Int J Pharm Pharm Sci, Vol 16, Issue 6, 33-38Original Article

SELF-MEDICATION F/OR PREVENTION AND TREATMENT OF DISEASES DURING COVID-19 PANDEMIC-A CROSS SECTIONAL SURVEY IN GENERAL POPULATION

SARITA PANIGRAHY1, DEEPANJANA DASS2, SUNIL KUMAR PANDEY1, DAMERA MEHER SHEENA1*

1Gayatri Vidya Parishad Institute of Health Care and Medical Technology Visakhapatnam-530048, Andhra Pradesh, India. 2MGM Medical College, Kamothe, Navi Mumbai, Maharashtra-410209, India
*Corresponding author: Damera Meher Sheena; *Email: mehersheena84@gmail.com

Received: 02 Feb 2024, Revised and Accepted: 09 Apr 2024

ABSTRAC

Objective: The goal of this study was to assess the pattern and reasons for self-medication during the COVID-19 pandemic.

Methods: The present study was an exploratory cross-sectional survey. The questionnaire was meant to be filled up by those who were older than 18 y and could read and write English. The questionnaire (related to socio-demographic status, pattern, and reasons for self-medication) was designed and validated by a committee of faculties in the department of pharmacology through a peer review process and sent through mail, WhatsApp, and other means of social media. A non-parametric Chi-square test was used to test relationships between categorical variables.

Results: The responses of 557 participants were analyzed; among them, the majority were females as compared to males. There was a significant difference (*p = 0.02) in the pattern of self-medication between the males (38%) and females (62%), and most of the participants used self-medication as a preventive measure for COVID-19 (39%). Fear of going out (13%) during COVID-19 was the main single reason for self-medication. Arsenic Album 30 was the most frequently used homeopathic formulation (26%).

Conclusion: This study showed that apprehension, coupled with the COVID-19 pandemic, was the main impulse for self-medication.

Keywords: COVID-19, Prevention, Self medication pattern

© 2024 The Authors. Published by Innovare Academic Sciences Pvt Ltd. This is an open access article under the CC BY license (https://creativecommons.org/licenses/by/4.0/)
DOI: https://dx.doi.org/10.22159/ijpps.2024v16i6.50520 Journal homepage: https://innovareacademics.in/journals/index.php/ijpps

INTRODUCTION

Self-medication remains an important issue to look at, especially in developing countries. The prevalence of self-medication differs significantly in urban, suburban, and rural India and varies with different types of medicines [1]. As per recorded data, it may account for as little as 11.7% and as much as 92% across the globe [2]. The term "Over-the-counter (OTC)" medicine is widely used for medicines that can be self-medicated. Self-medication has a low risk if done correctly. Factors like education, general knowledge, and socioeconomic status, media and the Internet, and increased advertising of pharmaceuticals [1] are a few influencers of self-medication. Costly consultation at private hospitals, poor quality of care and long queues, mild illness in government hospitals [3], and an old prescription are the few reasons for self-medication [3, 4]. These days, it has become an integral part of self-care [5].

Most of the medications are being constantly reclassified from a prescription only medication to medications available over-the-counter [5]. As per the definition of WHO, “self-medication is the use of medicinal products by consumers to treat self-recognized disorders or symptoms or the intermittent or continued use of medication prescribed by a physician for chronic or recurring diseases or symptoms" [5]. It involves the use of medications for family members as well, especially where the treatment of children or the elderly is involved [5, 6].

Where there are potential benefits of self-medication like direct and rapid access to treatment, convenience, and price, there are also many risks involved, like incorrect diagnosis, incorrect choice of treatment, adverse effects, worsening of the underlying disease, interactions, dependency, and resistance [5]. History of the disease, distrust of doctors, having no access to doctors, and low cost are a few of the top reasons for self-medication [7].

Self-medication is common not only in allopathy but also in other alternative systems of medicine like Ayurveda, homeopathy, and Unani [8].

A meta-analysis of self-medication shows its prevalence at 53.5% in India [7]. Adverse effects are very common in all forms of medicine, like hypothalamic-pituitary-adrenal axis suppression, hypertension, Cushing features [9], nausea, vomiting, abdominal pain, allergic reactions, inflammation, dependency [10], and vesico-bulbar eruptions [11].

