Research Report on self-medication in Uganda

1.0 CHAPTER ONE: INTRODUCTION

1.1 Background information

Self-medication is the selection and use of medicines chosen by the patient for the treatment of

an illness or the treatment of symptoms that the patient has perceived himself. (WHO 2010). It is

further described by WHO that: “Self-medication includes several forms through which the

individual him/herself or the ones responsible for him/her decide, without medical evaluation,

which drug they will use and in which way for the symptomatic relief and "cure" of a condition;

it involves sharing drugs with other members of the family and social group, using leftovers from

previous prescriptions or disrespecting the medical prescription either by prolonging or

interrupting the dosage and the administration period prescribed.”

Medicines for self-medication are often called ‘non-prescription’ or ‘over the counter’ (OTC)

and are available without a doctor’s prescription through pharmacies. In some countries OTC

products are also available in supermarkets and other outlets. Medicines that require a doctor’s

prescription are called prescription products (Rx products).Self-medication with OTC medicines

is sometimes referred to as ‘responsible’ self-medication to distinguish this from the practice of

purchasing and using a prescription medicine without a doctors’ prescription.

Despite the growing research interests in self-medication, little information has been available

about its major determinants especially in developing countries like Uganda.

Self-medication is prevalent widely all over the world. With people getting ‘over the counter’

drugs from pharmacies and drug shops without medical personnel’s prescription and evaluation.

People’s knowledge about drugs among different persons of all walks of life and it reveals that:

knowledge of common drugs is exercised, though not uniformly but widely spread. People in all

parts of the world encounter the same common health problems in roughly the same frequency. It

does not seem to matter where or how they live. Common colds, headaches, digestive problems

and body aches and pains do not discriminate by nationality, culture or climate. The drugs most

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commonly used are antibiotics, anti-protozoal drugs and pain-killers. The increasing knowledge

and availability of these drugs over the counter has probably contributed to the increase in self-

medication.

In Uganda, however a number of pharmacies are available, with the increasing knowledge and

business scope in Uganda, NDA (National Drug Authority) has seen the number of pharmacies

in Uganda rise steadily from the 1990’s. There are currently 12 manufacturers involved in the

production of medicinal products and supplies such as tablets, hard gelatin capsules, injectable,

liquid mixtures, and surgical gauze among others. The number of pharmacies and drug shops has

grown in the last five years from 216 and 2,700 in 2004 to 425 and 4,370 respectively in 2008

(www.ugandainvest.go.ug). This has been one of the major contributing factors to increase in

self-medication.

Responsible self-medication can help, prevent and treat ailments that do not require medical

consultation and reduce the pressure on medical services for the relief of minor ailments. These

potential benefits seem to be of a particular interest in the financially less privileged countries

with limited health resources, like Uganda.

However the knowledge on the dangers of self-medication has not yet spread amongst people of

the world so clearly for them to start evaluating a self-medication over going to a professional

health worker for evaluation and treatment.

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1.2 Statement of the problem

All people have unique health needs and yet they suffer from a vast spectrum of diseases. Hence,

people all over Uganda as a whole and Kabarole district need a clear and safe provision of health

care services especially medication under professional medical supervision, evaluation and

prescription. The government under the Ministry Of Health has at least addressed this problem

by putting up a regional referral hospital, health centers and health educating people.

However, inspite of all this, many of the people in Kabarole do not get to utilise these services,

but have increasingly opted to self-medicate themselves and the people around them without

professional medical intervention.

The National Drug Authority in 2010 estimated that in every 10 people 8 self-medicate or buy

drugs over the counter. This could be attributed to the increase in number of pharmacies and

drug shops in the region, expensive treatment from clinics and long distances to health facilities.

This has led to many health problems like increase in drug resistance, poor compliance, over and

under dosing, drug poisoning and toxicity reactions.

The discrepancy thus is that a large number of people are self-medicating, people around them

and using old prescription drugs from hospitals and clinics compared to those that actually seek

professional health medication and administration of drugs.

Thus the purpose of this research is to answer the following questions:

i) What factors facilitate the increase in self-medication amongst the people of

Kabarole?

ii) What are the effects of self-medication?

iii) What can be done to reduce the surge of self-medication?

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1.4 Significance and justification of the study.

It is hoped that the findings in this research will be used by MOH and DHO office, NGO’s, NDA

and all other sectors that are responsible for the provision of drugs and treatment of people.

The study will identify the needs in provision of drugs and find the loopholes in the existing

structure.

By identifying drug provision alternatives, the research will identify possible areas of

intervention which will improve professional medical treatment of the ill.

Data generated will help planners and policy makers to put organizational or institutional

arrangements which will improve the provision of professional medical evaluation, management

and prescription of drugs to persons.

The data will add to the existing knowledge for academic purposes and will stimulate further

research by earmarking the research gaps.

1.5 Objectives of the study.

1.5.1 General objective

To assess the factors and effects of self-medication of people in Kabarole.

1.5.2 Specific objectives.

To establish people’s knowledge on drugs.

To establish the extent of self-medication.

To find out which people self-medicate most.

Which illnesses do people self-medicate for?

To assess the major sources of health care provision.

To determine which drugs are used for self-medication, mainly.

To find out sources of drugs used in self-medication.

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1.6 Theoretical framework.

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Increased mortality

Treatment failure Under dose

Wrong drug consumptionDrug resistance Poor adherence Financial burden

Over dose Poor prognosis Increased expenditure

Poor quality life

SELF-MEDICATION

Health workers Human being Socio-economic status Environment Political

Poor patient relations

Poor drug knowledge and

usage

Increased number of

drug provison centres eg

pharmacies

PoorILLNESSES BELIEFS

Education level

rich

Take remainders old prescription drugs

Buy drugs for self-

medication when they

fall sick. Cheap drugs on market

Insufficient Human

resource

human resource

Few health facilities

Drug toxicity

increased market competition

2.0 CHAPTER TWO: LITERATURE REVIEW.

2.1 Knowledge attitudes and practices about self-medication.

Self-care may be defined as the care taken by individuals towards their own health and well-

being, including the care extended to their family members and others. ( IAPO - International

Alliance of Patients’ Organizations. A Survey of Patient Organizations’ Concerns. Summer

2006).

