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Implications of self-medication among medical students-A dilemma

Article  in  Journal of the Pakistan Medical Association · September 2018

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1363

KAP STUDY
Implications of self-medication among medical students-A dilemma
Zainab Gul Kanwal,1 Nighat Fatima,2 Saira Azhar,3 Ossam Chohan,4 Musarrat Jabeen,5 Muhammad Arfat Yameen6

Abstract
Objective: To evaluate the knowledge, attitude and practice of self-medication in medical undergraduate students.
Method: This cross-sectional questionnaire-based survey was conducted from January to June, 2017, among
undergraduate students of Ayub Teaching Hospital, Women Medical College, International Medical College and
Frontier Medical College in Abbottabad, Pakistan. The sample comprised students of first, second, third, fourth and
fifth professional year. Data was collected using self-generated questionnaire.
Results: Of the 400 subjects approached, 300(75%) returned the questionnaire fully completed. Of them,
208(69.3%) were females and 92(30.66%) were males. The most common age group was 22-25 years 182(60.7%).
Self-medication was found to be prevalent among 297(99%) subjects and 139(46.3%) respondents had practised
self-medication in the preceding 6 months more than two times. Over-the-counter drugs were commonly used for
the self-medication in 295(98.3%) cases. Overall, 285(95%) respondents had a positive attitude towards self-
medication. Media was found to be the most common source of information for 93(31%) cases.
Conclusion: High prevalence of self-medication was noticed, with over-the-counter drugs being the most
commonly used. Proper educational awareness programmes about self-medication can control the issue.
Keywords: Medical students, Self-medication, Abbottabad. (JPMA 68: 1363; 2018)

Introduction Medical students, being the future medical practitioners,

Self-medication (SM) is the treatment of common health play an important role in the counselling of patients
problems with medicines especially designed and regarding the advantages and disadvantages of drugs.
labelled for a specific use without medical supervision Medical students are also different from the general
and approval of being safe and effective for what it is population in terms of knowledge of diseases and their
being taken for.1 SM is also defined by The National treatment. Several studies have been conducted to
Health Surveillance Agency (ANVISA) of Brazilas, "the use evaluate SM practice among medical students.1,7,9,12-15
of drugs without prescription, guidance, or follow-up by The findings of these studies showed that the prevalence
a physician or dentist". 2 The International of SM varied among medical students of different
Pharmaceutical Federation (FIP) defines SM as "the use countries and the primary conditions for seeking SM were
of non-prescription medicines by people on their own found to be headache, common cold, cough, fever and
initiative". 3 As per the World Health Organisation abdominal pain. All these are illness of mild nature. Other
(WHO),4 SM is the selection and use of medicines by factors were found to be prior experience of treating
individuals to treat self-recognised illnesses or similar illness and economic considerations.16
symptoms.'' SM is now increasingly being considered a SM patterns vary among different populations and are
component of self-care.1,5 influenced by many factors, such as age, gender, self-care
In general, the practice of SM has been extensively orientation and medical knowledge. In particular, SM is
studied worldwide among populations of different more common among healthcare professionals like
countries of Africa, Asia and Europe.5-8 Level of education physicians, nurses and pharmacists than the general
of the respondents is found to be the most prevailing public.17
factor which influences SM. Many previous studies also The drug category mostly studied in reference to SM was
evaluated the prevalence, nature and reasons for SM over-the-counter (OTC) drugs and the results showed that
among medical and non-medical university students, about 25-75% population use OTC drugs for SM.10 A
worldwide.6,9-11
recent study conducted in Malaysia stated that 75% of the
studied population had used OTC drugs. The common
1-3,6Department of Pharmacy, 4Department of Mathematics, COMSATS OTC drugs used were analgesics, antipyretics and
Institute of Information Technology, Abbottabad, 5Faculty of Contemporary antibiotics. Cough remedies and supplements were also
Studies, National Defence University, Islamabad. frequently purchased along with these OTC drug groups.
Correspondence: Muhammad Arfat Yameen. Email: [email protected] Time-saving was found to be another approach towards

