The Prevalence and Pattern of self medication among nursing students in a Private Nursing Institution at Oachghat, Solan (HP) in 2016

 

Ms. Indu Rathore

Assistant Professor, Murari Lal Memorial School and College of Nursing, Village- Nagali, P.O. Oachghat

Solan (HP)-173223

*Corresponding Author E-mail: rathor.indu@gmail.com

 

ABSTRACT:

Self-medication is quiet popular practice among the general population as well as health care professionals all over the world. It is evident from the literature that the health care professionals in most of the medical disciplines develop this habit during their training time. The present study was conducted to assess the prevalence and pattern of self medication among nursing students in a private nursing institution. A cross-sectional descriptive research design was selected for study. A total of 316 students were selected from GNM, Basic B.Sc. Nursing and Post B.Sc. Nursing course by convenient sampling technique. Before the data collection, a written consent was taken from all the students selected for the study. The pretested semi-structured questionnaires were administered with regard to socio-demographic data and questions related to self-medication. Descriptive (Frequency, percentage, mean, range, S.D.) and inferential statistics (chi-square) were applied for data analysis. The study results revealed that 54.7% of the students reported self-medication within the last one year of recall period. Self -medication was common for complaints of fever (46.2%), headache (22.1%), dysmenorrhea (19.6%), cold and cough (16.7%), diarrhea (8.2%), and body ache (6.9%). Parents (50.3%) were the major source of information regarding self-medication. Pharmacy (52%) was the major source of drug supply. Most commonly used drug groups for self medication were antipyretics for fever (98.6%), analgesics for headache (82.9%) and body ache (81.8%), antibiotic and antitussives for cold and cough (49%). Nurse educators must be alert in this regard. Nursing students as well as their parents should be counseled to safer use of drugs.

 

KEYWORDS: Self-medication, nursing students, prevalence, pattern, drug.

 

 


INTRODUCTION:

Self-medication is one of the major global health concerns. Self-medication is the selection and use of medicines by which the individuals treat their self recognized illnesses or symptoms. Medicines used for self- medication are often known as Non-Prescription or over the counter (OTC) drugs. According to WHO, more than half of all drugs are prescribed and dispensed inappropriately. Nearly half of all patients fail to take them efficaciously. This results in wastage of scarce resources and may have serious health hazards.1,2

 

 

Improvement in educational status, increased awareness, development and availability of improved quality and safer medicines, demographic and epidemiological transitions towards chronic diseases requiring lifelong treatment and increasing health care costs are the common factors responsible for self-medication.2 The responsible self-medication not only prevent and treat ailments but also reduces burden on health care services especially for the people who are living in rural or remote areas. On the other hand, inappropriate consumer information, non-suitable diagnosis for self-medication, drug interaction (with prescription-only drugs, foods, alcohol etc.) and excessive or non-medical use (e.g. drug addiction) may have ill effects on the health of consumers. The use of drugs such as analgesics (e.g. paracetamol, aspirin, nonsteroidal anti-inflammatory drugs etc.) may result in chronic renal failure. Thus, there should be emphasis on the safe, effective and rational use of self medication drugs for the consumers. 3

Apart from the general population, self medication is quite popular among the health care providers because they are given knowledge regarding drugs in their routine curriculum. However, the pattern and incidence of self-medication may be different among them as compared to the general population. The habit develops during their training period. Due to the commercialization of nursing education there is a sharp increase in the nursing colleges all over the country. From the beginning of the nursing curriculum, nursing students have an easy access to medical literature and clinical exposure to drugs. Keeping this in mind, the present study was conducted to assess the prevalence and pattern of self medication among nursing students in a private nursing institution.

 

RESEARCH METHODOLOGY:

A cross-sectional descriptive research design was selected for study. The data was collected from Murari Lal Memorial School and College of Nursing, Solan (HP) from December, 2016 to January, 2017. The permission was taken from the Principal, Murari Lal Memorial School and College of Nursing, Solan. A total of 316 students were selected from GNM, Basic B.Sc. Nursing and Post B.Sc. Nursing course by convenient sampling technique. A semi- structured questionnaire was developed and pre-tested. The tool was validated by nursing and medical experts. The tool was divided into 2 parts: -

 

Section-A Socio-demographic Profile:

This section consisted of socio-demographic data of nursing students such as age, educational status, course, religion, parent’s occupation, marital status, type of family, place of residence, and income per capita.

