ARBAMINCH UNIVERSITY

COLLEGE OF MEDICINE AND HEALTH SCIENCES

DEPARTMENT OF MATERNITY AND REPRODUCTIVE HEALTH

NURSING

SELF MEDICATION PRACTICE AND ASSOCIATED FACTORS AMONG

PREGNANT WOMENS IN SODO TOWN, SNNPR, ETHIOPIA, 2021

INVESTIGATOR: SILENAT GASHAW (BSC, MSC STUDENT)

ADVISORS:

1. Mr. SERAWIT LAKEW (MSC, ASSISTANCE PROFESSOR)

2. Mr. DINKALEM GETAHUN (BSC, MSC, ASSISTANCE PROFESSOR)

THESIS PROPOSAL SUBMITTED TO ARBAMINCH UNIVERSITY

COLLEGE OF MEDICINE AND HEALTH SCIENCES SCHOOL OF NURSING
DEPARTMENT OF MATERNITY AND REPRODUCTIVE HEALTH
NURSING IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR
THE DEGREE OF MASTER IN MATERNITY AND REPRODUCTIVE
HEALTH NURSING.

FEBRUARY, 2021

ARBAMINCH, ETHIOPIA

i
 ARBAMINCH UNIVERSITY

COLLEGE OF MEDICINE AND HEALTH SCIENCES

DEPARTMENT OF MATERNITY AND REPRODUCTIVE HEALTH NRSING

SELF MEDICATION PRACTICE AND ASSOCIATED FACTORS AMONG

PREGNANT WOMENS IN SODO TOWN, SNNPR, ETHIOPIA, 2021

INVESTIGATOR: SILENAT GASHAW (BSC, MSC STUDENT)

E-Mail: [email protected]

Phone No. +251909191406

ADVISORS:

1. Mr. SERAWIT LAKEW (MSC, ASSISTANCE PROFESSOR)

E-Mail: [email protected]

Cell Phone: +251913273829

2. Mr. DINKALEM GETAHUN (BSC, MSC, ASSISTANT PROFESSOR)

E-Mail: [email protected]

Cell Phone: +251913866606

FEBRUARY, 2021

ARBAMINCH, ETHIOPIA
 Acknowledgement

First, I would like to express my gratitude to Arbaminch University College of Medicine and
Health Science for support in the accomplishment of this study. My sincere gratitude goes to my
advisors Mr. Serawit Lakew (MSc, Assistant Professor) and Dinkalem Getahun (MSc, Assistant
Professor) for their constructive and invaluable suggestions, advices, comments and

concerns by spending their time and energy starting from title selection to
proposal development.

I also thanks to Sodo town health administrative MCH coordinators for providing
information about the number of pregnant women that live in selected kebeles.

i
 Table of content

Table of Contents
Acknowledgement........................................................................................................................................i
Table of content...........................................................................................................................................ii
List of tables...............................................................................................................................................iv
List of figures..............................................................................................................................................v
List of abbreviations...................................................................................................................................vi
Summary..................................................................................................................................................viii
1. Introduction.........................................................................................................................................1
1.1 Background.......................................................................................................................................1
1.2 Statement of the problem...................................................................................................................1
1.3 Significance of the study....................................................................................................................3
2. Literature Review................................................................................................................................4
2.1 Prevalence of self-medication practice among pregnant women.......................................................4
2.2 Factors influencing self-medication...................................................................................................5
2.2.1 Socio demographic factors..........................................................................................................5
2.2.2 Obstetric factors..........................................................................................................................6
2.2.3 Health Facility related factors.....................................................................................................6
2.2.4 Prior experience and Non-prescribed drug related factors..........................................................7
2.3 Conceptual framework.......................................................................................................................8
3. Objectives............................................................................................................................................9
3.1 General Objective..............................................................................................................................9
3.2 Specific objective..............................................................................................................................9
4. Methodology......................................................................................................................................10
4.1 Study area........................................................................................................................................10
4.2 Study design and period...................................................................................................................10
4.3 Population........................................................................................................................................10
4.3.1 Source population.....................................................................................................................10

ii
 4.3.2 Study population.......................................................................................................................10
4.4 Eligibility criteria.............................................................................................................................11
4.4.1 Inclusion criteria.......................................................................................................................11
4.4.2 Exclusion criteria......................................................................................................................11
4.5 Sample size determination...............................................................................................................11
4.6 Sampling procedure and Technique.................................................................................................12
4.7 Study variable..................................................................................................................................13
4.7.1 Dependent variable...................................................................................................................13
4.7.2 Independent variable.................................................................................................................13
4.8 Operational definition......................................................................................................................13
4.9 Data collection instrument and procedure........................................................................................14
4.9.1 Data collection instrument........................................................................................................14
4.9.2 Data quality control..................................................................................................................14
4.9.3 Data management and Data analysis.........................................................................................15
5. Ethical consideration.........................................................................................................................16
6. Dissemination of result......................................................................................................................16
7. Work plan..........................................................................................................................................17
8. Budget...............................................................................................................................................18
9. Reference...........................................................................................................................................19
10. Annexes.........................................................................................................................................20
11. Declaration....................................................................................................................................27

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 List of tables

Table 1: work plan for prevalence of self-medication practice and associated factors among pregnant
women in Sodo town, Southern Ethiopia, 2021……………………………………………………..17

Table 2: Budget break down on prevalence of self- medication practice and associated factors
among pregnant women at Sodo town, Southern Ethiopia, 2021………………………………….18

iv
 List of figures

Figure 1: Conceptual framework on prevalence of self- medication practice and its associated factors
among pregnant women………………………………………………………………………………..7

Figure 2: Schematic diagram of the sampling procedure for selecting pregnant women from
selected kebeles, 2021……………………………………………………………………….13

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 List of abbreviations

ACOG American College of Obstetrics and Gynecology

ANC Antenatal Care
AOR Adjusted Odds Ratio

CI Confidence Interval

vi
CSA Central Statistical Agency of Ethiopia

DC Data Collector

ETB Ethiopian Birr

JUMC Jimma University Medical College

OTC Over the Counter

PI Principal Investigator

SM Self-medication
SPSS Statistical Package for the Social Science

SNNPR South Nations Nationality and Peoples Region

UTI Urinary Tract Infection
WHO World Health Organization

Summary

Background: Self-medication is significant throughout the world. Although pregnant women are
among the most vulnerable group of the population for drug-induced adverse effects on their
fetus and themselves, many pregnant women use self- medication without adequate precautions.

