Assessment of self-medication practices in Assendabo town, Jimma zone, southwestern Ethiopia

Total expenditure elasticity of spending on self-treatment and professional healthcare: a case of Russia

The studies on the demand for healthcare in low- and middle-income countries rarely take into consideration the fact that many people spend their income on self-treatment and professional treatment. The estimation of the income elasticity of demand for self-treatment and professional treatment can show a more precise picture of the affordability of professional care. This paper contributes to the discussion around estimates of income elasticity of health spending and discussion whether professional care and self-treatment are close to a luxury good and inferior good respectively in a middle-income country. We apply the switching regression model to explain the choice between self-treatment and professional healthcare via estimates of the income elasticity. Estimates are made with the use of the Russian Longitudinal Monitoring Survey - Higher School of Economics (RLMS-HSE), a nationally representative survey. While individual expenditure on professional treatment is higher than that on self-treatment, our estimates show that expenses on professional treatment can be income inelastic except when spending on medicines prescribed by a physician that are elastic. The results also indicate that cost of self-treatment is income elastic. In all cases, the considered income elasticities are statistically insignificant between professional and self-treatment.

Extent and Correlates of Self-Medication Practice among Community-Dwelling Adults in Eastern Ethiopia

Background

The use of medications without proper medical consultations poses significant health risks, drug resistance, and undiagnosed disease conditions, becoming a major pharmaceutical challenge in the 21st century. This study assessed the magnitude and associated factors of self-medication practice among adults in parts of Ethiopia.

Methods

A community-based cross-sectional study was conducted among 647 randomly selected adults residing in randomly selected households in eastern Ethiopia via a stratified sampling approach. A pretested interviewer-administered questionnaire was used to collect the data on self-medication practice. Data were presented using tables, frequencies, percentages, and graphs. A multivariable binary logistic regression was done to identify factors associated with self-medication practice and presented as an adjusted odds ratio along with its 95% CI. Associations with a p value below 5% were used to declare statistical significance.

Results

A total of 647 adults with a mean age of 41.7 (11.4) years were included. Overall, 15.8% (95% CI: 12.5-18.2) of them reported to have practiced self-medication in the past month, while 67.9% (95% CI: 64.1-74.7) have practiced self-medication, mainly due to the mild nature of the symptom (11%), intention to get a rapid cure (12.2%), physical accessibility (9.1%), and less confidence in the quality of health facility services (3.7%). The majority of the drugs were in the form of oral tablets in the antibiotic, antipain, and gastrointestinal categories. Female (AOR = 1.66 and 95% CI: 0.76-3.61), larger family size (AOR = 1.34 and 95% CI: 0.73-2.46), illiteracy (AOR = 4.47 and 95% CI: 1.17-17.1), poor socioeconomic class (AOR = 4.6795 and CI: 1.71-12.7), perceived health facility visit stay as long (AOR = 1.55 and 95% CI: 0.80-3.00), khat use (AOR = 2.86 and 95% CI: 1.27-6.47), cigarette smoking (AOR = 2.86 95% CI: 1.27-6.47), and poor knowledge on proper medication use (AOR = 7.98 and 95% CI: 4.61-13.8) were associated with increased odds of self-medication.

Conclusion

The practice of self-medication is a health concern and is associated with lower socioeconomic class, illiteracy, substance abuse, a perceived long stay at a health facility, and poor knowledge of medication use. Behavioral interventions targeting this segment of the population via various approaches would help.

Drivers of informal sector and non-prescription medication use in pediatric populations in a low- and middle-income setting: A prospective cohort study in Zambia

Obtaining medication from the informal sector is common in low- and middle- income countries. Informal sector use increases the risk for inappropriate medication use, including inappropriate antibiotic usage. Infants are at the highest risk of complications from inappropriate medication use, yet there is insufficient knowledge about the risk factors driving caregivers to obtain medication from the informal sector for young children. We aimed to define infant and illness characteristics associated with use of medication purchased in the informal sector for infants up to fifteen months of age in Zambia. We used data from, a prospective cohort study (ROTA-biotic) conducted among 6 weeks to 15 months old children in Zambia, which is nested within an ongoing phase III rotavirus vaccine trial (Clinicaltrial.gov NCT04010448). Weekly in-person surveys collected information about illness episodes and medication usage for the trial population and for a community control cohort. The primary outcome for this study was whether medication was purchased in the formal sector (hospital or clinic) or informal sector (pharmacy, street vendor, friend/relative/neighbor, or chemical shop) per illness episode. Descriptive analyses were used to describe the study population, and the independent and medication use variables stratified by the outcome. A mixed-effects logistic regression model with a participant-level random intercept was used to identify independent variables associated with the outcome. The analysis included 439 participants accounting for 1927 illness episodes over fourteen months in time. Medication was purchased in the informal sector for 386 (20.0%) illness episodes, and in the formal sector for 1541 (80.0%) illness episodes. Antibiotic usage was less common in the informal sector than in the formal sector (29.3% vs 56.2%, p < 0.001, chi-square). Most medications purchased in the informal sector were orally administered (93.4%), and non-prescribed (78.8%). Increased distance from the closest study site (OR: 1.09; 95% CI: 1.01, 1.17), being included in the community cohort site (OR: 3.18; 95% CI: 1.86, 5.46), illnesses with general malaise fever, or headache (OR: 2.62; 95% CI: 1.75, 3.93), and wound/skin disease (OR: 0.36; 95% CI: 0.18, 0.73) were associated with use of medication from the informal sector. Sex, socioeconomic status, and gastrointestinal disease were not associated with use of medication from the informal sector. Informal sector medication use is common and, in this study, risk factors for obtaining medications in the informal sector included a long distance to a formal clinic, type of illness, and not being enrolled in a clinical trial. Continued research on medication use from the informal sector is crucial and should include generalizable study populations, information on severity of disease, emphasis on qualitative research, and a move towards testing interventions that aim to improve access to formal health care settings. Our findings suggest that improved access to formal health care services may decrease reliance on medication from the informal sector for infants.

A qualitative study on community use of antibiotics in Kinshasa, Democratic Republic of Congo

BACKGROUND

Resistance to antibiotics is an increasing and major threat to global health. While the large majority of antimicrobial use occurs in the community where antibiotics are available without prescription, we did not find any studies investigating community-level factors influencing the inappropriate use of antibiotics in the Democratic Republic of Congo (DRC), where non-prescription antibiotic use is prevalent.

METHODS

This qualitative study was conducted from April 1st 2019 to May 5th 2019 and consisting of in-depth semi-structured interviews, utilizing purposive and snowball sampling schemes to recruit adult heads of households in the Pakadjuma slum, in Kinshasa, DRC. Participants with differing medical and educational backgrounds were selected. We employed a thematic analysis approach to explore community knowledge and use of antibiotics in the sampled population.

RESULTS

A total of 18 participants with a median age of 35 years were interviewed. The majority was female (77.7%), had at least a secondary education (83.4%), and unemployed (61.1%). We found that participants were familiar with the term "antibiotics", but had limited knowledge of the indications and risks of antibiotics, including the risk of antibiotic resistance. Inappropriate use of antibiotics was common and there was frequent self-medication of non-prescribed medicines for a range of non-indicated conditions such as menstruation. Having limited income was the most commonly reported reason for not visiting a health facility for appropriate health care.

