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 Table of Contents  
ORIGINAL ARTICLE
Year : 2019  |  Volume : 26  |  Issue : 3  |  Page : 189-194

Self-medication practice in Akuse, a rural setting in Ghana


1 Ghana Health Service, School of Pharmacy, University of Ghana, Accra, Ghana
2 USAID,DELIVER Project, School of Pharmacy, University of Ghana, Accra, Ghana
3 Ghana Police Hospital, School of Pharmacy, University of Ghana, Accra, Ghana
4 Department of Pharmacology and Toxicology, School of Pharmacy, University of Ghana, Accra, Ghana

Date of Web Publication13-Aug-2019

Correspondence Address:
Dr. Seth Kwabena Amponsah
Department of Pharmacology and Toxicology, School of Pharmacy, University of Ghana, Box LG 43, Legon
Ghana
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/npmj.npmj_87_19

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  Abstract 

Objective: In most resource-poor settings, there is a paucity of data on self-medication and possible factors that influence this practice. The current study assesses self-medication among the people of Akuse, a rural setting in the Eastern Region of Ghana. Methods: A quantitative cross-sectional study was carried out in Akuse from 4th January 2016 to 27th February 2016. Using a questionnaire, interviews were conducted to assess self-medication: class of drugs taken, sources of drugs, knowledge of potential adverse effects, among others. Results: Of the 363 participants enrolled, 361 completed questionnaires administered. Of the 361 respondents, 58.4% were female. A majority of the respondents were within the ages of 30 and 45 years. Respondents were mainly farmers (40.2%), and a majority (44.6%) had primary level as the highest education. One major reason for self-medication was influence from family and friends (32.7%). Antibiotics (32.1%) and analgesics (21.0%) were the most common self-medicated drugs, and these drugs were mostly obtained from licenced chemical sellers (32.5%). A little more than a third (39.9%) of the respondents said that their condition did not change after self-medication. A greater number of the respondents (81.7%) did not have knowledge of potential adverse reactions associated with self-medicated drugs. However, respondents with high educational level had the most knowledge of adverse drug reactions. Conclusion: The study found self-medication as a common practice among a number of residents of Akuse. Findings from this study provide data that could be used for targeted education and sensitisation of self-medication and its demerits in similar resource-poor rural settings.

Keywords: Drugs, questionnaire, respondent, self-medication


How to cite this article:
Mensah BN, Agyemang IB, Afriyie DK, Amponsah SK. Self-medication practice in Akuse, a rural setting in Ghana. Niger Postgrad Med J 2019;26:189-94

How to cite this URL:
Mensah BN, Agyemang IB, Afriyie DK, Amponsah SK. Self-medication practice in Akuse, a rural setting in Ghana. Niger Postgrad Med J [serial online] 2019 [cited 2019 Aug 26];26:189-94. Available from: http://www.npmj.org/text.asp?2019/26/3/189/264393


  Introduction Top


Self-medication can be defined as acquisition and use (either for the diagnosis, treatment or monitoring of treatment) of drugs without the advice of a medical practitioner.[1] According to the World Self-Medication Industry, one of the reasons for self-medication is because it is more cost and/or time effective.[2] People also practice self-medication because they feel their clinical condition does not merit an appointment with a health-care professional.[2]

Drugs have become readily available, with the advent of some drugs being sold even at supermarkets.[3] In certain households, cabinets-containing drugs from previous prescriptions may sometimes be used for current health problems.[4] In some resource-poor settings such as Ethiopia, there is the sale of drugs in kiosks, on buses and open markets, which encourages the practice of self-medication.[5] In most low- and middle-income countries, professional health care is relatively expensive and in some cases not readily available and thus making self-medication an obvious choice.[6] Purchase of drugs deemed 'prescription-only' can be bought over-the-counter (OTC) in some developing countries.[6] Furthermore, the lax in drug regulation in most of these developing countries has resulted in the proliferation of drugs that are available on buses and open markets.[7] It is noteworthy, however, that self-medication is not only limited to resource-poor settings but also developed countries.[8] Self-medication is associated with delay in people seeking medical help, possible adverse reactions, drug–drug (herb) interactions, incorrect dosage administration, masking of a severe health condition and risk of dependence.[9] Insomnia, depression, kidney failure, liver cirrhosis and ultimately death are also some of the outcomes of self-medication.[10],[11] Furthermore, antibiotics are among the common self-medicated drugs worldwide, with over 50% purchased and used without prescriptions.[12],[13] There are reports that indicate that self-medication is one of the major contributors to antimicrobial resistance.[14] Worldwide, antimicrobial resistance is a major challenge because it is associated with high health-care cost, morbidity and mortality.[13] Therefore, the implications of self-medication on an individual, and the society as a whole cannot be overemphasised.