Objective: To asses the prevalence of self-medication practice and associated factors among
pregnant women in selected households in Sodo town, SNNPR, Ethiopia, 2021.

vii
Methods: A mixed-method approach will be employed where; a community-based cross-
sectional quantitative and qualitative data collection and analysis will be performed concurrently.
The study will be conducted from April 2021 –May 2021. For the quantitative study, 330 study
participants will be selected using a simple random sampling method. Semi-structured and
pretested self-administered questioners will be used to collect data. Then the collected data will
be cleaned, coded, and entered into Epi data version 3.1 and exported to SPSS version 22 for
analysis. The result will be displayed through descriptive and inferential statistics i.e. simple and
multiple linear regressions. Variables with a P-value of less than 0.2 will be entered into a
multiple linear regression model and variables with a P-value of < 0.05 will be considered as
statistically significant. The total scores will be expressed using regression coefficient (β),
adjusted regression coefficients (β^), 95% Confidence Interval (CI). For the qualitative study, in-
depth interviews will be conducted until it comes back to reputation using an interview guide
selected with a purposive and intensity sampling method. The data will be entered and
thematically analyzed using open code software version 4.0. Finally, the results of quantitative
data will be triangulated with findings from the qualitative data.

Work plan: The duration of the study will be from February 2021 to May 2021.

Budget: A total cost of 25,260.00 ETB will be required to carry out this study.

Keywords: self-medication, practice, Ethiopia

viii
 1. Introduction
1.1 Background

Self-medication(SM) is broadly defined as the use of conventional or herbal medicine without

the prescription of health care provider for the treatment of self-recognized disorders (1). The
adverse effect of self-medication begins with incorrect self-diagnosis, incorrect choice of therapy,
failure to recognize special contraindications, warnings and precautions (2, 3). Self–medication
becomes a public health problem due to its significant prevalence and harmful effects. It practices
in both developing and developed countries (4). Nowadays, the excessive use of SM is considered
as one of the major health and socio-economic challenge in especially in developing countries (5).

The practice of self-medication have a serious situation, as people use drugs without the
knowledge on their harmful effect in connection with those specific medicines; thus, poor
knowledge on the negative effect of self-medication is adding significantly to the practice of self-
medication. As a result, people develop serious side effects from the drugs and have also led to
delay in seeking for medical care at the health facilities, thereby worsening their situations (6).

A significant proportion of antibiotics are dispensed without prescription (7). This widespread
use of self-medication has a huge positive impact on health by encouraging self-care and reducing
unwanted loads in the health care providers (1, 6). But it is affected by improper selection of the
medication, inappropriate dosage, poor knowledge on teratogenicity and precautions needed for
each (1). Ethiopia is one of the Sub Saharan country and the extents of self-medication practice
among pregnant women are not yet fully known (8).

1.2 Statement of the problem

World Health Organization (WHO) includes self-medication as one part of self-care but
precautions are taken especially in pregnant women. Self-medication also includes both herbal
and conventional medicines (1). In order to decrease the adverse effect and teratogenicity of self-
medication intensify efforts on education (9), implementation of drug regulatory policies and

1
public trainings for all women of reproductive age about the risks of inappropriate self-
medications are necessary (10, 11). The prevalence of self-medication among pregnant women
was 22%-44% reported throughout the world which is high (12).

Even if ACOG recommends to all women in early pregnancy should be asked about their use of
tobacco, alcohol, and other drugs, including marijuana used for nonmedical reasons only 2% to
5% women are self- reported in most studies (13). A study on identified cases of marijuana use
during the first three months of pregnancy, with non-users serving as controls revealed that the
odds of anencephaly in the offspring of users was significantly increased to 2.5% (14). A study
conducted in Sweden in 2017 among offspring born after exposure to antidepressants in the first-
trimester, compared with non-exposure, was associated with a 6.98% increment of preterm birth
among exposed (15).

Another studies conducted in Italy revealed that nimesulide administration in a term pregnancy
can rapidly cause premature ductal constriction and may induce abnormalities in the fetal heart
rate pattern (16). Even though existing WHO in 2019 recommendations on ANC for self-
administered interventions on common physiological symptoms are present, strengths of
recommendations and evidence of certainty are not specified, and specific formats for
educational intervention are not available including our country Ethiopia (17). Though it is
difficult to conclude that any drug is absolutely risk-free for pregnant women; even the most
familiar and easily accessed drugs like non-steroidal anti- inflammatory drugs are reported to
have a risk of pregnancy adverse outcomes (18).

Although the prevalence of self- medication during pregnancy is less than that of before
pregnancy, but its prevalence during pregnancy is still significant (19). The pooled prevalence of
herbal medicine use among pregnant women attending antenatal care in Ethiopia was 47.7% and
its harmful fetal effects are not known on these most commonly consumed plant species (20).