CONCLUSION

Inappropriate use of antibiotics is a widespread practice and is influenced by lack of adequate knowledge of antibiotic use, indications and risks, prevalent self-medication, and financial barriers to accessing appropriate health care. There is need for both community education as well as structural interventions addressing poverty in order to reduce the inappropriate use of antibiotics in the Pakadjuma slum in Kinshasa.

Oral health self-medication in Muiscas, Yanakunas and Pijaos indigenous populations of Colombia

Self-medication is a social practice that corresponds to the autonomous use of therapeutic elements to address diseases. It involves a sociocultural context of the disease, and a rationality focused on therapeutic efficacy and the availability of curative supplies. Identify and analyze the process of oral health self-medication in indigenous Muiscas, Pijaos, and Yanakunas of Colombia. This is a qualitative, ethnographic study employing techniques such as documentary analysis, participant observation, field diary, and ethnographic interviews. Self-medication is frequent among these indigenous people. It prioritizes the use of pharmaceutical drugs in the Muiscas and medicinal plants in the Yanakunas. The therapeutic supplementation is evident in the Pijaos. The pharmaceutical elements focus on a matter of social progress and the herbal elements on a matter of cultural identity. In these communities, oral health self-medication is a structured and daily practice in families to address their ailments. This practice is supported by the knowledge, management, and availability of different therapeutic resources.

Traditional Medicine Practice in the Context of COVID-19 Pandemic: Community Claim in Jimma Zone, Oromia, Ethiopia

Purpose

To assess traditional medicine practice claims by the community for the prevention and treatment of COVID-19.

Methods

A community-based cross-sectional study design was conducted among 422 households of Jimma Zone, and the data were collected by interviewing individuals from the selected households. The medicinal plants were recorded on Microsoft excel 2010 with their parts used, dosage form, route of administration and source of plants and tabulated in the table. Descriptive statistics were used to describe and organize the data. The Relative Frequency of Citation (RFC) was calculated for each traditional medicine to identify the top 10 medicinal products.

Results

Around 46% of participants used traditional medicines for the prevention and treatment of COVID-19. The study recorded 32 herbal and non-herbal medicinal products. Garlic (RFC: 0.166), ginger (RFC: 0.133), lemon (RFC: 0.133), garden cress (RFC: 0.069) and “Damakase” (RFC: 0.031) were the frequently used herbal medicines. Seeds (47.22%) and leaves (30.56%) were the most used parts of medicinal plants. Most preparation of medicinal plants (90.63%) was administered through the oral route. The majority of medicinal plants were from home gardens.

Conclusions and Recommendations

Around half of the participants practiced traditional medicines for COVID-19. Garlic, ginger, lemon, garden cress and “Damakase” were the frequently used herbal products. Seeds and leaves were regularly used parts. The oral route is the most used route of administration. The majority of medicinal plants were from home gardens. This quantity of traditional medicine practice is probably challenging to control the pandemic. However, it might open possibilities for pharmaceutical industries and researchers to look into the effectiveness and safety of claimed medicinal products. Therefore, all responsible bodies are advocated to behave accordingly.

Household Level Drug Utilization and Associated Factors in South Gondar Zone, North Western Ethiopia

Introduction

Methods

Results

Conclusion

Non-Prescription Antibiotics Use and Associated Factors Among Drug Retail Outlets in Ambo, Ethiopia: A Cross-Sectional Study

PURPOSE

To assess the non-prescription use of antibiotics and associated factors in Ambo Town, West Shoa, Oromia, Ethiopia.

METHODS

An institutional-based cross-sectional study design supported with the qualitative study was conducted in Ambo Town from February 1 to March 1, 2020. Data were collected using a pretested semi-structured questionnaire and in-depth interview guide questions. Simple random sampling was used to select retail outlets and systematic random sampling to select study participants. The data analysis was done using SPSS and univariate and multivariate binary logistic regression analysis was performed to identify factors associated with non-prescription use of antibiotics. Thematic framework analysis was applied for the qualitative data.

RESULTS

From the 421 study sample, a total of 399 participants were interviewed with a 94.8% response rate. Among the study participants, 214 (53.6) were males, 228 (57.1%) were married, 191 (47.9%) were orthodox by religion, and 343 (86%) were Oromo by ethnicity. One hundred seventy-two (43.1%; 95% CI: 38.6, 48.1) of the participants had used non-prescribed antibiotics. Being male [AOR=2.21 95% CI: 1.276, 3.835], residing in rural area [AOR=3.659, 95% CI: 1.479, 9.054], holding diploma [AOR=0.120, 95% CI: 0.025, 0.591], and hold BSC degree [AOR=0.050, 95% CI: 0.007, 0.378], and being farmer [AOR=0.034, 95% CI: 0.004, 0.285] showed significant association with the non-prescription use of antibiotics.

CONCLUSION

This study concluded that the non-prescription use of antibiotics 172 (43.1%) was relatively high. Being male, residing in a rural area, holding a diploma, BSc degree, and being a farmer were significantly associated with non-prescription use of antibiotics. So, West Shoa Zone regulatory body should actively focus on the prevention of non-prescription use of antibiotics through health communication and public awareness on the demerits of non-prescription use of antibiotics.

What does self-medication counseling in Bulgarian community pharmacies look like – a field study

The aim of the study is to identify the current practices of self-medication in Bulgaria, estimate the extent patients are influenced by information about the safety of OTC products and pharmacists’ role and behavior in the process. An anonymous, questionnaire-based, descriptive study was carried out among 280 pharmacists.

The majority of the patients (92.6%) ask for pharmacists’ advice before buying OTC products. Most often patients need OTC drugs for mild conditions (80.7%), to save time (63.9%), and because they are unable to consult a physician (61.9%). The medium duration of consultation for an OTC product is between 5 and 10 minutes. The main barriers hindering the process are unwillingness from the patient (72.5%), lack of time (27.5%), and lack of confidentiality (26.6%). OTC medicines are considered safer than prescription-only medicines by pharmacists.

Pharmacists could substantially contribute to rational self-medication and alleviate the burden on healthcare systems.

Self-Treatment Practices for Perceived Symptoms of Malaria in Ethiopia

One of the most significant public health issues faced in Ethiopia is malaria. The most influential problem of this public health issue is overcoming barriers of having proper access to professional care and treatment. This study aims to elucidate the self-interventions undertaken by individuals when they perceive symptoms of malaria in a family-member prior to, or instead of, seeking care at a healthcare facility. Our study found that the prevalence of self-medication for malaria in the Wirtu Yedi kebele is 37.3%. Almost all individuals eventually sought treatment for malaria at the healthcare facility. More than half did so in less than one day. When self-treatment was used, there was a wide array of self-medication practices used, including modern medications not prescribed by a healthcare professional, herbs, and non-pharmacological measures. The more commonly used medications were chloroquine and Coartem® (artemether and lumefantrine). Most reported obtaining these medications at a drug outlet store without a prescription and prior to seeking care at a health center. Of the various herbs reported that were used to self treat malaria the most commonly used were garlic, ginger, and harmaguse. The use of herbs was found to be less common than the use of modern medication. Of the non-pharmacological interventions, rituals were the most prevalent.

