Practice and Predictors of self-medication among urban and rural adults in Sri Lanka, three decades after Market Economic Reforms

 

Dr. Pushpa Ranjan Wijesinghe MD- Rostov (General Medicine)

MSc, MD-Colombo (Community Medicine)MPH-New Zealand ( Bio-security)  

Background

•  Practice of self-medication  in communities in  varying degrees

• Increased  private sector  involvement in health &  pharmaceutical  care since 1977 

• Increased utilization of private health / pharmaceutical    care for out patient conditions 

• Competition of the pharmaceutical companies for a larger share of over the counter drug market 

• What is the status of  self-medication in settings of   contrasting health and pharmacy care infra-structure in this context  ?     

Objective • To describe the current practice and predictors  of  self-medication  in  a selected urban and rural area  in Sri Lanka 

Methods  • Study design • A community based cross –sectional  study

• Study Population• Adults over 18 years of age, irrespective of sex , 

permanently residing in the selected districts over a period of 1 year

8 Urban Council areas

30 GN divisionsPSU

30 Households per aGN division

1 individual per house(900)

  7 Regional Council (PS ) areas                       

PPS

Voters list

Kish Table

30 GN divisionsPSU

30 Households per aGN division

1 individual per house(900)

n= 900Stratification

 Urban district Rural district

n= 900

Study Instruments

• Interviewer administered questionnaire (IAQ)

• Validated Likert scale to assess the Perceived satisfaction with available pharmacy services– Access, Continuity, General  Satisfaction of services – Availability , Affordability, Efficacy of drugs –  Inter-personal  explanation,  Considerateness

• Validated Likert scale to assess the  perceived  access to allopathic medical care – Availability of services, – Regularity and acceptability of services– Affordability of services – Concern for clients 

Medication use

Predisposing factorsEnabling factors

Need variables

ACCESS FACTORS

SOCIO DEMOGRAPHIC FACTORSBELIEFS & ATTITUDES

ACTUAL OR PERCEIVED MORBIDITYAnderson and Newman’s health services utilization model

  urban (n=863) Rural (n=846)

Prevalence of medication use (95% confidence interval )

33.9% (30.7%-37.1 %)

35.3% (32. 1-38.5)

Urban ( n =293 ) Rural ( n=846)

Only allopathic medicine users 91.4% 84.6%

Only traditional medicine users 3.8% 12.4%

Both allopathic and traditional medicine users

4.8% 3.0%

urban (n=863) Rural (n=846)

Prevalence of self medication * 12.2% (10% -14.4%)

7.9%(6.1%-9.7%)

Self medication as a proportion of medication use *

37.2% 25.6%

Practice of medication use

* P < 0.05

Practice of self-medication

Urban Rural

Conditions of Acute onset and short duration 58% 67%

Perceived non-severity of the condition for physician consultations

55% 64%

Previous satisfactory response of the same drug to a similar condition

53% 60%

Self-medication without any symptom 09% 12%

Using previous prescriptions for self medication for purchasing drugs

37% -

Using labels/blister packs of previously used drugs for purchasing drugs

- 45%

Self-medication with one drug 49% 73%

Self-medication with 2 drugs 28% 18%

Predictors of self medicationUrban Rural

Predisposing variables Adjusted OR ( 95% CI) Adjusted OR ( 95% CI)

Household number ≤ 2 4.3 ( 1.1-17.5) -

Non-affirmation of drugs availability at informal places

0.3 (0.1-0.8) -

Need Variables Adjusted OR ( 95% CI) Adjusted OR ( 95% CI)

Symptoms ≤ 2 7.9 (3.4-18.9) 2.4 (1.1-5.8)

Enabling Variables Adjusted OR ( 95% CI) Adjusted OR ( 95% CI)

Higher satisfaction with acceptability of medical services

0.96 (0.93-0.98) -

Affordability of medical services

- 0.4 (0.2-0.7)

Technical competence of pharmacy staff

- 2.8 (1.1-7.3)

Conclusion & recommendations • Self-medication   is more prevalent  in  the urban  setting• Prevalence of SM  is lower than global estimates • Self-medication  with 1-2 drugs selected on  previous

experience is an initial individual response   for diseases of acute onset and  perceived to be of less severity 

•  Lower symptom count is a need variable acting as a  proxy measure of perceived severity of the morbidity

•  Self medication  is  dependent on  characteristic access measures  unique in  the two specific settings

• Findings  should be utilized to– Shape policy changes related to implementation of  the CDD act– Design IEC programs for   consumers moving towards self-medication – Enhance the capacity of rural pharmacists/assistants as the  first 

contact points   in the rural sector

Limitations

• Less valid data as compared to data collected  in  a  prospective follow up study using  a diary method

• Non-objective  measurement of the severity of  the condition

• Social desirability bias due to use of  public health midwife for data collection 

• Perceived  access  measures to health care and  pharmaceutical  services reflect general rather than  specific context