self-medication in developing countries a systematic...

103

Journal of Pharmaceutical Technology, Research and

Management Vol 4, No. 2,

November 2016 pp. 103–127

DOI: 10.15415/jptrm.2016.42007

Self-medication in Developing Countries a Systematic Review

MEENA PARULEKAR, NANDAKUMAR MEKOTH, C.M. RAMESH, AJIT PARULEKAR

Goa Institute of Management Sanquelim, Poriem –Sattari, Goa

Email: mail:[email protected]

Received: June 7, 2016 | Revised: July 11, 2016 | Accepted: Sept. 5, 2016

Published online: November 02, 2016 The Author(s) 2016. This article is published with open access at www.chitkara.edu.in/publications

Abstract: Self-medication is common in developing countries where it has both economic and social implications. On the one hand, it is viewed as a large component of self-care, which relies heavily on the consumer’s expertise in terms of experience of the consumer, when it comes to medication use. On the other hand, if not practiced correctly it can lead to multiple issues including abuse and drug resistance. Across surveys conducted in developing countries the reasons why people self-medicate has been studied, to understand the determinants of self-medication and to explain the influence of knowledge and information on self-medication practices. To understand the same a detailed systematic literature review based on survey findings on self-medication in developing countries was carried out. From a total of 52 survey articles, 25 surveys were selected for the present review. From the survey outcomes it was found that the cost, time and past experience with the medicine and symptom were key determinants while healthcare professionals emerged to be the primary sources of information and knowledge for self-medication practices. The prevalence of self-medication as a phenomenon is high and it has both potential benefits and associated risks with it. To ensure that the risks and benefits of medicine usage are known by consumers, we really need to look at and design suitable interventions to promote responsible self-medication and in turn, rational drug use in the developing world.

Keywords: Self-medication, determinants, phenomenon, review, medicine

Parulekar, M Mekoth, NK Ramesh, CM Parulekar, A

104

1. INTRODUCTION

‘Self-medication’ is a global phenomenon. On the one hand, it is viewed as a large component of self-care, which relies heavily on the consumer’s expertise in terms of experience of the consumer, when it comes to medication use. On the other hand, if not practiced correctly it can lead to multiple issues including abuse and drug resistance.

Across the world, a consumer on an average suffers from at least one aspect of un-wellness in a 4-week period. Accordingly, 50% of people wait for the symptoms to subside, 25% take resort of prescription medicines while the remaining 25% turn to OTC (over-the-counter) medicines for relief. The graph below shows percentage of conditions treated with OTC’s by consumers in 10 nations. US and South Africa has the highest percentages of self-medication, only the reasons differ. While in the US it is more of a cost and time saving alternative, in South Africa it is high due to lower levels of infrastructure and professional staff. (wsmibro.pdf, 2005)

The WHO guidelines 2000 define self- medication as the use of medication by a patient on his own initiative or on the advice of a pharmacist or a lay person instead of consulting a medical practitioner. While in most of the developed world, it is synonymous with use of over-the-counter medications (responsible self-medication); the developing world faces a vast plethora of issues around

Graph1: Percentage of common conditions treated with OTC’s.

Self- medication in Developing

Countries a Systematic Review

105

the phenomenon. Some of these issues could be highlighted as self-medication with prescription drugs, misuse of antibiotics, overuse of injections, overuse of relatively safe medicines and unsafe use of herbal medicines (Hardon Anita et al, 2001).

Accordingly, the following two types of self-medication are commonly practiced worldwide and can be represented thus:

Self –medication in developing countries can be better understood as a phenomenon within the following two contexts (Geest Van Der Sjaak et al, 1990):

1. Economic-Infrastructural context: Accessibility to primary healthcare, Cost of medicines and development of alternative system of treatment are major concerns. For example: In rural areas in many developing countries like Cameroon for example, the public health system does not function properly, hence an alternative system develops.

2. Cultural-Cognitive beliefs: There are underlying beliefs that individuals hold when it comes to medicine use and are specific to communities and regions around the world. For example, Guatemalan villager’s categorized medicines as hot or cold based on their own classification system.

