ندااندإةعماج EDNA ADAN دنلايلاموصلا،اسيجره UNIVERSITY...

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TITLE OF THE STUDY:

The Effect Of Khat On Mental Health Amongst Adult In Hargeisa Mental Hospital,

Hargeisa, Somaliland

THESIS

A RESEARCH THESIS TO BE SUBMITTED TO EDNA ADEN

UNIVERSITY, IN PARTIAL FULFILLMENT FOR REQUIREMENTS FOR

THE AWARD OF BACHELOR DEGREE IN NURSING

SUBMITTED BY:

1. MOHAMOUD YASSIN H. DUALEH. ID: 510

2. NIMCO AHMED MUHUMED. ID: 544

3. SAFIA ABDIQADIR ALI. ID: 572

4. NIMCO ALI MOHAMED. ID: 546

SUPERVISOR BY:

MR. ABDIRRAHMAN ESSA NOUR

JULY, 2017

EDNA ADAN

UNIVERSITY

HARGEISA,

SOMALILAND

جامعةإدناادن هرجيسا،الصوماليالند

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DECLARATION

We declare that the thesis entitled the effect of khat on mental health amongst adult in Hargeisa

mental hospital is an original and our own study except where otherwise research. To our analysis

no part of this proposal has been submitted to any other institution in Edna Aden University for has

been prepared by us under the supervision and monitor of no part of this thesis has not been

submitted as research of any topic previously. We declare to not have presented before us this book.

1) Mohamoud Yassin H. Dualeh

Signature: __________________

Date: ______________________

2) Nimco Ahmed Muhumed

Signature: ___________________

Date: _______________________

3) Safia Abdiqadir Ali

Signature: ____________________

Date: _______________________

4) Nimco Ali Mohamed.

Signature: ____________________

Date: _______________________

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Edna Aden University

Faculty of Nursing

APPROVAL

I certify that this research satisfies the completed fulfillment of the requirement for the award

of Bachelor of Science in Nursing Edna Aden University in Hargeisa, Somaliland.

Supervisor:

Mr. Abdurrahman Essa Nur.

Signature: ____________________

Date: ____________________

Dean of Nursing:

Mrs. Ayan Abdi Hussein.

Signature: _________________

Date: ____________________

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DEDICATION

This thesis is dedicated to our beloved our parents whose gave us more encouragement which

on our future and how to competitive age and to suitable for our lives in the future and a

continuous support during our study in bachelor degree of nursing, besides we dedicated to

our brothers and sisters for thesis and also our classmates Mr. Abdirashid Ibrahim Aden, Mr.

Siyad Abdullahi Gudal, Mr. Abdinasir Salah Ahmed and Khadar Harir Mohamoud in Edna

Aden University. Thank you so much is the least we can say, May Allah protects you from

evil and Satan, may Allah grant you the highest level of paradise for our parents and siblings.

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ACKNOWLEDGEMENT

First and most, I would like to thank Allah give me this chance and being with me in doing all

my day to day activities.

I would like to thank chancellor Dr. Edna Aden Ismail, president prof. Mohamed Hussein

Osman, Academic of Dean Mr. Hassan Ibrahim Jama who allowed and helping us deeply to

finish to our first degree program at Edna Aden University.

I express my heartfelt gratitude and indebtedness to our dean of nursing Mrs. Ayan Abdi Hussein

for her genuine and constant advice starting from proposal development to the end of this

research thesis. She also motivated us to do our research in this area.

Special appreciation goes to our advisor Mr. Abdurrahman Essa Nur who taught us research

methodology and the supervision and constant support. His invaluable help of constructive

comments and suggestions throughout the experimental and research works have contributed to

the success of this research.

My sincere appreciation and heartfelt thanks goes to our research coordinator Ms. Ethil Salan

Omer Ahmed that chose us topic easy selecting the effect of khat on mental health.

I would like to express my appreciation to manager Dr. Mustafe Hussein Hersi for permission.

We would like to whole-heartedly appreciation the staff of the department of mental of the

Hargeisa group hospital for permitting us to research of the instruments and study of problem.

We are ever indebted to our family for their support and assistance during the period of

preparation of the manuscript and complete thesis in Hargeisa mental hospital.

Finally, sincere big thanks to all my advisor and hospital staffs. Special thanks to all of our

friends in degree courses. Our appreciation also extends to our classmates who cooperation us

when we were doing my thesis work. Last but not least, my deepest gratitude goes to our beloved

parents, brothers and sisters for their endless love, prayers, help and encouragement.

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Table of Contents

DECLARATION ............................................................................................................................ ii

APPROVAL .................................................................................................................................. iii

DEDICATION ............................................................................................................................... iv

ACKNOWLEDGEMENT .............................................................................................................. 5

ABSTRACT .................................................................................................................................... 8

LIST OF ACRONMY OR APPREVIATIONS .............................................................................. 9

CHAPTER ONE: INTRODUCTION

1.1Background .............................................................................................................................. 10

1.2 Statement of the problem ........................................................................................................ 11

1.3 Objectives of the study............................................................................................................ 11

1.3.1 General objective of study ................................................................................................... 11

1.3.2 Specific objective ................................................................................................................. 11

1.4 Research questions of the study .............................................................................................. 12

1.5 Hypothesis............................................................................................................................... 12

1.6 Significance of the study ......................................................................................................... 12

1.7 Scope of study ......................................................................................................................... 12

1.8 Time of scope .......................................................................................................................... 12

1.9 Operational research ............................................................................................................... 13

1.10 Conceptual framework .......................................................................................................... 13

CHAPTER TWO: LITERATURE REVIEW

CHAPTER THREE: RESEARCHMETHODOLOGY

3.1 Study area................................................................................................................................ 17

3.2 Study period ............................................................................................................................ 17

3.3 Study design ............................................................................................................................ 17

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3.4 Study population ..................................................................................................................... 17

3.5 Sample size & Sampling technique ........................................................................................ 18

3.6 Study Variable ........................................................................................................................ 18

3.7 Operational definition ............................................................................................................. 18

3.8 Data collection technique and tools ........................................................................................ 19

3.9 Data processing and analysis .................................................................................................. 19

3.10 Pre-test .................................................................................................................................. 19

3.11 Inclusion Criteria .................................................................................................................. 20

3.12 Exclusion Criteria ................................................................................................................. 20

3.13 Ethical Considerations: ......................................................................................................... 20

3.14 Limitation of the study .......................................................................................................... 20

3.15 Dissemination of findings ..................................................................................................... 20

CHAPTER FOUR: ANALYSIS AND INTERPRETATION OF FINDINGS.

