|
 
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| ORIGINAL ARTICLE |
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| Year : 2017 | Volume
: 19
| Issue : 1 | Page : 65-71 |
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Self-medication among rural residents in Lagos, Nigeria
Modupe B Ayanwale, Ifeoma P Okafor, Oluwakemi O Odukoya
Department of Community Health & Primary Care, College of Medicine, University of Lagos, Lagos, Nigeria
| Date of Web Publication | 7-Jun-2017 |
Correspondence Address:
Ifeoma P Okafor
Department of Community Health & Primary Care, College of Medicine, University of Lagos, P.M.B. 12003, Lagos
Nigeria
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/jomt.jomt_51_16
Background: Self-medication is becoming an increasingly important component of healthcare in both developing and developed countries and has the potential to do good as well as cause harm. The prevalence of irresponsible self-medication is high all over the world. This study aimed to assess self-medication among rural residents in Lagos, Nigeria.
Materials and Methods: This cross-sectional study was conducted in Ijede community, Ikorodu Local Government Area of Lagos state, Southwest Nigeria. A multistage sampling method was used to select 337 adult respondents. Data were collected using a structured, interviewer-administered questionnaire.
Results: Majority (315, 93.5%) of the respondents had good knowledge about self-medication; 334 (94.1%) had a positive attitude against the use of self-medication; and 311 (92.3%) practiced self-medication. There was no association between the respondents’ overall knowledge and their practice of self-medication. The practice of self-medication was significantly higher among respondents with the highest level of education (odds ratio 4.3, confidence interval 1.3–14.3).
Conclusions: Majority of the respondents had good knowledge about self-medication and a positive attitude against the practice. Despite the high level of education and the awareness of side effects, majority of them still practiced self-medication. There should be an increase in awareness and continuous education in the community regarding the importance of professional consultation before drug use, the implications of irresponsible self-medication, and the place of responsible self-medication.
Keywords: medicine use, Nigeria, rural community, self-medication
How to cite this article:
Ayanwale MB, Okafor IP, Odukoya OO. Self-medication among rural residents in Lagos, Nigeria. J Med Trop 2017;19:65-71 |
| Introduction | |  |
Individuals who feel unwell commonly tend to treat themselves probably due to the innate survival instinct in humans. Every day, all over the world, people act on their health without consulting qualified health personnel. They practice self-care, a lifelong habit and culture. Self-care is what people do for themselves to establish and maintain health as well as to prevent and deal with illness. Self-medication is a component of self-care which means the responsible selection and use of non-prescription medicines by individuals to treat self-recognized illnesses or symptoms.[1] Self-medication with “over the counter” (OTC) medicines is sometimes referred to as “responsible” self-medication to distinguish this from the practice of purchasing and using a prescription medicine without a doctor’s prescription. The latter is irresponsible, inappropriate, and potentially dangerous “self-prescription.” It has no place in self-care or responsible self-medication.[2] The prevalence of irresponsible self-medication is high all over the world, and it is a very common practice, both in the economically deprived communities as much as it is in the economically privileged.[3],[4] Globally, consumers commonly reach for self-care products to help them treat their common health problems which include fever, body pains, indigestion, diarrhea, vomiting, cough, and upper respiratory tract infections.[5] This is because it is considered easier, more cost-effective, time-saving, or the problem may seem too trivial to necessitate making an appointment with a healthcare professional, and in other cases, they may have few or no other options.
