assessment of self-medication practices in assendabo town, jimma zone, southwestern ethiopia

Available online at www.sciencedirect.com

Research in Social and

Administrative Pharmacy 5 (2009) 76–81

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

Sultan Suleman, M.Sc., B.Pharm.a,*, Admasu Ketsela, B.Pharm.a,Zeleke Mekonnen, M.Sc., B.M.L.T.b

aSchool of Pharmacy, Jimma University, EthiopiabSchool of Medical Laboratory Technology, Jimma University, Ethiopia

Abstract

Background: The actions taken for the treatment of illness or symptom of an illness vary depending on the

perceptions and experiences of individuals and other factors. A significant portion of all care in illness isself-care. In many cases, self-medication is an important initial response to illness. Although some health-care providers attach negative connotations to it, the World Health Organization acknowledges the exis-

tence of a valid role of self-medication.Objective: This study was aimed at assessing the magnitude, type, and factors of self-medication inAssendabo town, Jimma, southwestern Ethiopia.

Methods: A community-based cross-sectional study was conducted in Assendabo town during Februaryand March 2006. Open-ended questionnaire was used to collect data by interviewing heads of householdsin the study population. The data collected were properly screened before they were analyzed.

Results: A total of 242 households with 1257 individuals were visited, of which 143 (11.4%) reported atleast 1 episode of illness and of whom 56 (39%) used self-medication using both modern pharmaceuticalsand traditional medicines. Low severity of illness was a major reason for practicing self-medication; 80.6%of self-medicating individuals had no information on potential drug adverse effect. About 55% of ill

persons who treated themselves reported improvement in their condition.Conclusions: There is high prevalence of self-medication in Assendabo town. Lack of drug information andaccessibility to over-the-counter drugs without any health professional guide contributed to the high

incidence of self-medication. Enforcement of regulations in drug distribution and provision of appropriatehealth education to the community at large is critical.� 2009 Elsevier Inc. All rights reserved.

Keywords: Self-medication; Illnesses; Drugs; Traditional medicine

Introduction

Illness or symptom of an illness is a common

human experience. However, the actions taken

* Corresponding author. Pharmaceutical Chemistry, Jimma

471 11 19 79 (office); þ251 471 12 27 65 (residence); þ251 911

E-mail address: sultan.suleman@ju.edu.et (S. Suleman).

1551-7411/09/$ - see front matter � 2009 Elsevier Inc. All righ

doi:10.1016/j.sapharm.2008.04.002

vary depending on the perceptions and experi-ences of individuals and other factors.1 The bulk

of all care in illness is self-care, which is the oldestand most widely used behavior that affects the

University, P.O. Box 1925, Jimma, Ethiopia. Tel.: þ25174 23 54 (mobile); fax: þ251 471 11 44 84 (office).

ts reserved.

77Suleman et al./Research in Social and Administrative Pharmacy 5 (2009) 76–81

health of individuals. Self-medication, thus, can bedefined as the use of drugs to treat self-diagnoseddisorders or symptoms, or the intermittent orcontinued use of a prescribed drug for chronic

or recurrent disease or symptoms. There is a clearemerging patient demand for efficient drugsavailable without prescription.2–4 Inappropriate

self-medication results in wastage of resources,increases resistance of pathogens, and generallyentails serious health hazards such as adverse

reaction and prolonged suffering.5,6

Self-medication, which is one form of self-care,is an important initial response to illness, and

many illnesses can be successfully treated at thisstage. Self-medication is practiced by considerableproportion of the population and is affectedby sociodemographic and economic factors. Al-

though some health-care providers attach nega-tive connotations to it, the World HealthOrganization (WHO) acknowledges the existence

of a valid role of self-medication. Therefore, toolsto evaluate the appropriateness of self-medicationstill need to be developed.7,8

A number of reasons could be attributed to therise of interest in self-care issue. The shift in thepattern of disease toward more chronic diseases

with attendant shift from cure to care is oftenmentioned. The inadequacies (failures) of health-care system with its uneven distribution of drugs,rising cost and the issue of curative stance of

drugs are worth mentioning.9,10

In Ethiopia, the magnitude of self-medicationis not yet well known. The type of illness that

necessitate self-medication, sources of informa-tion for self-medication, drugs or category of drugproducts that are commonly self-administered

need to be understood to design interventions.11

A study conducted in Butajira (SouthernEthiopia) indicated that 15% of persons withperceived illnesses performed self-medication.6 In

another study conducted in Addis Ababa and cen-tral Ethiopia, the magnitude of self-care was ashigh as 50%. Low severity and poverty were the

major reasons for self-medication.1

There has not yet been any systematic researchconducted on the distribution and the use of drugs

at the community level, little is known about self-medication in Ethiopia. There is little informationwith regard to self-medication assessment studies

in southwest Ethiopia, our study area in spite ofthe common practice of self-medication. There-fore, this study is at the objective of investigatingthe nature and extent of self-medication in Assen-

dabo town, Jimma zone, southwestern Ethiopia.

Methods

Study area

The study site is Assendabo town, the capital ofOmonada Woreda, Jimma zone, southwestern

Ethiopia. The town is located 258 km away fromAddis Ababa and 55 km north of Jimma town.The population of Assendabo town according tothe year 1994 census is about 8500. The population

has access to some health facilities (The health sys-tem of the country has 4 tier systems: healthpost ! health center ! district hospital ! zonal/

referral/specialized hospital). There is 1 health cen-ter, 1 rural drug vendor, and 3 private clinics. Thereare also 2 traditional medical practitioners avail-

able on Saturdays (market day), as evidenced alsoduring data collection.12

Study design and population

A community-based cross-sectional study wasconducted during January andMarch 2006. Out of1200 households of Assendabo town, 242 samplehouseholds were randomly selected and included in

the study. To determine the sample size, thefollowing assumptions were made. Because therewas no previous study conducted in the study area,

a 50% expected prevalence of self-medication; andto increase the precision of the study, a 99%confidence interval with expected deviation from

the true prevalence of �3% were assumed.

Data collection and management

A pretested questionnaire was prepared by the

investigator based on literature to collect infor-mation on sociodemographic, socioeconomic, andtreatment approaches as well as general issues

about the use of drugs. The pretest was carriedout on selected households, which were excludedfrom the survey. The questionnaire was preparedin English language and translated into the local

language (Afan Oromo). The data were thencollected by trained 5th year (graduating class)pharmacy students by going from house to house

and interviewing the head of households/caretakers. One household was selected randomlyand every other 5th household was interviewed.

The collected data were cleaned and then analyzedmanually. Pie charts, bar charts, and frequencytables were used for data presentation.

Ethical issues

To obtain consent from town administratorsand interviewees, a detailed explanation on the

Table 1

Demographic characteristics of sick persons in the last 2

weeks in Asendabo town, February 2006

Variables Number

(n¼ 143)

%

Sex

Male 61 42.7

Female 82 57.3

Age (yr)

!1 14 9.8

1-14 32 22.4

15-24 31 21.6

25-35 27 18.8

35þ 39 27.4

Educational status

Illiterate 65 45.5

Only read and write 31 21.7

Primary school 26 16.2

Secondary school 16 11.2

12þ 5 3.5

Monthly income (Birr)

!100 91 63.6

101-200 36 25.2

201-500 11 7.7

O500 5 3.5

Table 2

Frequency of the reported symptoms, Assendabo Town,

February 2006 (n¼ 143)a

Illness Frequency %

Fever 58 40.6

Headache 33 23.1

Cough and cold 16 11.2

Eye disease 4 4.2

Gastric pain 6 4.2

Diarrhea 5 3.5

Abdominal pain 2 2.1

Othersb 19 13.3

Total 143 100

a One person with only 1 illness.b Stress, fatigue, loss of appetite, myalgia, arthralgia,

back pain, etc.

78 Suleman et al./Research in Social and Administrative Pharmacy 5 (2009) 76–81

aim and objectives of the study was communi-

cated before data collection. Confidentiality wasensured and the problems of self-medicationcommunicated at the end of every interview.

Results

This study canvassed a total population of

1257 residing in 242 households to identify in-dividuals with illness in the last 2 weeks before thestudy period. Figures in Table 1 show the

Table 3

Actions taken by sick people for their illness, Assendabo, Feb

Actions taken

Treatment at health institutions

Self-medication Modern drugs Source

Drug outl

Private cl

Shops

Past presc

Market

Neighbor

Treatment using home-made remedy

Subtotal

Nonpharmacological measures (holy-water, exercises, etc.)

No action taken

sociodemographic and economic background ofthe 143 respondents interviewed; and Table 2presents the different signs and/symptoms re-ported by the respondents.

The actions taken by sick people for theirillnesses are presented in Table 3, whereas per-ceived reasons for self-medication among respon-

dents are presented in Table 4. Awareness aboutthe possible adverse effects of drugs is presentedin Fig. 1, and perceived outcome of self-medica-

tion by the respondents is presented in Fig. 2.