According to a survey conducted on 20, 000 consumers in 10 cities in India by Lybrate (doctor- patient –end-to-end communication platform)), it was found that over 52 % Indians indulge in self-medication practices (The Hindu, New Delhi, April 2015). Most studies reporting prevalence of self-medication are very specific (with respect to regional and cultural contexts). As reported (Sandeep A et al, 2013) prevalence rates are high, 68% in European countries and as high as 92% for adolescents in India. Such high prevalence rates are a

Table 1: Self-medication (worldwide)*.

Responsible Self-medication Irresponsible self-medicationWide acceptance and availability of OTC products

Wide acceptance and availability of both OTC and prescription products

Careful use of OTC products, reading the label

Irrational use of OTC and prescription products (for example, self-prescription, use of prescription products on recommendation, non-medical use of a prescription drug

OTC products usage as safe and effective when compared to prescription products

Probability of Drug-Drug interactions higher due to improper use of different systems of medicine, combined use of OTC and prescription drugs.

*compiled by the author


106

cause of concern in a developing country especially when responsible self-medication is already a huge challenge. As reported in the book, Advances in Drug research and application, though there is a vast amount of research being done to measure self-medication practices including in children, there is sparse epidemiological data available worldwide (Ashton Acton, 2011).

According to World Drug Report 2010, the misuse of prescription drugs including opioids, benzodiazepines and synthetic prescription stimulants is a growing health problem in both developing and developed countries. In their study (Ruiz et al, 2010) the authors have highlighted the dangers of self-medication including polypharmacy, dependence and drug interactions. Thus, it becomes important to understand the various dimensions of this phenomenon including risks and benefits so that appropriate health interventions can be designed to promote rational drug use in the country.

2. OBJECTIVE

The main objective of this systematic review on self-medication is:1. To identify the determinants of self-medication practices in developing

countries.2. To study the influence of knowledge and information on self-medication in

developing countries.

3. METHODOLOGY

A manual search strategy was adopted to obtain research papers on Self-medication in developing countries. The search was primarily carried out using PUBMED, Ebsco, Proquest and Google scholar search engines and the key words used for the search were self-medication, reasons and determinants. A total of 52 survey articles were thus obtained.

See Figure 1 for flowchart of the articles selected for this review:

3.1 Inclusion and exclusion criteria

Articles are included based on types of surveys conducted, sample size, research methodology adopted and findings. Surveys conducted in the developed countries in the west were deliberately not included to take into account the economic and infra structural contexts unique to developing countries.

Studies selected for the review were surveys on self-medication in developing countries in the time period year 2000 to 2016. From a total of 52 different surveys conducted in developing countries, 25 were selected for this review. They were accordingly numbered as S1 to S25. These surveys were included based on the following criteria:



107

1. Studies included a population of both young and elderly. Because self –medication is being increasingly practiced by the young, which has its own, associated risks, it is necessary to understand the determinants and influence of information across these varying segments of the population.

2. Studies necessarily had information about the reasons or factors that promote or lead to an increase in the self-medication habits in consumers.

3. Surveys had a sample size of over 100 respondents 4. Surveys on children, pregnant women were excluded from the review.

The 25 survey articles selected for the review were then read and information obtained from them was used for analysis. Table II lists the summary of these selected studies.

Figure 1: Flow chart showing the selection of articles for review.

52 survey articles from Google scholar, ProQuest and Ebsco

Titles shortlisted after OTC removal, (n=44)

Total articles after removal of OTC and Antibiotic SM (n=36)

Articles excluded (n=8) Antibiotic self-medication(SM)

Articles excluded (n=8) OTC research

Articles excluded (n=8) general

Total articles after removal of general (n=28)

Articles excluded (n=3) thesis

Total Articles final (n=25)


108

Tabl

e 2:

Sum

mar

y of

incl

uded

stud

ies.

Stud

yC

ount

ryP

reva

lenc

e of

Sel

f-m

edic

atio

n

Stud

y M

etho

dolo

gy

Pro

port

ion

of s

ampl

e pa

rtic

ipan

ts

Len

gth

of

stud

yT

ypes

of

re

ques

ts fo

r

Self

-med

icat

ion

S1 P

anka

j Jai

n, In

do-g

loba

l jo

urna

l of P

harm

aceu

tical

Sc

ienc

es, 2

012

Har

yana

, In

dia

37.4

% o

f w

hich

28.

