Attitudes And Patterns Of Self- Medication Among Undergraduate Students Of Niger Delta University In...

Researchjournali’s Journal of Public Health Vol. 1 | No. 2 March | 2015

1

Owonaro Peter A.

Department Of Clinical Pharmacy And Pharmacy Practice, Faculty Of Pharmacy, Niger Delta University, Wilberforce Island, Bayelsa State, Nigeria

Okoroafor Gc

Department Of Pharmacy, Niger Delta University Teaching Hospital, Okolobiri, Bayelsa State, Nigeria

Eniojukan Joshua F

Department Of Clinical Pharmacy And Pharmacy Practice, Faculty Of Pharmacy, Niger Delta University, Wilberforce Island, Bayelsa State, Nigeria

Attitudes And Patterns

Of Self- Medication

Among Undergraduate

Students Of Niger Delta

University In

Wilberforce Island,

Bayelsa State, Nigeria


2

ABSTRACT

Self-medication is a common form of self-care behavior among the population of many countries world-wide.

This study assessed the attitudes and patterns of self medication among undergraduate students in Niger Delta

University, Bayelsa state, Nigeria. A multi-stage sampling method was used to select 200 students from five

faculties of the institution utilizing structured questionnaires to collect information after appropriate ethical

clearance and students’ verbal consent were obtained. Data collected were analyzed using SPSS version 16.

Majority (81.5%) were aged between 15-25 years; 42.5% were males; 90% were single; 67.5% lived on-

campus. Self-medication prevalence was 68.5%; perception of mild nature of ailment (37.5%), prior

experience with ailments (32%) and finance (18%) were reasons adduced for self-medication; analgesics

(49.5%) and Antibiotics (32%) were predominantly involved. Self-decision (47.5%) and recommendations

from family and friends (37.5%) were implicated as major determinants for self-medication whilst Patent

Medicines Stores were major sources of medications in spite of near-by access to health centres and

community pharmacies; 85.2% of respondents did not experience side-effects while self-medicating. There is

need to reinforce responsible self-medication, discourage irrational drug use and encourage appropriate

health-seeking behaviour among this population.

Keywords: Pattern, Prevalence, Rational drug use, Self-medication, Undergraduates.

1. INTRODUCTION

Self-medication is becoming an increasingly important option in the symptomatic management of common

ailments amidst escalating costs of health care globally. Self-medication encourages consumers to take an

active role in their health. Self-medication also provides positive outcomes at a societal level [Stosic et al,

2011].

It moves patients towards greater independence in making decisions about management of minor illnesses,

thereby promoting empowerment. Self medication also has advantages for healthcare systems as it facilitates

better use of clinical skills, increases access to medication and may contribute to reducing prescribed drug

costs associated with publicly funded health programmes [WHO, 2000; Hughes et al, 2011]. Advantage to

the patients is a quick and effective and financially acceptable removal of unpleasant symptoms of lesser

illness and prevention of development of serious disease, without much loss of much time. Advantage for

doctors is found in the more economical use of medicine, financial savings to the health funds, less patients in

ordinations as well as less phone calls relating to less important conditions, giving doctors more time to focus

on serious aspects of healthcare. Advantage for pharmacists is the commercialization of pharmacies, more

direct relationship with patients, increased turnover, etc.


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However, self medication is associated with risks such as misdiagnosis, use of excessive drug dosage,

prolonged duration of use, drug interactions and polypharmacy. The latter may be particularly problematic in

the elderly. Monitoring systems, a partnership between patients, physicians and pharmacists and the provision

of education and information to all concerned on safe self medication, are proposed strategies for maximizing

benefit and minimizing risk [WHO, 2000; Hughes et al, 2011].

Thus, accessibility of OTC products offers challenges and new possibilities to the medical profession. The

challenge lies within the education of the patients in order to apply these products properly.