Prevalence and Drivers of Self-Medication Practices among Savar Residents in Bangladesh: A Cross-Sectional Study

BACKGROUND

Self-medication practice (SMP) is widely adopted among residents of such countries as Bangladesh. However, the major determinants of SMP have only scarcely been evaluated. Therefore, this cross-sectional study aimed to fill this knowledge gap by assessing the prevalence and determining factors of SMP.

METHODS

A convenience sample of individuals residing in Savar (Dhaka, Bangladesh) >16 years of age and suffering from an illness >2 months underwent face-to-face interviews during January-February, 2019.

RESULTS

Among 520 interviewees fulfilling entry criteria, the prevalence of SMP was reported as 60.2%. Drug shops, previous knowledge or prescription, and consulting with peers (friends or relatives) were the most sought sources of SMP, whereas simple illness, higher consulting fees, unsatisfactory health-care services, and delayed access were reported as the motives. From the regression analysis, the sociodemographic risk factors of SMP were reported as being older (compared to <18 years), married, illiterate (compared to having higher education), having engaged in any occupation (ie, service, business, homemaker, and others compared to student), and suffering from chronic illness.

CONCLUSION

SMP is highly prevalent and exhibits significant socioeconomic determinants. Development of proper health care-access systems and public education should be implemented to reduce the rate of SMP.

Self-medication with non-prescribed pharmaceutical agents in an area of low malaria transmission in northern Tanzania: a community-based survey

Background

Self-treatment with antimicrobials is common in sub-Saharan Africa. Little is known about the prevalence of this practice where malaria transmission intensity is low, and little is known about the prevalence of self-treatment with other medications such as antihypertensives and antihyperglycemics.

Methods

A two-stage randomized population-based cluster survey with selection proportional to population size was performed in northern Tanzania. Self-identified healthcare decision-makers from randomly selected households were asked to report instances of self-medication without a prescription in the preceding year. Associations between self-treatment and sociodemographic characteristics were assessed with Pearson’s chi-squared and the Student’s t-test.

Results

A total of 718 participants completed the survey, and 344 (47.9%) reported any household member obtaining medication without a prescription. Of these, 85 (11.8%) obtained an antimicrobial and four (0.6%) obtained an antihypertensive or antihyperglycemic. Of respondents reporting self-treatment, 306 (89.0%) selected the medication themselves. Self-treatment with antimicrobials was associated with post-primary education (OR 1.95, 95% CI 1.22–3.16, p=0.005), younger age (43.1 vs 48.7 years, p=0.007) and higher socioeconomic status score (0.42 vs 0.34, p=0.023).

Conclusions

Self-treatment with antimicrobials in an area of low malaria transmission intensity was uncommon and self-treatment with antihypertensives and antihyperglycemics was rare.

Exploration of self-medication practice in Pokhara valley of Nepal

BACKGROUND

Self-medication (SM) is the practice of consuming medication without the consultation of physician. The drugs most commonly self-medicated are paracetamol, analgesics, ranitidine, oral rehydration solution and antibiotics. The objective of the study was to assess the SM status and its causes in Pokhara valley of Nepal.

METHOD

The study was conducted among the people residing in Pokhara metropolitan city. The study duration was of 4 months from April to July, 2018. The study population were patients attending health general and oral health screening programs at Baidam, Birauta, Hemja and Pame areas of Pokhara. Structured questionnaire was used to collect demographics of the patients and the details of the usage of self-medication.

RESULT

Out of 201 patients, 38.2% patients were found to be self-medicating. The most common illness sought for SM was ache (headache, body ache) in 50% subjects followed by cough and cold in 31% and gastritis in 23%. Paracetamol was the drug consumed by 16 subjects followed by nimesulide by 11. Lack of knowledge about the disadvantages of SM led to self-medication in 65% of respondents. The personnel most commonly consulted for medication were pharmacists (60%).

CONCLUSION

The trend of SM is high in Pokhara valley. The comedics were consulted most often for SM due to lack of knowledge of consultation to physicians. The public should be made aware about SM.

Self-Medication Practices and Associated Factors Among Health-Care Professionals in Selected Hospitals of Western Ethiopia

BACKGROUND

Even though the type, extent and reasons for self-medication practice (SMP) vary, globally self-medication (SM) is rising to relieve burdens on health services. However, inappropriate SMP results in economic wastes, damage of vital organs, incorrect therapy selection, risk of adverse drug reactions and development of antimicrobial-resistant pathogens. These consequences have severe implications including legal, ethical and quality of health-care delivery. Temporal increment and high prevalence of SM among health professionals is also a major bottleneck for Ethiopia. Hence, the study aimed to assess the SM among health-care professionals (HCPs) in selected governmental hospitals of Western Ethiopia.

METHODS

An instiution-based cross-sectional study was conducted among 338 HCPs using a pre-tested and self-adminstered questionnaries from March 1 to 25, 2018. Simple random sampling was used to select study participants and SMP (yes or no) was the outcome of the study variable. Data were entered and analyzed using SPSS version 20. Crude and adjusted odds ratios (95% CI) were calculated and all results were deemed to be statistically significant when p < 0.05.

RESULTS

Among the 338 participants, 184 (54.4%) were females and the mean age of the study participants was 25±3.23 years. About 154 (45.6%) of them had work experience of less than 5 years and 49.7% were nurses by profession. The prevalence of SM was 73.4% with 3 months of recall for SM. Familiarity with medicines and ailments (46.8%) and mildness of illness (40.7%) were the most common reasons to self-medicate. The most frequently reported ailments were headache (37.1%) and gastric pain (29.8%). Analgesics (44.4%) and antibiotics (42.7%) were the most commonly used self-medicated categories of drugs. Female sex (Adjusted odds ratio [AOR] =2.13, 95% CI: 1.43-8.66), age 20-29 years (AOR=4.53, 95% CI: 1.01-14.45) and work experience of <5 years (AOR= 3.01, 95% CI: 1.32-11.71) were significantly associated with SMPs.

CONCLUSION

The study revealed a high prevalence of SMP among HCPs. Sex, age, and work experience were significantly associated with SMPs. Hence, the use of prescription drugs without prescription should be discouraged and appropriate health education should be provided by all concerned bodies on the proper use of drugs.

Self-medication Pattern and Prevalence Among Iranian Medical Sciences Students

BACKGROUND

Self-medication could be risky behavior and has negative effects. While Over the Counter (OTC) drugs are available at drugstores, the behavior has become prevalent among the general population.

OBJECTIVE

This study aimed at surveying self-medication behavior among medical sciences students of Shiraz, Iran.

METHODS

A sample of 396 students from medical, paramedical, and health sciences disciplines were included in this cross-sectional study. They were asked to fill a questionnaire about their demographics and socioeconomic status, medication usage and self-medication in the last six months, information about the correct use of medication, and information about negative results of selfmedication. Data were analyzed using chi-square, t-test and logistic regression model using R statistical software.

