INTRODUCTION:

Self-prescribing is usually defined as "medication that was taken on the patient's own initiative or on the advice of a pharmacist or lay person"¹.In developing countries, private pharmacies are the predominant drug dispensers and "prescription only" drugs are available for sale in official pharmacies without a prescription².

Modern medicaments though of prime importance to mankind is potentially hazardous when administered indiscriminately in the form of "self-medication". Considering the above facts in mind the present study was undertaken to study the magnitude and pattern of self-medication in the urban population.

The range of medicines available is often more restrictive compared to prescribed medicines, and there are often limitations to indications and doses, although there has been a trend towards increasing deregulation of medicines from prescription to OTC supply and most recently the availability of Internet pharmacies. Importance of self-medication is the consumers are willing and able to take more responsibilities for their own health and by so doing a significant amount of resources could be used in more pressing areas than patients receiving consultation and prescription for minor ailments. The concept of rational drug use is inherent to the issue of self-medication. Herophilus, the Alexandrian physician in 300 B.C had famously said that “Medicines are nothing in themselves, but are the very hands of God if employed with reason and prudence³.

In country like India there is a range of disease occurrence coupled with an inadequate health service, reduce the load on the medical service^4-5.50% 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 relief⁶.

‘Irrational’ use of pharmaceuticals, in particular self-medication with antibiotics, has been widely reported leading the World Health Organization to call attention to the dangers of self-medication as a cause of antibiotics resistance⁷. However increasing availability of non-prescription medicine may encourage patient to believe that there is OTC drug treatment available for every element. It is practiced significantly worldwide even though its type,extent and reasons for its practice may vary. They thought that these medications are risk-free and useful for the treatment of common health problems, their excessive use can lead to side-effects and unfavourablereaction.

However, self-medication is not necessarily means the consumption of modern medicines but also of herbs. Medicines for self-medication are often called ‘non-prescription’ or OTC and are available without a doctor’s prescription through pharmacies. Medicines that require a doctor’s prescription are called prescription products (Rx products) ¹.

In several studies it has beenfoundthat inappropriate self-medication results in wastage of resources, increases resistance of pathogens and generally entails serious health hazards such as adverse drug reactions, prolonged suffering and drug dependence⁸.

If self-medication done appropriately it can readily relieve acute medical problems, can save the times spend in consulting doctor, may be economical and can even save lives in acute conditions. It is now accepted that self-care in the form of responsible self-medication can beneficial for patients, health care provider, the pharmaceutical industries and government².An international movement supporting the validity of self-care is being witnessed.At the regional conference on revitalizing primary health held at Jakarta, Indonesia, in August 2008, a new definition of health for All was proposed: “A stage of health development, whereby everyone has access to quality health care or practice self-care protected by financial security so that no individual or family experience catastrophic expenditure that may bring about impoverishment”⁹.

It is recognized that self-medication must be accompanied by appropriate health information. The increasing self-medication readily requires more and better education of both the public and health professionals to avoid irrational use of drug.The objective of this study was to assess the prevalence of self-medication practices as well as the factors associated with self-medication.

MATERIALS AND METHODS:

This study was a cross sectional study carried out for a period of three months from October 2016 to December 2016 in 3 community pharmacies atErnakulum, Kerala, India. Ethical clearance from the institution and patient consent from every individual concern was obtained.

The persons prescribing themselves and buying the drugs from the 3 community pharmaciesselected was included in the study. The persons buying the medicine without prescription were interviewed for the complaints about the drug use, social status, literacy, source of knowledge, etc. They were assessed by a questionnaire consists of certain questions, including the demographics, educational status, economic status, occupation, reason for practicing, source of information for practicing was included in the questionnaire.Peoples visiting pharmacies with prescription are excluded from the study. People aged above 20 years were included and below 20 were excluded.Data was analyzed using MS Excel and it was summarized as counts and percentages.

RESULTS:

A total of 327 members were participating in the study. Age, Sex, Education, Occupation related factors were presented in table 1. Out of 327 members, we found that percentage of male purchasing OTC drugs was 70.95% and the percentage of females was 29.05%. Our data shows that people in the age group of 20-30 years (43.42%) were taking more OTC drug than 30-40 years (26.60%), 40-50 years (19.88%) and remaining 10.1% included in 50-60 years of age. Unemployed peoples 174(53.30%) were using more OTC drugs than self-employee 98(29.96%) and government employed 55(16.84%).The prevalence of self-medication was high among graduate people 153(46.66%) than high school 131(40%) and post graduate 43(13.33%).