J Pak Med Assoc

Implications of self-medication among medical students-A dilemma 1364
SM as OTC drugs are easily available and do not need questionnaire included questions regarding
prescription of a physician. Most of the OTC drugs are demography, year of the Bachelor of Medicines, Bachelor
claimed to be safe but still inadequate knowledge of the of Surgery (MBBS) course, indications for SM, details of the
drug utilisation can lead to adverse effects. Another drug groups used, pattern of drug usage, sources of
dangerous outcome of SM is not obtaining the information for drug usage, reasons for favouring SM and
appropriate medication for the underlying disease which knowledge of adverse effects of drugs used for SM.
may lead to a delay in the diagnosis and treatment of
The data gathered was analysed and results were
actual disease condition.12
expressed in frequencies and percentages.
The prevalence of SM is high in European countries (68%)
and much higher than this in the developing countries,18 Results
with rates going as high as 92% in the young people of Of the 400 subjects approached, 300(75%) returned the
Kuwait. Among our neighbouring countries, India has a questionnaire fully completed. Of them, 208(69.3%) were
prevalence rate of 31%13,18 and 59% in Nepal.14 In females and 92(30.66%) were males. The most common
Pakistan, very few studies on SM have been conducted
Table-1: Demographics of participants.
which have also confirmed high rates of prevalence of
around 51%.7,15,19,20 Demographic Variables N (%)
There were several reasons for choosing medical students
Gender
for this study. One was their trait of being easily Male 92 (30.7)
influenced by the media, literature and the internet which Female 208 (69.3)
promotes SM. Also they are the future physicians, so their Age groups of Respondents (years)
health-seeking behaviour might influence their practice 18 - 21 118 (39.3)
as well. 22 - 25 182 (60.7)
Study year
This study was conducted to assess knowledge, attitude 1st year 20 (6.7)
and practice of SM in medical undergraduates. 2nd year 56 (18.7)
3rd year 43 (14.3)
Subjects and Method 4th year 105 (35)
This cross-sectional questionnaire-based survey was 5th year 76 (25.3)
conducted from January to June, 2017, and comprised
undergraduate students of Ayub Teaching Hospital, Table-2: Advantages and disadvantages of SM.
Women Medical College, International Medical College
and Frontier Medical College in Abbottabad, Pakistan. The The reasons stated Respondent's
study was approved by the ethics committee of COMSATS by respondents percentage (%)
Institute of Information and Technology, Abbottabad.
Verbal consent was taken from all those included. Advantages
Aware about OTC drugs 59 (19.7)
Sample size was calculated by using sample size Aware about generic and branded medicines 14 (4.7)
calculator.21 The population of district Abbottabad is Aware about ADRs, dose of medicines 2 (0.7)
about 1.3 million approximately according to 6th Aware about the importance of completing a course of medicines. 5 (1.7)
Read the package insert 5 (1.7)
Population and Housing Census-2017 by Pakistan Bureau
All of above 215 (71.7)
of Statistic.22 Confidence interval 4.9 and confidence level Disadvantages
95% was used and the sample size required was found to Risk of ADRs 37 (12.3)
be 400. Initially stratified random sampling and then Wrong Medication 9 (3)
simple random sampling was used for the recruitment of Disease aggravation 4 (1.3)
subjects. Drug Interaction 18 (6)
Masking underlying disease 38 (12.7)
Only completely filled-up questionnaires from students of Lack of knowledge about dose, frequency of administration and ADRs 45 (15)
first, second, third, fourth and fifth professional year were Drug addiction 33 (11)
included in the study. Professionals/doctors were not Drug Allergy 19 (6.3)
excluded and so were incomplete questionnaires. Drug Resistance 19 (6.3)
All of above 78 (26)
The questionnaire was adopted from various similar OTC: Over-the-counter
studies1-4,9,12,13,17,18 and was pre-validated. The ADRs: Adverse Drug Reactions.

Vol. 68, No. 9, September 2018

1365 Z. G. Kanwal, N. Fatima, S. Azhar, et al

Figure: Source of information for Self-Medication (SM).

age group was 22-25 years which had 182(60.7%) done so in the preceding 6 months more than two times.
subjects. Besides, 20(6.7%) students were from the first Major symptoms for self-medication were fever
year, 56(18.7%) second, 43(14.3%) third,105(35.0%) fourth 41(13.7%), cough 36(12%) and headache 37(12.3%), while
and 76(25.3%)were from the final year (Table-1). 126(42%) subjects were practising self-medication for
more than one symptom (Table-3).
Of the 297(99%) students practising SM, 207(69.7%) were
females and 90 (30.3%) were males. Also, 105(35.4%) of OTC drugs were commonly used for SM in 295(98.3%)
those practising SM were 4th year students. cases among which non-steroidal anti-inflammatory
drugs (NSAIDs) were frequently used by 223(74.3%)
Overall, 59(19.7%) were aware of OTC drugs use, 14(4.7%) respondents while 31(10.3%) respondents were using
knew about the generic and branded drugs, 5(1.7%) had more than one drug. Of all the respondents, 56(18.7%)
knowledge about the importance of completing a course stated that they self-medicated because of quick relief,
of medicines. Further, 215(71.7%) respondents agreed 56(18.7%) stated "I know what to take" and 59(19.7%) did
that they had enough knowledge about all the it because they thought it was time-saving (Table-3).
parameters of SM which were described in the study
questionnaire (Table-2). Of the total, 285(95%) respondents had a positive attitude
towards SM and agreed with the statement that self-
The most serious disadvantage as perceived by the medication is a part of self-care. Of them, 139(46.3%)
respondents was lack of knowledge about dose, 45(15%) stated that they will not continue with SM while
suggested adverse drug reactions (ADRs) and frequency 122(40.7%) said they will start/continue with SM.
of dose, 38(12.7%) suggested masking of underlying
disease 33(11%), checked drug addiction (11.0%, n=33) Media was found to be the most common source of
and 37(12.3%) risk of ADRs as disadvantages of SM information for 93(31%) cases. For 52(17.3%)
(Table-2). respondents family members and for 48(16%) subjects,
old prescriptions were the source of information
Of the 297subjects who had practised SM, 139(46.3%) had (Figure).