4.1 Introduction ............................................................................................................................. 21

4.2 Analysis and Interpretation ..................................................................................................... 43

4.3 Findings................................................................................................................................... 43

CHAPTER FIVE: CONCLUSION, DISCUSSION AND RECOMMENDATION

5.1 Conclusion .............................................................................................................................. 44

5.2 Discussion ............................................................................................................................... 44

5.3 Recommendations ................................................................................................................... 44

Appendix

References ..................................................................................................................................... 46

Questionnaires............................................................................................................................... 48

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ABSTRACT

Background: Khat is a woody plant cultivated predominantly in North East Africa and the

Arabian Peninsula. Its use is particularly prevalent in Yemen, Djibouti, Kenya, Ethiopia, Eritrea,

Somalia and Uganda. Its leaves are chewed by the local people for their mental health effect. For

over 700 years, the plant has been regularly utilized for its mental health effect. It is estimated

that about 10 million people chew it every day. Methods: The study adopted a cross sectional

descriptive study design will conduct to assess the effect of chat on mental health in Hargeisa mental

Hospital. Results: The results of the study indicated that most the surveyed illustrated that they

chew khat and showed that chewing khat effects their sleep satisfaction and the findings of the

study demonstrated that khat is the main factor that effects and causes mental illness in Hargeisa

Somaliland.

Conclusion: This study showed that khat chewing increases maximum and mental problems.

Our target population was 72 persons who attending at Hargeisa mental Hospital, 81.94% of

them were male where the remaining 18.94% were female in Hargeisa group hospital especially

mental department. The study was assessment the effect of khat on mental amongst adult. Based

on the analysis on this study the result of the assessment says that the respondents have effect of

khat on mental health.

Key words: Khat, Mental Health.

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LIST OF ACRONMY OR APPREVIATIONS

1. HMH: Hargeisa Mental Hospital.

2. EAU: Edna Aden University.

3. MOH. Ministry of Health.

4. SPSS: Statistical Package for Social Sciences.

5. WHO: World Health Organization.

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CHAPTER ONE: INTRODUCTION

1.1 Background

In world, khat is an evergreen plant that is extensively cultivated in the highlands of Ethiopia and

surrounding countries like Kenya and Yemen. It is a bushy plant whose leaves are the source of a

naturally occurring amphetamine-like substance. It is highly abused for its stimulant properties.

Stimulation is commonly obtained by chewing the leaves privately or in small social gatherings.

Its effects on the chewer include increased levels of energy, increased self-esteem, euphoria,

increased libido, excitement, and increased proclivity for social interaction. The practice of khat

chewing dates back thousands of years in eastern Africa and the Arabian Peninsula where the

plant is widely cultivated and known by a variety of names like chat or khat in Ethiopia (1).

In continent, Ethiopia is a major producer and exporter of khat in east Africa; khat is commonly

used for stimulation and social recreation. A significant number of adults consume khat to be

alert and wakeful at night especially during examination periods. In a similar manner other

sections of the community like teachers, soldiers and farmers chew khat in order to reduce

fatigue and increase performance. Despite its popularity, there is ample evidence of the adverse

effects of habitual use of khat on mental, physical and social well-being. Mentally and

physically, it leads to problems like depression and anxiety, psychosis, impotence,

cardiovascular events, liver failure and stomach ulcers, among others. Socially, khat chewing

results in diversion of household income among poor families and reduced productivity

including, low interpersonal relationship skill, personal neglect, social isolation. It has also been

implicated with use of drugs, smoking, alcohol and sexual risk behaviors (2).

In local, khat is popular among adults; there are no only studies that have investigated its effect

of khat on mental health amongst in the adults. Particularly in western Somaliland where the

majority of khat in the country is brought and took eastern cities such as Buroa to Erigavo, no

studies have been conducted to investigate the habit. So we desire to inform decision and policy

makers in their efforts to understand and reduce khat use. The aim of this study is therefore to

assess the effect of khat on mental health among adults in mental ward, Hargeisa hospital (3).

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1.2 Statement of the problem

Khat is a flowering plant native to the Horn of Africa and the Arabian Peninsula. Amongst adults

from these areas, khat chewing has a history as social custom dating back thousands of years.

Khat chewing is a practice that dates back thousands of years in the Horn of Africa and the

Arabian Peninsula where the khat plant is widely cultivated and known by a variety of names,

including qaat and jaad in Somaliland. From this, it is possible to understand that Hargeisa

mental inpatients are highly manifesting different symptoms of anxiety including feeling of

fearful, dizziness, nervousness, heart pounding, trembling, headache, feeling restless, etc. and

symptoms of depression i.e. appetite loss, insomnia, sadness, loss of sexual desire, loneliness,

feeling blue, thought of ending once life, feeling of being busy, worrying too much about things,

feeling no interest in things, etc. Some khat chewers also experience unpleasant effects even

during the chewing process, describing anxiety, tension, restlessness and hallucinations.

Objectively, chewers can be seen to show a range of experiences, from minor psychological

problems to the development of significant behavioral problems like over-talkativeness, over

activity, insomnia, a tendency of carelessness, anxiety, irritability, emotional instability agitation,

hallucination, low mood and sluggishness, depression, and aggression (4).

1.3 Objectives of the study: To assess the effect of khat on mental health amongst adults

in mental wards, Hargeisa group hospital and to explore their views about the links between khat

and mental health amongst adult in Hargeisa mental hospital.

1.3.1 General objective of study: In this we will assess the effect of khat on mental

health amongst adult in Hargeisa group hospital, Somaliland especially in mental male & female

wards.

1.3.2 Specific objective:

1) To determine the influence of chat on mental health amongst adults in mental wards,

2) To examine the level of khat that effected on mental health amongst adults in Hargeisa

group hospital.

3) To identify if there are any significant relationship between khat and mental health

amongst adults in Hargeisa mental hospital.

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1.4 Research questions of the study 1). what is the level of the influence of khat on mental health amongst adults in Hargeisa?

2). what is the level of khat that effected on mental health amongst adults in Hargeisa?

3). Are there any significant relationship between khat and mental health amongst adults?

1.5 Hypothesis There is no any relationship between khat and mental health in Hargeisa group Hospital.

1.6 Significance of the study

This study will be importance to the coming researchers to comprehend the effect of khat on

mental health. This study will be a significant for the following sectors: health workers, mental

centers, hospitals, traditional healers, future researchers, local government and national

governmental organizations, International non-governmental organizations. Researchers may use

this research as secondary data, because the study is benefit from academicians or researchers.

1.7 Scope of study

The study would conduct in one district of Hargeisa capital. Five main districts which are 26

June, Ahmed Dhagah, Mohamoud Haybe, Gacan Libah and Ibrahim Kodbur districts, Hargeisa

mental hospital is one of the public hospital in 26 June district which services many populations.

Knowledge: The main objective of the study is to address the psychological and social problems

associated with khat chewing among adults and fill the research gap concerning the associations

as well variations in the severity of khat dependency with chewer’s psychosocial problems.