In relation to Ayurvedic medicines, serious adverse effects like Steven-Johnson syndrome followed by fatal toxic epidermal necrosis [12], transient atrioventricular dissociation, and hypotension [13] have also been reported. Adverse effects like bradycardia, reversible pan conduction defect, and syncope with hemorrhage have also been reported after the self-medication of homeopathic medicines [14].

Only a few articles show any data on self-medication during any epidemic. Mortality and severe adverse effects like haemorrhagic duodenitis due to self-medication of Ibuprofen and Steven Johnson syndrome due to self-medication of Paracetamol and Codeine combination have been reported during epidemics [15]. During the ongoing COVID-19 pandemic, self-medications for prevention and treatment have been reported [16]. Deaths due to Coronavirus infection have been reported in the United States as well as in India [17].

The Ministry of Health and Family Welfare, India, has recommended the use of ayurvedic and homeopathic medicines like chyawanprash, turmeric, and arsenicum album-30 [18, 19]. The present study is designed with the thought that there may be an increase in the practice of self-medication during the lockdown due to the COVID-19 pandemic. Non-accessibility of hospitals and doctors, non-acceptability by the doctors and hospital, unavailability of transport, and lockdown terms and conditions may be the primary causes of self-medication during this pandemic. Since there are almost no publications related to self-medication during the pandemic, the present study was designed to assess the pattern and variety of self-medication, the adverse effects of self-medication, and the reasons thereof during the COVID-19 pandemic.

The objective of this study was to assess the pattern of self-medication among males and females and to identify the reasons for self-medication during the COVID-19 pandemic.

MATERIALS AND METHODS

Study design, population and method

The present study was an exploratory cross-sectional survey. The questionnaire was designed and validated by a committee of faculty in the department of pharmacology and through a peer review process. The pre-validated questionnaire, comprising questions related to socio-demographic status and questions related to the pattern and reasons for self-medication, was sent through mail, WhatsApp, and other means of social media.

Inclusion criteria

Participants living in India (whether temporarily or permanently) who were older than 18 and could read and write English were included in the study.

Exclusion criteria

Illiterate people and those less than 18 y of age were excluded from this study.

Sample size

The sample size was calculated using online software with a confidence level of 95% and an error of 5%, with a chance of an unlimited reachable population.

The total sample size calculated was 385. By the end of the study, a total of 573 responses had been received.

Statistical analysis

The collected data was manually fed directly into SPSS v.20, where frequency analysis was run. A non-parametric Chi-square test was also run to test the relationships between variables.

RESULTS

A sample size of 540 was set for the study. Although by the end of the study, 573 responses were received, only 557 were analyzed, as the remaining had missing data. The mean age of participants was found to be 35 y, with a minimum age of 18 y and a maximum age of 82 y. The mean age for females and males was 32 y and 39 y, respectively. The ratio of females to males was 1.3:1 (321/236), as shown in fig. 1.

There was a significant difference in the education level of males and females. Except for the above-postgraduate level of education, the percentage of school dropout was higher among females (73% vs. 27%), and the same held true for graduation (64% vs. 36%) and post-graduate level of education (55% vs. 45%), as shown in table 1.

Overall, 61% of participants reported a history of self-medication with allopathic//homeopathic/ayurvedic medicines or any combination of these during the study period or the past 3 mo (COVID period), as shown in fig. 2. There was a significant difference (p = 0.02) in the pattern of self-medication between the males (38%) and females (62%). Self-medication was found to be more common in the 18–30 and 31–43 age groups, as shown in fig. 1.

Among all the participants who had reported self-medication in the last three months, the majority of them said that self-medication was for the purpose of preventing COVID-19 (39%), followed by both prevention and treatment (19%), as shown in fig. 3. Once again, there was a significant difference between males and females, as shown in table 2.

Fear to go out (13%) during COVID-19 was the main single stimulus that surfaced for self-medication, as shown in fig. 2.