Pregnant women practiced self-medications, including medicines with high risk categories. Still
there are correctable gaps on pregnant women in program designing, screening of pregnant
women, guidelines, and strategies to take necessary measures at all levels to reduce risks of self-
medication during pregnancy (21). There is also insufficient evidence to recommend the routine

2
use of home visits in response to pregnant women with an illicit drug problem (22). Data
regarding prevalence of self-medication among pregnant women especially in SNNPR region is
limited. Therefore, the aim of this study is to determine prevalence of self-medication and to
identifying its associated factors among pregnant women.

1.3 Significance of the study

Self–medication practice exposures may have potential harmful effects and also the reason for
why people seek for hospital intervention late, thereby complicating ones condition particularly
among pregnant women. Despite all the harmful effects linked with self-medication, pregnant
women are still practicing it. The high prevalence of self-medication as seen in most of the
studies could largely be due to lack of knowledge on the harmful effects from irrational use of
medicine especially among pregnant women. Results of this study will therefore be important in
facilitating development of strategies that will be used in addressing the prevalence of self-
medication by providing information about the current prevalence of self-medication and related
factors. This is useful in planning a health education program that can be implemented during
community services and public enlighten at both local and national level which will help to
reduce maternal morbidity, mortality, abortion and fetal malformation as a result of the
teratogenic effects of unsafe drugs on the fetus and the mother.

3
 1. Literature Review
2.1 Prevalence of self-medication practice among pregnant women

Self- medication practice is the major public health problem throughout the world, particularly in
Sub-Saharan Africa. Different studies have been conducted in different countries to determine
the prevalence and associated factors of self-medication practice among pregnant women. A
systematic review and meta-analysis conducted in 2018& 2019 estimates the overall prevalence
of self-medication was from 22%-44% in the world (12), 38.46% in Iran respectively (23). A
cross-sectional study conducted in 2020 in five healthcare services in Indonesia of 333 female
participants, 39 (11.7%) used OTC medication. Women with a higher level of knowledge of
OTC medication were more likely to self-medicate (24).

A descriptive interviewed study in 2018 in central Mexico with a total of 1798 pregnant women
or women which is pregnant within three years ago shows a prevalence of 21.9% (25). Another
primary facility based crossectional study in Brazzaville, Congo in 2018 on seven health
facilities among 350 pregnant women is 41.44% (26). A qualitative meta-analysis in Switzerland
in 2019 showed that the experiences of self-medication could be classified into personal, social,
organizational, and cultural categories (27).

Hospital based cross-sectional studies conducted in Nekemte in 2018 with195 pregnant women
attending antenatal care there were participated. Self-medication practice among pregnant
women was 21.5% with the most common self-medicated drugs were paracetamol 19 (45.2%)
and amoxicillin 12 (28.6%) (28). Another facility-based cross-sectional study conducted in 2020
at Kemisie on 223 pregnant women, (60)26.9% and 111 (48.9%) practiced self-medication on
conventional and herbal medicine, respectively (29).

A hospital- based cross sectional study conducted on 1117 hospitalized pregnant women or
postpartum women in the maternity and gynecology wards at JUMC between February and June
2017 nearly 3 out of 10 women reported taking at least one type of conventional medicine for
self- medication, mainly analgesics was 92.3% (30). A community based cross sectional study
conducted in 2018 in Goba town on 323 pregnant mothers the prevalence of self-medication was
15.5% (31).

4
A cross-sectional study was employed among 400 pregnant women attending antenatal care
clinic at the University of Gondar Comprehensive Specialized Hospital between February 01 and
May 30, 2019 the prevalence of self-medication during the current pregnancy was 44.8%. Of all
respondents 38.0% and 12.5% used herbal and conventional medicine, respectively (2). An
institution-based mixed study design using a sequential explanatory approach employed in 2018
on 617 pregnant women and nine key informants in Addis Ababa revealed that the prevalence of
self-medication practice was 26.6% (21).

Institution based cross sectional study conducted with 244 pregnant women attending antenatal
care at Hiwot Fana Specialized University Hospital and Jugal Hospital from February to March,
2017 revealed that the prevalence of self-medication during current pregnancy was 69.4%; out of
which, 40.6% uses only herbal medicines to self-medicate (11).

2.2 Factors influencing self-medication

2.2.1 Socio demographic factors

Age had significant association with SM on pregnant women in different studies. A study
conducted in Ghana revealed that pregnant with age between18-24, 25-34 were greater practice
of SMs than age 35-45 (3). Another Hospital based cross-sectional study conducted showed that
the respondents aged between 20 to 30 years and 31 to 40 were less likely to practice self-
medication than those above 40 years old respondent (28), whereas studies on pregnant women
at Makongoro health center and Tanzania in 2018 reaveld that age and marital status were not
associated with self-medication (15). A study conducted in Indonesia observed that older
pregnant women were significantly more likely to self- medicate (24).

A facility based cross sectional descriptive study conducted in selected Ghanaian communities
revealed religion were significantly associated with SM in pregnancy (10). A study conducted in
Jima showed that Islam or Orthodox Christian religion followers were more likely to practice
self-medication during pregnancy than Protestant Christians and other religious groups (30).
Occupational status found to have a significant association with SM (28).

A study conducted in Indonesia observed that significant effects of a higher level of knowledge
on self- medication among women with lower income and education levels (24, 31). Farmer
pregnant women were less likely to use self-medication than those who were students; in contrast

5
a study in Nekemte told there is no significant association between monthly income, education
status, marital status and self-medication (28). In addition a study conducted in Goba town
revealed that pregnant women who can read and write and had primary education were more
likely to use self-medication (31). Another study conducted revealed that gender, marital status,
and chronic illness categories of the socio - demographic characteristics were not significantly
affect the risky practice (32).