It is said that every patient has at least two prescribers his own doctor and himself, while many

have additional prescribers in the form of friends, well-wishers etc. ( Mohamed Saleem T.K

2011)

(Tumusiime Kabwende Deo; 2008) defined self-medication as a new form of ‘mob justice’. He

further said that it was a way in which people were manifesting their loss of faith in the existing

health care system in Uganda.

Furthermore, research made by (MOH KENYA 2001) indicated that the hierarchy of medical

power which stretches from professional experts to lay adults to children reflects an unequal

distribution of medical knowledge between these groups. However, (Uganda and Division of

vector Borne Diseases 2001) noted that due to the ideology of childhood and of medical expertise

as described above, knowledge about the proper use of medication including potent hospital

medicines is easy.

It was also noted that; people are overwhelmingly satisfied with the non-prescription medicines

they use – to the point where many believe that OTC medicines can be as effective for the

relevant condition as prescription medicines. (South Africa. 2001. South African Healthcare

and the Proprietary medicine industry. W. Duncan Reekie, D.R. Scott. S Afr Med J 2002)

Most medical knowledge is distributed over the community, and everybody knows some

treatments for the illnesses from which they or their family members commonly suffer (Whyte

2009; Pearce 2010; Sindiga et al . 2010)

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2.2 Prevalence and extent of self-medication

(Der Pharmacia letter 2011) noted that patients receive adequate medication for their clinical

needs, at doses corresponding to individual requirements, and at the lowest possible cost for the

patient and the community. Taking this definition into account an effective drug treatment

requires patient compliance and consultation with a medical professional together with close

follow-up, conditions rarely attained. Irrational drug use and especially self-medication with

antibiotics is common throughout the world.

On the treatment patterns, Malest Afro (2002) et al cited that the majority of people relied on self-

medication. In comparison studies carried out in Ethiopia, Peru, Zambia, Uganda showed that

women are the majority involved in self-medication. ( Juliet Kanyesigye 2004).

Similarly,( World Bank 2007), showed that a third to a half of those who fall ill do not seek care at

modern health units but use home remedies, locally purchased drugs or traditional healers.

The results of a study may by (FAP/UNIMEP, 2003-2004) confirmed that the prevalence of self-

medication in children and adolescents is a real and frequent practice, independently on

socioeconomic data.

Home and self-treatment is a central part of culture in societies where people are used to taking

treatment into their own hands (Whyte 1988; Van der Geest and Whyte 1989; Adome et al.

1996) and that the average household had almost 30 different medications on hand, only five of

which were likely to be prescriptions (WJM-western journal of medicine 2008 November).

Females practiced more self-medication than men (Solomon worku,(2010) as also found out in

Mexico(2008) that identified women as the fundamental element in consumption of drugs and

employment of self-medication.

2.3 Analysis on illnesses commonly leading to self-medication.

People throughout the world suffer common health problems and their symptoms in roughly the

same frequency. Surveys conducted in numerous countries indicate that 9 out of every 10 people

suffer from at least one aspect of unwellness during the course of any 4-week period. (world

self-medication industry 2 2009).

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The most frequent use of medication on hand was for skin, followed by respiratory and

gastrointestinal. Medications purchased were mainly for respiratory, central nervous system,

gastrointestinal, and general systemic problems, respectively.(Roney James G Jr. and Nall

M.L.-Stanford research institute August 2001) also (IAPO - International Alliance of

Patients’ Organizations. A Survey of Patient Organisations’ Concerns. Summer 2006);

noted the same.

Elderly living independently often self-medicate for common problems such as fever, mild pain,

colds, allergies, indigestion-gas, constipation and insomnia. ( Der Pharmacia Lettre, 2011).

2.4 Analysis of drugs used in self-medication.

Analgesic/antipyretic and non-hormonal anti-inflammatory agents were the most commonly self-

prescribed drugs, which indicates that self-medication is usually associated with the symptomatic

treatment of pain. (WHO November 28, 2011).

2.5 Factors leading to self-medication.

Socio-economic and demographic factors are often related to self-medication, but vary greatly

from country to country. Self-treatment with western medicine has been linked to high socio-

economic status (Kamat and Nichter 1998).

The increase in self-care is due to a number of factors viz. socioeconomic factor, life style, ready

access to drugs, the increased potential to manage certain illness through self-care, public health

and environmental factors, greater availability of medicinal products and demographic and

epidemiological factors. ( Sydney: National prescribing service Ltd:2008.)

In addition, access to good and effective medical interventions is often limited due to poor

hospital facilities; service fees; poverty and hunger; and illiteracy. (Laura Shireman, Paul S

Pottinger and Kayode K Ojo 2010). In the second instance, private clinics have also taken

advantage of the disparity that gripped patients running away from government hospitals, by

inventing their own exploitative antics. The new ‘policy’ in many private clinics is the

assumption that every person that visits the clinic must be sick and must take home some

medicine usually well stocked in a pharmacy next door. ( Tumusiime Kabwende Deo 9

september 2009).

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It was also noted that the urge of self-care, feeling of sympathy towards family members in

sickness, lack of health services, poverty, ignorance, misbelieves, extensive advertisement and

availability of drugs in other than drug shops are responsible for growing trend of self-

medication. (Al Shifa College of Pharmacy, 1998)

The new ‘policy’ in many private clinics is the assumption that every person that visits the clinic

must be sick and must take home some medicine usually well stocked in a pharmacy next door.

However, With the mandatory consultation fees going to as much as 25,000/= in some clinics,

every patient can be sure to part with no less than 40,000/= for a single visit. As a way of beating

the exploitation by medics, many people have now resorted to self-medication. (Tumusiime

Kabwende Deo 2010)

Furthermore, poor diagnostic ability compounded by a limited knowledge of appropriate

management result in the increase of self-medication and low rate of health care utilization.( Dr.

Afolabi Adedapo Olanrewaju). While other people have a feeling that their ailment is beyond the

knowledge of western trained doctors. ( Annuals of African Medicine 2008)

2.6 Sources of drugs for self-medication and health care.

(Solomon Worku 2000) revealed that about one third of drugs were left over past prescription

unlike in France (Dr.Pierre Leforte 2011) which showed that drugs were obtained from other

individuals.

