Self - Medication and Over-the-Counter Practices: A Study in Palestine
Self - Medication and Over-the-Counter Practices: A Study in Palestine
, 8, 2004
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Abstract
Self medication, over-the-counter practices and drug utilization studies
are very few in Palestine. The purpose of this study is to describe and analyze
the self medication patterns and over-the-counter practices in Palestine. A
random sample of patients seeking self medication at community pharmacy
was interviewed using a 15-item questionnaire. Social, demographic, disease
information and information on drugs used for self-medication or dispensed
over the counter were collected. The percentage of patients who were seeking
self medication study was approximately 60%. Those patients were mostly
males, educated, above the age of 40 and have a monthly income of less than
200 USD. Most patients were seeking self medication for headache, dental
pains, muscle/joint pains and throat or respiratory or urinary tract infections.
The drugs most commonly dispensed or purchased on a self medication basis
were NSAIDs, paracetamol and anti-microbial drugs. Patient health awareness
programs and pharmacist continuing education are necessary in Palestine.
*Department of Pharmacology, College of Pharmacy, An-Najah University, Nablus,
Palestine.
Email: [email protected]
1
Introduction:
The Palestinian pharmacy practice law requires that prescription
medications are sold on a prescription only basis (1). However, due to the
political and economical instability, the pharmacy practice law in Palestine
is loosely applied. Furthermore, there is no well-established health care
system in Palestine that can provide health services with a reasonable cost.
This situation has encouraged many irrational health and pharmacy practices
which are unfortunately encouraged by patients and by community
pharmacists. One of these irrational practices is self medication for,
sometimes, serious infectious diseases. Another irrational practice is selling
a wide range of medication products as an over-the-counter (OTC) drugs.
Actually, there is no clear and official list of OTC medications issued by the
ministry of health (MOH) in Palestine, which practically makes the door
open for community pharmacies to sell a wide range of medications as OTC
products. As a consequence, community pharmacists have increasing
involvement in the self-management of minor and moderate illnesses as a
result of the availability of this wider range of over-the-counter (OTC)
medicines and because they are faster and less expensive than public or
private clinics. Drug utilization studies are very rare in Palestine.
Furthermore, there are no background information available on the
community pharmacy practices and their role in self medication among the
Palestinian population. The purpose of this study is to describe and analyze
the self medication patterns, over-the-counter sale practices and the factors
encouraging these practices in Palestine.
Method:
This study took place at community pharmacy center in the northern
part of Palestine over a three month period. Randomly selected samples of
customers were interviewed with a structured questionnaire after they had
purchased a medicinal product. The total number of patients interviewed
was 2087 patients. One thousand two hundred and sixty three (1263)
patients were purchasing one or more type of drugs without prescription for
one or more defined condition or ailment. The choice of medications was
made either by the patient or selected by the community pharmacist. Those
patients were asked to verbally answer a 15-item questionnaire that include
questions about age, sex, place of living, level of education, income, type or
nature of disease he or she is medicating, number, type, price and
knowledge about the drug(s) he or she is purchasing, presence of chronic
2
Results:
The percentage of patients who were seeking self medication was
approximately 60% from the total number of patients purchasing medication
from the community pharmacy over the study period of three months. Table
one (table 1) illustrates the statistical characteristics of the interviewed
patients in the sample. The majority of the patients under testing and
evaluation were males above 40 years of age. Most patients are residing in
the city (~58%) while the rest are residing in villages and refugee camps.
The majority of the patients were educated and (22%) were illiterate.
Regarding income, more than 60% of the patients in the sample had a
monthly income of less than 200 USD. Approximately half of those patients
are already suffering from chronic diseases and are currently taking one
(11%), or two or more than two (32.9%) medications on a chronic daily
basis. These medications include anti-hypertensive, other cardiac drugs,
anti-diabetics and bronchodilator drugs.
Age
Sex
Place of Living
Chronic Illness
Education
Income (USD monthly)
Social Status
Number
of
different
medications taken per day
on a chronic basis.
Result.
32.2% > 60 years.
41.9% 40-60 years.
25.9% < 40 years.
63.4% males.
36.6% females.
58.6% City
41.4% Village or Refugee Camp
6% Diabetes Mellitus
12.5% Cardiovascular diseases
14.2% Orthopedic and Rheumatology problems
3% Asthma and other COPD.
9% Peptic Ulcer or the GIT problems
7% other diseases.