2%

was

by

Self-

med

icat

ion

befo

re th

ey

cam

e fo

r cu

rren

t sel

f-m

edic

atio

n

Surv

ey m

etho

d in

com

mun

ity

phar

mac

ies-

st

ruct

ured

in

terv

iew

qu

estio

nnai

re

680

fem

ales

(a

ctua

l dru

g us

ers

and

mes

seng

ers)

1225

mal

es

(act

ual d

rug

user

s an

d m

esse

nger

s)

One

yea

r40

.1%

wer

e fo

rA

nti-m

icro

bial

S2 P

ahuj

a R

itu, I

JDD

R, 2

011

Del

hi, I

ndia

61%

(a

nalg

esic

s an

d an

tipyr

etic

s)

Des

crip

tive

surv

ey- o

nlin

e ex

plor

ator

y.

Judg

men

tal

sam

plin

g te

chni

que

103

(out

of 3

42

resp

onde

nts)

Res

pons

e ra

te:3

0%

Five

m

onth

s67

%-

Croc

in-fe

ver

Azi

thro

myc

in an

d D

-col

d- 2

9.8%

an

d V

icks

Act

ion

500

–col

d 25

.5%

S3 R

ohit

Ver

ma,

Asi

an

jour

nal o

f pha

rmac

eutic

al

and

clin

ical

rese

arch

, 201

0

Nor

th In

dia

87.0

%

(pro

fess

iona

l st

uden

ts)

Que

stio

nnai

re

base

d de

scrip

tive

surv

ey

1022

stud

ents

(1

075

tota

l pa

rtici

pant

s)

Not

sp

ecifi

ed61

.27%

- Cro

cin

follo

wed

by

Dis

prin

and

C

ombi

flam

S4 P

anka

j Gup

ta, A

sian

jo

urna

l of P

harm

aceu

tical

an

d cl

inic

al re

sear

ch, 2

011

Indi

a(u

rban

slum

co

mm

unity

)

55.9

%C

ross

sect

iona

l st

udy

760

hous

ehol

ds(2

68 m

ales

, 492

fe

mal

es)

Not

sp

ecifi

edM

eds f

or

head

ache

, fev

er,

ache

s, al

lerg

ies

and

diar

rhoe

a.

old

drug

pac

ks,

old

pres

crip

tions

sh

own

or

sym

ptom

s ex

plai

ned



109

S5 M

alvi

Rite

sh, I

RJP

201

1B

hopa

l, In

dia

77.3

%Q

uest

ionn

aire

ba

sed

surv

ey11

6 pe

ople

(5

8.6%

- mal

e,

41.3

%- f

emal

e)

Not

sp

ecifi

edFe

ver a

nd p

ain

cate

gorie

s. Pa

race

tam

ol,

Dis

prin

, C

ombi

flam

and

C

ipro

floxa

cin.

O

TC w

ere

used

fo

r SM

S6 Z

afar

Sye

d, Jo

urna

l of

Pak

Med

Ass

oc.,

2008

Kar

achi

, Pa

kist

an76

%C

ross

sect

iona

l su

rvey

572

parti

cipa

nts

(Mal

e: fe

mal

e rat

io

1:1.

5) 2

95 m

edic

al

stude

nts a

nd 2

77

wer

e non

-med

ical

stu

dent

s. Re

spon

se

rate

95.

3%

Jan-

Feb

2007

Hea

dach

es,

feve

r and

flu

like

sym

ptom

s

S7 S

onta

kke

SD, I

nt. j

ourn

al

of B

iolo

gica

l and

Med

ical

R

esea

rch,

201

1

Nag

pur,

Indi

a77

.98%

- 1st

year

, 74.

71%

- 3rd

yea

r

Com

para

tive

stud

y be

twee

n fir

st y

ear

and

third

ye

ar m

edic

al

stud

ents

. Cro

ss-

sect

iona

l stu

dy,

pre-

valid

ated

qu

estio

nnai

re.