More than 60% of people have bought drugs as over the counter (New Vision 4/03/2012 page

11) from pharmacies and drug shops.

2.7 People that self-medicate most.

(WHO 2010) noted that self-medication provides a cheap alternative to people who cannot

afford to pay medical practitioners. Hence, self-medication being the first response to illness

among people. (Solomon Worku 2000)

. Infact, Hesse (2009) et al clearly pointed out that women spend a large proportion of household

income on medicines for self-medication than men.

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2.8 Sources of information about drugs used in self-medication.

Whether one lives in a developing country or in a developed one, the sources of information are

similar. A person may seek advice from ‘an older person in your household who possesses the

knowledge of simple herbal remedies for common illnesses’ (Nepal, 2002) or with a pharmacist

because they can ‘provide a good help to assess the symptoms’ and ‘spend time explaining how

to use the medication properly’ (Brazil 1997, Singapore 2005). Or one may purchase an OTC

medicine ‘based on a previous medical recommendation’ (Mexico, 2009).

Product labels are also a good source of information for the consumer and should always be

easily accessible. In China for example, 70% of the consumers select the OTC medicine through

reading the specifications before purchase. ( IAPO - International Alliance of Patients’

Organizations. A Survey of Patient Organisations’ Concerns. Summer 2006).

Television advertising appears to have a limited impact with respect to overall non-prescription

medicine use: in Brazil (2007), 81% of consumers disagreed with the statement: “I customarily

purchase medicines advertised on TV”. In Italy, between 1977 and 1987 – a period known in

Europe for its large increase in television advertising, visits to physicians increased by 20%

while the use of OTC medicines increased by only 2%. There were similar results in all the

major European countries. (Brazil. 2010. Prevalence and factors associated with self-

medication.)

Today the internet is emerging as a major source of information on health issues and (with

appropriate quality control) offers great promise in helping people with self-care.

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3.0 CHAPTER THREE: STUDY AREA

3.1 District of study: Kabarole district.

3.2 Geographical location.

Kabarole district is found in western Uganda, and it lies between latitudes (00 15”N and 10

00”N) and longitude (300 00”E 310 15”E). Lying at an altitude of 1300-2300metres above sea

level, and occupying a total area of 1,814km² of which 1569km² is covered by land and 198km²

is covered by water/wetlands.

The district is bordered by Ntoroko district to the north, Kibaale district to the Northeast,

Kyenjojo district to the east, Kamwenge district to the south west, Kasese district to the south,

the democratic republic of Congo to the south west.

Fort portal, the chief town of the district lies approximately 320km by road west of Kampala, the

capital city of Uganda.

3.3 Population

In 2002, the population of kabarole district was estimated at 356,900 with a population growth

rate at 30% annually. It is estimated that in 2010, the population of kabarole district was

approximately 452,100.

3.4 Tribe/ ethnic composition.

The Batoro, Batuku and Basongora ethnicities constitute about 52% of the population. The

Bakiga constitute 25%, followed by the Bakonjo and the Bamba. The major languages spoken

are Rutooro, Rukiga and Runyankore.

3.5 Climate and weather.

The district has a good climate with temperature ranging from 20°C to 30°C and rainfall ranging

1200mm-1500mm per annum. The district has cool temperatures ranging from 22°C-25°C and

has bimodal rainfall, ranging from 1200mm-1500mm per annum.

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3.6 Administration.

Kabarole has the following administration units which are: (1) municipal council, (02) counties,

(03) town councils, (15) sub-counties, (03) divisions, (81) parishes and (582) villages.

3.7 Communication

The most used method of communication in the district is mouth to mouth. Other media used

include: radios, mobile phones, television and others. The district has tarmac roads but most

roads to rural areas are murram, rural feeder, secondary and community roads some of which

when rainy may be impassable.st

3.8 Health infrastructure.

There are 60 health facilities across the district these include: 3 hospitals, 3 health center IV , 23

health center III and 31 health center II and currently 8 new health center II are fully

functional.388 village health teams (VHTs) have been established since 2006 and 61 VHT parish

leaders.

The district also has NGO hospitals and health centres namely Virika hospital, kabarole hospital,

and Mitandi, Rambia, Kiamara, Ngombe orthodox, Mpanga growers, Nkuruba, lillah clinic,

Kihembo dispensary, kiko, kiruhura, Yerya and Toro kahuma all health units.

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4.0 CHAPTER FOUR: METHODOLOGY OF THE STUDY

4.1 Introduction

This chapter describes the methods used in the study, it includes:

Study design

Study population

Sampling procedures

Selection of the procedures

Study of the variables

Data collection tools

Pre-testing of data collection tools

Data processing and analysis

Ethical considerations

Study limitations.

4.2 Study design

A cross sectional study design was carried out in fort portal town for a period of two weeks on

the subject of factors influencing the pattern of self-medication in fort portal region.

4.3 Area of study

The area of study is Fort portal town, which is a major town of kabarole district , located in

western Uganda.

4.4 Study population

The study consisted of peasant farmers, business men and women, mothers, adoloscents,

teenagers, students, house wives, local council leaders, teachers, and students. Of all people

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chosen randomly, only 126 accepted to be interviewed using semi-structured questionnaires. Of

those interviewed, only 95 managed to fill in the questionnaires correctly.

4.5 sampling procedure

Fort portal town was chosen because of the researcher’s convenience. Since there was no

literature partaking the prevalence of self-medication in Kabarole district, a pilot study done in

kataraka village in Fort-portal yielded a prevalence of 64%, hence this was used to determine the

minimum sample size; using the formulae; n= z ² pqd ²

;

where n= minimum sample size, z=1.96 at 95% confidence interval obtained from standard

statistical table of normal distribution, p= estimated prevalence of non-adherence in a given

population (64% or 0.64), q= precision; i.e. number of adherence in a given population (1-p or

0.15) and d=margin of error (0.025); hence n=98 with the minimum sample size known,126

respondents were selected.

The selection of a sample was based on the existing Ugandan administrative structure of LCs. The

survey was carried out in 3 divisions of fort portal using systematic random sampling i.e., east,

west and south division(s) with at least 42 people sampled in each, hence making a total of 126

respondents.

4.6 Data collection tools.

Data was collected using questionnaires that had both open ended and closed ended questions.

This was administered to various age groups and both female and male respondents of varying

age groups.

