http://doi.org/10.33698/NRF0127 – Gurmit kaur ,Glory Samuel, Jasminder kaur
Abstract : Self-medication is age old practice. Urge of self-care, sympathy towards family members during sickness, lack of health services, poverty, ignorance, misbelieves; extensive advertisement and availability of drugs without prescription are responsible for growing trends of self-medication. Present study was conducted to assess the practices of self-medication among women in a selected community of Ludhiana, Punjab. The study was delimited to women (18- 60years) who were self-medicating with allopathic non prescribed drugs. Interview schedule was used to collect data. Data obtained was analyzed in term of descriptive and inferential statistics. Results of the study show that the 43.3% women practiced self-medication for joint/ muscular pain, 46.7% women with analgesics. It was further observed that 83.3% of the women checked dose of drug before self-medication. 92.7% of the women inform the physician about self-medicated drugs, 94% of women stored drugs at recommended conditions. Gastrointestinal adverse effects were reported by 13.3% women. There was negligible (r = .02) correlation between the adverse effects and practices of self-medication among women. Education had significant impact on checking of side effects, expiry date, reading pocket insert/leaflet and inquiring from pharmacist. Most of the women who were exposed to television had self-medication for joint /muscular pain, used analgesic medicines, checked dose of drug, avoid taking two different types of drugs at same time and store drugs at recommended conditions.
Key words :
Practices: Women, Self-medication, Adverse Effects.
Correspondence at :
Mrs. Glory Samuel
Lecturer, College of Nursing, C.M.C & Hospital, Ludhiana, Punjab
Background
Self-medication is one of the major problems resulting in improper or unnecessary consumption of drugs. It is common in both developed and developing countries, particularly in developing countries self-medication usually leads to inadequate drug utilization patterns.1 Internationally, self- medication has been reported as being on the rise.2 The World Health Organization has emphasized that self-medication must be correctly taught and controlled3. The females with a higher education level reported more frequently the use of non-prescribed medicines which in accordance with the Observations in civilian populations.4 The higher socioeconomic level was related to the more common use of Over the counter (OTC) medicines 5. World Health Organization has emphasized that self-medication must be correctly taught and controlled.3 Women typically are the safe keepers of their family health and women purchase medications, take their children and sometimes their older parents to health care providers and tend to make most of the family health care decisions.6
Evidence suggests that women have more symptoms from acute and chronic conditions than men do, although their conditions are probably less threatening than men. The more frequent symptoms among women lead to more drug use (WHO 1993)3 Although most self-medication with non-prescribed drugs result in desired outcomes but mishaps are not uncommon. Several studies have indicated that there are risks such as misdiagnosis, use of extensive drug dosage, prolonged duration of use, drug interaction. Serious side effects occurred due to self-medication with analgesic and anti-inflammatory agents (Huge2001)7
The drugs are to be kept in their recommended environmental condition in order to preserve drug stability. Improving knowledge about specific drugs, self- medication, expiry date checking and keeping them in their optimum environmental conditions may provide a benefit to population. 8 The extension of the nursing role and in par ticular the development of specialized nursing function in health promotion also has potential to influence consumer choice of over the counter drugs. Many practice nurses are already advising patient about over the counter solutions to minor health problems. Nurses need to establish lines of communication with community pharmacists, meeting with them to exchange ideas and problems and develop policies. 9 In order to help women in this regard it is important to know the practices of self- medication.
Objectives of the study
- To assess the practices of self- medication among
- To identify the adverse effects related to self-medication among women
Material & Methods
An exploratory approach was considered appropriate for the present study. The present study was conducted in the selected urban community (Jamalpur) of Ludhiana. 426 houses were surveyed. The target population of the study was the women (18-60 years) residing in Jamalpur of Ludhiana. Sample of the study was adult women who were self-medicating with non- prescription allopathic drugs. The Purposive sampling technique was used to collect data. Independent Variables age, education, family income, marital status, type of family, occupation, mass media exposure and adverse effects. Dependent variables Practices of self-medication among women. Interview schedule was prepared after extensive review of literature, expert’s opinions. First tool was prepared in English Language and then translated into local language i.e. Punjabi. The tool was divided into three parts, Sample characteristics, which consisted of age, education, family income (in Rs. /month), marital status, type of family, occupation & mass media exposure. Second part of tool was the checklist to assess practices of self- medication and adverse effects. This part consisted of need for self-medication, medicine practiced for self-medication, check about drug, pattern of self-medication, storage of drug. Checklist to identify adverse effects of self-medication consisted of six categories of adverse effects i.e. gastrointestinal adverse effects, nervous system adverse effects, urinary tract adverse effects, mental adverse effects, allergic reactions, drug dependence.
