Knowledge and practice on over-the-counter drugs among adults of age group 20 and above residing in Chapapani-12, Pokhara, Kaski, Nepal

INTRODUCTION

Globally, self-medication has been reported as being on the rise. People around the world tend to treat the disease, almost 50% either wait for the problem to run its course or use a home remedy. About 25% visit doctor or use prescription medicine previously obtained for the same condition. The remaining 25% turn to the OTC medicines.¹ The global increase in the consumption of medications needs for studying medication knowledge and behaviors.² Medication knowledge assessment is used to assess a person’s knowledge and ability to read and understand information necessary for appropriate medication use.³

The 2008 National Social Life, Health, and Aging Project examined the prevalence of both OTC and prescription medication use among adults aged 57 to 85 years old in Washington, DC. Results of the survey showed that 81% of the respondents took at least one prescription medication (29% took five or more prescription medications concurrently); 42% used at least one OTC medication; and 49% used a dietary supplement. Of those taking a prescription medication, 46% also took an OTC medication.⁴

In many countries, OTC drugs are selected by a regulatory agency to ensure that they are safe and effective when used without physician’s care. Taking over-the-counter medicines still has risk. Some interact with other medicines, supplements, food and drinks and some causes problem for people with certain medical conditions.⁵

In a recent New Mexico study of deaths from unintentional drug poisoning, 0.9% were from OTC medications.⁶ A study in California showed that 8.5% admitted to abusing prescription drugs and 16.2% admitted to abusing OTC medications, mostly ephedrine and other stimulants.⁷

Due to the hilly terrain in Nepal, the poor socioeconomic status, the high cost of modern medicines and non-availability of doctors in rural areas, difficulties arise in accessing modern healthcare. Drug retail shops frequently serve as the public’s first point of contact with the health care system from where over-the-counter drugs are much more easy to purchase.⁸

OTC drugs have drug interactions with prescriptions and other drugs, it can cause various adverse reactions and even lead to death as well. More medicines doesn’t necessarily mean better. However, there is no adequate study regarding OTC in Nepal. So, this study aims to assess the knowledge and practice on OTC drug among adults.

METHODS

This is a community based cross-sectional study conducted in Chapapani-12, Pokhara between 1^st February to 15^th August 2016. The sample of this study consists of 110 adults of age group 20 and above using non-probability convenient sampling method. Adults who are willing to participate and available at the time of data collection were included in the study.

The instruments were developed after review of literature and consultation with guide and experts. Instruments were divided into 3 parts: Tool I: Socio-demographic proforma, Tool II: Knowledge questionnaire, Tool III: Practice questionnaire.

The pre-testing was conducted in adults of age group 20 and above residing in Phulbari-11, Pokhara, Kaski, Nepal from 25^th May to 27^th May 2016 among 11 adults. The data was collected through questionnaire by interview technique and recorded systematically to facilitate computer entry and data analysis.

Data analysis was planned based on the objectives of the study. Data was compiled, edited, coded, classified and tabulated. It was done to reduce, organize and give meaning to the data by through descriptive and inferential statistics using SPSS package 18 version. In descriptive statistics frequency and percentage, in inferential statistics, chi square test was used to determine the association of knowledge and practice with selected demographic variables and Karl Pearson correlation test was used to correlate the knowledge and practice score.

Approval to conduct the study was taken from municipality office to perform study in the concerned community. Individual consent was taken from the respondents after explaining the purpose of the study prior to the data collection. Privacy and confidentiality of all respondents was maintained.

RESULTS

Data was collected by interviewing 110 adults of age group 20 and above residing in Chapapani-12, Pokhara.

Nearly 1/3^rd of the respondents (33.6%) were of age group 20-29 years and more than half (60.9%) were female. Less than half (47.3%) of the respondents were Gurung and majority of them (84.5%) were Hindu. Almost 3/4^th (74.6%) of the respondents were married. Less than half of the respondents (42.7%) have educational status of higher level and above as given in Table 1.

The current study shows that nearly about 1/3^rd of them (30.9%) were housewife and nearly half of them (45.5%) have monthly family income within range of NRs. 10,000-20,000. About 60.9% of the respondents live in joint family and about 2/3^rd of them (66.4%) took <15mins to reach the nearest pharmacy by foot. Nearly 60.9% had last purchased medicine without prescription 6 months before as shown in Table 1.

More than 3/4 of respondents were aware about OTC drugs. But only 1/10th of them know about caution taken before providing medicine to pregnancy and lactation. Minority (12%) respondents were aware about the use of OTC drugs for treating minor illness and injuriesas seen in Table 2.

Only 27% of respondent consult with the doctor before purchasing OTC drugs. Majority of the respondent (94.5%) purchase the medicine from pharmacy. Forty six percentage (46%) of the respondents replied that reason of consuming OTC drugs is time saving as they have to wait for long time for doctor as in Table 3.