The questionnaire had different parts: the socio-demographic profile, income, expenditure, cost

sharing and health seeking patterns.

4.7 Pre-test of data collection tools.

The data collection tools were pre-tested on 14 randomly selected people in fort portal town, to

test the suitability of the questions, corrections were made and a final copy was printed.

4.8 Ethical considerations

An introductory letter from fort portal school of clinical officers was presented to various local

council heads, who allowed the researcher to access information from various parishes/ sub-

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counties. Respondents consent was sought before interview to gain maximum co-operation

before starting data collection.

4.9 Data collection and analysis

Data was collected from 10:00am to 5:00pm Monday-Friday for 10 days by distributing

questionnaires to the respondents. It was analysed using tables, bar graphs, pie- charts and simple

statements.

4.10 Limitations of the study.

Lack of enough time than initially planned by the researcher as the study proved more

demanding than anticipated.

Lack of co-operation from some of the respondents who either refused to be interviewed

or pretended not to know anything about self- medication.

Insufficient funds.

The scotching sun shine as it required to stand under the sun in ceratin areas for long.

People were very busy with customers and the researcher seemed like wasting their time.

It was difficult gaining trust from some respondents.

The researcher’s mobility was hindered by lack of a potent transport system.

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CHAPTER FIVE: STUDY FINDINGS

5.0 Introduction

Presented are the findings from 120 respondents instead of the targeted sample of 120.

5.1 Demographic characteristics.

Table1: Sex of respondents

n=120

Sex frequency Percentage %

Male 45 37.5

Female 75 62.5

Total 120 100

From the table 1, above; less than two thirds of the respondents 75(62.5%) were females while

45(37.5%) were made.

Table 2: Age of the respondents

n=120

Age of respondents Number of respondents Percentage %

15-19 3 2.50

20-24 15 12.50

25-29 40 33.33

30-34 35 29.17

35-39 17 14.17

40 and above 10 8.33

Total 120 100%

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From the table above, a third of the respondents 40(33.3%) were between the age group of 20-24

followed by 35(29.17%) who were between 25-29.

Table 3: Tribe of respondents

A question was asked to determine the respondent’s tribe and these were the findings;

n=120

Tribe Frequency Percentage(%)

Bakiga 29 24.2

Batooro 41 34.2

Banyankore 14 11.7

Bamba 08 6.7

Bakonjo 17 14.2

Batuku 01 0.8

Basongora 00 00

Others 10 8.3

Total 120 100

According to table 3; less than a third of the respondents 41(34.2%) were Batooro followed by

the Bakiga who constituted only 29(24.2%).

Table 4: Occupation of respondents

A question was asked to ascertain the occupation of respondents, and these were the findings;

n=120

Occupation Frequency Percentage(%)

None 07 5.80

Farmer 25 20.8

Market vendor 16 13.3

Boda boda cyclist 08 6.7

Students 39 32.5

Housewife 13 10.8

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Business personnel 09 10

total 120 100

According to the table above, more than a quarter 39(32.5%) of the respondents were students,

followed by 25(20.8%) farmers who were farmers. The least were07(5.80%) for those who had

no jobs.

Table 5: Education level of respondents.

n=120

Education level Frequency Percentage(%)

Tertiary 8 6.7

Secondary A’ level 10 8.3

Secondary O’level 39 32.5

Primary 58 48.3

Nursery/kindergarten 1 0.8

Not educated 05 4.1

Total 120 100

According to the table above, more than a third of the respondents 58(48.3%) had stopped at

primary education and many 39(32.5%) who had dropped out from secondary O’level. However,

very few 8(6.7%) had achieved tertiary education.

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5.2 Knowledge on self-medication.

Fig 1: Respondents having knowledge on self-medication.

n=120

Yes18%

No83%

21(17.50%) responded “Yes” and 99(82.5%) said “No”.

Table6; Frequency of respondents who defined self-medication.

n=120

Answer Number of respondents Percentage of respondents (%)

It is the taking of medication

without medical persons

intervention

10 8.3

It is the medicating of self

without any prescription

09 7.5

It is the buying of drugs from a

shop, pharmacy, drug shop or

clinic and taking them based

on one’s own evaluation and

sickness.

03 2.5

Don’t know 99 82.5

Total 120 100

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According the table above; majority of the respondents 99(82.5%) did not know what self-

medication was, however 10(8.3%) said it was the taking of medication without medical persons

intervention.

Figure2: Frequency of self-medication.

n=120

Rarely11%

Quite often63%

Very often26%

According to the pie chart above, it showed that: 13(11%) of the respondents rarely self-

medicated, 31(26%) of the respondents self-medicated quite often and 76(63%) of the

respondents very often self-medicated. Meaning that a vast number of people self-medicate very

often.

5.3 Health seeking behaviour

Table7: Health seeking behavior.

n=120

Health seeking behavior Frequency Percentage(%)

Stay home and treat themselves or

family members

51 42.5

Go to traditional healer 11 9.2

Go to nearby clinic 25 20.8

Go to hospital 33 27.5

Total 120 100

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From the table above; more than a third of the respondents 51(42.5%) said they stay home and

treat themselves or family members, and the least 11(9.2%) said they go to traditional healers.

Table8: Reasons why people may not go to hospitals or clinics when they or their family

members fall sick.

n=120

Reasons why people don’t go to

hospitals/clinics.

Frequency Percentage(%)

Don’t want 3 2.5

Long distance to health facility 2 1.7

Expensive to get medical help 60 50

Prefer self-medicating to going to

hospital/clinic

55 45.8

Total 120 100

In the table above: majority of respondents said they felt it was expensive to get medical help,

followed by 55(45.8%) who preferred self-medicating to going to hospital/clinic.

Figure 3: Advise on how to use drugs after prescription

n=120

Yes77%

No23%

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From the pie chart above, it shows that: 92(77%) of the respondents are advised and given

information on the drugs they are given and only 28(23%) of the people said they were not

advised on how to use the drugs very clearly.

5.4 Habit on prescribed drugs.

Table 9; Frequency of following prescriptions.

n=120

Question Frequency Percentage(%)

Yes 103 85.8

No 17 14.2

Total 120 100

From the table above, it clearly shows that 103(85.8%) of the respondents follow the

prescriptions and only 17(14.2%) do not promptly follow the prescriptions.