RESULTS

Almost 72% of participants reported self-medication in the past sixth months. The main reasons included trust in their own diagnosis (59.9%), mildness of the disease (56.6%), and having previous experience about the disease (56%). Cough or cold (84.5%), headache (66.3%), and body pain (60.2%) were the most frequent diseases that led to self-medication. The majority of the participants (77.7%) reported they select their medicine on their own decision. Furthermore, self-medication was highly related to having medicine stock at home (OR=2.692), having less information about negative results of self-medication (OR=0.835), and more non-syllabus study time (OR=1.041).

CONCLUSION

Although, medical science students have information about the treatment of illnesses, they should be more informed about negative results and side-effects of self-medication. They should also share their knowledge with society to decrease self-medication.

Self-medication practice and associated factors among adult community members of Jigjiga town, Eastern Ethiopia

Background

Self-medication is the use of any drug or medication to treat an illness or ailment without the supervision of a licensed medical doctor/health care providers. Self-medication practice in Eastern Ethiopia is quite common. However, there is little information with regard to magnitude and associated factors. The objective of this study was to assess the magnitude of self-medication practice and associated factors among adult community members of Jigjiga town, Eastern Ethiopia.

Methods

A community based cross-sectional study was conducted from June 27- July 12, 2017. Multistage sampling method was used and the number of kebeles and Sub-kebeles were selected using simple random sampling technique. Finally, sampled households in the Sub-kebeles were selected using systematic random sampling. Data were collected using face to face interview with 547 adult (≥18 years) participants. It was entered and cleaned using EPI-Data version 3.02 and exported to Statistical Package for Social Science (SPSS) Version 23 for further analysis. Bi-variable and multivariable logistic regression models were carried out to identify factors associated with the self-medication.

Result

The magnitude of self-medication was found to be 37.5% (95% CI: (33.6%–41.7%). Educational status of secondary school [(AOR = 0.46; 95% CI: (0.22–0.98)], high income [(AOR = 3.00; 95% CI: (1.77–5.06)], advised by neighbors, friends or relatives to take drug for their complaint [(AOR = 2.59; 95% CI: (1.62–4.14)], used old prescription /past experience to bought drugs [(AOR = 12.19; 95% CI: (6.65–22.35)], follow advertisements of drugs by television [(AOR = 0.21; 95% CI: (0.05–0.85)], and perception about Hospital drugs (clinics, health centers and hospitals) do not work [(AOR = 2.36; 95% CI: (1.39–3.99)] were significantly associated with self-medication.

Conclusion

High income, advice by neighbors, friends or relatives to take drug for their complaint, old prescription/past experience use to bought drugs, and perception of hospital drugs do not work was positively associated with self-medication. Therefore, health education should be given to the community on the importance of hospital drugs (clinics, health centers and hospitals) to shift their perception.

Epidemiology of self-medication in Ethiopia: a systematic review and meta-analysis of observational studies

Background

Self-medication is the use of drugs to treat self-diagnosed disorders and/or symptoms, or the intermittent or continued use of a prescribed drug for recurrent disease or symptoms. This phenomenon is alarmingly increasing over time despite the occurrence of health-related hazards. This study is, therefore, aimed to quantitatively estimate self-medication practice and possible reasons for it in Ethiopia.

Methods

Data were identified from major databases and indexing services including EMBASE (Ovid), PubMed, MEDLINE (Ovid), and Google Scholar. Both published and unpublished records addressing self medication practice in Ethiopia without time limit were included for the study. Data were extracted with structured format prepared in Microsoft Excel and exported to OpenMeta[analyst] version 3.3 software for analyses. Pooled estimation of outcomes was performed with DerSimonian-Laird random-effects model at 95% confidence level. Sensitivity and subgroup analyses were also considered. Degree of heterogeneity of studies was presented with I² statistics. Publication bias was also performed with the help of Comprehensive Meta-Analysis version-3 software and presented with funnel plots of standard error supplemented by Begg’s and Egger’s tests. The study protocol is registered on PROSPERO with reference number ID: CRD42018093790.

Results

A total of 27 studies with 9586 participants were included for the study. The pooled prevalence of self-medication in Ethiopia was found to be 44.0% (95% confidence interval [CI]: 35.1, 52.8). Geographical-based subgroup analysis revealed that the highest prevalence was observed at the capital of Ethiopia, Addis Ababa, 62.8% (95% CI: 42.3, 83.2). Population based analysis indicated that healthcare professionals and students were the main practitioners of self-medication. Besides, the prevalence of self-medication practice in pregnant women is approximately 22.9% (95% CI: 9.8, 36). The most common reasons to practice self-medication were previous experience of clients and/or familiarity of treatments, 31.3% (95% CI: 21.5, 41.1) and perceived mildness of the illness, 31.1% (95% CI: 26.0, 36.2). The pooled prevalence of analgesics, antimicrobial agents and gastrointestinal drugs were 46.1% (95% CI: 36.2, 56.1), 28.2% (95% CI: 19.6, 36.8), and 14.9% (95% CI: 7.8, 21.9), respectively.

Conclusion

Self-medication practice becomes a common phenomenon in Ethiopia. The use of prescription-only medications including antimicrobial agents without medical consult has become alarmingly high. This practice will come with potential health related hazards including emergence of antimicrobial resistance. Therefore, there must be a multitude of strategies for reversing the current worrying trends of self-medication.

Electronic supplementary material

The online version of this article (10.1186/s40360-018-0248-8) contains supplementary material, which is available to authorized users.

Prevalence and determinants of self-medication practice among selected households in Addis Ababa community

Background and aim

Self-medication (SM) is one part of self-care which is known to contribute to primary health care. If practiced appropriately, it has major benefits for the consumers such as self-reliance and decreased expense. However, inappropriate practice can have potential dangers such as incorrect self-diagnosis, dangerous drug-drug interactions, incorrect manner of administration, incorrect dosage, incorrect choice of therapy, masking of a severe disease, and/or risk of dependence and abuse. The main objective of this study was to assess the prevalence and determinants of the self-medication practice (SMP) in Addis Ababa.

Methodology

A community based cross-sectional study was conducted among selected households in Addis Ababa from April 2016 to May 2016, with a recall period of two months before its conduction. Trained data collectors were employed to collect the data from the 604 sampled participants using pre-tested and validated questionnaires.

Result

Among the 604 participants involved in this study, 422 (69.9%) were female and 182 (30.1%) were male and there was a mean age of 41.04 (± 13.45) years. The prevalence of SM in this study was 75.5%. The three most frequently reported ailments were headache 117 (25.7%), abdominal pain 59 (12.9%) and cough 54 (11.8%). The two main reasons for SM were mildness of illness 216 (47.4%) and previous knowledge about the drug 106 (23.2%). The two most frequently consumed medications were paracetamol 92 (20.2%) and traditional remedies 73 (16.0%), while drug retail outlets 319 (83.3%) were the main source of drugs. The two most frequently reported source of drug information were health professionals 174 (45.4%) and experience from previous treatment 82 (21.4%). Moreover, there were statistically significant differences among respondents who reported practicing SM based on income and knowledge about appropriate SMP.

Conclusion and recommendation

Self-medication was practiced with a range of drugs from the conventional paracetamol and NSAIDs to antimicrobials. Being that the practice of SM is inevitable, health authorities and professionals are highly demanded to educate the public not only on the advantages and disadvantages of SM but on its proper use.

