Self-Medication Among the Masses: The Impact of Self-Medication

Abstract

Self-Care encompasses the actions taken by people for their own benefit in order to establish and maintain their own health, prevent, and deal with illness (World Health Organization, 1998). Self-Medication is an action that many take as a route for healing or preventing ailments. Self-Medication is the act or process of self-diagnosing and medicating oneself especially without the advice of a physician (Merriam-Webster). Taking of drugs, herbs or home remedies on one’s own initiative, or on the advice of another person, without consulting a doctor can also be classified under the guidelines of self-medication (Hernandez-Juyol, et al., 2002). Additionally, Self-medication involves the use of medicinal products by the consumer to treat self-recognized disorders or symptoms, or the intermittent or continued use of a medication prescribed by a physician for chronic or recurring diseases or symptoms. In practice, it also includes use of the medication of family members, especially where the treatment of children or the elderly is involved (World Health Organization, 2000). Every day, we are practicing self-medication in the form of self-care of our health (Senapathi, 2010).

Throughout human history the dominant paradigm of healthcare was individual self-care in the family and local community. Treatment involved self-treatment with locally-produced preparations of generally uncertain efficacy. People themselves were responsible for their own health, and that of their families, as self-sufficiency was obligatory and almost universal. The opportunities and needs for improvement were great. Starting in the Nineteenth Century and carrying on through the Twentieth Century, health care was revolutionized by scientific and medical discoveries, technological advances in diagnostics, surgery and medicines, and the development of the healthcare professions. Patients gratefully placed themselves into the hands of the doctors and took the effective newly-developed medicines they prescribed. The role model of the patient as a largely passive recipient of public services was complemented by the mystique of the expert healing physician. At the low point of self-care, Around the 1960’s in the West, self-care and self-medication were regarded as unnecessary and potentially even unhealthy practices. (WSMI, 2010).

Now-a-days, self-medication should be seen as the “desire and ability of people/patients to play an intelligent, independent and informed role (Hernandez-Juyol, et al., 2002), not merely in terms of decision-making but also in the management of those preventive (Laporte, et al., 1992), diagnostic and therapeutic activities which concern them (Laporte, 1997).” Modern consumers (patients) wish to take a greater role in the maintenance of their own health and are often competent to manage (uncomplicated) chronic and recurrent illnesses. They are understandably unwilling to submit to the inconvenience of visiting a doctor for what they rightly feel they can manage for themselves, given adequate information (Bennadi,2014).

Self-medication is very common, and a number of reasons could be enumerated for it (Worku, et al., 2004). Urge of self-care, feeling of sympathy toward family members in sickness, lack of time, lack of health services, financial constraint, ignorance, misbelieves, extensive advertisement and availability of drugs in other than drug shops are responsible for growing trend of self-medication (Phalke, et al.,2006).

Prevalence

Studies carried out on self-medication state that it is very common practice, especially in economically deprived communities (Senapathi, 2010). Now-a-days health care services getting costlier and in developing countries health care facilities are not available (Senapathi, 2010). Hence, that time self-medication becomes an obvious choice of healthcare service (Chang,2003). Furthermore, it has been noted that purchase of drugs and many drugs that can only be purchased with prescription in developed countries are OTC in developing countries (Senapathi, 2010). In addition, lax medical regulation has resulted in the proliferation of counter free drugs that are in high demand for the treatment of highly prevalent diseases (Verduin-Muttiganzi,1998). A study was conduct in December 2011 by discussed by Bennadi, in which it was revealed that self-medication had a prevalence of eight percent in Italy, Mexico, and Switzerland; nine percent in Sweden, the United Kingdom, and Spain; eleven percent in Germany and Australia; thirteen percent in the United States, and fourteen percent in South Africa (Bennadi,2014). This finding was a clear indication of self-medication’s commonality on a worldwide scale. Additionally, Self-medication was found to be very common among educated population (Phalke, et al.,2006). For instance, In Punjab, the prevalence of self-medication was seventy-three percent (Jagmohan, et al., 2011).

Current Challenge & Potential Risks1

Self-medication has a number of potential risks. In particular, the ordinary user will usually have no specialized knowledge of the principles of pharmacology or therapy, or of the specific characteristics of the medicinal product used. This results in certain potential risks for the individual consumer: Incorrect self-diagnosis; Failure to seek appropriate medical advice promptly; Incorrect choice of therapy; Failure to recognize special pharmacological risks; Rare but severe adverse effects; Failure to recognize or self-diagnose contraindications, interactions, warnings and precautions; Failure to recognize that the same active substance is already being taken under a different name (products with different trademarks may have the same active ingredient); Failure to report current self-medication to the prescribing physician (risk of double medication or harmful interaction); Failure to recognize or report adverse drug reactions; Incorrect route or manner of administration; Inadequate or excessive dosage; Excessively prolonged use; Risk of dependence and abuse; Risks at work or in sport; Food and drug interactions; Storage in incorrect conditions or beyond the recommended shelf-life. At the community level, improper self-medication could result in an increase in drug-induced disease and in wasteful public expenditure. (World Health Organization, 2000)

There are two current challenges regarding the potential risks of self-medication. First, Antimicrobial resistance is a current problem world-wide particularly in developing countries where antibiotics are available without any prescription (Pagán,2006). Second, Self-Medication is significantly prevalent among pregnant women worldwide, among other groups of people (i.e. marginalized populations).

Due to extensive complications of self-medication, attention to complications resulting from self-medication among people in a society is a matter of great importance; furthermore, attention to female population due to being in sensitive periods, such as pregnancy and lactation as well as their more contact with family members and being role model for other family members is an additional issue of importance so that it can be said that the occurrence of pregnancy can easily increase the use of medicines and chemicals among women, while self-medication during this period accounts for more than 3% of congenital anomalies. [15-17]

On the other hand, various studies showed that women, especially, tend to self-medicate and often frequently use medicines to treat problems such as dysmenorrhea, menopause symptoms, menstrual disorders, mood disorders, prevention of osteoporosis as well as complications during pregnancy and lactation (Yusuff, et al., 2011).

For instance, Mohseni et al. ’s study conduct in, showed that According to the findings, the most common drug groups the pregnant women self-medicated were herbal (48%), nutritional agents (27.1%), analgesics and antipyretic (25%), antibiotics (20.9%), vitamins (19.9), and sedatives and hypnotics (16.5%). Also, the most common diseases for which the pregnant women self-medicated were anemia (55%), respiratory (34%), digestive (27.3%), neurological (24%), cough and cold (19.5%), dermatological (18%), headache (16.3%) and articular health problems (14.5%) (Mohseni, et al., 2018).

Thus, due to the high prevalence of self-medication during pregnancy and its excessive adverse events during this period for both mothers and infants, conducting effective interventions to reduce and prevent self-medication during pregnancy is a matter of great importance. These interventions can include enhancing people’s knowledge about the consequences of self-medication, educating physicians and pharmacists about appropriate prescription of medicines, and counseling to medicines users as well as providing brochures and catalogs on a large scale. (Mohseni, et al., 2018)

Prevention & Management. There are various routes for managing and preventing the potential risks of self-medication among the masses. Given the fact that some governments are increasingly encouraging self-care of minor illnesses, including self-medication, the government should take necessary steps to regulate responsible self-medication (Senapathi, 2010). This can be done by making availability of safe drugs along with proper instructions about its use and if in need consulting a physician (Senapathi, 2010). Improved knowledge and understanding about self-medication may result in rationale use and thus limit emerging microbial resistance issues (Senapathi, 2010).

Secondly, the role of the pharmacist has been changing over the past two decades. The pharmacist is no longer just a supplier of medicines and a concocter of medicinal products, but also a team member involved in the provision of health care whether in the hospital, the community pharmacy, the laboratory, the industry or in academic institutions (World Health Organization, 1998). Pharmaceutical care is growing in importance with the challenges of self-care. For pharmacists, their greater involvement in self-care means greater responsibility towards their customers and an increased need for accountability (World Health Organization, 1998). Several indicators can be used to evaluate the role, efficiency and performance of pharmacists in response to self-care and self-medication needs (World Health Organization, 1998). These include: Structural, process, and outcome indicators. Structural indicators would include: level of training (pharmacists (continuing education); other staff; feedback mechanisms; documentation of detailed patient medical record (PMR) and medication history). Process indicators would include whether or not PMRs, reference materials, and adverse drug reaction monitoring were used in pharmacy. Lastly, outcome indicators would include the following: customer satisfaction regarding the purchase and use of the product acquired, including the intervention of and advice provided by the pharmacist; comprehension of information delivered by the pharmacist; health outcomes; increased patient knowledge of the practice of self-care and responsible self-medication. These outcomes should be reflected in a more positive attitude on the part of the patient towards self-care and self-medication. (World Health Organization, 1998)

The overall goal is to promote responsible self- medication and selecting the types of medicinal products that can be used for self-medication, in order to minimize the potential risks of self-medication (World Health Organization, 1998). Responsible Self Medication is the practice whereby individuals treat their ailments and conditions with medicines which are approved and available without prescription, and which are safe and effective when used as directed (World Health Organization, 1998). Responsible self-medication requires the following: Medicines used are of proven safety, quality and efficacy. Medicines used are those indicated for conditions that are self-recognizable and for some chronic or recurrent conditions (following initial medical diagnosis). In all cases, these medicines should be specifically designed for the purpose, and will require appropriate dose and dosage forms. Such products should be supported by information, which describes: how to take or use the medicines; effects and possible side-effects; how the effects of the medicine should be monitored; possible interactions; precautions and warnings; duration of use; and, when to seek professional advice. Ultimately, Responsible self-medication would help to reduce the cost of treatment, travelling time as well as doctor’s time (i.e. consultation time). (World Health Organization, 1998)