Figure4: Frequency of respondents who keep remainders of prescription drugs for later

usage.

n=120

Yes82%

No18%

From the pie-chart above, 98(82%) of the respondents keep remainders of prescription for later

usage while 22(18%) of the respondents simply discard them off.

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5.5 Drug provision

Table10: Where people usually get drugs from.

n=120

Source of drugs Frequency Percentage (%)

Home 18 15

Clinic 39 32.5

Pharmacies 31 26.7

Hospital 35 29.2

Total 120 100

The table above shows; that majority of the respondents 39(32.5%) get drugs from the clinic

followed by 35(29.2%) who get drugs from the pharmacy.

5.6 Drug usage.

Table11: Types of drugs used.

n=120

Response Number of respondents Percentage (%)

Anti-malarials 20 16.7

Anti-helminthes 10 8.3

Pain killers 67 55.8

Anti-biotics 21 17.5

Anti-fungals 01 0.8

Anti-histamines 01 0.8

Total 120 100

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From the table above; More than a half of the respondents 67(55.8%) use pain killers for self-

medication followed by 21(17.5%) who used anti-biotics. The least used drugs were anti-fungals

and anti-histamines which both constituted 1(0.8%) of the respondents.

Table12: Preparations of drugs.

A question was asked to find out the use of particular preparations of drugs for self-medication.

n=120

Form of preparation Frequency Percentage (%)

Tablets 80 66.7

Capsules 21 17.5

Syrups 13 10.8

Pastes 05 4.2

Shampoos 0 0

Lonzeges 0 0

Pessaries 1 0.8

Others 0 0

Total 120 100

According to the table above; Majority of the respondents 80(66.7%) used tablets followed by

capsules 21(17.5%).

Table13: Colours of drugs commonly used for self-medication.

A question was asked to assess which colours of drugs are commonly used in self-medication.

n=120

Colour of drug Frequency Percentage(%)

Red 25 20.8

Black 1 0.8

Black and red 22 18.3

White 45 37.5

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Yellow 6 5

Pink 15 12.5

Green 6 5

others 00 00

Total 120 100

Form the table above; more than a quarter of the respondents use white drugs for self-

medication, followed by red coloured drugs 25(20.8%).

Table14: Illnesses for self-medication.

A question was asked for which illness do they self-medicate for and the following is what was

found out;

n=120

Illness Frequency Percentage(%)

Headache 31 25.8

Abdominal pain 18 15

Allergic reactions 02 1.7

Common cold 18 15

Cough 15 12.5

Febrile illnesses/ fever 31 25.8

Backache 05 4.2

Total 120 100

From the table above; both headache and febrile illnesses/ fever constituted majority of

respondents 31(25.8%) each as reasons for self-medication while the least 05(4.2%) was

backache.

Table15: Cost of drugs.

A question was asked to ascertain the cost of drugs which are used to self-medicate.These were

the findings;

n=120

25

Cost of drugs (Ug. Shs.) Frequency Percentage (%)

50-500 78 65

500-1000 21 17.5

1000-5000 18 15

5001 and above. 03 2.5

Total 120 100

According to the table above; more than a half of the respondents 78(65%) bought drugs that

cost 50-500Ug.Shs, with the least 03(2.5%) buying drugs that cost 5001Ug.Shs. and above.

Figure 5: Source of drug information.

n=120

radio

telev

ision

newsp

aper

magazi

ne

bill board

villag

e educati

on

drug s

ellers

medica

l pers

onnel

old prescri

ption notes0.00%

5.00%

10.00%

15.00%

20.00%

25.00%

30.00%

35.00%

media of information

perc

enta

ge o

f res

pond

ents

.

According to the bar graph above; a third of the respondents 40(33.3%) said they got drug

information from medical personnel followed by 23(19.2%) said they got drug information from

drug sellers and the least 1(0.8%) said they got their drug information from either billboards or

magazines.

26

5.7 Effects of self-medication.

Figure6; Benefit of self medication

A question was asked to assess whether the respondents felt that self-medication was of benefit.

All they required to answer/ check was either “Yes” or “No” and these were the findings.

n=120

According to the pie-chart above, 43(36%) of the respondents said they felt that self-medication

was of benefit to them while 77(64%) of the respondents said that they felt that self-medication

was of not much benefit to them.

Of the 43(36%) of the respondents who answered “yes” above, another question was asked to

clear out what the exact benefit(s) were.

27

YES36%

NO64%

Table16: Exact benefit from self-medication.

A question was asked to those who responded “YES” on knowledge of exact advantages of self-

medication and these were the findings.

n=43

Response Frequency Percentage(%)

It is cheaper than going to a clinic 12 25.5

I get a feeling of responsibility over my

health and that of my family members.

07 14.9

Get a feeling of satisfaction that I’ve

tried to treat myself/ a family member

14 29.8

It saves time of going to a

hospital/clinic

10 21.2

Total 43 100

From the table above; of the 43(36%) respondents who had answered “Yes” about satisfaction

from self-medication, most of them 14(29.8%) said they got a feeling of satisfaction that they’ve

tried to treat themselves and or a family member, while the least 07(14.9%) said they got a

feeling of responsibility over their health and that of the family members.

Figure7: Knowledge on disadvantages of self-medication.

n=120

28

YES39%

NO61%

According to the pie-chart above; 47(39%) of the respondents answered YES while 73(61%) of

the respondents answered NO as partakes their knowledge on disadvantages of self-medication.

Table17: Specific disadvantages self-medication.

A question was asked to the respondents who answered “YES” regarding their knowledge on

self- medication and these were the findings.

n=47

Response Number of respondents Percentage(%)

Medicating myself or a family

member may not be curative enough

without medical help.

10 21.3

I don’t know whether I use the

correct treatment.

13 27.7

I may over or under dose myself or a

family member.

24 51.0

total 47 100

According to the table above, 10(21.3%) said that medicating themselves or a family member

may not be curative enough without medical help and 13(27.7%) of the respondents said they

didn’t know whether they use the right treatment while 24(51.0%)of the respondents said they

paused a risk of either under or over dosing themselves or their family members.

29

Figure8: Satisfaction with self-medication.