159

– 1st

yea

r (89

m

en, 7

0 w

omen

)17

8- 3

rd y

ear (

106

men

, 72

wom

en)

Not

sp

ecifi

edA

nalg

esic

s and

an

tipyr

etic

s fo

llow

ed b

y an

ti-

hist

amin

ics a

nd

antim

icro

bial

s

S8 H

usai

n et

al,

Afr

ican

jo

urna

l of P

harm

acy

and

Phar

mac

olog

y, 2

011

Paki

stan

15.7

% in

ur

ban

area

s

To 8

.3%

in

rura

l are

as.

Ran

dom

ized

cr

oss s

ectio

nal

mul

ti-ce

nter

st

udy

1850

hou

ses,

550

rura

l and

130

0 ur

ban.

Res

pons

e ra

te 1

850/

2100

- 88

.10%

June

20

09-

May

201

0

Mod

ern

drug

s av

aila

ble

in

64.2

% o

f ho

useh

olds

. 63%

- m

edic

ines

from

lo

cal p

harm

acie

s in

urb

an a

reas


110

S9 S

. Kay

alvi

zhi,

IJEI

MS

Sout

h In

dia

80.1

3%Q

uest

ionn

aire

ba

sed

desc

riptiv

e st

udy

1017

resp

onde

nts,

605

–mal

e,

412-

fem

ale

Sept

embe

r – N

ovem

ber

2010

Hea

dach

e, fe

ver

and

coug

h, c

old

and

sore

thro

at.

S10

Girm

a B

elec

ha G

utem

a,

J of A

pplie

d Ph

arm

aceu

tical

Sc

ienc

es, 2

011

Ethi

opia

43.2

4%D

escr

iptiv

e cr

oss s

ectio

nal

stud

y

307

heal

th

scie

nces

stud

ents

.28

3 re

spon

dent

s, re

spon

se ra

te –

92

.2%

Apr

il-

June

201

1Pa

race

tam

ol,

NSA

IDS

follo

wed

by

antib

iotic

s

S11

P.R

.Sha

nkar

, Par

tha

Shen

oy, B

MC

Fam

ily

Prac

tice

2002

Nep

al59

%of

re

spon

dent

s ha

d se

lf-m

edic

ated

in

the

6 m

onth

s pr

eced

ing

the

stud

y

Sem

i- st

ruct

ured

qu

estio

nnai

re

base

d st

udy

142

resp

onde

nts,

117

–mal

es,

25- f

emal

es

Aug

ust

2001

Para

ceta

mol

fo

llow

ed b

y an

alge

sics

S12

A.O

.Afo

labi

, Ann

als o

f A

fric

an M

edic

ine,

200

8N

iger

ia59

.5- 7

2.1%

Pret

este

d se

mi

stru

ctur

ed

ques

tionn

aire

205

mar

ket

wom

enN

ot

spec

ified

Med

s rec

ogni

zed

by tr

ade

or

gene

ric n

ames

S13

Al M

otas

sem

M.Y

ouss

ef,

Phar

m W

orld

Sci

.200

8Jo

rdan

42.5

%C

ross

sect

iona

l ob

serv

atio

nal

stud

y

819

out o

f 132

6 pa

tient

s (61

.2%

)D

ecem

ber

2003

and

A

pril

2004

No

spec

ific

cate

gory

m

entio

ned,

med

s as

ked

for b

y br

and

nam

es

Tabl

e 2:

Con

tinue

d

Stud

yC

ount

ryP

reva

lenc

e of

Sel

f-m

edic

atio

n

Stud

y M

etho

dolo

gy

Pro

port

ion

of s

ampl

e pa

rtic

ipan

ts

Len

gth

of

stud

yT

ypes

of

re

ques

ts fo

r

Self

-med

icat

ion



111

S14

Hen

ry Ja

mes

, Med

Pr

inc.

