|Year : 2019 | Volume
| Issue : 1 | Page : 54-59
Knowledge, attitudes, and practices toward self-medication in a rural population in South-Western Saudi Arabia
Hafiz A Makeen1, Ahmed A Albarraq2, Otilia J.F Banji2, Soha Taymour2, Abdulkarim Meraya2, Saad Alqhatani2, David Banji2
1 Department of Clinical Pharmacy, College of Pharmacy, Jazan University, Jizan, Saudi Arabia
2 Pharmacy Practice Research Unit, Department of Clinical Pharmacy, College of Pharmacy, Jazan University, Jizan, Saudi Arabia
|Date of Web Publication||16-May-2019|
Dr. Otilia J.F Banji
Pharmacy Practice Research Unit, Department of Clinical Pharmacy, College of Pharmacy, Jazan University, Jizan
Source of Support: None, Conflict of Interest: None
Aim: Self-medication is developed to encourage responsible self-care but is often carried out without sound rationality. This study assesses the reasons, knowledge, attitude, and practices toward self-medication in rural areas of south-western Saudi Arabia. Materials and Methods: A cross-sectional, descriptive, and questionnaire-based study was carried out on respondents visiting the primary healthcare center. Data were collected, analyzed using SPSS software version 23 and presented as frequencies and percentage. Association between variables was established using the Chi-square test, and logistic regression. Results: Among the 500 responses obtained, 58% were female, and 42% were male. Self-medication was practiced for pain (38.3%), influenza (26.3%), cough (24%), and allergy (11.4%). Over 70% failed to consult a physician, lacked awareness of medicine information inserts (71.06%), and failed to check the expiration date (85.2%). Recurrence of symptoms and accessibility of medicines in pharmacies or online stores were a widely accepted reason for self-medication. The respondents were 2.5 times likely to use medications based on others recommendations (odds ratio [OR]: 2.56; 95% of confidence interval [CI]: 1.59–4.13); however, this was lower in females (OR: 0.55; 95% CI: 0.38–0.79; P = 0.002). A significant association was observed between the reasons for self-medication and practices undertaken if symptoms persist with demographic characteristics. Conclusion: Recurrence of symptoms, adopting others advice, the absence of information about medication inserts, and expiration date were issues that can impede responsible self-medication in rural areas. Appropriate patient counseling and conscious dispensing of medications are needed to minimize risks associated with self-medication.
Keywords: Pharmacies, rational use, Saudi Arabia, self-medication
|How to cite this article:|
Makeen HA, Albarraq AA, Banji OJ, Taymour S, Meraya A, Alqhatani S, Banji D. Knowledge, attitudes, and practices toward self-medication in a rural population in South-Western Saudi Arabia. Saudi J Health Sci 2019;8:54-9
|How to cite this URL:|
Makeen HA, Albarraq AA, Banji OJ, Taymour S, Meraya A, Alqhatani S, Banji D. Knowledge, attitudes, and practices toward self-medication in a rural population in South-Western Saudi Arabia. Saudi J Health Sci [serial online] 2019 [cited 2019 Jul 20];8:54-9. Available from: http://www.saudijhealthsci.org/text.asp?2019/8/1/54/257765
| Introduction|| |
Self-medication is an integral part of self-care which deals with the maintenance of health, prevention, and treatment of diseases. Self-medication is commonly practiced for acute conditions such as influenza, headache, cough, and gastrointestinal disturbances which surface suddenly and progress aggressively. In addition, the concept of self-care for chronic conditions is also encouraged in many countries. Emphasis on using medications with one's own discretion and judgment without consulting a physician is intended to reduce the patient load on the general practitioner, transform the consumer into a decision-maker, improving one's own health and reduce the cost of healthcare. Despite the objective of self-medication being clear, it is often practiced without a sound scientific background. The possibility of food-drug interactions or choosing an inappropriate medication are issues of concern. The consumer self-medicates with the perception of instantly alleviating symptoms, saving on the cost of consultation even under alarming situations, and avoiding long waiting hours to consult a physician.
In general, self-medication could be anticipated in countries where healthcare is endured as an out-of-pocket expense. However, even in countries like Saudi Arabia where health-care expenses are borne mainly by the government, the practice of self-medication prevails. Saudi Arabia has the largest use of over-the-counter (OTC) products with the highest sales for diclofenac, followed by antibiotics sold as OTC, proton-pump inhibitors, and antihypertensives., Albatti et al. have reported extensive self-medication among adolescents between the age group of 13–18 years in Riyadh, Saudi Arabia. Several studies on self-medication, particularly with antibiotics have been reported from major cities in the Kingdom of Saudi Arabia. However, to the best of our knowledge, there are no studies carried out to assess self-medication in rural areas of Saudi Arabia. Further, it is essential to understand the inclination of rural inhabitants toward self-medication practices with OTC medicines as they might not be used with sound discretion. Second, the hot, humid climate, and sandstorms might increase the risk of acute infections instigating self-medication. In addition, distantly located health-care facilities could be a barrier to seek professional help. This survey attempts to explore the knowledge, attitudes, and practice toward self-medication for acute and chronic conditions in the rural public.
| Materials and Methods|| |
This study was approved by the Institutional Review Board, College of Pharmacy bearing the number 3813/222/1438 dated November 22, 2016.
