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Prevalence of self-medication and its pattern in medical students: a cross sectional study from Karnataka

Background: Self-medication is becoming a common type of self-care behavior among the population of many countries. Obtaining and consuming drugs without the advice of physician either for diagnosis, prescription or surveillance is called self-medication. The objectives of the study were to study prevalence and existing pattern of self-medication and its determinants among the medical students. Methods: A cross sectional descriptive study was conducted involving 200 medical students by systemic random sampling method using pretested semi-structured proforma. Analysis was done using SPSS and results were presented. Chi square and odds ratio (OR) was used as statistical tool. Results: Out of 200 students, 66.5% students were from 22-24 years of age group (mean age 20.2±1.4 years, p<0.05). Prevalence of self-medication was 93%, of which 53.8% were girls and 46.2% were boys (p>0.05). Majority of the students (95.2%) were self-medicating with allopathy drugs. 51.6% responded that they were getting quick relief with self-medication. 82% were aware about the possible adverse effects (OR 0.5, p>0.05). Self-medication was practiced by 78% students for upper respiratory tract infection, headache (70%), fever (67.7%) and gastrointestinal upset (36%). Majority (83%) students consumed paracetamol tablet for various health related reasons followed by cough syrups (55.3%), nonsteroidal anti-inflammatory drugs (54.3%), antibiotics (23.1%). Conclusions: Prevalence of self-medication was high in spite of awareness of possible adverse effects amongst students. Also, the knowledge of selection of appropriate drug for self-medication was observed to be poor.


INTRODUCTION
The use of medicines to treat self-recognized symptoms by an individual is globally on the rise. According to the WHO (World Health Organization), self-medication is defined as the "use of medicines by a patient on his own initiative or on the recommendation of a nonprofessional or a lay person instead of seeking advice from a health care provider". 1 Medicines for self-medication are often called 'nonprescription' or 'over the counter' and are available without a doctor's prescription through pharmacies, resubmitting old prescriptions to purchase medicines, sharing medicines with relatives or members of one's social circle or using leftover medicines stored at home. 2,3 Since many years self-care has been a feature of health care. Self-medication is a double-edged sword in that it can treat minor disease conditions that do not require the expensive medical treatment and in turn reduce the pressure on medical services particularly in countries with inadequate health care system. It provides a less cost alternative for people from lower socio-economic strata. But on the flip side, the inappropriate use of selfmedication can have serious insinuations and causes wastage of resources, increases resistance of pathogens and generally causes serious health hazards such as adverse drug reactions, prolonged suffering and drug dependence. 4 There is much public and professional hue and cry about the irrational use of drugs. The prevalence rates have been alarmingly high all over the world; up to 68% in European countries, whilst the scenario is much worse in the developing countries with the rates going as high as 92% in the adolescents of Kuwait. Our neighboring countries are not far behind and have a prevalence rate of 51% in Pakistan and 59% in Nepal. Very few studies regarding self-medication have been conducted in India which has confirmed high rates of prevalence of about 39% amongst the medical students. It is also alarming that the prevalence rates are on the rise despite unceasing efforts to limit this problem. It assumes a special significance among the medical students. The first-year medical students do not differ from the general population as they are not taught about the drug and disease condition in the first-year curriculum. But the students of the second and the subsequent years are well exposed to the details of disease condition and drugs. 4 hence, the prevalence and the pattern of drug usage varies with their knowledge of the drugs and diseases which increases with each passing year in the medical course.
Hence, the present study was designed to estimate the prevalence and evaluate the patterns of self-medication amongst the medical students of MR Medical college, Kalaburagi.

METHODS
A cross sectional descriptive study was conducted involving 200 medical students by systemic random sampling method using pretested semi-structured proforma. Analysis was done using SPSS and results were presented.

Study site
Study was carried out in MR Medical College, Kalaburagi, Karnataka.

Study population
A cross sectional descriptive study was conducted involving 200 medical students of MR Medical College by systemic random sampling method using pretested semi-structured proforma.

Data collection and analysis
The pre-tested, semi-structured questionnaire was prepared. Data was collected from 1st June to 15th December 2013. The study subjects were informed that the information collected would be anonymous; and participation would be totally voluntary. The age, sex, and year of study were noted. The information regarding the type of medication, illness for which the medication was used and the reason for not consulting a doctor was collected. The pattern of drug use over a two-month period preceding the study was noted. Their attitude toward self-medication and source of information for those who practiced self-medication were also recorded.

Inclusion criteria
First year to final year MBBS students who gave written consent were included.

Exclusion criteria
Medical students who didn't give written consent were excluded.

Statistical analysis
Data was collected with the help of prepared questionnaire after taking written consent from the students. Data was entered into Microsoft Excel Sheet and was analyzed with the help of SPSS 17.0 version. The results were presented using absolute figures and percentages. Chi square and odds ratio (OR) was used as statistical tool (p value less than 0.05 was considered as significant). Table 1 depicts that out of 200 students, majority i.e. 53.5% was females and 46.5% were males. Majority of the students (45.5%) were studying in final year of MBBS. 66.5% students were from 22 to 24 years of age group. Mean age observed was 20.2 years with standard deviation of 1.4 years. Age of study population and selfmedication was found to have a statistically significant association (p<0.05) whereas sex and self-medication association was not observed to be significant (p>0.05). Table 2 shows prevalence of self-medication was 93% in our study, of which 53.8% were girls and 46.2% were boys. Majority (95.2%) of students were practicing Allopathy for self-medication. More than half (51.6%) responded that they were getting quick relief with selfmedication and 43% told that their previous experience with self-medication for common ailments was a reason for current practice of the same. It is time saving also as responded by 32.8% of the students.

DISCUSSION
In our study the prevalence of self-medication was 93%. Similar finding was observed in a study by Badiger et al i.e. 92% and as against 59% in a study done by Shankar et al. 5,6 It was observed in our study that paracetomol was the most common medication for various ailments in 83% students followed by cough syrups (55.3%) and NSAIDs (54.3%). Drugs most commonly used by self-medication were analgesics and antipyretics. This has also been observed in most of the other studies on self-medication. [6][7][8][9] In our study more than half (51.6%) responded that they were getting quick relief with self-medication and 43% told that their previous experience about self-medication for common ailments as a reason for current practice of the same. It is time saving also as responded by 32.8% of the students. Similar findings were found by Verma et al in a study conducted in North India. 10 Majority of the students (78%) practiced self-medication for Upper respiratory tract infection followed by for headache (70%), fever (67.7%) and gastrointestinal upset (36%). Similar finding was seen in a study done by Gutema et al and Badiger et al. 5,11 In the study it was noticed that the classes of drugs that were commonly used were antipyretics (71%), analgesics (65%), antihistamines (37%) and antibiotics (34%). This is similar to studies done earlier, which showed antipyretics (43%), analgesics (81%), antibiotics (6%) and antihistamines (13%) were commonly used. 12 When asked about the sources of information most of them consulted their classmates and seniors for medication (36.6%). 33.3% took medication from pharmacy. This is similar to other studies, which showed medical students use their academic medical knowledge 50% of the time to self-medicate. 13

CONCLUSION
Prevalence of self-medication was high in spite of awareness of possible adverse effects amongst students. Allopathic drugs were commonly used for selfmedication. Also, the knowledge of selection of appropriate drug for self-medication was observed to be poor.