Khat-related liver disease in sub-Saharan Africa: neglected, yet important – Authors' reply

Abstract

We thank Stian Orlien and colleagues for raising attention to the issue of khat use as a recreational drug in sub-Saharan Africa in response to our Comment.1 Although we mentioned the fact that traditional herbal medicine could contribute to the burden of cirrhosis in this region, as the use of khat is associated with a substantial increase in liver fibrosis,2 we do not think that the available evidence shows that khat is a major contributor to chronic liver disease. Khat is used in parts of east Africa, including Djibouti, Ethiopia, Somalia, Somaliland, Kenya, Sudan, Uganda, and Madagascar. Apart from its long-standing popularity as a recreational drug, it can be used for the treatment of erectile dysfunction, malaria, influenza, vomiting, and headache.3 The Central African Republic, Gabon, and Côte d'Ivoire were in the top 10% of countries for cirrhosis-related deaths in 2010 but khat use is uncommon in west or central Africa.4