Knowledge, Attitude and Practices of Self-Medication Among Community Pharmacy Consumers` Perspectives in Derna City, Libya
Asmaa Abdulaziz A. Rabee1, Raga A. Elzahaf2, Yahya Saber E. Mansour3, Nusieba A. Mohammed Ibrahim3
1Faculty of medicine department of pharmacology, Omar Elmokhta runiversity, Derna Libya
Received: 08-Oct-2020 , Accepted: 23-Dec-2020
Keywords: Self-medication, Knowledge, Attitude, Practice, Derna city-Libya
How To Cite
Self-medication may be associated with side effects and increases the chance of drug interactions and also affects the potency of treatment and quality of life. This study aims to estimate knowledge, attitude and pharmacy practices concerning the usage of the drugs without prescription and identifying demographic factors that could influence self-medication among the consumers of community pharmacy in Derna- Libya. Cross-sectional study was conducted among 389 participants randomly selected depending on multi-stage random sampling technique. Data were collected by using a structured questionnaire distributed over 10 different regions in Derna city. This study continued over2 months, in our result 215 (55.3%) of total participant used the self medication, most of them were male, the mean age of participants was 37.40±13.190 ranged from 14 to 83 years, most of participants 179(46%) were in university level, 235(60.4%) were in low-income level and 214(55%) were employee. In our result 111(28.5%) of participants had low level of knowledge regarding the safety of self-medication, 186 (47.8%) don’t known OTC medication and prescription only medication. Based on the attitude total score 215 participants had negative attitude toward self-medications, 159 (40.9%) always purchase the medication without prescription, the most common reason for taking self-medication was that there was no need to visit the doctor for minor illness. And the most of medication dispensed without prescription were analgesics antipyretics for cases of cold and flu as well as in pain. Pharmacy practices were good, most of pharmacist provided information about drug interactions if taking this medicine without a prescription (84.6%) and did not face difficulties to find information about the medicine.
Self-medication is the use of medicinal products by the individuals to treat self-recognized disorders or symptoms, it also involves the intermittent or continuous use of a medication prescribed by doctors for chronic or recurring diseases or symptoms1.Serious side effects, drug resistance, some illnesses and even mortality are its problem; moreover, the financial costs increased by individuals and governments are often very high2.
The term over-the-counter (OTC) is used to describe the medicines. Such available to offer benefits in terms of convenient access to, and choice of, medicines as well as involving individuals as active participants in their own health and the treatment of diseases3. There has been a tendency for the public to perceive OTC medicines to be safer than prescription medicines4,5,6, but it has been recognized that OTC medicines have the potential for harm as well as benefit7. This may result in what has been variously referred to as the misuse or abuse of OTC medicines and their potential to cause addiction and dependency7.
The medicines such as stimulants, laxatives, sedatives and substances such as dextromethorphan, they noted that in relation to abused drugs, and their review tellingly omits opiate-based OTC analgesics, combine codeine or dihydrocodeine with either ibuprofen or paracetamol and have caused addiction and also gastric or hepatic damage, respectively8,9. The use of prescription medications is helpful to treat illnesses when they are used under the advice of physicians for appropriate diagnoses .it has been reported that self -medication is common practice among consumers in different developing countries, and purchasing the prescription medications without a prescription10,11.
Inadequate knowledge of medication use may lead to misuse by community and patients noncompliance with a drug regimen and results in serious outcomes like adverse drug reaction and reduction of the quality of treatment 12. Previous studies conducted in different areas suggested that people had a poor knowledge about the pros and cons of self-medication, as a result their outlook toward self-medication practice were majorly favorable for any perceived illness 13.A variety of studies have documented some of the major factors affecting or contributing to self-medication. One of these factors involves reforms in the health sector, Others include access to health care facilities, medical factors, socioeconomic factors, such as awareness about health, access to medical information, and educational level 14,the increase in cases of self-medication has been attributed to issues such as new technological developments (including the dominance of the Internet and online interactions), improvements in the socioeconomic status of individuals, level of education, and the people’s general knowledge15 , for these reasons, and in addition to there are limited studies on self- medication in Derna city, so the aims of our study to assess the knowledge, attitude, and practices of self- medication among community pharmacies in Derna city,also to known the most types of drugs used by self medication in compare with non self medication.
