Assessment of knowledge, attitude, and practice on self-care with over-the-counter medicines among pregnant women

Background

Self-care during pregnancy is a crucial topic to be discussed due to its effects on both the mother and fetus. In Sri Lanka, specifically regarding self-care with over-the-counter (OTC) medicines, usage among the pregnant population is scarce.

Objective

This study assessed knowledge, attitudes, and practices (KAP) on self-care with OTC medicine usage among pregnant women attending maternity clinics in the Colombo Medical Officer of Health (MOH) areas, Sri Lanka.

Method

A cross-sectional study was conducted among 399 pregnant women enrolled through simple random sampling using a self-administered questionnaire. Data were collected on knowledge, attitudes, practices, and sociodemographic characteristics. SPSS version 27 was used for descriptive statistical analysis.

Results

There were satisfactory levels of KAP on self-care with OTC medicines identified among participants. The Mean ± SD for knowledge was 4.38 ± 0.873, and for attitude and practice, 27.56 ± 3.752 and 20.35 ± 4.235, respectively. Significant positive linear correlation between knowledge and attitude (r = 0.375, p < 0.001), attitude and practice (r = 0.518, p < 0.001), and knowledge and practice (r = 0.224, p < 0.001) were observed. It refers to participants with higher levels of knowledge being more likely to exhibit certain attitudes and engage in good practice regarding self-care. However, 93% of the participants had a wrong intention that any medicine could be used at any stage of pregnancy, and 26.3% of the participants didn't know that the medications taken during pregnancy could impact the fetus. Surprisingly, 87% had misperceived that antibiotics can be purchased as OTC medicines. Additionally, the majority of the participants (96%) believed that they could use old prescriptions to purchase medicines during pregnancy.

Conclusion

Greater awareness regarding self-care with OTC medication usage is suggested to be provided during pregnancy.

Identification of At-risk Pregnant Population for Over-the-Counter Drug Usage in Low-Resource Settings

OBJECTIVE

Nearly 1.5 billion people of an Asian country are living their lives without a country-specific over-the-counter (OTC) drug list. A study was planned to assess the understanding and practice of OTC medication consumption in the pregnant population.

METHODS

A questionnaire-based cross-sectional study evaluating different perspectives on OTC drug consumption was planned in around 500 pregnant women attending tertiary care outpatient antenatal clinics. The association of knowledge, attitude and practice versus indications, knowledge regarding harmful effects possible, reasons for choosing OTC medication, the practice of consulting nonmedical persons and drug interactions with the disease or prescription medications was determined. Regression analysis was performed in statistical software R.

RESULTS

Seven percent (36/516) of pregnant women were found to consume oral antimicrobials without prescription. Local chemist consultation was the most common channel (72.48%) to procure the OTC medicines. Participants with good knowledge score showed an odds ratio (OR) of 1.87 (95% C.I.; 1.28-2.73), 1.6 (95% C.I.; 0.99-2.63), 1.66 (95% C.I.; 1.14-2.42) and 2.66 (95% C.I.; 1.49-4.89) for self-medication encouragement tendency possible, restricting sale of OTC medications, the habit of reading drug leaflets and understanding the potentially harmful effects, with OTC drugs, respectively. Right-attitude participants showed an OR of 1.89 (95% C.I.; 1.29-2.80) and 1.8 (95% C.I.; 1.19-2.76) for identifying knowledge of acetaminophen overdose and liver damage link as well as the disease symptom masking possibility with OTC, respectively. Participants with insufficient knowledge and attitude scores showed an association with more OTC antacid-antiemetics and analgesic use, respectively.

CONCLUSION

Antenatal pregnant women need to be guided on avoiding OTC antimicrobial usage. Both obstetricians and regulators have to play an active role in educating pregnant women and contributing to developing country-specific OTC drug lists with the guidelines.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s13224-021-01481-2.

Parabens and bisphenol A and its structural analogues in over-the-counter medicines from China

