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A QUESTIONNAIRE-BASED STUDY ON SELF-MEDICATION AMONG nd 2 YEAR

MEDICAL STUDENTS AT A TEACHING HOSPITAL, JAIPUR

Article in Indian Journal Of Applied Research · November 2020

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 Volume - 10 | Issue - 11 | November - 2020 | PRINT ISSN No. 2249 - 555X | DOI : 10.36106/ijar
Original Research Paper
Pharmacology

A QUESTIONNAIRE-BASED STUDY ON SELF-MEDICATION AMONG

2ndYEAR MEDICAL STUDENTS AT A TEACHING HOSPITAL, JAIPUR

Dr. SLDV Ramana Associate Professor, Department of Pharmacology, Jaipur National University Institute
Murty Kadali * of Medical Sciences and Research Centre, Jaipur-302017. *Corresponding Author
Professor, Department of Pharmacology, Jaipur National University Institute of
Dr. Mukul Mathur Medical Sciences and Research Centre, Jaipur-302017.
Dr. Simhadri Associate Professor, Department of Pharmacology, Shri Ram Murti Smarak Institute of
VSDNA Nagesh Medical Sciences, Bareilly.
Assistant Professor, Department of Pharmacology, Jaipur National University Institute
Dr. G. Chitti Babu of Medical Sciences and Research Centre, Jaipur-302017.
Dr. Prerna Professor & HOD, Department of Pharmacology, Jaipur National University Institute
Upadhyaya of Medical Sciences and Research Centre, Jaipur-302017.
ABSTRACT Background: Self-medication is very common, and it is practiced worldwide. Medical students constitute a segment that
is more knowledgeable about medicines by virtue of their curriculum but being students, those are unable to prescribe
medicines. The study was designed to ascertain the behavior, knowledge, and perception of students on self-medication.
Methods: 255 students participated in the study. A questionnaire containing a set of 14 questions was designed, to determine the knowledge and
perception of the students regarding self-medication. They were given 20 minutes to fill the questionnaire, and students were told not to mention
their identity, i.e., their names or roll number on the questionnaire. Informed consent was obtained from each student.
Results: The present study reveals that 71% of the students practiced self-medication. 98.4% of students could expand the abbreviation of OTC,
but only 79.1% are aware of the meaning of OTC. Drugs used for self- medication were 70.5% analgesics, 68.9% cough syrups, 62.2%
antipyretics, 52% antacids, 39.4% multivitamins, 35% antiemetics, 27.6% lozenges, 17.3% antimicrobials, 15.4% decongestants and 9.1%
antispasmodics.
Conclusions: Medical students who are the future doctors, and medical educators, can advocate, motivate, and impart useful knowledge to their
patients and the general public for responsible self-medication. Furthermore, doctors should also be knowledgeable about the self-medication
practice in the community so that they could enquire about the use of other medications by their patients prior to writing a prescription.
KEYWORDS : Self-medication, medical students, Over the counter, prescription, Questionnaire
INTRODUCTION- and effective when administered as directed. Medical students occupy
Self-medication is defined as the use of medication by a patient on his a unique position; they cannot yet legally prescribe medications, but as
own initiative or on the recommendation of a pharmacist or a layperson they progress through the course of study, they may acquire greater
rather than consulting a medical practitioner1. Self-medication is very knowledge about medicines and be more knowledgeable regarding
common, and it is being practiced worldwide.2 The prevalence rates of their rational use. 9 Medical students in their first year may not differ
self-medication are high, about 68% in European countries, 50% in the much from the general population as far as the practice of self-
UK, 77% in the USA, 92% in Kuwait, 76% in Pakistan, and 59% in medication is concerned. But second-year onwards, they may differ
Nepal.3,4 In India, the prevalence of self-medication is 31% and 71% in from the general population because they are exposed to knowledge
studies conducted in Nagpur and Karnataka, respectively. 5 about diseases and drugs.10 Since medical students are future
physicians and health prescribers of the community, it is essential to
Self-medication has both merits and demerits. Appropriate, self- know their knowledge level regarding different aspects of self-
medication relieves acute problems, economical, time-saving, and medication.
reduces the burden on the health care professional who can provide
time for more severe ailments that require greater attention. Studies on self-medication might provide useful insight on the reasons
Inappropriate self-medication can result in failure of therapy, adverse for which patients opt this practice and help the regulatory authorities
drug reactions, prolonged suffering, development of bacterial to streamline the process of drug regulations, to update the list of
resistance in case of antimicrobial agents, drug dependence, unwanted essential medicines and safety issues of over-the-counter drugs. 11
drug interactions economic loss, wastage of resources, and may delay
the correct diagnosis which may even endanger life.6 Several factors MATERIALS AND METHODS:
influencing the self-medication practice, which include This is a questionnaire-based study, and it was conducted after
socioeconomic factors, lifestyle, increased potential to manage certain obtaining the approval from the Institution Ethics Committee of
illnesses through self-care, increasing the availability of medicines, JNUIMSRC (JNUIMSRC/IEC/2019/56). A questionnaire containing
and availability of healthcare professionals, not enough time for a set of 14 questions were designed keeping in view the objectives of
medical consultation, exposure to the advertisement, education, and the study. Students were given 20 minutes to fill the questionnaire and
professional status. 7,8 were told not to reveal their identity, i.e., names or roll number on the
questionnaire. Informed consent was taken from each participant.
Unlike other aspects of self-care, self-medication involves the use of Before conducting the final study, the questionnaire was validated with
drugs, which have the potential to do good as well as cause harm. This a small number of students.
is particularly relevant in countries where there is a lack of
enforcement of regulations leading to the availability of prescription Inclusion And Exclusion Criteria:
medicines over the counter. Students become more and more cautious 2nd-year MBBS students of either sex pursuing studies in JNUIMSRC
in practicing self-medication, knowing that irrational and were included in the study. Who are not willing to participate were
inappropriate usage of them might be more harmful than useful. 1 excluded from the study.