2.2.2 Obstetric factors

A cross sectional study conducted in pregnant women at Makongoro health Centre, Tanzania,
self-medication was highest during first trimester and decreased as gestation age increased where
by less pregnant women self-medicated in the third trimester of pregnancy. However, gestation
did not emerge as a strong predictor for self-medication in pregnancy (33). In previous study
ANC follow-up were independent predictors of self-medication use The odds of using self-
medication were 71% less likely for pregnant women attending ANC services (31), whereas
other studies revealed there were no significantly associated between ANC visit (10, 28), timing
of first ANC, number of children previously born and SM (28).

2.2.3 Health Facility related factors

A study showed that the odds of those pregnant women whose distance from the health facility
was 5–10km were 90% less likely to practice self-medication compared to those pregnant
women who came from greater than 10km (29). Other study employed in Addis Ababa showed
the reasons for pregnant women to practice self- medication were long waiting time for provision
of health services (21).

2.2.4 Prior experience and Non-prescribed drug related factors

Based on the previous study findings, individuals’ previous experiences played an important role
in self-treatment (27). The probability of herbal medicine use among pregnant mothers who
have previous history of self-medication was about 9.90 times higher than mothers who have no
history of self-medication (20), and also the reasons why pregnant women practiced self-

6
medication were feeling that illness was not serious, self-medication is cheaper, easy access to
medicines from pharmacies or drug shops without prescription (21). Women who had health
problems during pregnancies were over six times more likely to use self-medication their
counterparts (31).

7
 2.3 Conceptual framework

The following conceptual framework developed based on evidences found in different studies
after reviewing different related literatures. There is association between dependent variables
with different independent variables (2, 3).

Socio demographic factors Obstetric factors

 Age  Gravidity
 Religion  Parity
 Educational level  Number of alive children
 Educational level of husband  Gestational age
 Marital Status  Previous history of abortion
 Occupational status  Time of first ANC visit
 Monthly income

Self-medication
practice
Health Facility related factors

 Waiting time
Prior experience and non-prescribed drug
 Availability of medications related factors
 Distance from health facility
 Access to drug without prescription
 Availability of Health professional
 Availability of pharmacy/drug store
 Availability of health facilities
 Cost of drugs
 Accessibility of health facility
 Illness as minor
 Prior experience with self- medicated drug

Figure1: Conceptual frame work for prevalence of self-medication practice and associated
factors among pregnant women at Sodo town, Southern Ethiopia, 2021.

8
 2. Objectives
3.1 General Objective

 To asses the prevalence of self-medication practice and associated factors among

pregnant women in selected households in sodo town, SNNPR, Ethiopia, 2021.

3.2 Specific objective

 To determine the magnitude of self-medication practice among pregnant women in

selected households in sodo town, Ethiopia 2021.

 To identify the associated factors of self-medication practice among pregnant women in

selected households in sodo town, Ethiopia 2021.

9
 3. Methodology
4.1 Study area

Sodo town is found 332 km from Addis Ababa and based on the 2007 Census conducted by the
Central Statistical Agency of Ethiopia (CSA) sodo town has a total population of 76,050 of
whom 40,140 are men and 35,910 are women. The study will be conducted in Sodo town. There
are 24 kebeles in Sodo town, of which 8 kebeles will be selected by simple random sampling.

4.2 Study design and period

A community based cross-sectional study supplemented with qualitative method will be
employed. The study will be conducted from April 2021 to May 2021.

4.3 Population

4.3.1 Source population

All pregnant women during the study period in Sodo town, Ethiopia. The key informants for the
in-depth interviews will be health extension coordinators, health extension workers and pregnant
mothers.

4.3.2 Study population

Quantitative study

All pregnant women found in selected kebeles of sodo town.

Qualitative study

The key informants (health extension coordinators, health extension workers and pregnant
mothers not included in the quantitative study).

4.4 Eligibility criteria

4.4.1 Inclusion criteria

Quantitative study

10
Pregnant women willing to participate in the study will be included.

Qualitative study

Health extension coordinators, health extension workers and pregnant mothers not included in
quantitative study.

4.4.2 Exclusion criteria

Quantitative study

Pregnant women who will be critically ill, on labor pain and unable to communicate at the time
of data collection will be excluded.

Qualitative study

Health extension coordinators, health extension workers not present during the collection time.

4.5 Sample size determination

Quantitative data

The sample size will be determined by using the single population proportion formula for the
prevalence. Using the assumptions of 95% confidence level and 5% marginal error and by
adding 10% non-response rates.

For the dependent variable taking prevalence of self-medication practice during pregnancy as
26.6% from a study conducted in Addis Ababa (21).

2
Zά
n= ( ) p ( 1− p)
2 where d = margin error which is 5%
d2
n = sample size
p = prevalence
Z = level of confidence interval
n= (1.96)^2(0.266) ((1-0.266) = 300
(0.05)^2
After using a 10% non-response rate the final sample size becomes 330.

11
Qualitative data

Study participants will be purposively and intensively selected to explore SM prevalence among
pregnant women and its factor. The interview will be guided by the degree of information
saturation or comes back to reputation during data collection.

4.6 Sampling procedure and Technique

Quantitative data

Participants will be selected out of the 24 administrative kebeles of the town using the simple
random sampling technique. From selected kebeles lists of households with pregnant women will
be obtained from health extensions. A sampling frame was designed and participants will be
proportionally drafted in each selected kebeles on the basis of the simple random selection
technique. In case of more than one pregnant woman in selected households, one of them will be
taken by the lottery method.

12
 Sodo
SodoTown
TownAdministration
Administration
kebeles
(24 (24 kebeles
) )

By using Simple random sampling (lottery method)

Selected
1 2 3 4 5 6 7 8
kebeles

Proportional allocation of study participants based on the number of pregnant women in each kebeles

Pregnant
1 2 3 4 5 6 7 8 women

Simple random sampling (330)

Figure 2: Schematic diagram of the sampling procedure for selecting pregnant women from
selected kebeles, 2021.