A question was asked as to whether respondents were satisfied with self-medication and all they

required to answer was either YES or NO.

n=120

NO64%

YES36%

satisfaction with self-medica-tion

According to the pie-chart above, 43(36%) of the respondents said they were satisfied with self-

medication, however the majority 77(64%) of the respondents said they were not satisfied.

30

Table18: Desire to learn more about drugs and self-medication.

A question was asked as to whether they desired to learn more about self-medication, and these

were the findings. All they required to answer was either YES or NO.

n=120

Response Frequency Percentage(%)

Yes 118 98.3

No 02 1.7

Total 120 100

According to the table above; 118(98.3%) of the respondents said YES to learning more about

self-medication and only 02(1.7%) of the respondents denied the opportunity to do so.

Table19: Respondents recommendations.

Respondents were asked to give their own recommendations on aiding to reduce self-medication.

These were the findings;

n=120

Response Number of respondents Percentage(%)

Government should try putting up more

health facilities

31 25.8

Government and local leaders should

regulate prices imposed by private

clinics and hospitals.

23 19.2

Common drugs should be made more

available to health facilities.

10 8.3

People should learn the habit of seeking

medical care.

17 14.2

People should be taught through health

education the dangers and advantages of

self-medication

11 9.2

31

People should employ other methods

like wet sponge/ cloth for fevers and

headache and avoid using of drugs they

least know about.

09 7.5

People should go for regular checkups

and avoid falling seek very often, hence

predisposing them to self-medicate.

19 15.8

Total 120 100

According to the table above; more than a sixth of the respondents 31(25.8%) said that

government should try pitting up more health facilities, followed by 23(19.2%) who said that

government and local leaders should regulate prices imposed by private clinics and hospitals.

While the least said that people should employ other methods like wet sponge/ cloth to bring

down fevers and headaches and avoid using drugs they least know about.

32

CHAPTER SIX: DISCUSSIONS, CONCLUSIONS AND

RECOMMENDATIONS.

6.0 Discussion

6.1 Demographic data of respondents.

Majority f the respondents 75(62.5%) were female and 45(37.5%) were male. Meaning that more

women were compounded in the research than men, may be due to the nature of jobs men entail

in, that may not give them the time to relax and participate in other activities. This result

however contradicts a study done by Mohamed saleem T.K 2011 where a majority male

respondents were found compared to females.

More than a quarter of the respondents 40(33.33%) were aged 25-29 followed by 35(29.17%)

who ranged 30-34 years. This shows that the majority of the population is in an economically

productive age group hence predisposing them to the dangers of various occupations which may

propel them to self-medicate. This finding correlates to a study done by Afolabi 2008 that found

a majority respondents between the age of 25-34.

Majority of the respondents were Batooro 41(34.2%) followed by the Bakiga 29(24.2%) these

findings do match with findings wiith a study done by Wikipedia 2010, showing a majority

Batooro with a rivaling number of Bakiga and the least being the basongora and the batuku who

constitute 01(0.8%) and 00(00%) respectively. This may show a deviation however in the

population where the same study by Wikipedia free encyclopedia 2010 estimated at least 5%

of the population were Batuku or Basongora.

33

Majority of the respondents were students 39(32.50%) followed by peasant farmers 25(20.80%)

of the total number respondents with a considerable number of 16(13.30%). This was not

surprising as many of the respondents had more than one occupation, especially the students who

also entailed themselves in other economic activities, and the few number of market vendors

explains the little time they have as they attend to their customers which is in agreement with

Juliet Kanyesigye’s study in 2004 which found that majority of people in Kabale (Uganda)

were peasant farmers.

Majority of the respondents had attended primary school education 58(48.3%) followed by

39(32.5%) had achieved secondary o’level education, and only 8(67%) had attained tertiary

training and only one (0.8%) had never attended school. This shows the high number of primary

school drop outs and attendance level as well as a reduce o’level education pattern and

increased drop out level which is stipulated by a reduced 8(6.7%) respondents who attended

A’level and a further reduction in tertiary school attendance. This study however contradicts a

study done by Azeem. A.K 2011 USA where majority of the respondents had completed/ were

attending tertiary education.

6.2 Knowledge of self-medication.

Majority of the respondents 99(82.5%) don’t have knowledge about the term self-medication

and only 21(17.5%) have heard about the term self-medication. This shows a gross deficit in

knowledge about self-medication and predisposes the population more to its dangers. However

knowledge of self-medication is more manifested amongst the educated, this findings cohere

with a study done by Lukman Thalib in Nigeria 2005 which found out that knowledge on

self-medication was directly proportional the level of education.

Among those who have knowledge on self-medication, all of them had a genuine idea about self-

medication with the majority 10(8.3%) saying;

“It is the taking of medicines without medical persons’ intervention.”

This definition is very close to the WHO 2010 definition which says;

34

“Self-medication includes several forms through which the individual him/herself or the ones

responsible for him/her decide, without medical evaluation, which drug they will use and in

which way for the symptomatic relief and "cure" of a condition; it involves sharing drugs with

other members of the family and social group, using leftovers from previous prescriptions or

disrespecting the medical prescription either by prolonging or interrupting the dosage and the

administration period prescribed.”

This may also show a sensible understanding of self-medication within a small population

mainly the very educated and a harsh lacking of knowledge of self-medication amongst the least

educated. This correlates to a study done in China in 2003 by Davis Wu for the Chinese self-

medication market and urban consumers that sighted a majority people with little or no

knowledge about self-medication and especially among the least educated.

6.3 Frequency of self-medication.

Majority of the respondents 76(63%) self-medication/ used un-prescribed drugs quite often,

followed by 31(26%) who self-medicated very often and the least 13(11%) rarely self-medicated.

This implies that there are still a large number of people who self-medicate quite often and very

often as noted by Universidade Estadal de Compinos (UNICAMP) in 2004, that said majority

of individuals still medicate quite often or even very often.

6.4 Health seeking behavior

From the study 51(42.5%) people said when they/ family members fall sick, they stay home and

treat themselves/ family members, 33(27.5%) and 25(20.8%) go to hospitals and clinics

respectively at the least 11(9.2%) go to traditional healers. This shows that majority of people do

not go immediately to hospitals or clinics when they fall sick but rather self-medicate

themselves/ family members. However, these findings disagree with a study done in India by

the world health organization 2008 that revealed a majority of people go to

shamans(traditional healers in India) when they fall sick.