Pra

ct, 2

006

Bah

rain

44.8

%Q

uest

ionn

aire

ba

sed

desc

riptiv

e st

udy

153

stud

ents

, 43

mal

es a

nd

91 fe

mal

es

Nov

embe

r 20

04H

eada

che,

cou

gh

and

cold

, sor

e th

roat

S15

Push

pa R

Wije

sing

he,

WH

O S

outh

-Eas

t Asi

a Jo

urna

l of P

ublic

Hea

lth,

2012

Sri L

anka

33.9

%- u

rban

, 35

.3%

- rur

alC

omm

unity

ba

sed

cros

s-

sect

iona

l stu

dy

1800

resp

onde

nts,

94.9

% re

spon

se

rate

2010

No

spec

ific

cate

gory

m

entio

ned

S16

Hus

ain

S.M

allik

, Sel

f-m

ed b

ehav

ior i

n Pa

kist

an,

Sout

hern

Med

Rev

iew

201

0

Paki

stan

7.1%

- rur

al,

2.6%

- urb

anR

ando

miz

ed

cros

s sec

tiona

l qu

estio

nnai

re

base

d st

udy

1346

hou

seho

lds

Janu

ary

2007

- Jul

y 20

08

Ant

ibio

tics,

anal

gesi

cs,

vita

min

s and

m

iner

als

S17

Bal

amur

ugan

E, B

JMP,

20

11So

uth

Indi

a71

%C

ross

sect

iona

l su

rvey

200

parti

cipa

nts

6 m

onth

s in

200

9H

eada

che,

st

omac

h ac

he,

coug

h an

d

feve

rS1

8 Fe

rnan

do R

uiz,

” SM

in

olde

r peo

ple”

, Dru

gs A

ging

20

09

Mex

ico

50%

and

m

ore

Obs

erva

tiona

l, de

scrip

tive,

cr

oss s

ectio

nal

stud

y

245

olde

r adu

lts

(152

wom

en a

nd

93 m

en )

Sept

embe

r an

d O

ctob

er

2006

Mus

cle

and

jo

int p

ain,

up

per r

espi

rato

ry

tract

and

cou

ghS1

9 So

nia

et a

l,”C

ondi

tions

, fr

eque

ncie

s and

soci

o de

mog

raph

ic fa

ctor

s lea

ding

to

self-

med

icat

ion

in

Sarg

odha

, Pak

ista

n, 2

013

Paki

stan

83%

Des

crip

tive,

cr

oss-

sect

iona

l st

udy

300

univ

ersi

ty

stud

ents

Janu

ary

to A

pril

2013

Med

s for

he

adac

he,

com

mon

col

d,

coug

h, fe

ver,

cons

tipat

ion,

di

arrh

ea.


112

S20S

ande

ep A

,”Se

lf-m

edic

atio

n: K

now

ledg

e an

d pr

actic

e am

ong

rura

l and

ur

ban

popu

latio

n”20

13

Man

dya,

M

adhy

a Pr

ades

h42

.5%

Que

stio

nnai

re

base

d su

rvey

120

resp

onde

nts

Mar

ch

and

Apr

il 20

13

Feve

r rel

ievi

ng

med

s, pa

in

kille

rs, c

ough

m

edic

ines

and

an

ti-al

lerg

ics

S21S

hyam

Sun

der K

esha

ri,

“Pre

vale

nce

and

patte

rn o

f se

lf-m

edic

atio

n pr

actic

es in

ru

ral B

arab

anki

”, 2

014

Bar

aban

ki, U

ttar

Prad

esh

69.6

%Cr

oss –

sect

iona

l H

ouse

-to-h

ouse

su

rvey

168

resp

onde

nts

Oct

ober

20

13 to

M

arch

20

14

Feve

r, pa

in,

resp

irato

ry

sym

ptom

s fo

llow

ed b

y in

fect

ions

, he

adac

he a

nd

diar

rhea

S 22

Akr

am A

hmad

, M

uham

mad

Um

air K

han

“Eva

luat

ion

of k

now

ledg

e,

attit

ude

and

prac

tice

abou

t se

lf-m

edic

atio

n am

ong

rura

l and

urb

an n

orth

Indi

an

popu

latio

n, ij

pcr 2

015

Mor

adab

ad,

Utta

r Pra

desh

100.

0%

(soc

io-

econ

omic

ba

ckgr

ound

)

Com

mun

ity

base

d cr

oss-

sect

iona

l stu

dy

380

resp

onde

nts

Mar

ch to

M

ay 2

014

Ana

lges

ics,

alar

min

g us

e in

chr

onic

co

nditi

ons i

n ru

ral a

reas

.