Less than half of the respondents (54%) had good knowledge, 43% had average knowledge and 3% had poor knowledge on over-the-counter drugs as depicted in Figure 1. More than half of the respondents 47% had good practice on over-the-counter drugs as shown in Figure 2.

The study shows that there is significant association of knowledge with age, marital status and education status of respondents. Whereas, there is no significant association with gender, religion, caste, type of family and occupation as presented in Table 4.

There is significant association of practice with education status of respondents. Whereas there is no significant association between other demographic characteristics and practice as given in Table 5.

There is weak positive correlation between knowledge and practice at the significance level of 0.05 and r -value was found to be 0.211 as shown in Table 6.

DISCUSSION

Study findings have been discussed in terms of objectives stated and with the findings of the other studies. Nearly 76% were aware about the OTC drugs similar to the study conducted in Lagos State, Ikeja (70%), and West Bengal (84%).^9,10 Most the respondents (43.6) use OTC when symptoms are minor and manageabe comparable to study by Ghosh et al 62% used the OTC drugs when disease is not serious.¹⁰ Many of the respondents(82.7%) used OTC drugs for fever (antipyretics) i.e, paracetamol which is in line with the study from Pune, West bengal, Ikeja, Lagos Resident(94%), 72% use crocin regularly.^8,9,11,12

*S= Significant; NS= Not Significant; df= degree of freedom.

*S= Significant; NS= Not Significant.

Correlation is significant at the level of 0.05.

Forty six percentage were using OTC as it is time saving alike to a study from Boudha, Kathmandu where 48% of respondents used OTC medicines due to easy to get the medicine as compared to visit to doctors or hospital and 87% of self-medicate due to convenience.^11,13 Among the respondent asked for place of purchasing OTC drugs, 94.5% replied as the pharmacy shop comparable to Lagos residents i.e. 74%.⁹

Only half(50.8%) of the residents claimed to always read the leaf-lets before using any drugs which is identical with the present study i.e 48.2%.⁹ Whereas a study from Tamil Nadu shows that 1/4^th respondents read the label content of the drugs.¹⁴ Only 9% of the respondents always check the expiry date before using any OTC drugs distinguish to the result obtained from Malaysia (86%).¹⁵ Almost 6% had experience the experienced adverse reactions such as gastrointestinal disturbance like constipation, diarrhoea, distension analogous to the result obtained from study done in Mangalore.¹⁶

The current study showed that more than half of the respondents (54%) had good knowledge on over-the-counter drugs similar to a study from Nigeria i.e. 47.2%, 67% from Taiwan.^17,18 Distinguish result was obtained from Central India that not even half of the respondents had adequate knowledge regarding over-the-counter drugs, their dose, duration, side-effects and interactions and Pune showed that 74 % respondents had no knowledge about medicines and 86.5% unaware about adverse drug reactions.^12,19

The present study showed that nearly half of the respondents (46%) had level of knowledge regarding over-the-counter drugs from average to poor. However, study by Mohammed et al found that majority of the respondents (82%) stated that their level of knowledge was moderate to low.²⁰

A study in Maharashtra showed that greater part (92%) of the respondents said that they have no knowledge about over-the-counter drugs and only 8% have some knowledge about OTC drugs.²¹ This study contradicts the present study where only 3% had poor knowledge and 43% had some knowledge regarding OTC drugs.

The study showed that about half (47%) of the respondent had good practice on over-the-counter drugs comparable results was obtained in a study from Nigeria (52.1%) and Taiwan (68.12%).^17,18

There is significant association of education status of respondents with knowledge and practice on over the counter drugs which is in line with studies by Bhambhani et al.¹⁹ There is no significant association between the age of respondent and the practice of the self-medication analogous to the study conducted in UAE.²² Whereas contrast results was obtained in Malaysian population.²³

CONCLUSION

Lower percentage (54%) had good knowledge on over-the-counter drugs. Less than half (47%) had good practice regarding over-the-counter drugs. The result showed that still they are lacking the concept of over-the-counter drugs, consultation of doctor before using the OTC drugs, its adverse effects, disease to be treated, caution to be taken, reading the instruction before use and checking the expiry date. In order to control this prevailing problem, legislation are to be made by the government especially to implement and facilitate the prescription system, conducting awareness programs and restricting drug advertisements for public. Therefore, it is suggested for awareness program among community people conducted at community level regarding over-the-counter drugs.