Self-Medication Practice in Limmu Genet, Jimma Zone, Southwest Ethiopia: Does Community Based Health Insurance Scheme Have an Influence?

Background

Self-medication, which is a form of self-care, is an important initial response to illness, and many illnesses can be successfully treated at this stage. It is practiced by a considerable proportion of the population and is affected by sociodemographic and economic factors. This study was conducted to assess the practice of self-medication and associated factors in Limmu Genet's town households, Jimma Zone, Southwest Ethiopia.

Methods and Materials

A community based cross-sectional study was done. Systematic sampling technique was used to select participants. Data was collected by face-to-face interviews by using structured questionnaires. After checking the completeness, missing values, and coding of questionnaires, data was tabulated and calculated on SPSS version 20.0. Finally data was presented in tables, graphs frequency, percentage, and cross-tabulation with different variables.

Result

In this study, both self-medication and the prevalence of diseases among households were 78.1%. That constituted any kind of illness reported by participants.

Conclusion

Self-medication practice is common among community members regardless of being community based health insurance members. Therefore, it needs pertinent health education on legal prescriptions and use of medicines as well as strengthening the access of community based insurance.

Self-medication among pregnant women attending antenatal clinic at Makongoro health centre in Mwanza, Tanzania: a challenge to health systems

BACKGROUND

Self-medication is a universal challenge that requires attention because of the potential threat not only to the pregnant women but also to unborn child. Data on self-medication practice and predictors among pregnant women is lacking in Tanzania. Information on the effects of this practice to the pregnant woman and the foetus globally is also scanty.

METHODS

This was a cross sectional study which was conducted using face to face interview with 372 pregnant women at Makongoro health centre. Semi-structured questionnaires were used. Data were analysed using STATA 13 (Statistical Corporation, College Station, Texas, US).

RESULTS

A total of 372 pregnant women participated in the study. The prevalence of self-medication among pregnant women was 172 (46.24%). There was a significant statistical association between self-medication and occupation (P value =0.01), gestation age (P < 0.01) and education (P < 0.01). Age, marital status and gravidity were not associated with self-medication (P = 0.809, P = 0.243 and P = 0.922) respectively. When bivariate logistic regression was performed, occupation and education were the only determining factors for self-medication. Pregnant women who were unemployed, doing business and house wife were most likely to practice self-medication than employed pregnant women (P = 0.03; OR = 2.33; 95% CI, 1.06-5.31, P = 0.01; OR = 2.31; CI 1.21-4.41, P = <0.01, OR = 2.73, 95% CI 0.52-2.43) respectively. Pregnant women with no formal education, incomplete primary education, primary education and secondary education were most likely to practice self-medication than pregnant women with college or university education (P < 0.01, OR = 6.37 95% CI 2.37-19.03, P < 0.01, OR = 6.58, 95% CI 2.36-18.25, P < 0.01, OR = 3.78, 95% CI 1.89-7.56, P < 0.01, OR = 2.59 95% CI = 1.30-5.17). The leading illness/symptoms which led to self-medication among pregnant women attending clinic were malaria 56 (32.56%, morning sickness 44 (25.55%) and headache 33(19.19%). Drugs commonly used in self-medication among pregnant women were ant malarial 42 (24.42%), antiemetics 59 (34.30%) and analgesics 33 (19.19%).

CONCLUSION

Prevalence of self-medication among pregnant women is high in Tanzania. This is a threat to the safety of the developing foetus and the pregnant woman. Therefore there is a need of interventions to minimize the practice among pregnant women.

The Needs and Resources of Drug Information at Community Pharmacies in Gondar Town, Northwest Ethiopia

BACKGROUND

Community pharmacists are in a key position to provide information on drugs and thus promote the rational use of drugs.

OBJECTIVES

The present study was designed to determine the needs and resources of drug information in community pharmacies.

METHODS

A prospective institution based cross-sectional study was carried out and data were collected on 48 community pharmacists in Gondar, Northwest Ethiopia, using interviewer administered structured questionnaire.

RESULTS

Almost all pharmacists (N = 47, 97.9%) often receive drug related queries and these were mainly from consumers (N = 41, 85.4%). While most questions relate to drug price (N = 29, 60.4%) and dosage (N = 21, 43.8%), the information resources mainly referred to were drug package inserts and national standard treatment guidelines. However, limited availability of information resources as well as limited ability to retrieve relevant information influenced the practice of pharmacists. Female pharmacists claimed better use of different information resources than males (P < 0.05).

CONCLUSIONS

Community pharmacists in Gondar, Northwest Ethiopia, are often accessed for drug related information. But there are limitations in using up to date and most reliable resources. Therefore, intervention aimed at improving pharmacists' access to and evaluation of drug information is urgently needed.

Customers' perceptions of and satisfaction with medicine retail outlet services in Addis Ababa, Ethiopia: a cross-sectional study

OBJECTIVES

The aim of this study was to assess customers' perceptions of and satisfaction with MRO services in Addis Ababa and to explore factors associated with their satisfaction and reasons for visits.

METHODS

A cross-sectional survey was conducted among customers selected from 28 MROs in Addis Ababa, using multi-stage sampling techniques. Simple descriptive statistics and multivariable logistic regression at 95% confidence interval were used for the analysis.

KEY FINDINGS

Of 396 respondents, 324 (81.8%) visited MROs to purchase prescription medicines. A majority (338/396; 85.4%) of them perceived that pharmacists and druggists (pharmacy professionals) play a major role in healthcare delivery. A third (140/396; 35.4%) of the respondents agreed with the statement that pharmacy professionals are more concerned about patient care than about their business. Regarding reasons for visiting, being married was positively associated with buying over-the-counter, higher educational status was linked with more satisfaction. Overall, 56.8% (225/396) of the respondents reported that they were satisfied with the service provided by MROs.

CONCLUSION

Customers of MROs had mixed perceptions of and satisfaction with the current service. Marital status and age were associated with the reason for visiting, while the educational level was associated with the level of satisfaction. The overall positive perceptions and satisfaction about MROs should be taken as an opportunity to promote and improve pharmaceutical services rendered in MROs, to ensure that the public is receiving maximum benefit.

Involvement of community pharmacists in public health priorities: A multi-center descriptive survey in Ethiopia

Located in the heart of the community and widely distributed geographically, community pharmacies provide a platform for a more proactive involvement in public health services. So far, little information has been gathered in Ethiopia on community pharmacists’ level of involvement in public health services. The aim of the present study was, therefore, to document the level of involvement of community pharmacy professionals in the provision of public health services and the barriers to such involvement. This study employed a self-administered questionnaire based survey, which asked participants to indicate their frequency and level of involvement in providing public health services and their perceived barriers in providing such services. Surveys were undertaken from May to July, 2016 with 472 community pharmacy professionals working in community pharmacies in six cities of Amhara regional state of Ethiopia: Debre Markos, Gondar, Dessie, Bahir Dar, Woldya and Debre Birhan. Among 472 community pharmacy professionals approached, 412 (233 pharmacists and 179 pharmacy technicians) completed the survey with a response rate of 87.3%. Most respondents reported as being either “not at all involved” or “little involved” in counselling on smoking cessation (79.3%), and screening for hypertension (86.9%), diabetes (89.5%), and dyslipidemia (88.9%). On the other hand, they reported a higher level of involvement in the management and screening of infectious diseases (72.8%) and counseling with partners when initiating treatment for sexually transmitted diseases (68.9%). Lack of knowledge or clinical skills and lack of personnel or resources were the most commonly reported barrier for expanding such services. This survey revealed a low level of involvement of community pharmacists in public health services. In order to better integrate community pharmacies into future public health programs and optimize the contribution of community pharmacy professionals, interventions should focus on overcoming the identified barriers.