A half of the respondents 60(50%) said that it was expensive seeking medical help, while

55(45.8%) said that they just preferred self-medication over going to hospital. This revealed that

just as much as private clinics were a lot more extensively spread, they insult a fear amongst the

locals through their financial exploitation and very high costs. This corresponds to a study done

35

by Tumusiime Kabwende Deo 9/sept/2008 research that revealed private clinics had taken

advantage of the disparity that gripped patients running away from government hospitals by

inventing their own income exploitive tactics.

6.5 Advise on how to use drugs on prescription

More than half the respondents 92(77%) respondents said that they are advised on how to use

drugs. This however indicates a good source of knowledge and good direction on how to use

drugs by health workers who prescribe the drugs. This finding correlates to a study done by The

World Self-Medication Industry 2010 that found a majority of respondents in Canada got

advise on drug usage from their physicians after prescription.

6.6 Habit on use of prescribed drugs.

103(85.8%) of the respondents said they strongly follow drug prescriptions and advise on how to

use them. This indicates a good respect for drugs used from health facilities and pharmacies and

a result that many of the people who actually bought drugs or got drugs from health facilities and

pharmacies, did follow prescription, unlike those who buy drugs from kiosks and those who just

get drugs from home/ a friend/family member. This study agrees with a study done in China

2004 that stipulated; “many of the consumers take their oral medicines strictly as directed in the

appropriate doses at the right time.”

On the other hand however, it was seen that many of the respondents 98(82%) do keep

remainders of prescription drugs for later usage. Thus implying that many people have lots of

remainders of drugs and a failure by many to complete dosages with demerits of poor cure rates

and an increased exposure to expired drugs. This finding correlates to a study done by A.

O.Afolabi 2008 that revealed a majority of respondents keep remainders of prescription drugs

for later usage.

6.7 Drug provision

The biggest number of respondents 39(32.5%) get drugs from clinics followed by 35(29.2%)

who get drugs from the hospitals. Thus many people have a comfort zone to seek drugs and

medical help from clinics due to their extensive existence and easy access compared to hospitals.

36

This study correlates with a study done by A.O Afolabi in Nigeria 2008 that found out a

majority of people is get their medications from hospital/pharmacy.

The study pointed out that more than a quarter of the respondents 45(37.5%) actually bought

drugs from clinics rather than from drug shops or pharmacies, this clearly confirms that majority

of the people often attend private clinic services than going to hospital and hence getting most of

their drugs from the former.

6.8 Specific drug use.

The fact that majority of the respondents 67(55.8%) used more painkillers for self-medication,

followed by antibiotics 21(17.5%) and antimalarial drugs 20(16.7%). This corresponds to the

severity and belief of people to manage pain as a minor and very common ailment as well as the

extensive availability plus knowledge about them, like panadol. These findings correlate to study

done by Mohamed saleem T.K 2011 that found a majority of respondents use more of

analgesics.

A vast majority of 80(66.7%) respondents did cohere with the fact that tablets are much more

used in self-medication than any other preparation. This explains the extensive availability of

many drugs in tablet form and the belief amongst many that tablet drugs have a very positive

therapeutic effect.

Another finding that could benefit the study is the attribute of colours of drugs and frequency

they are used. It was seen that most respondent; 45(37.5%) said they preferred using the white

coloured drugs, followed by red coloured drugs 22(18.3%). This matched the belief that white

drugs were considered to be pure and the red colour was synonymous to blood, hence replacing

blood. This is a new finding and previous researchers had not discovered.

6.9 Reason for self-medicating as per illness

Both headache 31(25.8%) and febrile illnesses/fevers 31(25.8%) struck the majority of

respondents and presented the main problem for self-medication followed by abdominal pain

18(15%). This shares out the frequency and discomfort often caused by these illnesses, hence

propelling people to quickly manage them promptly mainly by just buying drugs like antibiotics

and pain killers. This study however deviates from a similar study done in Australia by World

37

Self-medication Industry (WSMI) 2006 that ranked common cold as the most commonly self-

medicated illness.

6.10 Cost of drugs.

Drugs costing between 50Ugx-500Ugx constituted a majority of respondents’ use 78(65%). This

shows that cheap drugs are much often used for self-medication unlike their costly counterparts.

This finding correlates to a study done by Afolabi 2008 that found an increased demand and

perpetual usage of cheaper drugs for self-medication unlike the more costly ones.

6.11 Source of information about drugs.

Medical personnel were reported as the largest source of information about drugs 40(33.3%) of

the respondents had this to claim, followed by drug sellers 23(19.2%). This means that medical

persons are still the greatest source of drug information in the community. This study coheres

with a study done by Dr.Afolabi.O.A in Nigeria 2008; that revealed a majority of respondents

did obtain their drug information from hospitals through health workers, since they felt that

medical personnel were rich in medical and drug knowledge.

6.12 Benefit of self-medication.

A majority respondents 77(64%) said they felt little benefit from self-medicating despite their

continuation to do so. Only 43(36%) of the respondents agreed to benefit from self-medication

with the majority 14(29.8%) of them said that they get a feeling of satisfaction that they atleast

tried to treat themselves or a family member or friend. this is not surprising as many of the health

facilities are not easily accessible and little time is got to go for treatment in hospitals since a lot

of bureaucracy in hospitals. This study correlates to a study done by Juliet Kanyesigye 2004 that

found the same.

6.13 Disadvantages of self-medication.

A majority 73(61%) of the respondents did not know the disadvantages of self-medication as

opposed to only a minute number 47(39%) who have a clue. This may explain a lacking of

knowledge of drugs used and an insufficient knowledge distribution.

38

Of the respondents who said they knew, a majority 24(51.0%) of them said; they may either give

an under or over dose, followed by 13(27.7%) who said they were not sure whether they used the

correct treatment. This explains a knowledge deficit between the educated and the little educated

on self-medication. All these may predispose to self-medication dangers like drug resistance and

toxicity. This finding relates to a study done for South Africa 2004 by the World self-

medication industry (WSMI) that despite the knowledge on some disadvantages of self-

medication, they still found the urge to utilise an opportunity of self-treatment.

