Assessment of Self Medication Practice and Drugs Storage Among South Sudanese Community in Addis Ababa, Ethiopia

Although most self-medication with non-prescription drugs may result in the desired outcome, perhaps are not uncommon. Several studies indicated that there are risks such as misdiagnosis, use of excessive drug dosage, prolong duration of use, drug interaction ⁸.

Major problems related to self-medication is wastage of resources, increased antimicrobial drug resistance particularly in developing countries and serious health hazards such as adverse reaction and prolonged suffering ⁹.

The availability of the more complex drugs such as antibiotics without prescriptions is a source of great concern. Antimicrobial resistance is a current problem worldwide particularly in developing countries where antibiotics are often available without a prescription. Some OTC medicines may also have severe interactions with prescribed medicines. Other hazards of self-medication may also include drug dependence and addiction; dosing over ¹⁰.The use of prescription only medications without the knowledge of physicians can be less beneficial or even be dangerous for the patient ¹¹.

Inappropriate storage and use of medicines at home could have a direct influence on public health, the environment and the health-care services and it increases the risk of self-medication. Storing medicines at home might increase of self-medication, and between family members ¹².

Unlike the developed countries, illegal providers of drugs are common in developing countries, which are a further source of irrational and potentially dangerous drug use ¹³.In a number of developing countries many drugs are dispensed over the counter without medical direction. In this case, self-medication provides a lower cost-alternative for people who cannot afford the fee of medical services. However, increased access to non-prescription medicines may encourage patients to believe that there is a drug treatment for every ailment ¹⁴.

Another study conducted in Khartoum state, Sudan, on self-medication showed that from 1,200 individuals included in study 81.8% of respondents used medicines including herb without a medical consultation with in two months prior to the study period. Proprietary medicines alone were used 28.3%, herb alone by 20.7%, while 32.8% had used both ¹⁵.

Cross-sectional study in south-east Islamic Republic of Iran in 2010 revealed that, many householders (53.6%) reported that they practiced self-medication, and the frequency of reuse of physician prescribed antibiotics was high. Analgesics were the most common medicines stored at home, followed by adult cold remedies and antibiotics. The refrigerator was the most common place for storing medicines (50.6%). There was a significant association between self-medication and educational level but not with age, sex, marital status, occupation and type of insurance. Better public knowledge and information about storage and risks of reuse of prescription medications is needed ¹⁶.

Research on self-medication practice in Addis Ababa January-February shows that: - The most frequency requested category of drugs were analgesic/antipyretics (32.1%) antimicrobials (26.4%) GI drugs (17.7%) respiratory drugs (9.7%) and ORS (0.6%). Sources of information for self-medication 39% of drugs consumers reported that they obtained advice from health care providers (physicians, nurses, health assistants) but without formal prescription. However 23.5% of them said they were advice by friends, relatives those do not have background in health profession. Third (15.4%) sources of advice were reported to be the pharmacists or other personnel working in pharmacies. The other group of respondents (about 20%) received no advice but had information on the drug from the label, leaflet or promotion materials ¹⁷.

The majority of the respondents 64(75.3%) had good knowledge about the side effects of the drugs. More than half of the respondents reported their illness was improved after self- medication. From the self-medicated respondents, 85(51.8%) and 79(48.2%) of the respondents used self-medication with modern drugs and home remedies (Herbs), respectively. Regarding the source of drugs used for self-medication, majority of the respondents 40(47.1%) patronized drug vendor while pharmacy, shops, left over drugs from previous illness and neighbors and relatives were the suppliers to 19(22.4%), 14(16.5%), 7(8.1%)5(5.9%) respondents, respectively. Cost of modern health care (44.5%) and mildness of the illness (31.1%) were the two major reasons given by the respondents for self-medication ¹⁸.

Another cross-sectional study conducted in Mekelle from February to March 2013 revealed that the most frequently reported illnesses or symptoms of illnesses that prompted self-medication of study participants were headache/fever (20.7%), gastrointestinal diseases (17.3%) and respiratory tract infections (15.9%)%), eye disease (14.0%). Self-medicated respondents provided reasons that 21.7% of them believed the disease was not serious; 20.7% of them have had prior experience to the illness and/or the drug; 20.2% of them were of the opinion that it was less expensive in terms of time and money; 17.0% of them believed that it was an emergency care; and 16.9% of them requested medications for prevention of known or unknown illness or symptoms of illnesses. The most commonly used category of drugs for self-medication were analgesics/antipyretics (20.8%), GI drugs (17.5%), respiratory drugs (14.9%), ORS (14.2%), vitamins (11.1%) and antimicrobials (8.4%). The three most usual sources of advice/information for self-medication were pharmacists (22.9%), healthcare providers such as doctors, nurses and health assistants, but without formal prescriptions (20.6%), and friends, neighbors or relatives (18.5%). Nevertheless, 12.8% of the respondents obtained information by reading drug related materials such as labels, leaflets or promotional materials while 12.5% of them were suggested by traditional healers ¹⁹.

