Self-medication practices among female students of higher educational institutions in Selangor, Malaysia: A quantitative insight.

BACKGROUND: World Health Organization has defined self-medication as the selection and use of medications (including herbal and traditional product) by individuals to treat self-recognized illnesses or symptoms. The prevalence of self-medication is reported to be higher among female students.
OBJECTIVE: To investigate the awareness and self-medication practices among female students of higher education institutions in Malaysia.
METHOD: A descriptive, cross-sectional study was conducted in four higher education institutes of Selangor, Malaysia. Convenience sampling approach was used to collect data from a sample 475 students. A "pretested" questionnaire was used as a study instrument.
RESULTS: A total of 461 questionnaires were returned (response rate 97.05%). The prevalence of self-medication among female students in higher educational institutions was 57.2% (n = 262). The most common source of self-prescribed medicine was a pharmacy or clinics (n = 206; 45%). It was found that antipyretics were the most common medications used without doctor's consultation (n = 212; 89.1%). Analgesics and antipyretics (n = 79; 62.7%) were highly recommended by students to their family and friends. The common reason for self-medication was prior successful experience (n = 102, 81.0%). The majority of respondents (n = 280; 61.1%) reported that they believed over-the-counter medications were as effective as medications prescribed by a doctor.
CONCLUSION: The prevalence of self-medication practice among female students in the sample of the four higher education institutions was moderate. More studies are required to generalize these findings across Malaysia.

In early 19th Century, there was a great development in healthcare industry around the world. Ever since, lay public showed trust on doctors and other healthcare professionals. Generally, they prefer to take medications prescribed by the doctors and follow their suggestions and recommendations accordingly.[1] At that time, self-medication was thought to be unnecessary, risky, and strongly discouraged in the society.[2] However, with the recent technological advancements, people nowadays are more concerned about their health conditions and desire to take control of their health.[3] They incline to play the active role when dealing with common health problems rather than referring to medical professionals. In 1970, World Self-Medication Industry was established. Within 7 years, this industry was aligned with various healthcare systems around the globe to convert prescription medicine to nonprescription medicine in certain countries.[4] This paved the way for the public to have wider access to many medications and thus rejuvenated the era of self-medication.

Self-medication is defined as the conduct which treats certain health problems without the consultation of a doctor or any other healthcare professional. It does not necessitate any prescription and/or diagnosis from any healthcare professional.[5] Generally, self-medication is only practiced for health conditions that are minor and commonly prevalent. The medication taken may be a continuation from a previous prescription by the doctor, could be a leftover medicine from the previous treatment and/or suggestion or advice from relatives and friends.[2] However, self-medication only involves nonprescription or over-the-counter (OTC) products that are easily available from the local pharmacy store, supermarket, and other outlets.[6]

A large body of literature from the developing economies has reported self-medication practices. Studies conducted in Slovenia,[7] Brazil,[8] Mozambique,[9] Sudan,[10] Ethiopia,[11] India,[2] and Pakistan[12] have also shown a higher prevalence of self-medication practices. A study conducted in Khartoum State, Sudan reported that more than two-thirds of the population practiced self-medication in the past 2 months.[10] A Malaysian study also showed a higher prevalence of self-medication with large majority reported to practice self-medication in the past 1 week.[13]

As there is an upsurge in the practice of self-medication, medical complications caused by various molecular entities is also a cause of concern.[12] Individuals who practiced self-medication may not have enough knowledge on their medication and may sometimes pose an additional economic burden on the healthcare system by frequent hospitalizations and visits to clinics. They are more likely to diagnose themselves erroneously; taking inappropriate drugs, unaware of drug-food interactions, and failed to recognize adverse drug reactions.[14] A study claimed that females and students were most likely to practice self-medication.[15] Therefore, in the backdrop of this, the current study was aimed to explore the awareness and self-medication practices among females of higher education institutions in Malaysia.

Methods

Study design and population

A descriptive, cross-sectional design[2] was aimed to evaluate the awareness and self-medication practices among female students in higher educational institutions using convenient sampling method for the ease of accessibility and proximity to the researchers. The study was conducted in four higher educational institutions of Selangor state (one public university and three private universities), Malaysia. The target sample size was 377 female students which were calculated by using Raosoft sample size calculator.[16] This sample size was calculated by keeping the population size as 20,000, power as 80%, response distribution as 50%, while confidence interval and margin of error were set at 95% and 5%, respectively. However, by considering the response rate of 80%, a total of 472 female students were contacted to participate in this study.

Data management and collection

The data collection form was used as a study instrument. An initial draft of the questionnaire was designed by the authors after an extensive literature review.[2789101112] The questionnaire was set to collect data on demographic information, the prevalence of self-medication, awareness, and practices of self-medication among the students. This questionnaire was then subjected to content validity, for which it was sent to a panel of four subject experts who then screened the questionnaire for its relevance and significance. All the experts were academicians with teaching and/or research experience in nonprescription drugs and related courses in pharmacy and medical field. The corrections suggested by the panel were then incorporated in the questionnaire. The revised version was sent to a small group of 10 students for face validity who gave their opinion on making the questionnaire more simple and brief. The data used for the pilot study were not included for the final analysis. Reliability coefficient of the questionnaire was determined by (SPSS, version 20 for windows, IBM corporation, Armonk, New York, USA). The Cronbach's alpha value of 0.82 was computed.

