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ORIGINAL ARTICLE
Year : 2013  |  Volume : 2  |  Issue : 2  |  Page : 103-107

Sudanese parents' knowledge, attitudes and practice about self-medication to their children: Qualitative study


1 Department of Pharmacology and Toxicology, College of Pharmacy, Taif University, Saudi Arabia
2 Department of Therapeutics, Faculty of Pharmacy, National Ribat University, Sudan
3 Department of Clinical Pharmacy, College of Pharmacy, Taif University, Saudi Arabia

Date of Web Publication10-Sep-2013

Correspondence Address:
Ahmed S Eldalo
Department of Pharmacology and Toxicology, College of Pharmacy, Taif University
Saudi Arabia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2278-0521.117914

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  Abstract 

Aim: This study was designed to test the Sudanese parents' knowledge, attitudes and practice (KAP) toward self medicating their children. Design and Methods: A cross-sectional study was carried out by using a pretested questionnaire. Non probability convenient sampling method was used to select the participants. The total sample size was 1000 parents from different health settings in Khartoum State, Sudan in the period from January to June 2011. Results: The obtained response rate was 94.9%. The majority of Sudanese parents in this study 84% used to recommend western medicines to their children. More than one-third of children had received parental self medication in the month preceding this study. The results revealed that parents in 95.7% cases, self medicated their children from minor illnesses. The most frequently used medicines are antibiotics 36.6% followed by paracetamol 31.5%, even though the most common symptom reported was fever 39.7%. In case of self-treatment failure; 64.0% of responded parents used to consult physicians in public settings, while 8.0% seek advice from the community pharmacists. The main reasons of parental self medication were the expensive consultation fees and the long waiting time in the clinics. Conclusion: The study revealed that parents' knowledge was inadequate, and their parental self medication practice showed to be inappropriate. The study outcomes urge instant move toward educating parents on risk of liberal use of medicines in children.

Keywords: Children, knowledge, parental self-medication, Sudan


How to cite this article:
Eldalo AS, El-Hadiyah TM, Yousif M A. Sudanese parents' knowledge, attitudes and practice about self-medication to their children: Qualitative study. Saudi J Health Sci 2013;2:103-7

How to cite this URL:
Eldalo AS, El-Hadiyah TM, Yousif M A. Sudanese parents' knowledge, attitudes and practice about self-medication to their children: Qualitative study. Saudi J Health Sci [serial online] 2013 [cited 2019 Nov 18];2:103-7. Available from: http://www.saudijhealthsci.org/text.asp?2013/2/2/103/117914


  Introduction Top


Children constitute a large percent of the population in developing countries. [1]

Children drug utilization is of great concern globally and has received a lot of attention. Many studies have been conducted in this field in the developed and developing countries, and have all shown various problems ranging from misuse and abuse of prescribed drugs, and errors of medications. [2],[3] Most drugs in children are used outside the health settings with or without prescription. The family initial response to many illnesses in their children has been found to be self-medication. [4] Fever is among the chief complaints of all pediatric consultations in general practice. [5] A study by Crocitti, et al. 2001 indicated that parents still have a problem to resolve the fever in children. Some parents believe that fever is one of the diseases which may occur among their children, rather than to be a sign or symptom of ailment. [6] In many countries, the antipyretic drugs and other over-the-counter (OTC) medicines are commonly used among parents to treat their children. [7] Using (OTC) medicines among parents may be affected by their attitudes towards illnesses. However, some previous studies show that parents' knowledge about fever is still inaccurate. Most parents are confused about which medicine should be given to their children to manage the pain and fever associated with minor ailments. [8] The common ailments of children including headache, fever, flu, diarrhoea and sore throat can be treated at home. Some minor ailments can be relieved with (OTC) medications such as paracetamol or with some other traditional or herbal medicines, without seeking for physician consultation. When a child complains, the parents' concerns are often influenced by their knowledge of the ailments and treatment. Parents may get advice from the media, through family tradition, from friends and via other sources which affect their responses toward the ailments. [8] The concept of self-management in healthcare includes disease prevention, self diagnosis, self-treatment and appropriate consultation with health care practitioners. Within the context of children's ailments, the responsibility will usually be on the children' parents. [9]

The aim of this study was to test the Sudanese parents' knowledge, attitudes and practice (KAP) towards self medicating their children, to identify the most commonly used drugs and the reasons of parental self medications in Khartoum State, Sudan.


  Materials and Methods Top


A cross-sectional study was designed and the data collection was carried out in several governmental and private hospitals in Khartoum State, Sudan. The study was approved by National Ribat University Ethical Committee. Non probability convenient random sampling method was used to select the respondents. The target population was included parents from different areas regardless of their occupation, age, social status and education. The total distributed sample size was 1000 parents in the period from January to June 2011. A questionnaire was designed to elicit the knowledge, attitude and pattern of practice of the parents towards self-medicating their children and to best addressing the study objectives. Data collection was carried out through structured interviews. A pilot study was carried out in a similar area for validity testing of the contents and the results were not included in the original study. Verbal consents were obtained from the parents who were agreed to participate in the survey. Parents were requested to complete the questionnaire on the spot. The questionnaire consisted of three parts: The first part was designed to obtain demographic characteristics such as gender, age, occupation, education and number of children. The second part was investigated the parents' knowledge, and the pattern of self-medication practice. Questions were used to examine the type of medications given to treat the children, most frequent medicines used and the most favorite sources of health information. In the third part five point Likert scale ranging from strongly agree to strongly disagree was used to determine the attitude and the reasons of parental self medication. The collected data was computed by using SPSS (version 16), then analyzed descriptively and Chi-square test was used for categorical variables' associations.