Qualitative data

Purposive and intensity sampling methods will be used to select health extension coordinators,
health extension workers and pregnant mothers to explore their perspectives regarding the
prevalence of SM among pregnant.

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 4.7 Study variable

4.7.1 Dependent variable

Self-medication practice (yes/no)

4.7.2 Independent variable

Socio demographic characteristics (age, marital status, educational status of women, educational
status of husband, religion, occupation of women).

Obstetric factors (gravidity, parity, gestational age, number of alive children, previous history of
abortion).

Health Facility related factors (Waiting time, Availability of medications, Availability of Health
professional, Availability of health facilities).

Prior experience and non-prescribed drug related factors (Access to drug without prescription,
Availability of pharmacy/drug store, Cost of drugs, Illness as minor, prior experience with self-
medicated).

4.8 Operational definition

Self –medication- is the use of conventional or herbal medicine by pregnant women without the
prescription of health care provider for the treatment of self-recognized disorders (2).

Conventional medicines- Is a medicine what you get from medical doctors, nurses, physical
therapists, psychologists, and similar health-care professionals (29).

Herbal medicine- Is the use of medicinal plants for the prevention and treatment of diseases (29).

4.9 Data collection instrument and procedure

4.9.1 Data collection instrument

Quantitative data

Quantitative (2, 3) data will be collected using an interviewer- administered structured

questionnaire. The structured interview questionnaire was adapted from previous studies , and
modified to fit the current study. The questionnaire was originally prepared in English, translated

14
to local language (Amharic), and then back translated to English to validate consistency. The
questionnaire consisted of questions related to socio-demographic factors, obstetric factors,
health facility related and previous medication use.

Qualitative study

An in-depth interview will be conducted with purposively and intensively selected key
informants by a Semi-structured interview guide. It will be conducted at their work station. The
PI starts the interview with open-ended questions and then uses probing questions depending on
the participant's responses. During the interview, tape recording and note-taking will be done by
the data collector until saturation will reach. On average the interview will last 15 to 20 minutes.
The interview will be narrated. Tape records will be transcribed word by word into the Amharic
language (the language of interview) then translated to English by the principal investigator with
the support of a person well versed with both languages.

4.9.2 Data quality control

Quantitative data
The data will be collected by four experienced Bachelor of Science in degree midwifes, health
extension workers and pharmacists. Pretest will be done on 5% of sample in sodo town among
non-selected kebeles. The PI and one master in nursing supervisor will be closely supervising the
entire data collection process. A one day training will be given for both data collectors and
supervisor concerning to data collection tool and data collection process. Data quality will be
also assured through designing proper data collection tool and continuous supervision. All
collected data will be checked for completeness by data collector and supervisor every day.

Qualitative data
For the in-depth interview, the questions will be translated to the local language (Amharic) for its
simplicity, validity, and clarity of the questionnaire and it will be collected through audio
recording and notes. The data collector will be trained. The principal investigator will supervise
the correct implementation of the data collection procedure and check the logical consistency
and completeness during data collection time.

15
 4.9.3 Data management and Data analysis

Quantitative data
Data will be entered into Epidata version 3.1 and analyzed using SPSS version 22. Descriptive
statistics including frequencies means and standard deviations will be calculated. The result will
be presented in the form of tables and graphs. For the inferential statistical significance, the test
will be applied to reflect the association between the variables. Based on the results, conclusion
and recommendation will be made. Each variable will be first analyzed by using a logistic
regression model and independent variables having a P-value of less than 0.2 will entered into a
multi-variable logistic regression model for final analysis.
In multi-variable logistic regression analysis, variables with a P-value of < 0.05 will be
considered as statistically significant. The total scores will be expressed using regression
coefficient (β), adjusted regression coefficients (β^), the 95% Confidence Interval (CI), and p-
values. The Hosmer- Lemeshow goodness fittest will be done to check model fitness.

Qualitative data
Results will be written based on notes and memos. Each interview will be transcribed and
translated to English by cross-checking both the audio record and the note. Transcripts of each
interview will be read and re-read to gain an understanding of the whole situation and then re-
read slowly to determine its significant features. The data will be classified into analytic units
and themes on the open code software. The accuracy of transcripts will be checked by repetitive
audiotapes and by reading transcripts. The final result will be presented in narratives and
triangulated to supports the quantitative result.

4. Ethical consideration

Ethical approval of the research proposal will be obtained from the ethical review committee of
Arbaminch university college of medicine and health science ,and then formal letter will be
written by the department of nursing to the concerned office. After the letter of permission will
be obtained the letter will be taken to Sodo town health director and respective head .During
the data collection time , the objective of the study will be clearly explained for the concerned

16
bodies, and any information forwarded will be kept confidential and names will not be
written or specified.

5. Dissemination of result

The result of the study will be delivered to Arbaminch University College Medicine and Health
Science. The study findings will also be given to Sodo health beauro, health facilities,
Arbaminch University and other relevant bodies. The finding will be presented on appropriate
seminars, conferences, and workshops, also effort will be made to publish in peer-reviewed
reputable journals.

6. Work plan

Table1: Work plan for prevalence of self-medication practice and associated factors among
pregnant women in selected households in Sodo town, SNNPR, Ethiopia, 2021.