 

Section-B Self-medication prevalence and pattern Assessment Questionnaire:

This section included open-ended questions related to self-medication, its reason, conditions/symptoms for self-medication, source of information, source of drug, prescription of drugs to other family members/friends, average money spent, drugs, drug groups, their side-effects and knowledge regarding generic name, trade name, dose, course of treatment and side –effect of the drug used for self medication.

 

Before the data collection, a written consent was taken from all the students selected for the study. Confidentiality of the study was assured to them. The pretested semi-structured questionnaires were administered with regard to socio-demographic data and questions related to self-medication, its reason, conditions/symptoms for self-medication, source of information, source of drug, prescription of drug to other family members/friends, average money spent, drugs, drug groups, their side-effects and knowledge regarding generic name, trade name, dose, course of treatment and side –effect of the drug used for self medication. The investigator was present at the time of data collection to assist the students for completion of the questionnaire. For the study purpose, certain medical terms were explained to the GNM and B.Sc. first-year students including dysmenorrhea, allopathy, antipyretics and analgesics. On an average of 10-15 minutes were taken to complete the questionnaires.

 

The data was coded and entered into the master sheet. Analysis was carried out with the help of Microsoft excel and statistical package for social science (SPSS-16.0) program. Descriptive (Frequency, percentage, mean, range, S.D.) and inferential statistics (chi-square) were used for data analysis.

 

RESULTS:

Socio-demographic profile:

The age of the nursing students ranged from 17-29 years with mean age of 20.3±1.9 years. Nearly 156 students were enrolled from B.Sc. Nursing Course, 106 from GNM and 54 from P. B.Sc. Nursing course for the present study.  Majority of the students (98.4%) had their educational qualification up to 12th standard before entering into the nursing course. All of them were females. Almost all the students (98.7%) were Hindus.  Majority of the students (94.9%) had their parents (either mother or father) from non-medical profession and a few (5.1 %) with medical profession.  Majority of students (96.5%) were unmarried. Maximum students (76.9%) belonged to rural area. Majority of students (80.7%) had nuclear family. All the students were staying in the hostel. Regarding income, per-capita monthly income ranged from Rs.938/- to Rs.32500/- with mean per capita income of Rs. 7346.2 ±4.15.

 

Prevalence of Self-medication among nursing Students:

Figure -1 depicts that out of 316 students enrolled, 173 (54.7%) of the students reported self-medication within the last one year recall period. N=316

 

Figure -1 Prevalence of Self-medication among nursing students within the last one year recall period

Prevalence of self-medication for different conditions/ symptoms:

Figure -2 shows that among all the students, the prevalence of self-medication for fever was found to be high (46.2%). Self -medication was also common for complaints of headache (22.1%), dysmenorrhea (19.6%), cold and cough (16.7%), diarrhea (8.2%), and body ache (6.9%). Low prevalence was reported for the complaints of tooth ache (3.7%), abdominal pain (3.4%), anemia (2.8%) and acne (1.5) N=316

 

Table -1 depicts that majority of students (47.4%) self-medicated because they needed quick relief. Nearly 43.4% practiced self-medication because they already knew what to do. Among all 5.2% of the students were following self-medication because it was time saving. A few students (4%) found it to be easy and convenient. Parents (50.3%) were the major source of information regarding self-medication followed by relatives/friends/ seniors (17.9%), doctor’s old prescription slip (13.3%), pharmacist (12.1%), text book/magazine/internet (6.3%) etc. Major source of drug supply was pharmacy (52%) followed by parents/relatives (20.2%), ward/clinic (10.9%), warden (1.7%), multiple sources (15%).Nearly one-third of subjects (66.5%) used to prescribe drugs to other family members or friends. Money spent on self-medication ranged from Rs.0-2000/- (Mean+SD-177.6+254.6).