  Results Top


The study showed a very good cooperation of parents, with a total of 949 parents (94.9%) responding. Two thirds of those parents were females 629 (66.3%). The majority of population going through the interviews was less than 40 years old 666 (70.2%), and they were dominantly non-healthcare workers 789 (83.1%). Regarding parents' education level; 349 (36.8%) were university graduates. The obtained results revealed that most of the Sudanese families bearing large number of children, the families were having five and more children were dominant 267 (28.1%), as shown in [Table 1]. Although Sudan is a developing country; the majority of Sudanese parents in this study 797 (84%) used to recommend western medicines, while only 152 (16%) of them preferred to self medicate their children by traditional medicines. There were no significant difference between healthcare worker and non-healthcare workers (P = 0.535) whereas the graduated participants showed a significant difference, P value was (P < 0.001). The majority of interviewed parents obtained their medicines from private retail pharmacies 528 (55.6%), while only 273 (28.8%) of them had their medicines from public hospitals and just a few of them got their medications from friends or private clinics. Most of the participants reported that their children did not have any drug related allergy 687 (72.4%). The study showed that more than one-third of the children 365 (38.5%) had received parental self medication in the last month, while 271 (28.6%) of them did the same in the last year. The results revealed that the majority of parents used to self medicate their children from minor illnesses 908 (95.7%), and only 5 (0.05%) of them reported doing the same in case of more serious ailments. [Table 2] shows, the most common diseases that parent self medicated their children from and the most frequent medicines they tend to use. The most frequent medicines used were the antibiotics 347 (36.6%) followed by paracetamol 289 (31.5), although the most common self-treated symptom was fever 377 (39.7%).
Table 1: Socio-demographic characteristics of the sample (N=949)

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Table 2: The most common diseases and frequent medicines used by parental self medication (N=949)

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In case of self-treatment failure most of the parents in the present study tend to consult physicians in public settings 604 (64.0%), while 78 (8.0%) of them seek advice from the community pharmacists, as shown in [Figure 1]. The significant difference were found between the healthcare and non-healthcare workers (P < 0.001). The healthcare worker usually went to the pharmacists or to private clinics, while non healthcare usually went to the public hospitals, but sometime went to their relatives, also significant difference found between graduated and non graduated participants (P < 0.001). Some of non graduated participants seek advice from friends, but none of the graduated did. [Figure 2] illustrated the main sources from which parents retrieved health information. Doctors were the first favorite source for 769 (81.0%) of parents, while pharmacists were the second choice for 737 (77.7%) of them and relatives were the third favorite option for 407 (42.9%) of the parents. [Table 3] shows the reasons of parental self medication, the most common reasons were the expensive consultation fees and long waiting time in the clinics. Large portion of parents disagreed that healthcare workers' attitudes were bad, or that information relayed to them was insufficient. Another important finding was 488 (51.4%) of parents were convinced that they can diagnose their children's illnesses by the symptoms.
Figure 1: Participants attitude toward self-treatment failure P = 0.001 with parents' education and occupation

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Figure 2: Parents' favorite sources of health information P = 0.011 with the parents' occupation

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Table 3: Reasons for parental self medication to their children (N=949)