The final questionnaire was divided into three sections.

First part assessed the demographic information such as age, course of study, ethnicity, and religion. The second section explored the information about the self-medication practices such as frequency of drug use, source of drug purchase, reasons of self-care, and common medications advised for someone else. Third segment of the questionnaire assessed the awareness of students regarding the safety of self-medication.

Data analysis

Data were entered into (SPSS, version 20 for windows, IBM corporation, Armonk, New York, USA). Descriptive analyses were carried out to express the results as frequencies and percentages.

Results

A total of 472 questionnaires were distributed to the participants, of which 461 respondents returned the questionnaire, giving a response rate of 97.66%. As three questionnaires were incomplete, the analyses were carried out on 458 questionnaires.

The demographic characteristics are reported in Table 1. Participants’ age varied from 16 to 29 years (mean age in years = 19.55 ± 1.761). Majority of them were from health-related course (n = 183; 40.0%). Almost half of the participants were from Chinese (n = 225; 49.1%). The prevalence of self-medication among female students in higher educational institutions was found as 57.2% (n = 262). More than one-third of the respondents (n = 146; 31.9%) practiced self-medication 2–3 times a year, whereas less than one-fifth of the respondents (n = 85; 18.6%) self-medicated them once every few months [Table 2].

Table 1

Demographic characteristics of participants

Table 2

Frequency of taking medications without consulting a doctor

The most common source of self-prescribed medicine was a pharmacy or clinics (n = 206; 45%). 21% participants (n = 96) used medications from a stock available at their home, while 8.3% (n = 38) obtained from their family or friends. Other sources of medicines included a grocery store, hospital, and supermarket [Table 3]. The study also investigated the types of medication used for self-medication [Table 4]. It was found that antipyretics were the most common medications used without doctor's consultation (n = 212; 89.1%). Vitamins were the second most commonly self-prescribed medicine (n = 186; 83.4%), followed by eye-drops (n = 158; 60.3%), pain killers (n = 157; 59.9%), and herbal and/or traditional supplements (n = 125; 59.9%). In addition, the study also investigated the frequency of use of each type of medication [Table 4]. Vitamins were claimed to be the most frequent medicine used by female students (n = 68; 26%), while eye-drops were reported to be the second highest frequently used therapeutic category among female students (n = 28; 10.7%). As for the symptoms leading to self-medication, it was reported that fever, (n = 202; 44.1%) cough or cold (n = 195; 42.6%), and pain (n = 155; 33.8%) were the most common symptoms for self-medication [Table 5]. Other common symptoms reported were menstrual pain, diarrhea, constipation, vomiting, allergy, and indigestion.

Table 3

Sources of medications

Table 4

Frequencies of medicine used for self-medication

Table 5

Symptoms leading to self-medications

Minor health problem was stated as the main reason for self-medication (n = 175; 38.2%). More than one-quarter of respondents was (n = 129; 28.2%) self-medicated due to previous experience and some of respondents (n = 129; 28.2%) reported to practice self-medication because of urgent medical condition. Other common reasons given were convenience, cost, time, transport, and suggestions from either a friend or a relative [Table 6].

Table 6

Reasons for practicing self-medication

Moreover, 70.1% students (n = 320) stated that they consulted friends or relatives who were not medically qualified with regard to a health-related problem [Table 7], while 38.0% (n = 174) students reported that they follow the advice given by their friends or relatives. More than one-quarter students reported (n = 126; 27.5%) that they had previously advised friends and family members to take medicine. Analgesics and antipyretics (n = 79; 62.7%) were reported to be the highest recommended medicine by students to their family and friends, followed by cold and flu medicine (n = 9, 7.1%), anti-allergy drugs (n = 7; 5.6%), and cough mixture (n = 4; 3.2%) [Table 8]. The common reasons reported for taking medications were previous experience (n = 102, 81.0%), problem was not severe (n = 52; 41.3%), and urgency of problem (n = 50; 39.7%) [Table 9]. Awareness of respondents about the safety of self-medication was also investigated in this study [Table 10]. Most respondents (n = 331; 72.3%) were well-aware about the food interactions (n = 384; 83.8%) and adverse drug reactions (n = 399; 87.1%) associated with medicines. The majority of respondents (n = 280; 61.1%) believed OTC medications are as effective as prescribed medications.