A descriptive, cross-sectional study carried out on respondents residing in rural areas. The respondents were invited to answer the questionnaire or given the freedom to decline. The sample size was calculated assuming a prevalence rate of self-medication to be 50% in population size of 1.36 million in Jazan. Including an attrition rate of 10%, the total sample size required for this study was 424 respondents. Sample size (n) was calculated based on the formula: (n) = Z2 pq/e2, where d = margin of error (5%), P = estimated proportion in a population and q = (1 − p) and Z = 1.96. However, we finally obtained 500 filled questionnaires.
Of the nine primary health-care centers (PHC) located in rural Jazan, four centers were randomly selected. Every fifth individual, 18 years or above, visiting these PHC between 9 a.m. and 2 p.m. were selected using systematic random sampling. The use of a self-prescribed medication or use of medication based on an old prescription was considered as self-medication. The period for data collection was between December 2017 and April 2018.
After a thorough literature search, a questionnaire was developed to retrieve demographic information comprising age, gender, education, income, number of children, and possession of insurance. Both open- and closed-ended questions were included to envisage the knowledge, attitude, and practice of respondents toward self-medication. The questionnaire was translated in Arabic, and 30 questionnaires were pilot tested to eliminate ambiguous questions. The participants of the pilot study were not included in the final sample.
The results were entered into the Microsoft Excel and then analyzed using SPSS software version 23 (IBM Corp., Armonk, NY). Descriptive information was presented as frequencies and percentages. The Chi-square test was performed to ascertain the association between practices of self-medication versus demography as an independent variable. Multiple logistic regression was undertaken to assess the factors most likely to impact the knowledge and attitude toward self-medication. Data from logistic regression are reported as an odds ratio. The level of statistical significance was P < 0.05 for all comparisons.
| Results|| |
[Table 1] shows the sociodemographic details of the families which responded to the survey. A total of 500 questionnaires were answered providing a response rate of 100%. However, some questions were not answered by the respondents; hence, the response rate with regard to individual questions varied. About 58% of the respondents were female and 42% were male. Respondents aged <25 years was 18.4%, the age group of 26–36 years (48.8%), and 32.8% were >36 years. A more substantial proportion (68.1%) did not have a University degree, and 400 of the respondents (79.8%) did not possess insurance. Over 200 of the respondents had one child (42.2%), 30.8% had two children, and 26.4% of the respondents had more than two children. Chronic diseases affected 31.3% of the respondents [Table 1].
A little over 70% did not consult a physician [Figure 1]a. The majority (85.2%) failed to check the expiration date [Figure 1]b and over 70% were unaware of information leaflets [Figure 1]c. Furthermore, over one-third self-medicated for pain (38.3%), 26.3% for influenza, 24% for cough, and 11.4% for allergy. Side effects were experienced by 23.6% of the respondents with gastro-intestinal disturbances affecting 12% of the respondents, headache (8.4%), and allergy (2.4%) [Table 2].
|Figure 1: (a) Knowledge of the respondents about information inserts. (b) Knowledge about the expiry date of medications. (c) Respondents attitude toward consulting physicians about drugs|
Click here to view
|Table 2: Symptoms for which self-medication is undertaken along with the side effects|
Click here to view
Over 50% of the respondents recommend others to use medicines based on their experience. Sources of medicines were friends or family (23.3%), online stores (27.9%), and 48.7% procured medicines from the pharmacy [Figure 2].
Statistically significant association was observed between gender (χ2 [10.57, 2]; P = 0.014), age (χ2 (15.64, 4]; P = 0.016), income (χ2 (25.53, 4); P = 0.001), insurance (χ2 (26.64, 2); P = 0.001), and number of children (χ2 [13.02, 4]; P = 0.043) with reasons for self-medication [Table 3]. A statistically significant association was observed between the level of education (χ2 [13.56, 3]; P = 0.009) and the presence of children in families (χ2 [13.36, 3]; P = 0.010) with different practices undertaken if symptoms persist. However, an association was not found between gender, age, income, and insurance on practices undertaken if symptoms persist [Table 4].
|Table 3: Association between reasons for self-medication (practice) and sociodemographic features|
Click here to view
|Table 4: Association between the practice of self-medication and sociodemographic features|
Click here to view
In the logistic regression analysis, the odds of suggesting others regarding medication experience was lower in females as compared to that of males but was statistically significant (odds ratio [OR]: 0.55; 95% confidence interval [CI]: 0.38–0.79; P = 0.002). On the other hand, although the age group above 25 years had higher odds of sharing medication information compared with respondent's ≤25 years, yet it was not statistically significant [Table 4].
