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Prevalence of Self-medication and its Associated Factors among Pregnant Women Attending Antenatal Care at Nekemte Referral Hospital, Oromia Regional State, West Ethiopia
ISSN: 1948-593X

Journal of Bioanalysis & Biomedicine
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  • Research Article   
  • J Bioanal Biomed 2019, Vol 11(2): 228
  • DOI: 10.4172/1948-593X.1000228

Prevalence of Self-medication and its Associated Factors among Pregnant Women Attending Antenatal Care at Nekemte Referral Hospital, Oromia Regional State, West Ethiopia

Getu Bayisa Wakjira, Bontu Gemechu Boru and Busha Gamachu Labata*
Department of Pharmacy, Institute of Health Sciences, Wollega University, Ethiopia
*Corresponding Author: Busha Gamachu Labata, Department of Pharmacy, Institute of Health Sciences, Wollega University, Ethiopia, Tel: +251912119297, Email: [email protected]

Received Date: Feb 04, 2019 / Accepted Date: Mar 22, 2019 / Published Date: Mar 28, 2019

Abstract

Background: Self-medication is one element of self-care in which individuals to treat self-recognized illnesses or symptoms did the selection and use of medicines. Pregnant women’s practice self-medication to treat a number of medical conditions. However, self-medication in pregnant women’s leads to potential drug adverse reaction. Higher risks were reported if women were in their first trimesters of pregnancy.

Objectives: The objective of this study is to assess the prevalence of self-medication and its associated factors among pregnant women attending antenatal care at Nekemte Referral Hospital.

Methodology: A Hospital based cross-sectional study was conducted among 195 pregnant women attending antenatal care at Nekemte Referral hospital from May to June 2018. Semi-structured interviewer questionnaire was used to collect data from each study subjects. SPSS version 21 software was used to categorize and analyze data. Association is significant at p-value less than 0.05.

Results: In this study, 195 pregnant mothers were participated. The respondents’ age range from 21 to 45 years and their mean age was 30.4+3.45 years. Self-medication practice among pregnant women was 21.5% with the most common self-medicated drugs were paracetamol 19 (45.2%) and amoxicillin 12 (28.6%). Respondents aged between 20 to 30 years (AOR=0.108, 95% CI: 0.012-0.952) and 31 to 40 years (AOR= 0.078, 95% CI: 0.009-0.698) were less likely to practice self-medication than those above 40 years old respondent. Farmer pregnant women were less likely (AOR=0.881, 95% CI: 0.006-1.099) to use self-medication than students.

Conclusion: The prevalence of self-medication was 21.5% among respondents. Pregnant women with age group of 31 to 40 years and farmers had less likely to practice self-medication.

Keywords: Antenatal care; Pregnant; Self-medication; Women

Abbreviations

ANC: Antenatal Care; NRH: Nekemte Referral Hospital

Introduction

Self-medication is one element of self-care in which individuals to treat self-recognized illnesses or symptoms did the selection and use of medicines [1]. It was practiced throughout the world and among different age group individuals even though the magnitude shows a discrepancy [2-6]. It was mostly common in developing countries and consumer vulnerability to risks of self-medication in developing country related to low literacy levels in the common population, affordability of medicines and lack of accessibility to primary healthcare [7]. In Ethiopia research’s revels that the prevalence of self-medication varied from 12.8% to 77.1% [8]. Therefore, the use of prescription-only medications including antimicrobial agents without medical consult has become alarmingly high in Ethiopia [9].

Medications provide therapeutic benefits through curing a disease, slowing its evolution, or alleviating its symptoms. But medications also carry the risks of adverse drug reactions, which can span from minor symptoms to severe events such as anaphylaxis or organ failure [10]. Also self-medication will come with potential health related hazards including emergence of antimicrobial resistance [9].