Content validity of the tool was determined by exper t’s opinion and suggestions on the relevance of items. Formal permission was taken from the head of department of community medicine. A verbal consent was taken from the subjects to be a par t of study. Total 150 subjects were interviewed and data obtained was analyzed in term of descriptive statistics and inferential statistics i.e. frequency, percentage, Chi square and the relationship between practices of self-medication with selected demographic variables had been analyzed only with age, education, mass media exposure.
Results
Out of 150 subjects 30.67% of the women were in the age group of 29-38 years, 24.67% in 39-48 years, 22.67% in 18-28 years and 22.00% in 49-59 years. Educational status of 35.33% women was matric and 10+2, followed by32.0% primary and middle level, 18% graduate & above, only 14.67% were illiterate. Half of women 50.67% women were having family income in the range of Rs. 5001/- to Rs.10,000/- per month, followed by 47.33% having Rs<5000 per month, 2% had family income of Rs >10000 per month. Regarding marital status, most of women (81.33%) were married, 12.67 % were unmarried, 5.33% were widowed and 0.67% were separated. The type of family of 64.0% women was joint and 36% belonged to nuclear families. As per occupation 61.33% of women were housewives, followed by laborer (16.67%), student (10.00%), service (8.67%) and business (3.33%). Nearly half (49.33%) of women were exposed to television, followed by newspaper (30.67%), magazine (18.00%), internet (1.33%), and only 0.67% were not exposed to mass media.
Table 1 depicts that 43.3% of the women had self-medication for joint/muscular pain, followed by 40% for headache and 24.7% for acidity/indigestion. Other complains for which women practiced self-medications were weakness (24%), Fever (19.3%), skin ailments (18%), cough / cold (11.3%), abdominal pain (2.6%), Constipation (2.6%), Menstrual Pain (2.6%), Diarrhea (2.6%), Sleep difficulty (2.0%), Toothache (2.0%), Earache (2.0%) and Vaginal Discharge (0.67%).
Table 1: Need for Self Medication among Women N=150
| Need for Self Medication | n (%) |
| Joint/ muscular pain | 64(43.3) |
| Headache | 60(40.0) |
| Acidity/indigestion | 37(24.7) |
| Weakness | 36(24.0) |
| Fever | 29(19.3) |
| Skin ailments | 27(18.0) |
| Cough / cold | 17(11.3) |
| Abdominal pain | 04 ( 2.6) |
| Constipation | 04 ( 2.6) |
| Menstrual Pain | 04 ( 2.6) |
| Diarrhea | 04 ( 2.6) |
| Sleep difficulty | 03 ( 2.0) |
| Toothache | 03 ( 2.0) |
| Earache | 03 (2.0) |
| Vaginal Discharge | 01 (0.7) |
*more than one need for self- medication were reported by women
Table 2 depicts the medicines consumed during self-medication. Data reveals that 46.7 % women consumed analgesic and tablet Diclowin was the choice of drug. Another medicines consumed were tonic/vitamin (26%), antacids (24.7%), antipyretics (19.3%), Topical products (18.7%), anti-allergic drugs (14.7%) and cough and cold remedies (11.3%). Few women (1.3%) also had laxatives and antibiotics and one woman used antifungal drugs and sedatives also.
Table 2: “Medicines Practiced” for Self Medication among Women N = 150
| Medicines practiced | n (%) |
| Analgesic | 70(46.7) |
| vitamin /tonic | 39(26.0) |
| Antacid | 37(24.7) |
| Antipyretic | 29(19.3) |
| Topical products | 28(18.7) |
| Anti-allergic | 22(14.7) |
| Cough/cold remedies | 17(11.3) |
| Laxative | 02( 1.3) |
| Antibiotics | 02( 1.3) |
| Antifungal | 01( 0.7) |
| Sedative | 01(0.7) |
Further exploring on what they do before consuming self-medication majority of the women (83.3%) reported that they checked dose of drug before self-medication, 81.3% checked expiry date, 70% checked duration of drug therapy and 42% inquire about side effects of drug. Asking on procurement of drugs 92.7% women repor ted that they procured drug from drug store. Most of them (92%) reported that they avoid taking two different drugs at same time , 90% avoid taking double dose and 94% women store drug at recommended conditions, followed by 73% discard expired drugs immediately, 70.7% stored drugs out of the reach of children and 62% women stored different drugs in different containers.
|
Table 3: Adverse Effects Related to Self Medication among Women
More than one adverse effects reported by women Adverse effects of drugs were also repor ted by the women i.e.19.9% of the women had gastrointestinal adverse effects i.e. loss of appetite, nausea, vomiting and abdominal Pain.