Table 1: Educational status of males and females (p-value =0.001; p≤ 0.05 is considered significant)

Education Male (n=236) Female (n=321)
Count % Within gender % Within education Count % Within gender % Within education
School dropout 3 1.3 27.3 8 2.5 72.7
Graduation 101 42.8 36.1 179 55.8 63.9
Post graduation 95 40.3 45.5 114 35.5 54.5
Above PG 30 12.7 65.2 16 5.0 34.8
Anyother 7 3.0 63.6 4 1.2 36.4

Table 2: Reasons for self-medication among males and females (p-value =0.05; p≤ 0.05 is considered significant)

Male (n=236) Female (n=321)
Reason for self-medication Count % Within gender % Within reason for self-medication Count % Within gender % Within reason for self-medication
For prevention 86 36.5 40 129 40.2 60
For treatment of symptoms of corona 6 2.5 27.3 16 5 72.7
For both treatment and prevention 39 16.5 36.8 67 20.9 63.2
Neither for prevention nor for cure 105 44.5 49.1 109 34 50.9

Table 3: Stimuli for self-medication among males and females (p=0.35 p ≤ 0.05 is considered significant

Male (n=236) Female (n=321)
Stimuli for self-medication Coun % Within gender % Within stimuli for self-medication Count % Within gender % Within stimuli for self-medication
None 6 2.5 35.3 11 3.4 64.7
Non-accessibility to doctors 11 4.7 57.9 8 2.5 42.1
Non-accessibility to hospitals 2 0.8 16.7 10 3.1 83.3
Non-acceptability by hospitals 3 1.3 60 2 0.6 40
Non-availability of transporters 1 0.4 20 4 1.2 80
Fear to go out in Lockdown 31 13.1 42.5 42 13.1 57.5
Economic 2 0.8 66.7 1 0.3 33.3
Any other 104 44.1 46 122 38 54
All 8 3.4 47.1 9 2.8 52.9
Multiple options 68 28.9 110 35

For females, non-accessibility to hospitals, transportation problems, and non-accessibility of doctors were the main stimuli for self-medication during the COVID-19 period, whereas for males, increased cost, non-acceptability by hospitals, and non-accessibility to doctors were the three main stimuli, as shown in table 3.

Most participants who took allopathic, homeopathic, or ayurvedic medications did not report any adverse effects.

Among homeopathic self-medicating participants, arsenic album 30 was the most frequently used formulation (26%). Whereas, among ayurvedic self-medicating participants, most of them took all three, i.e., chyawanprash, herbal decoction, and golden milk, as shown in fig. 4.

The major source of knowledge for self-medication was from authorized websites (28%) https://ayush.gov.in, https://nch.org.in [18, 20], news channels, and social media (10.4%), as shown in table 4.

Table 4: Frequency distribution of sources of knowledge for self-medication

Sources of knowledge Frequency Percentage
Did not self-medicate 12 2.2
Social media 51 9.2
News channel 7 1.3
Word of mouth 53 9.4
Internet (unofficial) 15 2.7
Official websites 156 28.0
Any other 10 1.8
All 114 20.5
News channel+Word of mouth 22 3.9
News channel+Social media 58 10.4
Internet+official 50 9.0
News channel+official website 9 1.6

Fig. 1: Socio-demographic parameters of participants included in study

Fig. 2: Percentage of population taking self medications and their stimuli

Fig. 3: Percentage showing reasons for self medication

Fig. 4: Percentage of population taking ayurvedic and homeopathic medicine

DISCUSSION

Studies have reported varying prevalence among different states of India [3]. COVID-19 was one such situation where no definitive cure or vaccines were accessible, and it was further fueled by the false propaganda given by social media, leading to uncertainty and confusion in the public and a rise in the use of self-medication, including home remedies.

In a study conducted by Grace et al. at Cameroon 13% of adult participants use antibiotics as self-medication [6] as opposed to our study, where antibiotic usage was only 1%. Also, in this study, the reason for self-medication is due to the inaccessibility of health care services, which was more common in females but in our study fear to go out in lockdown was the main stimuli for self-medication with no significant difference between men and women. Grace also concluded that an increased risk of self-medication was more among middle-aged (40-59 y), which was not in agreement with our study as self-medication was more common in the age group of 18-30 y.

