Pharmaco-epidemiological study of self-medication pattern in Hyderabad
Jayawardhani V.1, Rajesh A. Kamtane1, Ashok K. Kulkarni2*
1Department of Pharmacology, Mediciti Institute of Medical Sciences, Ghanpur, Medchal Mandal, R. R. Dist., Hyderabad – 501401, A.P., India
2Department of Physiology, Mediciti Institute of Medical Sciences, Ghanpur, Medchal Mandal, R. R. Dist., Hyderabad – 501401, A.P., India
*Corresponding Author E-mail: kulashok_kar_biophy@yahoo.co.in
ABSTRACT:
Background
Inappropriate use of drugs for self-medication leads to emergence of drug resistant pathogens and poses serious health hazards.
Methods
The study was conducted in December 2011. It was a community based cross-sectional survey on a sample of 258 households, which were selected randomly. Data was collected by pre-designed questionnaire.
Results
The most common system involved for assessment was the respiratory system (21.34 %). Analgesics were most commonly used drugs for self medication (18.48%) followed by usage of antibiotics (16.80%). Most of the drugs for self-medication were obtained from drug retail outlets (35.71%) followed by friends/neighbours/family practice (34.45%). The major reason for using self-medication was attitude of not to waste money on doctors’ fees (37.81%) followed by inability to afford doctors’ fees (25.63%).
Conclusions
From the study it is concluded that majority of the persons go for self medication without proper knowledge of the dose, adverse drug reactions, and drug interactions. Hence, the issue needs to be addressed by the responsible authorities of State Pharmacy Council/Ministry of Health. The availability of drugs in informal sectors contributed to the increase in self-medication. Though self-medication is hard to eliminate, drug law enforcement and educating the public at large is vital.
KEYWORDS: Frequently used drug type, Hyderabad, NSAIDS, OTC, self medication
INTRODUCTION:
Self-medication can be defined as obtaining and consuming drugs without the advice of a physician either for diagnosis, prescription or surveillance of treatment. 1 This includes 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. 2 There is a lot of public and professional concern about the irrational use of drugs. In developing countries like India, easy availability of a wide range of drugs coupled with inadequate health services result in increased proportions of drugs being used as self medication as compared to prescribed drugs. 3
Although, over the counter (OTC) drugs are meant for self medication and are of proved efficacy and safety, their improper use due to lack of knowledge of their side effects and interactions could have serious implications, especially in extremes of ages (children and old age) and special physiological conditions like pregnancy and lactation. 4, 5 There is always a risk of interaction between active ingredients of hidden preparations of OTC drugs and prescription medicines, as well as increased risk of worsening of existing disease pathology. Since very few studies have been reported to be published regarding the self medication pattern in our community, therefore, we conducted this cross-sectional study in 238 members living in Hyderabad city to evaluate their self medication practices.
A simple questionnaire was prepared and each member was interviewed only once in the local language after obtaining their consent. Participants were informed about the purpose of the study.
|
Sl. No. |
Types of illness |
Number |
(%) |
|
1 |
Respiratory system: Conditions included: Cough, cold, fever, breathlessness, sore throat, asthma, sinusitis (pain) |
54 |
21.34 |
|
2 |
Skin Conditions included: Itching, minor burns, cuts/bruises, any rash over body, acne, perineal rash, any skin lesions, external injuries, silencer burns, any skin infection |
40 |
15.81 |
|
3 |
Gastro-intestinal system Conditions included: Loose motions, constipation, acidity, belching, stomach pain, stomach upset, hemorrhoids, indigestion, stomach tightness, bowel upset |
38 |
15.01 |
|
4 |
Gynaecology Conditions included: Postponement of periods, dysmenorrhoea, bleeding during menses |
38 |
15.01 |
|
5 |
Pain Conditions included: Neck pain, hand pain, leg pain, body pain, headache, sudden headache with body warmth, toothache |
33 |
13.04 |
|
6 |
Fever/weakness |
24 |
9.48 |
|
7 |
Miscellaneous Conditions included: Burning micturition, lack of sleep, any illness, tingling sensation in fingers |
17 |
6.71 |
|
8 |
Eye Conditions included: Redness of eyes, strain in eyes, pain and irritation in eyes, watering from eyes, defective vision |
9 |
3.55 |
|
9 |
Ear Conditions included: Pain in ear, slightly decreased hearing |
9 |
3.55 |
|
Sr. No. |
Parameter |
Number |
(%) |
|
1 |
Sources for self medication- |
|
|
|
a |
From pharmacist. |
85 |
35.71 |
|
b |
Form friends/ neighbors’/practiced in family. |
82 |
34.45 |
|
c |
From previous prescriptions. |
55 |
23.10 |