Geographical: The study would conduct in one district of Hargeisa capital. Hargeisa mental

hospital is one of the public hospitals in 26 June district. This study will be conducted in

Hargeisa mental hospital.

Hargeisa mental hospital is located in the central of Hargeisa. It was the second mental hospital

to open in the country, regular wards established on 2nd June, 1971 (5).

1.8 Time of scope: The duration of the study was four months starting from March to June

in 2017.

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1.9 Operational research: This research we find out to how many mental that effect of

khat in terms of their ages and gender for male and female involvement that mentally. Adults are

individuals who are older than 40 years of age.

1.10 Conceptual framework

Khat Mental Health

Extraneous Factors

A. Fatigue.

B. Impotence.

C. Personal neglect.

D. Over-talkativeness.

E. Aggression.

F. Cardiovascular events.

G. Hallucination.

H. Irritability.

I. Social isolation.

J. Death.

1. Insomnia.

2. Loss of sexual desire.

3. Appetite loss.

4. Nervousness.

5. Headache.

6. Heart pounding.

7. Feeling blue.

8. Dizziness.

9. Loneliness.

10. Liver failure.

1. Environmental factors.

2. Culture factors.

3. Belief Religion of policy.

4. Lack of awareness.

5. Lack of orientation.

6. Behavior.

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CHAPTER TWO: LITERATURE REVIEW

2.1. In global, khat is an evergreen plant that grows mainly in Ethiopia, Kenya and Yemen and at

high altitudes in South Africa and Madagascar is an addictive stimulant and highly effect khat

among individuals. Khat user highly affects mental health and social skills of many young lives.

Currently, several million people are estimated to be frequent khat users for its euphoric effects

and other subjectively explained desirable effects. It is believed to enhance social interaction and

usually used by individuals to improve their working capacity mainly by students, drivers,

female sex workers, military personnel, pastoralists, farmers, etc. Besides in some countries

where the use of khat is widespread, the habit has a deep-rooted socio-cultural tradition, (6).

In Ethiopia; chewing of khat in the western and south-eastern parts of the nation has a deep-

rooted socio-cultural consumption. Although khat is used by different groups of the society,

overstated effect of khat consumption marks to adult. A study which was conducted in

Somaliland stated that the effect of khat on mental illness among adult ranges from age 40 to

70of the total khat mental illness in the country. The effect of khat chewing by adult constitutes.

Such alarmingly ever-increasing psychoactive khat has a number of side effects. Several case

reports of khat-induced psychological problems have been published; though results seem

inconsistent. Subjectively, the pleasurable effects of khat use are considered as beneficial. These

effects are similar to those of amphetamine and include euphoria, increased alertness and

excitement. Adults who have an experience of using khat believe their habit as a source of better

alertness, concentration, imaginative abilities; improve interpersonal relationship, (7).

In line with this, pointed out that khat is not considered as harmful; rather it is well thought-out

as a drug which is said to induce mild euphoria and excitement, often accompanied by making a

person to be better in fluency and sometimes progressing to high excited state. In contrast, some

of the studies indicated that after about two to three hours of chewing ceases, unpleasant after-

effects tend to dominate its euphoric effect and is replaced by insomnia, lack of sensation, lack of

concentration and low mood. Some khat chewers also experience unpleasant effects even during

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the chewing process, describing anxiety, tension, restlessness and hallucinations. Objectively,

chewers can be seen to show a range of experiences, from minor psychological problems to the

development of significant behavioral problems like over-talkativeness, over activity, insomnia,

a tendency of carelessness, anxiety, irritability, emotional instability agitation hallucination, low

mood and sluggishness, depression, and aggression. On the other hand, this research findings

state that the psychological and social problems of khat use is associated with the level of

dependency on khat. Its frequent use leads in to psychological dependency that appears to

increase self-esteem, confidence, friendliness and pleasure during chewing session; otherwise,

their psychological and social problems including anxiety, depression, and social-skill become in

trouble. As to the observation of the researchers, khat chewer adults in different settings,

including in mental health centers and hospitals, hold a positive view about the mental illness 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. On the other hand, findings obtained from previous studies indicated that

many individuals face a number of problems as a result of khat chewing, (8).

It has a significant influence on the psychological constructs like anxiety and depression among

individuals. However, those psychological problems of khat chewing are strongly associated

with the severity of dependency on khat. “The heavier and more frequent the use, the greater the

risk was seen to be”. Besides, dependent khat chewers’ show diversified psychological

symptoms including stress, anxiety, depression, irritability and emotional instability more

frequently than non-chewers. One more problem related to khat chewing is that its euphoric

effect directs to use other psycho-active and/or depressant drug/s like cigarette, alcohol,

‘hashish’, and then leads to use other hard drugs like marijuana, cannabis, cocaine supposed to

have diversified psychosocial maladjustment. Despite the positive attitude for the mental illness

of using khat and inconsistencies of case reports on psychological and socio-economic problems

related to khat use, we can clearly observe multidimensional difficulties of using khat from

different groups of the community as a result of high effect in the mental health of khat chewing

among this, adults are highly vulnerable groups in Somaliland. More specifically, adults in

Hargeisa is highly vulnerable as a result of very high widespread of khat buying and

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consumption in Hargeisa mental hospital and the effect of khat chewing centers in the nearby

villages of the hospital building that are recent phenomenon in Hargeisa mental hospital.

Although the effect of khat chewing and its physiological and socioeconomic effects are studied

in some parts of Somaliland, the problems of khat chewing related to anxiety, depression and

social skills are not yet further investigated in Hargeisa mental hospital. Rather, some of studies

have been undertaken in the eastern culture where khat is not usually bought and consumed. So

that little is understood in detail on its psychological and social problems in a culture where it is

highly bought and consumed. Therefore, it is vital to conduct a research on empirical basis to

assess the psychological and social problems that are induced by khat chewing. Thus, taking

those problems into consideration, the present study tried to assess khat induced psychological

and social reaction among adults in Hargeisa mental hospital who attending on the mental wards.

Therefore, the main objective of the study is to address the psychological and social problems

associated with khat chewing among adult and fill the research gap concerning the associations

as well variations in the severity of khat dependency with chewer’s psychosocial problems, (9).

In Somaliland, when adults do khat they become very hyper, their eyes come out and they want

to be cleaning, they just want to be doing something inside the house. The blood pressure goes

high; they sweat a lot. They get that energy and they want to do a lot of work. Some adults when

they eat the khat they come to you very angry. The first thing they do is hitting the kids and the

mother and all those things. The partner is not happy with that, the children are not getting a fair

share of his life, all those kinds of things, and then it may constitute domestic violence because

of defending his habit. Many mental patients reported that khat users experienced dental

problems “I see a lot of dental issues. You have adult, very older adult, their teeth are falling

out”. Some mental patients reported that khat users often neglected dental hygiene after a long

night of chewing. “They eat a lot of sugar cubes, tea, something to make it sweet because it’s

very bitter”. Most reported that khat chewing caused constipation, although some reported a

laxative effect. Many claimed they used khat as a treatment for diabetes mellitus. Khat was said

to “help with blood sugar level”. Many associated khat use with increased libido and fertility:

“It’s more like Viagra”, and “It increases the amount of his sperm”, (10).