WHO gives importance to responsible self-medication, where Statistical Analysis:

individuals treat their minor ailments and conditions with medicines Data were analyzed by using Microsoft Excel and the results were
which are approved for use without a prescription and which are safe expressed as counts and percentages. Some questions had multiple
80 INDIAN JOURNAL OF APPLIED RESEARCH
 Volume - 10 | Issue - 11 | November - 2020 | PRINT ISSN No. 2249 - 555X | DOI : 10.36106/ijar
options, hence the sum of the percentage was not always 100%. 95.7% of the students check the expiry date of a drug, whereas 4.3%
don't check the expiry date of a drug (Figure-5).
RESULTS
The total number of second MBBS students are 300, out of that 255
participated in the study. Students were between the age group of 20.4
± 1.2 years. The female participants were 64.7%, and male participants
were 35.3% (Figure-1).

Figure-5: Students Distribution Based On An Expiry Date Check

Students opted if a full course of medication is not completed, the

complications will be 61% recurrence of disease, 36.6% antibiotic
resistance, 32.7% full response may not be obtained even after
repeating the course, 24.8% aggravation of the disease, and 3% for
Figure-1: Distribution Of Students Based On Gender other reasons. The reasons mentioned by the student for not taking the
medication without prescription were 60% risk of adverse effects, 44%
98.4% of students could expand the abbreviation of OTC, but only risk of using wrong drugs, 35% risk of misdiagnosing, 34.6% lack of
79.1% knew the meaning of the term OTC. In the present study, 71% of knowledge about medicines, 32.3% risk of using drugs wrongly,
the students has practiced self-medication (Figure-2). 20.1% risk of drug dependence and 5.1% others(Figure-6).

Figure-6: Reasons For Not Practicing Self-medication By The

Students
Figure-2: Distribution Of Students Based On Self-medication
Practice 53.5% textbook, 52.8% previous prescription, 30.3% classroom
teaching, 22.8% advertisement, and 11% opted for other (internet) are
7.1% always, 28.3% rarely, 60.2% sometimes consult the medical the source of drug information for self-medication(Figure-7).
practitioner for their minor ailments. 76% of students knew the dose
and frequency of a drug that they have taken, and 24% did not know the
dose and frequency of a drug that they have taken (Figure-3).