|
d |
From advertisement/ radio/ television/ internet. |
16 |
6.72 |
|
2 |
Reasons for self medication- |
|
|
|
a |
Don’t want to waste money on doctor’s fees. |
90 |
37.81 |
|
b |
Can’t afford doctor’s fees. |
61 |
25.63 |
|
c |
Lack of time to visit doctors. |
46 |
19.32 |
|
d |
Doctors’ advice not needed for common illness. |
41 |
17.22 |
|
3 |
Symptoms- |
|
|
|
a |
Relieved. |
118 |
49.57 |
|
b |
Not relieved. |
120 |
50.42 |
|
4 |
General awareness about- |
|
|
|
a |
Dose/ duration |
|
|
|
I |
Knows. |
130 |
54.62 |
|
II |
Does not know. |
108 |
45.37 |
|
b |
Side effects- |
|
|
|
I |
Knows. |
18 |
7.56 |
|
II |
Does not know. |
220 |
92.43 |
The study questionnaire was adapted from similar study conducted 6 previously. In case where the families were not well educated, questionnaires were filled by qualified assistants. The questionnaire contained the questions pertaining to identifications data (name), address, qualifications, employment, income, practice of self medication by the family, commonly used drugs as self medication, knowledge about the dose, duration and side effects of the drugs in use, source of information about the drug, and attitude towards allopathic, ayurvedic and homeopathic medicines. The study was also performed to assess the trend of low knowledge about dose/duration, side effects of commonly used drugs in accordance with reports of the previous studies. 7, 8 The collected data were analyzed by using PC based statistical software routines.
The participants’ knowledge about the above said parameters was extracted by asking direct questions or indirectly by enquiring about the drug use in sub-therapeutic dose for inadequate period or over use of drugs, use of drugs with a potential to aggravate the existing pathology for which it is used. These included for the assessment of their knowledge for the use of non steroid anti inflammatory drugs (NSAIDS) for epigastric pain, the use of cold and cough remedies containing sympatho-mimetic drugs by hypertensive and diabetic patients, the use of antimotility dugs for diarrhoea/dysentery in children, and the use of hormonal pills by hypertensive or diabetic women. It was also assessed for the concomitant use of drugs with potential interactions (for example, the use of NSAIDS and antihypertensive drugs or iron /calcium preparations and antimicrobials or irrational drug combinations).
The trend of self medication, as noticed from Table 1 and Figure 1, was more in females as compared to males. Also practice of self medication was more in educated individuals as compared to uneducated ones. The common illnesses for which the subjects took action were: cough, cold, fever, itching, minor burns, diarrhoea, constipation, abdominal pain, indigestion, etc.
The assessment for the reasons for self medication among the study population of 238 participants has been envisaged in Figure 2 and Table 2. It was found that, 90 persons (37.81% of population) didn’t want to waste money on doctors’ fees. Similarly, about 25.63% of the population (61 persons) followed the self medication on the grounds that they could not afford doctor’s fees.
Figure 1 - Types of illness for which self medication was taken: The most common type of illness was respiratory system for which self medical was taken
|
Sr. No. |
Typeofdrug |
Number |
% |
|
1 |
NSAIDs’ |
44 |
18.48 |
|
2 |
Antibiotics |
40 |
16.80 |
|
3 |
Others(homeopathy, ayurvedic, coughsyrups) |
35 |
14.70 |
|
4 |
Skincreams |
25 |
10.50 |
|
5 |
Antihistaminics |
20 |
8.40 |
|
6 |
Antacid |
13 |
5.46 |
|
7 |
Householdmeasures |
11 |
4.62 |
|
8 |
Antidiarrhoeals |
10 |
4.20 |
|
9 |
Foodsupplements |
10 |
4.20 |
|
10 |
Progesteronetablets |
10 |
4.20 |
|
11 |
Antimotility/antisecretory |
4 |
1.68 |
|
12 |
Antiseptics |
4 |
1.68 |
|
13 |
Antispasmodics |
3 |
1.26 |
|
14 |
Laxatives |
2 |
0.84 |
|
15 |
Bronchodilators |
2 |
0.84 |
|
16 |
Antiemetic |
1 |
0.42 |
|
17 |
Antihypertensives |
1 |
0.42 |
|
18 |
Sedative |
1 |
0.42 |
|
19 |
Antimalarial |
1 |
0.42 |
|
20 |
Citralkasyrup |
1 |
0.42 |
The practice of self medication by 19.32% of population (46 persons) was found to be due to lack of time to visit doctors. And, about 17.22% of population (41 persons), practiced self medication due to the fact that doctor’s advice was not needed for common illness
Eighty five persons (35.71% of study population) were found to be reported that they obtained the drugs from drug retail outlets, which was the most common source for drugs used in self medication (Table-3 and Figure 3). From the study (Table-3), it was observed that the most frequently used drug type for self medication is NSAIDs (18.48%). A study carried by Rajput et al 9 also showed similar results. In their study about 85.38% preferred antipyretics and analgesics. Other studies also support the results from the works of Wilbur K 10 and Verma RK. 11 Followed by them were the antimicrobials (16.80%).
