|Year : 2015 | Volume
| Issue : 1 | Page : 16-20
Prevalence and pattern of self-medication practices in an urban area of Delhi, India
Varun Kumar, Abha Mangal, Geeta Yadav, Deepak Raut, Saudan Singh
Department of Community Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
|Date of Web Publication||8-Jan-2015|
Department of Community Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi
Source of Support: None, Conflict of Interest: None
Background: Self-medication is one of the major health concerns worldwide and World Health Organization has laid emphasis on correctly investigating and controlling it. There is much public and professional concern regarding self-medication practices, which has dramatically increased in the last few decades, especially in the developing countries. Hence, this study was designed to study the prevalence and practice of self-medication practices in an urban area of Delhi, India. Materials and Methods: A cross-sectional study was conducted in March 2013 and data were collected by personal interviews using pretested questionnaires. An urban colony in the south district of Delhi was chosen and the eldest member of the family, present at the time of the visit was interviewed. Data were collected from 236 persons and analyzed using SPSS version 21. Results: The prevalence of self-medication was 92.8% (95 confidence interval: 66.5-79.4). 74.9% preferred allopathic medicines. Self-medication was found to be practiced more among younger persons than older age group persons (P = 0.000). Graduates and postgraduates practiced self-medication more than others (P = 0.002). Common cold (61.6%) and fever (51.8%) were the most common ailments for which self-medication were practiced. Paracetamol and cough syrups were the most commonly used class of drugs. Conclusion: The prevalence of self-medication in this study was high. Drugs especially antimicrobials were not taken for the proper length of time. Awareness regarding self-medication practices to help patients decide on the appropriateness of self-medication is required.
Keywords: India, self-medication, urban area
|How to cite this article:|
Kumar V, Mangal A, Yadav G, Raut D, Singh S. Prevalence and pattern of self-medication practices in an urban area of Delhi, India. Med J DY Patil Univ 2015;8:16-20
|How to cite this URL:|
Kumar V, Mangal A, Yadav G, Raut D, Singh S. Prevalence and pattern of self-medication practices in an urban area of Delhi, India. Med J DY Patil Univ [serial online] 2015 [cited 2020 May 27];8:16-20. Available from: http://www.mjdrdypu.org/text.asp?2015/8/1/16/148828
| Introduction|| |
Self-medication is one of the major health concerns worldwide and World Health Organization (WHO) has laid emphasis on correctly investigating and controlling it.  There is much public and professional concern regarding self-medication practices, which has dramatically increased in the last few decades, especially in the developing countries. Studies have reported wide variations in its prevalence in India increasing from 31% in 1997  to 71% in 2011.  The nature and extent of self-medication varies according to cultural, social, and educational influences. 
World Health Organization has defined self-medication as "use of pharmaceutical or medicinal products by the consumer to treat self-recognized disorders or symptoms, the intermittent or continued use of a medication previously prescribed by a physician for chronic or recurring disease or symptom, or the use of medication recommended by lay sources or health workers not entitled to prescribe medicine." 
Self-medication is associated with risks such as misdiagnosis, use of excessive drug dosage, prolonged duration of use, wastage of resources, and increased resistance to pathogens.  Further there is an increase in the promotion of self-medication products, which has enhanced consumer and patient awareness of the availability of products. 
Despite these drawbacks, self-medication is an important component of primary health care. There are some advantages of self-medication like treating minor symptoms and ailments that do not require medical attention and thereby decreasing the burden on delivering health care. However, there are several critical issues that must be explored before promoting the potential benefits of self-medication. Any self-medication product should be safe for use. This implies the availability of appropriate consumer information and avoidance of any delay in diagnosis and treatment of diseases not suitable for self-medication. 
Since the individual bears the primary responsibility for using self-medication, they should be able to recognize the symptoms they are treating, to determine that their condition is suitable for self-medication, to choose an appropriate self-medication product and to follow the directions for use of the product as provided in the product labeling. 