The odds of using medicines without consultation for allergy was marginally high (OR: 1.04; 95% CI: 0.53–2.04) compared with the reference. The odds of self-medicating for cough was twice lower as compared to that of self-medicating for influenza (OR: 0.49; 95% CI: 0.27–0.88; P < 0.01). With self-medication, the odds of cough as a side effect were four times higher as compared with the reference. However, a statistically significant effect was not observed [Table 5].
In chronic disorders, the primary source of medicines for the respondents were pharmacies (OR: 1.89; 95% CI: 0.74–1.90) or online stores (OR: 1.64; 95% CI: 0.95–2.81), but a statistically significant response was not observed. The odds of using medications for chronic disorders based on others experience were high and statistically significant (OR: 2.56; 95% CI: 1.59–4.13) compared with the suggestion not being given to others [Table 5].
| Discussion|| |
Several studies have focused on self-medication practices with antibiotics, particularly in the urban population; however, this study focused on the self-medication practices, particularly in rural public with OTC medicines. Many countries have adopted the strategy of self-medication for the management of minor ailments with nonprescription drugs as well as self-care for chronic conditions. These measures empower and place an enormous responsibility on the consumer to use medicines judiciously. However, in reality, the autonomy provided to the consumer is often misused resulting in the self-use of medications that need to be taken with a prescription. Every medication needs to be administered in the right dose, at the right time, and for the right duration to elicit a beneficial response. Nearly one-half of the respondents in our study expressed that they reach out to a pharmacy or an online store to purchase medications, and a little over 20% indicated that they obtain it from friends and family revealing a strong propensity to self-medicate. This finding aligns with a previous report regarding pharmacies serving as a significant source of medications to families in Saudi Arabia. Incidentally, families in the lower income range did not opt to visit the pharmacy possibly because they were unable to bear the out-of-pocket health expense.
Poor compliance, switching between physicians in case of an inadequate response or if symptoms persist could be a vital source of left-over medicines instigating self-medication. Moreover, the majority of the respondents did not feel the need to consult a physician, indirectly acknowledging the practice of self-medication. Self-medication was more rampant for the relief of pain, managing symptoms of influenza, allergic conditions, and cough. This finding is in concordance with several other reports on self-medication from the Gulf Co-operation Council with Kuwait having over 90% of the population, Bahrain having nearly 50% of medical students, and Saudi Arabia has over 30% of the population indulging in this practice. Several studies carried out in urban areas in the Kingdom of Saudi Arabia have also reported the phenomenon of self-medication.,, We observed from our findings that the likelihood to self-medicate was almost similar for influenza, pain, and allergies; however, the odds of self-medicating for a cough were one-half the times less than that for influenza. Self-medication for acute infections such as influenza and allergies could plausibly be with antibiotics procured as OTC products or with anti-histaminic drugs despite being under the category of prescription-only medicines. Importantly, in chronic disorders, self-medication could cause potential drug interactions.
Participants in our study were one-half times less likely to check the expiration date on the package. A vast majority were not aware of medicine information inserts, thereby missing out on vital information. This could plausibly be due to their lower level of education or lack of instruction from the pharmacist.
Several reasons prompted consumers to self-medicate. The predominant reason being ready accessibility with family and friends or to delay medical opinion or overcome the economic implications of consultation. However, this can mask a precarious condition due to the temporary relief of symptoms or involve the use of an irrational combination of medications. In our study, over 50% of the participants preferred self-medication to relieve recurrent symptoms, over 30% self-medicated because they found access to the hospitals difficult and small percentage related it to high prices. Recurrence of symptoms was considered a crucial factor for self-medication indicating that drugs once prescribed might be used as a tenable option to manage frequent symptoms. Self-medication needs to be practiced judiciously as they are often presumed to be safe; however, there is a risk of adverse drug reactions with the use of self-prescribed medications. The continuous use of analgesics has the risk of inducing renal failure, cardiovascular effects, and delay healing of fractures., In the Kingdom of Saudi Arabia, healthcare expenses are meted mainly out by the Government except for employees in the private sector. Due to this, the majority of the respondents did not desire to have health insurance as evidenced by our finding. Moreover, high prices were not considered a significant factor for self-medication plausibly as healthcare is provided to them at Government expense. Although this is done for the welfare of society, there could be a problem of over-use and misuse of this benefit.
