A community based study on self-medication practices

ORIGINAL ARTICLE
A community based study on self-medication practices in urban settings of
Jamnagar, Gujarat
Patel Parita1*, Patel Nisarg2 , Solanki Dipak3
1
Tutor, GMERS Medical College, Sola, Ahmedabad
2
MS Obstetrics & Gynaecology
3
Professor & Head, GMERS Medical College, Gotri, Baroda

ABSTRACT
BACKGROUND: According to World Health Organization (WHO) self-medication is the selection and use of
medicines by individuals to treat self-recognized illness or symptoms. Considering the hazards of irrational use of
drugs under self-medication, this study aimed to study self-medication and its practices in urban community. Aims
and objectives: To 1) measure the prevalence of self-medication practices. 2) Study socio-economic and
demographic factors influencing self-medication practices and 3) Study the outcome of self-medication practices.
MATERIALS AND METHODS: A cross-sectional community based study was carried out between June - Dec
2010 in an urban area of Jamnagar in a sample of 450 adults (aged 18 years & above). RESULTS: Based on recall
of last 6 months, self-medication prevalence was 64.2%. 78.6 % study subjects used allopathic drugs and 26.0%
used household drugs. Self -medication for homeopathic or Ayurvedic drugs was from minimal to nil. Most
common conditions for which self-medication were practiced were common cold (48.8 %), Cough (31.1%),
headache (20.4%), fever (14.5%) and body-aches (10.0%). Non-steroidal anti-inflammatory drugs (NSAIDs)
(49.1%) were the most commonly used drugs followed by household remedies (23.9 %) like milk with turmeric
powder, ginger, honey, tulsi, steam inhalation, etc. CONCLUSION: Self-medication practice was widely
prevalent for allopathic and household medicines and observed mainly in common type of sicknesses and not for
serious illnesses. “Doctor’s advice is not needed for minor illnesses” was a widely prevalent belief in this study.
General population need to be educated about the dangers of indiscriminate use of drugs happens more under the
practice of self-medication.

Key Words: Self-medication, Allopathic drugs, Household remedies, Non-steroidal Anti-inflammatory drugs.

INTRODUCTION wishers etc. The decision for self-medication

“Medicines are nothing in themselves, but are
the very hands of god if employed with reason &
prudence” Herophilus, Alexandrian physician
(300 B.C).
Self-medication is an age old practice.
According to World Health Organization
(WHO) self-medication is the selection and use
of medicines by individuals to treat self-
recognized illness or symptoms. For the purpose
of this definition, medicines also include herbal
and traditional products.1 Urge of self care,
feeling of sympathy towards family members in
sickness, lack of health services, poverty,
extensive advertisement/availability of drugs in
other than drug shops are responsible for
growing trend of self-medication. It is said that
every patient has at least two prescribers; his
own doctor and himself, while many have
additional prescribers in the form of friends, well
*
Corresponding Author:
Parita Patel,
Turor, Department Of Community Medicine,
GMERS Medical College, Sola,
Ahmedabad
Email: dr.dhyanp@gmail.com
40 Int J Int Med Res. 2015; 2(4):40-45
may be influenced by different factors (cultural,
economical, psychosocial, etc.) that culminate in
the utilization of various therapeutic approaches
in searching for a relief.
Self-medication is widely practiced in both
developing2-7, as well as developed countries.8-14
In developing countries like India, easy
availability of a wide range of drugs with
inadequate health services result in increased
proportions of drugs used as self-medication.
Availability of large number of over-the-counter
(OTC) drugs with proven efficiency and safety
(?) further increase the trend of self-medication.
Development of antimicrobial resistance
following the self-medication with antimicrobial
agents15 is an undesirable outcome associated
with self-medication. In India prevalence of self-
medication was found 37% in urban and 17% in
rural population.16
As on today, there is no information with regards
to self-medication in the study area. Considering
the hazards of irrational use of drugs as self-
medication this study aimed To1) measure the
prevalence of self-medication practices, 2) study
socio-economic and demographic factors
e ISSN: 2393-9869 p ISSN: 2350-0360
 A community based study on self-medication practices
influencing self-medication practices and 3)
study the outcome of self-medication practices.
