Download 762-Wijesinghe-_a

Practice and Predictors of self-medication among
urban and rural adults in Sri Lanka,
three decades after
Market Economic Reforms
Dr. Pushpa Ranjan Wijesinghe
MD- Rostov (General Medicine)
MSc, MD-Colombo (Community Medicine)
MPH-New Zealand ( Bio-security)
Background
• Practice of self-medication in communities in varying degrees
• Increased private sector involvement in health & pharmaceutical
care since 1977
• Increased utilization of private health / pharmaceutical care for out
patient conditions
• Competition of the pharmaceutical companies for a larger share of
over the counter drug market
• What is the status of self-medication in settings of contrasting
health and pharmacy care infra-structure in this context ?
Objective
• To describe the current practice and predictors of
self-medication in a selected urban and rural area
in Sri Lanka
Methods
• Study design
• A community based cross –sectional study
• Study Population
• Adults over 18 years of age, irrespective of sex ,
permanently residing in the selected districts over a
period of 1 year
Urban district
8 Urban Council areas
Rural district
Stratification
n= 900
n= 900
30 GN divisions
PSU
7 Regional Council (PS ) areas
PPS
30 GN divisions
PSU
30 Households per a
GN division
Voters list
30 Households per a
GN division
1 individual per house
(900)
Kish Table
1 individual per house
(900)
Study Instruments
• Interviewer administered questionnaire (IAQ)
• Validated Likert scale to assess the Perceived satisfaction
with available pharmacy services
– Access, Continuity, General Satisfaction of services
– Availability , Affordability, Efficacy of drugs
– Inter-personal explanation, Considerateness
• Validated Likert scale to assess the perceived access to
allopathic medical care
–
–
–
–
Availability of services,
Regularity and acceptability of services
Affordability of services
Concern for clients
ACCESS
FACTORS
SOCIO DEMOGRAPHIC FACTORS
BELIEFS & ATTITUDES
Enabling factors
Predisposing factors
Medication use
Need variables
ACTUAL OR PERCEIVED MORBIDITY
Anderson and Newman’s health
services utilization model
Practice of medication use
Urban (n=863)
Prevalence of medication use
(95% confidence interval )
33.9%
(30.7%-37.1 %)
Urban (n =293)
Rural (n=846)
35.3%
(32. 1%-38.5%)
Rural (n=846)
Only allopathic medicine users
91.4%
84.6%
Only traditional medicine users
3.8%
12.4%
Both allopathic and traditional
medicine users
4.8%
3.0%
Urban (n=863)
Prevalence of self medication *
(95% confidence interval )
Self medication as a proportion of
medication use *
* P < 0.05
Rural (n=846)
12.2%
(10.0% -14.4%)
7.9%
(6.1%-9.7%)
37.2%
25.6%
Practice of self-medication
Urban
Rural
Conditions of Acute onset and short duration
58%
67%
Perceived non-severity of the condition for
physician consultations
55%
64%
Previous satisfactory response of the same
drug to a similar condition
53%
60%
Self-medication without any symptom
09%
12%
Using previous prescriptions for self
medication for purchasing drugs
37%
-
-
45%
Self-medication with one drug
49%
73%
Self-medication with 2 drugs
28%
18%
Using labels/blister packs of previously used
drugs for purchasing drugs
Predictors of self medication
Urban
Predisposing variables
Household number ≤ 2
Non-affirmation of drugs
availability at informal places
Need Variables
Symptoms ≤ 2
Enabling Variables
Adjusted OR ( 95% CI)
Rural
Adjusted OR ( 95% CI)
4.3 ( 1.1-17.5)
-
0.3 (0.1-0.8)
-
Adjusted OR ( 95% CI)
7.9 (3.4-18.9)
Adjusted OR ( 95% CI)
Adjusted OR ( 95% CI)
2.4 (1.1-5.8)
Adjusted OR ( 95% CI)
Higher satisfaction with
acceptability of medical
services
0.96 (0.93-0.98)
-
Affordability of medical
services
-
0.4 (0.2-0.7)
Technical competence of
pharmacy staff
-
2.8 (1.1-7.3)
Conclusion & recommendations
• Self-medication is more prevalent in the urban setting
• Prevalence of self-medication is lower than global estimates
• Self-medication with 1-2 drugs selected on previous experience is
an initial individual response for diseases of acute onset and
perceived to be of less severity
• Lower symptom count is a need variable acting as a proxy measure
of perceived severity of the morbidity
•
Self medication is dependent on characteristic access measures
unique in the two specific settings
• Findings should be utilized to
– Shape policy changes related to implementation of the CDD act
– Design IEC programs for consumers moving towards self-medication
– Enhance the capacity of rural pharmacists/assistants as the first contact points
in the rural sector
Limitations
• Less valid data as compared to data collected in a
prospective follow up study using a diary method
• Non-objective measurement of the severity of the
condition
• Social desirability bias due to use of public health
midwife for data collection
• Perceived measures of access to health care and
pharmaceutical services reflect general rather than
specific context