SELF-MEDICATION AMONG UNDERGRADUATE PHARMACY STUDENTS OF UNIVERSITY OF UYO
1.0 INTRODUCTION AND LITERATURE REVIEW
Self-medication is the medically unsolicited use of prescription and/or Over-The-Counter (OTC) drugs. The practice is becoming a form of self-care (Hughes et al., 2001) and is a global trend that is encouraged when it deals with minor illness (Porteouset al., 2005). According to Loyola et al. (2004), it involves acquiring medicines without prescription, resubmitting old prescription to purchase medicine, sharing medicines with relatives or members of one’s social circle or using leftover medicines stored at home. Although self-medication is widely practiced globally, it is more common in developing countries. Drugs that are prone to self-medication include analgesics, antimalarials, antibiotics and cough syrups, among others (Afolabi, 2000). Self-medication can potentially do well and also harm people. This is especially significant in those countries where prescription drugs are available over-the-counter due to lack of enforcement of regulations (Sontakkeet al., 2011).
Self-medication if practiced appropriately can help in the prevention and the treatment of signs and symptoms which do not require a doctor’s visit; it can also enable those patients with chronic conditions to take responsibility to control their own condition (Jain et al., 2011). Also, rational self-care practice can decrease the pressure on the medical services, where health care personnel are inadequate (Jain et al., 2011). Furthermore, it can increase health awareness among people and allow them to build confidence and take charge to manage their own health (Hughes et al., 2011). However the practice of responsible self-medication for positive effects requires a certain level of knowledge about medications (Aljinovic-Vucicet al., 2005) as well as disease conditions. For an individual to self-medicate appropriately, WHO (2000) states that they must be able to accurately recognize symptoms, set therapeutic objectives, select appropriate medicine to be used for their medical condition, and determine appropriate dosage and dosage schedule taking into account his medical history, contraindication(s) and possible side effects of the medicine.
The increasingly high prevalence rates of self-medication may be due to socio economic factors, lifestyle, ready access to drugs, the increased potential to manage certain illnesses through self-care, and greater availability of medicinal products (World Health Organization, 1998).
The World Health Organization (1995) states that rational self-medication helps in the prevention and treatment of minor pathological conditions at an affordable cost. However, the practice is not without undesirable and sometimes serious drawbacks. In addition to the possibility of serious adverse effects, drug interactions, poly pharmacy, drug abuse and dependence, the emergence of resistant pathogens poses a problem when dealing with misuse of antibiotics.
An amplified risk of worsening of existing illness pathology as well as risk of interactions between prescription medicine and hidden active ingredients of OTC drugs are always present with self-medication (Choonaraet al., 1996). Improper practice of self-medication due to deficiency in knowledge can lead to side effects especially in physiological conditions like pregnancy and breastfeeding, and in special populations, such as children and the elderly (Shankar et al., 2002; Murray et al., 2003).
In developing countries, self-medication usually leads to inadequate drug utilization patterns and is especially worrysomer when it involves specific diseases (e.g. diarrhoea or the common cold) or prescription drugs such as antibiotics (Laporte, 1997).
Recent developments of the pharmaceutical companies contribute to a wide spread availability of OTC medicines (Hussain and Khanum, 2008).
James et al. (2006) reported numerous reasons for self-medication which include high cost of medical consultation, long hours of waiting at clinics, lack of time, social or family support, previous experience with the condition and its drug management and lack of nearby health facilities and unavailability of health professionals.
1.2 Statement of the Problem
The problem of self-medication among pharmacy and other health-related students is an issue of great concern. These populations of students, because of their access to knowledge of drugs and disease conditions, are usually inclined towards self-medication – treating ailments without professional supervision or advice.
Although self-medication is a useful tool to treat minor ailments, improper self-medication practice or medication abuse may lead to serious adverse drug reactions and possibly fatal consequences (Cicala, 2003). Despite the seriousness of the problem of self-prescription and its far reaching consequences, prevalence of this practice still remains high particularly in developing countries like Nigeria, where there is virtually unlimited access to most prescription drugs. Studies have shown that self-medication is practised widely among undergraduates generally (Eke et al., 2014; Osemene and Lamikanra, 2012; Klemenc-Ketiset al., 2010; Sawalha, 2008; Zafaret al., 2008;), and is especially common among Pharmacy undergraduates than Medical students (Bolluet al., 2014; Kumar et al., 2013; Gutemaet al., 2011).