Non-prescribed antimicrobial use and associated factors among customers in drug retail outlet in Central Zone of Tigray, northern Ethiopia: a cross-sectional study

Background

Non-prescribed antimicrobial use and their resistance are among the main public health problems, worldwide. In Ethiopia, particularly in the northern part, the magnitude of non-prescribed antimicrobial use and its major determinants is not yet well known. Thus, this study was done to assess the magnitude of non-prescribed anti-microbial use and associated factors among customers in drug retail outlet in Central Zone, Tigray, Ethiopia.

Methods

A drug retail outlet based cross-sectional study was conducted among adults aged 18 years and above. A multistage sampling procedure was used to select study participants. Data were collected using a structured questionnaire by druggists under the supervision of pharmacists. Data were entered into EpiInfo software version 3.5.4. Binary logistic regression was used to identify independently associated variables in bivariate and multivariable analyses using SPSS version 21. Odds Ratios with 95% confidence intervals were estimated.

Results

From 829 study samples, a total of 780 respondents participated in this study with a response rate of 94.1%. Of 367 respondents who received non-prescribed antimicrobial, 249 (67.8%), 121 (33%), and 94 (25.6%) of them were males, secondary school and paid employed respectively. The magnitude of non-prescribed antimicrobial use was 47.1% (95% CI: 43.8, 50.5). The factors which were independently associated with non-prescribed antimicrobial use were male sex [AOR = 1.72, 95% CI = 1.21, 2.44], seeking modern health care in private/Non-Governmental Organization (NGO) [AOR =0.47, 95% CI; 0.23, 0.98], moderate waiting time in health care facilities [AOR = 1.92, 95% CI; 1.20, 3.09], delayed waiting time in health care facilities [AOR = 1.56, 95% CI; 1.03, 2.38], ever received antimicrobial [AOR = 3.51, 95% CI; 2.45, 5.02], and frequency of purchasing non-prescribed antimicrobial (1–3 times and 4 times, [AOR = 2.04, 95% CI; 1.36, 3.06] and [AOR = 2.66, 95% CI; 1.24, 5.68] respectively).

Conclusion

The magnitude of non-prescribed antimicrobial use was high. Familiarizing with health care utilization and delayed waiting time in health care facilities were the very important factors independently associated with non-prescribed antimicrobial use. Emphasis should be given to community education through involvement of the private health sector and health care providers. Regulation and policy enforcement are also necessary to promote the rational use of antimicrobial.

Self-Medication Pattern among Social Science University Students in Northwest Ethiopia

Background. Inappropriate self-medication causes wastage of resources among others. Method. This survey study was conducted to determine self-medication pattern of 404 social science university students in Northwest Ethiopia, who were selected through stratified random sampling technique. Data were collected using self-administered questionnaire and analyzed with SPSS version 20 statistical software. Binary Logistic Regression analysis was employed with P value < 0.05 considered statistically significant. Result. At 95.3% response rate, mean age of 21.26 ± 1.76 years, and male/female ratio of 1.26, the prevalence of self-medication during the six month recall period was 32.7%. Headache (N = 87, 69.1%) was the primary complaint that prompted the practice and hence analgesics (N = 67, 53.2%) were the mostly used drugs followed by antimicrobials (N = 50, 39.7%). The top two reasons driving the practice were nonseverity of the illness (N = 41, 32.5%) and suggestions from friends (N = 33, 26.2%). Female sex (P = 0.042) and higher income (P = 0.044) were associated with the practice. Conclusion. Self-medication practice, involving the use of both nonprescription and prescription drugs such as antimicrobials, among the social science university students is high. Therefore health education interventions regarding the risks of inappropriate self-medication are essential.

Self-medication practice in Ethiopia: a systematic review

BACKGROUND

Self-medication patterns vary among different populations, and are influenced by many factors. No review has been done that comprehensively expresses self-medication practice in Ethiopia. The aim of this study was to provide an overview of the literature on self-medication practice in Ethiopia.

MATERIALS AND METHODS

Databases (PubMed, Google Scholar, ResearchGate, and Hinari) were searched for published studies on the practice of self-medication in Ethiopia without restriction in the year of publication or methodology. Some studies were also identified through manual Google search. Primary search terms were "self medication", "Ethiopia", "self care", "non-prescription", "OTC drug use", "drug utilization", and "drug hoarding". Studies that measured knowledge only or attitude only or beliefs only and did not determine the practice of self-medication were excluded.

RESULTS

The database search produced a total of 450 papers. After adjustment for duplicates and inclusion and exclusion criteria, 21 articles were found suitable for the review. All studies were cross-sectional in nature. The prevalence of self-medication varied from 12.8% to 77.1%, with an average of 36.8%. Fever/headache, gastrointestinal tract diseases, and respiratory diseases were the commonest illnesses/symptoms for which self-medication was taken. The major reasons for practicing self-medication were previous experience of treating a similar illness and feeling that the illness was mild. Analgesics/antipyretics, antimicrobials, gastrointestinal drugs, and respiratory drugs were the common drug classes used in self-medication. Mainly, these drugs were obtained from drug-retail outlets. The use of self-medication was commonly suggested by pharmacy professionals and friends/relatives.

CONCLUSION

Self-medication practice is prevalent in Ethiopia and varies in different populations and regions of the country. Some of the self-medication practices are harmful and need prompt action. Special attention should be given to educating the public and health care providers on the types of illnesses that can be self-diagnosed and self-treated and the types of drugs to be used for self-medication.

Self-medication among health workers in a tertiary institution in South-West Nigeria

INTRODUCTION

Inappropriate self-medication results in wastage of resources, resistance to pathogen and generally entails serious health hazard. This study was undertaken to determine the knowledge, practice and reasons for practice of self-medication among health workers in a Nigerian tertiary institution.

METHODS

This was a cross-sectional descriptive study conducted among staff of Federal Medical Center Ido-Ekiti, Nigeria. Simple random sampling technique was used to select 305 respondents that were interviewed via a pretested semi-structured questionnaire. Analysis was done using SPSS version 15 and while chi-square test was used to test significance between variables, significant (p value set<0.05).

RESULTS

Among the 305 respondents interviewed, the age range was 18-52yrs with greater proportion being males (51.8%). Majority of respondents were aware of self-medication (94.8%), but only 47.2% had good knowledge of it. Reasons for practicing self-medication were financial problem (10.8%), mild sickness (10.8%), lack of time (13.4%), knowledge of diagnosis (5.6%), convenience (2.3%) and non-availability of doctors (3.0%). The drugs used by respondents without prescription included analgesics (38.2%), antibiotics (19.0%) anti-malaria drugs (13.3%), and others (29.4%). Conditions for which respondents self-medicated were body pains (14.9%), catarrh (14.9%), headache (14.3%), sore throat (11.5%), diarrhea (11.2%), fever (9.0%) and toothache (5.6%).