Studies across 50 countries have shown that 95% of respondents were open to taking medicines to self-treat

minor ailments [AESGP, 2009]

In 2004, studies revealed that the total annual savings resulting from a move of 5% of prescribed medications

to self-medication in seven European countries has been estimated to be in excess of €16 billion. [AESMI,

2004]

However, the benefits of such self-medication practices are dependent upon their being undertaken

responsibly. Safety and efficacy are deemed the most important product attributes and responsible self-

medication is driven largely by two aspects of drug safety: the intrinsic characteristics of the drug and how the

drug is used. Further, appropriate use depends upon the availability of information, and how easily it can be

used [Stosic et al, 2011].

A number of studies have been conducted in Nigeria, many other countries in Africa, Asia and Europe to

evaluate the population prevalence of self-medication [Martins et al, 2002; Awad et al, 2005; Yousef et al,

2008; Fadare and Tamuno, 2011]

Many studies have also previously looked at the prevalence, nature and reasons for self-medication among

university undergraduates (non-medical) in different countries of the world [Lucas et al, 2007; Sawalha et al,

2008; Zafar et al, 2008]. There are also studies on general self-medication practices among medical

undergraduates in some other countries [Buke et al, 2005; Chowdhury et al, 2009; Verma et al, 2010]

In Nigeria, previous studies have focused on health care workers [Bamgboye et al, 2006] and university

medical undergraduates [Fadare and Tamuno, 2011].

One of the factors that have been found to influence this practice is the level of education of respondents

[Afolabi, 2008].

Appropriate use of self-medication requires that people have enough high general knowledge, level of

education and socio-economic status to make effective and safe decisions about their self-medication [WHO,

2000; WesternLund et al, 2001].


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Whilst patient empowerment is a positive step in the development of the relationship between patient and

health care provider and is considered as an important health policy concept, a major shortfall of self

medication is the lack of clinic evaluation of the condition by a trained medical professional, which could

result in missed diagnosis and delays in appropriate treatments [Harmel et al, 2001].

In developing countries like Nigeria, most people have access to all types of medication which makes self

medication an easy practice that could lead to a multitude of problems including the global emergency of

multi-drug resistance pathogens, drug dependence and addiction, masking of malignant and potentially fatal

disease, hazard of misdiagnosis, problems relating to over and under dosing, drug interactions and tragedies

relating to the side effect profiles of specific drugs [Sinclair et al, 2001; Akinyede and Banjo, 2004; Reetesh

et al, 2011]

This study determined the frequency and nature [prevalence and patterns] of self-medication practice among

undergraduate students of Niger Delta University, Wilberforce Island, Bayelsa State, Nigeria.

2. METHODS

A cross-sectional questionnaire-based study was conducted to unveil the prevalence and patterns of self-

medication practice. This study was carried out at Niger Delta University (NDU) in Bayelsa State, which is

one of the state Universities in the Niger Delta area of Nigeria. It is located within Wilberforce Island about

32 km from the State capital Yenagoa and is made up of three campuses, the Glory land campus (main

campus), the college of Health Science Campus, and the temporary Campus of the faculty of Law.

Approximately 10,000 students were enrolled at Niger Delta University with a total of eleven different

faculties

The sample size used for the studies was two hundred undergraduate students in different faculties. Out of the

eleven faculties, five faculties were selected by balloting. These were: Arts, Education, Engineering,

Pharmacy and Social Sciences. Then, forty undergraduate students were selected from each of the five

faculties.

The instrument used for data collection was a structured questionnaire. The information obtained included

bio- data of the respondents, history of self medication, type of drugs employed, the reasons for resorting to

self medication, profiles of side-effects experience, and availability / proximity of health institutions /

professionals.

Informed consent was obtained from each of the two hundred respondents. Ethical clearance was granted by

the Faculty of Pharmacy Ethics Committee. The data obtained was collated and analyzed using SPSS V.16

statistical software package.


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3. RESULTS

3.1 DEMOGRAPHY

The demographic characteristics of respondents are detailed in Table 1.