Pregnant women’s practice self-medication to treat a number of medical condition [2,3,11,12]. The most common reasons reported by pregnant women to practice self-medication were disease not serious, prior experience about the drug, economical cost and easy access to the drug without prescription [12,13]. However, self-medication in pregnant women’s leads to potential drug adverse effects likes congenital birth defects, a miscarriage, and allergic disease. Higher risk was reported if women were in their first trimesters of pregnancy [14].

Medications use during pregnancy normally based on evaluation of their harm to the mother and fetus. In most cases, the first choice for treatment of a condition during pregnancy differs from treatment in non-pregnant women. Hence, the choice of drugs must take into account the fetus and may direct therapy to non-standard regimens [15]. Therefore, assessment of medication use during pregnancy is important for clinical, educational, economical, and public health. By taking into consideration the potential effects of self-medication, this study aimed to assess prevalence of self-medication and associated factors to help health care providers in educating and counseling pregnant women about the consequence of self-medication use.

Methodology

Study area and study period

The study was conducted in Nekemte Referral Hospital antenatal care (ANC) clinic from May to June 2018. The Hospital was found in Nekemte Town, Oromia region, West Ethiopia at 331 km from Addis Ababa.

Study design

A Hospital based cross-sectional study was conducted.

Populations

All pregnant women who attend antenatal care clinic at Nekemte Referral Hospital during the study period were the study population.

Inclusion and exclusion criteria

All Pregnant women who attend antenatal care clinic at NRH during study period and willing to participate in the study were included in the study. Nevertheless, pregnant women who were critically ill, mentally ill, and unable to hear and speak were excluded from study.

Sample size determination and sampling technique

The sample size was determined using the single population proportion formula considering prevalence of self-medicine use; 26.6% (p=0.266) (11) with a margin of error of 5% (d=0.05) and a 95% confidence interval. Substituting this value in the formula yields 301 pregnant women.

image

Where: n= sample size

p= Prevalence of self-medication among pregnant women

d= Margin of sampling error tolerated

Zα/2= Critical value for normal distribution at 95% confidence level which equals to 1.96 (z value at α =0.05).

Since the total pregnant women, attending ANC at NRH was less than 10,000, which was 553; reduction formula was applied as follow:

image

Where; Nf = final sample size

n = Calculated sample size (301)

N = Source of population (553)

Therefore, 195 pregnant women were recruited consecutively and interviewed. During the study period, 203 pregnant women were comes to the hospital. Only 195 pregnant women were fully participated whereas five pregnant women were critically ill and three of them were not voluntary to participate in the study.

Study variables

Dependent variables: Self-medication

Independent variables: Age, marital status, number of children, occupation, monthly income, place of residence, distance from health center.

Data collection instrument and procedure

Data about socio-demographic, medical history, and self-medication practice of the pregnant women was collected from participants by semi-structured interview questionnaire items. The questionnaire was prepared in English language after reviewing literatures. Then translated to Afan Oromo language and back translated to English to ensure consistency of meaning. Before the beginning of the actual data collection, the questionnaire was pretested on 5% pregnant women attending NRH antenatal care who were later excluded from the study and a slightly modification was made on questionnaire

Ethical consideration

Ethical clearance was obtained from Wollega University, College of Health Sciences Ethical Review Committee. A formal letter was written to the NRH. Then permission was given from NRH in order to conduct the study. Written informed consent was obtained from study participants prior to data collection.

Data processing and analysis

Data was coded, entered, and analyzed by using SPSS version 21 software. Statistical significance was considered when p-value is less than 0.05. Univariable and multivariable logistic regression analysis was used to determine factors associated with self-medication practice.