CONCLUSION

The study demonstrates that the prevalence of self-medication is relatively high. There is need for health education on the implication and danger of self-medication. There is also need for government to pass and enforce law to restrict free access to drugs.

Prevalence of self-medication in the adult population of Brazil: a systematic review

OBJECTIVE

To evaluate the prevalence of self-medication in Brazil’s adult population.

METHODS

Systematic review of cross-sectional population-based studies. The following databases were used: Medline, Embase, Scopus, ISI, CINAHL, Cochrane Library, CRD, Lilacs, SciELO, the Banco de teses brasileiras (Brazilian theses database) (Capes) and files from the Portal Domínio Público (Brazilian Public Domain). In addition, the reference lists from relevant studies were examined to identify potentially eligible articles. There were no applied restrictions in terms of the publication date, language or publication status. Data related to publication, population, methods and prevalence of self-medication were extracted by three independent researchers. Methodological quality was assessed following eight criteria related to sampling, measurement and presentation of results. The prevalences were measured from participants who used at least one medication during the recall period of the studies.

RESULTS

The literature screening identified 2,778 records, from which 12 were included for analysis. Most studies were conducted in the Southeastern region of Brazil, after 2000 and with a 15-day recall period. Only five studies achieved high methodological quality, of which one study had a 7-day recall period, in which the prevalence of self-medication was 22.9% (95%CI 14.6;33.9). The prevalence of self-medication in three studies of high methodological quality with a 15-day recall period was 35.0% (95%CI 29.0;40.0, I² = 83.9%) in the adult Brazilian population.

CONCLUSIONS

Despite differences in the methodologies of the included studies, the results of this systematic review indicate that a significant proportion of the adult Brazilian population self-medicates. It is suggested that future research projects that assess self-medication in Brazil standardize their methods.

Acute liver failure and self-medication

INTRODUCTION

Not responsible self-medication refers to drug use in high doses without rational indication and often associated with alcohol abuse. It can lead to liver damage and drug interactions, and may cause liver failure.

AIM

To warn about how the practice of self-medication can be responsible for acute liver failure.

METHOD

Were used the Medline via PubMed, Cochrane Library, SciELO and Lilacs, and additional information on institutional sites of interest crossing the headings acute liver failure [tiab] AND acetaminophen [tiab]; self-medication [tiab] AND acetaminophen [tiab]; acute liver failure [tiab] AND dietary supplements [tiab]; self-medication [tiab] AND liver failure [tiab] and self-medication [tiab] AND green tea [tiab]. In Lilacs and SciELO used the descriptor self medication in Portuguese and Spanish. From total surveyed were selected 27 articles and five sites specifically related to the purpose of this review.

CONCLUSIONS

Legislation and supervision disabled and information inaccessible to people, favors the emergence of cases of liver failure drug in many countries. In the list of released drugs that deserve more attention and care, are some herbal medicines used for the purpose of weight loss, and acetaminophen. It is recommended that institutes of health intensify supervision and better orient their populations on drug seemingly harmless, limiting the sale of products or requiring a prescription for release them.

A meta-analysis of the proportion of antimicrobial resistant human Salmonella isolates in Ethiopia

BACKGROUND

Antimicrobial resistant Salmonella is a global problem and recently, a strain on the verge of pan-resistance was reported. In Ethiopia, the therapeutic management of Salmonellosis is difficult because drug sensitivity tests are not routinely carried out and treatment alternatives are not available in most health care facilities. The objectives of this study were to estimate the temporal changes and proportions of drug resistant isolates in Ethiopia.

METHODS

Published studies on drug resistant Salmonella isolates were searched in Medline, Google Scholar and the lists of references of articles. Eligible studies were selected by using inclusion and exclusion criteria. Generic, methodological and statistical information were extracted from the eligible studies. The extracted data included the proportions of ampicillin, co-trimoxazole, chloramphenicol, ceftriaxone, ciprofloxacin and multi-drug resistant isolates. Pooled proportions were estimated by a random effects model.

RESULTS

The odds of multi-drug resistant isolates in the 2000s was higher than before the 1990s (OR =18.86, 95% CI = 13.08, 27.19). The pooled proportions of ampicillin, co-trimoxazole, chloramphenicol, ciprofloxacin and multi-drug resistant isolates in the 2000s were 86.01%, 68.01%, 62.08%, 3.61% and 79.56% respectively. S. Concord (>97%) was resistant to ampicillin, co-trimoxazole, chloramphenicol and ceftriaxone.

CONCLUSION

The proportion of drug resistant isolates has increased since the 1970s. All drugs currently used for the treatment of Salmonellosis but ciprofloxacin are not reliable for an empirical therapy. Alternative drugs should be included in the essential drug list and measures should be taken to re-enforce the drug use policy.

Self medicated antibiotics in Bangladesh: a cross-sectional health survey conducted in the Rajshahi City

BACKGROUND

Antibiotic self medication is highly prevalent in the developing countries due to easy availability and poor regulatory controls for selling these drugs. The purpose of this study was to evaluate the prevalence of self-medication with antibiotics for the treatment of various diseases by the peoples of Rajshahi city in Bangladesh.

METHODS

A cross-sectional survey was conducted to the patient's (n = 1300) at eight locations of Rajshahi city in Bangladesh from March to April, 2014. The locations were selected by convenience and the study population within each study area was randomly selected. The survey was self-administered and included questions pertaining to self medicated drugs and antibiotic usage patterns as well. Data were analyzed using descriptive statistics.

RESULTS

It was found that 347 (26.69%) out of 1300 participants experienced self medication with antibiotics. Over fifty percent of the patients studied were between the ages of 21-30 years with 83.57% of them being males and 16.43% females. The highest percentage of self medicated antibiotics was metronidazole (50.43%) followed by azithromycin (20.75%), ciprofloxacin (11.53%), amoxicillin (10.37%) and tetracycline (7.49%) respectively. The key reasons for the self medication of antibiotics was the pre-experience (45.82%), suggestions from others (28.24%) and knowledgeable of the antibiotics (16.14%). The perceived symptoms to purchase the antibiotics independently was dysentery, diarrhea and food poisoning (36.02%), cold, cough and fever (28.24%), infection (12.97%), dental carries and toothache (9.22%), irritable bowel syndrome (3.46%), acne (4.32%), ear and throat pain (2.31%). The duration of maximum antibiotics usage was ranges between 0-10 years. Only 4.32% patient's used self medicated antibiotics longer than 10 years. The patient's compliance for self medication of antibiotics varies from excellent to no comments whereas only 6.92% patients reported side effects for the self medication of antibiotics.

CONCLUSIONS

The results of this study confirm that antibiotic self-medication is a relatively frequent problem in Bangladesh. Drug Administration of Bangladesh should implement the regulatory controls immediately on the distribution and selling of antibiotics in order to reduce the frequency of antibiotic misuse.