 

Figure -2 Conditions/ symptoms for self medication Pattern of Self-Medication among the study subjects                   N=173

 

Table-1 Pattern of Self-Medication among the study subjects

Characteristics

N (%)

Reasons for self medication

 

Needed quick relief

Already knew what to do

Time saving

Ease and convenience

82(47.4)

75(43.4)

9(5.2)

7(4)

Source of information regarding self-medication

 

Parents

Relatives/ Seniors/ Friends

Doctor’s old prescription slip

Pharmacist

Textbooks and agazines/Internet

87(50.3)

31(17.9)

23(13.3)

21(12.1)

11(6.3)

Source of the drug

 

Pharmacy

Parents /Relatives

Ward/Clinic during duty

Warden

Multiple sources

90(52)

35(20.2)

19(10.9)

3(1.73)

26(15)

Average money spent on Self Medication during last 1 year (in Rs.) *

0-100

101-200

201and above

106(61.3)

57(32.9)

10(5.8)

Prescription of drugs to other family members/friends

Yes

No

115(66.8)

58(33.5)

*Money spent- Mean+SD-177.6+254.6, Range-Rs.0-2000/-

 


Drugs and Drug groups used for Self-Medication Table-2 shows that most commonly used drugs for self medication were Paracetamol for fever (98.6%), Disprin for headache (71.4%), Meftalspas for dysmenorrhea (93.5%), D-cold for cold and cough (41.5%) and Metronidazole (69.2%) for diarrhea. Diclofenac was used for bodyache (72.7%), toothache (41.7%) and abdominal pain (72.7%). All the students with symptoms of anaemia reported the use of IFA (Iron and folic acid) tablets for self –medication.


Table-2 Drugs used for Self-Medication

Condition/ symptoms for self medication

Drugs

n(%)

Fever N=146

PCM

Diclofenac

Cetrazine

144(98.6)

1 (.7)

1 (.7)

Headache N=70

Disprin

PCM

Saridon

Diclofenac

Azithromycin

Brufen

Stopace

50 (71.4)

11 (15.7)

4(5.7)

2 (12.9)

1 (1.4)

1(1.4)

1(1.4)

Dysmenorrhea N=62

Meftalspas

Brufen

Diclofenac

PCM

58(93.5)

2(3.2)

1(1.6)

1(1.6)

Cold and Cough N=53

D-cold

Cough syrup

Azithromycin

Ammoxycillin

Cetrazine

Saridon

PCM

22(41.5)

13(24.5)

9(17)

4(7.5)

3(5.7)

1(1.9)

1(1.9)

Diarrhea N=26

Matronidazole

ORS

Ofloxacin

18(69.2)

7(26.9)

1(3.8)

Bodyache N=22

Diclofenac

PCM

Metronidazole

Brufen

Stopache

16(72.7)

4(18.2)

1(4.5)

1(4.5)

1(4.5)

Toothache N=12

Diclofenac

Zerodol

Amoxycillin

Disprin

5(41.7)

4(33.3)

1(8.3)

2(16.7)

Abdominal pain N=11

Diclofenac

Dicyclomine

Combiflam

Pantoprazole

8(72.7)

1(9.1)

1(9.1)

1(9.1)

Anaemia N=9

Folic acid

9(100)

Acne  N=5

Clindamycin

Azithromycin

Crisentals (antiandrogen)

Betamethosome

2(40)

1(20)

1(20)

1(20)

 


Drug groups used for Self-Medication:

Major drug groups used for self medication were antipyretics for fever (98.6%) and analgesics for headache (82.9%), body ache (81.8%), toothache (91.7%) and abdominal pain (72.7%). The antibiotic and antitussives were used for cold and cough (49%) whereas antispasmodics (93.5%) and antiprotozoal (69.2%) were used for dysmenorrhea and diarrhea respectively. For the self-medication of other minor symptoms major drug group used were IFA for anaemia (100%) and antibiotics for acne (60%). (Table-3)

 


 

Table-3 Drug groups used for Self-Medication to relieve different conditions/ symptoms N=173

Conditions/ symptoms for self medication

Fever n=146

Headache n=70

Dysmeno- rrhoea n=62

Cold and Cough n=53

DRUG GROUPS

Antipyretics

 144(98.6)

11(15.7)

1(1.6)

23(43.4)

Analgesics

1(.7)

58(82.9)

3(4.8)

1(1.9)

Antispasmodic

-

-

58(93.5)

-

Antibiotic

-

1(1.4)

-

13(24.5)

Antiprotozoal

-

-

-

-

Anti-tussive

-

-

-

13(24.5)

IFA

-

-

-

-

ORS

-

-

-

-

Antihistamine

1(.7)

-

-

3(5.7)

Anti-inflammatory

-

-

-

-

Antiandogen

-

-

-

-

PP Inhibitors

-

-

 

-

 

Table-3 Continue…..