Results

Socio demographic characteristics of study participants

In this study, 195 pregnant mothers were participated. The respondents mean age was 30.4+ 3.45 years, which range from 21 to 45 years. Ninety-eight (50.3%) of the respondents were between the ages of 21-30 years. Urban residents’ account 159 (81. 5%) of respondents. There is no smoking history among all respondents. Majority of the respondents were married, which account 187 (95%). In addition, seventy-three (37.4%) had completed diploma/degree. Government employees were 54 (27.7%) of participants. One hundred thirty five (69.2%) respondent get greater than 3000 Ethiopian birr per month. One hundred thirty two (67.7%) of respondents have less than 5-kilometer distances from health facility and 52 (26.2%) of respondents has two children previously born. Majority of pregnant women 179 (91.8%) had planned pregnancy, in 29 (14.9%) respondents history of adverse pregnancy outcome occurred and 101 (51.8%) participants were currently at second trimester pregnancy (Table 1).

Variables Number (n) Percent (%)
Age in years    
21-30 98 50.3
31-40 69 35.4
>41 28 14.4
Marital status    
 Single 4 2.05
 Married 187 95.9
 Widowed 4 2.05
Educational status    
Illiterates 34 17.4
Primary 25 12.8
Secondary 25 12.8
College/university 38 19.5
Diploma/degree 73 37.4
Occupational status    
Government employee 54 27.7
Self-employee 63 32.3
Farmer 12 6.2
House wife 31 15.9
Student 35 17
Monthly in come    
<1000 11 5.6
1001-2000 14 7.2
2001-3000 35 17.9
>3000 135 69.2
Place of residence    
Urban 159 81.5
Rural 36 18.5
Distance from health facility    
13267.7
5-10 km 27 13.8
>10 km 36 18.5
Number of children previously born    
 No 41 21.0
 One 37 19.0
 Two 51 26.2
 Three 42 21.5
≤ Four 24 12.3
Pregnancy stage    
First trimester
Second trimester
Third trimester
51
101
43
26.2
51.8
22.0
Timing of first ANC visit    
First trimester
Second trimester
191
4
98.0
2.0
Number of ANC visit
<4
≥ 4
96
99
49.2
50.8
Pregnancy planning status
Planned
Unplanned
179
16
91.8
8.2
History of adverse pregnancy outcome
Yes
No
29
166
14.9
85.1

Table 1: Socio-demographic characteristics of pregnant women attending antenatal care at Nekemte Referral Hospital, 2018.

Self-medication practice

Self-medication practice among pregnant women was 42 (21.5%) during current pregnancy (Figure 1). The most common self-medicated drugs were paracetamol 19 (45.2%) and amoxicillin 12 (28.6%) (Figure 2). This drugs were used for headache 13 (31%) and diarrhea 11 (26.2%) management (Figure 3).

bioanalysis-biomedicine-Self-medication

Figure 1: Self-medication practice among pregnant women attending antenatal care at Nekemte Referral Hospital, 2018.

bioanalysis-biomedicine-pregnant-women

Figure 2: Percentage of drugs used for self-medication during current pregnancy among pregnant women attending antenatal care at Nekemte Referral Hospital, 2018

bioanalysis-biomedicine-antenatal-care

Figure 3: Indication for self-medication use among pregnant women attending antenatal care at Nekemte Referral Hospital, Ethiopia, 2018.

Twenty-four (57.1%) of pregnant women obtain information about self-medication practice from druggist/pharmacist. The mentioned reason for using self-medication was; prior experience to the drug 19 (45.2%) and better knowledge about the disease and treatment 16 (38.1%). Forty one (98%) of respondent access to self-medication at community pharmacy and drug store. Only three (7.1%) of respondent who used self-medication knows the side effect of the drug they used (Table 2).

Reason for self-medication  Number   Percent (%)
Time saving 1 2.4
Better knowledge about the disease and the treatment 16 38.1
Had prior experience to the drug 19 45.2
Easy available 6 14.3
Source of information    
Your self 1 2.7
Your neighbor 17 40.5
Pharmacist/druggist 24 57.1
From where do you get the drug    
Community pharmacy and drug store 41 97.6
Neighbors 1 2.4
What do you know about drugs that you have used    
Dose 11 26.2
Side effect 3 7.1
How to take 19 45.2
No information 9 21.4

Table 2: Characteristics of self-medication among pregnant women attending antenatal care at Nekemte Referral Hospital, 2018.