Low literacy was the main reason for self-medication among women in a study by Karimy et al. [21] which was not in line with our study, where women with higher education preferred self-medication more (96.3%). In a study by Gurmeet Kaur [10], the source of information for self medication was only television, whereas in our study, both men and women subgroups had multiple sources of knowledge (television, social media, and websites) of self-medication and multiple chronic co-morbidities were the prime reasons for self-medication.

In our study, about 61.9% used ayurvedic medicine as self-medication during COVID, as compared to 22.5% in a study done by Priyanka [22]. Easy availability of ayurvedic home-made medicines and a lack of adverse effects might be the reasons for their increased use. Also, we found a significant association between gender (p=0.00) and education (p =0.00) on the utilization of ayurvedic drugs. Information uploaded to the Ministry of Health and Family Welfare was the major source for self-medication in the present study, which is not on par with the above study [22], where mass media was the major source. The most common herbal product used for prevention was herbal tea (70.9%) [23] whereas in our study, only 5.9% used herbal tea.

Apart from Ayurveda and allopathy, it was found that 26.1% of participants used arsenic album in our study, whereas in the study done by Iftekhar Ahmed [23], 15% of participants took both homoeopathy and allopathy as preventive medicine, among which arsenic album (30.1%) was the most frequently used. In this same study, besides arsenic album, vitamin supplements (27.1%) were also commonly used by the public, which was similar to our study (11.8%).

Official websites were the major source of knowledge for self-medication (28%), especially for homeopathic and ayurvedic medicines (https://ayush.gov.in, https://nch.org.in) [18, 20], as opposed to the study by Onchonga D, where Google searches on self medication showed increased people’s awareness of self-medication [24]. According to Gupta [25], students with less schooling are likely to self-medicate more, in contrast to study done by Rakesh [26] and present study, where graduates preferred to self-medicate.

The study by Kumari [27] stated the most common reason for self-medication was being more economical, working doctors were the common source of information, and the most common drugs used were analgesics, as compared to the present study, where our major stimuli for self-medication was fear of going out during lockdown (13%), the official website was the main source of knowledge (28%), and antibiotics were the most common drugs used.

The study conducted by Ainsy Goldlin [28] concluded that main factors related to self-medication were COVID 19 spread and fatality, fear of going to hospitals, lack of trouble-free access to hospitals (39.6%), which was in accordance to our study. Another similarity of our study was with the study done by Chopra [29] and also by Jalpa [30] where self-medication was more common in women with 62% and 66%, respectively than in men.

LIMITATIONS

No research is devoid of limitation. So, our study also has few limitations. As the data was collected based on convenient sampling, findings cannot be generalized. Another drawback of this study was that the people were not questioned directly as this was a self-answered questionnaire, which may result in recall bias and deviated responses as there was less scope for direct interaction.

CONCLUSION

Fear of exposure during COVID-19 was the key factor linked to the adoption of the behavior of self-medication. Self-medication is becoming more common in the younger population too. People turn to self-medication mainly because of limited access to facilities and an increase in the source of information during the pandemic. Better strategies towards the availability of medical treatment for acute and chronic infections should be the prime focus during any pandemic.

ACKNOWLEDGEMENT

Nil

FUNDING

Nil

AUTHORS CONTRIBUTIONS

Dr. Sunil Kumar Pandey: Conduction of the project, data analysis and interpretation, submission, revision, Dr. Sarita Panigrahy: preparation of protocol, manuscript, data input, revision, Dr. Deepanjana Dass: Data collection and compilation, Dr. Meher Sheena: Data collection and compilation.

CONFLICTS OF INTERESTS

Declared none

REFERENCES

  1. Mathias EG, D’souza A, Prabhu S. Self-medication practices among the adolescent population of South Karnataka, India. J Environ Public Health. 2020 Sep 7;2020:9021819. doi: 10.1155/2020/9021819, PMID 32963558, PMCID PMC7492945.

