Alcohol and khat dual use among male adults in Ethiopia: A multilevel multinomial analysis

INTRODUCTION: Substance use has been a long-standing global public health problem with detrimental physical, psychological, social, and economic consequences at individual and societal levels. Large-scale and gender-specific studies on the dual use of alcohol and khat are limited. This study aimed to estimate the prevalence of dual alcohol and khat use and identify associated factors among male adults in Ethiopia. METHODS: The present study used data from the 2016 Ethiopian Demographic and Health Survey (EDHS). Prior to data analysis, the data were weighted to ensure a representative sample and obtain a reliable estimate. Multilevel multinomial logistic regression was used to identify the factors associated with alcohol and khat use. Adjusted Odds Ratios (AOR) with 95% confidence interval and P value ≤ 0.05 in the multivariable model were used to identify significant factors associated with alcohol and khat use. RESULTS: This study included 12,688 participants, of which (80.29%) were from rural areas. The mean age of participants was 30.92 years old. The prevalence of neither Alcohol nor Khat users were (33.2%); 95% Confidence Interval (CI) (32.4–34.1) only Khat users (22.0%); 95% CI (21.2–22.7), only Alcohol users (35.6%); 95% CI (34.7–36.4), and dual Alcohol and Khat users were (9.0%); 95% CI (8.5–9.5). At the individual level: being in the age group of 15–29 years and 30-49years increases the odds of Khat chewing by AOR (95%CI) 2.27 (1.75, 2.89) and 1.55 (1.16, 2.07) times, respectively. At the community level: males from Amhara 3.49(1.91, 6.42), and Tigray 2.7(1.49, 5.05) regions were more likely to drink alcohol. CONCLUSION: The high prevalence of dual alcohol and khat use implies for greater access to evidence-based treatment. Multiple factors are associated with alcohol and khat use at individual and community levels. All male adults would benefit from targeted preventive strategies.