A number of studies conducted on self-medication have been on prescription-only drugs and possible repercussions on patients.[15],[16],[17] Although OTC drugs can partly be said to be 'self-medicated' drugs, improper use and abuse could lead to adverse events, especially among children, geriatrics, pregnant and lactating mothers.[18],[19] There are few studies that have evaluated drug-related problems associated with both prescription-only and OTC medicines.[20] Few studies have also tried to find associations between demographic characteristics and self-medication. Furthermore, there is a dearth of published research on self-medication in a resource-poor setting like Ghana. Therefore, we sought to assess self-medication practice among the people of Akuse, a rural setting in the Eastern Region of Ghana. Findings from this study would provide baseline information on self-medication in resource-poor settings and eventually enhance public health education on drug use and misuse in such similar settings.


  Methods Top


The study was a quantitative cross-sectional community-based study. The site for this study was Akuse, located in the Lower Manya Krobo District of the Eastern Region of Ghana. The District is estimated to have a total population of 89,246, comprising urban and rural dwellers; 74,733 and 14,513, respectively.[21] Akuse is presently a rural settlement. It was once a prominent commercial hub for indigenes of the Eastern, Volta and Greater Accra Regions. It is located about 115 km from Accra (the capital of Ghana). The population of Akuse is about 6280.[22] The local dialect of residents is Krobo, although Dangbe, Ada, Twi and Ewe are also spoken. The predominant occupation of residents of Akuse is farming. In Akuse, there are two licenced chemical shops and no community pharmacy. There are also a number of traditional medicine practitioners in Akuse. The only hospital in Akuse is a Government Hospital, built in 1911 by the Germans, and this facility is under the management of the Ghana Health Service. In most parts of Ghana, the most common health problems include malaria, lower respiratory tract infections, typhoid, hypertension and diabetes.[23]

Inclusion criteria for the survey were residents who were at least 18 years and who had resided in Akuse for not <6 months. The resident was to be one who had practiced self-medication, at least, over the past 3 months, and who had consented to be a part of the study. The sample size was calculated by adopting a 95% confidence level, and 5% margin of error at a response distribution of 50% for the population (n = 6280).[24] The estimated sample size was 363. A purposive sampling technique was used, where households in Akuse were visited.

An adapted questionnaire from a previous study,[25] modified slightly was used as data collection instrument. The questionnaire was tested for face validity by a panel of subject experts and modified in accordance with their recommendations to ensure comprehension by respondents. Internal consistency of the questionnaire was assessed using Cronbach's alpha and the scores ranged between 0.85 and 0.92. Questionnaires used in this study were in two major sections. The first section sought bio-data or demographic information of respondents (gender, age, occupational status, marital status and educational background), while the second section sought information on self-medication. Questions asked in the latter section of the questionnaire included: reasons for self-medication, frequency of self-medication, most purchased self-medicated drugs, how drugs were acquired, the outcome of the practice and knowledge of adverse effects of drugs, among others.

The administration and retrieval of all questionnaires from respondents were done from 4th January 2016 to 27th February 2016. Before data collection, the questionnaire was pre-tested at the study site, Akuse. Ten questionnaires were used for this purpose, and this exercise aided in rephrasing some of the questions. Interviews were carried out by three trained field assistants who explained and/or translated interview questions to the local language of participants who could not read or write in English.

Data collected were coded, stored and analysed using the Statistical Package for the Social Sciences (SPSS) Version 18 Software (SPSS Inc. Released 2009. PASW Statistics for Windows, Chicago, USA). Incompletely filled questionnaires were not included in data analysis. Results were presented as percentages (chart and tables). Cross tabulations (using Pearson's Chi-square test) were used to assess associations between some demographic characteristics (age, the highest level of education, occupation and gender) and responses to some of the interview questions. A value of P < 0.05 was considered statistically significant for all inferential statistics.

Ethical approval for this study was obtained from the Lower Manya Krobo Municipal Health Directorate. Informed consent was obtained from each respondent by explaining the objectives (in the local language if need be) of the study before inclusion. Respondents were further assured of confidentiality and anonymity. Respondents consented by signing or thumb-printing against their decision as indicated on the questionnaire.