6.14 Satisfaction with self-medication.

Majority 77(64%) of the respondents said they were not satisfied with self-medicating . This

implies that people are crippled due to the long queues in government hospitals and high costs in

private clinics, hence resorting to buying drugs or using old prescription drugs for treatment.

This study however deviates from a study done in South Africa 2004 by the World self-

medication industry (WSMI) that noted more than a half of the people believed that non-

prescription drugs over the counter are much safer than drugs prescribed by Physicians.

6.15 Respondents desire to learn more about self-medication.

Almost all the respondents 118(98.3%) agreed on the idea to actually provide them with

knowledge on drugs and self-medication. This implies a great urge in the public to actually have

some essential knowledge on common drugs and safe self-medication.

39

6.16 Conclusion

Majority of people don’t have knowledge about self-medication.

The prevalence of self-medication is essentially very high in Kabarole district.

The greater number seems to be spread much more in those with intermediate income, the very

educated, females especially those above 30 years.

Pain killers, anti-malarials and antibiotics are the drugs most commonly used for self-medication.

Self-medication was more likely to be used than prescribed medication to treat headache, fever

and abdominal pain.

Tablets and white coloured drugs were most frequently used without prescription.

Majority of respondents get drug information from medical personnel.

40

6.17 Recommendations

Sensitization programs on self-medication and probable dangers should be emphasized

both locally and widely at national level in order to change people’s attitudes positively.

Literacy of the population both locally and at national level should be encouraged.

The practice of community pharmacies should be encouraged especially in places where

health care provision is limited. The presence of such professionals ensures that the

practice of self-medication is accompanied by appropriate training on how to use drugs

appropriately, safely and effectively.

The government should set-up and facilitates more health facilities as to improve on

quality assurance.

Health workers should learn good drug provision services as in explaining to patients

how to use drugs well and effectively in a right dose and right time.

The government should improve and try data basing all patients’ data as many hop from

one health facility to another. This hence reduces on government expenditure and drug

wastages.

41

Government should try to empower health workers more through perpetual trainings as to

ensure good patient care and increased cure rates in the hands of professionals.

Good and healthy self-medication practices should be encouraged by all stake holders

including the Ministry Of Health, District health officer and medical personnel in

Kabarole.

REFERENCES

1. Juliet Kanyesigye 2004 The impact of structural adjusment programmes on women’s

changing health seeking patterns in Uganda: the case of kabale.

2. P Wenzel Geissler 2001 self-treatment by Kenyan and Ugandan Children and the need for

school based education . Health policy and Planning Oxford Press 16(4): 364-371.

3. Mohamed saleem T.K 2011 Self -medication with over the counter drugs: A questionnaire based

study Der Pharmacia Lettre, 2011, 3(1): 91-98.

4. Brazil. 1997. Research on habits and attitudes for purchasing and using OTC drugs. Fundaçao

Instituto de Administraçao.

5. Nepal. 2002. Self-Medication and non-doctor prescription practices in Pokhara valley, Western

Nepal. PR Shankar, P Partha and N Shenoy. BMC Family Practice. 2002, 3:17.

6. South Africa. 1987. South African Healthcare and the Proprietary medicine industry. W. Duncan

Reekie, D.R. Scott. S Afr Med J 1988; 74:205-208.

7. IAPO - International Alliance of Patients’ Organizations. A Survey of Patient Organizations’

Concerns. Summer 2006.

42

8. Healthcare, Self-Care and Self-Medication. 14 National Surveys Reveal Many Similarities in

Consumer Practices. WSMI. 1988.

9. Mandavi Pramil Tiwarl and Vinay Kapur. Indian J. Pharm .pract1 (1), Oct-Dec, 2008.

10. Ministry of Health KENYA 2001.

11. Uganda and Division of vector Borne Diseases 2001.

12. Tumusiime Kabwende Deo 9 september 2008 Uganda: Self- medication - a new form of mob

justice http:\www.africafiles.com Uganda Self -medication - a new form of mob justice.htm

13. South Africa. 2001. South African Healthcare and the Proprietary medicine industry. W.

Duncan Reekie, D.R. Scott. S Afr Med J 2002

14. Whyte 2009; Pearce 2010; Sindiga et al . 2010 A research on African self-medication

mayhem 24-26.

15. WJM-western journal of medicine 2008 November.

16. WHO November 28, 2011 (www.who.com/self-medication) and WHO 2010.

17. Sydney: National prescribing service Ltd:2008

18. Al Shifa College of Pharmacy, 1998 Research on effect of self-medication on teenage population

34-38.

19. A. O.Afolabi 2008 Factors affecting the pattern of self-medication in an adult Nigerian

population. Annals of African Medicine 2008 vol7. 120-140.

20. Pharmacies in Uganda www.ugandainvest.go.ug.

43

21. The World Self-Medication Industry studies.

Appendix1; Work plan

Activities Period: December 2011 to April 2012

December January February March April

Submission of the research

topic to the academic

registrar/ supervisor and

corrections

Writing the research

proposal and submission of

the first draft

Correction and submission

of the second and final

research proposal.

Pretesting and fine tuning

of the research instruments.

Data collection analysis

and writing of the first draft

report

44

Submission of the first

draft report to the

supervisor

Corrections and submission

of the second draft report to

the supervisor

Submission to the

academic registrar

Appendix2: BUDGET

Item Quantity Unit price (UgShs) Total price (UgShs.)

Stationary

Pencil

Paper(s)

Ruler

Pen(s)

White wash

2

1 ream ruled

1

5

1

100

15000

1000

400

3000

200

15000

1000

2000

3000

Data collection tools

(questionnaire) printing,

typing and photocopy

10 pages each

questionnaire

(130 copies)

(each questionnaire)

500 printing @ page

100 photocopying @

page.

5000

130000

Research proposal

(printing and typing)

30 pages 500 each page 15000

45

Data management ----------------------- ----------------------- 40,000

Final report

typing\, printing and

binding

65 pages 500 each page 32500

Contingency 10% of budget 21120

TOTAL 232320

Appendix3: Map of Uganda showing kabarole district.

46

Map of Uganda showing kabarole district 1

Appendix4: Map of kabarole district

47

KENYA

DEM.REP. CONGO

TANZANIARWANDA

SUDAN

48