Corrigenda

236 Bull World Health Organ 2010;88:235–236 | doi:10.2471/BLT.09.067512 Perspectives Khat and driver impairment in Ethiopia William Eckersley et al. References 1. World report on road traffic injury prevention. Geneva: World Health Organization; 2004 Available from: http://www.who.int/violence_injury_ prevention/publications/road_traffic/world_report/en/index.html [accessed 20 January 2010]. 2. Global status report on road safety: time for action. Geneva: World Health Organization; 2009 Available from: www.who.int/violence_injury_prevention/ road_safety_status/2009 [accessed 20 January 2010]. 3. How safe are Ethiopian roads? Addis Ababa: Ethiopian Roads Authority; 2005 Available from: http://www.era.gov.et/roadsafety.htm [accessed 20 January 2010]. 4. Assessment of khat. Report of the: 34th expert committee on drug dependence. Geneva: World Health Organization; 2006 (WHO 34th ECDD 2006/4.4). Available from: http://www.who.int/medicines/areas/quality_ safety/4.4KhatCritReview.pdf [accessed 20 January 2010]. 5. Toennes SW, Kauert GF. Driving under the influence of khat-alkaloid concentrations and observations in forensic cases. Forensic Sci Int 2004;140:85-90. PMID:15013169 doi:10.1016/j.forsciint.2003.11.028 6. Drug use, impaired driving and traffic accidents. Lisbon: European Monitoring Centre for Drugs and Drug Addiction; 2008. Available from: http://www. emcdda.europa.eu/publications/insights/driving [accessed 20 January 2010]. may also govern khat’s influence on driver impairment.5 Driving while chewing, or having recently chewed, khat is implicitly out- lawed in Ethiopia under a federal law banning “driving under the influence of mind-affecting drugs”. However, many of the traffic police officers we interviewed were not aware of this law. Further, there is no readily available technology that tests for khat consump- tion. A simple method is to ask a driver to stick out his/her tongue and check if it is stained green. However, this test does not provide an accurate guide of the quantity of khat consumed and the drug’s effects are likely to outlast such staining. The global context In considering appropriate responses to khat consumption, lessons can be drawn from international experience of deal- ing with driving under the influence of other drugs. There is growing awareness of the influence of a range of medicinal and recreational drugs – both legal and illegal – on road safety.6 As it is legally available and integral to social life for many people, khat use in Ethiopia is comparable to alcohol use in many high-income countries. However, unlike khat, the impairment effects of alcohol on driving are well understood. This has provided evidence on which countries have built extensive regulatory frameworks and responses, such as public education campaigns, permitted driver blood-alcohol con- centrations and testing technologies. Similar responses might prove to be appropriate for khat. However, as with alcohol, responses must be based on thorough understanding of the effects of khat on driver impairment, an ap- preciation of the social context of its use and consideration of the practicality of regulation. Currently, this evidence is not available for khat. Road safety research Globally, relative to the scale of the health problems caused by road crashes, there has been insufficient investment in research and interventions to reduce road traffic injury. Existing research has been skewed towards issues that concern high-income countries, such as alcohol and, more recently, the use of mobile phones while driving. We suggest that khat-related impairment could be an overlooked contributor to the extraordinarily high traffic crash and fatality rates in Ethiopia and other countries in eastern Africa. What is now needed is empirical research that identifies the impairment effects of khat grounded in social un- derstanding of how khat is used. We propose two research questions: (i) What is the relationship between the consump- tion of khat and driver impairment? In particular, is it safe for a driver to chew a small amount of khat? And if so, what is a “safe” amount? (ii) Given that khat is often used by drivers to help them stay awake, what are the effects of khat combined with fatigue? We also propose three social re- search questions, which need to be answered to inform effective policy responses: (i) Which drivers chew khat? (ii) When, and under what circum- stances, do they chew it? (iii) What beliefs do drivers have about the effects of khat on their driving ability? Without further research, Ethio- pian policy-makers will remain inade- quately informed about the real impact of khat on drivers and will be unable to design meaningful legislation or effec- tive road safety education campaigns. The public will remain unaware of the risks of chewing khat and driving, and will be unable to make informed deci- sions such as whether or not to board a bus if a driver is chewing khat. Road building continues apace in Ethiopia but the contribution of khat use to the country’s poor road safety record is not yet understood. ■ Acknowledgements We thank Mahateme Mikre and Daniel Hailu for their invaluable assistance with interviewing informants. Competing interests: None declared. Corrigenda In volume 88, Number 1, January 2010, the footer for pages 22–30 should be “Bull World Health Organ 2010;88:22–30” and the footer for pages 58–65 should be “Bull World Health Organ 2010;88:58–65”. Also in volume 88, Number 1, January 2010, page 49, the affiliation for David Carmena should read: Medical Research Council, Imperial College London, Du Cane Road, London, W12 0NN, England.