The tannins present in Khat leaves are held responsible for the observed
gastritis 22. Moreover, Makki
(1975) 23 stressed the importance of Khat when she
found that most of the oral squamous cell carcinomas of her study
patients were located in the buccal mucosa and lateral sides of the
tongue, which comes into direct contact with the Khat during chewing.
Also, many authors stressed the correlation between Khat chewing and
oral squamous cell carcinoma.24,25
One important observation about Khat is that West to Sanaa’ city in
Yemen is a new area for harvesting Khat in the past 30-40 years.
Junko et al. (2010[23]) 26proved
that areas west to Sanaa’ city needed organic phosphorous insecticide to
grow the Khat. Also, areas north to Sanaa’ city have natural Sulphur;
mandatory to Khat growing. Other regions in Yemen do not use organic
phosphorous insecticide.27
The rationale intended for this current study was to explore the
relation between the types of Khat; hot (spicy: insecticide-grown) or
cold as a cause of oropharyngeal fibrosis seen as a pattern in Khat
chewers.
Subjects and
Methods
The current study was a descriptive cross-sectional study that included
all patients using Khat referred to Phoniatric Unit,
Oto-Rhino-Laryngology department, Faculty of Medicine, [removed for
blind peer review] due to different reasons during the period of March
2017 and September 2019. The patients are found to be from Yemen and all
are found to have the habit of Khat chewing.
The objective of the study was explained to the study participants. All
participants included in the study have provided an oral consent. We did
not believe that the questionnaire provided to patients compromises
ethical principles. The Ethical Review Board of the faculty of
Medicine-has approved this study.
Patients with history of head and neck trauma, (surgical, physical),
patients with cleft palate and patient with granulomatous lesions
(Leprosy, TB, scleroma or syphilis) were excluded from study.
A nine-question self-administered structured questionnaire consisting of
open and closed ended questions was developed from a review of the
literature and translated into the Arabic language, the official
language of Yemen, by an expert translator fluent in both English and
Arabic. The questionnaire covers all the socio-demographic factors in
addition to Khat chewing habits. The questionnaire was anonymously
responded.
Full evaluation was done under the protocol of voice assessment in
[removed for blind peer review] using Flexible naso-endoscope with
distal chip (Henke Sas Wolf) and biopsies were obtained whenever
possible. 28
The
patients were grouped into two groups; one using hot Khat
(insecticide-irrigated) and the other using cold Khat (not
insecticide-irrigated). Both groups were compared for all demographic
variables as well as clinic-pathologic variables.
Recorded data were coded, entered, cleaned, and analyzed using the
statistical package for social sciences, version 20.0 (SPSS Inc.,
Chicago, Illinois, USA). Quantitative data were expressed as mean±
standard deviation (SD). Qualitative data were expressed as frequency
and percentage. Chi-square (x2) test of significance
was used in order to compare proportions between two qualitative
parameters.
Bivariate
analyses, Chi-square test or t-test according to the type of the data,
were carried out to examine the relationship between the outcome
variable of Khat chewing and selected determinant factors. The
confidence level was set to 95% and the margin of error accepted was
set to 5%. So, the p-value was considered significant if< 0.05.
Results
The overall sample was 120 cases; 22 are using hot Khat and 98 cold
Khat. All patients in the hot Khat group are from Sanaa and west regions
while all of the cold Khat group are from areas north to Sanaa. The
questionnaire used in this study was validated and the Cronbach alpha
was 0.847.