Prevalence and predictors of self-medication practices among adult household members in Hosanna town, Hadiya zone, central Ethiopia

Abstract

Background

Self-medication is a global health concern with serious public health implications. Excessive and inappropriate self-medication practice can lead to recurrent infections and increased antibiotic resistance, which is a major problem impacting morbidity and mortality worldwide. Despite the significance of this issue, no single study has been conducted on self-medication practices in the study area, to the best of the researchers’ knowledge.

Objective

To assess prevalence and predictors of self-medication practices among adult household members in hosanna town hadiya zone, central Ethiopia 2024.

Methods

A community-based cross-sectional study was conducted from March 1–30, 2024, among 566 randomly selected households in Central Ethiopia. Households were chosen using a simple random sampling technique. Both bivariable and multivariable binary logistic regressions were used to assess the explanatory variables associated with self-medication practices. Adjusted odds ratios (AOR) with a p-value < 0.05 at a 95% confidence interval were considered statistically significant.

Results

Out of the 566 study participants, 546 respondents were interviewed, yielding a response rate of 96.46%. Among the study participants, 338 (61.9%) with a 95% CI of (57.8–65.9) practiced self-medication in the past two months. Age of respondents ≥ 48 years (AOR = 2.76, 95% CI: (1.27, 5.99)), being married (AOR = 3.24, 95% CI: (2.0-5.26)), having a family size ≥ four members (AOR = 1.69, 95% CI: (1.00-2.87)), and not being a member of a health insurance scheme (AOR = 3.13, 95% CI: (1.95–5.04)) were significantly associated with self-medication practices.

Conclusion and recommendations

The prevalence of self-medication practice in the study area was relatively high. Self-medication practices were associated with the age of respondents, marital status, family size, and health insurance membership. Public health education and awareness campaigns should be strengthened to emphasize safe and responsible self-medication practices, particularly among older adults and those living in larger families.

Introduction

The World Health Organization recognizes self-care, including appropriate self-medication, as beneficial for treating minor illnesses that do not require medical attention on safe and appropriate manner that include using approved or over-the-counter medication, following the label, awareness of safety and precautions seeking professional advice when needed [18].

Self-medication is the use of any drug or medication to treat an illness or ailment without the supervision of a licensed medical doctor [9]. It involves the selection and use of medicines by individuals to address self-recognized illnesses or symptoms [35].

Reasons for self-medication vary, including the desire for self-care, caring for sick family members, limited health services, poverty, lack of knowledge, misconceptions, excessive drug advertising, and easy access to medications outside pharmacies [36].

Self-medication practice is a worldwide health problem with serious public health implications [20]. Globally, the prevalence of self-medication practice varies from 32.5 to 81.5% [37]. Self-medication is practiced commonly in the world in both developed and developing countries, and its utilization may be even more than prescribed medication [7]. The prevalence of self-medication practice (SMP) was found to be: Pakistan 85% (Abdul Haseeb and Muhammad Bilal [3], Iran 53% [13], Yemeni 85% [25], India 92.8% [22], Uganda, it was 75.7% [1, 26].

The prevalence of SMP also varies in different studies of Ethiopia. Study conducted in Jigjiga town, Eastern Ethiopia, SMP was found to be 37.5%, [9], Addis Ababa 75.5% [32], Wolaita Soddo town, southern Ethiopia, SMP was found to be 33.7% [23], Dire Diwa Eastern Ethiopia SMP was found to be 35.9% [20], and Gondar town 50.2% [19].

Factors influencing frequency of self-medication in the previous studies includes: age, educational level, family attitudes, advertising of drug manufacturers, legislation regulating dispensing and sale of drugs, and previous experiences with the symptoms or disease [5, 27, 29].

Excessive and inappropriate use of antibiotics has led to recurrent infections and increased emergence of antibiotic resistance, which is a global problem with a strong impact on morbidity and mortality [16]. Self-medication is highly prone to inappropriate use and has drawbacks resulting in wastage of resources, increased drug resistance pathogens, and adverse reactions [15, 30]. It can also lead to incorrect self-diagnosis, delays in seeking appropriate care, dangerous drug interactions, risk of dependence, drug abuse, incorrect dosage, and choice of medication [14, 31].

