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Books - The health and socio-economic aspects of Khat use
Written by C.K. Maitai   


Since time immemorial, human beings have sought ways and means of making life more pleasurable. It is in this light that the use of narcotics must be viewed. Narcotics alter moods, produce pleasant sensations or dreams and a feeling of well-being at dosage levels low enough to avoid marked peripheral effects.
Catha edulis popularly known as "khat" has been the subject of discussions in several national and international meetings since 1935 when the question was first raised at the League of Nations. A lot of literature is available on the botany, chemistry and pharmacology of khat. Although research on khat dates back to about 1887, the most significant results were those obtained in the last 10-20 years. It is not necessary for me to review the historical aspects of the problem or the more recent progress in the chemistry and pharmacology of khat as these will be covered by other speakers. It is now well established that chewing of khat leads to mental dependence. Pharmacologists recognise that mental dependence represents one broad and continuous spectrum ranging from mild from (habituation) to the more severe type, popularly known as "addiction". Trying to assign mental dependence of khat to a particular point in this broad spectrum is probably an academic exercise not worth undertaking.
In general, drugs which cause mental dependence are characterised by one or more of the following:
a. Compulsive abuse, i.e. psychic craving for euphoric or pleasurable sensations
b. Physical dependence manifested as withdrawal or abstinence syndrome when the taking of drug is discontinued abruptly.
c. Tolerance necessitating an increase in dose.
The pleasurable and euphoric properties associated with ingestion of khat can be attributed almost wholly to two closely related phenylalkylamines, cathine (d-norpseudoephedrine) and cathinone (alpha-aminopropiophenon). The pharmacology of both cathine and cathinone closely parallels that of amphetamine and therefore ingestion of khat would be expected to be associated with compulsive abuse, but not physical dependence or tolerance necessitating increase in dose.
Catha edulis grows in several countries, the most important ones being Democratic Yemen, Ethiopia, Kenya, Madagascar, Somalia, Tanzania and Yemen Arab Republic. I shall confine my remarks to the problem of khat in Kenya. The problem of khat is often highlighted in our news media. A letter from a reader which appeared in the SUNDAY NATION newspaper, January 16, 1983 under the heading "Stop this Bad Habit" is a case in point. It read as follows: "Chewing miraa has become some people's habit but it is a habit that retards development and prosperity of both the individual and his nation. It makes one sleepy at odd times, particularly when others are working. It makes one weak and, hence less resistant to diseases. A miraa chewer does not care about proper nutrition and health care but spends many hours chasing and chewing miraa. Chewing miraa is a hazard to a student because he will not concentrate on books. Miraa also has some negative psychological effects. It makes one see the possibility of building castles in the air. But all this disappears when the chewing period is over. Are we going to let our manpower be ruined by this mild but dangerous drug ?"
Geographical Distribution of Khat in Kenya 
In Kenya, khat is being grown on a commercial scale in Kangeeta and Nyambeni Divisions of Meru District, close to the slopes of Mount Kenya. This area has fertile soil, cool climate and plenty of rain and it is an important coffee growing region. Khat is also growing in scattered fashion in other parts of Kenya at different altitudes and climatic conditions. Many farmers in the khat growing area get more money selling khat than they would otherwise get from coffee. It is estimated that the sale of khat to other countries (Zambia, Uganda, Tanzania, Zaire, Sudan, Somalia and elsewhere in the Middle East) earn Kenya approximately two million dollars each year. The exact amount of khat exported to other countries is difficult to determine since much of it is smuggled out to avoid paying tax to the county councils. Because of the tremendous economic gain to the farmers and the cultural value that the indigenous people of Meru District attach to khat, the whole question has become an important political issue. Certainly no politician who condemns the growing or chewing of khat in Kangeeta and Nyambeni Divisions can expect to be elected to parliament if he contests a seat in those areas.
Cultivation, Harvesting and Sale of Khat in Kenya 
In the cultivation of khat, vegetative propagation is applied using suckers or rooting branches arising from underground near the stem. This is usually done during the heavy rain season. Usually the plant takes 4-6 years to yield its first crop. Harvesting of khat is done mainly towards the end of the wet season for maximum yield. The young tender shoots that grow directly from the main stems and older branches are picked about twice a week. The harvested shoots are first tied in twos (if they are long) or in bunches of four or five (for very small ones) to form a small bundle called "apa". Ten "apas" are tied together to form half a "bandari". Two half "bandaris" are tied together, wrapped in fresh green leaves and secured with a dry banana fibre. This bundle is called a "bandari". Ten bandaris are finally wrapped together with green banana leaves and secured with a dry banana fibre to form a "Kilo". The "Kilo" is the major wholesale exchange unit while the bandari is the retail exchange unit.