Self-medication practices are more common in women, those who live alone and have a lower socioeconomic status. It is also more common among those with more chronic ailments, psychiatric conditions, of younger age, and students.[3],[4],[5] The practice of self-medication is associated with negative health effects such as misdiagnosis, drug resistance, use of drugs in excessive amounts, use of expired drugs, prolonged duration of use, drug interactions, poly-pharmacy, and other toxicological and pharmacological risks associated with improper use of medicines. People also tend to self-medicate, when they have previous experience of treating similar illness or non-availability of healthcare personnel with analgesics and antimicrobials being the most common medications used.[4],[6]
Nigeria is among the developing countries of the world, where drugs are freely displayed for sale in unauthorized places such as markets, shops, roadside stalls, motor parks, and other public places by individuals not duly licensed.[7] This occurs as a result of poor medical services and lack of professional control of pharmaceutical products, thus, forcing people to self-medicate irresponsibly.[8] There is a high incidence of self-medication with OTC and prescription medicines ranging from 15.0 to 81.5% in different localities.[8],[9] It is a serious problem in Nigeria, and a study from the southern part of the country showed that as many as 60–90% of the population in some communities practice self-medication in one way or the other.[8] The perception of illness and incessant advertising, among others, have increased the prevalence of irresponsible self-medication, which accounts for about 2.9–3.7% causes of death in hospitals in Nigeria as a result of drug–drug interactions.[3],[8],[10] Self-medication is very common among individuals in many developing countries, and despite the growing research interest on the topic, not much is known about its major determinants.[9]
Evidence indicates that rural residents have a limited access to healthcare, and that rural areas are underserved by primary care physicians.[11] In the developing world, many rural individuals usually travel substantial distances for primary medical care, requiring significantly longer travel times to reach care than their urban counterparts could avail.[11] Since an inappropriate or dangerous self-medication is more likely to occur among poorly informed people in rural areas with poor terrain, limited health facilities, high illiteracy level and poverty, the level of knowledge, extent of inappropriate as well as appropriate self-medication in a rural community need to be assessed. This study was aimed at assessing the knowledge of medicines and self-medication, attitude to and patterns of self-medication among residents of Ijede Local Council Development Area (LCDA), Ikorodu, a rural community in Lagos State, Nigeria.
The hypothesis is that residents would exhibit poor knowledge and high practice of self-medication.
| Materials and methods | | |
Study setting
Ijede residents are majorly Christians or Muslims of the Yoruba ethnic group, who speak the Ijebu dialect. Majority of them have some form of formal education, and the residents’ main occupation is one among the following: trading, fishing, and farming. Ijede LCDA constitutes one enumeration area (National Population Commission) and four political wards. It has three primary health facilities, one secondary health facility, and nine private health facilities.
Study design, study population, and sampling method
The study was a descriptive cross-sectional type, conducted among Ijede residents. Only adults, who were at least 18 years old and permanent residents of the community (had lived in the community for at least a year prior to the study), were included in the study. Temporary visitors and those who could not respond coherently to questions were excluded.
An adequate minimum sample size was calculated using the Cochran formula for descriptive studies (n = z2pq/d2), at 95% confidence, 5% error margin, and an estimated proportion (respondents who practiced self-medication) of 73% from a previous study.[10] However, to compensate for non-response and invalid data forms, the calculated sample size was increased by 10% to get the final sample size of 337 for the study.
A multistage sampling method was used for the study, and the stages are described as follows: A simple random sampling method (balloting) was used to select two wards (wards A and C) out of the four wards in Ijede LCDA. Ward A has 82 streets, whereas ward C has 98 streets. In the second stage, a list of the streets was obtained, and a simple random sampling method was also used to select 46 streets from a total of 180 streets from both wards. In the third stage, systematic sampling method was used to select the houses on each street with a sampling interval of two. Both wards had an average of 16 houses on each street, and a starting point was chosen by simple random sampling between the first two houses. From that point, one out of every two houses on that street was selected giving a total of about eight houses on each street. In the final stage, one adult was selected from each house. If more than one adult was met, one of them was selected by simple random sampling using balloting. This process was repeated until the desired sample size (337) was achieved. One hundred and sixty-six respondents were interviewed in ward A, whereas 171 respondents in ward C.