A community-based cross-sectional study of 1200 households conducted during January and March 2006 in Assendabo town revealed that the prevalence of self-medication is 39.2%. The commonest illnesses that led to self-medication were headache (23.1%), fever (40.6%), cough and cold (11.2%) eye disease (4.2%), and diarrhea (3.5%). In addition, people practiced self-medication for illnesses they perceived as of low severe type. The most common reasons for the practice of self-medication was its relative less cost. Drug vendors and private clinics were identified as the main sources of modern pharmaceuticals for rampant practice of self-medication. Drugs for self-medication were obtained from neighbors or in the sick person’s house as leftover drugs from the past prescriptions ²⁰.

Due to lack of proper health education to the population, the practice of SM and improper drug storage is becoming one of the public health problems.

The rising level of resistance of infectious agents on the drug effect can be related to SM as one main factor and Poor drug storage is one of the reasons that can decrease the effectiveness of the drug. Therefore, the aim of this study will be to assess the prevalence of self-medication and drug storage pattern and the finding of this study may be used as input for intervention by the authorities in this critical area and it may also serves as a base line data for further study.

To assesses self- medication practice and drug storage among South Sudanese community in Addis Ababa, Ethiopia.

To determine the prevalence of self-medication and to identify the reason for self-medication

To identify commonly treated illness by self-medication and to identify commonly used drugs for self-medication

To identify source of modern medicine for self-medication and to assess drugs storage pattern

The Study was conducted in Addis Ababa, Capital city of Ethiopia. Addis Ababa is 346.2km from Jimma University. The city lies a few miles west of east African Rift which splits Ethiopia into two. Ethiopian ethnic groups are represented in Addis Ababa. Foreigners from many other countries and south Sudanese reside in Addis Ababa, Ethiopia.

The total population of the South Sudanese community in Addis Ababa is 1325 which is composed of 500 households. The study was conducted from April 22/2019-25/2019.

A cross-sectional study was conducted using semi structured questioner consisting of general socio-demographic, socio- economic, perceived illness and action taken to overcome the illness and practice of drug storage among South Sudanese community in Addis Ababa, Ethiopia.

Semi-structured questionnaire was used to collect the necessary information. Accessories materials like, pencil, chalk, binder, eraser and sharpener were used. The data was collected by investigator.

The data was collected by interviewing the respondents using semi structured questionnaire.

The collected data was checked for completeness of information and then it was analyzed manually and presented in the form of frequency table, graphs & charts.

An official letter was written from Jimma University Community Based Education (CBE) office to South Sudan Embassy in Addis Ababa, Ethiopia to get permeation for data collection. Verbal consent from the respondent was obtained. The Respondents was convinced on confidentiality of the information that they will give.

The final finding of the study will be disseminated for concerned bodies ’i.e. Institute of health science, School of pharmacy and Jimma University Community Based Education Office.

This study was conducted on a total population of 1325 residing in 500 households. Figures in Table 1 show the socio-demographic and economic background of the 297 respondents interviewed. 227(76.4%) were males and 70 (23.5%) were females. 11 (3.7%) were attending primary school, 34(11.4%) were attending secondary school and 252(84.8%) were in college or university. Regarding marital status, 147(49.4%) of the respondents were married. From the total respondents, 252(84.8%) respondents were students and 29(9.7%) were government employee.

From the total 297 respondents shown in Figure 1 below, 196 (65.9%) had reported symptoms of illness in the last one month before the study period.

Figure 1.Show respondents reported symptoms of illness in the last one month among South Sudanese community in Addis Ababa, Ethiopia from April 2019.

From the total 297 respondents shown in Figure 2 below, 286 (96.2%) had reported self-medication in the last one month before the study period.

Figure 2.Show respondents reported take self-medication in the last one month among South Sudanese community in Addis Ababa in April 2019.

In this study shown in Figure 3 below, the most common types of ailments for which the respondents reported to have practiced self-medication were cough, cold and sore throat 90(30.3%), followed by headache 66(22.2%), diarrhea 52(17.5%) ,abdominal pain 47(15.8%), fever 21(7.07%) and vomiting 10(3.3%) each as shown in bar chart below.

Figure 3.Frequency of reported symptoms of illness, among South Sudanese community in Addis Ababa, Ethiopia in April 2019.