ACKNOWLEDGEMENTS

The authors are greatly indebted to all the participants of the study.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: The study was approved by the institutional ethics committee

REFERENCES

1. 1. The World Safe Medication Industry. Healthcare, Self-care and Self-medication, 14 National surveys reveal many similarities in consumer practices. WSMI 1988. Available at http://www.wsmi.org/wp-content/data/pdf/wsmibro3.pdf. Accessed on 20 December 2016.
2. 2. Hgiano F, Lee J, Tomghuang W, Chen S, Xinchen H. Survey of medication knowledge and behaviors among college students in Taiwan. Am J Pharma Edu. 2006;70(20):1-5.
3. 3. American society on aging and American society of consultant pharmacist. Medication knowledge. Available at http://www.adultmed.com/assessment toosl-2html. Accessed on 23 March 2016.
4. 4. Qato DM, Alexander GC, Conti RM. Use of prescription and over-the-counter medications and dietary supplements among older adults in the United States. JAMA. 2008;300(24):2867–78.
5. 5. Over-the-counter Medicines: Medline Plus. Food and Drug Administration. Available from URL: http://www.nim.nih.gov/medlineplus/over the counter medicines.html. Accessed on 23 December 2016.
6. 6. Shah NG, Lathrob SL, Reichard RR, Landen MG. Unintentional drug overdose death trends in New Mexico, USA, 1990-2005: combinations of heroin, cocaine, prescription opioids and alcohol. Addiction. 2008;103(1):126-36.
7. 7. Rockhold KC. Report on Tulare Country Drug Court (Porterville), California. Justice Programme Office. Available from URL: http://jpo.wrlc.org/.../Recommendations%20Regarding%20Development%20o. Accessed on 20 January 2017.
8. 8. Kafle KK, Madden JM, Shrestha AD, Karkee SB, Das PL, Pradhan YM, Quick JD. Can licensed drug sellers contribute to safe motherhood? A survey of the treatment of pregnancy related anemia in Nepal. Soc Sci Med. 1996;42(11):1577- 88.
9. 9. Kuku K. Attitude and Practices towards Self Medication among residents of Ikeja, Lagos residents(dissertation). Available at http://www.academia.edu/4161319/Attitude_and_Practices_towards_Self_Medication_among_residents_of_Ikeja_Lagos_residents. Accessed on 9th December 2016.
10. 10. Ghosh A, Biswas , Mondal K, Haldar M, Biswas S. Study on knowledge and practices of over the counter medications among 2nd year medical students. World J Pharma Pharmaceu Sci. 2015;4(7):1074-81.
11. 11. Kasabe GH, Tiwari SA, Ghongane BB. A survey of knowledge, attitude and practices of self-medication in Pune region. Int J Med Res Health Sci. 2015;4(4):811-6.
12. 12. Dawane JS, Borole KD, Pandit VA, Salunkhe SD. Parents’ Knowledge, attitude and Perception about the commonly used drugs and their adverse drug reactions in Children. Int J Pharm Bio Sci. 2013;4(3):461-8.
13. 13. M Maharjan, K Adhikari. Practices on Over the Counter Medication among Mothers of Under Five Aged Children Attending Child OPD at Friends of Shanta Bhawan, Boudha, Kathmandu. Health Prospect. 2011;10:19-21.
14. 14. Manohar HD, Manohar HL. Impact of Knowledge and Attitude on Practices of Over the counter medications. IEOM Soc. 2015;10-11:775-84
15. 15. Hassali MA, Shafie AA, Al-Quazaz, Tambyappa J, Palaian S, Hariraj V. Self-medication practices among adult population attending community pharmacies in Malaysia: an exploratory study. Int J Clin Pharm. 2011; 33(5):794-9.
16. 16. Sanjeev B. Self-medication patterns among medical students in South India. Australas Med J. 2012;5(4):217–20.
17. 17. Babatunde OA, Fadare JO, Ojo OJ, Durowade KA, Atoyebi OA, Ajayi PO, et al. Self-medication among health workers in a tertiary institution in South-West Nigeria. The Pan African Med J. 2016;24:312.
18. 18. Hsiao F, Jen-Ai L, Weng-Foung H. Survey of medication knowledge and behaviours among college students in Taiwan. Am J Pharmaceutical Edu. 2006;70(2):30.
19. 19. Bhambhani G, Saxena V, Bhambal A, Saxena S, Pandya P, Kothari S. Self-medication practice amongst patients visiting tertiary care Dental Hospital in Central India. Oral Health Prev Dental. 2015;13(5):411-6.
20. 20. Azhar MIM, Gunasekaran K, Kadirvelu A, Gurtu S, Sadasivan S, Kshatriya BM. Self-medication: Awareness and Attitude among Malaysian Urban Population. Int J Collaborative Res Internal Med Public Health. 2013;5(6):436-43.
21. 21. Gupta UK, Gupta CD, Patel JR. Assessment of awareness and attitudes towards over-the-counter drugs amongst urban population: A Questionaire-based study. Res J Pharmaceutical Biol Chemical Sci. 2012;3(2):1037.
22. 22. Sharif SI, Bugaighis LMT, Sharif RS. Self-Medication Practice among Pharmacists in UAE. Pharmacol Pharm. 2015;6:428-35.
23. 23. Azhar MIM, Gunasekaran K, Kadirvelu A, Gurtu S, Sadasivan S, Kshatriya BM. Self-medication: Awareness and Attitude among Malaysian Urban Population. Int J Collaborative Res Internal Med Public Health. 2013;5(6):436-43.