  Results Top


Of the 363 participants enroled, 361 (99.4%) filled and completed questionnaires. Two questionnaires were rejected because they were incomplete. Of the 361 respondents, 211 were female. About 60% (n = 218) of the respondents were between ages 18 and 45 years. A summary of the demographic data of respondents are shown in [Table 1].
Table 1: Demographic characteristics of respondents (n=361) of the study

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From October 2015 to December 2015, a majority of the respondents (n = 148) self-medicated once. Respondents' responses to the frequency of self-medication, represented as percentages in a chart, from October 2015 to December 2015 (in the past 3 months) are shown in [Figure 1].
Figure 1: Frequency of self-medication among respondents (n = 361) from October 2015 to December 2015 (in the past 3 months)

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With the question “What was the main reason for self-medication without consulting a medical professional,” a majority of the respondents cited influence from friends and relations as a reason for self-medication. Responses to the afore-mentioned question by respondents are presented in [Table 2].
Table 2: Respondents' main reason for self-medication (n=361)

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With the classes of drug class most often purchased [Table 3], the study found that 116 (32.1%) of the respondents most often purchased antibiotics, 76 (21%) analgesics, 75 (20.8%) anti-diabetics, 36 (10%) antimalarials, 39 (10.8%) antacids and 19 (5.3%) anti-hypertensive drugs.
Table 3: Classes of drugs most often purchased by respondents (n=361)

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The study found that a majority of the respondents, 117 (32.5%) obtained their medications from licenced chemical sellers, 94 (26.0%) from traditional practitioners, 77 (21.3%) from family members or friends and 73 (20.2%) obtained drugs from community pharmacies.

Of the 361 respondents, 275 (81.7%) had no knowledge of potential adverse effects before taking drugs, whereas 86 (18.3%) had some knowledge of potential adverse effects. Furthermore, 158 (43.8%) of respondents said that they did not experience any undesired reactions from self-medicated drugs, while 203 (56.2%) affirmed having experienced some undesired drug reactions.

A majority of the respondents (44.8%), after self-medication and experiencing adverse reactions went to the hospital. A summary of other steps taken after experiencing adverse reactions from self-medication are summarised in [Table 4].
Table 4: Steps taken by respondents who experienced adverse drugs reactions after self-medication

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In ascertaining general outcome of self-medication from the study participants, irrespective of number of times of self-medication within the past 3 months (from October 2015 to December 2015), 144 (39.9%) saw no change in their condition, 111 (30.7%) observed improvement, while 106 (29.4%) reported that their condition worsened.

Cross tabulations (using Pearson's Chi-square test) to find association between certain demographic characteristics of respondents and self-medication practice are shown. With the various inferential statistics, occupation was found to be associated with frequency of self-medication over the past 3 months [Table 5]: for example, among respondents who self-medicated three times over the past 3 months (October 2015–December 2015), teachers were found to be the most. An association was found between the class of drugs administered and treatment outcome [Table 6]: respondents taking analgesics reported having the most improved condition. Furthermore, respondents with tertiary education were most knowledgeable about adverse drug reactions associated with self-medication [Table 7].
Table 5: Association between occupation and how often self-medication was practiced

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Table 6: Association between class of drugs self-medicated and treatment outcome

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Table 7: Association between level of education and knowledge of adverse reactions associated with self-medicated drugs

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  Discussion Top


In the current study, we assessed self-medication practice among the people of Akuse in the Eastern Region of Ghana. The reasons for self-medication among respondents in this study included; influence from others (friends and family), the bureaucracy of health or hospital system, cost-saving and perceived minimal severity of illness. Other studies also cite similar reasons for self-medication.[6],[26],[27],[28],[29] In this study, however, influence from friends and family members was the most common reason people practiced self-medication. This could be attributed to the extended family system in most parts of Ghana. There is the possibility that a sick person would often seek advice from family members or friends. Other similar studies have reported that the main reason people self-medicate was the fact that they perceived that their illness was not severe to warrant an appointment with a medical practitioner.[5],[30],[31] In another related study, the main reason for self-medication by respondents was because they felt it was more time-saving than visiting a health facility.[32]