Conditions/ symptoms for self medication

Diarrhoea n=26

Body ache n=22

Tooth Ache n=12

Abdom-inal Pain n=11

Anaemia n=9

Acne n=5

DRUG GROUPS

Antipyretics

-

4(18.2)

-

1(9.1)

-

-

Analgesics

-

18(81.8)

11(91.7)

8(72.7)

-

-

Antispasmodic

-

-

-

1(9.1)

-

-

Antibiotic

1(3.8)

-

1(8.3)

-

-

3(60)

Antiprotozoal

18(69.2)

-

-

-

-

-

Anti-tussive

-

-

-

-

-

-

IFA

-

-

-

-

9(100)

-

ORS

7(26.9)

-

-

-

-

-

Antihistamine

-

-

-

-

 

-

Anti-inflammatory

-

-

-

-

-

1(20)

Antiandogen

-

-

-

-

-

1(20)

PP Inhibitors

-

-

-

1(9.1)

-

-

 


Table-4 depicts knowledge regarding generic name, trade name, dose and course of treatment of drug for fever was 61%, headache (58.6%), dysmenorrhea (64.5%), cold and cough(66%) whereas  for diarrhea and  body ache were 65.4% and  72.7% respectively. In case of the self-medication for other minor symptoms, knowledge regarding generic name, trade name, dose and course of treatment of drug for tooth ache was 75%, abdominal pain (27.3%), anemia (55.6%) and acne (80%). Knowledge regarding side-effect of the drug for fever was 60.3%, headache (50%), dysmenorrhea (56.5%), cold and coughs (58.5 %) whereas for diarrhea and body ache were 53.8% and 50% respectively. While self medicating for few other symptoms, knowledge regarding side-effect of the drug for tooth ache was 83.3%, abdominal pain (36.4%), anemia (36.4%) and acne was 55.6%.


 

Table-4 Knowledge regarding Self-Medication for different conditions /symptoms and side-effects experience N=173

Conditions/ symptoms for self medication

Fever n=146

Headache n=70

Dysmeno rrhoea n=62

Cold and Cough n=53

Diarrhoea n=26

Knowledge regarding generic name, trade name, dose and course of treatment of drug

89(61)

41(58.6)

40(64.5)

35(66)

17(65.4)

Knowledge regarding the side-effect of drug

88(60.3)

35(50)

35(56.5)

31(58.5)

14(53.8)

Any side –effect of the self-medicated drug experienced

14(9.6)

3(4.3)

5(8.1)

3(5.7)

3(11.5)

 

 

Table-4 Continue…..

Conditions/ symptoms for self medication

Body ache n=22

Tooth Ache n=12

Abdominal Pain n=11

Anaemia n=9

Acne n=5

Knowledge regarding generic name, trade name, dose and course of treatment of drug

16(72.7)

9(75)

3(27.3)

5(55.6)

4(80)

Knowledge regarding the side-effect of drug

11(50)

10(83.3)

4(36.4)

5(55.6)

4(80)

Any side –effect of the self medicated drug

experienced

-

-

-

2(22.2)

-

 

 

 


Side- effects reported for the self medication for fever were 9.6%, headache (4.3%), dysmenorrhea (8.1%), cold and cough (5.7%) whereas for diarrhea and anaemia were 11.5% and 22.2% respectively. No side effects were reported for the self –medication for body ache, toothache, abdominal pain and acne.

 

Relationship of selected Socio-demographic variable with self medication practices:

In present study the age of the subjects was significantly associated with self medication practices (p< 0.05).

 

Rest of the selected socio demographic (educational status, course, religion, parent’s occupation, marital status, type of family, place of residence, income per capita) did not found to be associated with self-medication practices.

