Prevalence And Patterns of Self-Medication Practices in Urban Field Practice Area, Dharwad

Context/Background: The estimated prevalence of self-medication practices globally and nationally is 95% and 71% respectively. Inappropriate self-medication leads to irrational use of drugs and develop-ment of drug resistance. Hence, the present study was conducted to estimate the prevalence and patterns of self-medication practices in urban field practice area, SDMCMS&H, Dharwad. Methodology: A cross-sectional study was conducted during 2018-2019 among adult aged 18-60 years. The estimated sample size was 335. Systematic random sampling technique was used to select the samples. Data was collected by administering questionnaire to the consented study participants. Results: A total of 335 adults participated in our study. The prevalence of self-medication practices was 46%. Minor-illness 89 (57.7%) and quick relief 50 (32.46%) were the major reasons given for practicing self-medication. Fever and headache 146 (94.8%) were the most common symptom and analgesic 128(83.11%) was the most common drug used. significant association was found between self-medication practices and religion, age, employment, and presence of health care workers in the family. Conclusions: Around half of the study participants practiced self-medication. Easy availability and lim-ited knowledge are the reasons for wide range of practice. Creating awareness about dangers of self-medication is important to prevent untoward effects and drug resistance.

INTRODUCTION According to World Health Organization selfmedication is defined as "The use of medications without prior medical consultation regarding indication, dosage and duration of treatment". 1 Self-care is a broad concept which contains many components like nutrition, lifestyle, hygiene, environmental factors, socioeconomic factors and self-medication. Thus, self-medication is one of the integral components of broader aspect of self-care. 2 Self-medication is an age-old practice and is a burning issue all over the world. 3 Being practiced globally, self-medication with OTC drugs is a public health problem. According to World Health Organization expert committee 1995 it was stated that selfmedication was widely practiced in both developed and developing countries. The practice has been dramatically increased especially in developing countries in the last few decades which has led to professional and public concern. 4 The estimated prevalence globally ranges from 32.5% to 81.5%. 5 The prevalence of self-medication in developing countries ranges from 12.7% to 95%. 6 In developing country like India in which universal health care accessibility is not yet achieved the practice of self-medication is of concern. 7 The estimated prevalence of self-medication in India was 31% in 1997 which has increased to 71% in 2011. It is seen that there are wide range of prevalence reported in many Indian studies, this might be because of methodology adopted, population selected, or the definitions used to define self-medication. The extent of practices is influenced by cultural, social and economic factors. 4 Inappropriate self-medication leads to irrational use of drugs. Self-medication practices cause potential harm to an individual as well as to the society. Almost every drug has a potential to cause side-effects due to hidden active ingredient in it and also due to drug interactions. 8 This practice particularly with antimicrobials had led to emergence of drug resistance which is a serious issue globally. Hence, this study was conducted to know the prevalence, patterns of self-medication practices in urban field practice area, Dharwad.

OBJECTIVE
The study was conducted to estimate the prevalence and patterns of self-medication practices in urban field practice area, SDMCMS&H, Dharwad.

METHODOLOGY
This was a community based cross-sectional study among adults aged between 18-60 years residing at Jannat Nagar, Urban field practice area of Dharwad. The urban field practice area attached to Department of Community Medicine, SDMCMSH, Dharwad. The study was conducted from November 2018 to October 2019.
Inclusion criteria: Adults aged between 18-60 years of age, permanent residents and gave consent to accepted to participate in the study were included in the study.
Exclusion criteria: People who were seriously ill, mentally challenged and incapable of hearing and speaking at the time of data collection were excluded.

Sample size calculation and sampling technique:
The sample size was estimated using following formula. n = z 2 pq/ d 2 . Based on the previous studies the prevalence of self-medication was found to be 35.9%. 6 Alpha error of 5%, relative error of 15% of prevalence and with non-response rate of 10% the estimated sample size was 335.
Systematic random sampling technique was used to locate the house. Jannat Nagar is an urban slum which is located around 1.5kms from Urban Health Training Center. It has a population of 5099 with 1300 households. The list of sample population was taken from Anganwadi survey register. Systematic procedure was followed to choose a sample by taking every Kth household. K is the sample interval which was calculated by dividing number of houses in the area with that of sample size which was calculated as 4. One random number from 1 to 4 was selected by lottery method. The subsequent house was selected by adding 4 to the random number. If the selected house was locked or non-availability of study participants at the time of visit, frequent and subsequent visits were made to collect the data. Even after 3 subsequent visits, if the participants are unavailable then the next random house was selected. The process is repeated until the desired sample size is achieved.
Once the household was chosen, only one member from the family was allowed to participate in the study. All the available members of the family who are less than 60 years and more than 18 years of age were listed and one participant among them were selected by lottery method.
Institutional ethical committee approval was taken before conducting the study.
A questionnaire was self-developed for this study. It was pilot tested, and the necessary changes were incorporated. The questionnaire consisted of two parts. The first part included data on sociodemographic variables-age, gender, education, occupation, income, medical history and health insurance. The second part had details on patterns of selfmedication, frequency in the past six months, type of medication, sources, commonly used drugs, the diseases for which self-medication was practiced and perceptions on self-medication.
Statistical Analysis: All data was entered and analyzed using SPSS 23.0 software. Descriptive statistics like frequencies and percentages were calculated. Association between self-medication and other factors were ascertained by applying Chi-square test or Fischer's exact test. P value of <0.05 was taken as statistically significant.