MATERIALS AND METHODS
A community based cross-sectional study was
conducted in an urban area of Jamnagar district
in Gujarat to measure the prevalence of self-
medication practices. Study was done from June
2010 to December 2010 and participants were
adult male & female aged 18 years and above.
Participants below 18 years of age were
excluded as they were minor because they had
limited practice of self-medication and unable to
give consent to participate.
Prevalence of self-medication in different studies
vary between 15% - 80%.17 - 22 Sample size for
the study was calculated with 50% as anticipated
p23 with 10% allowable error at 95% level of
significance. Sample size was 400; considering a
non-response rate of 12.5 %, final sample size
decided for the study was 450.
Sampling Technique: Study was undertaken in
the Patel Colony (a prototype of urban society
and hence selected purposively). Houses were
selected by systemic random sampling (every
10th house) and one elder member per family
was selected as a respondent. Pre-tested semi
structured proforma was used for the study &
information was collected through oral
questionnaire method.
Inclusion Criteria: All individuals aged ≥18
years with history of any illness in last six
months for ensuring better reliability. Exclusion
Criteria: Those taking alcohol and the
occupational groups like doctors or health
workers were excluded.
Data entry and analysis were done using the
Microsoft excel 2007. Statistical tests such as
Chi-square test were applied wherever required.
Ethical Issues: Ethical clearance from the
Institutional Ethical Committee was obtained
before conducting the study. All the study
individuals were explained the purpose of study
and verbal consent was taken.
RESULTS
Data was collected from all 450 subjects as there
was no refusal. Amongst them 46.7% were from
18-35 years age group followed by 36.6% from
36-55 years age group and 16.9% from 55 years
and above age group. Further amongst them,
52.9% were females and 47.1% were males.
64.7% study subjects were graduates and above,
28.9 % were educated up to secondary/higher
41 Int J Int Med Res. 2015; 2(4):40-45
secondary level and only 2.4% were illiterate.
36.4% study subjects were in various kinds of
jobs, 35.6% were housewives, 13.6% subjects
were in business and 7.3% study subjects were
unemployed/retired. Based on Modified B. G.
Prasad’s socio-economic classification method24,
61.3% study subjects were in social class I
followed by 35.6% in class II and only 3.1%
from class III & IV. None of the subject
belonged to social class V.
Based on the recall of practices in last 6 months,
overall prevalence of self-medication in this
study was 64.2% while rest consulted a doctor
for any illness which they suffered in last six
months.
78.6% study subjects used Allopathic drugs for
self-medication. 26.0% study subjects used
household drugs and 10.7% used Ayurvedic
medicines. Few individuals used a combination
of drugs of Allopathic, Ayurvedic and household
remedies but none of the individuals used herbal
or homeopathic medicines for self-medication.
Almost all (93.7%) study subjects practiced self-
medication orally, 8.0% used locally applicable
drugs while 2.1% study subjects used both
routes of medication. None of the subject used
any parenteral drug as self- medication. Self-
medication was practiced for common cold
(48.8%), cough (31.1%), headache (20.4 %),
fever (14.5%), body-ache (10.0%) diarrhea
(3.8%), constipation (2.7%) and vomiting
(2.0%). Commonly used drugs for these
conditions are shown in Table 1.
Table 1: Conditions and used drugs
Conditions
Most commonly used
drugs
Chlorpheniramine Maleate,
Common cold
Cetirizine
Syrups containing
Dextromethorphan,
Cough
Chlorpheniramine Maleate,
Menthol
Headache Paracetamol, Ibuprofen
Fever Paracetamol
Bodyache Combiflam or Diclofenac
L Loperamide, Norflox-TZ,
Diarrhea
Ofloxacin, ORS powder
Constipation Triphala
Vomiting Domperidone
Amongst the drugs used as self-medication, non-
steroidal anti-inflammatory drugs (NSAIDS)
were the most commonly used drugs (49.1%)
followed by household remedies (23.9%) like
milk with turmeric powder, ginger, honey, tulsi,
vicks inhaler, steam inhalation, fenugreek etc.