Data from the current study also showed that respondents often took antibiotics and analgesics. This finding corroborates a study by Sado and Gedif,[5] who assessed self-medication at Nekemte Town of Western Ethiopia. Arrais et al.,[33] also reported paracetamol and other analgesics as the most commonly self-administered class of drugs in a study conducted in Brazil. In other similar studies in Nigeria and Mexico, antibiotics were found to be the class of drugs most self-medicated.[16],[34] In most developing countries, the purchase of drugs deemed 'prescription-only' drugs, like antibiotics, can be bought OTC.[6] It is noteworthy, however, that, irrational use of especially antibiotics without appropriate diagnosis contributes to increase health-care cost, high morbidity and the emergence of resistant strains of infectious microorganisms.[35] Antibiotic resistance that can occur from self-medication may result in prolonged illnesses, more hospital visits, extended hospital stays, the need for more expensive antibiotics and even death.[36]

Licenced chemical sellers were the main source of self-medicated drugs among respondents in this study. This finding corroborates a study conducted in Ethiopia, where licenced chemical shops were the main source of self-medicated drugs.[37] Majority of respondents in this study also obtained drugs from traditional practitioners, from family members or friends, and also from community pharmacies. In order to minimise health risks and possible antimicrobial resistance associated with self-medication, it is important that especially antibiotics and other prescription-only drugs are much more regulated.[37]

A majority of respondents (81.7%) in this study had no knowledge of the possible adverse effects of the drugs they purchased. This lack of knowledge of possible adverse effects of self-medicated drugs is also reported by respondents in similar studies conducted in Nigeria, Hong Kong and Switzerland.[38],[39],[40] In the study conducted in Hong Kong, 96% of respondents lacked knowledge of the possible side effects of drugs purchased for self-medication.[39] Indeed, the lack of knowledge of the adverse effect of a drug does not mean a patient will invariably experience adverse effects. However, knowledge of the adverse effects of a self-medicated drug would help the patient to take appropriate action(s) once these adverse effects are experienced. Common adverse reactions often associated with self-medication may include skin rashes, hypoglycaemia, upper gastrointestinal bleeding, hypercorticism and hepatitis.[41],[42] Interestingly, more than half of the respondents (56.2%) in this study claimed that they experienced adverse reactions, although only 18.3% had prior knowledge of possible adverse reactions of self-medicated drugs. About 45% of these respondents who experienced adverse reactions, however, visited the hospital to seek treatment.

This study also showed that some of the respondents (39.9%) who self-medicated reported no improvement in their condition. This may be attributed to the fact that self-diagnosed (before self-medication) is often a misdiagnosis, hence, wrong drug choice being made by respondents. On the contrary, a majority of respondents in similar studies in Sudan and Nigeria reported improvement in their condition after self-medication.[17],[43]

The highest level of education was found to be associated with respondents' knowledge of adverse reaction, similar to other studies on self-medication.[3],[43] With formal education, people are more circumspect in the prevention and treatment of diseases, and will usually visit qualified persons for medical consultation. Furthermore, some studies report that higher formal education decreases the tendency for people to contact patent medicine dealers (individuals with no formal training in pharmacy who sell orthodox pharmaceutical products on a retail basis for profit).[44],[45] In this study, occupation was also found to be associated with how often respondents self-medicated. Occupation and the highest level of education are correlated,[46] and interestingly, health workers and teachers (with higher formal education) over the period of October 2015–December 2015 self-medicated more (i.e., three times) than other occupations. There is also the tendency for people with higher formal education to indulge in self-medication more than those without formal education. This is because they can search for information about symptoms they are experiencing from the Internet (or literature) and would most likely come up with a self-diagnosis, and consequently indulge in self-medication.

A limitation of the current study was that the questionnaire should have been properly translated to the local dialect of respondents to ensure uniformity and strengthen internal validity. Nevertheless, we believe our findings are relevant and reflect what pertains in most resource-poor settings.


  Conclusion Top


This study found that reasons that influenced self-medication among respondents were family members and friends, cost-saving, perceived minimal severity of illness, and bureaucracy of health or hospital system. Among these, influence from subgroup of family members and friends was the most common reason people self-medicated. Antibiotics and analgesics were the most common self-medicated drugs, which respondents often purchased from licenced chemical sellers. Majority of the respondents were found to have minimal knowledge of the potential adverse effects of self-medicated drugs. However, respondents with high educational level had the most knowledge of adverse drug reactions associated with self-medication. In addition, after self-medication, over a third of the respondents reported that they did not see improvement in their health condition. The findings of this study provide data that can be used for targeted education and sensitisation in similar rural and resource-poor settings. We recommend, however, that future studies should seek data on the re-use of prescriptions among respondents.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
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