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CHAPTER THREE: RESEARCHMETHODOLOGY

3.1 Study area

This study area will be carried out at Hargeisa mental hospital. Hargeisa mental hospital is one of

main psychoactive hospital at Hargeisa which is located in the capital in Somaliland. Study will

be carried out at Hargeisa group hospital. Hargeisa is the largest city in Somaliland, located in

the Marodijeh region. Hargeisa is the capital of Somaliland with the total population of 750, 000

in 2015 across five broad districts with an average household of 5.5 members. Hargeisa has

borders in east Sahil region, west Gabiley region, South Hawd region and North Awdal region.

Hargeisa is also a commercial hub for precious stone-cutting, construction, retail services and

importing/exporting, among other activities, (11).

Hargeisa is home to various colleges and some universities. The main ones include University of

Hargeisa, Admass University, Frank Franz University, Gollis University, New Generation

University, Edna Adan University, and Hope University etc. There are also several state-run and

privately owned secondary and high schools, such as Noradin Secondary School, Ilays

Secondary school, Salama Secondary School, Bahrain Secondary School, Abaarso School of

Science and Technology, the premiere secondary school in the capital region. Most of them they

are located in Hargeisa while Abarso School is located about eight miles west of Hargeisa.

Additionally, many primary schools and secondary schools are dispersed all around the city (12).

3.2 Study period: The study was conducted in the period between March to July in 2017.

3.3 Study design: A cross sectional descriptive study design will conduct to assess the

effect of chat on mental health in Hargeisa mental Hospital. Inclusion criteria will be all khat

users attending Hargeisa mental hospital. The exclusion criteria will be non- khat users who were

attending Hargeisa mental hospital.

3.4 Study population: The population who safeguarding in Hargeisa mental hospital is too

large for us to consider collecting information from all its members instead we select a sample of

individuals hoping that the sample is representative all characteristics of the population.

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The target population of the research study will be composing 88. The researcher will be

collected research only khat users in order to find full information about this research for the

effect of chat on mental health in Hargeisa mental hospital.

3.5 Sample size & Sampling technique: The sample size will be 72 respondents

drawn from the categories of respondents in the study area and population. The respondents will

khat users in Hargeisa mental hospital, formula will calculated to find sample size is 72.

The sample size will be calculated by using Slovenes’ formula;

n = N = 88 = 72

1+N*(e) 2 1+88(0.05) 2

Where

n = number of sample

N = total population

E = Level of significance (0.05)

The study sampling technique used will be purposeful non-probability sampling. Purposeful

sampling strategies for qualitative studies is qualitative research methods are typically used when

focusing on a limited number of informants, whom we select strategically so that their in-depth

information will give optimal insight into an issue about which little is known. Purposive

sampling simplifies the researcher to get particular information that is based in Hargeisa.

3.6 Study Variable

The dependent variable for the study is khat and the independent variables are mental health

amongst adults and context is Hargeisa mental hospital.

3.7 Operational definition 2. Khat is a woody plant cultivated predominantly in North East Africa and the Arabian

Peninsula. Its use is particularly prevalent in Yemen, Djibouti, Kenya, Ethiopia, Eritrea,

Somalia, Somaliland and Uganda. Its leaves are chewed by the local people for their

stimulant action. For over 700 years, the plant has been regularly utilized for its stimulant

effect. It is estimated that about 10 million people chew it every day, (13).

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3. Health is a state of complete physical, mental and social well-being and not merely the

absence of disease and disability as defined World Health Organization (WHO).

4. Mental health is a state of balance between the individual and the surrounding world, a

state of harmony between oneself and others, a co-existence between the realities of the

self and that of other people and that of the environment as defined (WHO).

5. Adult is the human that has reached maturity for above 40 years.

6. Amongst is a variant of among or separate object.

7. Hargeisa Mental Hospital Hargeisa mental hospital is one of the public hospitals of

Hargeisa which located in the central of Hargeisa. HMH is a mental health center that

services the mental person who attending different ward as male mental wards and

female mental wards and get help and treatment for their care. This picture shows us

location at Hargeisa Mental Hospital, Hargeisa.

3.8 Data collection technique and tools: The collection of data in this study based on

two forms, namely the collection of primary data and the collection of data in secondary form

primary data is data that researchers are collecting information for the specific purposes of their

study which involved the use of questionnaires to gather information from the selected

respondents. The collection of secondary data involved review of official documents such as

patient files, patient examination papers, patient diagnostic paper and others previous data

collecting. The researcher will be used instrument questionnaires. The questionnaire in this

research study will be used close and end questionnaires by the researcher.

3.9 Data processing and analysis: Quantitative data will enter in SPSS data will be

cleaned by running frequencies of all the variables to check for incorrectly coded data.

Incorrectly coded data will be double checked with the raw data in the questionnaire and

corrected. Statistical methods will be used to analyses the data collected such as descriptive

statistics, for example numerical summations, graphs and tables. The analysis software

performed using the data will be Statistical Package for Social Sciences (SPSS).

3.10 Pre-test: Validity will be measured checklist and consulted by the some experts will be

in developing the tool and therefore the field and also there consultation and review of the

research in order to become valid and reliability measured by repeatedly checking, and also there

were questionnaire translation to the respondents and pre-test were done. Such as mental health

staffs, khat user and non-khat user persons.

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3.11 Inclusion Criteria: In this study, male and female khat chewers aged between 40-70

years old, All khat users adults attending Hargeisa district during data collection period and can

give consent will be included the study and also permanent attended of the study area were

include in the study.

3.12 Exclusion Criteria: Those who are seriously sick and unable to respond to the

questions, non-khat user adults who could not give consent and all people, who could not talk or

listen, which have mentally were excluded from the study.

3.13 Ethical Considerations: The researchers will be undertaken to observe all relevant

ethical and legal considerations that are applicable to scientific research. The researcher will

obtained authorization from the relevant department of health research and consultancy center in

Hargeisa mental hospital to conduct the study.

a) Informed Consent: The researcher obtained consent from the participants in the research

from the khat user persons, non-khat user persons and health professional included in the

sample.

b) Confidentiality: All information obtained in the course of this study will be treated with

utmost confidentiality and shall not be used outside the scope of the study. This is done in

compliance with the requirement for confidentiality, which seek to protect the identity of

research subject against potential abuse/stigmatization.

c) Voluntary participation: The participants were duly informed that their participation in

the research survey was purely voluntary. There would not be any punitive measure taken

against those who declined to participate and neither was there any reward for

participation.