S.no Activities Responsibl Feb March April May June

17
 e bodies
1 Develop & write a PI
proposal
2 Preparing study PI
tool (questioner)
3 Submission final PI
draft proposal and
defense
4 Ethical clearance REC
and approval
5 Prepare for PI
fieldwork
6 Select data PI
collector and
training for the data
collector
7 Per test PI &
DC
8 Data collection, DC& PI
entry & cleaning
9 Data processing & PI
analysis
10 Writing report PI
11 Submit of final PI
report and defense

7. Budget

S.no Description of cost Unit QUT Unit price Total Price

(Budget category)
1 Personal Daily wage per Multiplying factor
diem times working da
Data collector
Subtotal
2 Supplies and

18
 stationery
A4 photocopy paper
Photocopy cost
Printing binding
Flip chart paper
Transparency
Calculator
Pen and Pencil
Subtotal
3 Transport
Car
Subtotal
4 Training
Data collectors and
supervisor
Tea
Subtotal
Contingency
Grant total

8. Reference

1. organazation wh. guideline 2000.

2. Sema FD, Addis DG, Melese EA, Nassa DD, Kifle ZD. Prevalence and Associated Factors of
Self-Medication among Pregnant Women on Antenatal Care Follow-Up at University of Gondar
Comprehensive Specialized Hospital in Gondar, Northwest Ethiopia: A Cross-Sectional Study.
International Journal of Reproductive Medicine. 2020;2020:1-12.
3. SINA A. SELF-MEDICATION PERCEPTION AND PRACTICE AMONG PREGNANT
WOMEN IN WA MUNICIPALITY. 2017.
4. Sara A. Hanafy1* SAS, Ibrahim F. Kharboush3and Iman H. Wahdan. DRUG UTILIZATION
PATTERN DURING PREGNANCY IN ALEXANDRIA, EGYPT. 2016.
5. Mahmood Karimy1 MR-M, Mahmoud Tavousi3, Ali Montazeri3 and Marzieh Araban2,4*. Risk
factors associated with self-medication among women in Iran. 2019.
6. Mensur Shafie1* ME, Kedija Muzeyin2, Yoseph Worku3, Sagrario Martı´nArago´n4. Prevalence
and determinants of selfmedication practice among selectedhouseholds in Addis Ababa community. 2018.
7. Randa N. HaddadinID1☯* MA, Mayyada Wazaify3☯, Linda Tahaineh4 ☯. Evaluation of
antibiotic dispensing practice incommunity pharmacies in Jordan: A crosssectional study. 2019.
8. Shibiru6 GFDDGZNTBWETTTGFLAMGT. Self-Medication Practices and Associated
FactorsAmong Health-Care Professionals in Selected Hospitals of Western Ethiopia. 2020.
9. Ibironke C. Ojo1 NAO, Oluwakemi E. Adeola3, Modupe M. Adamolekun4, Rukayat F.
Adewoyin5. Factors Influencing Self-Medication Practice among Pregnant Women Attending Antenatal
Clinic in Primary Health Facilities in Akure South Local Government, Ondo State. 2020.
10. Fred Yao Gbagbo JN. Implications of self-medication in pregnancy for Safe Motherhood and
Sustainable Development Goal-3 in selected Ghanaian communities. 2020.

19
11. Abera Jambo1 GM, Mekonnen Sisay3, Firehiwot Amare1 and Dumessa Edessa1. Self-
Medication and ContributingFactors Among Pregnant WomenAttending Antenatal Care at Public
Hospitals of Harar Town, Ethiopia. 2018.
12. Mohammad Mohseni 1 SA-A,  Sepideh Gareh Sheyklo 3, Ahmad Moosavi 4, Majid Nakhaee
1, Fatemeh Pournaghi-Azar 5, Aziz Rezapour 6 7. Prevalence and Reasons of SelfMedication in Pregnant
Women: A Systematic Review and MetaAnalysis. 2018.
13. ACOG. Marijuana Use During Pregnancy and Lactation2017.
14. Werler MMHJvGJRCfDCaPARCMM. Maternal Periconceptional Illicit Drug Use and the Risk
of Congenital Malformations. 2009.
15. Ayesha C. Sujan MMER, PhD; A. Sara Öberg, MD, PhD; Patrick D. Quinn, PhD; Sonia
Hernández-Díaz, MD, PhD; Catarina Almqvist, MD, PhD; Paul Lichtenstein, PhD; Henrik Larsson, PhD;
Brian M. D’Onofrio, PhD. Associations of Maternal Antidepressant UseDuring the First Trimester of
Pregnancy With Preterm Birth,Small for Gestational Age, Autism Spectrum Disorder,and Attention-
Deficit/Hyperactivity Disorder in Offspring. 2017.
16. a FPaMMbPDBaPLV. Acute Premature Constriction of the Ductus Arteriosus after Maternal
Self-Medication with Nimesulide. 2008.
17. Organization WH. WHO Consolidated Guideline on Self-Care Interventions for Health. 2019.
18. De-Kun Li 1 JRF,  Roxana Odouli 2, Charles Quesenberry 2. Use of nonsteroidal
antiinflammatory drugs during pregnancy and the risk of miscarriage. 2018.
19. Hossein Ebrahimi1 GA, Farzaneh Amanpour3, Azam Hamidzadeh2,&. Self-medication and its
risk factors among women before and during pregnancy. 2017.
20. Fentahun Adane1* GS, Yoseph Merkeb Alamneh2, Worku Abie2, Melaku Desta3 and Bihonegn
Sisay4. Herbal medicine use and predictors among pregnant women attending antenatal care in Ethiopia:
a systematic review and metaanalysis. 2020.
21. Beza2 KGMBaSW. Self-medication practice and associated factors among pregnant women in
Addis Ababa, Ethiopia. 2018.
22. Woodman GSK. Interventions to reduce illicit drug use during pregnancy (and in the postpartum
period). 2016.
23. Azam Rahmani SAH, Arezoo Fallahi2, Reza Ghanei Gheshlagh3,4, Sahar Dalvand5. Prevalence
of Self-Medication among Pregnant Women: A Systematic Review and Meta-Analysis. 2021.
24. Rizka Novia Atmadani1, Owen Nkoka2, Sendi Lia Yunita1,2 and Yi-Hua Chen2*. Self-
medication and knowledge amongpregnant women attending primaryhealthcare services in Malang,
Indonesia: a cross-sectional study. 2020.
25. Angel Josabad Alonso-Castro a, Alan Joel Ruiz-Padilla a, Yeniley Ruiz-Noa , Clara Alba-
Betancourt a,Fabiola Domínguez c, Lorena Del Rocío Ibarra-Reynoso b, Juan José Maldonado-Miranda
d,Candy Carranza-Álvarez d, Christian Blanco-Sandate e, Marco Antonio Ramírez-Morales a,Juan
Ramón Zapata-Morales a, Martha Alicia Deveze-Álvarez a, Claudia Leticia Mendoza-Macías a,Cesar
Rogelio Solorio-Alvarado f, Joceline Estefanía Rangel-Velázquez a. Self-medication practice in pregnant
women from central Mexico. 2018.
26. BiBintsene-Mpika G MJ, 2Ndziessi G,3 Mozoma LO,4 Iloki LH,1 Abena AA3. Self-medication
practice among pregnant women in Brazzaville. 2018.
27. Kalyani3 ZFMKMMN. Experiences of self-medication among people: a qualitative meta-
synthesis. 2019.
28. Getu Bayisa Wakjira BGBaBGL. Prevalence of Self-medication and its Associated Factors
among Pregnant Women Attending Antenatal Care at Nekemte Referral Hospital, Oromia Regional State,
West Ethiopia. 2019.
29. Gobezie ATAGFSAMMY. Self-Medication and Associated Factors Among Pregnant Women
Attending Antenatal Care at Kemisie General Hospital, North East Ethiopia. 2020.
30. Seid Mussa Ahmed 1, *, Johanne Sundby 1, Yesuf Ahmed Aragaw 3 and Fekadu Abebe 1. Self-
Medication and Safety Profile of Medicines Used among Pregnant Women in a Tertiary Teaching
Hospital in Jimma, Ethiopia: A Cross-Sectional Study. 2020.