The anti-histaminic drugs were used by 21.8%
e ISSN: 2393-9869 p ISSN: 2350-0360
 A community based study on self-medication practices

and Ayurvedic drugs by 10.73% study subjects. subjects, previous family practices (32.2%),
10.4% study subjects used anti-acidity drugs. advice from Pharmacist for 21.5% of subjects,
Locally applicable ointments like Moov, Volini advertisements of the medicine on the television,
were used by 8.7% study subjects. [Table 2] radio, news papers, magazines, banners or on the
Table 2: Distribution of the study subjects internet (9.3%). [Figure 2]
according to commonly used drugs for self-
medication (n = 289)*
Drugs/medicines/remedies Frequency Percentage
Non-steroidal anti-
inflammatory drugs 142 49.13
(NSAIDs)
House-hold remedies 69 23.88
Anti-histaminic drugs 63 21.80
Ayurvedic drugs 31 10.73
Anti-acidity drugs 30 10.38
Local application drugs 25 8.65
Antidiarrhoel drugs 9 3.11
Anti-emetic drugs 6 2.08
Anti-biotic drugs 4 1.38
*Multiple responses
As for the factors leading to self-medication,
most common reason was “Doctor’s advice is
not needed for minor ailments” (97.9%)
followed by “Left over medicine previously
used for the similar illness” (44.3%), “lack of
time to visit doctor” (25.6%), “saving of money”
(10.4%), “embarrassment issue”(8.7%) and
“non-availability of health facility in nearby
areas”(4.2%). Other factors were “for initial 1-2
Precautions taken before self-medication were
days of illness only” and “in emergency
“noting the expiry date of drug”(86.9%), “not
conditions only.e.g.at night” (3.1%). (Figure 1)
taking drugs on the empty stomach” (78.2%),
“noting the general condition of the drug”
(65.7% ) and “to be careful about the dose and
side effects of the drugs” (10.6%). 35.6% study
subjects had correct knowledge about the dose of
the drugs, 20.8% subjects had about indication
of drugs, 19.0% subjects had about side effects,
while 17.3% subjects had about the duration of
treatment. Only 4.2% subjects had correct
knowledge about above mentioned four
characteristics of the drugs. 51.6% study
subjects responded that they were relieved of the
symptoms after taking/applying the drug (self-
medication); rest got either no relief/ partial
relief. Out of them, 37.0% study subjects needed
to change the drug because of partial relief while
11.4% study subjects needed to change the drug
because of no relief.
Out of 289 study subjects, 25 (8.7%)
experienced side/adverse effects; most common
The most common source of information for being acidity (48.0%), sedation (28.0%), nausea
self-medication was previous prescription by a (20.0%) and skin reaction (4.0%).
doctor for similar complaints (62.3%), 64.2% study subjects opined that the “Self-
friends/relatives/neighbors for 35.6% of study medication is best possible medication for minor

42 Int J Int Med Res. 2015; 2(4):40-45 e ISSN: 2393-9869 p ISSN: 2350-0360
 A community based study on self-medication practices

illnesses”. 35.8% study subjects opined that self- males (56.1%) and the association here too was
medication should not be practiced. 4.0% study statistically significant. A statistically significant
subjects had other opinions like “It should be upward trend was seen between the level of
used only for minor illnesses, during odd hours education and self-medication practices; highest
like at night-time” and “Only for initial 1-2 (68.4%) being in those who were graduates and
days”. [Table 3] above. Further self-medication practices were
Table 3: Distribution of study subjects more in class I (66.7%) and class II (63.1%)
according to opinion about self-medication compared to Class III & IV (28.6%) and the
(n = 450)* association was statistically significant.