Figure –7: Source Of Drug Information For Self-medication

The purchasing/procurement of drugs for self-medication is 48.8% by

generic name, 37.8% of students based on signs and symptoms, 37%
by brand name, 24% based on old prescription, and 4.3% by other
Figure-3: Students Awareness About Dose And Frequency Of methods. The reasons for the favor of self-medication are 53.9% no
Medicines(%) need to visit the doctor for minor illness, 46.1% time saving, 40.6 %
quick relief, 39% ease and convenience, 31.1% confidence on your
71.7% knew the adverse effects of a drug that they have taken, and knowledge about medicines, 16.9 % economical, 15.7% learning
28.3% did not know the adverse effects of a drug that they had opportunity, 14.2% crowd avoidance and 2.8% by other (Figure-8).
taken(Figure-4).

Figure –8: Various Reasons For Practicing Self-medication By The

Figure-4: Students Awareness About ADR Of Medicines(%) Students
INDIAN JOURNAL OF APPLIED RESEARCH 81
 Volume - 10 | Issue - 11 | November - 2020 | PRINT ISSN No. 2249 - 555X | DOI : 10.36106/ijar
The most common illnesses for which self-medication was done for drugs that they are taking. William Osler once commented, “The desire
85.4 % headache, 69.3% cough, cold, sore throat, 68.5 % fever, to take medicine is perhaps the greatest feature which distinguishes
37.8% vomiting, 37% stomach ache, 34.6% diarrhea, 26.8% man from animals. 19 Drugs commonly used for self-medication
menstrual symptoms and 3.5% ocular symptoms(Figure-9). include analgesics, antitussives, antipyretics, antacids, multivitamin
supplements, antiemetics, lozenges, antibiotics, decongestants, and
antispasmodics. In the present study, 70.5% of students used
analgesics. NSAIDs were the most common drug consumed by self-
medication, which was at par with other studies. The improper use of
NSAIDs may cause gastritis and nephrotoxicity. A study from Bahrain
reported analgesics as the most common class of drugs self-medicated
with antibiotics contributing only to 6%.20 The reason given by
researchers for the limited use of antibiotics in Bahrain is that the
government in Bahrain has strict regulatory policies about the
prescription and over the counter sale of antibiotics .20

In the present study, 85.4 % of students taking self-medication for

headache out of 40.6 % male and 44.6 % females. Compared to the
male counterparts, the prevalence of headache among females students
were found higher. Studies demonstrated that the prevalence of
headaches among females is higher than male counterparts. This
difference might be due to endocrine factors, the way they respond to
Figure –9: Common Illnesses For Which Self-medication Is stressors, and even psychosocial burdens on females. 21 The most
Practiced common indication for self-medication was headache, cold and cough,
vomiting, stomachache, diarrhea, menstrual pain, and ocular disease.
Drugs were used for self- medication are 70.5% analgesics, 68.9% However, cold and cough are the most common indication for self-
cough syrups, 62.2% antipyretics, 52% antacids, 39.4% multivitamins, medication in a study conducted in Gulbarga.18 Whereas fever was the
35% antiemetics, 27.6% lozenges, 17.3% antimicrobials, 15.4% most common indication for self-medication in a study conducted in
decongestants and 9.1% antispasmodics (Figure-10). Mangalore19 and Ethiopia21.

The OTC Committee of the Organization of Pharmaceutical Producers

of India (OPPI) is working to promote responsible self-medication. It
aims to get regulatory support for problems like the accessibility of
household remedies and increasing the concern of the importance of
responsible self-medication with the general public and the
Government. The sale of analgesic rises by 15.8% in 2009, which was
10.7% in 2008. Gastrointestinal drugs rise to 10.4%, and other OTC
drugs increased by 38.9 %. Vitamins, minerals, and other supplements
are increased by 8.8% from 8.2%. 22

Media helps the public to create awareness about various aspects.

