ResearchGate ASSESSMENT OF KNOWLEDGE, ATTITUDE AND PRACTICE OF SELF MEDICATION AMONG ADULTS IN BOSASO; PUNTLAND-SOMALIA ° 460 °°Somali Health Research Journal; 1 (1): 16-22; 2018 Somali Health Research Journal Available: www.soherej.com/publications ASSESSMENT OF KNOWLEDGE, ATTITUDE AND PRACTICE OF SELF MEDICATION AMONG ADULTS IN BOSASO; PUNTLAND-SOMALIA +23¢1mi Omar, ‘Ayan Said, 'Amino M. Ali, ‘Asma Abdirizak , 'Hawo Mohamed 1 Department of Public Health; East Africa University, Bosaso - Somalia ? Fast Africa University Center of Research and Development, Bosaso - Somalia 3 Somali Health Research Center, Somalia. Abstract: Background: Unjustified and inappropriate self-medication results in wastage of healthcare resources and increases resistance of pathogens, drug to drug interactions, and adverse drug-drug reactions leading to hospital ‘admissions. The use of medications without prior medical consultations regarding Indication, dosage, and duration of treatment is referred to as self-medication inmost illness episodes, self-medication is the first option which makes self-medication common practice worldwide. Objectives: To assessment the level of Knowledge, attitude and practices (KAP) of self-medication among adult. Methods: cross-sectional study was conducted among adult in Bosaso. Study population was 15-70 yrs old. The Total number was 385, The respondents were selected by systematic sampling. Results: The age of respondent were 136(35.3%) age of between 20-29, Mostly the respondents were males 207(53.80%), Mostly the respondent 191(49.60%) were married, in their occupation mostly about 34% were students, Self-medication was rightly defined as the use of drugs not prescribed by an authorized medical personnel (a doctor) by 223 (57.9%. 305 (71%) disagreed self medication Practice only 80 (21%) agreed. 277 (72%) practice self medication they use drug without Prescription, Conclusion and Recommendation: 72%, practiced self medication mostly they use Paracetamol for Headache and fever. It should be made professional consultation before drug use and Strategies should be formulated and policies enforced to prevent the supply of medicines without prescription by pharmacies. Key Words: Self Medication, Adults, Knowledge, attitude and Practice BACKGROUND Almost half of all medicines globally are used irrationally. This can have severe consequences. Adverse drug reactions, drug resistance, protracted iliness and even déath [1]. In addition, the financial cost incurred by individuals and governments due to irrational use is unnecessary and often extremely high, particularly in developing countries where patients often pay for medicines out of their own pockets [1] Unjustified and inappropriate self-medication results in wastage of healthcare resources and increases resistance of pathogens, drug to drug interactions, 16Somali Health Research Journal; 1 (1): 16-22; 2018 and adverse drug_ drug reactions leading to hospital admissions [2]. The use of medications without prior medical consultations regarding Indication, dosage, and duration of treatment is referred to as self- medication in most illness episodes, self-medication is the first option which makes self-medication common practice worldwide. Responsible self-medication which requires a certain level of knowledge and health orientation had several advantages [3]. The significance of self-medication has. increased during the last decades due to, for example, an increasing trend of switching prescribed medicines to OTC medicine status in many countries In Finland, nearly 40 prescribed medicines have been switched to OTC medicine status since 1986 until 2007 In European countries, the widest selection of OTC medicines can be found in the United Kingdom and Germany, and the smallest in Croatia and Greece. The selection of OTC medicines in Finland may be considered as slightly smaller than in European countries on average. The general knowledge of self- medication has also increased among people, due to increased information sources of self-medication on the Internet and related communication systems [4]. Medicines for self medication are often called ‘non-prescription ‘or ‘over the counter’ (OTC)and are available without doctor's prescription through pharmacies, In some countries OTC products are also available in supermarkets and other outlets. Medicines that require a doctor's prescription are called Prescription products (Rx products). Self- medication with OTC Medicines is sometimes referred to as ‘responsible’ self- medication to distinguish it from the practice of purchasing and using a prescription medicine without @ doctors’ prescription [5], Self-medication is a common practice to treat most episodes of illnesses in economically deprived