3.14 Limitation of the study: The study had some limitations. We have difficult

language barrier and not have prevision experience of research thesis. We were difficult how to

enter the data SPSS (Statistical Package for Social Sciences) and Microsoft Word (2010)

statistical software package for used of computers.

3.15 Dissemination of findings: The research study findings will be presenting to the

clinic community and will be encouraged to comment on them.

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CHAPTER FOUR: ANALYSIS AND INTERPRETATION OF FINDINGS.

4.1 Introduction

This chapter presents data collection, analysis and interpretation from the field. The data was

collected using instruments like questionnaire, documentation, which the investigators check

and rearrange all the collected data or information from the respondents in order to analyze

and then make interpretation, also data analysis in this study the following data analysis are

consist two part staff questionnaire and patient questionnaire so the total are 72 respondents and

questions from the staff and directly focuses on the effect of khat chewing on mental health in

Hargeisa mental hospital. We used different charts for frequency such as table, circle and graphs.

Analysis and result interpretation

Table 1: age of the respondents

Frequency Percent Valid Percent Cumulative

Percent

Valid 18 to 25 18 25.0 25.0 25.0

26 to 40 36 50.0 50.0 75.0

41 to 52 16 22.2 22.2 97.2

53 to above 2 2.8 2.8 100.0

Total 72 100.0 100.0

According to above table 1, the investigator asked the respondents, how old are you? They reply

are 25.0% the respondents ages between 18-25 years old, while are 50.0% the respondents said,

age between 26-40 years. Other while are 22.2% the respondent ages between 41-52 years.

While are 2.8% the respondents said, age between 53 to above years although the above figure

shown that the majorities of the respondents are ages between 26 to 40 years old.

22

Table 2: Gender of the respondents


Percent

Valid Female 13 18.1 18.1 18.1

Male 59 81.9 81.9 100.0

Total 72 100.0 100.0

According to above table 2, the investigator asked the respondents. What is your gender? They

reply are 81.9% in our respondent they are male, while 18.1% in our respondent they are female.

So that the majorities answered 81.9% are male.

Table 3: Residence of the respondents


Percent

Valid 26 June district 20 27.8 27.8 27.8

Ibrahim Kodbur district 12 16.7 16.7 44.4

Ahmed Dhagah district 26 36.1 36.1 80.6

GacanLibah district 7 9.7 9.7 90.3

Mohamoud Haybe district 7 9.7 9.7 100.0

Total 72 100.0 100.0

According to above table 3, the investigator asked the respondents, which district is you resided?

36.1% they are reply Ahmed Dhagah district, while 27.8% in our respondent the said 26 June

district, while 16.7% in our respondent they said Ibrahim Kodbur district, while 9.7% in our

respondent they said Gacan Libah district and also while 9.7% in our respondent they said

Mohamoud Haybe district. So that the majorities answered 36.1% are Ahmed dhagah district.

23

Table 4: Marital status of the respondents


Percent

Valid Single 23 31.9 31.9 31.9

Married 32 44.4 44.4 76.4

Divorced 17 23.6 23.6 100.0

Total 72 100.0 100.0

According to above table 4, the investigator asked our the respondents to their marital status

44.4% they are reply married, while 31.9% in our respondent the said single, while 23.1% in our

respondent they said divorced. So that the majorities answered 44.4% are married.

Table 5: Educational level of the respondents


Percent

Valid Primary 14 19.4 19.4 19.4

Secondary 21 29.2 29.2 48.6

University 19 26.4 26.4 75.0

Illiteracy 10 13.9 13.9 88.9

Others 7 9.7 9.7 98.6

11.00 1 1.4 1.4 100.0

Total 72 100.0 100.0

According to above table 5, what is your educational level? 29.2% they are reply secondary

school, while 26.4% in our respondent the said university, while 19.4% in our respondent they

said primary school, while 13.9% in our respondent they said illiteracy and also while 9.7% in

our respondent they said others. So that the majorities answered 29.2% are secondary school.

24

Table 6: Occupation of the respondents


Percent

Valid Business 20 27.8 27.8 27.8

Teacher 7 9.7 9.7 37.5

Health professional 16 22.2 22.2 59.7

Others 29 40.3 40.3 100.0

Total 72 100.0 100.0

According to above table 6, what is your occupation? The investigator asked our respondents.

40.3% they are reply others, while 27.8% in our respondent the said business, while 22.2% in our

respondent they said health professional, while 9.7% in our respondent they said teacher. So that

the majorities answered 40.3% are others.

Table 7: Live in home of the respondent


Percent

Valid 2 to 5 32 44.4 44.4 44.4

6 to 10 21 29.2 29.2 73.6

11 to 15 18 25.0 25.0 98.6

More than 16 1 1.4 1.4 100.0

Total 72 100.0 100.0

According to above table 7, the investigator asked the respondents, how many persons live in

your home? 44.4% they are reply 6 to 5, while 29.2% in our respondent the said 6 to 10, while

25.0% in our respondent they said 11 to 15 and also 1.4% in our respondent the said more than

16. So that the majorities answered 44.4% are 6 to 5 persons.

25

Table 8: Currently living of the respondent


Percent

Valid Parents 27 37.5 37.5 37.5

Relatives 20 27.8 27.8 65.3

Friends 11 15.3 15.3 80.6

Others 14 19.4 19.4 100.0

Total 72 100.0 100.0

According to above table 8, the investigator asked the respondents. You are currently living

with? 37.5% they are reply parents, while 27.8% in our respondent the said relatives, while

19.4% in our respondent they said others and 15.3% in our respondents they said friends. So that

the majorities answered 37.5% are parents.

Table 9: Chewed khat of the respondents


Percent

Valid Yes 63 87.5 87.5 87.5

No 9 12.5 12.5 100.0

Total 72 100.0 100.0

According to above table 9, the investigator asked our respondents, have you ever chewed khat?

87.5% they are reply YES, while 12.5% in our respondent the said NO, So that the majorities

answered 87.5% are yes.

26

Table 10: Started to chew khat of the respondents


Percent

Valid 15 to 25 44 61.1 61.1 61.1

26 to 40 18 25.0 25.0 86.1

41 to 50 1 1.4 1.4 87.5

None 9 12.5 12.5 100.0

Total 72 100.0 100.0

According to above table 10, the investigator asked our respondents, at what age you started to

chew khat? 61.1% they are reply 15 to 25, while 25.0% in our respondent the said 26 to 40,

while 12.5% in our respondent they said none and also 1.4% in our respondent the said 41 to 50.

So that the majorities answered 61.1% are 15 to 25 started chew khat.

Circle 11: Bundles per day of the respondents.

According to above circle11, the investigator asked the respondents, how many bundles per day?