Advertisements also contribute to people getting ideas or familiarity
with particular drugs. But if a keynote message was not appropriately
taken by the individuals leads to inappropriate self-medication. “The
programs in which a doctor is talking on television are often harmful,
because ordinary people do not properly understand the message, or
Figure –10: Most Commonly Used Drugs For Self-medication they take some parts of the message they like and think they know
everything about that disease, so they prescribe medication for
DISCUSSION themselves and others.” The availability and affordability of the
98.4% of students can expand the abbreviation of OTC. This might be internet as a reason for self-medication, although some students
due to high knowledge among students about pharmacology. The believed that the majority of websites were unreliable. 4 In the present
prevalence of self-medication is 70.9% out of 34.3 % males and 36.6% study, 4% of students depend upon the internet for self-medication.
females. Recently published studies shows that the way they self-
medicate evolves along with the increase in their knowledge and easy Self-medication is widely practiced worldwide both in urban and rural
access to drug information and familiarity with various kinds of drugs. populations, including India because various drugs are dispensed over-
12, 13,14,15
This is correlated with the present study; almost 71% of the the-counter without a prescription, which provides a low-cost
students practicing self-medication. Studies conducted on self- alternative to people. 23 In India, some individuals take medication
medication practice among undergraduate medical students in India, either consult a pharmacist and obtain medicine, or consult a
the prevalence of Self-medication was 57.05% in West Bengal 12 and neighbour who may be having some left-over tablets from his/her
78.6% in Mangalore 13,14. Medical students, though, have not legal previous illness.23 In developing countries like India, the easy
permit to prescribe the medicine, but have an inevitable urge of self- availability of a wide range of drugs coupled with inadequate health
medication practice themselves and also for others as they are going services result in an increased proportion of medicines used as self-
through the professional course for their gradual acquirement of medication. 18
knowledge regarding different drugs and their proper use. As they
Across the world, a consumer on an average suffers from at least one
reach their final semester self-medication practice increase with the
aspect of un-wellness in 4 weeks. Accordingly, 50% of people wait for
increment in the ability of their diagnosis of different clinic conditions
the symptoms to subside, 25% take resort of prescription medicines
and knowledge of the use of drugs. 16
while the remaining 25% turn to OTC (over-the-counter) medicines
for relief. The US and South Africa have the highest percentages of
In the present study, female student's self-medication practice is
self-medication, only the reasons differ. While in the US it is more of a
slightly higher when compared with males but statistically no
cost and time-saving alternative, in South Africa it is high due to lower
significant difference between gender. These observations are
levels of infrastructure and professional staff. 24
contradicting Rajanish Kumar Sankdia et al., findings where female
students were more interested in taking Self-medication as compared In India, Schedule H (prescription drugs) and Schedule H 1 (antibiotics
to male students. 1 This may be because the female students are more and other restricted medications) can be sold by a legally qualified
hesitant to go to the hospital or outpatient department for minor registered pharmacist upon presentation of valid prescription as per the
illnesses. 1 In Badiger et.al, Patil Shivraj et al studies more male Drug and Cosmetics Act of 1940. In India, advertisement in media or
students (94%) practiced self-medication than female students (91%). 17,18 any other form regarding drugs and diseases are banned under Drug
and Magic Remedies Act and Schedule J under drug and cosmetics act
Nearly 72-76% of students know the dose, frequency, and ADR of but pharmaceutical companies do advertise their products such as
82 INDIAN JOURNAL OF APPLIED RESEARCH
 Volume - 10 | Issue - 11 | November - 2020 | PRINT ISSN No. 2249 - 555X | DOI : 10.36106/ijar
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medication may be included in the MBBS curriculum to avoid or
minimize the inappropriate self-medication. Awareness should be
created among the medical students to be responsible for self-
medication.

Acknowledgment
We are very much thankful to the students of the second MBBS for
their support and participation in this study.

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INDIAN JOURNAL OF APPLIED RESEARCH 83

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