Self-Medication Practices among the Adolescent Population of South Karnataka, India

Introduction Self-medication is used every day in the form of self-care of our health. Different studies in India have shown that more than 50% of the adolescent population takes self-medication every day for their health. Self-medication is an important concern at the global level, and it is an important issue in the health area. Aims To determine the prevalence of self-medication among adolescents, identifying the commonly used drugs as self-medication and finding the association between self-medication and selected demographic variables are important. Materials and Methods In a descriptive cross-sectional survey, 220 adolescents were enrolled through cluster random sampling. A self-administered questionnaire (developed by the researcher) along with a demographic profile sheet to assess the prevalence of self-medication and commonly used drugs was exercised. In the study, self-medication was defined as the consumption of medication without the prescription of the physician in the past year. Data analysis was performed by descriptive and inferential statistics using SPSS 16.0 software, and the significance of p value (<0.05) was considered. Results Around 120 (54.5%) adolescents were in the age group of 17 years; among them, 123 (55.9%) were females. The prevalence of self-medication was found to be 173 (78.6%). Antipyretics were consumed by 147 (78.6%) adolescents and antitussives by 120 (54.5%). It was observed that 110 (50%) of the adolescents preferred allopathic system of medication. It was also reported that 52 (23.6%) adolescents self-medicated continuously (i.e., for a month). The results also showed that factors like the type of family (χ2 = 9.615, p < 0.05), father's education (χ2 = 13.791, p < 0.05), mother's education (χ2 = 14.633, p < 0.05), and distance from a nearest medical store (χ2 = 17.290, p < 0.05) were associated with self-medication. Conclusion The present study has shown that the prevalence of self-medication is high among adolescents, and most of them had taken it without consulting a doctor. The study concludes that it is important to create awareness among adolescents regarding self-medication.


Introduction
Self-medication practice (SMP), an element of self-care, is the consumption of medication without being prescribed by the healthcare professionals (e.g., resubmitting old prescriptions, sharing medication with relatives/family members, or using leftover medications) for the treatment of self-recognized illnesses [1]. Concerns about the practice of self-medication (SM) are based on associated risks such as adverse drug reactions, disease masking, inaccurate diagnosis of disease, increased morbidity, drug interactions, wastage of healthcare resources, and antibiotic resistance.
e World Health Organization (WHO) has defined self-medication as the use of drugs to treat self-diagnosed disorders or symptoms, or the intermittent or continued use of prescribed drugs for chronic or recurrent disease or symptoms [2]. Selfmedication thus forms a significant vital portion of self-care, which can be defined as the chief public health resource in the healthcare system. It includes self-medication, nondrug selftreatment, social support in illness, and first aid in every day life. According to William Osler, a great feature which distinguishes man from animals is the desire to take medicine [3]. In 1995, the WHO expert committee on National Drug Policies (NDP) stated "self-medication is widely practiced in both developed and developing countries. Medications may be approved as being safe for self-medication by the national drug regulatory authority. Such medicines are normally used for the prevention or treatment of minor ailments or symptoms, which do not justify medical consultation. In some chronic or recurring illnesses, after initial diagnosis and prescription, self-medication is possible with the doctor retaining an advisory role" [4]. Not much is known about health-related problems and healthcare utilization, including self-medication among young adults. e youth are highly influenced by the media and the Internet, which promotes self-medication behavior. e increased advertising of pharmaceuticals poses a larger threat of self-medication to the younger population in general. is raises concerns about incorrect self-diagnosis, drug interaction, and the use of drugs other than for the original indication. e increase in the quantities and varieties of pharmaceuticals worldwide eases the accessibility of medicine by consumers, thereby giving options for its misuse. A study from Nigeria has observed selfmedication as a common practice among a group of health workers that included dental, midwifery, and nursing students. It has been suggested that self-prescription is also prevalent among practicing physicians [5].
rough the literature review, it is clear that most of the adolescents choose self-medication. e researcher identified that there are limited studies that have been conducted on preuniversity college adolescents among South Karnataka. Hence, there was a need to recognize the prevalence of self-medication among adolescents and identify the commonly used drugs and the factors associated with selfmedication, which helps the health professionals to focus the attitude of adolescents towards self-medication and take appropriate actions.