References

1. World Health Organization. (1998). The Role of Pharmacist in Self-Care and Self-Medication. Retrieved October 20, 2018, from http://apps.who.int/medicinedocs/en/d/Jwhozip32e/3.3.html#Jwhozip32e.3.3
2. The Merriam Webster dictionary. (1995). Dallas, TX: Zane Pub.
3. Hernandez-Juyol, M., & Job-Quesada, J. R. (2002, November/December). Dentistry and self-medication: A current challenge. Retrieved October 20, 2018, from https://www.ncbi.nlm.nih.gov/pubmed/12415218/
4. World Health Organization. (2000). Guidelines for the Regulatory Assessment of Medicinal Products for Use in Self-Medication. Retrieved October 20, 2018, from http://apps.who.int/medicinedocs/en/d/Js2218e/1.1.html
5. Vizhi SK, Senapathi R. (July-December 2010). Evaluation of the perception, attitude and practice of self-medication among business students in 3 select Cities, South India. International Journal of Enterprise and Innovation Management Studies (IJEIMS).
6. WSMI. (2010). The Story of Self-Care and Self-Medication: 40 years of progress, 1970-2010. Retrieved October 20, 2018, from http://www.wsmi.org/wp-content/data/pdf/storyofselfcare_bdpage.pdf
7. World Self Medication Industry
8. Laporte, J. R., & Castel, J. M. (1992, October 10). [The physician and self-medication]. Retrieved October 20, 2018, from https://www.ncbi.nlm.nih.gov/pubmed/1469938
9. Laporte, J. R. (1997, December 06). [Self-medication: Does information to users increase at the same rate as consumption]. Retrieved October 20, 2018, from https://www.ncbi.nlm.nih.gov/pubmed/9493159
10. Bennadi, D. (2014). Self-medication: A current challenge. Journal of Basic and Clinical Pharmacy,5(1), 19. doi:10.4103/0976-0105.128253
11. Worku, S., & G/mariam, A. (2004). Practice of Self-medication in Jimma Town. Ethiopian Journal of Health Development,17(2). doi:10.4314/ejhd.v17i2.9851
12. Phalke, V., Phalke, D., & Durgawale, P. (2006). Self-medication practices in rural Maharashtra. Indian Journal of Community Medicine,31(1), 34. doi:10.4103/0970-0218.54933
13. Chang, F., & Trivedi, P. K. (2003). Economics of self-medication: Theory and evidence. Health Economics,12(9), 721-739. doi:10.1002/hec.841
14. Verduin-Muttiganzi, R., & Verduin-Muttiganzi, G. (1998). Assessment of the incidence of substandard drugs in developing countries. Tropical Medicine and International Health,3(7), 602-602. doi:10.1046/j.1365-3156.1998.00269.x
15. Pagán, J. A., Ross, S., Yau, J., & Polsky, D. (2006). Self-medication and health insurance coverage in Mexico. Health Policy,75(2), 170-177. doi:10.1016/j.healthpol.2005.03.007
16. Awareness and Practice of Malaria Prevention Strategies Among Pregnant Women in Uyo, SouthSouth Nigeria. (2009). The Internet Journal of Gynecology and Obstetrics,11(1). doi:10.5580/f8a
17. Bello, F., Olayemi, O., Morhason-Bello, I., & Adekunle, A. (2011). Patterns and predictors of self-medication amongst antenatal clients in Ibadan, Nigeria. Nigerian Medical Journal,52(3), 153. doi:10.4103/0300-1652.86124
18. Abeje, G., Admasie, C., & Wasie, B. (2015). Factors associated with self-medication practice among pregnant mothers attending antenatal care at governmental health centers in Bahir Dar city administration, Northwest Ethiopia, a cross sectional study. Pan African Medical Journal,20. doi:10.11604/pamj.2015.20.276.4243
19. Yusuff, K. B., & Omarusehe, L. D. (2011, October). Determinants of self-medication practices among pregnant women in Ibadan, Nigeria. Retrieved November 15, 2018, from https://www.ncbi.nlm.nih.gov/pubmed/21881933
20. Mohseni, M., Azami-Aghdash, S., Sheyklo, S. G., Moosavi, A., Nakhaee, M., Pournaghi-Azar, F., & Rezapour, A. (2018, October 6). Prevalence and Reasons of Self-Medication in Pregnant Women: A Systematic Review and Meta-Analysis. Retrieved November 15, 2018, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6226611/