Data collection
A structured interviewer-administered questionnaire was used for data collection. The information on the questionnaires includes the following: sociodemographic variables, questions on knowledge of self-medication in terms of the definition of self-medication (use of drugs not prescribed by authorized medical personnel), how medications are used, what type of drug information should be made more readily known to consumers, and the various negative effects of self-medication. Their attitude towards self-medication was assessed by the respondents’ agreement on a Likert scale. Statements such as if they will use medications without seeing a doctor, if he or she shares their medications with family and friends, if they would rather use self-medication than visit the nearest health facility, if the chemists and other mobile medicine sellers/dealers are well equipped to give correct information to consumers who purchase self-medication products and if self-medication should be encouraged. The patterns of practice of self-medication comprised questions on the following: medications they use without a doctor’s prescription, the conditions for which they use medications and reasons for using the medications. Information was also sought on procurement and storage of their medications, and the perceived outcome of their treatment the last time they self-medicated (i.e., whether it was successful or not). Five interviewers were trained on administering the questionnaires. They all had post-secondary education and spoke English, Yoruba language, and “Pidgin English” fluently. Each interview lasted for about 10 minutes.
Respondents’ knowledge about self-medication was assessed using 12 questions. Each correct answer was scored one mark, otherwise zero. The total score was converted to percentage and graded as follows: 0–49% = poor knowledge and ≥50% = good knowledge. Their attitude to self-medication was assessed using seven statements rated on a Likert grading on a three-point scale which was scored as: Agree = 1; Neutral = 2; Disagree = 3. The minimum score obtainable was seven and the maximum 21. The mid-point (14) was used as the cut-off. A score of 0–13 was graded as negative attitude, whereas ≥14 was graded positive attitude. The respondents’ pattern of practice was not scored.
Data analysis
Data collected were analyzed using Epi-info version 3.5.1. statistical software developed by Centre for Disease Control, Atlanta, GA. Summary and inferential statistics were worked out. The chi-square test was used to test for associations between selected variables, and the level of significance was pre-determined at 5% (P < 0.05). Data were presented as frequencies, mean ± standard deviation (SD), and proportions.
Ethical considerations
Ethical approval was obtained from the Health Research and Ethics Committee of the Lagos University Teaching Hospital. Written consent was obtained from the participants prior to interview. Participants who were wrongly self-medicating were educated on responsible and irresponsible self-medication.
| Results | | |
A total number of 337 respondents were studied. Majority (177; 52.5%) of the respondents were between the ages of 18 and 30 years with mean ± SD = 34 ± 13. There was almost equal proportions of males (174; 51.6%) and females (163; 48.4%). More than half (192; 57.0%) of the respondents were married. Other characteristics of the participants are as shown in [Table 1].
Self-medication was rightly defined by most of the respondents (90.8%). The majority (93.2%) of the respondents knew that self-medication may damage body organs and 279 (82.8%) knew that over-use of panadol/paracetamol specifically can cause liver disease [Table 2]. Overall, the respondents had good knowledge about self-medication (93.5%).
Majority (256; 76.0%) of the respondents agreed that it was wrong to use drugs when ill without consultation, whereas 244 (72.4%) of the respondents agreed that self-medication should not be encouraged. Only few (32; 9.5%) would rather treat themselves than pay a visit to the nearest health facility. Two hundred and ninety-two (86.6%) of the respondents believed that the doctor should ask them about the medicines they have taken before seeing him/her, and majority of the respondents 218 (64.7%) disagreed to the use of antibiotics to treat all minor ailments. One hundred and thirty-three (39.5%) of the respondents agreed that the chemists and other mobile medicine sellers/dealers are well equipped to give correct information to consumers who purchase self-medication products [Table 3]. A majority (334, 99.1%) had a positive attitude against the use of self-medication, whereas only 3 (0.9%) had negative attitude towards self-medication.
Almost all the respondents (311, 92.3%) practiced self-medication in the last 1 month preceding the study. Common illnesses experienced by respondents in the preceding month were headache (241, 71.5%), fever (144, 42.7%), and common cold (98, 29.1%).