RESULTS
A total of 335 adults residing in Jannath Nagar, field practice area of SDMCMS&H, Dharwad participated in the study. Majority of the participants were females 267 (79.7%), 99 (29.6%) of them belonged to 30-39 years of age, 190 (56.7%) were unemployed, 94 (27.5%) were illiterate, 180 (53.7%) were from nuclear family, 280 (83.6%) of them married and 155 (46.3%) belonged to class IV socio-economic status.   Of 154 participants who practiced self-medication 64 (41.5%) of them took drugs less than 3 times in last 6 months, 150 (97.4%) preferred oral medications. Fever and headache 146 (94.8%) were the most common symptom for which self-medication was practiced and least was for skin problems 5 (3.24%) ( Table 2). The drug commonly used to alleviate their symptom was analgesic 128 (83.11%). 145 (94.1%) of them procured drugs from pharmacy and 112 (72.7%) of them procured by describing the symptoms. (Table 3) When enquired about their experience on selfmedication, 146 (94.8%) of them told they were relieved of symptoms, 147 (95.5%) of them did not experience any adverse effect, 91 (59.09%) of them preferred to continue the practice. Of 154 (46%) participants who practiced self-medication 63 (40.9%) of them wanted to stop self-medication practice due to the fear of adverse events 37 (58.73%) and chances of misdiagnosis 10 (15.87%). We found significant association between self-medication practices and religion (chi-square= 5.47, p = 0.019), age (chi-square= 5.13, p= 0.027), employment status (chi square= 4.27, p= 0.038) and presence of health care workers in the family (chi-square= 6.134, p= 0.013) as shown in the table 4.

DISCUSSION
The study was conducted among adults residing in Jannath Nagar, field practice area of SDMCMS&H, Dharwad. 335 participants were selected based on systematic random sampling technique. The prevalence of self-medication in our study was 46%. A study conducted in urban slums of Udupi also showed similar results. 9 The studies conducted all over India showed wide range of prevalence of self-medication practices ranging from 29.1% to as high as 92.8%. The prevalence of self-medication practices in various parts of India are: Rural south India (51.75%), 3 Urban areas of Udupi (35.9%), 6 Maharashtra (29.1%), 10 Delhi (92.8%), 4 and Urban areas of Belagavi (35.1%). 11 The wide range of variation in the prevalence may be due to the literacy status, socio-economic status, easy accessibility and availability of over-the-counter drugs and accessibility and availability of health services.
Of those 154 (46%) who practiced self-medication, majority 89 (57.79%) answered that they were using it only for minor illnesses, 50 (32.46%) of them said it gave quick relief. A study done in Islamabad, Pakistan in urban and rural areas showed the following reasons for practicing self-medication: mild illness 158 (41.8%), economical 65 (21.2%) and previous experience 60 (19.6%). 12 This shows that the study participants practiced self-medication only if it is a non-serious illness as it would give quick relief and also may be due to the socio-economic status which made them reserve money for future and serious illnesses. And also, as most of them were labourers, they couldn't afford to go to a doctor for minor illnesses as they may lose their daily wages. The most common symptoms for which self-medication practiced was fever and headache 146 (94.8%) followed by cold and cough 80 (51.94%). In a community based cross-sectional study done in Harar city of Eastern Ethiopia in 2018 showed that headache 112 (30.3%) and respiratory symptoms 109 (29.5%) were the common symptoms for which selfmedication was practiced. 13 When we intend to know the perceived outcome of self-medication among participants who practiced it, we found that 146 (94.8%) of the study participants were relieved of symptoms after practicing selfmedication and 7 (4.5%) had experience minor side effects like itching, rashes, nausea and vomiting. A study conducted in Addis Ababa found that 275 (45.5%) of them were relieved of the symptoms, 79 (13.1%) had no improvement, 72 (11.9%) of the participants perceived complete cure while the remaining 5% had worst experience and said that it aggravated their present condition. 14 A study done in Eastern Ethiopia in 2018 showed that 44 (11.9%) of participants had experienced adverse effect following self-medication. 13 The difference in perceptions of study participants from place to place can be attributed to literacy status, information on drug and availability of the over the counter drugs.
Majority 46 (13.7%) of the study participants who practiced self-medication belong to 30-39 years of age. We found a significant association between age and self-medication practices (chi-square= 5.13, p= 0.027). The higher proportion of study participants practicing self-medication were of younger age group, which may be due to the carefree behaviour, easy accessibility to information or risk-taking behaviour. In the present study of 335 (100%) study participants 190 (56.7%) of them were unemployed, of which 78 (23.3%) of them practiced selfmedication which was found to be statistically significant (chi square= 4.27, p= 0.038). Similar findings were reflected in a study conducted in Bangalore. 15 The relatively higher proportion of unemployed people preferring self-medication can be attributed to the affordability to pay doctor and self-medication being a cheap alternative. Our study shows that majority 108 (32.3%) of literates practiced selfmedication. A study conducted in Rajasthan also reflected similar findings. The higher proportion of literates practicing self-medication can be attributed to their ability to read and understand the information on drugs.

CONCLUSION
This study showed that around half (46%) of the adult population in Jannath Nagar, Dharwad practiced self-medication. Statistically significant association was found between self-medication practice and few socio-demographic variables like age, employment status, religion and presence of health care professional in the family. Minor illness and quick relief were the common reasons quoted by study participants for practicing self-medication. Fever and headache were the most common symptom and analgesic was the most common drug used for self-medication purpose. As we assessed self-medication practices in the last 6 months, there could be a possibility of recall bias. The cross-sectional nature of the study is unable to prove the temporal association between socio-demographic profiles and self-medication practices. Drug authorities and health professionals should educate the community regarding the dangers of self-medication with impressive attention. Strong policies should be applied prohibiting the supply of medicines without a valid prescription.