  2. Rathod P, Sharma S, Ukey U, Sonpimpale B, Ughade S, Narlawar U. Prevalence, pattern, and reasons for self-medication: a community-based cross-sectional study from central India. Cureus. 2023 Jan 18;15(1):e33917. doi: 10.7759/cureus.33917, PMID 36819304, PMCID PMC9936784.

  3. Rangari GM, Bhaisare RG, Korukonda V, Chaitanya YL, NH. Prevalence of self-medication in rural area of Andhra Pradesh. J Family Med Prim Care. 2020;9(6):2891-8. doi: 10.4103/jfmpc.jfmpc_204_20, PMID 32984145.

  4. Limaye D, Limaye V, Fortwengel G, Krause G. Self-medication practices in urban and rural areas of western India: a cross-sectional study. Int J Community Med Public Health. 2018;5(7):2672-85. doi: 10.18203/2394-6040.ijcmph20182596.

  5. World Health Organization. Guidelines for the regulatory assessment of medicinal products for use in self-medication. World Health Organization; 2000. Available from: https://iris.who.int/handle/10665/66154 [Last accessed on 25 May 2020]

  6. Elong Ekambi GA, Okalla Ebongue C, Penda IC, Nnanga Nga E, Mpondo Mpondo E, Eboumbou Moukoko CE. Knowledge, practices and attitudes on antibiotics use in Cameroon: self-medication and prescription survey among children, adolescents and adults in private pharmacies. PLOS ONE. 2019 Feb 28;14(2):e0212875. doi: 10.1371/journal.pone.0212875. PMID 30818373, PMCID PMC6394986.

  7. Rashid M, Chhabra M, Kashyap A, Undela K, Gudi SK. Prevalence and predictors of self-medication practices in India: a systematic literature review and meta-analysis. Curr Clin Pharmacol. 2020;15(2):90-101. doi: 10.2174/1574884714666191122103953, PMID 31763976, PMCID PMC7579319.

  8. Keshari SS, Kesarwani P, Mishra M. Prevalence and pattern of self-medication practices in the rural area of Barabanki. Indian J Clin Pract. 2014;25(7):636-9.

  9. Pawar K, Haran A, Nadig P. Multiple adverse effects of betamethasone used as self-medication: a case report. Asian J Pharm Clin Res. 2015;8(2):11-2.

  10. kaur G, Samuel G, kaur J. An exploratory study to assess the practices of self –medication among women in a selected community of Ludhiana, Punjab. Nursing and Midwifery Research Journal. 2011;7(3):122-9. doi: 10.33698/NRF0127.

  11. Roy SS, Roy A, Santra Dhali R, Bagchi C, Banerjee G, Tripathi SK. A case of inappropriate self-medication compounded with prescribing vis-a-vis dispensing errors and the hazardous consequence. Curr Drug Saf. 2018;13(1):51-4. doi: 10.2174/1574886312666170919174925, PMID 28933275.

  12. Jangra MS, Chhabra M, Bhagavathula AS. Self-medication of ayurvedic medicine associated with fatal toxic epidermal necrolysis: a case report. Curr Trad Med. 2020;6(3):250-5. doi: 10.2174/2215083805666190617121548.

  13. Laddhad D, Sancheti SR, Dinde Y. Transient A-V dissociation and severe hypotension due to consumption of ayurvedic medicine-vatsanabha (aconitum ferox). J Assoc Physicians India. 2014 May;62(5):434-5. PMID 25438496.

  14. Guha S, Dawn B, Dutta G, Chakraborty T, Pain S. Bradycardia, reversible pan conduction defect and syncope following self-medication with a homeopathic medicine. Cardiology. 1999;91(4):268-71. doi: 10.1159/000006922, PMID 10545684.

  15. Stevenson R, MacWalter RS, Harmse JD, Wilson E. Mortality during the winter flu epidemic-two cases of death associated with self-medication. Scott Med J. 2001 Jun;46(3):84-6. doi: 10.1177/003693300104600307, PMID 11501327.

  16. Choudhury R. COVID-19: Assam doctor dies allegedly after taking anti-malarial drug as virus prevention. NDTV News. 2020 Mar 31. Available from: https://www.ndtv.com/india-news/coronavirus-assam-doctor-dies-allegedly-after-consuming-anti-malarial-drug-2203271.

