Khat consumers exposure to toxicity: Agrochemical toxicity awareness, protective practice and self-reported health ailments among khat consumers in Ethiopia.

Khat consumption represents a complex health challenge where agricultural intensification, specifically the unregulated use of persistent organic pollutants such as DDT, creates a bridge between environmental degradation and human pathology. Despite the severe health implications of chemically contaminated fresh leaves, empirical evidence regarding consumer awareness and protective engagement remains limited. This study in Eastern Ethiopia aimed to assess consumer awareness and protective practices regarding the potential of multiple toxins (encompassing pharmacological effects, heavy metals, and pesticide residues) and evaluated related self-reported health ailments among adult chewers to inform multisectoral reform. A quantitative community-based cross-sectional study was conducted in Dire Dawa, Harar, and Jigjiga with 803 regular khat chewers. Data were collected using pre tested, and structured questionnaire were analyzed via descriptive statistics, and multivariable binary logistic regression. General risk awareness was high (86.4%), yet only 37.4% of the respondents consistently adopted protective practices. High awareness was significantly associated with tertiary education being seven times more likely to be aware than illiterate chewers were (AOR: 7.23, p = 0.003). Awareness was notably greater among individuals who experienced mental (AOR: 2.05, p = 0.040) or gynecological ailments (AOR:2.36, p = 0.006). The adoption of protective practices was overwhelmingly predicted by high monthly income (AOR: 12.48, p < 0.001) and awareness (AOR: 7.41, p < 0.001). The primary barriers included cost (55.8%) and availability (53.7%). The self-reported ailments included digestive issues (82.3%) and decreased libido symptoms (48.1%). The study concludes that there is a significant gap between awareness and protective practices among consumers. We recommend targeted public health education and multisectoral collaboration between health and agricultural bureaus to improve pesticide regulation and consumer safety. Interventions should focus on overcoming cultural barriers to protective behaviors rather than relying solely on individual behavioral change.