As per drug laws applicable to India, self-medication are permitted for over-the-counter (OTC) drugs, but in India there is no specific list of OTC drugs. The OTC Committee of the Organization of Pharmaceutical Producers of India is working toward the promotion of responsible self-medication and creating awareness in the general public as well as the government.  Self-medication in modern pharmaceuticals seems to be a field in which information is scarce and only a very little information has been available about self-medication and its major determinants, especially in developing countries.  Hence, the present study was designed to study the prevalence of self-medication and its pattern in an urban area of Delhi, India.
| Materials and Methods|| |
This study was of cross-sectional design and conducted during the months of March and April 2013. The district of South Delhi was selected by convenience due to easy access. There are 16 urban colonies in the selected district and one among them was selected by simple random sampling. House listing was done in the selected urban colony and every fifth house was included in the study.
Data were collected by personal interviews by trained personnel using pretested questionnaire. Study subjects were the elder most members in each of the selected house available at the time of visit. If any of the members of the selected house cannot be reached after three consecutive visits, the next house was included in the study. Registered medical practitioner, pharmacist, nurse, and paramedic personnel were excluded along with those who refused to participate in the study.
Resident Welfare Association of the selected urban colony was contacted and their permission was obtained to conduct the study after explaining the purpose of the study. Written informed consent was obtained from the study participants and thumb imprint was obtained from illiterates after assuring full confidentiality. Then, they were personally interviewed.
The prevalence of self-medication practices was 31.3% in a similar study conducted in urban resettlement colony in New Delhi.  This was used to determine the minimum sample size for this study using the formula, n = z 2 pq/d 2 , where n = minimum sample size; z = 1.96 at 95% confidence interval obtained from standard statistical table of normal distribution; P = estimated prevalence of self-medication in a given population (31.3% or 0.313); q = precision that is, (1-p) or 0.687 and d = relative error of 20%. Using this formula the minimum sample size calculated was 211 and in this study, data were collected from 236 individuals. Data were analyzed using Statistical Package for Social Sciences (SPSS) version 21, IBM. Chi-square test was used for drawing statistical inferences and P < 0.05 were considered as significant.
For the purpose of study, self-medication is defined as use of any pharmaceutical or medicinal products to treat self-recognized disorders or symptoms in the previous 1 month.
| Results|| |
Among 236 study participants, 130 (55.1%) were males. 81 (34.3%) were between 30 and 39 years of age and 216 (91.5%) belong to Hindu religion. On educational background, 151 (64%) were graduates and 36 (15.3%) were postgraduates. According to revised Kuppusamy's socioeconomic classification 2012, 144 (61%) belong to upper middle socioeconomic class [Table 1].
|Table 1: Distribution of study subjects according to socio-demographic factors (n = 236)|
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Of 236 study participants, 219 (92.8%) people took medicines without doctor's prescription and among them 164 (74.9%) preferred allopathic medicines. There was no significant association between self-medication and gender (P = 0.182), but there was a significant association with age (P = 0.000) with younger age groups practicing self-medication more than older age group persons. Significant association was also found with educational statuses of the study participants (P = 0.002), with graduates and postgraduates practicing self-medication more than others. However, there was no association with religion (P = 0.566) and socioeconomic status (P = 0.213) [Table 2]. Awareness about self-medication was seen in 226 (95.8%) study subjects [Table 3].
Among those who practice self-medication, 117 (53.4%) had used it more than twice during the last 3 months and 26 (11.9%) had spent more than six hundred rupees for it during the same duration. 159 (72.6%) felt that self-medication was more convenient while 49 (22.3%) felt that it was cheap and 30 (13.6%) replied they resorted to self-medication because of nonavailability of doctors.
|Table 2: Distribution of study subjects according to self-medication practices (n = 236)|
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Regarding the sources of information for the self-medication, majority 102 (46.5%) started using it from their own past experience. Cough 135 (61.6%) was the most common symptom for using self-medication followed by fever 131 (59.8%). Paracetamol was the most commonly used drug followed by cough syrups and 16 (7.3%) experienced side-effects of drugs during the course of the self-treatment [Table 4].