There were two hundred respondents, 163 (81.5%) were aged between 15-25 years and 37 (18.5%) were aged

between 26 – 35 years. There were 85 males (42.5%) and 115 females (57.5%). One hundred and eighty

(90%) were single; 18 (9%) were married and two (1%) were widowed. One hundred and thirty-five (67.5%)

lived in the hostel, 55 (27.5%) lived off the Main Campus and 10 (5%) lived in Yenagoa. Fifty-seven

(28.5%), 75 (37.5%), 34 (17%), 18 (9%), and 16 (8%) were in 100, 200, 300, 400 and 500 level respectively.

3.2 PREVALENCE AND PATTERNS OF SELF-MEDICATION

Majority of the respondents: 137(68.5%) admitted to self medication within the past 1 month; 61 (30.5%) did

not practice self medication. Indeed, 165 (82.5%) of respondents opined that most commonly used drugs are

obtained for self medication; 141 (70.5%) either agreed or strongly agreed that students self medicated

because they had good knowledge of drugs. All (100%) respondents claimed to be able to name 4 commonly-

used medicines for self-medication.

There were no strong associations between self-medication practice and Gender, Age, Marital status,

Discipline, Academic level and Place of Residence of respondents (p>0.05)

Regarding the reasons for practicing self medication, 75 (37.5%) felt that ailments were simple and did not

require professional medical intervention; 64 (32%) because there was a previous experience with the ailment,

and 36 (18%) because of the need to save money; Lack of trust in the medical services was cited as

reason for self-medication by 6 (3%) respondents. Table 2.

3.3 TYPES AND SOURCES OF MEDICINES

As shown in Table 3, different types of medicines were used by the respondents. Headache relievers (49.5%)

and Antibiotics (32.0%) were the most frequently used.

Ninety-five (47.5%) of respondents self-medicated on self-decision whilst 75 (37.5%) as a result of

recommendations from Family members and friends; 20 (10%) got recommendations from Herbalists and 10

(5%) through the media.

Most of the products were obtained from Patent Medicine Stores (41%); 28.5% from Community Pharmacies;

16% from hospitals and 3% from the open market.

Majority respondents (70%) affirmed the availability of health centre nearby while 11% claimed not to be

aware there was a health facility nearby; 19% were emphatic there was none nearby. Majority respondents

(69%) claimed there were physicians in the health centers.


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Majority of respondents (66.5%) also confirmed the availability of Community Pharmacy nearby; 22.5% said

there was none and 8% were not aware.

3.4 KNOWLEDGE OF MEDICATIONS AND ATTITUDES TO ADVERSE EFFECTS

Regarding knowledge of medications, majority respondents (60%) claimed to have knowledge, 15% had no

knowledge and 25% were uncertain.

A large majority of respondents (82.5%) claimed not to experience side-effects following self-medication. For

the 13% that claimed to experience side-effects, 23%, 18% and 7% respectively reported such side-effects

occasionally, often and frequently.

Majority of the respondents (88%) either agreed or strongly agreed that self-medication can lead to drug

abuse.

4. DISCUSSION

In this study population, the ratio of male to female was 1:1.4.which is at variance with studies in northern

Nigeria and India where male to female ratios of 1.9:1 and 1.4:1 were reported respectively [Fadare and

Tamuno, 2011; Reetesh et al, 2011]. It is generally known that there is a disparity in female education

between the northern and southern parts of Nigeria. In this study, respondents were (expectedly)

predominantly single with a ratio of 10 to 1 for singles and married respondents. Further, the ratio of

respondents living in hostels to those that lived off-campus was 2.1:1.

The prevalence of self-medication among undergraduate students in NDU was found to be 68.5%.this is fairly

high but lower than a reported rate of 82.3% in a study among medical undergraduates in India [Pandya et al,

2013], 73.9% and 81.8% reported in two separate studies in Sudan [Awad et al, 2005; Awad et al, 2006] 92%

reported among adolescents in Kuwait [Abahussain et al, 2005] and 72.1% among secondary school pupils in

Hong Kong [Tse et al, 1989]. This study further buttresses the postulation that there might not be a

significant difference in self-care or health-seeking behaviour between segments of the population [Fadare

and Tamuno, 2011]. Thus, a study among health care workers of a tertiary healthcare facility in South-West

Nigeria recorded over 70% rate of self-medication [Bamgboye et al, 2006].

The high prevalence of self-medication practices may be attributed to literacy level, access to drugs and

financial status amongst others. In this study, majority of the respondents admitted that students self

medicated because they had good knowledge about drugs. All respondents indeed claimed to be able to name

4 commonly-used medicines for self-medication. However, there was no association of self-medication

practice and socio-demographic characteristics of respondents. The study among undergraduates in northern

Nigeria also revealed no strong associations between gender, level of medical education and the practice of


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antibiotic self-medication [Fadare and Tamuno 2011]. This is however at variance with a research in the

Arabian Gulf where the prevalence of self-medication was higher in the more senior medical students [James

et al, 2008]. A study in India had resolved that the pattern of self-medication practice changes with time and

advancement of knowledge [Pandya et al, 2013]

This study, in consonance with series of others [Fadare and Tamuno, 2011; Zafar et al, 2008; James et al,

2006; Shankar et al, 2002; Omolase et al, 2007] reported that the major reason for self-medication was the

perceived mild clinical conditions of the ailments involved. This premise is fraught with serious danger

including the global emergency of multi-drug resistance pathogens, drug dependence and addiction, masking

of malignant and potentially fatal disease, hazard of misdiagnosis, problems relating to over and under

dosing, drug interactions and tragedies relating to the side effect profiles of specific drugs [Fadare and

Tamuno, 2011; Akinyede and Banjo, 2004; Sinclair et al, 2001; Reetesh et al, 2011; Omolase et al, 2007]

Other major reasons for self-medicating in this study were previous experience with the ailment, financial and

lack of trust in the medical services which tally also with other studies elsewhere [Fadare and Tamuno, 2011;

Omolase et al, 2007; Badiger et al, 2012] Other reasons cited in literature include high consultant fee, lack of

time, quick relief [Reetesh et al, 2011].

Different types of medicines were used by the respondents with Headache relievers (49.5%) and Antibiotics

(32.0%) being the most frequently used. This result is quite similar to other studies [Pandya et al, 2013;

Omolase et al, 2007; Sanghani et al, 2008] The prevalence of antibiotic use tallies with a study on antibiotic

self-medication among university medical undergraduate in northern Nigeria which reported a prevalence rate

of 38.8% [Fadare and Tamuno, 2011].

A sizable majority of respondents based their self-medication practices on self-decision in consonance with

their averred good knowledge of medications. This is closely followed by recommendations from family

members and friends. It would appear that the decision to self medicate was strongly motivated because most

respondents confirmed the close proximity of health care centers with physicians on hand to render

professional service.

Further a majority of respondents obtained their medications from Patent Medicine Vendors who have limited

or no technical knowledge and skills to advise appropriately. This is in spite of the claim by most respondents

that there were community pharmacies nearby. There is therefore a very strong need to educate this

community on patronizing professional health institutions to receive appropriate professional services even if

they have to self-medicate.

One confounding issue is that a large majority of respondents (82.5%) claimed not to experience side-effects

following self-medication. It is either that they self-medicated responsibly or they were ignorant of associated


8

side-effects. What is good from this study is that, the few respondents who experienced side-effects, about

half of them reported such effects; and a large majority of respondents opined that self-medication can lead to

drug abuse. This last confession can be built upon via aggressive enlightenment strategies to reverse any form

of irresponsible self-medication practices in this population. Since there are distinct advantages of self-

medication to the patient, physician, pharmacist and society at large, the level of literacy and other associated

factors motivating self-medication can be utilized to provide needed information to enhance responsible self-

medication.

5. CONCLUSION

The prevalence of self-medication among undergraduate students in NDU was high based on acquisition of

good knowledge of medications and high literacy level. However, there was no association between self-

medication practice and socio-demographic characteristics of respondents.

The major reason for self-medication was the perceived mild clinical conditions of the ailments involved.

Other reasons given were previous experience with the ailment, financial and lack of trust in the medical

services.

Analgesics (especially to relieve headaches) and Antibiotics were the most frequently used. Majority of

respondents based their self-medication practices on self-decision closely followed by recommendations from

family members and friends. Also, majority obtained their medications from Patent Medicine Vendors. These

are in spite of availability of health centers, physicians and community pharmacies closely nearby.

Majority of respondents claimed not to experience side-effects following self-medication but the few that did

experience side-effects promptly reported them.

There is need for aggressive educational and enlightenment intervention to enhance responsible self-

medication and to encourage appropriate use of health facilities for their health-seeking behaviour. The

structure and contents of some of the elective General Studies courses can be proactively and routinely

utilized for this purpose. The Guidance and Counselling Units of the University and relevant Faculties and

Units should also assume these mandates.

6. REFERENCES

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Table 1: Demographic Characteristics of Respondents

Variables Frequency %

Gender:

Male

Female

85

115

42.5

57.5

Age:

15-25

26-35

36-45

163

37

0

81.5

18.5

0.0

Marital Status:

Single

Married

Divorced

Widowed

180

18

2

0

90.0

9.0

1.0

0.0

Discipline:

Arts

Education

Engineering

Pharmacy

Social Sciences

40

40

40

40

40

20.0

20.0

20.0

20.0

20.0

Academic Level:

100

200

300

400

500

57

75

34

18

16

28.5

37.5

17.0

9.0

8.0

Place of Residence:

Hostel

Off Campus

City (Yenagoa)

135

55

10

67.5

27.5

5.0


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Table 2: Prevalence and Patterns of Self-medication


Have you practiced self-medication in the past one month?

Yes

No

No response

137

61

2

68.5

30.5

1.0

Do you know that most commonly used drugs are obtained for self medication?

Yes

No

165

35

82.5

17.5

It is stated that students self medicate because they have knowledge about drugs?

Strongly agree

Agree

Strongly Disagree

Disagree

40

101

53

6

20.0

50.5

26.5

3.0

Can you list any four commonly used drugs 200 100.0

What are the reason(s) for practicing self medication?

The ailments were simple and do not require professional medical intervention

There was a previous experience with this Type of ailment

Lack of trust in the medical services

To save money

No definite reason

75

64

6

36

19

37.5

32.0

3.0

18.0

9.5

Table 3: Types and Sources of Medicines


What Type of medications have you utilized in self-medication?

Analgesics (Headache relievers)

Antibiotics

Sedative

Herbal remedies medications

Topical treatment or Creams

Back-Pain Relievers

Ulcer medications

Allergy medications

Cannot remember

99

64

13

4

10

0

2

4

4

49.5

32.0

6.5

2.0

5.0

0.0

1.0

2.0

2.0

Who recommended the self-treatment for you?

Self-decision

Family and Friends

Media

Herbalist

95

75

10

20

47.5

37.5

5.0

10.0

Source of purchase of medicines

Hospital

Community Pharmacy

Private Clinics

Patent Medicine Store

Market

32

57

23

82

6

16.0

28.5

11.5

41.0

3.0

Is there any health centre Nearby?

Yes

No

Not Aware

140

38

22

70.0

19.0

11.0

Is there any physician in the Health Centre?

Yes

No

Not Aware

138

27

35

69.0

13.5

17.5

Is there any pharmacy Nearby?

Yes

No

Not Aware

133

51

16

66.5

25.5

8.0


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Table 4: Knowledge and Attitudes of Respondents to medications and adverse reactions


Do you have knowledge on what medication is?

Yes

No

Uncertain

120

30

50

60.0

15.0

25.0

Any side effects after self-medication?

Yes

No

Uncertain

26

165

9

13.0

82.5

4.5

If Yes, do you report any side-effect?

Occasionally

Often

Frequently

46

36

14

23.0

18.0

7.0

Do you think that self Medication can lead to drug abuse?

Strongly agree

Agree

Strongly Disagree

Disagree

65

111

16

8

32.5

55.5

8.0

4.0

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