 

DISCUSSION:

Self-medication is the utilization of drugs for the treatment of self diagnosed medical problems or irregular utilization of drugs prescribed by the doctor for repeated disease or symptoms. As suggested from the previous studies self medication is a common practice among the health care professionals all over the world. Nursing is one of the upcoming professions. With the availability of knowledge regarding diseases and drugs for their treatment, self medication is a common among nursing students. This may result in severe health consequences. Hence the primary aim of the study was to assess the prevalence and pattern of self- medication among nursing students in a private nursing institution.

 

The present study reported that 54.7% of the nursing students practiced self –medication whereas in other similar studies conducted in India among nursing students it ranged from 63% -100%.4-10 This may be due to differences in the socio-demographic characteristics. The most common condition/symptom for self-medication was fever followed by headache, dysmenorrhea and cold and cough. In a similar study by Surendran et al. the most common symptoms for which self medication was practiced were fever, ache/pain, common cold and menstrual problems.4 In another study Sheethal et al. found fever, headache, common cold/cough and myalgia as a common indication of self-medication among nursing students.5

 

Our results suggested that majority of the students self-medicated because they needed quick relief. Other similar studies found ‘mild symptoms’ (Surendran et al.), ‘illness not serious’ (Sheethal et al.), ‘ease’ (Goel et al.) and ‘relief from minor illness’ (Stephen et al.) as the common reasons for self-medication by nursing students.4-7

 

The cost of medicines shares a large portion of out of pocket expenditure on health. According to Health in India Report (Source: NSSO Round 71) 57% people in rural and 68% people in urban areas attributed ‘financial constraints’ as the first reason for treatment without any medical advice. In our study, out of pocket expenditure on health for self medication during the last one year ranged from Rs.0-2000/- (Mean+SD-177.6+254.6) among the nursing students.  Thus, students found it easy to treat themselves on their own rather than going outside and consulting to a doctor for the treatment of their symptoms or conditions.8

 

It is evident from the present study that parents were the major informants regarding self –medication whereas the other similar studies found previous prescription (Sheethal et al. and Stephen et al.), pharmacist (Goel et al.) and seniors and colleagues (Ali et al.) as the most common source of information regarding self medication.5,7,6,9 In the current study major source of drug supply pharmacy. The studies conducted by Ali et al., Surendran et al. and Sheethal et al. also documented the similar findings.4,5,8 Nearly one-third of subjects used to prescribe drugs to other family members or friends. Similar findings were reported by Stephen et al. and Sama et al.7,10

 

In present study, most commonly used drugs for self medication were Paracetamol, Disprin, Meftalspas, D-cold, Metronidazole and Diclofenac whereas Ali et al. found D-cold, Crocin, Disprin, Vicks and ORS as commonly used drugs for self medication.9 Antipyretics and analgesics were the most common drug groups utilized for self medication in our study. Surendran et al. Goel et al. and Stephen et al. too found antipyretics and analgesics as most common drug groups utilized for self medication among nursing students in the similar studies in their areas.4,6,7

 

Present study reported that overall, more than half of the students who practiced self medication had knowledge regarding generic name, trade name, dose and course of treatment of drugs and their side-effects which is lower than the study findings of Sama et al. where the 87.6% of the nursing students with self medication practices were aware regarding generic name, trade name, dose and course of treatment of drugs and nearly 82.7% of the nursing students were aware about side-effects of the drugs.10

 

In the current study, a few side- effects were reported with drugs used for self medication of fever, headache, dysmenorrhea, diarrhea and cold and cough as all the nursing students who self medicated were not aware about the side effects of drugs and were not able to recognize them appropriately. The finding is in contrast with the study findings of Surendran et al. and Stephen et al. which also documented the side-effects of the self medicated drugs among the nursing students.4,7

 

It was noted that the there was significant relation with the age of students and self medication practice which is in contrast with study findings of Gholap et al. as the self medication practices increased with advancing aged due to progressive increase in the knowledge and experience.11

 

CONCLUSION:

Today’s nursing students are the tomorrow’s responsible staff nurses. Over dose, under dosage and misuse of drugs are harmful for the health. In present study prevalence of self –medication among nursing students was found to be high. Parents were the major source of information and pharmacy was the major source of drug supply. Nurse educators must take attention in this regard. Nursing students and their parents should be counseled for safer use of drugs from the beginning of their academic curriculum. There should be ban on the sale of medicines without a doctor’s prescription slip by pharmacies.