Table 1: Demographic details of study population

Parameter	Frequency	Percentage
Sex
Male	232	70.95%
Female	95	29.05%
Total	327	100%
Age(years)
20-30	142	43.42%
30-40	87	26.60%
40-50	65	19.88%
50-60	33	10.1%
Education
High school	131	40%
Graduate	153	46.66%
Post graduate	43	13.33%
Occupation
Government-employee	55	16.84%
Self-employee	98	29.96%
Un employee	174	53.30%

Fig. 1: Self-medication usage in different medical treatment

Table 2: Practice related to self-medication among study respondent

Parameter	Frequency	Percentage
Reason for practicing self-medication
High consultation fee	98	29.97%
Lack of time	44	13.46%
Quick relief	185	56.57%
Source of information for self-medications
Doctor’s previous prescription	185	56.67%
Pharmacist	119	36.39%
Television (TV) /Radio advertisement	11	03.34%
Books	12	03.70%
Commonly used category of drugs
Analgesics/Antipyretics	144	44.03%
Laxatives	13	3.97%
Anti-tussives	110	33.63%
Antibiotics	27	8.25%
Antacids	15	4.58%
Topical agents	18	5.50%

Practices related to self-medication were presented in table 2. Quick relief 185(56.57%) was the main reason for self-medication than high consultant fee 98(29.97%) and lack of time 44(13.46%). The sources of self-medication was found to be doctors previous prescriptions 185(56.57%), pharmacist 119(36.39%), tv/ Radio 11(3.34%) and books 12(3.70%). The most commonly used categories of self-medicationwas analgesics/antipyretics 144(44.03%) than followed by antitussive 110(33.63%) and antibiotics 27(8.25%).

Fig. 2: Symptoms reported for self medication

Fig. 3: Awareness of the study population in checking the expiry of drugs

From Fig. 1, it shows that 82.87% of populations were using allopathic medicines, 7.03% were using homeopathy medicines and 10.09% were using Ayurvedic medicines. Fig. 2, represents thesymptoms forwhich the self-medication practices takes place. Results shows that 82.56% were consumed self-medication because of pain. 59.63% were taking for fever, 55.04% for cough, 13.45% for diarrhoea and 11.62% for respiratory complaints. Fig. 3, shows that 86.23% of study population did not aware about checking the expiry date of self-medication and only 13.76% of study population were aware about checking theexpiry date of their self-medication.

DISCUSSION:

The current study examined the prevalence of self-medication among the people of Ernakulam in Kerala.The figure of participants who usedself-medication was high, which requires immediate attention.Interactions between prescribed drugs and the drugs taken for self-medication is an important risk factor of which health care provider must be aware^10,11-12.

Total of 327 participants,gender distribution respondents showed that70.95% of male population and 29.05% of female population practice self-medication which is comparable to the results of other studies^13-14.The association between the use of self-medication and female sex is stastically significant.The reason for higher prevalence of these practicing women might be the restricted movement outside the house and the secondary status in the household. This lead to decrease in the tendency to take professional help resort to self-medication².

Highest proportion (43.42%) of individuals practicing self-medication amongst the study population was found in the age group of 20-30 years which is comparable to a study conducted in Madhya Pradesh (75%).The abuse of self-medication is more common in youth and it might be due to pharmaceutical industries media advertisement strategies¹⁵. The young age group is commonly involved in self medication practice¹⁶. In this study,amongthe level of qualification, the highest prevalence of self-medication was recorded among graduates which is supported by other studies¹⁷.The reasons could be, higher the knowledge about medications, the greater is the feeling of personal autonomy in the face of decisions about their own health ¹².

Majority of the study participants followed allopathic system of treatment which is similar to the observations made in other studies. Most easily available drugs are allopathic and also they were part of allopathic system, hence majority were using allopathic drugs¹⁸.

Most of the peoples preferred to have information about the drugs from previous prescriptions, so they save the time and money. Maximum of the respondents used, analgesics self-medication for treating common problem.Analgesics were the most common class of drugs self-medicated by majority of the participants in the present study.Analgesics (non-narcotics) especially NSAIDs were the most common class of medications used in the self-medication practices as reported in many studies in other areas^19-21. Therefore the people directly purchased the medicine from drug store without prescription.

Participants sited multiple reasons for the use of self-medication like lack of time, quick relief from illness, and high consultation fee, a similar reason were sited in an another Indian study^13,22-25.86.23% of study population did not check expiry date for their self–medication and only 13.76% of study population were aware about checking theexpiry date of self- medication.To establish the reason for self-medication requires more study in future. The potential limitation of the study is the limited sample size which we tried to overcome by adopting a random sampling method so as to generalize findings.

CONCLUSION:

From our study, we concluded that self-medication was very common among 20-30 years age group of male people inErnakulam. Analgesics were the most commonly purchased OTC drug for which fever is the main indication.Un-employee was taking more OTC drugs by using doctor’s previous prescription. Quick relief is the main reason for self-medication. The survey high lights the urgent need of public education about specific risk or side effects of self-medication. A proper statutory drug control must be implemented, rationally restricting the availability of drugs to the public.

ACKNOWLEDGEMENT:

I wish to thank my colleagues and coworkers in the department of pharmacy practice for their support in the execution of this project work.

CONFLICT OF INTEREST:

The authors declare no conflict of interest.

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Received on 27.07.2017 Modified on 13.09.2017

Research J. Pharm. and Tech 2018; 11(2):700-704.

DOI: 10.5958/0974-360X.2018.00132.4