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  Discussion Top


This study investigated the knowledge, attitudes and practice of parental self-medication to their children in Sudan, and identified the main ailments and the most used types of medications. The majority of the participants were younger which reflect the actual status of the Sudan population distribution. [10] The results showed that 84% of the parents preferred the western medicines compared to the traditional ones. This is probably because most of the respondents were well educated and they think that modern medicines are more efficient and more reliable than traditional ones. The results agree with the Malaysian study which, showed that most of the parents prefer modern medicine to treat their children, [11] but differs from a Nigeria one which showed 34% of the mothers had used herbal medicines for their children. [12] The self-medication tendency among Sudanese community was clearly shown by the fact that 55.6% of the investigated population obtained their children's therapy directly from retail pharmacies. This might be due to financial reasons as well as the liberal over-counter dispensing of medicines in the community pharmacies. The study revealed that 95.7% of parents tend to liberally self medicate their children for minor illnesses which could be considered as an irrational attitude. This is in agreement with Escourrou et al. study which decided that parents self-medicate their children in France study mostly for mild pathologies. [13] More than one-third 38.5% of the children in this study had received parental-self medication in the last month, while 28.6% of them received it in the last year. This attitude was common in many countries, for example a study conducted in China showed about 51% of children had received parental self-medication on six or more occasions during a year period and 32.8% on four to five occasions. [14] The most frequent medicines used were the antibiotics 36.6%, paracetamol 31.0% and cough syrups 7.7%, although the most common symptoms reported were fever 39.7%, cough 22.3% and flu15.7%. The empiric treatment of fever with antibiotics without further microbiological investigations had been considered as a major component of irrational drug use among communities of the developing countries in general and Sudan in specific. [15] Common cold and sore throat are usually viral pathological conditions that will induce bacterial resistance and decrease the efficiency of antibiotics, [16] overuse of antibiotics has been described worldwide in both community and hospital settings particularly in developing countries. [17],[18] In previous similar studies; the main groups of self-prescribed drugs were: Analgesics/antipyretics and the main ailment was respiratory tract infection. [11],[19],[20],[21] Since medical consultations in public hospitals are less expensive than private ones; most of the present study participants 64.0% used to go to public hospitals in case of self-medication failure. This findings in agreement with Malaysian study by Dawood et. al. which reported; most of the parents prefer to bring their children to consult a doctor in public hospitals. [11] The reasons of parental-self medication obtained in this study were in line with the reasons reported in a study of antibiotics use among Chinese children carried out by Tong et.al., showing that payment of the medical fees is important reason of self-medication. [14]


  Conclusion Top


The parental liberal self-medication practice in Sudan should be considered as alarming problem. Parents' knowledge on the diseases and treatments seems to be inadequate, and their self-medication practice was inappropriate. The most commonly used medicines were antibiotics and antipyretics, while the most frequently treated symptom was fever. The main reasons for parental self-medication were expensive consultation fees and long waiting time in clinics. Therefore it is necessary to expose Sudanese parents to a national program in rational use of medicines in children.


  Acknowledgment Top


The authors highly appreciated the hard work of data collection that was carried out by the undergraduate final students, batch number six, National Ribat University.

 
  References Top

1.Lee D, Balasubramaniam K, Ali H. Drug utilization studies: Their transferability between industrialized and developing countries. WHO Reg Publ Eur Ser 1993;45:193-218.  Back to cited text no. 1
    
2.Edwards DJ, Richman PB, Brandley K, Eskin B, Mandell M. Parental use and misuse of antibiotics: Are there differences in urban vs. suburban settings? Acad Emerg Med 2002;9:22-6.  Back to cited text no. 2
    
3.Olayemi SO, Akinyede AA, Oreagba AI. Prescription pattern at primary health care centres in Lagos State. Niger Postgrad Med J 2006;13:220-4.  Back to cited text no. 3
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6.Crocetti M, Moghbeli N, Serwint J. Fever phobia revisited: Have parental misconceptions about fever changed in 20 years? Pediatrics 2001;107:1241-6.  Back to cited text no. 6
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7.Maison P, Guillemot D, Vauzelle-Kervroedan F, Balkau B, Sermet C, Thibult N, et al. Trends in aspirin, paracetamol and non-steroidal anti-inflammatory drug use in children between 1981 and 1992 in France. Eur J Clin Pharmacol 1998;54:659-64.  Back to cited text no. 7
    
8.Kai J. Parents and their child′s fever: Do as I say, not as I do? Fam Pract 1998;15:505-6.  Back to cited text no. 8
    
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12.Oshikoya KA, Njokanma O F, Bello J A, et al. Family self-medication for children in an urban area of Nigeria. Paediatr Perinatal Drug Ther 2007;8:124-130.  Back to cited text no. 12
    
13.Escourrou B, Bouville B, Bismuth M, Durrieu G, Oustric S. Self-medication in children by parents: A real risk? A cross-sectional descriptive study. Rev Prat 2010;60 Suppl 6:S27-34.  Back to cited text no. 13
    
14.Bi P, Tong S, Parton KA. Family self-medication and antibiotics abuse for children and juveniles in a Chinese city. Soc Sci Med 2000;50:1445-50.  Back to cited text no. 14
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15.Awad A, Eltayeb I, Matowe L, Thalib L. Self-medication with Antibiotics and Antimalarials in the community of Khartoum State, Sudan. J Pharm Pharm Sci 2005;8:326-31.  Back to cited text no. 15
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16.Linder JA, Bates DW, Lee GM, Finkelstein JA. Antibiotic treatment of children with sore throat. JAMA 2005;294:2315-22.  Back to cited text no. 16
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17.Isturiz RE, Carbon C. Antibiotic use in developing countries. Infect Control Hosp Epidemiol 2000;21:394-7.  Back to cited text no. 17
    
18.Chalker J. Improving antibiotic prescribing in Hai Phong Province, Vietnam: The "ant ibiot ic-dose" indicator, Bull World Health Organ 2001;79:313-20.  Back to cited text no. 18
    
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21.Tourinho FS, Bucaretchi F, Stephan C, Cordeiro R. Home medicine chests and their relationship with self-medication in children and adolescents. J Pediatr (Rio J) 2008;84:416-22.  Back to cited text no. 21
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    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1], [Table 2], [Table 3]


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