The common drugs used for self-medication were acetaminophen (paracetamol) (301, 89.3%), worm expellers (281, 83.4%), vitamins (131, 28.9%), flagyl (127, 37.7%), and piriton (105, 31.2%). Most (292, 86.6%) of them perceived the outcome of their self-medication to be successful. The most common reasons given by the respondents for practicing self-medication in the instances that occurred over the last 1 month were previous experience of treating the ailment (233, 69.1%) and their perception of the ailment as minor (105, 31.2%). One hundred and fifty-seven (46.6%) of the respondents reported that they obtained drug information from other medical personnel (nurses and health assistant workers) and 115 (34.1%) from chemists/sales person and pharmacy personnel, 200 (59.3%) of the residents claimed to always read the leaflets before using any drug. Regarding the purchase, recognition, and storage of drugs, many (144, 42.7%) of the respondents patronized the private pharmacy, whereas 140 (41.5%) purchased from chemists/supermarket. Only 45 (13.4%) purchased from hospital pharmacy. Most (229, 68.0%) of the respondents recognized the medications by the generic name, 158 (46.9%) by its common usage name, whereas 9 (2.7%) recognize it through the shape of the drug. One hundred and ninety-four (57.6%) of them bought drugs, which were in their packs. Majority of the respondents (188, 55.8%) stored their medicine in the refrigerator, 78 (22.9%) in the drug cabinet, 45 (13.6%) in the wardrobe, and 26 (7.7%) in the room.
Respondents’ age, sex, and level of education were not significantly associated with their overall knowledge. Though the practice of self-medication was higher in the younger age group 18–30 years, the difference was not statistically significant (P = 0.135). There was also no statistically significant association between the respondents’ sex and their practice of self-medication. The practice of self-medication was significantly higher among respondents with higher level of education [Table 4]. Using respondents with only primary education or less as the reference category, those who had more than secondary education were four times more likely to practice self-medication (odds ratio 4.3, confidence interval 1.3–14.3). | Table 4: Factors influencing overall knowledge and practice of self-medication
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| Discussion | | |
The practice of self-medication, despite its attendant negative effects, is quite common. These rural residents had good knowledge about medicines and self-medication and were not in support of self-medication, yet majority practiced it. Respondents in this study could be said to be “educated,” and this may have been responsible for their good knowledge of self-medication and their general attitude against the use of drugs not prescribed by authorized medical personnel. In spite of this, however, a majority still engaged in self-medication. The influence of higher educational level on the increased practice of self-medication was also reported among general outpatients in a community hospital in Ondo and university students in Kogi State, Nigeria,[12],[13] and other countries such as Singapore, Brazil, China, and Nepal.[2],[14] Conversely, a study conducted in another part of western Nigeria among dental patients reported that though majority of the respondents had higher level of education, most of them did not engage in self-medication.[15] The study was conducted in an urban health facility, and so their respondents were probably more health-conscious about the consequences of self-medication hence the lower practice.
These rural dwellers also had a good knowledge of the potential side effects of self-medication as regards addiction, drug resistance, and damage to body as a result of majority of the respondents having formal education. This was similar to reports from a rural study in Northern Nigeria (Kano), and among undergraduate students in Kogi, Nigeria and Accra, Ghana.[10],[13],[16] But in Sudan, the United Kingdom, and India, researchers showed that their respondents generally had poor knowledge of the potential side effects of their medications in spite of their higher level of education.[17],[18],[19] These were patients who should have been better informed about medications and their side effects.