communities It is explained by the reduced demand for doctor consultations and subsequent costs for treating perceived self-limiting conditions Prevalence of self-medication —_ in developing countries is in the range of 12.7% to 95% Estimates vary in the South-Asia Region. In Nepal, self-medication was 59% in the six-month period preceding the interview while the estimate in India was 31%. A wide variation has been reported in India. For example, in coastal regions of South India, the prevalence was 71% In Pakistan, self- medication prevalence was around 51%. study in Bangladesh revealed that for three most frequently reported illnesses, 81.3%of the young and 78.5% elderly health care seekers self-medication [6]. A major problem of self-medication with antimicrobials is the emergence of resistance of human pathogens. Antimicrobial resistance (AR) is a current problem world-wide particularly in developing countries, where antibiotics are often available without prescription Resistance to anti-malarial drugs has also been reported in many third world countries Reasons for this resistance include the irrational use of anti- malarias including indiscriminate non-prescription use, The adverse effects of self-medication cannot be overemphasized. However some people may engage in the practice of self-medication due to ignorance, poverty and in availability of health facilities [7] even also corruption and increasing political instability have resulted in defective functional health institutions. In addition, the attitude and low morale of staff in public healthcare clinics, as well as the cultural beliefs and perception have contributed immensely to alternative healthcare practice. Therefore, self-medication has become a norm and is widely practiced and patronized though largely empirical and observational, evidence suggests that the practice may be high in rural areas with poor terrain, limited health facilities, high literacy level and poverty, Some of the substances used are locally formulated-mixtures with ingredients capable of resulting in abuse with serious health hazard on both the population and environment [8] Antibiotics are one of the most prescribed drugs worldwide, Self-medication with antibiotics is a common practice in many countries in the world although the trend seems to be more in developing or resource-poor nations Some of the reasons that have been found responsible for this trend include lack of access to health care, availabilty of antibiotics as over the counter (OTC) drugs and in open markets and poor regulatory practices Self-medication with antibiotics has been identified as one form of irrational ”Somali Health Research Journal; 1 (1): 16-22; 2018 use, Increased healthcare costs, antimicrobial drug resistance and sometimes increased morbidity among the population. The practice of self-medication in general has been widely studied among populations of many countries in Africa, Asia and Europe [9] In Somalia imports of poor quality medicine, misuse of drugs are endangering public health in the Somali community living in the country. Self-medication is becoming major health concern in Somalia as many people take medicine without consulting a doctor or trained pharmacist. Further exacerbating the problem are television advertisements for drugs targeting consumers, a lack of trained personnel at pharmacies and the government's inability to verify the quality of medications that make it to the Somalia market. This study aims to assess the level of Knowledge, attitude and practices of self-medication among adult living Bosaso city of Somalia, METHODS. Study area and period The study was conducted in Bosaso district the capital of Bari region, it is the commercial city of Puntiand state of Somalia, itis located north eastern regions of Somalia on the southem coast of the Gulf of Aden Data collection period was from June to July 2015, Study design, study population and sampling A cross-sectional study was conducted to asses knowledge, attitude and practice of self medication ‘among adult in Bosaso, The study population were 385 and it was found by using this formula Zx(P) x(1-P)/D2. Zx(P) x(1-P)/D? N= (1.96) ®x(0.5)x(05)/(0.05)? N = 0.9604/0.0025 N= 385 Considering 95% confidence interval, 5% margin of error, 385 adults were taken from the 7 villages out of 16 villages by systemic sampling Method of data Collection Questionnaire was used as data collection tool, the study duration was from May to October 2015. Data entry, analysis and interpretation Analysis was done by SPSS software package version 19. The results were presented in absolute figures (percentages) as depicted in Tables, Figures and Charts. RESULTS Socio-demographic characteri ics. Table 1: Socio- demographic characteristics among adults in Bosaso (N=385) Variable frequency _| Percent 96 24.9 Age 136 35.30 81 21 40 10.4 21 55. 