Opinion Frequency Percentage A gradient was also seen between education of
Self-medication is best possible
medication for minor illnesses
289 64.22 the subjects and precautions taken before self-
One should have sufficient medication. Such precautions were high in
knowledge about dose and 270 60.00 graduates and above (95.0%) and low in
duration of drugs illiterate study subjects (25.0%) and difference
One should at least have sufficient
knowledge about side effects of 266 59.11 was statistically significant ( 2 = 39.52, df = 5, p
drugs = < 0.0001). Precautions taken were high in
Self-medication should not be social class I (93.8%) and class II (85.5%)
161 35.78
practiced.
Other 18 4.00 compared to class III and IV (41.7%) and
*Multiple responses association was statistically significant ( 2 =
Prevalence of self medication was studied with 30.619, d.f. = 2, p = < 0.0001).
relation of certain demographic characteristics DISCUSSION
such as age, gender, education, and social class In the present study prevalence of the self-
(Table 4). medication was 64.2%. In a study from Western
Table 4: Association of self medication Nepal18 59.0% had some form of self-medication
practices with certain demographic factors during the same period of recall. Yet another
Total Those with study from an urban slum community in India 25
Statistical
Factor
Subjects self
Interpretation in 2011, the prevalence of self medication was
(N = medication
55.9%. Reasons for variations may be due to
450) No. % differences in education, socio-economic status,
Age (In years) non-availability of medical facilities, easy
18 – 35 210 150 71.43 availability of drugs and faith in traditional
2 = 10.229,
36 – 55 164 91 55.49 d.f. = 2, system.
>55 76 48 63.16 p = 0.0060 In the present study self-medication was
Sex practiced maximally for allopathic drugs
Male 212 119 56.1 2 = 10.762, followed by household drugs and Ayurvedic
d.f. = 1, medicines. Few individuals used combination of
Female 238 170 71.4 p = 0.0010
Literacy status
above groups of remedies but none used herbal
Illiterate 11 4 36.7 or homeopathic medicines for self-medication.
Primary 18 10 55.6 In a study conducted amongst professional
Secondary 82 48 58.5 2 = 15.669, students in North India in 2010, allopathic drugs
Higher d.f. = 5,
Secondary
48 28 58.3 p = 0.0079 for self-medication were used by 80.1%,
Graduate 247 199 65.2 Ayurvedic, homeopathic and unani drugs were
Postgraduate 44 38 86.4 used by 11.7%, 20.8% and 2.6% subjects
Social Class
respectively. 26
I 276 184 6d6.7 In this study most individuals who practiced
2 = 8.628,
II 160 101 63.1 d.f. = 2, self-medication believed that the “Doctor’s
III & IV 14 4 28.6 p = 0.0134 advice is not needed for minor ailments.” or
A statistically significant association between “Left over medicine previously used for the
age and self-medication practices was found similar illness”. In another study 26 reasons for
with the highest prevalence of self-medication in self-medication were saving of time (45.0%),
age group of 18-35 years. Self-medication was economical (23.4%), no need to visit doctor for
more in the females (71.4%) as compared to minor illnesses (12.6%), unavailability of doctor

43 Int J Int Med Res. 2015; 2(4):40-45 e ISSN: 2393-9869 p ISSN: 2350-0360
 A community based study on self-medication practices
(11.3%), quick relief (6.9%), ease and
convenience (5.6%). Common conditions for
which self-medication was practiced in the
present study were common cold, cough,
headache, fever and body-aches. In a recent
study in Maharashtra 27 Diarrhea, sore throat and
common cold were the conditions where the
self-medication was commonly practiced.
NSAIDS were the most commonly used drugs in
the present study followed by household
remedies (milk with turmeric powder, ginger,
honey, tulsi, steam inhalation, fenugreek etc.),
anti-histaminic drugs, Ayurvedic drugs, anti-
acidity drugs. In a study conducted 26 in Punjab,
most frequently used class of drug for self
medication was also NSAIDs (Paracetamol,
Ibuprofen & Diclofenac) for treatment of fever,
body ache, head ache etc. 62.0% of the
population prefer kitchen medicines (household
remedies) for the chronic illnesses like joint
pain, asthma, obesity, baldness etc.
