Prevalence and determinants of problematic khat use in Ethiopia

**Background** Evidence on khat use prevalence is substantial in Ethiopia and elsewhere. However, problematic khat use remains largely understudied because the concept has not been clearly defined or consistently measured. This study estimated the prevalence and determinants of problematic khat use among Ethiopian adults. **Methods** This descriptive cross-sectional analysis used baseline data from a prospective khat cohort study conducted in Butajira and adjacent districts in Central Ethiopia Regional State. We included 504 khat users who had chewed khat within the previous five years. Problematic khat use was assessed using the locally developed and validated 17-item Problematic Khat Use Screening Tool (PKUST-17). A score of >17 indicated problematic use. Binary and multivariable logistic regression models were used to identify associated factors. **Results** Among the 504 khat users, most were male (82.3%), married (85.0%), and rural residents (70.8%). The prevalence of problematic khat use was 19.6%. Daily or near-daily khat users had eightfold higher odds of problematic use than occasional users (AOR = 8.05, 95% CI: 3.75-17.24). Stressful life events were associated with 3.48-fold higher odds of problematic use (AOR = 3.48, 95% CI: 1.56-7.76), while depressive symptoms were associated with 3.70-fold higher odds (AOR = 3.70, 95% CI: 2.00-6.75). **Conclusion** Problematic khat use affects approximately one in five khat users in Ethiopia. It is strongly associated with frequent khat use, stressful life events, and depressive symptoms. Longitudinal studies are needed to clarify causal pathways and evaluate culturally appropriate prevention and treatment interventions.