  17. Galvan A, Cooper JJ. Arizona death prompts warning against virus self-medication. AP News; 2020 Mar 24. Available from: https://apnews.com/article/1c82191c0d586317ae34325d1276ae4f [Last accessed on 28 May 2020]

  18. Ministry of AYUSH. Available from: https://www.ayush.gov.in [Last accessed on 15 Dec 2023]

  19. Central council for research in homoeopathy. Homoeopathic perspectives in COVID-19 coronavirus infection fact sheet. Available from: https://www.ccrhindia.nic.in/showimg.aspx?ID=15677 [Last accessed on 15 Dec 2023]

  20. National Commission for Homeopathy. Available from: https://nch.org.in [Last accessed on 15 Dec 2023]

  21. Karimy M, Rezaee Momtaz M, Tavousi M, Montazeri A, Araban M. Risk factors associated with self-medication among women in Iran. BMC Public Health. 2019 Aug 1;19(1):1033. doi: 10.1186/s12889-019-7302-3, PMID 31370891, PMCID PMC6676788.

  22. Satyanarayana P, Olickal JJ, Thidil NE. Prevalence and factors associated with utilization of ayurvedic drugs during COVID-19. A community-based cross-sectional study. Clin Epidemiol Glob Health. 2023 Feb;19:101204. doi: 10.1016/j.cegh.2022.101204, PMID 36569413, PMCID PMC9763204.

  23. Ahmed I, Hasan M, Akter R, Sarkar BK, Rahman M, Sarker MS. Behavioral preventive measures and the use of medicines and herbal products among the public in response to COVID-19 in Bangladesh: a cross-sectional study. PLOS ONE. 2020 Dec 11;15(12):e0243706. doi: 10.1371/journal.pone.0243706, PMID 33306725, PMCID PMC7732085.

  24. Onchonga D. A google trends study on the interest in self-medication during the 2019 novel coronavirus (COVID-19) disease pandemic. Saudi Pharm J. 2020 Jul;28(7):903-4. doi: 10.1016/j.jsps.2020.06.007, PMID 32641903, PMCID PMC7299852.

  25. Gupta S, Chakraborty A. Pattern and practice of self-medication among adults in an urban community of West Bengal. J Family Med Prim Care. 2022 May;11(5):1858-62. doi: 10.4103/jfmpc.jfmpc_1823_20, PMID 35800576, PMCID PMC9254776.

  26. Meena, Sudhanshu Sharma, Vivek Sagar. Self-medication practices in dermatological diseases: a cross-sectional questionnaire-based study. Asian J Pharm Clin Res. 2023;16(9):129-32. doi: 10.22159/ajpcr.2023v16i9.49012, doi: 10.22159/ajpcr.2023v16i9.49012.

  27. Kumari D, Lahiri B, Das A, Mailankote S, Mishra D, Mounika A. Assessment of self-medication practices among non-teaching faculty in a private dental college-a cross-sectional study. J Pharm Bioallied Sci. 2022 Jul;14Suppl 1:S577-80. doi: 10.4103/jpbs.jpbs_796_21, PMID 36110747, PMCID PMC9469260.

  28. TJ AG, MP. Cyberchondria and its impact on self-medication and self-care in COVID-19 pandemic-a cross-sectional study. Biomed Pharmacol J. 2021;14(4):2235-44. doi: 10.13005/bpj/2322.

  29. Chopra D, Bhandari B, Sidhu JK, Jakhar K, Jamil F, Gupta R. Prevalence of self-reported anxiety and self-medication among upper and middle socioeconomic strata amidst COVID-19 pandemic. J Educ Health Promot. 2021 Feb 27;10:73. doi: 10.4103/jehp.jehp_864_20, PMID 34084820, PMCID PMC8057176.

  30. Suthar J, Shrina PP, Riddhi NS. Knowledge, attitude, and practices of self-medication among the students of private university. Asian J Pharm Clin Res. 2020;13(8):104-7. doi: 10.22159/ajpcr.2020.v13i8.37989.