Materials and Methods
A descriptive cross-sectional survey was conducted among 220 adolescents studying in three different preuniversity colleges of Udupi District, Karnataka, in January 2016 (one month). e colleges had different streams of subjects such as science, commerce, and arts. Participants were selected based on cluster sampling (the entire class was taken as a cluster). e sample size was calculated based on the pilot study findings, where relative precision was kept 10% of proportion, and anticipated precision was 0.83%; cluster effect of two was applied. e approximate sample size taken was 220. Ethical permission was obtained (IEC 680/2015) for conducting the study. Formal written permission from the college authority, written consent from the parents, and assent from the participants were obtained before the study. e purpose of the study was explained to the participants, and the confidentiality of the information was maintained. e researcher presented questionnaires to the participants, and they took thirty minutes to complete the task. Data collected were entered and statistically analyzed using the Statistical Package for Social Sciences (SPSS) version 16.0. e sample characteristics, prevalence, and associated factors were described using frequency and percentage. A chisquare test was used to find the association between the prevalence of self-medication and demographic variables.

Sample Size.
e sample size was calculated using the following formula: where n � minimum sample size required, p � anticipated For cluster sampling, sampling size × design effect �78.67 × 2 �157.34.

Description of the Tool.
Tools used for the study were demographic pro forma and self-medication assessment tool. ese tools were developed by the researchers. e demographic tool consisted of 12 items, and the self-medication assessment tool consisted of 26 items. e tools were validated by seven experts, and the reliability of the tool in English was assessed using the test-retest method and was found to be 0.8. e tool was translated to Kannada because the medium of education for some colleges was in the Kannada language; the reliability of the tool in Kannada was found to be 0.8.

Statistical Analysis.
Data collected were entered and statistically analyzed using the Statistical Package for Social Sciences (SPSS), version 16.0. e sample characteristic, prevalence, and associated factors were described by using frequency and percentage. A chi-square test was used to find the association between the prevalence of self-medication and demographic variables.

Distribution Based on Sociodemographic Variables (N: 220).
e total number of adolescents selected for the study was 220. In this study, 173 (78.6%) adolescents were found to be practicing self-medication, out of which 123 (55.9%) of them were females and 147 (66.8%) were males. e majority of the adolescents (197 (89.5%)) belonged to the rural area, 142 (64.5%) belonged to the nuclear family, and 175 (79.5%) adolescents reported that the distance from the nearest medical store was 1-4 km ( Table 1).

Distribution of Practices of Using Self-Medication (N:173).
It was also reported that, among 173 adolescents, 110 (63.5%) adolescents preferred the allopathic system of medicine, and 110 (63.5%) preferred tablets. It was surprising that 52 (30%) adolescents had taken self-medication for a month. Among 173 adolescents, 52 (30.0%) had checked the expiry dates at the time of purchase, and the adolescents remembered the brand name while buying the drug. Among the 173 adolescents, 81 of them (46.9%) consulted a physician while treating the illness ( Table 2). . Adolescents also experienced few adverse effects due to self-medication; 9 (5.2%) of them reported headache, 2 (2.8%) allergy, and 4 (2.3%) diarrhea (Table 2).

Distribution of Reason for Using Self-Medication (N: 173).
e majority of adolescents (102 (59.2%)) reported the reason for taking self-medication was severe illness, and at that moment, they were not able to visit any doctor; 35 (20.2%) had self-medicated because of their busy schedule, and 7 (4.0%) had referred the previous prescription. Most of the adolescents (89 (51.7%)) also informed that the source of information was parents and 42 (24.2%) from mass media ( Table 3). (N: 173).
Analgesics were taken by 86 (50%) adolescents, and the reason stated was emergency by 79 (91.8%) and parental advice by 7 (8.1%). ey took it for a maximum of 1-4 days, and most of the adolescents took tablet Combiflam.
It was surprising to find that 58 (33.5%) adolescents had taken antiemetics, and the reason stated was emergency by 29 (50.3%), busy schedule by 9 (15.5%), teacher's advice by Extended family: family which resides with grandparents; joint family: a type of family composed of parents, children, their spouses, and offspring in one household; nonprofessional: describes someone who does something not as their job but because they are interested in it; professional: a member of a profession or any person who earns living from a specified professional activity; semiprofessional: an occupation that requires advanced knowledge and skills but is not widely regarded as a true profession. 6 (10.3%), and difficulty in getting doctor appointment by 6 (10.3%), and 8 (13.7%) reported the distance of pharmacy being far away. e study further revealed that most of the adolescents (48 (82.7%)) had taken antiemetics for just 1 day, and the drug was Tab. Domstal 25 (43.1%). It was observed that 46 (26.50%) adolescents had taken antacids, 30 (17.30%) antiallergics, 20 (12%) antidiarrheals, and 4 (2.4%) had taken antibiotics without consulting any doctor. Antacids and antiallergics were consumed for 1-3 days while antibiotics for a month by two adolescents (tablet cefixime 200 mg).