Implementing ward based clinical pharmacy services in an Ethiopian University Hospital

Background

Clinical pharmacy practice has developed internationally to expand the role of a pharmacist well beyond the traditional roles of compounding, dispensing and supplying drugs to roles more directly in caring for patients. Studies on the activities of the clinical pharmacist in an inpatient ward in resource constrained settings are scarce, however.

Objective

To assess ward based clinical pharmacy services in an internal medicine ward of Jimma University Specialized Hospital.

Methods

The study was carried out in the internal medicine ward from March to April, 2011 at Jimma University Specialized Hospital. The study design was a prospective observational study where pharmaceutical care services provided by clinical pharmacists for inpatients were documented over a period of two months. Interventions like optimization of rational drug use and physician acceptance of these recommendations were documented. Clinical significance of interventions was evaluated by an independent team (1 internist, 1 clinical pharmacologist) using a standardized method for categorizing drug related problems (DRPs).

Results

A total of 149 drug related interventions conducted for 48 patients were documented; among which 133(89.3%) were clinical pharmacists initiated interventions and 16(10.7%) interventions were initiated by other health care professionals. The most frequent DRPs underlying interventions were unnecessary drug therapy, 36(24.2%); needs additional drug therapy, 34(22.8%) and noncompliance, 29(19.5%). The most frequent intervention type was change of dosage/instruction for use, 23(15.4%). Acceptance rate by physicians was 68.4%. Among the interventions that were rated as clinically significant, 46(48.9%) and 25(26.6%) had major and moderate clinical importance respectively.

Conclusions

Involving trained clinical pharmacists in the healthcare team leads to clinically relevant and well accepted optimization of medicine use in a resource limited settings. This approach can likely be generalized to other health care settings in the country to improve medication outcomes.

Strengthening pharmaceutical care education in Ethiopia through instructional collaboration

OBJECTIVE

To describe the development, implementation, and initial outcomes of a pharmaceutical care training-of-trainers course developed to assist Ethiopian pharmacy faculty members and graduate students in the development of curriculum and provision of pharmaceutical care services of relevance to this low-income country.

DESIGN

In this collaboration, US and Ethiopian faculty members worked together in a week-long seminar and in hospital ward rounds to develop and offer a course to facilitate faculty members, curricular, and service development in pharmaceutical care in Ethiopia.

ASSESSMENT

Assessments were conducted during the seminar, immediately post-seminar, at 3 months post-seminar, and at 1 year post-seminar. An examination was administered at the conclusion of the course to assess immediate learning outcomes for the graduate students. Post-course assessments of short-term (3-month) and longer-term (12-month) impact were conducted to identify pharmaceutical care services that had been implemented to assess knowledge and skill gained during the seminar. Correspondence between seminar participants and the US faculty members as well as graduate student thesis projects provided further evidence of changes at 3 and 12 months post-course.

CONCLUSION

Pharmaceutical care training was developed for Ethiopian faculty members through a seminar and hospital ward rounds. Enhancements have been added to curricula for bachelor in pharmacy students and select pharmaceutical care services have been implemented through master's thesis projects.

A qualitative study about self-medication in the community among market vendors in Fuzhou, China

Despite government efforts to increase healthcare insurance and access in China, many individuals, regardless of insurance status, continue to engage in high levels of self-medication. To understand the factors influencing common self-medication behaviour in a community of food market vendors in Fuzhou China, a total of 30 market vendors were randomly recruited from six food markets in 2007. In-depth interviews were conducted with each participant at their market stalls by trained interviewers using a semi-structured open-ended interview protocol. Participants were asked broad questions about their health-seeking behaviours as well as their past experiences with self-medication and hospital care. ATLAS. ti was used to manage and analyse the interview data. The results showed that hospital-based healthcare services were perceived as better quality. However, self-medication was viewed as more affordable in terms of money and time. Other factors prompting self-medication, included confidence in understanding the health problem, the easy accessibility of local pharmacies and the influences of friends/peers and advertising. Three broad domains, attitude, cost and effectiveness, were all seen to determine past decisions and experiences with self-medication. Interestingly, the effective management of self-medication via pharmacy resources raised particular concern because of perceived variation in quality. In conclusion, self-medication was found to be an important and common health-seeking behaviour driven by multiple factors. A sound and comprehensive public health system should systematically attend to these behaviours and the pharmacies, where much of the behaviour occurs.

Self-medication practices among adult population attending community pharmacies in Malaysia: an exploratory study

OBJECTIVE

To assess the prevalence of self-medication among adults in an urban setting and to identify any factors contributing to self-medication in relation to consumer characteristics.

SETTING

The study was carried out in Kuala Lumpur, the capital of Malaysia.

METHODS

A cross-sectional study using a self administered questionnaire including adults above 21 years old as an exit survey was conducted in Kuala Lumpur.

MAIN OUTCOME MEASURES

Number of medications taken in a day by participants, source of medication for the treatment of minor illnesses among participants, common illnesses chosen for self-medication by participants, and the sources of information of participants.

RESULTS

Of 314 participants, 62.7% had taken at least one medication in the past week without prescription and 62.7% believed that over the counter medicines were just as effective as those prescribed by doctors. 69.4% would seek a healthcare professional's advice before purchasing any medication and 86.9% would consult a pharmacist prior to buying medication from the pharmacy. Only 86% checked the expiry dates on medications and 54.5% reported keeping leftover medication.

CONCLUSIONS

Self-medication practice is prevalent in Kuala Lumpur but some practice might be harmful. Education on appropriate use of self-medication need to be emphasized in order to ensure quality use of medicines.

Survey of non-prescribed use of antibiotics for children in an urban community in Mongolia

OBJECTIVE

to estimate the prevalence and identify the determinants of non-prescription use of antibiotics for children in Mongolia.

METHODS

a community-based cross-sectional survey was undertaken in 10 subdistricts in Ulaanbaatar, Mongolia's capital. We used a structured questionnaire to collect data from a random sample of 540 households with at least one child aged < 5 years. Logistic regression was used to identify factors associated with antibiotic misuse.

FINDINGS

of 503 participating caregivers, 71% were mothers; 42.3% (95% confidence interval, CI: 37.8-46.9) of caregivers had used non-prescribed antibiotics to treat symptoms in their child during the previous 6 months. Symptoms commonly treated were cough (84%), fever (66%), nasal discharge (65%) and sore throat (60%). Amoxicillin was the most commonly used antibiotic (58%). Pharmacies were the main source (86%) of non-prescribed antibiotics. Non-prescribed use by mothers was significantly associated with keeping antibiotics at home (odds ratio, OR: 1.7; 95% CI: 1.04-2.79), caregiver self-medication (OR: 6.3; 95% CI: 3.8-10.5) and older child's age (OR: 1.02; 95% CI: 1.01-1.04). Caregivers with a better knowledge of antibiotics were less likely to give children non-prescribed antibiotics (OR: 0.7; 95% CI: 0.6-0.8).

CONCLUSION

the prevalence of non-prescribed antibiotic use for young children was high in Ulaanbaatar. Because such use leads to the spread of bacterial resistance to antibiotics and related health problems, our findings have important implications for public education and the enforcement of regulations regarding the sale of antibiotics in Mongolia.