Self-Medication Practices: A Threat to Health Care.

Sir,

Illness or symptoms of an illness are common human experiences. People respond to illness in diverse modalities. The modalities that are finally chosen and adopted depend both on cultural and socioeconomical factors and in the perception of the illness. Most of the signs and symptoms of an illness perceived or identified by the population are attended or treated by the ill people themselves. Of the very many symptoms, an individual experiences only a small proportion with an estimate of 10%–30% are brought to the attention of physicians. This presumed that the majority of the symptoms are either tolerated or self-medicated.[1]

The most widely self-medicated substances are over-the-counter drugs used to treat common health issues at home, as well as dietary supplements. Which do not requires medical prescription and also easily available. Rampant irrational the use of antimicrobials without medical guidance may result in a greater probability of inappropriate, incorrect, or undue therapy, missed diagnosis, delays inappropriate treatment, pathogen resistance, and increased morbidity.[2]

A cross-sectional study was conducted to assess the self-medication practices among patients attending outpatient department (OPD) of a tertiary care center. The sample size was estimated as 244 with an expected percentage of patients practice self-medication as 65.9% at 5% absolute precision and 90% confidence level. A consecutive sampling method was used to enroll the patient into the study. Inclusion criteria's includes people who attend outpatient medicine department of both gender and >18 years of age. A structured self-administered questionnaire for assessing Socio-demographic variables, clinical variables, and practice on self-medication was utilized to collect the data. The content validity was established with expert's opinion and consensus on items was established. Reliability was established with the test-retest method on 10% of sample size, r = 0.9. After obtaining approval from research monitoring committee, and institute ethics committee, the data collected from the patients after obtaining written informed consent. All the categorical data were presented on frequencies and percentages. The association of self-medication practice with demographic variables was done with the Chi-square test.

The results showed, Among 244 patients attending medicine OPD, 113 (46.3%) belong to the age group of 35–55 years, 164 (67.2%) were female. Regarding the educational status, 124 (50.8%) had primary education. A majority of patients 124 (50.8%) were unemployed and 210 (86.1%) had average income less than 5000. Majority of patients 195 (79.9%) reside in the rural area and most of them 205 (84%) did not have a health-care provider at home. One hundred and thirty-two (54.1%) were suffering from chronic illness.

Of 244 participants, 147 (60.2%) of participants had self-medication and the pattern of their practice was as shown in Table 1.

Table 1

Patterns of self- medication practices (n=244)

Responses	Frequency, n (%)
Common complaints for which self-medication was used
Runny nose	6 (4.08)
Nasal congestion	2 (1.36)
Cough	2 (1.36)
Sore throat	1 (0.68)
Fever	10 (6.80)
Aches and pains	67 (45.57)
Diarrhea	2 (1.36)
Multiple ailments	57 (38.77)
Where do you usually obtain self- medication from?
Community pharmacies	129 (87.8)
Leftover from the previous prescription	16 (10.9)
Neighbours	2 (1.3)
Reason for self- medication
Cost-saving	21 (14.3)
Convenience	120 (81.7)
Others	6 (4.0)
Did you check instructions that come with self- medications
Yes, always	40 (27.2)
Yes, sometimes	18 (12.2)
Never	89 (60.5)
Have you taken self- medication for single ailment chronically
Yes	37 (25.17)
No	110 (74.82)
Participants awareness of what medication they are taking
Yes	50 (34)
No	97 (66)
When did you normally stop taking self- medication after?
Few days regardless of the outcome	8 (5.4)
Symptoms disappeared	125 (85.0)
Few days after recovery	5 (3.40)
Medications ran out	7 (4.7)
Consulting pharmacist	1 (0.68)
Others	1 (0.68)

Among the group, 37 (25.1%) have suggested self-medication to others and 11 (7.48%) have tried multiple drugs for a single ailment. Majority of the group 123 (83.67%) is not concerned regarding the consumption of counterfeit medication, and 125 (85%) have stopped taking self-medication after symptoms disappeared.

Among 147 participants thirty (20.4%) have experienced side effects while taking self-medication, most of them 12 (40%) had nausea and vomiting, 13 (43.3%) of them have stopped taking the medication following an adverse reaction. About 66% of the participants were not aware of the medicine they were taking hence the specific drug usage was not estimated.

Table 2 depicts the association of self-medication practices with sociodemographic variables. sociodemographic variables such as age (P = 0.03) and occupation (P = 0.03) were found to be statistically significant, but may not be clinically significant because of heterogeneity of the study population.

Table 2

Association of self- medication practices with sociodemographic variables (n=244)

Variables/categories (n)	Self-medication (N=147)n (n/N%)	P value
Age (years)
<35 (78)	45 (30.6)	0.03
35 - 55 (113)	75 (51.0)
>55 (53)	27 (18.4)
Gender
Male (80)	49 (33.3)	0.83
Female (164)	98 (66.7)
Education
Illiterate (70)	44 (29.9)	0.18
Primary (125)	73 (49.7)
Secondary (19)	9 (6.1)
Graduate (30)	21 (14.3)
Occupation
Not working (124)	67 (45.6)	0.03
Working (53)	36 (24.5)
Labourer (67)	44 (29.9)
Income/month (Rs.)
<5000 (210)	124 (84.4)	0.32
5000 - 10,000 (25)	17 (11.6)
>10,000 (9)	6 (4.1)
Domicile
Urban (49)	30 (20.4)	0.91
Rural (195)	117 (79.6)

The present study reveals that among 244 participants, 147 (60.2%) were practicing self-medication. Studies have reported that the prevalence of self-medication practice is about 30-50% in various settings. It also found that, among the 147 patients taking self-medication, 67 (45.57%) have taken self-medication for aches and pains, and 57 (38.77%) have used self-medication for more than one ailment. Literatures also support that the common problems for which self-medication is used are fever, aches, vomiting, cold, and cough. This study also found that the majority of the participants never check or read the instructions that come with medication leaflet and the majority of them have stopped taking self-medication after symptoms disappeared. The similar results were appreciated in other studies also. However, few studies have identified that the common self-medicated drugs are antipyretics, analgesics, and antibiotics for common ailments.[45]

Acquiring medicines without a prescription, resubmitting old prescriptions to purchase medicines, sharing medicines with relatives or members of one's social circle, or using leftover medicines stored at home is considered as common in self-medication practice. This practice has been on the rise worldwide with huge variation in its prevalence among developing and developed nations due to inherent differences in cultural and socioeconomic factors and disparities in health care systems lead to self-medication as a major threat. Hence, there are need for health-care professionals to educate the general public about the hazards of inappropriate medicine use, and there should be restrictions on over-the-counter sale of drugs without doctor's prescription which will play a greater role in preventing inappropriate use of analgesics and antibiotics and its related consequences, to name a few, wastage of resources, increased resistance of pathogens, serious health hazards such as an adverse reaction and prolonged suffering.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.