S23V

arun

Kum

ar, A

bha

Man

gal”

Prev

alen

ce a

nd

patte

rn o

f sel

f-m

edic

atio

n in

an

urb

an a

rea

of D

elhi

, Ind

ia

2015

Del

hi92

.8%

(urb

an

area

s)C

ross

-sec

tiona

l st

udy

236

resp

onde

nts

Mar

ch

and

Apr

il 20

13

Com

mon

col

d an

d fe

ver

Tabl

e 2:

Con

tinue

d

Stud

yC

ount

ryP

reva

lenc

e of

Sel

f-m

edic

atio

n

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113

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114

4. RESULTS

The surveys selected were mainly of descriptive, cross –sectional, questionnaire type and the duration of the study ranged from two months to one year. Total number of respondents studied was 19, 973 across the 25 surveys. These surveys were carried out independently in the countries during the period 2000-2016. The respondents included young students in colleges with both a medical and non-medical background and adults among others. Many of the surveys were conducted in Asia of which fourteen were in India, three in Pakistan and one was conducted in Sri Lanka.

5. DISCUSSION

5.1 Self-medication prevalence

The overall prevalence of self-medication ranged from 8.3% (Husain et al, 2011) in the sample population studied to 87% (Husain S, 2010) across the 25 surveys selected for the review. S22 (socio-economic background of sample) and S23 (only urban areas) had higher prevalence rates but the data on prevalence was not considered due to limitations of the samples. In some studies, self-medication prevalence was higher in females, 59.8% vs 48.9%in males (Gupta Pankaj et al, 2011, Balamurugan E, 2011)

5.2 Determinants of self-medication practices

Across the surveys, lack of time, cost saving and mildness of disease/symptoms were cited as the major reasons for self-medication.(Verma Rohit, 2010, Sontakke SD, 2011, Balamurugan E, 2011, Malvi Reetesh, 2011) Socio-economic conditions, prior experience with the medicine and emergency use were the other key determinants.( Pahuja Ritu, 2011, Gupta Pankaj, 2011, S.Kayalvizhi, 2010, James Henry, 2006). Expected self-medication was higher in urban areas than in rural areas ( Wijesinghe Pushpa, 2012). No major differences were noticed in self-medication patterns in men and women. Categories of medicines that were utilized for self-medication range from analgesics, anti-microbials, antipyretics and antibiotics. Vitamins and minerals are also common categories used for self-medication by consumers. (Husain S, 2010). It was interesting to note that selection of products for self-medication was based on previous experience with the similar medicine or disease symptoms. (Al Motassem, 2008, Zafar Syed, 2008, Afolabi A.O., 2008).

There is an emerging trend of increasing self-medication in the past five years (2011-2016) and this can be attributed to factors like people showing



115

sympathy for ill relatives and friends, unavailability of healthcare services in rural areas, unawareness, misbeliefs and advertisements by pharmaceutical companies( Akram Ahmad, 2015). It was interesting to note that though self-medication has increased among the common population, many of the people consuming drugs by self-medication do not follow instructions regarding dose, duration and instruction for use with many non-prescription drugs thus making them vulnerable to side effects.

The rural areas in India are fast catching up with self-medication practices with reportedly higher percentages of use for analgesics and antipyretics (Akram Ahmad, 2015). In addition, the usage of products by self-medication in chronic conditions is increasing among the rural population, which is an area of concern.

Many of the classes of drugs used by self-medication in developing countries consist of drugs under Schedule H (Drugs and Cosmetics Act, 1940). However; they inevitably are consumed by self-medication without the consumer many times being unaware of their side effects in the dosage consumed. For example in the survey (Malvi Reetesh, 2011) 16 participants (13.7%) used Diclofenac among the analgesics category and 10 participants, (8.6%) used Ciprofloxacin as an antibiotic for self-medication (Total Sample size: 116 participants). In a study (Akram Ahmad, 2015) on rural and urban self-medication pattern in North India, it was found that respondents (380) self-medicated across a wide range of therapeutic categories as shown below:

The above graph clearly indicates that there a lot of drug categories which are being misused by self-medication and the trend is increasing in the rural areas. Most of these drugs have harmful side effects and are known to cause drug-drug interactions when not used carefully with other drugs or drug combinations.