20
31. Taye Zewdie1 TA, Alemayehu Shimeka3 and Ayenew Molla Lakew3*. Self-medication
during pregnancy and associated factors among pregnant women in Goba town, southeast Ethiopia:
a community based cross sectional study. 2018.
32. Sirak Tesfamariam1* ISA, Ghide Kaleab1, Samson Berhane1, Biruck Woldai2, Eyasu Habte3
and Mulugeta Russom4. Self-medication with over the counter drugs, prevalence of risky practice and
itsassociated factors in pharmacy outlets of Asmara, Eritrea. 2019.
33. Karol J. Marwa1* AN, Deodatus Ruganuza2, Deogratias Katabalo3 and Erasmus Kamugisha4.
Self-medication among pregnant women attending antenatal clinic at Makongoro health centre in
Mwanza, Tanzania: a challenge to health systems. 2018.

9. Annexes
Annex I- Information sheet
Introduction
Hello? I am ___________from Arbaminch University. I am here with my colleagues to study about
SM. The main objective of this study is “to assess the prevalence of self-medication practice and
associated factors among pregnant women in Sodo town, Ethiopia.
Purpose of the Research Project: To determine the prevalence of self-medication practice and
associated factors among pregnant women in Sodo town, Ethiopia.

Risk and/or Discomfort:- Since the study will be conducted by taking appropriate information
from pregnant women and key informants, it will not cause any problem on the patients. The
name or any other identifying information will not be recorded on the questionnaire and all
information taken will be kept strictly confidential and in a safe place. The information gotten
will be used only for the study purpose.

Benefits: The research have no direct benefit for one whose document/ record is included in this
research. But the indirect benefit of the research for the participant and other clients in

21
the program is clear. This is because if program planners are preparing predicted plan there is a
benefit for clients in the program of getting appropriate care and treatment services. Of all, the
research work has a big direct benefit for health care planners and managers, especially for those
on SM prevention, treatment and support program planning and management

Confidentiality: To reassure confidentiality the data will be collected by those individuals

who are working in the facility and information will be collected without the name of the
clients. The information collected from this research project will be kept confidential and will be
stored in a file. In addition, it will not be revealed to anyone except the principal investigator.

Annexes II: Questioner

Quantitative study

This questioner is prepared to assess the prevalence of self-medication practice and associated factors

among pregnant women on Sodo town, Southern Ethiopia.

Section-1: Socio-Demographic Information

1. Age (in years) _______________

2. Marital status

a) Single b) Married

c) Divorced d) Widowed

3. Occupation

a) Governmental employed b) self-employee

c) Housewife d) Farmer

e) Student f) others (specify) ________________

22
4. Monthly income (in ETB) ________________________________________

5. Education level

a) Illiterate b) Primary school (1-8)

c) Secondary school (9-12) d) College/University student

e) Diploma/Degree

6. Education level of husband

a) Illiterate b) Primary school (1-8)

c) Secondary school (9-12) d) College/University student

e) Diploma/Degree

7. Religion

a) Orthodox b) Muslim

c) Protestant d) Catholic

e) Others ______________

Section-2: Obstetrics Information

8, Number of gravidity____________________________

9, Number of parity ____________________________

10. Number of alive child _____________________________

11. History of abortion

a) No b) Yes

12. If yes, the reason for abortion is

a) Health problem b) Low economic level

c) Unwanted pregnancy d) other

13. Stage of pregnancy

a) First trimester b) Second trimester c) Third trimester

14. Do you have ANC follow up for this pregnancy?

a) Yes b) No

15. If “yes” for Q, 14 at what month of your pregnancy?

a) First trimester (1-3 month) b) Second trimester (4-6 month) c) Third trimester (7-9month)