The investigation into self-medication practices in Ethiopia has revealed a significant gap in research, particularly in Central Ethiopia. Despite various studies conducted across different regions of the country, there is no comprehensive analysis focusing specifically on self-medication practices within this area. This study aims to fill that void by assessing the prevalence of self-medication practices and identifying the associated factors among adult household members in Central Ethiopia for the year 2023.

Methods and materials

Study area

The study was conducted in Hosanna town, the capital of Hadiya Zone in central Ethiopia. Hosanna town is located 232 km southwest of Addis Ababa, the capital of Ethiopia. According to the Hosanna city administrative office, the current population projection estimates the total population to be 117,362, with 57,574 males and 59,855 females. Hosanna town has a well-developed healthcare infrastructure, including one public specialized hospital, three public health centers, and eight urban health extension worker offices. The private healthcare sector in the town comprises 35 pharmacies, 22 primary clinics, 19 medium clinics, 2 dental clinics, and 2 eye clinics. The town is administratively divided into six kebeles (the smallest administrative units), and the study was conducted in two of these kebeles: Arada and Lichamba.

Study design and periods

A community-based cross-sectional study was conducted from March 01–30/2024.

Populations

All adult household members residing in Hossana town, Hadiya Zone, central Ethiopia were the source population for this study. The study population consisted of all selected adult household members who had an illness within two months prior to the survey, living in the selected kebeles of Hossana town during the study period.

Eligibility criteria

All family members of households aged 18 years and above with an ailment in the selected kebeles (Arada and Lichamba) of Hosanna town, central Ethiopia, who had lived in the town for at least six months during the study period were included in the study. Family members who were seriously ill and unable to respond to the questions during the data collection period were excluded.

Sample size determination

To determine the sample size, outcome variable was considered, prevalence of self-medication practices p = 33.7% from study of Wolaita Soddo town [23] was used in order to estimate minimum sample size to achieve objective of study. Sample size was calculated using single population proportion and considering the following assumptions, level of confidence 95% with the corresponding value (1.96 for normal distribution), and absolute precision 5%.

The following statistical formula was used.

$$\begin{aligned} &\text{n} = \frac{\text{Z}\ \upalpha/2]^{2}\ \text{P}(1-\text{P})}{\text{d}^{2}}\\ & \text{n}\ = \text{the minimum needed sample size,}\\ & p = 33.7\%\ \text{prevalence of self-medication practices in a similar study}\\ & \text{z} = \text{the standard value for normal distributed with confidence level of}\ \upalpha = 95\%\\ & \text{d} = \text{the margin of error between the sample and the population}\ (0.05.\\ & \text{Z} = 1.96, \text{P} = 33.7\%, \text{d} = 5\% = 0.05, \text{n} = \frac{(1.96)^{2} \times 0.337 (1-0.337)}{(0.05)^{2}} = 343.2 \end{aligned}$$

then add 10% by considering non response rate = 377.5 and multiplying with 1.5 design effect, therefore 566 sample of household required to carried out this particular study.

Sampling techniques and procedure

A Multistage sampling technique was used. A total of six kebele are found in Hossana town. Of these, two kebeles were selected using simple random sampling technique (lottery method). List of villages found in both kebeles along with their respective household numbers were obtained from both selected kebele. Each selected kebele contain 20 villages and four village were selected by using simple random sampling technique from each selected kebele. Finally, sampled households in the villages were selected using simple random sampling after preliminary survey was done to identify households, which contain persons with ailment two month prior to the survey. When more than one individual with perceived ailment is available in one household, one participant was selected by lottery method (Fig. 1).

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Study variable

Dependent variable

*

❖ Self- medication practices.

Independent variable

*

❖ Socio-demographic Characteristics: Age, sex, marital status, educational status, Occupation, Religion and average monthly income.

*

❖ Environmental factors: Health care system, Availability of drugs and pharmaceutical promotional activities.

