SELF-MEDICATION PRACTICES AMONG 1 st - AND 2 nd -YEAR MEDICAL UNDERGRADUATES

Objective: The objectives of our study were to estimate the prevalence of self-medication, to assess the knowledge, attitude, and practice of self-medication, and to compare the risk factors of self-medication practices among 1 st -and 2 nd -year medical undergraduates, of a Government Medical College in Kerala, India. Methods: A questionnaire-based cross-sectional study was conducted among medical students after obtaining Institutional Ethics Committee approval and informed consent. A pre-validated questionnaire was used to collect data. Descriptive and analytical statistics were performed and variables associated with self-medication were entered into a multivariate logistic regression model to compute adjusted odds ratio (OR) and 95% confidence intervals (95% CI). Results: The response rate was 59.47% (233/375). More than three-quarters of the participants responded correctly to the query on definition of over-the counter drug. As compared to 46.8% of 1 st years, 67.6% of 2 nd years had practiced self-medication in the past 6 months. The most common medical condition/symptom for consuming self-medication was for managing the common cold and paracetamol was the most common medication. The risk of developing adverse drug reactions was considered a serious threat after self-medication by around three-quarters of the participants. There was a significant association of self-medication practice among the 2 nd years as compared to the 1 st years (p=0.009, OR-1.64 (95% CI 1.16–2.31). Conclusion: The prevalence of self-medication was high among medical students and there was a greater risk of self-medication among the 2 nd years (1.64 times) as compared to the 1 st -year students. The study revealed that the students exhibited inadequate knowledge regarding appropriate self-medication. Although they had a positive attitude toward self-medication they commonly engaged in inadequate self-medication practices. Knowledge of medicines obtained for similar previous illnesses and the feeling that there is no need to consult a doctor for minor ailments that were the main reasons for self-medication.


INTRODUCTION
Self-medication is the selection and use of medication to treat self-recognized symptoms or diseases by individuals [1].The responsible self-medication is the use of approved and available medicines with proven safety and efficacy for self-recognizable or chronic conditions after initial medical diagnosis [2,3].Factors influencing the frequency of self-medication in the previous studies are age, educational level, professional status, family attitudes, advertising or drug manufacturers, availability of healthcare and health professionals, the regulation of drug dispensing and sales through legislation, as well as prior experiences with symptoms or diseases, significance attributed to the disease, home-kept prescription drugs, economic situation of the patient, depression, and anxiety [4,5].Montgomery et al., in a meta-analysis, state that the prevalence of self-medication could range between 12 and 99% among medical students and health-care professionals.Compared to the general public, many factors like easy access to information from various sources to self-diagnose and self-medicate influence the practice of self-medication among medical students [6].As they are future doctors and health prescribers of the community, it is important to know their knowledge level regarding different aspects of self-medication.This study was done to estimate the prevalence of self-medication, to describe the perceptions of participants on self-medication, and to determine the association of gender and year of study with self-medication practices among the first-and 2 nd -year medical undergraduates.

METHODS
This was an online questionnaire-based study conducted by the Department of Pharmacology, Government Medical College, Thiruvananthapuram from June to November 2020 after getting IRC clearance (A2/SBMR/158/2020/MCT dated March 17, 2020) and IEC clearance (HEC 03/38/2020 dated May 12, 2020).First-and 2 nd -year medical undergraduates studying in the institution during the year 2020 formed the study population.A Google Fill out Form link was used to invite all 1 st -and 2 nd -year medical undergraduates to participate in the study.The participants who denied consent were automatically eliminated from the study by directing them to click the submit button.The identity of participants willing to provide informed consent was kept anonymous and all obtained data were kept confidential.A structured and validated questionnaire prepared based on the previous studies was used to collect information regarding age, gender, awareness of self-medication practice, type of drugs self-medicated, and source of information for self-medication [5,7,8,9].Self-medication in this study was defined as the use of medicine for self-treatment without consulting a health-care professional within the past 6 months.