48.3% have no chronic diseases
21.3% illiterate
78.7 % educated
29% <100 USD
37% 100 - 200 USD
34% > 200 USD
74.6% married.
23% single.
2.4% widowed.
11.6% take one medication.
32.9% take two or more medications.
55.5% take no medications at all
The patients in the sample were seeking self medications for the
following conditions (Table 2): muscle and joint pains, cough and common
cold, headache and dental pain, dermatological problems, contraceptive
method, throat and chest infections, gynecological problems, hyperacidity
and GIT disorders, ophthalmic infections and allergy, pediatric remedies
and urinary tract infections.
Frequency
16.1%
15.3%
10.2%
8.1%
Dermatological problems
9.2%
13.8%
10%
Ophthalmic conditions
5.6%
4.2
Pediatric conditions
6.1%
Miscellaneous
<2%
E/E/N
H and G
D and E
C and V
0%
N and P
5%
Reason
48%
41%
39%
Lack of Insurance
28%
14%
Discussion:
Self medication could be defined as taking drugs without the advice
and monitoring of a physician (2). Self-medication is widely practiced in
many less developed countries (3, 4, 5). In our sample study in Palestine,
self medication was common and irrational. Predictive factors for selfmedication in Palestine seem to be, males with age above 40, married, good
level of education and less than 200 USD monthly income. In our country,
self medication should be considered a public health problem due to lack of
health awareness among the population and lack of medical continuing
education among community pharmacists. The number of population in the
West bank (Palestine) is 1,873,476 and the annual growth rate is 3.1% (6).
The number of community pharmacies in West bank is approximately 500
until the time of submission of this paper. This means that there is a good
pharmacy provider to population ratio (one community pharmacy services
approximately 4,000 individuals). The Palestinian pharmacy law strongly
advocates the proper and legal sale of medications, however, in Palestine,
as well as in many less developed countries, almost any drug available in
the market can be purchased as an over the counter medication. In Palestine,
many patients seek medical advice directly from the community pharmacies
because they are easily accessible, faster and less expensive than the
doctors clinics. This is even more obvious in village areas where medical
services are less developed. This makes the community pharmacies in a
situation to play a major and important role in public and community health
issues. Unfortunately, the pharmacy personnel in Palestine are scientifically
behind and un-updated on clinical pharmacology and pharmacy practice
issues. For example, anti-diarrhoeal drugs might be sold without emphasis
on ORS therapy, strong antibiotics are sold as OTC and many strong
NSAIDs are sometimes dispensed without direction for secure use. Nineteen
percent of the sample took antimicrobials without prescription. These
antibiotics were mainly self-administered for upper respiratory tract
symptoms, particularly sore throat, and urinary tract infections with
community pharmacies being the major source in more than 90% of the
cases. This irrational use of antibiotics might contribute to the development
of new resistant bacterial strains in Palestine. The local pharmaceutical
companies play a negative role in the marketing and promotion of these
antibiotics in the Palestinian market.
Conclusion:
The potential effectiveness of self medication is questionable
because of the lack of medical follow-up, inadequate information supplied
to the patient by community pharmacists and above all the incorrect
diagnosis and/or therapy. In the case of antibiotics sale, for example, subtherapeutic doses were given to at least one third of the patients. In some
other instances, antibiotics were purchased with no clear signs or symptoms
of bacterial infection. Furthermore, these irrational self medication and over
the counter practices might cause serious drug interactions or adverse
reactions among patients taking medications for chronic diseases. This study
indicates the need for an educational campaign on proper medication use
amongst the Palestinian general public and health practitioners.
Furthermore, a national health insurance policy must be adopted to offer
good quality of health services with a reasonable cost.
References:
1- Palestinian Pharmacy Practice Law, 1998.
2- JL Montastruc, H Bagheri, T Geraud & M Lapeyre Mestre:
Pharmacovigilance of self-medication. Therapie 1997,52:105-110.
3- Martins AP, Miranda Ada C, Mendes Z, Soares MA, Ferreira P,
Nogueira A. Self-medication in a Portuguese urban population: a
prevalence study. Pharmacoepidemiol Drug Saf. 2002 JulAug;11(5):409-411
4- Angeles-Chimal P, Medina-Flores ML, Molina-Rodriguez JF. Selfmedication in a urban population of Cuernavaca, Morelos Salud Publica
Mex. 1992 Sep-Oct;34(5):554-61.