Prevalence of Dokha use in Arabian countries: A systematic review and meta-analysis

Background: Dokha, a form of tobacco smoked using midwakh pipes, is increasingly used in Arabian countries, yet comprehensive prevalence data remain limited. This study aimed to systematically review and meta-analyze the prevalence of Dokha use across Arabian countries, stratified by gender, type of use, and use of specific smoking tools. Methods: A systematic literature search was conducted in PubMed, Scopus, Web of Science, and Embase for studies published in English from inception to June 2025. Eligible studies reported prevalence estimates of Dokha use among any population subgroup in Arabian countries. Two independent reviewers screened studies, extracted data, and assessed methodological quality using the Joanna Briggs Institute checklist. Random-effects meta-analyses were performed to estimate pooled prevalence rates for current and lifetime Dokha use among males and females, as well as use of specific Dokha smoking tools. Data were analyzed using Comprehensive Meta-Analysis version 3.0. Results: Out of 729 studies found, 12 studies were included, encompassing populations from multiple Arabian countries. Current Dokha use among females was extremely low (0.7%, 95% confidence interval [CI] = 0.1%–4.9%), whereas males exhibited substantially higher current use (14.6%, 95% CI = 7.9%–25.4%). Lifetime use followed similar trends, with a pooled prevalence of 9.1% (95% CI = 3.9%–20.0%) among females and 25.6% (95% CI = 10.8%–49.5%) among males. Use of specific Dokha smoking tools was reported at 7.3% (95% CI = 5.6%–9.4%) for current use and 15.8% (95% CI = 10.0%–24.0%) for lifetime use. Considerable heterogeneity was observed across studies, particularly among male users, reflecting differences in population, geography, and study methodology. Conclusion: Dokha use in Arabian countries demonstrates pronounced gender disparities, with males showing substantially higher prevalence than females, which highlights the need for targeted public health interventions, surveillance, and culturally sensitive tobacco control strategies addressing Dokha use in this region.