Common sources of information in the present
study about self-medication were previous
prescription by a doctor for similar complaints,
friends/ relatives/ neighbors, previous family
practices, advice from Pharmacist and
advertisements of the medicine. A study from
South India 28, also found doctors’ prescriptions
provided during their prior illness as commonest
source for self-medication followed by advice
from Pharmacist, friends, advertisements/ books.
In the present study most of the study subjects
(86.9%) had taken precaution of “noting the
expiry date of the drug” before self-medication
while 11.8% did not take any kind of precaution
before practicing self-medication. In a study
from urban slums25, 21.4% respondents checked
for expiry date of the drugs before using them.
When viewed with relation of various
demographic determinants in the present study,
self-medication was more prevalent in
youngsters (< 35 years), females, literates and
those from upper social class (social class I &
II); everywhere the differences being statistically
significant. Study from urban community,
prevalence was significantly more amongst
young adults and females. According to them 25,
this might be due to their restricted movement
and a secondary status in the household leading
to self medication. Better awareness/ knowledge
of the adults and females about the home
remedies or lack of time to visit a doctor or
44 Int J Int Med Res. 2015; 2(4):40-45
confidence about the treatment of minor
ailments with self-medication were other
explanations mentioned. Another study
29
conducted from Punjab in 2011 reported a
trend towards self-medication high in educated
population because of more knowledge,
awareness, information etc. Self-medication
prevalence and observance of precautions were
higher in class I and II because of higher
literacy, knowledge, information etc. Self-
medication practice was widely prevalent both
for allopathic and household medicines and
observed mainly in common type of sicknesses
and not for serious illnesses.
General population should be educated about the
dangers of indiscriminate use of drugs.
Secondly, the physicians should be more
judicious in prescribing and must insist on drugs
being supplied by the chemist only on a valid
prescription. Thirdly, a proper statutory drug
control must be implemented, rationally
restricting the availability of drugs to the public.
These three measures would definitely reduce the
incidence of drug-related mishaps and help in
maintaining good health of the individual and
society.
Acknowledgement
Authors are thankful to all the respondents for
their response, co-operation and sparing their
valuable time during data collection. They are
further thankful to Dr. Pradeep Kumar Professor
& Head, Community Medicine Department,
GMERS Medical College, Sola, Ahmedabad for
reviewing the entire manuscript and making
useful suggestions.
REFERENCES
1. World Health Organization. The role of the
pharmacist in self-care and self-medication.
Report on the 4th WHO Consultative Group
on the Role of the Pharmacist.
WHO/DAP/98.13. WHO, Geneva,
Switzerland. 1998. As available from,
http://www.who.int/medicinedocs/pdf
/whozip32e/whozip32e.pdf.
2. Saeed AA. Self medications among primary
care patients in farazdak clinic in Riyadh. Soc
Sci Med, 1988; 27:287-289.
3. Quah SR. Self medication in Singapore.
Singapore Med J, 1985; 26:123-29.
4. Greenhalgh T. Drug prescription and self
medication in India. An Exploratory survey.
Soc Sci Med, 1987; 25:307-18.
e ISSN: 2393-9869 p ISSN: 2350-0360
 A community based study on self-medication practices
5. WHO. Self medication and its impact on
essential drugs schemes in Nepal. Action
Programme on essential drugs
WHO/DAP/93.10, Geneva, 1993.
6. Deressa W, Ali A, Enqusellassie F. Self-
treatment of Malaria in rural communities,
Butajira, southern Ethiopia. WHO Bulletin,
2003; 81(4):261-68.
7. Stein CM, Gora NP, Macheka B.M. Self-
medication with Chloroquine for malaria
prophylaxis in urban and rural
Zimbabweans. Trop Geogr Med. 1988;
40:264-68.
8. Tse M.H, Chung J.T, Munro J.G. Self-
medication among secondary school pupils
in Hong Kong: a descriptive study. Fam
Pract 1989; 6:303-06.