Statistical analysis
The data were analyzed using SPSS software version 16 (SPSS for Windows.The quantitative data were expressed using descriptive statistics of frequencies and percentages.Chi-square was done to determine the association of gender and year of study with selfmedication practices.Asian J Pharm Clin Res, Vol 16, Issue 4, 2023, 161-166 proper knowledge of drugs, 22 (46.8%) 1 st years and 119 (67.6%) 2 nd years had practiced self-medication in the past 6 months and some (3 1 st years and 28 2 nd years) even recommended it for nonmedical people and some (7 1 st years and 26 2 nd years) thought that self-medication is acceptable for medical students.Fifteen (31.9%) 1 st years and 34 (19.3%) 2 nd years thought that medical students can treat their symptoms and 14 (29.8%) 1 st years and 47 (26.7%) thought that medical students bother their doctors with minor problems.Twenty-eight (59.6%) 1 st -years and 85 (48.3%) 2 nd -years opined that pharmacists can help in treating minor clinical problems.
The majority (29.8% 1 st years and 50% 2 nd years) preferred allopathy medicines for self-medication as compared to other AYUSH medications, as shown in Fig. 1.As depicted in Fig. 2, "knowledge of medicines through previous experience of symptoms' 85(71.4%) in 2 nd years and 14 (63.6%) in 1 st years, and the thought that "there is no need to consult for minor ailments" (82 [68.9%] in 2 nd years and 13 [59.1%] in 1 st years) were the main reasons for self-medication among both first-and 2 nd -year medical undergraduates.
The most common medical condition/symptom for which both the 2 nd -year (109, 91.6%) and 1 st -year students (14, 63.6%) had taken selfmedication was for managing the common cold.However, as shown in Table 1 and Fig. 3, in the 2 nd year 96, 80.7% had used it for fever; 91, 76.5% had used it for cough; and 79, 66.4% for headache in the 1 st year 11.50% had used it for the same.While none had taken self-medication for lack of sleep that three (2.5%) had taken self-medication for combating stress in 2 nd years which was 2 (9.1%) and 1 (4.5%) among 1 st years.
Thirty-four (72.3%) 1 st years and 134 (76.1%) 2 nd years responded correctly to the query on what an over-the-counter drug is and marked the statement that they are "drugs procured by the patient for himself without prescription."The remaining participants thought that they were dispensed by the pharmacist on physician orders or drugs always dispensed by the pharmacist or drugs procured from relatives and friends.Out of the participants, 44 1 st -year students (93.6%) and 171 2 nd -year students (97.2%) correctly identified self-medication as the selection and use of medication by individuals to treat selfrecognized symptoms or illness.The remaining participants either provided incorrect responses or indicated that they did not know the answer.However, only 21.3% of 1 st years and 50 (28.4%) of 2 nd years knew that self-medication is an element of self-care and is entirely safe.Nine (19.1%) 1 st years and 45 (25.6%) 2 nd years thought that AYUSH medicines were over-the-counter drugs.Even though only 2 1 st years and 19 2 nd years preferred self-medication and all 1 st years and 99.4% 2 nd years thought that self-medication can be harmful if taken without We could not find any association between the use of self-medication with male or female gender (p=0.66,Odds ratio (OR)-0.88(95% Confidence Interval [CI] 0.51-1.52);however, there was a significant association of self-medication practice among the 2 nd years as compared to 1 st years (p=0.009,OR-1.64 (95% CI 1.16-2.31).Table 2 summarizes the practice of the participants with regards to self-medication.
As shown in Fig. 5, the risk of developing adverse drug reactions was considered a serious threat after self-medication by both 1 st years (34.72.3%) and 2 nd years (133, 75.6%).The risk of a wrong diagnosis, the risk of missing the actual diagnosis, and the risk of drug dependence were the other identified problems after self-medication.researchers shows that the process of self-medication evolves with their knowledge [11].This is consistent with our study which showed that there was a greater risk of self-medication in the 2 nd years (1.64 times) as compared to the 1 st years.
Several studies have suggested that self-medication could lead to delayed medical care seeking, ultimately resulting in economic loss.In addition, improper self-medication with antibiotics can contribute to the development of antimicrobial resistance [12].According to a survey carried out among 1 st -year medical students on self-medication at the Arabian Gulf University in Bahrain, the results indicated that these students had insufficient knowledge and frequent but inadequate practice, despite having a positive attitude [8].In this study, both 1 styears and 2 nd -years practiced self-medication and had comparable knowledge about the elements of self-care.