As evidenced in this study and other similar studies in Pakistan and Brazil,[14],[20] people generally exhibit attitudes which are against self-medication, yet they still practice it. This may not be surprising in Nigeria, where there is in-equitable access to health and high out-of-pocket health expenditure. Elsewhere, this was not the case, as the respondents had attitudes favoring the use of self-medication despite high awareness of its harmful effects and high level of education.[6],[21],[22]
The practice of self-medication has long been in existence worldwide, and the situation continues to increase particularly in developing countries, where high prevalence had been reported.[8],[9] The proportion of the respondents who had practiced self-medication in the last 1 month prior to the study was high. This is indeed worrisome in view of the possible risks associated with such a practice. The findings in this study are consistent with the high prevalence of self-medication found in other studies.[10],[12]
Paracetamol was the most common drug used for self-medication as previously reported in numerous studies conducted in Ethiopia, Ondo, and Plateau States of Nigeria, as well as in many parts of India and the United Kingdom.[6],[12],[15] In some other studies, anti-malarials and antibiotics were the most common drugs used.[10],[13],[26] In addition, in this study, the outcome of last self-medication was perceived to be successful among majority of the respondents, and this will further encourage the practice of self-medication practice, whereas a report of a study conducted in Ghana showed a 50–50 outcome of the last self-medication, which had the same results as being successful and unsuccessful.[13]
Previous studies reported that headache, fever, cough/cold, malaria, skin rashes, and abdominal pain are the most common conditions for self-medication,[19],[23] which is similar to this study, where majority of them self-medicated for the same conditions. The respondents largely believed that the treatment of ailments with pain relievers (paracetamol/panadol), antimalarial drugs, antibiotics, worm expellers, multivitamins, and cough mixtures were particularly safe enough to be used without consulting a doctor. This study revealed that the main reasons for practicing self-medication by the respondents were a previous experience of treating the ailment and the perception of the ailment as a minor one, just as it was revealed in some communities in Ondo and Plateau States and also in Ethiopia.[6],[12],[15],[24] Hospital-based studies in Ethiopia and Akure, Southwest Nigeria revealed that patients’ common reasons for practicing self-medication were easy availability, saves time, and money.[15],[27]
This study revealed that the practice of self-medication was significantly higher among respondents, who had better education similar to another study conducted in Lagos, which stated that the level of education was identified as a major factor that influenced self-medication practice.[28]
Majority of the respondents in this study considered self-medication to be unsafe and most likely to be associated with side effects, whereas others gave reasons for using self-medication as being more affordable and cost effective, their assessment of their ailment as being minor, due to financial constraint and also due to the long delays in government hospitals. Similarly, respondents in some other studies gave the same reasons.[12],[21],[24] This would mean that health services need to be improved to the point where treatment becomes more accessible, and the patient’s waiting time is minimized.
Strengths and limitations
This study has generated vital information from rural areas, which usually have disproportionately less health resources. In addition, several areas of the problem were addressed in the study. Findings are useful for design and implementation of effective programs to tackle the problem of self-medication.
The mid-point cutoff (as against a higher one) used in grading their knowledge and attitude was mainly due to the fact that they were rural residents, and the questionnaire was designed to obtain basic information about medicines and self-medication. In addition, more rural areas could have been covered to improve generalization.
| Conclusions and recommendations | | |
The findings of this study showed that respondents had good knowledge about self-medication in terms of its definition, harmful effects, dosage, interactions, and drug information. Their attitude was also against the use of self-medication. In spite of this, a majority still practiced it, largely due to affordability and ailment judged as minor. Most respondents also judged their last self-medication use to be successful, and this may further encourage the practice.
There is a dire need to adequately equip the populace with drug information as well as educate the public on the limits and acceptable attitudes and practices of self-medication even as the health authorities and pharmaceutical companies put in place more guided safety measures.
There should be an increase in awareness and continuous education in the community regarding the importance of professional consultation before drug use, the implications of irresponsible self-medication, and the place of responsible self-medication.
The cost of healthcare services should be reduced and strategies should be put in place to ensure efficient healthcare services, so that receiving healthcare becomes easily accessible and less time consuming.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4]
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