Astonishingly, dissemination of medication information was observed in nearly 60% of the respondents, particularly in the higher age group reflecting an unhealthy trend. Corrêa da Silva et al. have discerned that advice from family and accessibility of home-stored medicines can foster self-medication. Self-medication based on other's experience could be of grave concern as the underlying disease can differ between individuals. Incidentally, our results showed that females were less likely to suggest others based on their experience compared with males. This response was in disagreement with our expectation as they follow the patriarchal system in the Kingdom, wherein females have limited independent accessibility; and therefore, might depend on advice from family. However, this is reflective of responsible self-care and corroborates with another finding carried out in the Kingdom.
As this study involved self-reported outcomes, there is a possibility that respondents might fail to reveal vital information, serving as a limitation. However, we were able to identify specific areas that the respondents need guidance and counseling regarding self-medication.
| Conclusion|| |
Our findings revealed that self-medication was practiced among the general population in rural areas in the Kingdom. However, the paucity of awareness on crucial issues such as expiration date and reading medication information on inserts indicates that patient education is needed. Besides, undertaking self-medication based on other's recommendation can be a dangerous trend. Hence, public education on the rational use of medications and the involvement of pharmacists in this campaign can serve as essential steps in mitigating the irresponsible use of drugs. Patient counseling, judicious dispensing, and professional choices made by the pharmacist can help in creating responsible consumers. In future, we aspire to compare self-medication among urban and rural users, to delineate the similarities and differences prompting self-medication.
We express our gratitude to Renad Solan, Hessah and Asma AbduRehman, PharmD interns for helping out in data collection.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Coons SJ, McGhan WF, Bootman JL, Larson LN. The effect of self-care information on health-related attitudes and beliefs of college students. J Am Coll Health 1989;38:121-4.
Noone J, Blanchette CM. The value of self-medication: Summary of existing evidence. J Med Econ 2018;21:201-11.
Phalke VD, Phalke DB, Durgawale PM. Self-medication practices in rural Maharashtra. Indian J Community Med 2006;31:34. [Full text]
Al-Rukban MO, Khalil MA. Adherence to OTC directory-the perception of community pharmacists in Saudi Arabia. J Ayub Med Coll 2012;24:3-4.
Al-Mohamadi A, Badr A, Bin Mahfouz L, Samargandi D, Al Ahdal A. Dispensing medications without prescription at Saudi community pharmacy: Extent and perception. Saudi Pharm J 2013;21:13-8.
Aljadhey H, Assiri GA, Mahmoud MA, Al-Aqeel S, Murray M. Self-medication in central Saudi Arabia. Community pharmacy consumers' perspectives. Saudi Med J 2015;36:328-34.
AlKhamees OA, AlNemer KA, Bin Maneea MW, AlSugair FA, AlEnizi BH, Alharf AA. Top 10 most used drugs in the Kingdom of Saudi Arabia 2010-2015. Saudi Pharm J 2018;26:211-6.
Albatti TH, Alawwad S, Aldueb R, Alhoqail R, Almutairi R. The self medication use among adolescents aged between 13-18 years old; prevalence and behavior, Riyadh – Kingdom of Saudi Arabia, from 2014-2015. Int J Pediatr Adolesc Med 2017;4:19-25.
Saeed MS, Alkhoshaiban AS, Al-Worafi YM, Long CM. Perception of self-medication among university students in Saudi Arabia. Arch Pharm Pract 2014;5:149.
Ibrahim NK, Alamoudi BM, Baamer WO, Al-Raddadi RM. Self-medication with analgesics among medical students and interns in King Abdulaziz university, Jeddah, Saudi Arabia. Pak J Med Sci 2015;31:14-8.
Aashi MM, Alghanmi HA, Alhibshi RH, Alsaati BA, Aljohani NJ. Self-medication among medical student in King Abdul-Aziz University. Int J Res Med Sci 2016;4:942-94.
Bennadi D. Self-medication: A current challenge. J Basic Clin Pharm 2013;5:19-23.
Gerstein NS, Gerstein WH, Carey MC, Kong Lam NC, Ram H, Spassil NR, et al.
The thrombotic and arrhythmogenic risks of perioperative NSAIDs. J Cardiothorac Vasc Anesth 2014;28:369-78.
van Esch RW, Kool MM, van As S. NSAIDs can have adverse effects on bone healing. Med Hypotheses 2013;81:343-6.
Geusens P, Emans PJ, de Jong JJ, van den Bergh J. NSAIDs and fracture healing. Curr Opin Rheumatol 2013;25:524-31.
Corrêa da Silva MG, Soares MC, Muccillo-Baisch AL. Self-medication in university students from the city of Rio Grande, Brazil. BMC Public Health 2012;12:339.
[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]