*

❖ Individual factors: Knowledge towards SMP, Attitude towards SMP and Prior experience)

Data collection tools

Data collection questionnaire was adopted from previous study conducted in Ethiopia about self- medication practices [20]. It was prepared in English language by reviewing the previous similar studies. The tool was designed to cover socio-demographic characteristics, knowledge towards self- medication, Attitude measuring questions and self-medication practices.

Data collection methods

Face to face interview was conducted with household member’s aged 18 years and above. Data were collected by four health extension workers and supervised by one MPH holder. The data collectors were trainedfor one day by the principal investigator about the purpose of the study, tools and sampling methods. Data was collected after obtaining informed consent from the study participants by data collectors through structured interviewer administers questionnaires.

Operational definition

*

➢ Self-medication: Is defined as the self-reported treatment of common health problems by adult household members with an illness two month prior to the survey, using modern medicine without direct health professional prescription or intervention [12].

*

➢ Knowledge on appropriate SMP: Respondents were categorized as knowledgeable about self-medication if they answered correctly to a median score or above of 13 questions related to knowledge about self-medication. Those who scored below the median were considered poor knowledge [32].

*

➢ Favorable attitude: The study participants were considered to have a favorable attitude towards self-medication practices if they responded with a median score or above on a set of 7 attitude-measuring questions. Those who scored below the median were categorized as having an unfavorable attitude [32].

Data quality control

To ensure data quality control, several measures were taken. Training was provided for data collectors and supervisors using the local language (Amharic). This training aimed to equip the data collection team with the necessary skills and knowledge to conduct the survey effectively and consistently. The questionnaire was translated into the local language for data collection and then back-translated into English to check for consistency. This process ensured that the translated version accurately captured the intended meaning of the questions and maintained consistency with the original English version. The tool was pre-tested at Sechduna to ensure its consistency and errors was corrected. Short-term discussions were held after each data collection day with all data collectors and supervisors to address challenges and clarify how to solve any issues they faced. The completeness of each questionnaire was checked by the principal investigator and supervisors on a daily basis.

Data processing and analysis

The data were cleaned and coded, then entered into Epi-data version 4.6 software and exported to SPSS version 25 for analysis. Different tables and graphs were used to present the study variables. Binary Logistic regressions was performed to assess the strength of association between each independent variable and the outcome variable. Hosmer and the Lemeshows goodness of fit test show that the model was fitted. All variables with ?? values less than 0.25 in bivariable logistic regressions were fitted into the backward stepwise multivariable logistic regression model. Finally, only those independent variables that maintain their association with outcome variables in multivariable regressions (p- value < 0.05) were declared as statistical significant. Odds ratio with its p- value and confidence interval were used or reported in each logistic regression analysis. For measuring strength of the statistical association between the outcome and independent variables, Crude Odd Ratio (COR) and Adjusted Odd Ratio (AOR) along with 95% Confidence interval (CI) were used.

Ethical considerations

Ethical clearance was obtained from Wachemo University College of Medicine and Health sciences post graduate coordinators offices. Official support letter was given for each selected kebele found in the Hossana town. Oral informed consent was obtained from all randomly selected study participants for their volunteerisms to participant in the study. No personal identification of participants was recorded to ensure confidentiality.

Results

Sociodemographic characteristic

Out of the 566 estimated study participants, 546 respondents were interviewed, yielding a response rate of 96.46%. The participants’ mean age was 37.11 with a standard deviation of ± 12.35 years. Of the study participants, more than half 300(54.9%) were females, and more than one third (41.0%) were found to be between the ages of 28 and 37. In terms of educational status, 188 (34.4%) attended primary school, and 159 (29.5%) were employed by the government. Regarding ethnic group 368 (67.4%) were Hadiya ethnic group, and 413 (75.6%) were protestant religious followers. Of the study participants, 183 (33.5%) were members of community based health insurance (Table 1).

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Knowledge about self-medication

From total of study participants 163(29.9%) know availability of drugs not simultaneously taken with other drugs and most of respondents 432(79.1%) know availability of drugs not be taken with alcoholic drinks. Only 129(23.6%) of respondents said that same drug can be a remedy and a poison and nearly one-thirds of respondents 164(30.0%) were know importance of checking expiry date of drugs during purchase or before use (Table 2).

