The Use of Over the Counter (OTC) Medications by University Students

During Examinations in Afghanistan: A Cross-Sectional Study

Introduction

Self-medication or over the counter (OTC) medicines are those which are sold legally without

approval of an authorized health professional to treat self-diagnosed diseases or indications. OTC

drugs usage is a prevalent habit, both in developed and developing countries and use even more

than prescribed medicines (Orayj et al., 2021; Parikh et al., 2013; Shehnaz et al., 2013;

Tesfamariam et al., 2019). These drugs thought to be safe and it remove the need to visit the

doctor and save money (Chua & Sabki, 2011; Orayj et al., 2021; Tesfamariam et al., 2019). Their

commonly usage is to treat illnesses that do not need immediate medical care or monitoring, and

they must be shown to be fairly safe and well-tolerated (Orayj et al., 2021; Parikh et al., 2013).

Due to research from various nations, study groups with varying demographic features, variable

definitions of terms utilized, and the length of the recall interval, the usage of OTC drugs differ

from 30-97% across different nationalities (Chua & Sabki, 2011). Only in the U.S, there are over

300,000 OTC medicines accessible (Parikh et al., 2013).

Despite their many advantages, misuse of the OTC medications can be harmful to one's

health and life, particularly for those with chronic diseases, pregnant and nursing women, and

patients at the extremes of age (pediatrics and geriatrics) (Bekele et al., 2020; Orayj et al., 2021;

Tesfamariam et al., 2019). Having prescription is unusual for the OTC drugs, where socio-

economic concerns are the main cause to enforce people to use OTC drugs (Almalak et al.,

2014). Increased improper usage of OTC drugs is becoming a public health problem across the

world (Parikh et al., 2013; Tesfamariam et al., 2019). Therefore, improving the peoples’
awareness and knowledge of using safe drugs is critical for the individuals health care (Orayj et

al., 2021).

Both individuals and communities tremendously affected by these medications

(Macdonald, 2008; Orayj et al., 2021). Afghanistan is well-known for its heavy usage of over-

the-counter medications, as due to poverty and lack of knowledge about adverse effects,

inappropriate self-treatment is becoming a big public health concern (Gobar, 1976; Macdonald,

2008). Antibiotic resistance, long-time self-medications such as using of potent painkillers, and

tranquilizers are one of the biggest concerns of ministry of public health (MoPH) of Afghanistan

(Emro, 2017; Macdonald, 2008). Due to improper prescriptions, low quality of the medications

and long-term self-treatments, most of households spend 9-26 % of their incomes in health-care

issues (Paterson & Karimi, 2005).

Based on National Licensed Medicine List of Afghanistan there are around 85 types of

drugs that the MoPH Afghanistan announces as OTC medications (Products, 2018). Decades of

war related poverty, social dislocations, lack of knowledge about side effects of OTC drugs, and

chronic mental health difficulties such as anxiety, depression, sleeping abnormalities, and

posttraumatic stress disorder with symptoms suchlike rage, obtrusive memories, impatience, and

difficulty to concentrate are the main contributing factors to enforce people to use OTC drugs

(Macdonald, 2008). According to the US Special Inspector General for Afghanistan

Reconstruction (SIGAR), the latest World Bank findings shows that 72% Afghan population are

living under poverty line (Group, 2021). Even people, those who are unable to visit a qualified

doctor or public health clinics are not available, they go to the pharmacy or even street sellers for

both, diagnosis and treatment (Paterson & Karimi, 2005).

 Teenage is a critical term of a person's life when they take their first efforts toward self-

care and treatment. These health-care behaviors may be maintained into maturity, and they may

engage in independent health behaviors such as misuse of OTC medications (Shehnaz et al.,

2013). Of the 31.6 million population of Afghanistan, 48% of them are under 15 (Abdul Subor

Momand, 2020) and 62% of them are under 35 years age. This study also found that 60-62% of

the population were illiterate and have no reading capability (Kovess-Masfety et al., 2021).

Based on data from 2013, enrollment rate to public universities was 135,000 (Babury &

Hayward, 2013). According to the U.S. Agency for International for Development initiatives

(USAID), as of now around 300,000 students are studying at public and private universities in

Afghanistan ( U.S. Agency for International for Development initiatives).

Still there is a big gap to find how many people are addicted to use OTC medications

among Afghan people and university students at all. In this study we want to find the percentage

of university students they got habit to use OTC medications during semester exams.

Materials and Methods

Study Design and Study Area

This is a descriptive, Cross-sectional, questionnaire-based study, will conduct among

undergraduate students within 20 July 2021 until 20 August 2021 during there the semester exam

at public and private universities in Afghanistan.

Study Population and Sample Size Calculation

While finding reliable statistics is difficult in Afghanistan, therefore, the prevalence of self-

medication is assumed to be 60%. The margin of error was set to be 5%, with the confidence
interval (CI) of 95%, and 5% precision or absolute error (d). The sample size was calculated as

follows:

Sample Size = Z1-α/22 p(1-p)/d2

Z1-α/2 = Is standard normal variate at 5% type I error (P<0.05) it is 1.96.

p = Expected proportion in population based on previous studies or pilot studies.

d = Absolute error or precision.

Sample Size = 1.962 x 0.60 (1-0.60)/0.052 = 3.8416 x 0.60 (0.4)/0.0025

Based on these assumptions, a minimum sample size of 369 students, both male and female,

from medical and non-medical colleges, was required for this study.

Study Tool and Data Collection

This study's questionnaire was derived from earlier research (Bekele et al., 2020; Orayj et al.,

2021).
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