Pharmaceuticals, such as over-the-counter (OTC) medicines, may be an important source of human exposure to several endocrine disruptors, though unnoticed to date. In the present study, we investigated the presence of six parabens and nine bisphenol A (BPA) and its analogues in OTC medicines manufactured in China. Parabens and bisphenols were present in more than 90% of the samples. The total measured concentrations of parabens and bisphenols were in the range of non-detectable (ND) to 213 ng/g and ND to 415 ng/g, respectively. Regarding parabens, methyl paraben (MeP) was the predominant analog, accounting for 43 ± 36% of the total amount, followed by ethyl paraben (EtP) (39 ± 35%), and others (< 10%). Bisphenol F and BPA were the predominant bisphenols, accounting for 24 ± 28% and 22 ± 26% of the total amount, respectively. The median values of estimated daily intakes (EDIs) of parabens and bisphenols were the highest for infants (2.96 and 3.14 ng/kg_bw/day, respectively) and the lowest for adults (0.69 and 0.25 ng/kg_bw/day, respectively); moreover, the EDIs of parabens and bisphenols were higher in Chinese patent medicines than in western pediatric medicines. The hazard quotient (HQ) for sum of MeP and EtP (∑(MeP + EtP)) and BPA in three age groups were within the safe zone (HQ < 0.0004). Monte Carlo simulation was applied to predict the human exposure risk of parabens and bisphenols. The predicted ranges of EDIs of parabens and bisphenols were much wider, and the extreme predicted values were observed in all four age groups, which were higher than the acceptable daily intake. The extreme predicted values of ∑(MeP + EtP) and BPA were indicative of carcinogenic risk in toddlers. These results implied potential risks for the Chinese people existed. Considering the huge export of Chinese traditional medicines and western medicines worldwide, and easy access to OTC medicines for the general population, the presence of parabens, bisphenols, and other environmental contaminants in medicines still need to be monitored.

Prescribing over-the-counter medication in an OMFS department: a service review

In 2018, NHS England released guidelines restricting the prescription of over-the-counter medicines (OTC). This was a project initially targeted at primary care, but we felt that it could also be used to improve services in secondary or tertiary care. We were interested to investigate our OTC prescribing pattern within a busy maxillofacial department and therefore carried out a service review. All outpatient prescriptions were reviewed between October 2017 and October 2018. The review was then repeated between October 2018 and October 2019. All OTC medications prescribed during these periods and their costs to the Trust were highlighted. Our aim was to improve prescribing patterns based on current guidelines and reduce the departmental spend in this area. The first year of data revealed that a total sum of £2742.75 was spent on OTC medications. Those most frequently prescribed were Difflam™ (Mylan) mouthwash and spray; chlorhexidine mouthwash, and miconazole oral gel. The findings of the service review indicated deficiencies in knowledge with regards to prescribing appropriately. Following departmental training the amount spent reduced from £2742.75 to £1312. There is a need to educate nationally to reduce spending on OTC medications, which would help to relieve financial pressures on other NHS services. As a department, we can also hope for further improvement.

Prevalence of homeopathy use by the general population worldwide: a systematic review

AIM

To systematically review surveys of 12-month prevalence of homeopathy use by the general population worldwide.

METHODS

Studies were identified via database searches to October 2015. Study quality was assessed using a six-item tool. All estimates were in the context of a survey which also reported prevalence of any complementary and alternative medicine use.

RESULTS

A total of 36 surveys were included. Of these, 67% met four of six quality criteria. Twelve-month prevalence of treatment by a homeopath was reported in 24 surveys of adults (median 1.5%, range 0.2-8.2%). Estimates for children were similar to those for adults. Rates in the USA, UK, Australia and Canada all ranged from 0.2% to 2.9% and remained stable over the years surveyed (1986-2012). Twelve-month prevalence of all use of homeopathy (purchase of over-the-counter homeopathic medicines and treatment by a homeopath) was reported in 10 surveys of adults (median 3.9%, range 0.7-9.8%) while a further 11 surveys which did not define the type of homeopathy use reported similar data. Rates in the USA and Australia ranged from 1.7% to 4.4% and remained stable over the years surveyed. The highest use was reported by a survey in Switzerland where homeopathy is covered by mandatory health insurance.

CONCLUSIONS

This review summarises 12-month prevalence of homeopathy use from surveys conducted in eleven countries (USA, UK, Australia, Israel, Canada, Switzerland, Norway, Germany, South Korea, Japan and Singapore). Each year a small but significant percentage of these general populations use homeopathy. This includes visits to homeopaths as well as purchase of over-the-counter homeopathic medicines.

Pharmacy students' use and views on over-the-counter (OTC) medicines: a questionnaire study

INTRODUCTION

The role of the pharmacist centers on ensuring the safe and effective use of medicines, including over-the-counter (OTC) medicines. It is important to ascertain pharmacy students׳ use and opinions on OTC medicines, given that they are the pharmacists of the future and that this market continues to expand. This study aimed to investigate Queen׳s University Belfast (QUB) final-year pharmacy students׳ use and views on OTC medicines. Scarce work has been conducted in this area to date.

METHODS

Following ethical approval and a pilot study, all students (n = 155) were invited to participate in a self-completed questionnaire (n = 20 questions), distributed at a mandatory class. Descriptive statistics and non-parametric tests (Chi-squared and Mann-Whitney U test) were used for data analyses.

RESULTS

The response rate was 99.4% (154/155). The majority (153/155) reported using OTC medicines; the key consideration during personal product selection was effectiveness. Most [96.1% (147/153)] were in agreement that safety was the over-riding concern during OTC consultations. While 96.1% (149/155) considered that using an evidence-based approach improved the quality-of-patient care, 68.0% (104/153) would be prepared to sell a product that lacks evidence of effectiveness, provided it would not cause harm.