45.83% they are reply quarter, while 23.61% in our respondent the said kilo, while 12.50% in

our respondent they said none and 9.72% in our respondents they said less than quarter and also

8.33% in our respondent they said two quarter. So that the majorities answered 45.83% are

quarter.

27

Circle 12: Where chewing khat of the respondents.

According to above circle 12, the investigator asked the respondents, where do you usually

chewing khat? 34.72% they are reply others, while 23.61% in our respondent the said home,

while 18.06% in our respondent they said market and 12.50% in our respondents they said none

and also 11.11% in our respondent they said office. So that the majorities answered 34.72% are

others.

Circle 13: Spend for khat per day of the respondents.

28

According to above circle 13, how many dollars do you usually spend for khat per day? the

investigator asked our respondents 33.33% they are reply 2 to 4, while 25.00% in our respondent

the said 6 to 8, while 16.67% in our respondent they said 4 to 6, while12.50% in our respondent

the said 8 to above and also 12.50% in our respondent the said none. So that the majorities

answered 33.33% are 2 to 4 khat per day.

Circle 14: Money buys a khat of the respondents.

According to above circle 14, where do you get the money to buy a khat? The investigator asked

our respondents 50.00% they are reply my own, while 18.06% in our respondent the said

relatives, while 12.50% in our respondent they said friends, while12.50% in our respondent the

said none and also 5.56% in our respondent the said parents, while 1.39% in our respondents said

others. So that the majorities answered 50.00% are my own.

29

Circle 15. Usually chew khat of the respondents.

According to above circle 15, with who do you usually chew khat? The investigator asked our

respondents 44.44% they are reply with friends, while 18.06%% in our respondent the said

nobody, while 12.50% in our respondent they said co-workers, while12.50% in our respondent

the said with my family and also 12.50% in our respondent the said none. So that the majorities

answered 44.44% are friends.

Circle 16: Any substance of the respondents.

30

According to above circle 16, do you use any substance when you are chewing khat? The

investigator asked our respondents 56.94% they are reply NO, while 43.06% in our respondent

the said YES, So that the majorities answered 56.94% are no.

Circle 17: Interest chew khat of the respondents.

.

According to above circle 17, how did you usually get the khat when you are interest to chew

khat? The investigator asked our respondents 36.11% they are reply from khat store, while

30.56%% in our respondent the said from office friends, while 12.50% in our respondent they

said none, while11.11% in our respondent the said with from co-workers and also 9.72% in our

respondent the said from my family. So that the majorities answered 36.11% are from khat store.

Table 18: Chew khat and cigarettes smoking of the respondents.


Percent

Valid Yes 41 56.9 56.9 56.9

No 31 43.1 43.1 100.0

Total 72 100.0 100.0

31

According to above table18, have you ever tried chew khat and cigeratte smoking? The

investigator asked our respondents 56.9% they are reply YES, while 43.1% in our respondent the

said NO, So that the majorities answered 56.9% are yes.

Table 19: Believe khat chewing to increase energy of the respondents.


Percent

Valid Yes 45 62.5 62.5 62.5

No 27 37.5 37.5 100.0

Total 72 100.0 100.0

According to above table 12, do you believe khat chewing to increase energy levels, sense of

excitement, improves alertness and enhance the ability to concentrate? The investigator asked

our respondents 62.5% they are reply YES, while 37.5% in our respondent the said NO, So that

the majorities answered 62.5% are yes.

32

Circle 20: Think chewing to enhance of the respondents.

According to above circle 7, do you think that chewing to enhance social interaction and usually

used by individuals to improve their working capacity? The investigator asked our respondents

56.94% they are reply NO, while 43.06% in our respondent the said YES, So that the majorities

answered 56.94% are no.

Circle 21: Believe khat chewing of the respondents.

33

According to above circle 8, do you believe that khat chewing is a taboo? The investigator asked

our respondents 68.06% they are reply YES, while 31.94% in our respondent the said NO. So

that the majorities answered 68.06% are yes.

Circle 22: Khat chewing on mental health of the respondents.

According to above circle 9, did you know to effect of khat chewing on mental health? The

investigator asked our respondents 70.83% they are reply YES, while 29.17% in our respondent

the said NO. So that the majorities answered 70.83% are yes.

Table 23: Khat chewing on physical health of the respondents


Percent

Valid Yes 43 59.7 59.7 59.7

No 29 40.3 40.3 100.0

Total 72 100.0 100.0

According to above table 13, did you know to effect of khat chewing on physical health? The


said NO. So that the majorities answered 59.7% are yes.

34

Table 24: Khat chewing on social health of the respondents


Percent

Valid Yes 46 63.9 63.9 63.9

No 26 36.1 36.1 100.0

Total 72 100.0 100.0

According to above table 14, did you know to effect of khat chewing on social health? The



Table 25: Felt fatigue of the respondents.

During your chew khat, have you ever felt fatigue?


Percent

Valid Yes 38 52.8 52.8 52.8

No 34 47.2 47.2 100.0

Total 72 100.0 100.0

According to above table 15, during your chew khat, have you ever felt fatigue? The investigator

asked our respondents 52.8% they are reply YES, while 47.2% in our respondent the said NO. So

that the majorities answered 52.8% are yes.

35

Table 26: Family mental illness of the respondents


Percent

Valid Yes 30 41.7 41.7 41.7

No 42 58.3 58.3 100.0

Total 72 100.0 100.0

According to above table 16, does anyone in your family have illness? The investigator asked

our respondents 58.3% they are reply NO, while 41.7% in our respondent the said YES. So that

the majorities answered 58.3% are no.

Circle 27: Things of the respondents.

According to above circle ten, when you chewed khat, do you see things that are not there? The



36

Table 29: Change sleep of the respondents


Percent

Valid Yes 47 65.3 65.3 65.3

No 25 34.7 34.7 100.0

Total 72 100.0 100.0

According to above table 17, during your chew khat, is there any change to your sleep? The



Table 30: Change appetite of the respondents


Percent

Valid Yes 44 61.1 61.1 61.1

No 28 38.9 38.9 100.0

Total 72 100.0 100.0

According to above table 18, when you chewed khat, is there any change to your appetite? The



37

Circle 31: Put idea of the respondents.

According to above circle 11, when you chewed khat, have you ever felt that someone put idea

into head? The investigator asked our respondents 58.33% they are reply YES, while 41.67% in

our respondent the said NO. So that the majorities answered 58.33% are yes.

Graph 32: Removed idea of the respondents.

38

According to above graph 1, during your chew khat, have you ever felt fatigue? The investigator

asked our respondents 41 equivalent 56.94% they are chose YES, while 31 equivalent 43.06% in

our respondent the said NO. So that the majorities answered 41 equivalent 56.94% are yes.

Graph 33: Help of the respondents.

