F, Schauer M, Elbert T, Catani C, Lingenfelder RB. Khat use as risk factor for psychotic disorders: a cross-sectional and case-control study in Somalia. BMC Med. 2005;3:5.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Balint E, Falkay G, Balint G. Khat—a controversial plant. Wiener klinische Wochenschrift. Midd Eur J Med. 2009;121:604–14.

    Google Scholar 

  31. Mwenda J, Arimi M, Kyama M, Langat D. Effects of khat (catha edulis) consumption on reproductive function. A review. East Afr Med J. 2003;80(6):318–23.

    CAS  PubMed  Google Scholar 

  32. Yucel M, Lubman D. Neurocognitive and neuroimaging evidence of behavioural dysregulation in human drug addiction: implications for diagnosis, treatment and prevention. Drug Alcohol Rev. 2007;26:33–9.

    Article  PubMed  Google Scholar 

  33. Yucel M, Lubman D, Harrison B, Fornito A, Allen N, Wellard R, et al. A combined spectroscopic and functional MRI investigation of the dorsal anterior cingulated region in opiate addiction. Mol Psychiatr. 2007;12:691–702.

    Article  CAS  Google Scholar 

  34. Al-Motarreb A, Al-Habori M, Broadley KJ. Khat chewing, cardiovascular diseases and other internal medical problems. J Ethnopharmacol. 2010;132(3):540–8.

    Article  CAS  PubMed  Google Scholar 

  35. Meressa K, Mossie A, Gelaw Y. Effect of substance use on academic achievement of health officer and medical students of Jimma University Southwest Ethiopia. Ethiop J Health Sci. 2009;19:3.

    Google Scholar 

  36. Kebede Y. Cigarette smoking and khat chewing among university instructors in Ethiopia. East Afr Med J. 2002;79(5):274–8.

    Article  CAS  PubMed  Google Scholar 

  37. Basunaid S, van Dongen M, Cleophas TJ. Khat abuse in Yemen: a population-based survey. Clin Res Regul Affairs. 2008;25(2):87–92.

    Article  Google Scholar 

  38. Al Khader NL, Darwish H. Prevalence of cigarette smoking and khat chewing among Aden university medical students and their relationship to BP and body mass index. Saudi J Kid Dis Transpl. 2009;20(5):862.

    Google Scholar 

  39. Deressa W, Azazh A. Substance use and its predictors among undergraduate medical students of Addis Ababa University in Ethiopia. BMC Public Health. 2011;11(1):660.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Kassa A, Loha E, Esaiyas A. Prevalence of khat chewing and its effect on academic performance in Sidama zone Southern Ethiopia. Afr Health Sci. 2017;17(1):175–85.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Moher D, Liberati A, Tetzlaff J, Altman DG, Group P. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6(7):e1000097.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Borenstein M, Hedges L, Higgins J, Rothstein H. Comprehensive meta-analysis version 2. Englewood: Biostat; 2005. p. 104.

    Google Scholar 

  43. Gebrie A, Alebel A, Zegeye A, Tesfaye B. Prevalence and predictors of khat chewing among Ethiopian university students: A systematic review and meta-analysis. PloS ONE. 2018;13(4):e0195718.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  44. Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ. 2003;327(7414):557.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol. 2010;25(9):603–5.

    Article  PubMed  Google Scholar 

  46. Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977;33:159–74.

    Article  CAS  PubMed  Google Scholar 

  47. Dires E, Soboka M, Kerebih H, Feyissa GT. Factors associated with khat chewing among high school students in Jimma Town Southwest Ethiopia. J Psychiatry. 2016;19(4):372.

    Google Scholar 

  48. Abdeta T, Tolessa D, Adorjan K, Abera M. Prevalence, withdrawal symptoms and associated factors of khat chewing among students at Jimma University in Ethiopia. BMC psychiatry. 2017;17(1):142.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Lakew A, Tariku B, Deyessa N, Reta Y. Prevalence of catha edulis (khat) chewing and its associated factors among ataye secondary school students in northern shoa, Ethiopia. Adv Appl Sociol. 2014;4(10):225.

    Article  Google Scholar 

  50. Gebrehanna E, Berhane Y, Worku A. Khat chewing among Ethiopian University Students—a growing concern. BMC Public Health. 2014;14:1198.

    Article  PubMed  PubMed Central  Google Scholar 

  51. Adugna F, Jira C, Molla T. Khat chewing among Agaro secondary school students, Agaro, southwestern Ethiopia. Ethiop Med J. 1994;32(3):161–6.

    CAS  PubMed  Google Scholar 

  52. Adere A, Yimer NB, Kumsa H, Liben ML. Determinants of psychoactive substances use among Woldia University students in Northeastern Ethiopia. BMC Res Notes. 2017;10(1):441.

    Article  PubMed  PubMed Central  Google Scholar 

  53. Astatkie A, Demissie M, Berhane Y, Worku A. Prevalence of and factors associated with regular khat chewing among university students in Ethiopia. Subst Abuse Rehabil. 2015;6:41.

    Article  PubMed  PubMed Central  Google Scholar 

  54. Kassa A, Loha E, Esaiyas A. Prevalence of khat chewing and its effect on academic performance in Sidama zone, Southern Ethiopia. Afr Health Sci. 2017;17(1):175–85.

    Article  PubMed  Google Scholar 

Download references


We thank the authors for providing additional data. We would like to thank our friends for their tireless gratitude and honest support even though we were preparing this review.


Not applicable.

Author information

Authors and Affiliations



WGA had a primary role in the conceptualization, data review, data extraction, data analysis, in the write-up and editing of this manuscript. TAZ had a role in data review, data extraction, in the write-up and editing of this manuscript. WWT had a role in data review, data extraction, in the write-up and editing of this manuscript. SSM had a role in data review, data extraction, in the write-up and editing of this manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Wondale Getinet Alemu.

Ethics declarations

Ethics approval and consent to participate

This review of previously reported studies required no ethical approval or additional consent from participants.

Consent for publication

Not applicable.

Competing interests

The authors declared that they have no competing interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Alemu, W.G., Zeleke, T.A., Takele, W.W. et al. Prevalence and risk factors for khat use among youth students in Ethiopia: systematic review and meta-analysis, 2018. Ann Gen Psychiatry 19, 16 (2020).

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: