Providing useful and effective healthcare to the community is essential to keep good health as well as a vital agenda of life. In low- and middle-income countries (LMICs), rural inhabitants especially have poor access to modern healthcare infrastructures and low affordability of drugs and medical supplies [
Thus, self-medication can be defined as the use of drugs to manage self-diagnosed health complaints or symptoms or the usual use of a prescribed drug for chronic or acute diseases or disease manifestations. According to some studies, the demand of patients is increasing for efficient drugs available without prescription [
Medicines for self-medication are often called “nonprescription” or “over-the-counter” (OTC) medicines, which are claimed as safe, effective for use, and available without a medical professional’s prescription. In some countries, OTC products are available and dispensed by supermarkets and other outlets. On the other hand, medicines that require a doctor’s prescription are called prescription products [
Self-medication is a form of self-care, which is basically performed to treat illnesses, with the ability to relieve illnesses at this stage. Self-medication is used by a significant number (proportion) of the population. It is affected by socioeconomic and demographic health facilities and economic factors. Although some healthcare providers exhibit negative understanding and perspectives towards self-medication, the World Health Organization (WHO) recognizes the existence of a valid role of it. There are a number of reasons why self-medication gets focus. The transition of the trend of diseases especially chronic ones with attendant shift from cure to care is becoming a large-scale transition. In addition, the inaccessibility (failures) of the healthcare system with its uneven distribution of drugs, unaffordable price, and the issue of curative stance of drugs is notable [
Community based health insurance (CBHI) is defined as a mechanism that households in a community (the population in a village, a district, or other geographical areas, or a socioeconomic or ethnic population group) use to finance or cofinance the current and/or capital costs associated with a given set of health services and enable them to have some involvement in the management of the community financing scheme and organization of health services [
Moreover, limited access to health information and education on medications and diseases might be linked with hazardous drawbacks to communities in rural areas. Lack of trained pharmacists/professionals creates favorable environment for self-medication. Even though SMA is somehow important to treat minor ailments, wrong self-medication practice may cause serious adverse drug reactions and possible fatal consequences. For instance, currently, AMR is becoming globally prevalent, mainly in LMICs [
However, illegal scandalmongers of drugs are prevalent in several LMICs. Thus, the use of these drugs from informal sources increases the chances of self-medication and home drug storage. The availability of drugs at home has enabled an extent of self-medication for illnesses. For that reason, handling unnecessary dangerous and bacterial resistant medicines from illegal and informal sources is important to consider the manners of drug availability to consumers [
As per studies in Ethiopia, the magnitude of self-medication varied from 12.8% to 77.1%, with an average of 36.8%. The type of illness that leads to self-medication, sources of information for self-medication, and drugs or category of drug products that are commonly self-administered need to be understood to design interventions [
A study conducted in Butajira (Southern Ethiopia) indicated that 15% of people with perceived illnesses performed self-medication [
In previous studies, the association between being a CBHI member and the self-medication trend has not been studied yet in Ethiopia. Therefore, this study aimed to assess the prevalence and the nature of these practices in the CBHI members and nonmembers levels, which is important to devise appropriate educational, regulatory, and administrative measures.
A community based comparative cross-sectional study was conducted in a community in Limmu Genet town from February to March 2016, because in the town there are a number of private pharmacies and governmental hospitals which provide both preventive and curative services for communities in and out of the catchment areas. Limmu Genet is located 425 kms and 75 kms southwest of Addis Ababa, the capital of Ethiopia, and Jimma, the capital of Jimma Zone, respectively. It has a total surface area of 1200 hectares. It is bounded by Sokoru in the east, Gomma in the west, Limmu Sakka in the north, and Kersa in the south. The total projected population of the town from the 2007 Central Statistical Agency (CSA) census report is 12,674. The town has a temperature within the range of 30°C and an average annual rainfall of 800–2500 mm3 and is at an altitude of 1750–2000 m above sea level.
All households found in Limmu Genet town during the study period were used as the source population of the study. The study population was selected from community health insurance members and nonmembers, found in Limmu Genet town during the study period, who were regarded as the source population of the study. Based on eligibility criteria of households, members and nonmembers of CBHI were the study units. All community health insurance members and nonmembers were included in the study. All community health insurance members aged below 18 years were excluded. After this, 422 study participants were recruited in the study.
The multistage systematic sampling technique was used to select participants for data collection from the community. After the sample size was determined, the systematic random sampling technique was applied. Systematic random sampling was used to select study participants.
Data collection tools were adapted from various literatures after a thorough revision of them. The questions and statements were grouped and arranged according to the particular objectives that they could address. The instruments included both closed-ended and open-ended questionnaires.
Data was collected on self-medication for both the health insurance members and the nonmembers. One questionnaire took an average of 20–30 minutes for a person. Patient characteristics such as sociodemographics and history of drug use were recorded.
Data were analyzed using SPSS version 20. Descriptive statistics were used to illustrate proportions, tables, and means. Rates of total self-medication were calculated for each of the variables considered. Statistical analysis was carried out using Pearson’s CBHI square with values of
To estimate the independent effect of each of these variables on self-medication, further statistical analysis was carried out by linear regression. Initially, data showed that being a member of community insurance was found to be an important factor in self-medication and, in turn, community insurance might have influenced other variables.
There was regular cross-checking for the completeness of the questionnaires. The data collection tool was pretested for its validity. The data collection tool was first prepared in English and later translated to Afan Oromo local language to keep meaning consistency. To avoid information bias, pretest was conducted in the adjacent district town, and after getting feedback from the pretest we revised the tool to maintain validity.
The ethical approval and clearance letter of permission was obtained from Jimma University; an official letter was obtained from the Department of Pharmacy. During data collection, all respondents were asked for their permission and informed consent was obtained prior to the interview. An official letter was sent to Limmu Genet’s health center and hospital. The confidentiality of the study participants was secured.
This population-based survey examined three hundred and eighty-nine households which were sampled from three kebeles. Of the total 422 questionnaires distributed to be filled by respondents, 389 were filled completely and collected, which gave a response rate of 92.2%. The mean age of the respondents was 42.2 years (SD = 13.7). The minimum age was 18 and the maximum was 90. Since the interview was conducted with female household heads, 47.6% of the respondents were females. Regarding the respondents’ family monthly income, the majority, 37.0%, reported a monthly income of between 1001 and 1500 Ethiopian Birr (Table
Sociodemographic characteristics of respondents (head of the household), Limmu Genet town, May 2016 (
Sociodemographic profile | |
---|---|
CBI | |
Members | 269 (69%) |
Nonmembers | 120 (31%) |
Sex | |
Male | 204 (52%) |
Female | 185 (48%) |
Age | |
<18 | 9 (2%) |
19–35 | 133 (34%) |
36–59 | 187 (48%) |
>60 | 60 (16%) |
Marital status | |
Married | 357 (92%) |
Single | 18 (5%) |
Widowed | 5 (1%) |
Divorced | 9 (2%) |
Religion | |
Orthodox | 121 (31%) |
Muslim | 265 (68) |
Protestant | 3 (1%) |
Educational status | |
Illiterate | 139 (36%) |
Grade 1–8 | 197 (51%) |
Grade 9–12 | 43 (11%) |
Higher education | 10 (3%) |
Ethnicity | |
Oromo | 310 (80%) |
Amhara | 54 (14) |
Tigre | 7 (2%) |
Other | 18 (5%) |
Monthly income | |
<550 | 47 (12%) |
501–1000 | 63 (16%) |
1001–1500 | 144 (37.0%) |
1501–2000 | 120 (31%) |
>2000 | 15 (4%) |
From a total of 389 households, three hundred and eight (308) household members had faced health-related problems within the last two weeks prior to the study, translating to an illness prevalence of 91.8%. But the degree of illness varies from person to person. Among them, 241 (78.2%) treated themselves. No households reported more than one ill person. About 95.4% of the sick individuals were married. Females, 48%, reported less illness than males, 52%.
Depending on the different socioeconomic and sociodemographic factors, the types, extents, and reasons for self-medication can vary from country to country. In this study, self-medicated participants were 237 with health problems out of 304 with illness conditions. This made self-medication’s prevalence 78.1%. Over 70% of CBHI members and 30% of nonmembers practiced self-medication. The most common types of ailments for which the respondents reported practicing self-medication were cough and fever (Table
The major reasons listed by the self-medicated study participants are shown in Table
Sociodemographic characteristics of those who reported an illness within the 2-week recall period, Limmu Genet town, May 2016 (
Sociodemographic profile | |
---|---|
CBI | |
Members | 308 (77%) |
Nonmembers | 90 (23%) |
Sex | |
Male | 157 (52%) |
Female | 147 (48%) |
Age | |
<18 | 5 (2%) |
19–35 | 98 (32%) |
36–59 | 158 (52%) |
>60 | 43 (14%) |
Marital status | |
Married | 290 (96%) |
Single | 7 (2%) |
Widowed | 4 (1%) |
Divorced | 3 (1%) |
Educational status | |
Illiterate | 115 (38%) |
Grade 1–8 | 197 (54%) |
Grade 9–12 | 21 (5%) |
Higher education | 4 (1%) |
Monthly income | |
<550 | 23 (78%) |
501–1000 | 30 (10%) |
1001–1500 | 129 (42%) |
1501–2000 | 114 (38%) |
>2000 | 8 (3%) |
Type of illness reported (
Type of illness | Community based health insurance members, | Community based health insurance nonmembers, | Total, |
---|---|---|---|
Headache | 25 (68.9%) | 11 (31.1%) | 36 (14.8%) |
Fever | 35 (66.7%) | 17 (33.3) | 52 (21.7%) |
Cough | 38 (70.6%) | 16 (29.4) | 54 (22.4%) |
Diarrhea | 37 (73.0%) | 14 (27.0) | 51 (20.7%) |
Others | 34 (72.9%) | 14 (27.1%) | 48 (19.4%) |
| |||
| | | |
Out of 241 self-medicated participants, the most commonly requested categories of drugs were analgesics/antipyretics (93, 38.5%), antimicrobials (91, 36.8%), antimalarials (28, 11.8%), anthelmintics (28, 11.8%), and traditional medicine (3, 1.0%) (Figure
Categories of drugs requested for self-medication (
The two most usual sources of advice/information for self-medication were drug retail outlets (37.8%) and healthcare providers such as doctors, nurses, and health assistants, but without formal prescriptions (42.1%). Nevertheless, friends, neighbors, or relatives (2%) and 37.8% of the respondents obtained information by reading drug-related materials such as labels, leaflets, or promotional materials, while 18.0% of them reported obtaining such information by previous experience (Table
Reasons for self-medication in community in Limmu Genet town (
Community based health insurance | Reason for self-medication | Total | |||
---|---|---|---|---|---|
Low cost alternative in money and time | Illness was minor (not serious) | Emergency | Previous experience of drug use | ||
Member | 114 (67.3%) | 6 (3.7%) | 45 (26.2%) | 5 (2.8%) | 170 (70.4%) |
Nonmember | 50 (70%) | 5 (6.7%) | 16 (23.3%) | 0 (0%) | 71 (29.6%) |
| |||||
| 164 (68.0%) | 11 (4.6%) | 61 (25.4%) | 5 (2.0%) | 241 (100%) |
As shown in Tables
Sources of information or advice for self-medication at Limmu Genet community (
Community based health insurance | Source of information | Total | |||
---|---|---|---|---|---|
Drug retail outlet | Other health professionals | Previous experience | Neighbor | ||
Member | |||||
Number | 68 | 62 | 36 | 4 | 170 |
Nonmember | |||||
Number | 23 | 39 | 8 | 1 | 71 |
| |||||
| 91 | 101 | 44 | 5 | 241 |
Association made between CBHI members and nonmembers to self-medication reported by selected background variables, May 2016 in Limmu Genet (
Variables | Self-medication | CBHI square | |
---|---|---|---|
Marital status | |||
Married | 230 (95.4%) | | |
Single | 6 (2.3%) | ||
Widowed | 4 (1.6%) | ||
Divorced | 1 (0.98%) | ||
Educational status | |||
Illiterate | 91 (37.8%) | | |
Grade 1–8 | 130 (53.9%) | ||
Grade 9–12 | 17 (6.9%) | ||
Higher education | 4 (1.3%) | ||
Monthly income | |||
<550 | 18 (7.5%) | | |
501–1000 | 24 (9.8%) | ||
1001–1500 | 102 (42.4%) | ||
1501–2000 | 90 (37.5%) | ||
>2000 | 6 (2.6%) | ||
Occupation | |||
Farmer | 121 (50%) | 21.98 | |
Merchant | 81 (33.8%) | ||
Government employed | 9 (2.9%) | ||
Daily laborers | 23 (9.5%) | ||
Other | 9 (3.6%) |
Self-medication in our study was much higher than it was in previous studies. Mainly, the increasing healthcare cost and the shift in the pattern of diseases towards chronic ones (from 30% to 80% in 40 years) led to a more person-centric approach involving self-care and responsible self-medication [
In this study, the prevalence of self-medication was found to be 78.2%, which is almost more or less similar to other studies in the country [
This study also showed that 37% of the study population used antibiotics without medical prescription. Recent reports from developed countries clearly show that SMA is commonly encountered. Our findings are in line with the study from Israel in which 37% of participants treated themselves with antimicrobial drugs. However, this proportion was too much higher than the ones in Northern Europe (3%), Central Europe (6%), and Southern Europe (19%). This was lower than findings from Pakistan (69%), China (48%) [
Higher period prevalence has been reported in most of the developing countries. This has been associated with several factors, particularly the lack of access to healthcare, availability of antibiotics as over-the-counter drugs, and the relatively higher prevalence of infectious diseases [
Even if direct studies on the availability of antibiotics without prescription in pharmacies in Ethiopia are scarce, several studies have shown that the main source of drugs that are used for self-medication was pharmacies [
The present study result also showed that 42% of the individuals who practiced SMA reported that they obtained drug-related information from other health professionals. Also, they obtained drug-related information (at least when to take and what should never be taken with the drug) from the dispensers. This is not in agreement with studies done in most developed countries where leftovers from previous courses and from relatives were the main sources of drugs for the practice of SMA [
While it was consistent with what has been reported in previous studies in Africa [
Findings from key informants with private community pharmacists also showed that private pharmacies were the major source of drugs for self-medication. All of them reported that people could buy antibiotics without a prescription, and when antibiotics are requested by consumers, requests are neither refused nor questioned. Though antibiotics are prescription-only drugs, community pharmacists dispense these drugs without a doctor’s prescription. This might lead to the misuse or overuse of antibiotics. This irrational use of antibiotics promotes antibiotic resistance [
Previous experience with similar symptoms and mildness of the illness were the two major reasons for SMA in this study. The main reasons for SMA in developing countries include OTC sale of antibiotics, high cost of medical consultation, low satisfaction with medical practitioners, and misconceptions regarding the efficacy of antibiotics [
The present study results showed that some sociodemographic variables had a significant association with the practice of SMA. This finding is consistent with several study results in Africa and Ethiopia where the educational level is a significant factor for the practice of SMA [
The prominent limitations of this study were the lack of previous comparative, cohort, or RCT studies, which made the discussion poor. Also, the recall bias might affect the prevalence and type of drug used by the participants. In addition, participants were asked simply for self-medication but not for the type of drugs they used. This might make sense for all types of drugs used by them.
There is no significant difference between members and nonmembers of CBHI concerning self-medication in the study area. Although appropriate self-medication can be advantageous without proper education of the public and proper regulation of potent drugs dispensary, it may cause tragic consequences. Thus, health education regarding the dangers of self-medication must also be given with impressive attention.
Therefore, education on the prescription and use of medicines as well as strengthening the CBI scheme utilization among the society is needed. Further interventional studies are needed to evaluate the effect size of being a CBHI member versus self-medication in the study area.
Antimicrobial resistance
Community based health insurance
Gregorian calendar
Jimma University
Low- and middle-income countries
Randomized controlled trial
Self-medication with an antimicrobial
World Health Organization.
All relevant data are within the paper and supporting information files but any additional data required by the journal can be available anytime.
The authors declare they have no conflicts of interest.
The authors’ heartfelt gratitude goes to the College of Health Sciences and the Department of Pharmacy, Jimma University, for funding this research. Last but not least, the authors would like to thank all the study participants.