According to above graph 2, do you feel you need help? The investigator asked our respondents

37 equivalent 51.39% they are chose YES, while 35 equivalent 48.61% in our respondent the

said NO. So that the majorities answered 37 equivalent 51.39% are yes.

Graph 34: Thought to harm-self of the respondents.

According to above graph 3, when you chew khat, have you ever thought to harm yourself? The

investigator asked our respondents 49 equivalent (68.06%) they are chose NO, while 23

39

(31.94%) in our respondent the said YES. So that the majorities answered 49 equivalent

(68.06%) are no.

Graph 35: Try to harm other people of the respondents.

According to above graph 4, when you chew khat, have you ever try to harm other people? The

investigator asked our respondents49 equivalent (68.06%) they are chose NO, while

23equivalents (31.94%) in our respondent the said YES. So that the majorities answered 68.06%

are no.

40

Circle 36: Harm other people of the respondents.

According to above circle 12, are there any people to harm you? The investigator asked our

respondents, 69.44% they are reply NO, while 30.56% in our respondent the said YES. So that

the majorities answered 69.44% are no.

41

Graph 37: In experience of the khat chewing of the respondents.

According to above graph 5, in your experience of chewing khat what is the effect of khat on

mental health? The investigator asked our respondents, 28 equivalent (38.89%) they are

answered I am mentally and aggressive, while 15 equivalents (20.83%) in our respondent the

said memory loss and activities loss, while 14equivalent (19.45%) in our respondent they said

the change my mind and missed my goals and ambitions, while 9equivalent (12.5%) in our

respondent the said with I don’t chew khat and also 6 equivalent (8.33%)in our respondent the

said constipation and anorexia. So that the majorities answered 28 equivalent (38.89%)are i am

mentally and aggressive.

42

Graph 38: Recommendation of the respondents.

According to above graph 6, do you have any recommendation about how to stop chewing khat?

The investigator asked our respondents 23 equivalent (31.94%) they are answered we have to

stop our people because we are fatigue, while 19 equivalent (26.39%) in our respondent said I

am recommend to not chew khat because it reduce our health and economically, while 17

equivalent (23.61%) in our respondent they said I am advice to stop chewing khat it cause

constipation and gastric and banning for tax, while13 equivalent (18.06%) in our respondent

said we must to pray and to forget chewing khat. So that the majorities answered 23equivalents

(31.94%) are we have to stop our people because we are fatigue.

43

4.2 Analysis and Interpretation

4.3 Findings

1: Figure 9, the investigator asked our respondents have you ever chewed khat? 97.50% they are

reply YES, while 12.50% in our respondent the said NO, So that the majorities answered 97.50%

are khat dependency.

2. According to above circle 11, did you know to effect of khat chewing on mental health? The



3. According to above table 12, do you believe khat chewing to increase energy levels, sense of

excitement, improves alertness and enhance the ability to concentrate? The investigator asked

our respondents 62.5% they are reply YES, while 37.5% in our respondent the said NO, So that

the majorities answered 62.5% are yes.

4: Figure 29, during your chew khat, is there any change to your sleep? The investigator asked

our respondents 65.28% they are reply YES, while 34.72% in our respondent the said NO. So

that the majorities answered 65.28% are Insomnia.

5: Figure 37, in your experience of chewing khat what is the effect of khat on mental health? The

investigator asked our respondents 38.89% they are reply I am mentally and aggressive, while

20.83%% in our respondent the said memory loss and activities loss, while 19.44% in our

respondent they said the change my mind and missed my goals and ambitions, while12.50% in

our respondent the said with I don’t chew khat and also 8.33% in our respondent the said

constipation and anorexia. So that the majorities answered 38.89% are psychosis.

44

CHAPTER FIVE: CONCLUSION, DISCUSSION AND RECOMMENDATION.

5.1 Conclusion

The study is intended to assess the effect of chewing khat on mental health in Hargeisa group

hospital mental department, our target population was 72 persons who attending at Hargeisa

mental Hospital, 54 of them were male where the remaining 18 were female in Hargeisa group

hospital especially mental department. Based on the analysis on this study the result of the

assessment says that the respondents have effect of khat on mental health, 61.11% they are reply

15 to 25, while 25.00% in our respondent the said 26 to 40, while 12.50% in our respondent they

said none and also 1.39% in our respondent the said 41 to 50. So that the majorities answered

61.11% are 15 to 25. So this age is very young when they starting their age. you ever tried chew

khat and cigeratte smoking? The investigator asked our respondents 56.94% they are reply YES,

while 43.06% in our respondent the said NO, So that the majorities answered 56.94% are yes. So

together these substance are serious mental health problem.

5.2 Discussion

This study was designed to assess the effects of chewing khat on mental health amongst adult.

1) Inadequate knowledge of khat because they are chewing khat easily.

2) Insomnia causes the person become mentally because they are not sleep whole night.

3) When the person chewed khat become loss of contact with reality and hyperactivity.

5.3 Recommendations

Based on the findings of the study the researchers recommended the following suggestions for

our people especially khat users and non-khat users to give those following programs.

1) The curriculum must be including orientations and teaching for primary and secondary

schools in Somaliland about khat problems.

2) Ministry of Media of Somaliland must get adequate awareness about khat for health problems.

45

3) To uses the mass media to reach the awareness of the khat large population.

4) The adults must be given the advices for health training programs about khat users.

5) Geriatrics centers and hospitals staff should take a big continuous campaign and encourage

and teach adults about khat problem.

6). Promoting and providing knowledge about khat problems to not buy the khat sellers.

7). Ministry of Health and Ministry of Commerce and Investment of Somaliland should

encourage to stop like khat and any substances which can increase our country and can help the

people to prevent khat problems.

8). We will implement this work by making health education programs about khat to the

community who are illiterate, public leader, religious leaders, Somali poetry, and informal

leaders, must made awareness to the community. If these done successfully it decreases chewing

khat.

46

References

1. AtalayAlem&TeshomeShibre .(1999). Khat Induced Psychosis and Its

Medico legal Implication.Ethiopian Medical Journal, 35: 137-141.

2. Al-Motarreb.A.L, Al-Habori M., Broadley K.J. (2010) Khat chewing, cardiovascular diseases

and other internal medical problems: The current situation and directions for future research. J

Ethnopharmacology vol. 132: 540-548

3. Nencini, P., Ahmed, A. M., Aminconi, G., et al (1984) Tolerance develops to sympathetic

effects of khat in humans. Pharmacology, vol.28: 150–154

4. Toennes S.W., Harder S., Schramm M., Niess C., Kauert G.F. (2003). Pharmacokinetics of

cathinone, cathine and norephedrine after the chewing of khat leaves. Br J ClinPharmacol

vol.56:125-130.