The previous research showed that even though good health is required for proper commitment and work, medical students, and health-care professionals face difficulties in seeking health care for themselves [13,14].In this study, some participants thought that selfmedication is good so that they do not bother doctors with their minor ailments which could be treated by themselves based on their previous experience.
Donkor et al. found that the main condition treated with selfmedication by the respondents were cold, cough, fever, and abdominal pains [15].Jagadeesh et al. found that fever, cough, and cold were the most common conditions for which self-medication was practiced [2].In the present study, the main conditions for which self-medication was adopted were cold followed by fever which is consistent with findings of similar studies.In line with Jagadeesh et al., paracetamol was the most common drug used for self-medication in this study [2].Dutta and Hazarika reported analgesics followed by antipyretics as the most frequently self-medicated drugs [16].While expenses related to the hospital especially if the stay is a long, trivial illness, and desire for quick relief from symptoms were cited as reasons for self-medication in some studies, others cited lack of access to healthcare, availability of OTCs, and inadequate regulatory practices [15,16].In this study, knowledge of medicines through similar previous illnesses and the feeling that there is no need to consult for minor ailments were the main reasons for self-medication among both first and 2 nd -year medical undergraduates.This is in line with Suthar et al., in which the participants who were university students stated that there is "no need to visit the doctor for minor illness" [17].Jagadeesh et al. stated that self-medication creates awareness among individuals toward maintaining their health and hence need to be promoted amongst medical students [2].However, risk of ADR, wrong diagnosis, missing an actual diagnosis, and drug dependence can occur after self-medication as pointed out by participants in this study, and hence, a healthy attitude of self-care can be acquired by in-depth knowledge.In contrast to Jagadeesh et al., Lukovic et al. state that self-medication among future health-care professionals can represent a serious threat to professionalism and put the trust of the public at risk [5].According to Mehta and Sharma, there are numerous risks associated with self-medication, including but not limited to developing a habit, experiencing allergic reactions, under-dosing, over-dosing, and temporarily masking symptoms which may lead to a delay in proper diagnosis [11].Mythri suggest that it is important to use caution when taking any medication because each drug has its own set of advantages and disadvantages that are specifically linked to it [18].Chouhan and Prasad stated that the use of medication without consulting a registered medical practitioner, and unawareness about the safe and rational use of medicine may lead to serious consequences especially  antimicrobial resistance and increased morbidity [19].In this study, the most commonly used antibiotic was amoxicillin followed by azithromycin.The majority of participants had also used albendazole for deworming.Sharma et al. pointed out that self-reported practices among students regarding antibiotics were found to be satisfactory although not completely convincing [20].During the COVID-19 wave, there was an increase in the self-medication practices in all the sectors among the public as well which was influenced by fear of getting COVID from health care facilities, ease of access to drugs, and internet with growth in information and communication [21].
Limitations of this study are that a self-reported questionnaire has been used which can cause recall bias.The response rate was 59.47%.This study was done in a single institution and was restricted to the first and 2 nd years.Studies in multiple institutions with all phases of students and more response rates could give a better perspective on self-medication practices.

CONCLUSION
Two hundred and twenty-three students participated in this study and the response rate was 59.47%.The prevalence of self-medication practice was 46.8% in the 1 st years and 53.2% in the 2 nd years.The majority of the participants preferred allopathic medication, used oral medications, completed the full course of medicines, reused prescriptions, and came to know about self-medication through previous consultations.There was a statistically significantly higher risk of self-medication in the 2 nd years' students as compared to the 1 st year.

Table 2 : Self-medication practices among students
*Multiple responses by the same participant