Factors associated with self -medication

Age group and occupational status were found to have a significant association in multivariate logistic regression analysis. Respondents aged between 20 to 30 years (AOR=0.108, 95% CI: 0.012-0.952) and 31 to 40 years (AOR= 0.078, 95% CI: 0.009-0.698) were less likely to practice self-medication than those above 40 years old respondent. Farmer pregnant women were less likely (AOR=0.881, 95% CI: 0.006- 1.099) to use self-medication than those who were students.

There is no significant association between self-medication use and monthly income, place of residence, education status, marital status, distance from health facility, number of children previously born, timing of first ANC and Number of ANC visit both in the univariate and in multivariate logistic regression analysis (Table 3).

Variables Self-medication use COR AOR 95%CI  
Yes No (95%CI) p-value 95% CI p-value
Age            
20-30 21 77 0.136 (0.017,1.059) 0.057 0.108 (0.012-0.952) 0.045*
31-40 20 49 0.091 (0.012,0.714) 0.023 0.078 (0.009-0.698) 0.023*
>41 1 27 1.00 1.00 1.00 1.00
Educational status            
Illiterate 7 27 1.456 (0.548,3.869) 0.452 1.419 (0.445-4.520) 0.554
Primary 4 21 1.981 (0.605,6.490) 0.259 1.727 (0.431-6.928) 0.440
Secondary 4 21 1.981 (0.605,6.490) 0.259 1.017 (0.235-4.400) 0.982
College& above 7 31 1.671 (0.635,4.400) 0.299 2.920 (0.498-17.119) 0.235
Diploma/degree 20 53 1.00 1.00 1.00 1.00
Occupation            
Govt. employee 14 40 0.989 (0.374,2.614) 0.982 0.277 (0.049,1.560) 0.146
Self-employee 14 49 1.212 (0.463,3.174) 0.696 0.293 (0.058,1.488) 0.139
Farmer 1 11 3.808 (0.429,3.783) 0.230 0.881 (0.006,1.099) 0.040*
House wife Student 4
9
27
26
2.337 (0.640,8.531)
1.00
0.199
1.00
0.184 (0.028,1.201)
1.00
0.077
1.00
Monthly income            
<1000 1 10 3.107 (0.383.25.207) 0.289 6.993 (0.089,2.059) 0.985
1001-2000 2 12 1.864 (0.396,8.770) 0.431 0.585 (0.112,3.063) 0.525
2001-3000 7 28 1.243 (0.496,3.113) 0.643 0.866 (0.331,2.264) 0.769
>3000 32 103 1.00 1.00 1.00 1.00
Residence            
Urban 33 126 1.273 (0.546,2.966) 0.576 0.429 (0.089,2.059) 0.290
Rural 9 27 1.00 1.00 1.00 1.00
Distance from health facility            
<5 km 30 102 1.133 (0.481,2.671) 0.775 1.751 (0.436,7.035) 0.430
5-10 km 3 24 2.667 (0.646,11.006) 0.175 0.579 (0.192,3.756) 0.542
>10 km 9 27 1.00 1.00 1.00 1.00
Number of children            
No 10 31 1.033 (0.322,3.319) 0.956 0.503 (0.128,1.975) 0.325
One 10 27 0.900 (0.278,2.914) 0.860 0.759 (0.192,3.009) 0.695
Two 9 42 1.556 (0.482,5.019) 0.460 0.466 (0.119,1.820) 0.272
Three 7 35 1.667 (0.487,5.700) 0.416 0.308 (0.073,1.294) 0.108
> four 6 18 1.00      

Table 3: Factors associated with self-medication among pregnant women attending antenatal care at Nekemte Referral Hospital, 2018.