3 8 8 24 Gender 207, 53.8 178 46.2. Married 191 49.6 Marital Single 165 42.9 Status divorced 18 47 widowed i 29 Health workers 28 73 Office workers R 18.7 Merchants | 56 145 Occupation | Mechanic 7 44 Teacher 47 12.2 Student. 131 34 Unemployed _| 34 88 University | 134 348. College 31 at Secondary | 101 26.2 Education | Intermediate _| 40 10.4 Level Primary. 14 36 Non Formal__| 41 10.6 literate 24 62 18Somali Health Research Journal; 1 (1): 16-22; 2018 Knowledge level of self medication among Lanta Hawada | 91 236 Respondents New Bosaso_| 73 19 Table 2: Knowledge level of self medication among Raf iyo Raaxo | 63 164 Bosaso Community (N=385) Residential [Biyo Kulule | 58 15.1 Frequency | Percent ‘area Ridwaan | 44 14 Knowledge of [Yes | 223 58% Xafatu Ara 131 2 self medication No | 162 i Santos 25 65. Knowledge of [Yes [334 36.8% Out of 385 respondent, 136(35.3%) were the age Grug name No [51 13.2% between 20-29 years, 96(24.9%) were the age between 15-19 years, 81(21.8%) were the age | grumenge,._ oF Yes _[ 260 ore between 30-39 years, 40(10.4%) were the age No [125 32.5% between 40-49 years, 21(5.5%) were age between [knowledge of | Yes | 160 416% 50-59 years, 3(0.8%) were age between 60-69 years, | frequency and [yj —Pg95 wae £8(2.10%) were above 70 years. duration of drug Mostly the respondents 207(53.80%) were males | usage while the females were about 178 (46,20%). Knowledge of | Nes_| 122 31.7% Mostly the respondent 191(49.60%) were married, 9 No] 263 68.3% 165(42.90%) were single, 18(4.70%) were divorced and 11(2.90%) were windowed. Mostly the respondents 131(34.00%) were students, 72(18.70%) of them were office workers, 56 (14.50%) were business _man/women, 47(12.20%) were teachers, Unemployed, Doctors and mechanics are making up the minority. Mostly the respondents’ population had university level 134(34.80), 101(26.20%) were secondary level, 40(10.4%) were intermediate level, 41(10.6%) were non formal education, 31(8.10%) were college level, 24(6.20%) were illiterate and 14(3.60%) were primary level The respondents mostly 91(23.60%) were from Lanta- Hawadada village in Bosaso city, 73(19,00%) were from New Bossaso village in Bosaso city, 63(16.40%) were residents of Raf-iyo-Raxo Village, 58 (15.10%) were from Biyo-kulule, 44(11.40%) were from Ridwan village, 31 (8%) were from Xafatul arab and 25(6.50%) were Santos village, Self-medication was rightly defined as the use of drugs rot prescribed by an authorize ed medical personnel (a doctor) by 223 (57.9%) of the respondents while 162 (42.1%) defined incorrectly. 334 (86.8%) were known the name of drug that they consume while 51(13.2%) were not known the name of drug that they consume. 260 (67.5%) knew indication for the drug while 125 (32.5%) were not known the indication for drug that they consume. 160 (41.6%) know frequency and duration of drug usage while 225 (58.4%) did not know. Mostly 263 (68.3%) didnt know drug side effects while 122 (31.7%) knew side effects of drug.Somali Health Research Journal; 1 (1): 16-22; 2018 Attitude towards self-medication practices Agree mDisagree Fig i: Attitudes of respondents towards medication practices in Bosaso, (N=385). sel Out of 385 respondents, only 80 (21%) agreed with the practice of self-medication while majority of them 305 (79%) disagreed. Self-medication prac ices among respondents Table 3: Self Medication Practice among respondents from June to July 2015 in Bosaso (N=385) Frequency | Percent Drug usage with | Yes a 72% ‘out Prescribtion No. 108, 28% Out 385. respondents, 277 (72%) practice self medication, they use drug without Prescription on the other hand 108 (28%) did not practice self medication, Most drugs used without prescription Table 4: Medications reported by the respondents who self-medicated from June to July 2015 in Bosaso, (N=277). N % Paracetamol | 133/48 Most drugs used without — [Aspirin 33 12% Prescription _| Ibuprofen 34 12.2% Chloroquinne | 15 5.4% Cough Syrups _| 8 2.9% Tetracycline | 13, 47% Piriton 1 0.4% Penicilin 35 12.6% Others: 5 1.8% Paracetamol was the most used in self medication about 133 (48%) used it, Penicillin was the second most used drug about 35 (12.7%) used it, 34 (12.5%) used Ibuprofen, 33 (12%) used Aspirin, the other drugs used include Chloroquine, Cough Syrups, Tetracycline, Piriton and other medications. Condition for self Medication Table 5: Conditions for those setf-medicated from June to July 2015 in Bosaso, (N=277). N | % Fever and) 170 | 614% Conditions Headache used drugs | Abdominal 2 7.6% without discomfort prescription | Common Cold 36 | 13% inthe last [Allergies B (47% fone month Musculoskeletal | 12 4.3% pain Vomiting and] 25 | 9% Nausea ‘The most common types of ailments for which the respondents reported to have practiced self- medication were fever and headache 170 (61.4%), followed by common cold 36 (13%), Vomiting and Nausea 25 (9%), Abdominal discomfort 21 (7.6%), Allergies 13 (4.7%) and Musculoskeletal pain 12 (4.3%). Reasons for self-medication Table 6: The reasons for self-medication given by respondents who self-medicated from June to July 2015 in Bosaso, (N=277). 