23
Section-3: Pregnant women’s attitude and prevalence on self-medication

16. Do you believe that self-medication is important for maternal health?

a) Yes b) No c) I have no any idea

17. Do you believe that self-medication is important for fetal health?

a) Yes b) No c) I have no any idea

18. At which trimester of pregnancy the negative effect of self-medication can mostly occur?

a) First trimester b) Second trimester

c) Third trimester d) I have no any idea

19. Do you believe that unusual health problem can occur on the infant(s) due to self-medication during
pregnancy?

a) Yes b) No c) I have no any idea

20. Have you fallen sick or experience any symptoms for the past month since you became pregnant?

a) Yes b) No

21. If yes, for Q-20, what did you do?

a) Went to the hospital/ clinic to see the doctor

b) Bought drug from the drug store

c) Took some herbal medication

d) Took some left over drugs from the previous visit

e) Took some medicine from a relative or friend

Section 4: Factors influencing self-medication

22. Did you have any passed experience with the drug without prescription?

a) Yes b) No

23. If yes, was it the reason for using the drug without prescription?

a) Yes b) No

24. How will you describe the sickness/ illness?

a) Illness are not serious (minor) b) Illness are serious

25. Distance from health facility (hospital or health center)

a) In km ______________ b) In time ______________

24
26. Does the facility have enough skilled professional to meet your health needs?

a) Yes b) No

27. How will you describe the waiting time at your health facility

a) Normal b) Short c) Long

28. How many times are you told there is no medicine in the facility since you became pregnant?

a) Never b) Sometimes c) Always

29. Is it difficult getting transportation to the health facility?

a) Yes b) No

Section-5: Self-Medication Practice by conventional medicine

30. Have you practiced self-medication by conventional medicine (modern medicine) during the current
pregnancy?

a) Yes b) No

(If your answer is “No” for question 30, please jump to Section 6 Q-36)

31. What makes you to practice self-medication by conventional medicine (modern medicine) (Reason
for selecting self-medication) during the current pregnancy?

a) Time saving b) Easily available

c) Better knowledge about the disease and the treatment d) Had prior experience to the drug

e) Other reason (specify) _______________________________

32. For what types of ailments have you practiced self-medication by conventional medicine (modern
medicine) during the current pregnancy?

a) Headache b) Nausea/Vomiting

c) Typhoid d) UTI

e) Common cold f) Diarrhea

g) Cough h) Other (specify) ______________________________

33. What is the name of the medicine(s) that you have used for self-medication by conventional medicine
(modern medicine) during the current pregnancy?

25
 a) Paracetamol b) Aspirin

c) Tetracycline d) amoxicillin

e) Cough syrup f) Hyoscine

g) Amoxicillin h) I don’t remember i) other (specify) __________

34. Who is your source of information about the conventional or modern medicine(s)?

a) Yourself b) Your husband

c) Your friend d) your neighbor

e) Internet f) Pharmacist/Druggist

g) Other health professional h) other (specify) __________________________

35. What did you know about the conventional or modern medicine(s) that you have used for self-
medication?

a) Dose b) Side effects

c) How to take d) No information

Section-6: Herbal Medicine Use Practice

36. Have you practiced herbal medicine for self- medication during the current pregnancy?

a) Yes b) No

(If your answer for Q-36 is “No” you have finished)

37. What makes you to practice herbal medicine use (Reason for selecting herbal medicine use) for self-
medication during the current pregnancy?

a) Herbal medicines are effective than conventional medicines

b) Herbal medicines have fewer side effects

c) Herbal medicines have lower cost

d) Herbal medicines are accessible without prescription

e) Herbal medicines are the only option

e) Other (specify) _______________________________

38. For what purpose and ailments have you used herbal medicine for self-medication?

a) Headache b) Nausea/Vomiting

c) Typhoid d) UTI

26
 e) Common cold f) Diarrhea

g) To facilitate labor h) to prevent abortion

i) Other (specify) _____________________________

39. What Types of herb(s) have you used for self-medication?

a) Ginger b) Garlic

c) Ruta chalepensis (Tena Adam) d) Ocimum lamifolium (Damakese)

e) Thyme (Tosign) f) other (specify) _________________

40. Who is your source of information about herbal medicine for self-medication?

a) Traditional healers b) Health professionals

c) Religious leaders d) Family and friends

e) Neighbors f) other (specify) _____________________________

Thank you for your willingness to participate in the study.

Name of data collector_______________________________

Signature_________________________________________

Date of data collection________________________________

Name of health facility_________________________________________

Qualitative study
Socio demographic characteristics
Age -------------

Year experience------------------

Starting time------------------------

Ending time----------------------------

Initial Open-Ended Questions

1. Please describe your current position and what your responsibilities are?

Intermediate Questions
2. What self-medication practice mean to you?

27
Probe: In your position, how do you access current research, or updates about self-medication practices?

3. What are the perceptions of people about self-medication?

4. What are the associated factors with self-medication?

5. What recommendations do you have for future efforts such as these?

 Is there anything more you would like to add?

 I'll be analyzing the information you and others gave me and submitting a draft report to your
facility in few months.

Thank you for your time!!!

10.Declaration

I hereby declare that this MSC student proposal is my original work in the fulfillment of
the requirement for master degree in Maternity and Reproductive Health nursing and
submitted to department of Maternity and Reproductive Health nursing, school of health
sciences ,college of medicine and health sciences , Arbaminch University .

Name: Silenat Gashaw

Signature _____________

Date ________________

This thesis proposal will be submitted for ethical review with approval of advisors

Advisors

28
Name Signature Date

Mr. Serawit Lakew _____________ _____________

Mr. Dinkalem Getahun _____________ _____________

29