5.3 Influence of knowledge/ information on self-medication

These could be categorized depending on the sources of information and knowledge. Some of the common sources of information are listed below. The percentages listed are specific to particular studies but a pattern could be seen. The most preferred source of information was healthcare professionals followed by friends and family suggesting that medicine use in different cultures across countries may have a major role to play in self-medication habits (Verma Rohit, 2010, Malvi Reetesh, 2011, Pahuja Ritu, 2011, Gupta Pankaj, 2011, S. Kayalvizhi, 2010). It is interesting to note that in most studies, though the respondents were knowledgeable about the medicine used for self-medication, they were not adequately informed about the risks of self- medication, which is really a cause of concern (Zafar Syed,


116

Table 3: Determinants of Self-Medication practices.

Study Reference Reasons for Self-Medication

S1 Jain Pankaj, 2012 Emergency use, disease not serious, prevention of diseases, prior experience about the drug, less expensive in terms of time and money.

S2 Pahuja Ritu, 2011 Did not feel the need to consult a doctor for minor illness, unavailability of medical practitioner in nearby community and economical.

S3 Verma Rohit, Asian journal of pharmaceutical and clinical research, 2010

Time saving, did not need advice for minor illness, economic, fear from crowd at clinic.

S4 Pankaj Gupta, Asian journal of Pharmaceutical and clinical research, 2011

No time /could not afford to miss work, mild illness, doctor’s clinic too far, monetary constraints, previous good experience with the drug, Not one student had knowledge about complete profile of the drug being consumed by self- medication.

S5 Malvi Ritesh, IRJP 2011 Time saving, did not need advice for minor illness, economic, fear from crowd at clinic.

S6 Zafar Syed, Journal of Pak Med Assoc., 2008

43% alter regimen of prescribed meds, 61.9% stop taking prescribed medicine without consulting a doctor 82.5% felt that it is necessary to consult a doctor before taking a new medicine. Previous experience, problem too trivial, urgency of problem, advice from friend was enough, convenience, lack of time, cost of consultation, availability of transport.

Graph 2: Consumption of different classes of drugs by participants (Akram Ahmad, 2015).



117

S7 Sontakke SD, Int. Journal of Biological and Medical Research, 2011

Time saving, easy availability, convenient and economical.

S8 Husain et al, African Journal of Pharmacy and Pharmacology, 2011

Age, gender, education, family, society, law, availability of drugs, exposure to ads and nature of illness. Self-medication leads to inadequate drug utilization patterns.

S9 S. Kayalvizhi, IJEIMS Mild illness, previous experience of treating similar illness, economic considerations and a lack of availability of health personnel.

S10 Girma Belecha Gutema, J of Applied Pharmaceutical Sciences, 2011

Confidence in time in relation to self-treatment. People’s belief that only safe medicines are sold without prescription and that OTC medicines do not usually have side effects

S11 P.R.Shankar, Partha Shenoy, BMC Family Practice, 2002

Alternative medicine- Herbs and medicinal plants- Self-medication. Self-medication was started once fever, headache did not subside in 24 hours.Illness was mild, did not require services of the doctor. Previous experience of similar illness, even if they go they will be prescribed the same medicine.Patient’s satisfaction with healthcare provider, cost of drugs, educational level, socioeconomic factors, age, and gender.

S12 A.O.Afolabi, Annals of African Medicine, 2008

118 respondents felt it cured their ailment and saved their time and money. 15 felt they had the independence to take care of themselves. For all age groups, respondents used medicines in combination than single doses. Most of the respondents recognized medicines by their trade or generic names.

S13 Al Motassem M.Youssef, Pharm World Sci.2008

Patients select products based on previous experience with similar products or similar diseases.Non-prescription drug supply pattern is of three kinds-by prescription, by direct Self-medication (OTC’s) and indirect Self-medication –sought advice of pharmacy staff before buying the medicine.

S14 Henry James, Med Princ. Pract, 2006

Previous experience, mild illness and shortage of time.


118

S15 Wijesinghe R Pushpa, WHO South-East Asia Journal of Public Health, 2012

Self-medication was higher in urban than rural areas of Sri Lanka. Usage of traditional medicines for Self-medication was higher in rural areas. Self-medication was higher in urban males than urban females. Lower number of symptom count as a proxy measure of lower severity of illness emerged as a strong predictor of Self-medication.