Allergic reactions were reported by 19.9% subjects such as skin rashes, itching, inflammation of face/body, redness of skin and burning sensation in body. Nervous system adverse effects were repor ted by 11.2% subjects i.e. Numbness of body, dizziness, loss of consciousness and drug dependency was reported by 3.9% & mental adverse effects were repor ted by 4.6 % subjects and 1.4% repor ted urinary tract adverse effects.(Table 3) The correlation between practices of self medication and adverse effects among women was negligible ( r = .02).
Age had significant impact on checking about what other drug should be avoided. Educations had significant impact on check about side effects, expiry date, read pocket insert/leaflet and inquire from pharmacist. Most of the women who were expose to television practiced self-medication for joint /muscular pain, used analgesic medicines, checked dose of drug, avoid taking two different type of drugs at same time and store drugs at recommended conditions.
Discussion
Medicines are essential part of health care. At individual level taking prescribed or non-prescribed medicine is one of the means of relieving illness and their symptoms. Shifting several medicines from prescription only to over the counter availability of has recently increased the assor tment of pharmaceuticals available to customers and further increased patients’ possibility to affect their own health by practicing self-medication. Hence the present study was conducted to assess the practices of self-medication and identify the adverse effects related to self- medication among women.
The findings of the present study revealed that common ailment for which women practiced self-medication were joint/ muscular pain, headache and acidity/ indigestion. The findings are supported by Saleem et al 10 reported that most common symptoms for self-medication were headache (72.4%), flu (65.5%) and fever (55.2%). Whereas Bolle De L. et al 11 repor ted the findings of a community pharmacy study on 63 community pharmacies identified that upper gastrointestinal symptoms are a common reason for self-mediation with over the counter medication (49.2%), acid regurgitation (53.2%).
The present study reveals that common drugs consumed as self-medication were analgesics,tonic/vitamin and antacids. Few consumed antibiotics, antifungal and sedative also. The findings are inconsistent with Annie Lam et al12 who identified that participants were using nutritional supplements most frequently (32%), followed by gastrointestinal products (17%), analgesics (16.3%) herbals (14.4%), topical products (12%), and cold / cough products (8.5%). Kapur Vinay et al 13reported that Majority of patient reported need for self- medication was gastrointestinal disorder. The analgesic and antipyretics were the most frequently used drugs, the most commonly used drugs for pain were diclofenac, disprin. The present study shows that majority of the women (83.3%) reported that they check dose of drug before self-medication, 81.3% check expiry date, 70% duration of drug therapy and 42% inquire about side effects of drug. Nuralia 6 found that only 35% of respondents practiced proper self- medication in term of appropriate medicine type, dosage and duration of therapy.
The present study shows that the majority 92.7%, inform the physician about self-medicated and 92% avoided taking two different drugs at same time, 90% avoided taking double dose and least 28% women procure drug from drug store only. Durguwale PM. et al 14identified 36.1% procure drug from chemist shop, identified that less than 40% of the respondents do not check expiry dates of drugs. The present study reveals that majority 94% of women store drugs at recommended conditions. These findings are inconsistent according to Asefzadeh Saeed8 who reported that 50% of the families kept tablet, ointment in refrigerator without any knowledge of the drug information. Drugs were kept in diverse conditions, without considering there recommended conditions.
The findings of the present study revealed that women reported some adverse side effects also among them gastrointestinal adverse effects and Nervous System adverse effects topped the list. A study conducted by Sharma R. et al15 reported that no serious drug adverse effects reported by respondents of study with drugs used as self-medication except few episodes of epigastric discomfort, sedation, rashes and diarrhea with use of non- steroidal anti-inflammatory drugs, cough and cold remedies. The present study found that there was negligible correlation between practices of self-medication and adverse effects among women. Carvalho et al 16reported adverse drug reaction was cause of 6.6% of hospital admission from 42% cases who practiced self-medication.