METHODS AND MATERIALS
A questionnaire-based cross sectional study were used. The questionnaire consisted of personal information (gender, age, level of education, income of family, occupation) and other question related to knowledge, attitude, and practices of prescribed and non-prescribed medicines. In addition to questions of the pharmacy has to be answered. Community pharmacies were 10 pharmacies in different regions in Derna city, which they are selected randomly, where the sample size for this study was calculated by using Raosoft sample size calculator. it was calculated assuming a prevalence rate of self-medication to be 50% in population size of 130000 in Derna. Assuming a 95% confidence interval and 5% margin of error, the minimum effective sample size calculated for this study was 383.
The study was continued over 2 months started in June to August 2020.Data collectors distributed the questionnaires to consumers buying medications with or without prescriptions from the selected pharmacies at different times of the day, but not included consumers buying cosmetics and medical equipment. The questionnaire was written in Arabic language, in cases where consumers were blind or can’t read the question, the pharmacy was asked to interview them and complete the questionnaire on their behalf.
Data were analyzed using Statistical Package of Social Science (SPSS version 25.0). Descriptive statistics (frequencies, percentages, mean, range and standard deviation.) were used to describe the categorical study and outcome variables. Chi‑square test was used to compare the distribution of proportions between two groups and p value ≤ 0.05 were considered statistically significant.
Appropriate scoring was done for the assessment of knowledge, attitude and practice regarding self-medication among participants. Each correct answer = 1 mark; each incorrect answer = 0 mark. Minimum score was “0” and maximum score was 5 for knowledge questions, 4 for attitude questions, and 2 for practice questions. Patients score 70% and above was taken as having good knowledge, attitude and practice less than was taken as having bad knowledge, attitude and practice.
A total of 389 participants were included in the study, 215(55.3%) of them take a medicine without prescription (Table 1 & Fig 1). Of these, 257(66.1%) were male and 132(33.9%) were female. Moreover, the mean age of participants was 37.40±13.190 ranged from 14 to 83 years. Most of participants 179(46%) were in university level, 235(60.4%) were in low-income level and 214(55%) were employee (Table 2).
Knowledge of self-medication
Based on the knowledge total score, 215 participants had not good knowledge regarding self-medication.111(28.5%) of participants had low level of knowledge regarding the safety of self-medication, 186 (47.8%) don’t known OTC medication and prescription only medication.While127(32.6%) and 186(47.8%) of 215 participants know how to take the medicine also know the dose of medications respectively and 175(45.0%) don’t know the drug interaction of medications that purchased (Table 3 & Fig 2). There is no statistically significant difference between the level of knowledge to the use of self-medication among participants and their age (X2 =1.596, p=0.810) (Table 4).
Attitude toward the self-medications
Based on the attitude total score 215 participants had negative attitude toward self-medications, 159 (40.9%) always purchase the medication without prescription, but based on total score 389 recorded positive attitude, 251 (64.5%) think the consultation of pharmacist don’t takes the place of seeing a physician, 364(93.6%) consult the pharmacy to give them the correct medicine if they don’t see the doctor, and 161(41.4%) ask the pharmacist about drug information (Table 5). There is no statistically significant difference between the level of attitude to the use of self-medication among participants and their age (X2 =1.357, p=0.852) (Table 6).
More than third of participants 124(31.9%) had reported that they always read the pamphlet when they bought medication without prescription and 84(21.6%) said sometimes (Table 7).
Practices toward self-medication
In general pharmacy practices is very good, most of pharmacist provided information about drug interactions if taking this medicine without a prescription (84.6%) and did not face difficulties to find information about the medicine (91.3%) (Table 8).