S16 Husain S. Mallik, Self-med behavior in Pakistan, Southern Med Review 2010

No differences in health seeking behavior with respect to private sector in rural and urban Pakistan.

S17 Balamurugan E, BJMP, 2011 Self- med in South India

Lack of time to visit a doctor (41.5%) followed by minor illness and quick relief. Females were more likely to use Self-medication than males.

S18 Fernando Ruiz,” Self-medication in older people”, Drugs Aging 2009

Self-medication was significantly higher in older people who stayed alone than in those who were married and among the illiterate and who belonged to low socio-economic groups. Muscle and joint pain most common reason for self-medication followed by hypertension. No differences between self-medication practices in men and women.

S19 Imtiaz Sonia et al, Conditions, frequencies and socio demographic factors leading to self-medication in Sargodha, Pakistan, 2013

High consultation cost, minor illness, friends’ advice and easy availability of all drugs from drug stores without prescription.

S24 Nagarajaiah BH, Preva-lence and pattern of self-medication practices among population of three districts of South Karnataka, 2016

The most important reason for increase in trend of self-medication is easy availability of all categories of medicines-OTC, prescription or Schedule X drugs without a prescription

TABLE III: Continued

Study Reasons for Self-Medication

2008). Some of the respondents also did not check the expiry date of the medicine before consuming it by self-medication (Gupta Pankaj, 2011).

For non-prescription medicines, the physician and pharmacist was the most important source of information for self-medication. Table IV lists this information accordingly.



119

7. CONCLUSION

As per the guiding principles in self-medication (WSMI, 1998) “the first key to developing a drug policy which includes self-medication is to draw a distinction between those products which require more active involvement by a doctor or other qualified health professional for safe and effective use-prescription medicines, and those products which are safe and effective for use by consumers on the basis of their marketing authorization and labeling-nonprescription medicines”.

Accordingly, some of the major challenges that can be seen for a developing country with respect to self-medication could be literacy levels in the common population, Affordability of medicines and lack of accessibility to primary healthcare. Easy availability of medicines at pharmacies and convenience stores compounds the problem thus making the consumer vulnerable to risks of self-medication.

It is hence necessary to design interventions to tackle the growing problems associated with self-medication practices. The first step towards achieving this is through educating the masses about the dangers and side effects about the drugs used by self-medication. These programs have to be initiated at the grassroots level in rural areas where there are many consumers who do not hesitate to spend on healthcare and are not at all aware about risks and benefits of drugs being used by self-medication (Wijesinghe Pushpa, 2012, Gupta Pankaj, 2012). The second mechanism in a country like ours would be through active involvement of the pharmacist in patient interactions over-the-counter (Jain Pankaj et al, 2012, Malvi Reetesh, 2011). This is probably the best interface where a healthcare professional can consult the consumer

Table 4: Influence of Knowledge/ Information on self-medication.

Sources of Information/Knowledge Percentage

Doctors 39%Chemists/Pharmacists 40% and aboveFriends 18.9%Advertisements 25.2%Family 18.9%Internet 6.8%Books 7%Television 7.1%Previous prescription 21.5%


120

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121

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122

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S18

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125

on various aspects of drug safety and efficacy. There are already a number of positive changes initiated in this direction, for example GPP (Good Pharmacy Practices, FIP/WHO guidelines, 2011).

From the provider perspective, especially in a country like India, there are two major issues or challenges one can observe with respect to self-medication practices in the society. One is we do not have a specific OTC listing of drugs (Jain Pankaj, 2012) so in practice a lot of prescription drugs get used over-the-counter. In addition, there are diverse medicine systems in practice (Malvi Reetesh, 2011) and there is no mechanism to gather discrete information on self-medication across various medicine categories (freely available) being used by consumers. These are a larger set of issues and will need policy interventions from the government in the future.

Amidst this, self-medication practices can pose serious challenges if medicines either prescription or over-the –counter get misused, over used or underutilized. To ensure that the risks and benefits of medicine usage are known by consumers, we really need to look at and design interventions to promote healthy self-medication and in turn, rational drug use in the developing world.

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