Knowledge of medicines has been shown to influence self-medication (Klemenc-Ketiset al, 2010; Sawalha, 2008; James et al, 2006), although reports from Autaet al. (2012a) contradicts this observation. Gutemaet al.(2011) in their study showed that Pharmacy students practiced self-medication more frequently than Medical and other paramedical students, probably as a result of the compositional differences in drug-related courses taken by the different disciplines of Health Sciences. This, according to the researchers, predisposes Pharmacy students to deeper knowledge of medicines and hence more practice of self-medications as compared to Medical and other Health Sciences students (Gutemaet al., 2011). However, information on self-medication among pharmacy students in Nigeria is sparse. This study therefore sought to assess the prevalence of self-medication among undergraduate students of Pharmacy of the University of Uyo, determine factors that might predispose to this practice, as well as assess the students’ attitude towards self-medication.
1.3 Significance of Study
Pharmacy students possess some level of drug knowledge and may tend to utilize it towards self-medication. However, information on self-medication among this population is lacking. Depending on the results obtained from this study, therefore, adequate education and information on responsible self-medication, if necessary, can be conveyed effectively once the study objectives are accomplished.
Furthermore, issues of medication abuse and misuse can be assessed and necessary measures put in place to curb such issues which can arise from inappropriate self-medication among pharmacy students and indeed students of other disciplines. Since these students who are mostly young and single, will eventually graduate and become parents, proper education and understanding of the concept of self-medication would ultimately lead to a well-informed society with a consequent reduction in inappropriate medicines use and its attendant risks.
1.4 Literature Review
Every day, people are practicing self-medication in the form of self-care of our health (Vizhi and Senapathi, 2005). Self-medication is therefore a major form of self-care (Howard, 1996). Ruiz (2010) defines self-medication as the selection and use of medicine by individuals to treat self-recognized or self-diagnosed conditions or symptoms. Self-medication has traditionally been defined as ‘the taking of drugs, herbs or home remedies on one’s own initiative, or on the advice of another person, without consulting a doctor’ (Hernandez, 2002).
Medicines for self-medication are often OTC drugs, which are available without a doctor’s prescription through pharmacies, mostly in the less developed countries (Pawaret al., 1996; Kamatet al., 1998). According to McAcllifeet al.(1987), the buyer diagnoses his/her own illness and buys a specific drug to treat it. A person may also self-medicate by taking more or less than the recommended dose of a drug (Dabney, 2001). Some mental illness sufferers attempt to correct their illnesses by use of certain drugs (Kenna and Woods, 2004). Depression, for example, is notorious for being a trigger of alcohol, tobacco, cannabis, or other mind-altering drug use; while this may provide immediate relief of some symptoms such as anxiety, it may evoke and/or exacerbate some symptoms of several kinds of mental illnesses that are already latently present, and may lead to addiction/dependence, among other side effects of long-term use of the drug (Nancy and Mark, 1997). In their exposition of the theory of self-medication, Duncan (1974) and Khantzian (1985) noted that drug dependence or addiction results from self-medication for the distress caused by a pre-existing condition, a concept which has come to be known as the self-medication hypothesis. Patients who are frequently relying on self-medication should therefore be educated about the potential risks and adverse effects.
Association of the European Self-medication Industry (1998) has listed common treatment areas in self-medication: pain conditions, skin problems, acne, colds, sore throats, coughs, hay fever, oral hygiene, eye problems, vitamins and minerals, food supplements, smoking cessation, upset stomach, constipation, diarrhoea, travel sickness, haemorrhoids, sleeping and calming, gynaecologic problems, cystitis and worm treatments.