The present studies revealed that education had significant impact on checking of side effects, expiry date, read pocket insert/ leaflet and inquire from pharmacist about the drug to be practiced for self-medication. These findings are consistent according to Sharma R. et al 15 who repor ted that knowledge related to dose of duration of drug therapy, adverse drug reaction and drug interaction was significantly more in group who were educated more than 12th standard as compare to group who were educated less than 12th standard. They clearly indicated that variation in self-medication pattern with education status fur thermore Nuralia et al 6repor ted that education level influenced proper self-medication behavior significantly. Syeed Nabeel et al 17 reported prevalence of self-medication in educated youth despite majority being aware of its harmful effects, whereas Propper C 18reported that years of education are negatively related to the use of self-medication. The present study identified that the most of the women who were expose to television practiced self-medication for joint /muscular pain, used analgesic medicines, checked dose of drug, avoid taking two different type of drugs at same time and store drugs at recommended conditions. Whereas a survey repor t in Brazil 19 revealed that television adver tisements have a limited impact with respect to overall non- prescription medicine use. Abebe G. 20 repor ted that self-medication is hard to eliminate, but drug law enforcement and education to public at large is vital.
Hence it is concluded that the practice of self-medication is common but in the meantime women are aware of especially educated women that they need to go through pocket leaflet to know about the drug. They also checked expiry date of drug and dosage of drug but still the adverse effects are also not uncommon. So the health professional have the responsibility to educate the community about the right use of drugs and discourage self-medication as it can be life threatening if not taken with proper caution and taken without consulting physician.
Rerferences
- Tripathi CD, Bapna JS, Tekur Drug utilization patterns in the third world. Pharmacconomics1996;9:286-94.
- Bradley C,Blenkinsopp The future of Self Medication over the counter drugs. BMJ 1996; 312:835-837
- What influences drug use by consumers promoting rational use in the community. Geneva www.WHO.int. 1993.
- Itterman, Johnson, Taylor, J G. Health status and self-medication patterns in Alberta, Results from a population health survey. Journal Of Social And Administrative Pharmacy. 2003; 20(2):43-52
- Tobi H, Meijer WM, Tunistra J et OTC and prescription drugs in adolescence are there gender and socioeconomic differences. Pharmacol Toxicol Suppl 2001;1:62.
- Nuralia, Arina Utami, Athijh et al . Analysis of factors influencing self medication behaviours by housewives. Malaysian Journal of pharmaceutical Science 2005;3(2): 74-75.
- Huges CM, McElnay JC, Fleming Benefits and risks of self medication. Drug Safety 2001;24:1027-34.
- Asefzadeh Saeed, Asl Marjan, Nassrri Drugs at home in Quazin, Tran, community Based participatory Research European Journal of Scientific Research 2009;329(1)43-47.
- Aspinall, Monica B,Jeff Whittie, Maher Robert L et Improving Adverse Drug Reaction Reporting in Ambulatory Care Setting. American Journal of Health System 2002;59(9). www.medscape.com
- Saleem Sarah, Sana Waqar , Faria A Irani. Prescription of medicines by medical students of Karachi, Pakistan: A cross-sectional study .BMC Public Health 2008; 8: 1471-2458.
- Bolle De Len, Bortel Lao Van, Mehuyas et al. Self Medication of upper Gastrointestinal Symptoms: A community Pharmacy Study. The Annualsof pharmacotherapy 2009;43(5):890-898.
- Annie Lam, Bardley Use of Self Prescribed non prescription medication and dietary supplements among assisted living facility residents. Journal of American Pharmacists Association 2006; 46(5): 574-581
- Kapur Vinay, Mandavi, Tiwari Self Medication Pattern among Elderly Patients of North India Public Hospital: A hospital Based Questionnaire Appraisal. Indian Journal. Pharm. Pract. 2008;Oct-Dec; 1(1): 26-29.
- Durguwale PM, Phalke DB, Phalke D. self Medication Practices in Rural Maharashtra. Indian Journal of Community Medicine 2006; Jan– March; 31(1):34-35.
- Sharma R, Verma U, Sharma CL, Kapoor
- Self medication among urban population among Jammu city. Indian J Pharma Col. 2005;37:40-43.
- Carvalho ML, Arrais PS, Coelho HL, et Profile of self medication in Brazil. Revista de Saude Publica1997;31(1):71-77.
- Syad Nabeel, Zafer Saeed Reema. Self medication among students of Karachi Prevalence, Knowledge and The journal of Pakistan medical association 2008;58(4):214- 217.
- Propper The demand for private health care in the UK. Journal of health economics 2000;19:855-76.
- Research on habits and attitudes for purchasing and using otc drugs1997.
- Abebe G Mariam, Warku Practice of Self Medication in Jimma Town. Ethiop J. Health Dev 2003; 17(2):111-116.