Prevalence, Knowledge and Associated Determinants of Auto-Medication in the Limbe Municipality ()
1. Background
With the emergence and discovery of new medicine for the management of various diseases, the practice of self-care in the form of self-medication has been on the rise. In recent years, lay public are progressively more and more concerned about their health-care by active involvement in decision making. In most societies a person suffering from physical discomfort or emotional distress has a number of ways of helping himself or seeking help from other people [1]. In remote and impoverished areas, western health care is often part of a pluralistic medical system in which it coexists with traditional medicine that includes both self-care with medicinal plants and consultation with specialised traditional healers [2]. The practice of self-medication is prevalent worldwide, especially in developing countries like Cameroon where many drugs are dispensed over-the-counter without prescription [3]. Without realising the repercussions of excess use, people often pop pills for even minor ailments. Irrational use of these drugs causes increased microbial resistance, wastage of re-sources, masked diagnosis, and use of excessive drug dosage and can also lead to drug dependence. On the contrary, if used appropriately, self-medication can be time saving, economical and relieves the burden on health professionals, giving them more time to heal major ailments. Starting from the presupposition that no pharmacologically active substance is innocuous to the body, self-medication could be prejudicial to individual and collective health [4].
The practice of self-medication must be based on authentic medical information to avoid irrational use of drugs which in turn can cause wastage of resources, increased resistance of pathogens to drugs and can lead to serious health hazards like prolonged sufferings, drug reaction and drug dependence [5]. People may practise self-medication for a variety of reasons, like the urge for self-care, sympathy for family members in sickness, lack of health services, poverty, ignorance, misbelief, excessive advertisements of drugs, and availability of drugs in establishments other than pharmacies. The WHO has also pointed out that responsible self-medication can help prevent and treat ailments that do not require medical consultation and provides a cheaper alternative for treating common illnesses. Moreover, antimicrobial resistance is a current problem worldwide particularly in developing countries like India where antibiotics are often available over the counter without a prescription [6].
The adverse effects of self-medication cannot be over-emphasized. However, some people may engage in the practice of self-medication due to ignorance, poverty and unavailability of health facilities. It is widely believed that human malpractices such as inadequate dosing, incomplete courses and indiscriminate drug use have contributed to the emergence and spread of antimicrobial resistance [7]. The consequence of this is the loss of relatively cheap drugs that will require new drug development which will be more expensive and will further disadvantage patients in developing countries [8]. The rational use of drugs like antibiotics is thus of utmost importance to limit the increase in bacteria resistance [9]. Globally, the prevalence of SMP is inconsistent ranging from 32.5% to 81.5% [10] [11] [12]. The underlying motivation for this study is the prevailing health issues associated with in-appropriate use of drugs, which is increasingly becoming a challenge in our community.
2. Methodology
2.1. Study Design
This was a community based cross-sectional study.
2.2. Study Setting
The study was carried out at Down beach and Newtown-Limbe Cameroon. Limbe (known as Victoria from 1858 to 1982) is a seaside city in the South-West Region of Cameroon. Limbe was founded in 1858 on the southern slopes of Mount Cameroon by the British missionary Alfred Saker. At the 2005 Census, the population was 84,223.
2.3. Study Duration
This study was conducted from January to August 2021.
2.4. Study Population
The target population included adults residing in Down beach and New-Town quarters in the Limbe municipality
2.5. Sampling Method
We used the probability convenience sampling method to recruit our study participants’ population. Adults that gave their consent to participate in the study were included. The sample size was estimated using Lorenz’s formula.
Sample size,
where, q = 1 − p;
z = standard normal variate, 1.96;
p = expected proportion in population based on previous studies (prevalence). The prevalence of 75% was used in this study which was obtained from a study conducted by Omolase et al. to “assess the self-medication amongst general outpatients in a Nigerian community hospital”;
d = absolute error or precision, 5%.
From the above formula, the sample size was 284 adults.
Inclusion criteria
r All adults that had lived for at least six months at down beach and Newtown Limbe.
Exclusion criteria
r We excluded all adults who were morbidly ill and those with hearing and visual disorders.
r Individuals who were busy at the time and couldn’t provide adequate time to answer questionnaires till the end.