Table 7

Frequency of consulting friends/relatives with regard to health-related problem

Table 8

Common medications advised to someone else

Table 9

Reasons for advising one to take medicine

Table 10

Students’ awareness on the safety of self-medication

Discussion

The study reported the moderate prevalence of self-practice medication practices among female students. However, the prevalence of self-medication among female students is reported to be higher in Malaysia elsewhere.[1317] However, it is important to consider that target sample in this study was conveniently sampled, educated students from higher educational institutions and, therefore, more than half of the reported respondents practicing self-medication might be an underestimation on the prevalence of self-medication among the community. Moreover, education could also be interpreted as a likely variation of results between the current study and previously published research. Either a pharmacy and/or clinic were reported to be the main source for obtaining medications. This is in congruence with the findings in Slovenia[7] and Ethiopia[11] where medications were mainly procured from the pharmacy.

Wong reported mushrooming of private pharmacy stores in Malaysia.[18] This may explain as to why pharmacy was the main source of medicine in the current study, and one can easily locate them in closely-knitted locations in urban areas. The current research reported antipyretics, vitamins, pain killers, and traditional supplements as most common therapeutic categories for self-medication. Similar findings were reported by Zafar et al. in Karachi, Pakistan,[12] and Lucas et al. in Maputa, Mozambique.[9]

OTC medications are generally safe when taken according to the instructions on the label. However, medications such as antipyretics and analgesics should be used with caution in certain groups of patients as these therapeutic categories might pose gastrointestinal problems and adverse renal effects. Likewise, an overdose of OTC acetaminophen is associated with hepatotoxicity.[19] The current results of fever, cough, cold, and pain being the leading symptoms of self-medication are in line with the studies by Zafar et al. and Hassali et al.[1213]

A previous study at Universiti Sains Malaysia reported poor knowledge about the disease and its treatment, and time-saving as two major reasons for self-medication among female students.[14] The results of current findings could be related to above-mentioned study as female students indicated minor health problems, previous experience, urgency of condition, convenience of available facilities, cost, and time-saving as reasons for practicing self-medication in this study.

In recent years, National Health Services has promoted self-medication for minor ailments. It is claimed that self-medication could reduce unnecessary consultation for minor ailments, consequently more time and quality of care could be spent for patients with more severe conditions.[20] Thus, self-medication for minor illnesses could be perceived as a good practice as it is most likely to reduce the burden of Malaysian healthcare professionals. Still, we endorse the views of Eickhoff et al. in this regard who highlighted the role of pharmacists in detecting the drug-related problems associated with OTC drugs and emphasized to enhanced pharmacist's education, training, and practice in this regard.[21] In 2007, Ministry of Health and Consumers Association of Malaysia organized a project “Know Your Medicine”, which was aimed to increase awareness about the rational use of medicine, and to provide consumers important information about various medications.[22] In this study, it was surprising to discover that 38% students practice self-medication based on advised by their friends or family. Therefore, awareness on safety of self-medication is rather an important issue highlighted in this study. It reflects the significance of government's effort in promoting responsible self-medication. Fortunately, the results showed that respondents understood their medicine clearly. They would read the label that comes with medication and checked the expiration date before and after purchasing it. They were also aware that certain medications might cause adverse drug reactions and interact with food or other medication. A Malaysian study reported a similar result to this study, wherein consumers knew their medications well.[13] In this study, it was observed that female students would prefer to consult a pharmacist than a doctor. It was relatively unexpected as doctors are thought to be the main preference for medicine consultation. The results indicate that the pharmacist plays a more crucial role in self-medication practice compared to a doctor. Therefore, pharmacists should be encouraged to provide maximum pharmaceutical care to the patients.[21]

In this study, participants supported the concept of self-medication. However, few participants commented that doctors or pharmacists should be consulted at the first place because self-medication is risky and at times potentially harmful.[1] On the contrary, respondents also viewed themselves not qualified enough to practice self-medication. They advocated that proper education pertaining to self-medication should be emphasized before launching the concept of self-medication.[23] Furthermore, not only the pharmacists but also other allied healthcare professionals, physicians should also be enlightened about the wider use of over-the-counter medication when prescribing new medications.[23]

The strength of this study is that it has focused on determining the prevalence and awareness of female students about self-medication in higher education institutes of Selangor, Malaysia. The findings of this study would be a valuable contribution to the existing literature as not many studies have explored the topic of self-medication among female students. Furthermore, the current research confirmed the outcomes from previous studies done in developing countries, forming a strong base to design data-driven interventions to improve the practice of self-medication in Malaysia. Like any research, this study draws attention to some of the unavoidable constraints of research approach that have been adopted. The study was executed in only one state of Malaysia using convenient sampling techniques, and therefore, the findings cannot be generalized to all the female students in other states of Malaysia. A large number of respondent were associated with healthcare-related courses which may have caused some bias in how they view self-medication. Survey bias, intentional dishonesty on the part of respondents, and recall bias may also have affected the survey results.

Conclusion

Prevalence of self-medication was moderate among female students in the sampled higher educational institutions in Selangor, Malaysia. There is a need to initiate campaigns to enhance the awareness of students about self-medication practices. The role of pharmacists should be expanded to include minor illness management service in the community pharmacies.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.