This study was conducted to evaluate the knowledge, attitude and practice of self medication among community pharmacy consumers` perspectives in Derna city (Libya). This study included 389 participants; whose ages ranged from 14-83 years with a mean (37.40±13.190). The prevalence of self medication in our study was found to be 215(55.3%) of them take a medicine without prescription. It supported by the studies done in Saudi Arabia (51.2%) 16 and in Ain Shams University, Egypt was (55%).
Overall, participants (50.1%) of participants know how to take the medicine with the correct dose and 119(30.6%) know that the medicine they bought needs a prescription, in other hand had negative knowledge toward the drug interactions. There is no statistically significant difference between the level of knowledge to the use of self-medication among participants and their age (Table 4) (X2 =1.596, p=0.810). Most of participants had negative attitude toward self-medication
While 159(40.9%) always purchase the medicine without prescription and 251(64.5%) think the consultation of pharmacist takes the place of seeing a physician. Good attitude toward the consultation of pharmacist about the medicinal information. And generally, more than third of participants always read the pamphlet before using the drug, when they bought medication without prescription (Table 7). The most common reason for self-medication between participants was no need to visit the doctor for minor illness (23.5%). As well as because of time saving (21.3%) and (18.7%) for economic reason (Fig. 3). The same finding of James et al., 200618.
In the other hand the most common reason of non self-medication in this study was risk of worse the condition, about (30%) followed by risk of misdiagnosis, which scored about (25%) (Fig 4). In our study (Table 9) the drugs that are commonly used for self‑medication were analgesics antipyretics it score (14.7%) of total participants in cases of cold and flu as well as in pain which agree with the earlier studies reported that analgesics was the most commonly used group of drugs18,19, when we compare the uses of analgesics antipyritics by self medication with non self medication. Also, we found (14.7%) of medication dispensed for self medication while (3.9%) were given with prescription which was the same as that in a study conducted in 2015 in Saudi Arabia16.
Antibiotics had been used in present study by self-medication (6.7%) of the total participants. This result was similar to other results reported by studies done in Karachi19 and India20. In addition, studies from Nigeria21 and Egypt2 have reported a higher percentage in antibiotics as self‑medication. The current study revealed that participants thought that antibiotics are effective in the treatment of both bacterial and viral infection.
Pavydė et al.,22 showed that almost half of the respondents incorrectly identified antibiotics as being effective either in treating viral or mixed (bacterial and viral) infections. Also found cough preparation had (5.7%) of uses of the total participants. Incorrect self‑diagnosisand, drug‑ drug interaction were the most common concerns about self‑medication found in our study. These findings were similar to observations made in Bahrain18 and Egypt 17. In general pharmacy practices is very good, most of pharmacist provided information about drug interactions if taking this medicine without a prescription (84.6%) and did not face difficulties to find information about the medicine (91.3%).
Through this study, we found that analgesic antipyretics most of the medication consuming by self medication followed by antibiotics and cough preparations, we found also bad knowledge and attitude toward the self medication in Derna city, but the pharmacy practices was good, incorrect self diagnosis and risk of drug interaction and serious of adverse effects is the most common problem that face the self medication, therefore, it is recommended that the public should be educated on the use of OTC medications to increase their knowledge and awareness and facilitate responsible self-care.
Also we suggest further research conduction in regards to the practice of self medication with traditional medicine were remarkably used in our country and Future research regarding the self medication among larger samples in different cities of Libya.
CONFLICTS OF INTEREST
We hereby declare that there are no conflicts of interest regarding the publication of this study.
We express our deep sense of gratitude to all of the esteemed participants for their support and cooperation to make this study possible. We would also like to express our gratitude to the pharmacists : Ahmad Elwederny, Aziza Eltashany, Aya Elhasy, Gofrane Elbah, and Monia Sultan for the assistance in collection of data.
This work was carried out in collaboration with all of the authors.Author AAAR designed the study, wrote the protocol, collected the data and wrote the manuscript. Author RAE performed all of the statistical analyses and wrote the results. Author YSEM and NAMI managed the literature review. All authors reviewed and approved the final manuscript.
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