1.4.2 Prevalence of Self-Medication
The extent of self-medication varies from country to country. This may, at least in part, be due to study methodologies utilized and also the different socioeconomic and socio-demographic factors (James et al., 2006). Despite being highlighted by retrospective studies and considered to be the major source of non-prescribed drug use and abuse by these students, the prevalence of unauthorized drug use and dependency among students has been considered inestimable (Kenna and Wood, 2004). Kumar et al. (2013) reported a self-medication prevalence of 78% in Coastal South India; Abay and Amelo (2010) found the prevalence to be 38.5% among Medical, Pharmacy and Health students of Gondar University, Ethiopia; Philip et al.(2015) reported 87.5% among Pharmacy students in India while Bolluet al.(2014) reported as high as 92% among Pharmacy students in Guntur.
In Nigeria, a few studies of self-medication have been carried out with different prevalence rates of self-medication. In a survey of undergraduates of Imo State University, Owerri, only 38.9% of the respondents consulted qualified doctor when ill, the rest (61.1%) practiced self-medication by using drugs recommended by friends, family members or a paramedical worker (Eke et al., 2014). Similarly, Osemene and Lamikanra (2012) reported a self-medication prevalence rate of 53.8 %where self-medication increased as the students’ class level in the university increased. Fadare and Tamuno (2011) found a low prevalence rate of 38.8% antibiotics use among medical undergraduates in Kano State; and in Jos, 51.5% self-medication prevalence rate was recorded by Autaet al. (2012b).
1.4.3 Predictors of Self-Medication
Self-medication is very common and a number of reasons could be enumerated for it (Chang and Trivedi, 2003). Urge of self-care, feeling of sympathy towards family members in sickness, lack of health services, poverty, ignorance, misbelieves; extensive advertisement and availability of drugs in places other than drug shops are responsible for growing trend of self-medication (Phalkeet al., 2006).
Demographic factors such as age, socio-economic status, education, gender have also been reported to affect self medication(Osemene and Lamikanra, 2012; Sapkotaet al., 2010; Awadet al., 2005). Davies (1994) however, reported that self-medication is independent of age for both males and females. In a study by Upadhyay and Joshi (2011), some females claimed to have resorted to self-medication due to lack of family support, and also due to inability to walk to medical facilities. Lack of time, high consultant fee of physician, the desire for quick relief, and belief in Ayurveda has also been stated as reasons for self-medication (Upadhyay and Joshi 2011). Other reasons include: wider availability of medicines, greater choice of treatments, ease of access (Basak and Sathyanarayana, 2010), increased potential to manage certain illnesses through self-care (WHO, 1998) and self-reliance in preventing or reliving milder symptoms or condition (Omolaseet al., 2007). Eke et al. (2014) reported that major reasons respondents gave for self-medication included cheaper costs, avoidance of delay at the hospital and past experience of the efficacy of the drugs
1.4.4 Benefits of Self Medication
The positive demand towards pharmaceutical products for self-medication raises ethical issues of medication abuse. However, one literature concluded that most adults are capable of distinguishing major and minor complaints, for which complaints is doctors’ consultation needed and when responsible self-medication would suffice (Bradley et al., 1994). This indicates patients’ willingness to be more responsible for their health issues.
People having financial difficulties tend to consider self-medication as the main source of treatment (Shankar et al., 2002). These patients believed that self-medication offers an affordable response to their medical problems and needs. Symptomatic relief by self-medication enables the patients to treat long term or chronic complaints. Some patients have discovered that self-medication of minor ailments is more convenient and less time consuming (Hugeset al., 2001).
The benefit of self-medication has been made obvious as it helps to reduce the pressure on medical services particularly in the underprivileged countries with limited health care resources (Bradley et al., 1994). Therefore, self-medication for the treatment of minor illnesses provides a platform to reduce costs and wastage of resources.
1.4.5 Drawbacks of Self Medication
Though studies have shown that self-medication have some advantages, there are reported evidences of unfortunate outcomes due to improper practice of self-medication. These include risk of misdiagnosis, masking of a more serious underlying ailment, overdosing, prolonged course of treatment, undesirable or fatal drug interactions, poly-pharmacy (Hughes et al., 2001) and pharmacological and toxicological risks associated with improper use of OTC drugs (Gore and Mahavan, 1994), as well as prescription drugs which are so freely available over-the counter in most developing countries. According to WHO (2000), risk of double medication, risks of dependence and abuse, inappropriate storage and administration of expired medicines, medication wastages, amongst others, are disadvantages associated with self-medication.