J Pak Med Assoc

Implications of self-medication among medical students-A dilemma 1366
Table-3: General parameters for SM. were more females respondents doing SM in the
preceding six months than male respondents. One reason
General Parameters N (%)
might be the higher number of female students in
SM in last six month
medical colleges as highlighted in a previous study.26 But
Once 95 (31.7) the finding was not statistically significant. These findings
Twice 63 (21) were similar to other studies conducted in Palestine,
More than twice 139 (46.3) Slovenia, India and Nepal, where the SM was reported
Never 03 (01) high among students.13,23,27,28
Symptoms for SM
Abdominal pain 11 (3.7) There were 300 respondents in the study from different
Allergy 11 (3.7) professional years of different medical colleges.
Body aches 14 (4.7) Knowledge about the SM was adequate which is quite
Cough 36 (12) similar to other studies.1,9,16,17 Students were well aware
Fever 42 (14) of the different aspects of SM. They had the knowledge
Headache 37 (12.3) about the merits and demerits of SM, as they are the
Miscellaneous 24 (8)
future physicians so they got all knowledge from books,
More than one reason 125 (41.7)
Drug Groups used in SM teachers, senior students and some had it from the media.
Anti-infective 13 (4.3) Even though they had enough knowledge about the
Antihistamines 14 (4.7) merits and demerits of SM, they did not know about the
GIT Drugs 11 (3.7) proper dose and use of medication.
Herbal 08 (2.7)
More than one Drug 31 (10.3) About half of the respondents practised SM for fever,
NSAIDs 223 (74.3) cough body aches and abdominal pain. They were
Reasons for SM practising for multiple conditions and majority were using
Time saving 59 (19.7) OTC NSAIDs; most commonly paracetamol. Similar results
Convenience 11 (3.7) were reported in a study conducted in India,18 showing
Quick relief 56 (18.7) that OTC drugs usage was more in medical students for
Economical 19 (6.3)
the conditions like cough and fever. A study conducted in
Emergency use 14 (4.7)
Prevention of known illness 29 (9.7) Jammu1 depicted that majority of the respondents
Mild ailments 10 (3.3) practised SM. The most common system practised was
Prior experience 19 (6.3) allopathic system and very few of them practised
Unavailability of health service 2 (0.7) ayurveda/herbal system. In addition, fourth and fifth
Physician will prescribe the same medicine 25 (8.3) professional medical students practised SM more if we
I have already the symptoms and i know what to "take". 56 (18.7) compare them with first, second and third professional
SM: Self-medication year students because they have more knowledge about
GIT: Gastrointestinal tract the medicines and their usage as this is a part of their
NSAIDs: Non-steroidal anti-inflammatory drugs.
curriculum.
In the present study, majority of the participants felt that
Discussion SM was a part of self-care which was higher to that
SM is the treatment of common health problems with reported in studies from Karachi,7 Ethiopia29 and
medicines without medical supervision. Different studies Southern India.30 Less than 50% of the respondents
have reported the practice of SM among students of wished to continue/start with the SM which is low
medical as well as non-medical undergraduates.23-25 The compared to a study conducted in Southern India.30
current study was conducted among medical students of
different institutions to evaluate their level of knowledge In order to reduce SM practices, the government has to
and pattern of practice regarding SM. This study used self- take special measures for the implementation of rules and
explanatory questionnaire which was largely dependent regulations on selling and purchasing of drugs. Also,
upon the information given by the respondents. Students various educational programmes should be initiated in
were encouraged to independently fill the questionnaire medical institutions to raise awareness among students
but still mutual influence between the students and recall on the pros and cons of responsible SM to eventually
bias could not be ruled out completely. improve their attitudes towards SM. Also, it might be
helpful if the concepts and principles of SM could be
SM was found high among the study participants. There reflected in the curriculum of healthcare institutions.

Vol. 68, No. 9, September 2018

 1367 Z. G. Kanwal, N. Fatima, S. Azhar, et al

Conclusion 14. Shankar P, Partha P, Shenoy N. Self-medication and non-doctor

prescription practices in Pokhara valley, Western Nepal: a
SM practices were more common in senior students questionnaire-based study. BMC Fam Pract. 2002; 3:17.
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medicines. Even juniors knew about some aspects of SM medication among university students of Karachi. JLUMHS. 2011;
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16. Banerjee I, Bhadury T. Self-medication practice among
available OTC drugs were most commonly used for SM. undergraduate medical students in a tertiary care medical
college, West Bengal. J postgrad Med. 2012; 58:127-31.
Disclaimer: The article is a part of thesis of the first
17. Goh LY, Vitry AI, Semple SJ, Esterman A, Luszcz MA. Self-
author's degree of Master of Science (MS). medication with over-the-counter drugs and complementary
medications in South Australia's elderly population. BMC
Conflict of Interest: None. Complement Altern Med. 2009; 9:42.
18. Parikh D, Sattigeri B, Kumar A, Brahmbhatt S. A survey study on
Source of Funding: None. use of over the counter (OTC) drugs among medical students,
nursing and clerical staff of a tertiary care teaching rural hospital.
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