Discussion

Community provision of effective health-careservices is very important, as good health is thebasic need for life and productivity. In developing

countries like Ethiopia, the limited access to themodern health-care infrastructure and appropri-ate and affordable drugs may urge the community

ruary 2006, n¼ 143

Frequency (n) %

68 47.6

ets 8 5.6

inics 8 5.6

6 4.2

ription leftover 5 3.5

3 2.1

s 1 0.7

or herbs 25 17.5

56 39.2

5 3.5

14 9.8

Table 4

Factors for conducting self-medication, Assendabo,

February 2006 (n¼ 56)

Factors Frequency Percentage

(%)

Cannot afford modern health

care

6 10.7

Low severity of illness 23 41.1

To save time 7 12.5

Remoteness of health-care

facility

7 12.5

Expectation of less/no benefit

from modern health care

13 23.2

Total 56 100

79Suleman et al./Research in Social and Administrative Pharmacy 5 (2009) 76–81

to seek for alternative source of treating itsillnesses. One of the potential alternatives is self-medication. The study revealed that the preva-lence of self-medication in Assendabo town is

39.2%; which is less than that reported in Jimmatown (27.6%). This is attributed to the inclusionof herbs and home-made remedies as a means of

self-medication, and the availability of more drugretail outlets in towns like Jimma where most ofthe drugs for self-medication were obtained than

rural areas. More or less comparable results werereported in some studies done in China (32.5%)13

and Mexico (30%).14

The commonest illnesses that led to self-med-ication in this study (headache, fever, cough, anddiarrhea) were also reported similarly in Franceand Brazil. This was partly because of the high

prevalence of malaria in the study area during thestudy period. The studies done in France andJimma also pointed out headache as the main

ailment that necessitated self-medication interven-tion.8,11 In addition, this study showed type of

19.4

0

10

20

30

40

50

60

70

80

90

YesAwareness abou

Percen

tag

e freq

uen

cy

Fig. 1. Awareness about side effect of d

illness as a major contributing factor to the typeof action taken for illness by sick individuals sup-ported by statistics (P ! .005), which strengthensthe finding that people practiced self-medication

for illnesses they perceived as of low severe type.Unlike the results of a similar study in China

where people used self-medication mainly because

they felt that they know what to do, in this studyone of the most common reasons for the practiceof self-medication was its relative less cost. Pov-

erty and low severity of illness were pointed out asthe major reasons for conducting self-medicationin this particular study area. As WHO noted, self-

medication provides a cheap alternative to peoplewho cannot afford to pay medical practitioners.Thus, self-medication is often the first response toillness among people with low income. The low

severity of illnesses as a major reason for thepractice of self-medication is a frequently reportedfinding in literature.1,15-17

Drug vendors and private clinics were identi-fied as the main sources of modern pharmaceuti-cals for rampant practice of self-medication. This

could result from of weak enforcement of regula-tions regarding drug handling and dispensing. Thestudy uncovered the availability of drugs in in-

formal sectors like shops and open markets.Drugs for self-medication were obtained fromneighbors or in the sick person’s house as leftoverdrugs from the past prescriptions. This contributes

to deterioration of the drugs’ quality, developmentof resistance to antimicrobials, and treatmentfailures. Implementation of pharmaceutical care

in community pharmacies could alleviate theseproblems.9

More than 80% of persons reporting illness in

this study explained that they had no idea aboutthe potentially dangerous effects of modern drugs

80.6

Not drug side effects

rugs, Assendabo, February 2006.

10.7

33.9

55.4

0

10

20

30

40

50

60

Improved condition No change Worsened condition

Outcome of self-medication (n=56)

Percen

tag

e freq

uen

cy

Fig. 2. Perceived outcome of self-medication among respondents, Assendabo, February 2006.

80 Suleman et al./Research in Social and Administrative Pharmacy 5 (2009) 76–81

when used without the advice of health profes-sionals. This should be intervened with provisionof appropriate health information on drugs used

in the community.7 The study pointed out thatmost sick individuals who practiced self-medicationreported improvement in their condition. This may

affect the attitude of the patient toward practicingself-medication concerning the type of action tobe taken during future illnesses.

Limitations

There were a number of limitations to thisstudy that preclude its generalizability to otherpopulations. These include recall bias, the possi-bility of respondents providing socially desirable

responses, potential variation in interviewer styleand technique that may have elicited unique re-sponses, and our inability from the study methods

and design to discern validity and reliability instudy instrumentation.

Conclusions

The practice of self-medication is highly prev-alent in Assendabo town. The major reason given

for self-medication is low severity of illnesses.Drug retail outlets and private clinics are themajor sources of drugs for self-medication; andthe availability of drugs in informal sectors

contributes to the increase in practice of self-medication. Although it is difficult to monitorself-medication practices, interventions such as

dissemination of information about potentialproblems in self-medicating would be prudent.Emphasis should be given to increase access to

modern health facilities by creating mechanismsto reduce cost of medication, uncontrolled chan-nels of drug dispensaries, and taking corrective

measures on illegal drug purveyors. Future studyshould examine self-medication practices in otherparts of Ethiopia and developing African nations

as well as take a more comprehensive analysisof medication-taking behaviors using a theoret-ical approach with appropriate inferential statis-

tics to discern factors that contribute to thesebehaviors.

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