The use of drugs or other substances in self-medication can be harmful or even fatal especially in the hand of those who are having little or no knowledge on the side effects and potential risks as seen in a study by Autaet al. (2012a) where students had poor knowledge of contraindications, drugs interactions, drug administration and indication of medicines. It has also been observed that adolescents gain awareness of the medication after consuming the medication rather than before consuming the medication. This event leads to the increase in potential risk of self-medication (Stoelbenet al., 2000). Another study showed that college students are highly influenced to use medications which frequently appear in media and advertisements and as a result embark on self-medication practices (Burak and Damico, 2000).
Currently, worldwide concern about antibiotic self-medication is mostly on the development of antibiotics resistant strains of microorganisms. The findings and reasons for the emergence of such resistance have been well documented (Association of the European Self-medication Industry, 1998).
1.4.6 The Role of the Pharmacist in Self-Medication
As a health care provider who is highly knowledgeable and well trained in preparing and dispensing drugs, a pharmacist has a professional responsibility towards self-medication issue (Worku and Mariam, 2003). An increasing trend of self-medication has called upon a greater role of pharmacist. Even though, health care providers especially general practitioners attach negative connotations towards self-medication but its role in enhancing health and promoting positive lifestyle have been acknowledged by the World Health Organization (1998). Hence, pharmacists should be able to provide assistance in terms of identifying ailments amenable to self-medication, choosing a proper product, monitoring a desired outcome and counselling on the medication taken (AbdNazir, 2010).
Patients who have a negative view of the pharmacist or who depend on doctors for health information tend to display disapproving attitudes towards pharmacist’s assistance. Nonetheless, patients with higher social levels and herbal remedy users have been reported to show favourable attitudes (Bradley et al., 1998). Taken as a whole, evidence suggested that the role of pharmacists in conveying information and providing supervision is not really achieving its potential.
Patient counselling is one of the measures that can be taken in order to monitor self-medication. Through counselling, patients will be able to gain proper and adequate knowledge of the medication they are taking. In a study to find out whether patients gained sufficient information about medications from pharmacies, only 70% of patients reported to have received such information (Lyons et al., 1996).
Absolute roles of pharmacist in self-medication have been stated by a joint statement by the International Pharmaceutical Federation and the World Self-Medication Industry (1999):
A Pharmacist has the obligation to provide sound advice about appropriateness of self-
medication and medicinal products available for self-medication, report to the regulatory
authorities and manufacturers of any case of adverse drug reaction due to self-medication
and encourage public to buy, use and store medication in a proper manner.
In another publication, World Health Organization/Drug Action Program (1998) outlined several functions of pharmacist in self-medication. Pharmacist is obliged to act as initiator in communicating with patients, supplier of good quality medications, supervisor of a healthy service and activities, collaborator with other parties to improve self-medication practice and health promoter in health issues and awareness. All of these obligations are supervised under precise protocols and patient‘s interest is always treated as the main priority.
Roles of pharmacist in self-medication do not always revolve around advising and supervising patients. As a key figure in the area that concerns medications, the pharmacist has the duty to advice doctors via discussion and supporting in medication review (Denham, 1988). Hence, a safer prescribing can be promoted by means of this step for the sake of patient‘s understanding and compliance about the particular medication. Health care providers: doctors, pharmacists, nurses and drugs manufacturers should all share a common goal which is to provide high quality of health service to the public and emphasizing on the responsible use of medication in self-medication (Barnett, 1998).
1.5 Objectives and Aims of Study
The main objective of this study was to assess the prevalence of self-medication practice among undergraduate Pharmacy students of the University of Uyo, AkwaIbom State. Specifically, this study sought to:
- Identify demographic factor(s) affecting self-medication among pharmacy students;
- Assess students’ perception and attitude towards self-medication practice;
- Identify common illnesses that prompt self-medication among pharmacy students;
- Identify classes of drugs used to self-medicate among the students;
- Pinpoint the source(s) of information with respect to the drugs used; and
- Identify the sources of such drugs.