2.6. Data Collection Tools/Technique
Data was collected using a well structured questionnaire. The questionnaire was structured from reviewing existing literature. Pretesting of the questionnaire was done in some 20 adults in the New Town community to ensure its feasibility. Ambiguities were modified based on the pretest findings. The finalised questionnaire was used to collect data by face-to-face interview with eligible participants. The variables in this research study consisted of use of self-medication (dependent variable) and knowledge, attitude and practice of self-medication (Independent variable). The technique of the data collection was through a self-administered questionnaire with the participant to elicit responses if eligibility for the study were met within the period of data collection. Individuals who were unable to read and write were assisted by the investigator to fill their questionnaire. The questionnaire was made up of 5 sections. Section one (1) was on the socio-demographic factors of the respondent and made of seven (7) questions with options for the respondent to choose one option. These questions include; Name, age, Gender, marital status, educational level, income level, employer of respondent. Section two (2) is on self-medication habits with nine (9) questions. The first six (6) questions were made of short statements for the respondent to mark a cross (X) on either always, most of the time, often, sometime or rarely as appropriate to them. The next 3 questions (question 7 - 9) were made of short questions and options for the respondent to select more than one choice. Section three (3) was on the knowledge of self-medication and made of seven (7) statements (questions) for the respondent to place a cross (X) in the box on either right, wrong or uncertain as appropriate to them. Section four (4) was on attitude towards self-medication and made of six (6) questions (statements) for the respondent to place a cross (X) in the box on either strongly agree, agree, uncertain, disagree, or strongly disagree. Section five (5) was on the practice of self-medication and made up of eight (8) questions (statements) for the respondent to place a cross (X) in the box on either right, wrong or uncertain as appropriate to them.
2.7. Ethical Approval
Ethical clearance was obtained from the Faculty of Health Sciences, University of Buea. Administrative authorization was obtained from the Regional Delegation of Public Health for the South West Region. A written consent form was signed by each participant willing to partake after going through the participant’s information sheet. All the information was recorded anonymously and confidentiality was assured throughout the study.
2.8. Study Procedure
After signing an informed consent form, participants were administered a pre-tested survey questionnaire and any ambiguity was modified based on pre-test findings.
2.9. Data Processing and Analysis
Data was entered and analysed using Statistical Package for Social Science (SPSS) version 17. Descriptive statistics such as frequencies and percentages were presented using tables, graphs, and texts. P-value less than 0.05 was used to determine variables significantly associated with Self-medication practice. The prevalence of self-medication was obtained from the answer provided in the questionnaire by all the participants that answered “yes” to having given medication to anyone that fell ill at home. Knowledge of self-medication was obtained from answers provided on the questionnaire. All participants who ticked “right” with the statement, were considered to have “good knowledge”, those who ticked “wrong” were considered to have “poor knowledge” while participants who ticked uncertain with the statement were considered to be “uncertain” with self-medication practice. Attitude was analysed based on the option made by participants against the statement. Those who agreed or strongly agreed were considered to have “negative attitude”, participants that disagreed or strongly disagreed were considered to have “positive attitude” while those who said to be uncertain were considered to be “indifferent” on the practice of self-medication. The practice of self-medication was based on the options ticked by participants against the statements in the questionnaire. Those who agreed or strongly agreed were considered to have “good practice”, participants that disagreed or strongly disagreed were considered to have “poor practice” while those who said to be uncertain were considered to be “uncertain” on the practice of self-medication. All this data was printed and kept safe in a clean dry cupboard and accessibility was restricted from all except the investigator. The softcopy of the document was converted to a pdf file and backed up on a google drive and into a USB flash disk.
3. Results
A total of 284 questionnaires were printed and administered (100% distribution) and all the 284 questionnaires were received (100% response rate).
3.1. Sociodemographic Data
This study involved 284 participants of varied age ranges, ≤19 years 23 (8.1%), 20 - 29 years 120 (42.3%), 30 - 39 years 60 (21.1%), 40 - 49 years 58 (20.4%) and ≥50 years were 23 (8.1%). The total number of individuals per household; 1 - 2 persons 73 (25.7%), 3 - 5 persons 109 (38.4%), 6 - 7 persons 68 (23.9%) and ≥8 persons were 34 (12.0%). For educational level, the majority 159 (56.0%) had been to the university as shown on Table 1 below.