CONCLUSIONS

The importance of evidence of effectiveness was acknowledged, yet many students in this study were prepared to recommend unproven products. Further strategies are required at QUB to ensure this routine consideration alongside safety in practice.

Assessing the relationship between pharmacists' job satisfaction and over-the-counter counselling at community pharmacies

BACKGROUND

Community pharmacies have an increasing role in self-medication and community health is dependent on the quality of counselling services provided to patients. Some studies show that pharmacists' job satisfaction affects their work quality; other studies found that higher involvement in clinical services increases pharmacists' job satisfaction.

OBJECTIVE

To test the relationship between job satisfaction and over-the-counter counselling practice at community pharmacies.

SETTING

Community pharmacies in Lithuania.

METHOD

A convenience sample (n = 305) of community pharmacists participated in the cross-sectional survey where they expressed satisfaction with job and reported on their over-the-counter counselling behaviour on self-report scales. The Partial Least Squares Structural Equation Modelling approach was employed for data analysis.

MAIN OUTCOME MEASURE

The strength of the relationship between job satisfaction and over-the-counter counselling service.

RESULTS

A bidirectional relationship between job satisfaction and over-the-counter counselling service was found. In addition, job satisfaction and over-the-counter counselling quality depended on pharmacists' age.

CONCLUSION

Organizations were recommended to create a counselling friendly environment that would increase pharmacists' job satisfaction and, in return, counselling quality. Also, additional motivation of the retired pharmacists, as well as development of counselling skills of the younger pharmacy workforce, were seen as a means to improve both organizational climate and counselling quality over the counter.

Prevalence and pattern of self-medication in Karachi: A community survey

Objective:

To study the prevalence and pattern of self-medication among adult males and females in Karachi, Pakistan.

Methods:

This cross-sectional community- based survey was carried out at five randomly selected towns of Karachi (Defence, Gulshan-e-Iqbal, North Nazimabad, Malir, Orangi town) over a period of 3 months (October, November & December 2012). A sample size of 500 adult cases (250 males & 250 females), with systemic random selection from different towns of Karachi were inducted in this study. The city was divided in 5 zones and one town from each zone was selected by systemic randomization. First available male and female from each randomly selected house were included in the study. After consent and confidentiality assurance they were interviewed on semi-structured Performa designed for this purpose. Results were analyzed and tabulated through SPSS v14.0.

Result:

The prevalence of self-medication in males and females in Karachi is found to be 84.8% (males 88.4% and females 81.2%). The most frequent symptoms for which self-medication used were headache (32.7%), fever (23.3%) and the medicines used were painkillers (28.8%), fever reducer medicines (19.8%). The most common reason 33.3% was previous experience with similar symptom.

Conclusion:

Self-medication is highly prevalent (84.8%) in Karachi. It was frequently used for headache followed by fever. Predominantly painkillers, fever reducer and cough syrups were used in the form of tablets and syrups. Main source of medicines for males were friends and for females were relatives.

"So they believe that if the baby is sick you must give drugs…" The importance of medicines in health-seeking behaviour for childhood illnesses in urban South Africa

A mixed method approach was used to investigate the treatment of childhood illnesses in Johannesburg and Soweto. In 2004, in-depth interviews were held with caregivers (n = 5), providers of traditional (n = 6) and Western (n = 6) health care, as well as 5 focus groups with black caregivers of children under 6 years. An utilisation-based survey was conducted with 206 black caregivers of children under 6 years of age at 1 public clinic in Soweto (n = 50), 2 private clinics (n = 50) in Johannesburg, 2 public hospitals (n = 53) from Johannesburg and Soweto and 2 traditional healers (n = 53) from Johannesburg and Orange Farm, an informal settlement on the outskirts of Johannesburg. Caregivers reported how they would respond to 4 common child health problems. Home treatments would be a common first resort particularly for diarrhoea (79%, mostly salt and sugar solution) and constipation (53%). In the case of constipation, the spuit [enema] was cited as a particularly effective home treatment method, particularly amongst TMP patients. Approximately 50% of caregivers would access a health care provider as a first resort for coughs. OTC medicines are commonly used for fever (63%), less-so for coughs (37%). Overall, higher SES respondents would be more likely to use over-the-counter (OTC) medicines and less likely than other groups to use home treatments. Shortages of medicines at clinics and caregiver beliefs about the efficacy of medicines affect health-care seeking behaviour. Medicines are not always used as intended or according to instructions and some products such as household detergents may be used medicinally. As well as the need for improving facility-readiness for delivering IMCI (Integrated Management of Childhood Illnesses), the patient-provider relationship is instrumental in improving the treatment of childhood illnesses.