9. Kitaw Y. Self-care: A study of three
communities in Ethiopia. Ethiop J Health
dev, 1987; 2(2):45-7.
10. Teklehaymanot T, Giday M. Ethnobotanical
study of medicinal plants used by people in
Zegie Peninsula, Northwestern Ethiopia.
Journal of Ethnobiology and Ethnomedicine
2007; 3(12):1-11.
11. Kloos H, Etea A, Degefa A. Illness and
behavior in Addis Ababa and rural central
Ethiopia. Soc sci Med, 1987; 25:1003-09.
12. Lam C.L.K, Tse M, Munro C.A. Study on
Practice of self medication in Hong Kong.
H.K.Pract, 1989; 11(6):272-86.
13. Antonio I, De Loyola Filho, Maria Fernanda
Lima-Costa, Elizabeth Uchoa, Bambui
project: A qualitative approach to self
medication. Cad Saude Publica, Rio de
Janeiro, 2004; 20(6):1661-69.
14. Chandra S, Rajinder K, Raina MB. Some
aspects of drug use in Ethiopia. Tropical
Doctor, 1981; 11:116-8.
15. Antimicrobial resistance. As available from,
http://www.who.int/mediacentre/factsheets/f
s194/en
16. Dineshkumar B, Raghuram T.C, Radhaiah
G, Krishnaswamy K. Profile of drug use in
urban and rural India. Pharmacoeconomics,
1995; 7:332-46.
17. Afolabi AO. Factors influencing the pattern
of self-medication in an adult Nigerian
population, Annals of African Medicine
2008; 7(3): 120-127.
18. Shankar P.R, Partha P, Shenoy N. Self-
medication and non doctor prescription
45 Int J Int Med Res. 2015; 2(4):40-45
practices in Pokhara valley, Western Nepal;
A questioner based study. BMC Fam Pract
2002; 3:17.
19. Durgawale P.M. Practice of self-medication
among slum-dwellers. Indian J
Public Health 1998; 42(2):53-5.
20. Phalke V.D, Phalke D.B, Durgawale P.M.
Self-medication practices in rural
Maharashtra. Indian J Community Med
2006; 31(1):34-5.
21. Lal V, Goswami A, Anand K. Self-
medication among residensts of urban
resettlement colony, New Delhi. Indian J
Public Health, 2007; 51(4):249-51.
22. Solomon Worku, Abebe G/Mariam. Practice
of Self‐medication in Jimma
Town. Ethiop.J.Health Dev.2003;
17(2):111‐116.
23. Sample size determinations in health studies
A practical manual S. K. Lwanga
and S. Lemesho; World Health Organization
Geneva
24. Sunderlal, Adarsh, Pankaj; Textbook of
Community Medicine; 3rd Edition
25. Pankaj Gupta, Prateek S. Bobhate, Saurabh
R. Shrivasta. Determinants of self-
medication practices in an urban slum
community. Asian Journal
Pharmaceutical and Clinical Research, 2011,
Vol. 4, Issue 3 ISSN - 0974-2441.
26. Rohit K Verma , Lalit Mohan, Manisha
Pandey. Evaluation of self medication
among professional students in North India:
proper statutory drug control must
be implemented. Asian Journal of
Pharmaceutical and clinical research; Jan-
May 2010, Vol 3(1)
27. S Bang, Smita Sontakke, Vijay Thawani. Pre
and post-interventional pattern of
self-medication in three common illnesses in
staff of a tertiary hospital, Indian J
Pharmacol. 2011; 43(3): 275-7.
28. S.Kayalvizhi and Dr. R. Senapathi.
Evaluation of the perception, attitude and
practice of self-medication among business
students in 3 selected cities, South
India. International journal of Enterprise and
Innovation management studies
Vol. 1 No.3
29. Shveta S, Jagmohan S. A study of self
medication pattern in Punjab. Indian
Journal of Pharmacy Practice; 2011; 4(2)
e ISSN: 2393-9869 p ISSN: 2350-0360