Discussion

The present study assessed self-medication and its associated factors among pregnant women Attending Antenatal Care at Nekemte Referral Hospital. The prevalence of self-medication practice in our study was 21.5%, which was lower than study done in Congo, Tanzania and Iran [2,3,16]. This discrepancy might be because of sample size difference since data for this study was lower, differences in regulatory compliance and knowledge of medications. Also the finding of this result is lower than a study conducted in Harar, Ethiopia [13]. The main reason for this difference is that in our study self-medication to modern medicine was assessed whereas self-medication to both conventional and herbal medicines was assessed in Harar study.

On the contrary the finding of this study is higher than a study done in Bangladesh [17]. This is due to the weak pharmaceutical regulatory system in case of Ethiopia since any one can buy any medicine without a prescription from the retail outlets without prescription, differences in knowledge of medications and sample size. However, the current findings of self-medication practice was in line with a studies conducted in the Iran, Bahir Dar Ethiopia and Addis Ababa Ethiopia [11,18,19].

In 17.5% of pregnancies, at least one drug associated with a teratogenic mechanism was in use during first trimester. The teratogenic total exposure trend increase in the second and third trimesters [20]. In current, study the most common self-medicine used were paracetamol 19 (45.2%) and amoxicillin 12 (28.6%). This study is in line with a study done in Brazzaville, Congo and Ethiopia [2,21]. The most common indication for use were headache 13 (31%) and diarrhea 11 (26.2%).

Pregnant women use self-medication because of safe treatment, availability of drugs, emergency usage, knowledge about drugs, advice from traditional healers, non-serious illness and lack of faith in doctor’s practice [2,17]. Similarly, our study indicated the reasons why pregnant women practiced self-medication. Accordingly easy access to medicines from pharmacies or drug shops without prescription, time saving, have prior experience to the drug, better knowledge about the disease and the treatment were responsible to self-medication in Nekemte Referral Hospital.

In the present study, respondents aged between 20 to 30 years and 31 to 40 years were less likely to practice self-medication than those above 40 years old respondent. The low rate of self-medication in the age group younger than 40 years could be because this group of pregnant mothers had less experience of diseases and using medications than older pregnant mothers. Farmer pregnant women were less likely to use self-medication than those who were students. The low practice of selfmedication in farmers’ pregnant mothers might be fear of side effect and poor communication with pharmacies to purchase drug.

Generally, this study has the following strength: The study determined the prevalence of self-medication practices among pregnant women and identified factors associated to self-medication practices.

Limitation of the Study

This study has the following limitations: First data was gathered through interview questionnaire; therefore, recall bias may influence the results. Some patients may prefer telling stories about their positive side. Second, the study subjects were recruited consecutively that might affect the finding.

Conclusion

The prevalence of self-medication use among pregnant women attending ANC at Nekemte Referral hospital was found to be 42 (21.5%). The most common indication for use was headache 13 (31%) and diarrhea 11 (26.2%). Paracetamol (45.2%) and amoxicillin (28.6%) were found to be the most self-medicated drug among the pregnant women. Pregnant women with age group of 20 to 30 years, 31 to 40 years, and farmer were less likely to practice self-medication. However, in this study, herbal medicine use was not addressed and further prospective longitudinal study will be required to clarify their use in pregnant women.

Acknowledgements

We were thankful for the co-operation of all pregnant mothers who participated in this study for their sincere response and precious time.

Availability of data and materials

The data used during current study are available from the corresponding author up on reasonable request.

Competing interests

The authors declare that they have no competing interests.

Authors’ Contributions

BGB conceived and designed the study; extracted, analyzed and interpreted the data. GBW and BGL supervised the whole research, guided the conception and design of the study, and assisted with analysis, interpretation of data and drafted the manuscript. All authors read and approved the final manuscript.

References

Citation: Wakjira GB, Boru BG, Labata BG (2019) Prevalence of Self-medication and its Associated Factors among Pregnant Women Attending Antenatal Care at Nekemte Referral Hospital, Oromia Regional State, West Ethiopia. J Bioanal Biomed 11: 160-165. DOI: 10.4172/1948-593X.1000228

Copyright: © 2019 Wakjira GB, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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