|Table 4: Distribution of study subjects according to self-medication practices (n = 219)|
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With respect to self-medication usage, the type of medicine 114 (52.1%) was the most important consideration followed by the brand of medicine 83 (37.9%). In majority of cases, knowledge regarding the dosage of self-medication was obtained through previous experience 85 (38.8%) followed by consulting a pharmacist 65 (29.6%). 106 (55.7%) study subjects reported that they can fully understand all the instructions given in the package insert while 80 (42.1%) reported that they could only partly understand and 4 (2.2%) reported they can't understand at all.
Antibiotics were used by 52 (23.7%) participants practicing self-medication reported using antibiotics and among them 42 (80.7%) changed the dose of antibiotic during the course of self-treatment. 14 (27%) switched antibiotics and the availability of cheaper alternative antibiotic was the main reason for switching antibiotics. 40 (76.9%) reported they stopped taking antibiotic as soon as the symptom got relieved without completing the entire course of treatment. The average duration for which an antibiotic was used was 3.17 days [Table 5].
|Table 5: Distribution of study subjects according to antibiotic usage pattern|
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Overall only 23 (9.7%) people considered self-medication as a good practice. 131 (55.5%) said it was acceptable, while only 82 (34.8%) felt self-medication was not an acceptable practice. 90 (38.1%) subjects felt confident that they were competent enough in treating common ailments using self-medication.
| Discussion|| |
The prevalence of self-medication was found to be 92.8% in the present study. This was very high when compared with a study done by Lal et al.  in an urban resettlement colony in Delhi during 2005 which reported prevalence of 31.3%. In this study, self-medication practices were significantly more in younger age group persons and also among graduates. This high prevalence found in this study can be attributed to better educational status and socioeconomic background. Similar studies carried out in India showed the prevalence of self-medication as 37% in urban areas and 17% in rural areas in India.  There was wide variation in prevalence of self-medication ranging from 12.7% to 95% in other developing countries. , Due to the different socioeconomic profiles and demographic characteristics of the populations studied, it was difficult to compare the results.
The common sources of information regarding self-medication in the present study were found to one's own personal experience and doctors' old prescription. Similar results were obtained in a study conducted in Karachi, Pakistan.  Results of the present study indicated that the most common reasons for self-medication were minor ailments (68%) and lack of time to consult a doctor (26%), which is similar to a study that reported the reasons as mild illness (40%) and shortage of time to consult a doctor (32%). 
The most common reasons for self-medication in the present study were found to be common cold (61.6%) and fever (51.8%). Paracetamol and cough syrups were the most commonly used class of drugs, which is similar to a study done in Ahmadabad, India.  In concordance with previous results,  our results also indicate that antimicrobials were not commonly used for self-medication, and were mostly obtained on prescription and among those who use antibiotics; most of them did not take it for a complete course. The average duration for which an antibiotic was used was 3.17 days. The duration of drug use was arrived at by asking the respondents, and "recall" bias may be a confounding factor.
This study was conducted in an urban background having relatively better socioeconomic and educational conditions compared with the rest of India. The usage of self-medication was asked for the previous 3 months in which recall bias may be present. These may be considered as limitations of this study.
| Conclusion|| |
Self-medication is prevalent in the urban community of Delhi with 92.8% of respondents using some form of self-medication, mostly allopathic medicines in the month preceding the study. Paracetamol and cough syrups were the drugs most commonly used for self-medication. Fever and the common cold were the most common reasons. Drugs especially antimicrobials were not taken for the proper length of time. Awareness regarding self-medication practices to help patients decide on the appropriateness of self-medication is required.
| Recommendations|| |
Holistic approach should be used to curb this escalating menace of self-medication by creating awareness and education regarding implications of self-medication among the general public. Strict rules should be imposed regarding pharmaceutical advertising. Advertising and marketing of nonprescription medicines should be responsible, providing clear and accurate information and exhibiting a fair balance between benefit and risk information.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]