All the above data were well in consistence to support with those from previous studies that the trend towards self medication has been increasing day by day but coming to the part of knowledge regarding safety and efficacy. These observed results were shown to be disappointing as only 54.62% had the knowledge regarding the dose/ duration of the drug (Table 2) and only 7.56% knows the side effect of the drug taken by them as self medication and only few reported adverse drug reaction like sedation, rashes etc. The information regarding dose / duration of the drug was less. There was little or no information regarding the side effects and drug interactions which was in 6, 8 accordance with the previous studies.
Trend was observed towards homeopathic and ayurvedic system of medicines for chronic illness likes joint pains, bronchial asthma, constipation, etc. Moreover herbs and homeopathic drugs were shown to be considered safe and free from adverse effects, but the risk of possible drug interactions is always with their use. However no serious side effects were reported with drugs used as self medication. However few episodes of epigastric discomfort, sedation and rashes were observed with the use of NSAIDS, cough and cold remedies.
There are various factors that play important role in influencing this type of self-medication pattern among the population. These factors include patient satisfaction with the health care providers, cost of the drugs, education level, socioeconomic factors, age and gender.
Although, self medication - using non-prescription drugs - could be beneficial to patients, the drugs being supplied by the healthcare professionals, the pharmaceutical industry and the government have been used rationally. This asks for the quite important role to be played by the pharmacists regarding education of the persons for rational use of the drug as the practice of self medication often has many severe adverse effects and can lead to many problems.
Hence, provisions should be made for proper education regarding the rational use of drugs by the consumers. Apart from community education, safety and efficacy of OTC drugs must be assured, so that these products could be safe even in the event of improper use. For registration as an OTC drug, specific efficacy trials may be conducted in real self-medication situation. Due to the difficulty in approaching the health care services, self medication will often be the simplest option for the patients. Since traditional practitioners are easily accessible, people also turn out to them for their health care needs. However, traditional practitioners need to be educated about when to refer a patient for more specialized care.
The study also showed that there is an influence of other individuals in the practice of self medication (34.45%). This reveals the existence of bad trend in the community where non-professionals recommend drug use, which needs to be discouraged through public education. This finding is similar with the study done in Brazil where 51.2% of self-medication used was recommended by third party. 12
Though the study has some shortcomings like recall bias, bias by the professionals who collected the data, not revealing the truth by the respondents, and not including the drugs used for self-medication, we believe the study addresses an important issue as self-medication could be considered as one of the public health problems in a population where there is lack of wide controlled medical education.
In conclusion, it is stressed that a significant number of people use self-medication. The major reason for self-medication is its relative lower cost. Drug retail outlets are cited to be the major sources of drugs that are used for self-medication, and the availability of drugs in informal sector contribute to the increase in the practice of self-medication. Therefore, though self-medication is difficult to be eliminated, intervention such as dissemination of information about problems of self-medication and drugs at large, through media, health education sessions, posters etc, can be made. Drug law enforcement authorities need to have clear and effective legislation on drug handling and dispensing so that policies can be implemented and, necessary measures may be taken on illegal purveyors of drugs. Ministry of health and the regional health bureau may need to facilitate the solutions towards increasing the health service delivery institutions so that more people can have access for utilizing health facilities. Finally, we recommend further studies have to be done on self-medication in different cities, in different regions of the country.
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Received on 20.06.2012 Modified on 15.07.2012
Accepted on 20.07.2012 © RJPT All right reserved
Research J. Pharm. and Tech. 5(8): August 2012; Page 1114-1117