One major problem facing khat farmers is that once the crop is ready it must be harvested, regardless of market and price fluctuations. The harvested crop cannot be stored and must reach the consumer within one to two days. Depending on the availability of the material, where it is sold and the demand for it, the retail price of khat can vary considerably from one dollar to four dollars. To many peasants in Meru District, khat has acted as a "bridge" and "highway" from grass thatched, mud houses to corrugated roofed stone houses.
Khat Chewing Habits in Kenya 
A survey to determine khat chewing habits in Kenya was undertaken. The survey covered main urban centres (Nairobi, Mombasa, Garissa and the main growing area, i.e. Meru District. The following categories of khat chewers were interviewed: poor, unemployed individuals, dealers in khat, self-employed people of average income, very successful businessmen, night watchmen, drivers of heavy commercial vehicles, prostitutes living in urban and periurban centres, men in the armed forces, policemen and civil servants. Over 500 people were interviewed. Approximately 50% of those interviewed were Muslims (Somali, Boran, Swahili and Arabs) while about 40% were Meru people (farmers, dealers in khat, businessmen, etc). The remaining 10% was made up of others (Kikuyu, Turkana, Tanzania, Indians, Giriamas, etc). Approximately 7.5% of khat chewers were in the age group 10-20 years; 50% in the age group 21-40 years; 30% in the age group 41-60 years and 4% in the age group 71-100 years.
The duration of khat chewing varied considerably. Approximately 12% of those interviewed had been chewing khat for 1-5 years, 35% for 6-13 years while on the extreme end 4.5% of those interviewed had been chewing khat for more than 50 years.
The average consumption was calculated to be 7.5 "bandaris" (S.D.=4.5), the average weight of each "bandari" being 41.8 g (S.D. 22.3). Several chewers of khat were invited to peel off the bark from the shoots as they normally do. From this the percentage of the khat paterial masticated (i.e. bark of shoots) was calculated to be 78% of the starting material, the remaining 21.3% being made up of woody fibrous material which is never chewed. It was calculated that an average individual masticates 246.7g of fresh khat material each day, and the cost of this material (approx. 7.5 bandaris) is 7.50-30 dollars per day. This expenditure on a single non-essential item can hardly be justified even if it is not harmful. Ironically some poor individuals were chewing khat to allay hunger yet the amount of money spent on buying khat was more than enough for a decent meal in some of the backstreet restaurants in Nairobi.
Control Measures to regulate Chewing of Khat in Kenya
Control measures were first introduced in 1939 but these were not strictly enforced until 1951 when a prohibitive ordinance was enacted in parliament. The ordinance (Chapter 339, Law of Kenya) was meant to regulate the sale, cultivation, use and possession of khat; in certain gazetted areas. However, the ordinance gave power to provincial administrators to issue permit (subject to certain conditions) to individuals to sell, purchase, consume or possess khat. This was probably a recognition that certain individuals who had been consuming khat could not do without it. The prohibitive ordinance remained in force until 1974 when it was repealed by a Presidential decree. Even before the ordinance was repealed it was not being enforced and there were registered co-operative movements dealing in khat and paying tax to the local and central Government.
Undesirable Effects Associated with Chewing of Khat (other than Mental Dependence) 
To most people the terms "mental dependence" and "drug abuse" are synonymous and while this may be true of many narcotic drugs, it is not always the case. Both terms are associated with social stigma. Thus the concept of drug abuse is often viewed from the standpoint of cultural value. Several individuals chew khat to relax and facilitate communication during social occasions. Among the Meru people of Kenya, children and women were not allowed to chew khat. Chewing of khat played a significant role during religious ceremonies in some countries of the Middle East and hopefully we shall hear more about it from other speakers.
There are deleterious effects arising from chewing of khat although these are rarely mentioned. As with amphetamine, there is substantial evidence to show that excessive chewing of khat may lead to male impotence and generally to impairment of sexual function. However, by far the most serious damage arising from khat chewing is the extensive damage to the gastrointestinal tract, especially the stomach, due to the large amount of tannins ingested. This damage may vary from catarrhal inflammation to the more severe hemorrhagic gastritis and duodenitis. Chewers of khat often complain of stomach pain, constipation and this coupled with anorexogenic effects of cathine and cathinone often lead to poor health. The astringent effect of tannins in the buccal cavity lead to sore mouth and limits the speed and amount of khat one can chew continuously within a given time. As both cathinone and cathine are excreted in urine rapidly (can be detected in urine within 30 minutes after ingestion of khat), the blood level of these compounds never rises above a certain level and acute poisoning arising from chewing of khat is practically unknown.
In contract, the chronic toxicity of khat is fairly well documented. Much has been said about the problem of khat and no doubt we shall be saying more in our present discussions. It is possible that we are looking for a scientific answer to what is essentially a political question. To many Governments, the decision on the khat problem will have to be based on a number of competing values and this definitely will not be an easy decision. International meetings such as this one can help to put the problem in the right perspective and hopefully facilitate the work of Governments.

Our valuable member C.K. Maitai has been with us since Sunday, 19 May 2013.

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