As shown in Figure 4 below the reasons given for self-medication were; the illness was minor 226(76%) and previous experiences with similar ailments 31 (10.4%) were found to be the two major reasons given by the respondents for self-medication in this study.

Figure 4.Show reason for preferring self-medication by sick persons among South Sudanese community in Addis Ababa, Ethiopia in April 2019.

As shown in the Figure 5 below the majority of the respondents 242(81.4%) who practiced self-medication obtained information on self-medication from friends and 29(9.7%) obtained information from family members.

Figure 5.Show Source of information for self-medication for choosing S/M among South Sudanese community in Addis Ababa in April 2019.

The most frequently used group of drugs used forself-medicationwere analgesics/antipyretics 177(59.5%)and antimicrobial which account 75(25.2%) each followed by antihelmenthics 24(8.08%) as shown in Figure 6 below.

Figure 6.Category of drugs agents used for self-medication by sick individuals among South Sudanese community in Addis Ababa, Ethiopia in April 2019.

As shown in Figure 7 below, Regarding the source of drugs used for self-medication in figure below, main source was in pharmacy 220(74.07%) followed by leftover drugs 41(13.8%) while drug retail outlet, and neighbors and relatives were the suppliers to 12.13% respondents each.

Figure 7.Source of information modern medicine among South Sudanese community in Addis Ababa, Ethiopia in April 2019.

In this study shown in Figure 8 below, from the total 297 respondents interviewed, 286(96.2%) reported drug storing practice in the house.

Figure 8.Show the distribution of clients that store modern drugs among South Sudanese community in Addis Ababa, Ethiopia in April 2019.

As shown in Figure 9 below, the total respondents who practice drug storage in the house 235(79.1%) store drugs to treat similar illness , 41(13.8%) store leftover drug from previous prescription drug, whereas 15(5%) store drugs for emergency cases.

Figure 9.Show reasons they store modern drugs among South Sudanese community in Addis Ababa, Ethiopia in April 2019.

As show in Figure 10 below, the most commonly stored drugs are analgesics/antipyretics 177(59.5%) followed by antimicrobial 75(25.2%) and anthelmintic which is 24(8.08%).

Figure 10.Show the type of drugs store in the house among South Sudanese community in Addis Ababa, Ethiopia in April 2019.

As shown in Figure 11 below, the most places the store modern drugs are in locked cabinet, open shelf and on the table.

Figure 11.Show the place they store modern drugs among South Sudanese community in Addis Ababa, Ethiopia

The practice of self-medication is widespread all over the world especially urban and educated population (1). WHO (World Health Organization) is promoting practice of self-medication for effective and quick relief of symptoms without medical consultations and reduce burden on health care services, which are often understaffed and inaccessible in rural and remote areas (3). In this study, the prevalence of self-medication among respondents was found to be 96.2%. This seems to be highly prevalent as compared to the studies done in Kolladiba town ¹⁸ and Assendabo town ²⁰.

The commonest illnesses that led to self-medication in this study (headache, fever, and cough, cold, sore throat) were also reported similarly in Jimma, Mekele and Assendabo towns (16, 19, 20). This was partly because of the studies done in South India and kolladiba town also pointed out fever, headache and cough and cold as the main ailment that necessitated self-medication intervention (4, 18).

Like the results of a similar study in Mekele, in this study, people used self-medication mainly because of they have had prior experience to the illness and/or the drug (19). In contrary to this, the results of studies done in Kolladiba and Assendabo towns revealed that the most common reasons for the practice of self-medication was its relative less cost (18, 20). Relative the illness was minor was the main reason for the practice of self-medication in this study. As WHO noted, self-medication provides a cheap alternative to people who cannot afford to pay medical practitioners. Thus, self-medication is often the first response to illness among people with low income (20).

In this study, the three most usual sources of information for self-medication were friends, family members, self- experience and neighbor, unlike the result of similar study in Mekele where pharmacists, healthcare providers such as doctors, nurses and health assistants served as sources of information for self-medication, but without formal prescriptions (19).

A significant number of respondents (96.2%) use S/M from those perceived illness. Majority of the self-medicated individuals used due to minor illness. The most common category of drugs used was analgesics/antipyretics and antimicrobials. And the reason reported for using S/M was minor illness and previous experience with the illness. Most of respondents obtained drugs easily from pharmacy. So, pharmacies are the major sources of drugs used for S/M. The increased of drugs storage to treat similar illness/symptom and drugs left over from previous use contribute to the increase in the S/M practice. Common drugs store reported by respondents who store modern drugs were analgesic/antipyretic. Most of the respondents stored the drug in locked cabinets.