3.2. Prevalence of Self-Medication
Among the participants, 213 (75.0%) said yes to self-medication at home when sonhmeone was sick, while 71 (25.0%) said no to self-medication. Also, 151 (71.4%) of participants said they self-medicated when they have fever and headache, 23 (10.7%) said when they had cough and cold, 8 (3.7%) said acidity, 4 (1.7%) said when they have nausea and vomiting, 4 (1.7%) said when they had diarrhoea and 23 (10.8%) said others (Figure 1).
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Figure 1. Prevalence of self-medication and rational for automedication.
Distribution of Drug Types Used and Motivation of Usage
For self-medicated drug used by the participants, majority 204 (18.9%) said paracetamol and the least was dexamethasone 5 (0.5%) (Figure 2).
Concerning the reason for self-medication, the majority 95 (15.6%) said it saves time and the least 5 (0.8%) response of the participants was that doctors were too busy with many patients (Figure 3).
3.3. Knowledge of Self-Medication
The various responses of the participants to test their knowledge are represented on Table 2 below.
Overall, 68.9% of the participants had good knowledge, 13.1% of participants had poor Knowledge while 18.2% of participants were uncertain (See Figure 4).
3.4. Attitude of Self-Medication
The attitude of the participants towards self-medication varied in this study, as some agreed, others disagreed and others were uncertain. These attitudes were represented on Table 3 below.
Overall, 58.3% of participants had a positive attitude on self-medication, 12.7% were indifferent while 29.0% had a negative attitude (Figure 5).
3.5. Factors that Promote the Practice of Self-Medication on Adults in Limbe Community
A chi-square test was done to check for factors that promoted self-medication among households of the Limbe community, there was a statistically significant relationship between age and self-medication (p = 001) the age group < 19 years had the highest case of self-medication (100%). Also, there was a significant association between the total number of family members staying at a house and self-medication (p = 0.001), households with 6 - 7 members had the highest rate of self-medication (100%). There was also a significant association between the highest level of education and self-medication, primary and secondary education
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Table 2. Knowledge on self-medication.
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Table 3. Attitude of self-medication.
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Figure 3. Reasons for practice of auto-medication amongst participants.
was found to be the greatest (100%) promoter of self-medication. The type of illness also promoted self-medication (p = 0.001) as those with acidity and diarrhoea (100%) were most likely to self-medicate. There was a statistically significant association between all the elements of knowledge on self-medication (p < 0.05) and self-medicating, most of the participants responded that it was right. (Table 4)
3.6. Practice of Self-Medication
The practice of self-medication among the participants varied in this study, as some agreed, others disagreed and others were uncertain. These practices of self-medication are represented on Table 5 below.
The overall practice of self-medication showed that 46.0% of participant had good practice on self-medication, 46.0% were uncertain while 8.0% had poor practice of self-medication (Figure 6).
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Table 4. Factors that promote the practice of self-medication on adults in Limbe community.
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Table 5. Practice of self-medication.
4. Discussion
The practice of self-medication has long been in existence worldwide. The situation continues to increase particularly in developing countries where high prevalence has been reported [13]. The responsible practice of self-medication could be life saving and cost effective in areas where inadequate provision of health services do exist. However, self-medicating has its drawbacks as it may lead to unintended effects if inappropriately used. In this study we found a high prevalence of self-medication, 75.0% which is similar to studies reported in the Northern part of Uganda [14], Pakistan amongst university students [15] and amongst pregnant women in Uyo, Nigeria [16]. Lower prevalence has been reported in Ghana [17], and Ethiopia [18]. In Ethiopia in particular, the study was conducted amongst university students who are believed to be more educated and abreast with medication use and side effects thus the lower prevalence.
Fever/Headache were found to be the most frequent symptom for which the participants self-medicated. This matched similar reports from Ethiopia, India and Pakistan [19] [20] [21]. For these symptoms, Paracetamol was the most commonly used medication. This is consistent with findings from an assessment carried out amongst medical, pharmacy and health science students in Gondar University, Ethiopia [22]. Paracetamol is a very common medication, it was the first drug to be made available over the counter (OTC) in modern times [23]. These findings however contradicted the results reported from a study amongst pregnant women in the Northwest region of Cameroon, which found antiemetics to be the most common drug used for self-medication [24].