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The mean and standard deviation of study participants were found to be 6.26 ± 2.26 respectively. As a result, 54.6% of respondents had adequate knowledge about self-medication (Fig. 2).

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Attitude towards self-medication practices

The mean and standard deviation of study participants were found to be 4.43 ± 1.34 respectively. As a result, 56.2% (52.2%, 60.4%) of respondents had positive attitude towards self-medication (Fig. 3).

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Self-medication practice

Of the total study participants 338(61.9%) were practices self-medication in past two month with 95%CI of (57.8–65.9). About 220(65.1%) of respondents remember the name of the self-medicated drug. Regarding types of medication, 140(41.2%) respondents used analgesic for self-medication. Concerning sources of self-medication drug, 263(77.8%) of respondents reported getting them from the pharmacy. Seventy (20.7%) respondents get self-medication by using old prescription. (Table 3)

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Reason for self-medication

From total of self-medicated respondents, 158 (46.7%) of study participant self-medicated due to having minor illness and 37(10.9%) of respondents due to easily Accessible pharmacy. Seventy-two (21,3%) of use self-medication due to high cost of consulting physician. About 130(38.4%) of respondents use self-medicated drug due to presence of previous experiences (Table 4).

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Factors associated with self-medication practices

To assess different factors, bivariable logistic regression analysis was employed. Therefore, candidate factors with ?? values less than 0.25 included the respondents’ age, marital status, level of education, occupation, average monthly income, size of family, health insurance status, and knowledge of self-medication. In a multivariable logistic regression model, all candidate variables were fitted. However, age, marital status, size of family, and health insurance status were significantly associated with self-medication practices on multivariable analysis.

Respondents 48 years of age or older had 2.76 times higher odds of self-medication practices than those in the younger age group 18–27 years old (AOR:2.76(1.27–5.99)). Married respondents were 3.24 times more likely than single respondents to report using self-medication (AOR: 3.24(2.0–5.26)). Those with four or more family members had 1.69 times higher likelihood of engaging in self-medication activities than those with fewer family members (AOR: 1.69(1.00–2.87). The likelihood of self-medication behaviors was 3.13 times greater in respondents without health insurance than in those with health insurance (AOR: 3.13(1.95–5.04) (Table 5).

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Discussion

This study aimed to investigate self-medication practices and associated factors among adult household members in Hosanna town Hadiya zone, central, Ethiopia. Through this community-based cross-sectional study, the research delved into assessing and exploring the self-medication practices and associated factors among adult household members that hinder recommended guidelines.

Our findings reveal that 61.9% (95% CI: 57.8–65.9%) of participants practiced self-medication in the past two months. Factors like; the age of respondents, marital status, family size, and being a member of health insurance were significantly associated with the irresponsible self-medication practices.

Our study findings revealed that the overall proportion of self-medication practices among adult household members was 61.9%. This prevalence is consistent with studies conducted in other regions, such as Saudi Arabia, where the prevalence of self-medication practice was found to be 59% [8], and Gorgan City in northern Iran, which also reported a 59% prevalence rate [8]. The findings from this study align with the prevalence range of self-medication practices identified in a systematic review of studies conducted in Ethiopia, which ranged from 12.8 to 77.1% [11]. The consistency between the current study’s findings and these previous investigations suggests a common pattern of self-medication behaviors across different regions. The high prevalence of self-medication observed in this study, as well as the consistency with findings from other regions, highlights the need for targeted interventions to promote responsible medication use and address the potential risks associated with unsupervised self-treatment.

However, the prevalence found in our study is higher compared to studies in Nigeria.