Prevalence of Self-Medication.
e findings of this study show that, among 220 adolescents, the majority of the adolescents (197 (89.5%)) belonged to the rural area. 173 (78.6%) adolescents were found to be practicing selfmedication; out of which, 123 (55.9%) of them were females and 147 (66.8%) were males. A study in Puducherry showed the prevalence was as high as 71% [3]. A study in urban Delhi showed that the prevalence of self-medication among those who had suffered some illness episodes in the past 1 month was 31.3% [6]. Another study in an urban slum showed that the self-medication was practiced by 34.5% of respondents and prevalent among all the age groups [7]. A recent study from Sri Lanka had reported 12.2% and 7.9% prevalence of self-medication to allopathic drugs from an urban and rural area, respectively, two weeks prior to the interviews [8]. e study from South Africa had shown a very high prevalence of self-medication (93-98%) [9]. However, all these studies had taken accountable types of drugs including homeopathy or other Indian system-related drugs.
e studies on self-medication practices among medical students in Accra, Ghana, showed higher prevalence rates [10].

Commonly Used Drugs for Self-Medication.
e present study shows that most of the adolescents (147 (66.8%)) took antipyretics, followed by antitussives (120 (54.5%)) and analgesics (86 (39%)). 17 (44.7%) out of the 38 users of antibiotics got hold of it from their respective homes and other sources. is is in contrast with many studies that reported the major sources were pharmacies, patent medicine stores, friends, and families [11]. Paracetamol (75.1%) was the most used drug among the students. Similar reports were found in other studies as well [12]. Tetracycline (34.2%), amoxicillin (28.9%), and metronidazole (18.4%) were the most used antibiotics. Studies also reported that ampicillin and amoxicillin were the most self-medicated drugs among students [13]. Onethird (33%) of the students reported using antimalarial drugs without prescription. Artemether/lumefantrine (37%), artesunate (21%), and sulfadoxine + pyrimethamine (16%) were the most commonly used antimalarial drugs. Self-medicated antimalarial use was also reported to be prevalent in some studies among tertiary institution students [14]. Self-medication practices with antibiotics  in some studies were mostly reported to be for urinary tract infection, sore throat, gastrointestinal ailments, and cough [15].

Factors Associated with/Promoting Self-Medication.
is study also portrays that the adolescents also experienced few adverse effects due to self-medication such as headache reported by 9 (5.2%); 2 (2.8%) reported allergy, and 4 (2.3%) reported diarrhea.
is finding was supported by studies conducted in Meket, Ethiopia, China, southern India, and Nigeria. e possible justification might be due to the inability of the participants to afford healthcare fees and lack of time to consult healthcare professionals.
erefore, improving the perception of participants about the quality of healthcare services, creating awareness, and managing peer pressure may reduce self-medication practices [16]. A study in Porto Alegre/RS (Southern Brazil) showed that almost 80% of those who practiced self-medication was influenced by laypeople, with the vast majority being recommended by friends or family members, with the self-medication being an occasional use.
ere are indications that self-medication is associated with stocks of medicine at home,   Journal of Environmental and Public Health which can facilitate this risky behavior of self-medication for health-related problems [17].

Limitation
In this study, the analysis was based on self-analysis with the possibility of over-or underreporting. With the questionnaire provided by the researcher, only limited information was captured.

Conclusion
In conclusion, our findings demonstrated that the prevalence of self-medication was high among adolescents. Most of the drugs were stored at home and consumed by referring to previous prescriptions. It is important to educate the public and provide counseling to adolescents regarding the risks of taking self-medication.

Data Availability
e data used to support the findings of this study are available from the corresponding author upon request.