20Somali Health Research Journal; 1 (1): 16-22; 2018 Frequency | Percent Prior Reasons | experience 109 39.4% minor ailments | 83 29.9% In emergency use 40 14.4% purpose of prevention 6 22% Less costly [39 14.1% 109(39.4%) of the respondents in this study reported that they used self-medication because they had prior experience of treating a similar illness, 83 (29.9%) used self-medication because they had minor ailments, 40 (14.4%) used self-medication because of ‘emergency use while 39 (14.1%) used self-medication because of Less cost on the other hand 6 (2.2%) used self-medication for the purpose of prevention, DISCUSSION 223 (57.9%) was rightly defined as the use of drugs not prescribed by an authorized medical personnel (a doctor) while the rest did not know. 334 (86.8%) were known the name of drug that they use while 51(13.2%) were not known, mostly 260 (67.5%) knew drug indication, 225 (58.4%) do not know frequency and duration of drug usage. Mostly 263 (68.3%) didn’t know drug side effects 305 (79%) disagreed self medication Practice only 80 (21%) agreed. The prevalence of self-medication in this study is 72%,. This result is almost similar with the study done in Islamabad, Pakistan among adults which was 69% (11). Paracetamol, NSAIDs like Ibuprofen and Aspirin, antibiotics, Chloroquine, Cough Syrups were the most commonly used class of drugs, followed by Flagyl and Piriton in this study. One study in Mozambique, also reported similar findings [12]. The most common types of ailments for which the respondents reported to have practiced —self- medication were fever and headache 170 (61.4%), followed by common cold 36 (13%), 71 (25.6%) practiced self medication for the following ailments Vomiting and Nausea, Abdominal discomfort, Allergies and Musculoskeletal pain. Similarly studies made in Ethiopia (13] 109(39.4%) of the respondents in this study reported that they used self-medication because they had prior experience of treating a similar illness, 83 (29.9%) used self-medication because they had minor ailments, 40 (14.4%) used self-medication because of emergency use while 39 (14.1%) used self-medication because of Less costly on the other hand 6 (2%) used self-medication for the purpose of prevention CONCLUSION 72%, practiced self medication even though the majority of them had good attitudes towards self- medication practices at Bosaso city. Analgesics, particularly Paracetamol, NSAIDs, antibiotics, and cough syrup were the most commonly reported types of medications consumed in seff-medications, all of which were obtained from drug retail outlets. Fever and Headache, cough/common cold and Voriting and Nausea were he three most commonly reported conditions for self-medication practices in the current. study. The major reasons indicated for self medication by respondents were prior experience and minor of the illness. Recommendation 1. There should be increasing awareness and education at all levels regarding the importance of professional consultation before drug use the implications of self-medication and the place of responsible self-medication. 2. Strict policies need to be implemented by the Government and other stake holders on the advertising and selling of medications to prevent this problem from escalating. 3. Strategies should be formulated and policies enforced to prevent the supply of medicines without prescription by pharmacies. 4, Further researches should be carried out to find out the factors associated to high level practice of self Medication. aSomali Health Research Journal; 1 (1): 16-22; 2018 ETHICS ‘The study was approved by Ethics Research Committee of East Africa University. ‘CONSENT TO PUBLISH STATEMENTS Written informed consent was obtained from all participants of the study for the publication of this report. COMPETING INTERESTS ‘The authors declare that they have no competing interests. AUTHORS’ CONTRIBUTIONS The authors patticipated in the design of methodology, data collection and analysis, interpretation of data and prepared the final manuscript for publication. ACKNOWLEDGEMENT ‘The authors are very thankful to the generous support from Department of Public Health at East Africa University and the Somali Health Research Centre. REFERENCES 1. 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