47.6% [17], and Kenya 53.5% [24], Jigjiga town 37.5% [9], Wolaita Soddo town 33.7% [23], A Meket District, 35.9% [20], Gondar town, 50.2% [19]. This variation in prevalence can be attributed to several factors, including differences in the sociodemographic characteristics of the study populations, sampling and study design methodologies, temporal and cultural factors, and access to healthcare services. The higher prevalence observed in the current study may be due to a combination of these factors, where the study population’s social determinants of health, beliefs, and cultural practices, as well as variations in study design and sampling, contribute to the differences in self-medication rates compared to the previous studies conducted in other regions.

The practice of self-medication in our study was lower than in studies from: Addis Ababa. 75.5% [32], Damascus Hospital, Syria 67.3% [2], Kisumu City, Western Kenya 74% [21], and Gorgan City, northern Iran 67.9% [33]. These elevated rates of self-medication practices in comparison to our study might reflect regional variations in health literacy, socioeconomic status, availability of medical services, and cultural beliefs surrounding self-treatment.

The odds of self-medication practices were 2.76 times higher among respondents aged ≥ 48 years old when compared with the young age group (18–27 years old) (AOR:2.76(1.27–5.99). The finding is consistent with studies from; Damascus Hospital, Syria [2], Gorgan City, northern Iran [33], and Iran [32]. This condensed description accentuates the uniformity of the correlation between age and self-medication practices throughout various investigations, highlighting the tendency for older adults to partake in self-medication activities more often than their younger counterparts do.

The odds of self-medication practices were 3.24 times higher among married respondents when compared with unmarried. Our findings are consistent with previous studies conducted in the Meket District, northeast Ethiopia [20], and Gorgan City in northern Iran [33]. This result suggests that marital status may be a significant factor influencing self-medication behaviors among adult household members. Married individuals often have additional responsibilities, such as caring for their spouse and children, which can lead to a higher likelihood of self-medicating to quickly alleviate symptoms and return to their caregiving duties. Married couples may also share similar health experiences and information about medications, normalizing the practice of self-medication within the relationship and household [10].

The odds of self-medication practices were 1.69 times higher among respondents who had ≥ four family members when compared with less than four family size The finding is consistent with studies from [32] Gondar [19], Eastern Ethiopia [28]. A larger family size could potentially lead to increased exposure to illnesses within the household, resulting in a higher likelihood of self-medication practices as a means of managing common health issues. Moreover, larger families may face challenges in accessing healthcare services promptly, leading individuals to resort to self-medication for immediate relief.

The odds of self-medication practices were 3.13 times higher among respondents who were not members of health insurance as compared with members of health insurance Saud Arabia [6]. The possible explanation could be health insurance membership may serve as a proxy indicator for access to formal healthcare systems, financial resources, and knowledge about proper treatment options. Individuals lacking health insurance coverage may turn to self-medication due to limited access to affordable professional healthcare services, lack of financial resources to cover prescription costs, or insufficient knowledge about alternative treatment options [4, 34].

Limitation of the study

May be provision of socially acceptable responses by the study participants, however, the study participants were assured about the confidentiality of the information they provide. Furthermore, this is a cross-sectional study, so it does not address the difference in self-medication patterns among different seasons.

Conclusion and recommendation

Generally, the prevalence of self-medication practice in the study area was relatively high. The self-medication practice was associated with the age of respondents (≥ 48 years), marital status (being married), family size (≥ four members), and not being a member of a health insurance scheme. Based on these findings, it is recommended to plan focused educational programs that emphasize safe and responsible self-medication practices, especially among older adults, those living in larger families, and married individuals. Additionally, exploring the possibility of integrating health insurance schemes with self-medication counseling and guidance could help reduce the reliance on unsupervised medication use. Furthermore, the regional health offices should collaborate with media organizations to disseminate accurate information about the risks and benefits of self-medication, encouraging responsible decision-making and promoting the value of seeking professional consultations.

Data availability

The dataset used and analyzed during the current study will be available from the corresponding author upon reasonable request.

Abbreviations

AMR:

Antimicrobial Resistance

AOR:

Adjusted Odds Ratio

CI:

Confidence Interval

COR:

Crude Odds Ratio

HHs:

Households

KM:

Kilometer

OTC:

Over The Counter

POM:

Prescription-Only Medication

SMP:

Self-Medication Practices

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