5. Dr. Mustafe H. Hersi (2017) Psychiatric Doctor at Hargeisa Mental Hospital

6.Halbach H. (1972). Medical aspects of the chewing of khat leaves. Bulletin of the World

Health Organization vol. 47:21–29.

7. Kalix P, Braenden O. (1985).Pharmacological aspects of the chewing of khat leaves.

Pharmacol Rev vol. 37:149-164.

8. Dr. Ahmed B. Ahmed (2017), Expert in Hargeisa Mental Hospital

9. Ministry of health of Somaliland for Book (2015) at Hargeisa group hospital

10. Al-Motarreb A.L, Briancon S., Al-Jaber N. et al., (2005).Khat chewing is a risk factor for

acute myocardial infarction: a case-control study. Br J ClinPharmacol.vol .59:574-58.

11. Cox G., Rampes H. (2003). Adverse effects of khat: A review. AdvPsychiatrTreatm.

12. Hassan N.A., Gunaid G.M., Khally A.A., Murray-Lyon I.M. (2002). The effect of Khat

chewing leaves on the Human mood. Saudi Med J vol. 23(7): 850–853.

13. Alem A, Kebede D, Kullgren G. (1999): The prevalence and socio-demographic correlates of

khat chewing in Butajira, Ethiopia. ActaPsychiatricaScand (Suppl), 100:84-91.

47

Dear Manager

Dr. Mustafe Hussein Hersi.

Request: Permission to conduct a study in Hargeisa mental hospital.

Date: 13/05/2017.

We are group of students, student’s number 510, 546, 544 and 572 for ten group students in Edna

Aden University of senior nursing students.

Would like to request a permission to carry out a study at Hargeisa mental hospital, the title of

the research topic is “The effect of khat on mental health amongst adults in Hargeisa mental

hospital”.

We are kindly requesting manager to collaborate our thesis research and questionnaire. We need

your support without you we can’t finish and your institution will be genuinely confidential and

used only for academic purpose, the questionnaire will take about 15 minutes to complete.

The purpose of the study is to explore the effect of chat on mental health amongst adults in

Hargeisa mental hospital.

We trust that our application will receive your favorable consideration.

Yours sincerely

48

Edna Adan University

Faculty Nursing

Questionnaires

Dear respondents

we are senior students of nursing at Edna Adan University, we are conducting a research thesis

project about the effect of khat on mental health, The questionnaires will take about 15 minutes

and we would very much be thankful for your participation, If there are any questions that you

do not want to answer, you can tell us and we will continue to the next question. Participation is

voluntary but we hope you will chose to take part as your views are very important to us. Please

encircle on the item containing your response and if you change your answer, erase your old

answer completely and mark your new choice clearly. Do not write your name or identification

card registration.

Part one: Demographic characteristics of the respondents.

1. How old are you?

A. 18 to 25□

B. 26 to 40□

C. 41 to 52□

D. 53 to above□

2. What is your gender?

A. Female □

B. Male □

3. Which districtis you resided?

A. 26th June district □

B. Ibrahim Kodbur □

C. Ahmed Dhagah □

D. GacanLibah □

E. Mohamoud Haybe □

4. Your marital status is

A. Single□

B. Married □

C. Divorced □

49

D. Widowed □

5. What is your occupation?

A. Business man/woman□

B. Teacher□

C. Health Officer□

D. Others □

6. What is your educational level?

A. Primary□

B. Secondary□

C. University □

D. Illiteracy□

E. Others □

7. How many persons live in your home?

A. 2 to 5 □

B. 6 to 10 □

C. 11 to 15 □

D. More than 16□

8. You are currently living with

A. Parents □

B. Relatives □

C. Friends □

D. Others □

Part two: Khat chewing and mental health

9. Have you ever chewed khat?

A. Yes □

B. No □

10. When do you start khat chewing?

A. 15 to 25 □

B. 26 to 40 □

C. 42 to 50 □

D. 51 and above □

E. None□

11. How many bundles do you chew per day?

A. Kilo □

50

B. Quarter □

C. Two quarter □

D. Less than quarter □

E. None □

12. Where do you usually chewing khat?

A. Home □

B. Market □

C. Office□

D. Others □

E. None □

13. How many dollars do you usually spend for khat per day?

A. $ 2 to 4□

B. $ 4 to 6□

C. $ 6 to 8□

D. $ 8 to above □

14. Where do you get the money to buy a khat?

A. My own □

B. Parents□

C. Relatives□

D. Friends□

E. Others□

F. None □

15. With whom do you usually chew khat?

A. With co-workers□

B. With my friend’s□

C. With my family□

D. Nobody □

E. None. □

16. Do you use any substance when you are chewing khat?

A. Yes□

B. No□

17. How did you usually get the khat when you are interested to chew khat?

A. From co-workers □

51

B. From office friend□

C. From khat store □

D. From my family □

E. None □

18. Have you ever tried together chew khat and cigarette smoking?

A. Yes □

B. No □

19. Do you believe khat chewing to increase energy levels and sense of excitement?

A. Yes □

B. No □

20. Do you think khat chewing to enhance social interaction and usually used by individuals to

improve their working capacity?

A. Yes □

B. No □

21. Do you believe that khat chewing is a taboo?

A. Yes □

B. No □

22. Did you know to effect of khat chewing on mental health?

A. Yes □

B. No □

23. Did you know to effect of khat chewing on physical health?

A. Yes □

B. No □

24. Did you know to effect of khat chewing on social health?

A. Yes □

B. No □

25. During your chew khat, have you ever felt a fatigue?

A. Yes □

B. No □

26. Does anyone in your family have mental illness?

A. Yes □

B. No □ 27. When you chewed khat, do you see things that are not there?

A. Yes □

No. No □

28. When you chewed khat, do you hear voices from person that are not present?

A. Yes □

B. No □

29. When you chewed khat, is there any change to your sleep?

A. Yes □

B. No □

30. When you chewed khat, is there any change about your appetite?

A. Yes □

B. No □

52

31. When you chewing khat, have you ever felt that someone put idea into your head?

A. Yes □

B. No □

32. When you chewing khat, have you ever felt that someone removed ideas from your head?

A. Yes □

B. No □

33. Do you feel you need help?

A. Yes □

B. No □

34. When you chew khat, have you ever thought to harm yourself?

A. Yes □

B. No □

35. When you chew khat, have you ever try to harm other people?

A. Yes □

B. No □

36. Are there any people to harm you?

A. Yes □

B. No □

37. in your experience of chewing khat what is the effect of khat on mental

health………………………………………………………………………………………………

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……..………………………………………………………………………………………………

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38. do you have any recommendations about how to stop chewing

khat…………………………………………………………………………………………………

………………………………………………………………………………………………………

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………………………………………………………………………………………………………

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Date post:	16-Apr-2020
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ندااندإةعماج EDNA ADAN دنلايلاموصلا،اسيجره UNIVERSITY...

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