Amongst the several reasons for why participants choose to self-medicate, saving time was the most frequent. In sub-Saharan Africa access to healthcare is still a major problem. Currently, at least one-sixth of the population lives more than two hours away from a public hospital and one in eight people is no less than one hour away from the nearest health center [25]. Related findings were made in Punjab and Islamabad, Pakistan where access to hospital (24/7) was a powerful trigger for self-medication practices. Provision of appropriate health facilities can significantly constrain self-medication practices [26] [27].
Out of the 284 participants in this study, 68.9% had good knowledge on the practice of self-medication. This finding is higher than 9.7% in Somaliland where they assessed the knowledge, perception and practices of self-medication among households of children under five years in Borama district [28]. This significant knowledge gap could be due to the fact that more participants in our study had attained at least a secondary level of education and had more access to internet services. This finding agrees with a similar study conducted in the Northern Indian population where those who lived in Urban settings were more likely to have good knowledge as compared to their rural counterparts [29]. Over 58.3% of the household had a positive attitude towards self-medication, which is in line with 54.6% in Somaliland.
The study result revealed that 46.0% of the households had good practice to self-medicate, which was higher than the 1.4% study in Somaliland. This may be due to Lack of knowledge and education on self-medication. Also increased health care cost and increased availability and use of the internet has increased the practice of self-medication.
From this study, A chi-square test was done to check for factors that promoted self-medication amongst adults in Limbe community, there was a statistically significant relationship between age and self-medication (p < 0.05) the age group < 19 years had the highest case of self-medication (100%). This could be explained by the fact that this age group consists of teenagers who are more likely to be under supervision and or parental guidance and can be instructed or given medications in the face of health challenges.
In addition, there was a significant association between the total number of family members staying at a house and self-medication (p = 0.05), households with 6 - 7 members had the highest rate of self-medication (100%). This could be explained by the fact that a higher number of people in a household comes with higher cost for healthcare services thus the majority will go for the relatively cheaper over the counter auto medications. There was also a significant association between the highest level of education and self-medication, primary and secondary education were found to be the greatest (100%) promoter of self-medication. The type of illness also promoted self-medication (p = 0.05) as those with acidity and diarrhoea (100%) were most likely to self-medicate. There was a statistically significant association between all the elements of knowledge on self-medication (p < 0.05). This was in agreement with a study in Somaliland with p < 0.05.
5. Conclusion
The study reveals a high prevalence of self-medication among household individuals in the Limbe community. Adults in Newtown and Down Beach Limbe are knowledgeable in the practice of self-medication with a good proportion of them self-medicating because it saves time. Participants preferred to automedicate irrespective of the severity relating to a state of ill health.
5.1. Recommendations
To the problems identified in this study, the following proposed suggestions have been made:
To health personnel
• Health care providers should educate patients on the dangers of self-medication. Such messages should be extended to the community at large periodically by government health ministries.
To the government
• Government should enforce relevant legislation which limits the sales of drugs without prescription to only a few relatively harmless over the counter ones.
• Create awareness about existing health facilities so that patients will know where to go when the need arises thereby minimising the potential resort to self-medication.
• Further research should be carried out in the rural area of the Limbe community, South West region and Cameroon as a whole assessing the awareness of both modern and traditional medicine in order to be able to make a definitive conclusion.
5.2. Limitations
• This study was conducted in an urban setting which didn’t show the practices of the rural area.
• The study assessed conventional medicine and did not include practices of traditional medicine.
• The study might also prone to recall bias as a result of self-reporting of the participants for their last 6 months experiences.
Author’s Contributions
TPB, AFE and NFA conceived and designed the study; all authors participated in the data collection process; TPB, NFA, ZBF performed data analysis and interpretation; TPB, and NFA wrote the first draft of the manuscript and AGE, DDY, ACT, ZBF, DNA, TBB reviewed and corrected the manuscript. TPB, NFA, ACT, DDY, TBB and DNA constituted the questionnaire for the study. All authors did proofreading and inputting of data into Excel sheets. All authors approved the final copy.