 

ACKNOWLEDGEMENT:

The author would like to thank the vice -principal and students of Murari Lal Memorial School and College of Nursing, Solan (HP) for their help in the present study.

 

REFERENCES:

1.        WHO. Rational use of medicines [Internet]. [Cited 2017Mar15]. Available from: http://www.who.int/medicines/areas /rational_use/en/

2.        The Role of the Pharmacist in Self-Care and Self-Medication [Internet]. [Cited 2017Mar19]. Available from:http://apps.who. int/medicinedocs/pdf/whozip32e/whozip32e.pdf

3.        WHO. Drug Information Vol. 14, No. 1, 2000 General Policy Issues. [Internet]. [Cited 2017May10]. Available from: http://apps.who.int/medicinedocs/documents/s21959en/s21959en.pdf

4.        Surendran N, Pavithran S, SM. Self-medication practice and related knowledge among students of selected nursing institutions, Ernakulam Int. J. Pharm. Med. and Bio. Sc. [Internet]. 2014 [cited 2017May10]. Available from: https://www.researchgate.net/publication/307156532_Self-Medication_Practice_And_Related_knowledge_Among_Students

5.        PM, MS, KB. A Cross-Sectional Study on Self Medication among Nursing Students in Mandya. International Journal of Health Sciences and Research [Internet] December 2014[cited 2017May10];4(12):79 -83 Available from: http://www.ijhsr. org/IJHSR_Vol.4_Issue.12_Dec2014/11.pdf

6.        Goel D, Gupta S. Self-medication patterns among nursing students in North India. IOSR Journal of Dental and Medical Sciences. [Internet]Nov-Dec 2013[cited 2017May10];11(4):14-17. Available from: http://www.iosrjournals.org/iosr-jdms/papers/Vol11-issue4/D01141417.pdf?id=8203

7.        Stephen S, MS, Scaria T, Sunny TT, Shettigar D. Self medication practices among undergraduate nursing students in south India: a cross sectional study. American International Journal of Research in Science, Technology, Engineering and Mathematics. [Internet] June-August 2013[cited 2017May10];3(2): 159-162. Available from:  http://iasir.net/AIJRSTEM papers/AIJRSTEM13-248.pdf

8.        Government of India. Ministry of Statistics and Programme Implementation. Health in India-NSS 71st Round [Internet].April 2016 [cited 2017May10]. Available from: mospi.nic.in/sites/default/files/ publication_reports/nss_rep574.pdf

9.         Ali SS, Sharma S, Ahmed T, Sharma R, Jaiswal M, Chaurasia R. Evaluation of Self Medication amongst Nursing Students of Bastar Region: A Questionnaire Based Study. International Journal of Pharmacological   Research. [Internet]2015[cited 2017May10];5(6): 145-149.Available from: http://www.ssjournals.com/index.php/ijpr/article/view/2273/1811

10.     Sama S, V M, CM, SN. Study of self-medication patterns among medical and nursing students in Deemed Medical University. International Journal of Basic and Applied Medical Sciences. [Internet] January-April 2015[cited 2017May10]; 5(1): 280-284. Available from: http://www.cibtech.org/J-MEDICAL-SCIENCES/PUBLICATIONS/2015/Vol_5_No_1/48-JMS-051-MAHESH-PATTERNS.pdf

11.     Gholap MC, Mohite VR. Assess the self medication practices among staff nurses. Indian Journal of Science and Research. [Internet] 2013[cited 2017May10]; 4(1): 81-84. Available from:https://www.ijsr. in/upload/510269599CHAPTER_14.pdf

 

 

 

 

 

Received on 13.05.2017          Accepted on 20.07.2017        

© Asian Pharma Press All Right Reserved

Asian J. Res. Pharm. Sci. 2017; 7(3):125-131. 

DOI:  10.5958/2231-5659.2017.00020.0