RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES BENGALURU, KARNATAKA
PERFORMA FOR REGISTRATION OF SUBJECTFOR DISSERTATION
1. / NAME OF THE CANDIDATE AND ADDRESS / Ms. DIMPLE. C. GABRIEL1ST YEAR MSc. NUSRSING
THE OXFORD COLLEGE OF NURSING,
NO.6/9 & 6/11,1ST CROSS,
BEGUR ROAD, HONGASANDRA, BENGALURU– 560068
2. / NAME OF THE INSTITUTION / THE OXFORD COLLEGE OF NURSING,
NO.6/9 & 6/11,1ST CROSS,
BEGUR ROAD, HONGASANDRA, BENGALURU– 560068
3. / COURSE OF STUDY AND SUBJECT / MASTER OF SCIENCE IN NURSING
CHILD HEALTH NURSING
4. / DATE OF ADMISSION TO THE COURSE / 11/06/2012
5. / TITLE OF THE
TOPIC / A STUDY TO ASSESS THE KNOWLEDGE AND PRACTICES OF SELF MEDICATION AMONG ADOLESCENTS IN SELECTED COLLEGES, BENGALURU WITH A VIEW TO DEVELOP AN INFORMATIONAL BOOKLET.
6. BRIEF RESUME OF THE INTENDED WORK
INTRODUCTION
“Let food be thy medicine and not medicine be thy food”
-Hippocrates
Medications are one of the main options in the cure, treatment, and prevention of numerous medical conditions.Infact, medications are the primary treatment client associate with restoration of health.1
Self medication can be defined as obtaining and consuming drugs without advice of a physician either for diagnosis, prescription or surveillance of treatment. There is a lot of public and professional concern about the irrational use of drugs. Knowledge of their side effects leads to serious long term deleterious complications. Self medication is the treatment of common health problems with medicines especially designed and labeled for use without professional supervision and approved as safe and effective for such use. These medications do not require a prescription for purchase and are thus called non-prescription medicines.2
According to WHO self-medication is defined as the selection and use of medicines by individual to treat self recognized illness or symptoms. Self medication is one element of self care3.self medication can take place through the consumption of industrialized or manipulated medicines or the use of home remedies (teas, herbs etc)and include various type of activities-acquiring medicines without a prescription, resubmitting old prescriptions to purchase medicines, sharing medicines with relatives or member of one social circle, using left over medicines stored at home or failing to comply with professional prescription either by prolonging it or interrupting it too early or decreasing or increasing the originally prescribed dosage4
The consumption of medications can be considered an indirect indicator of the quality of health care services. Children and adolescents are strongly susceptible to the irrational use of drugs with and without medical control. Economic, political and cultural factors have contributed to the growth and spread of self-medication worldwide. These factors are related with aspects such as the great availability of products in the current days; the state of health that a pharmaceutical agent may represent; irresponsible publicity; pressure to convert prescription-only drugs into over-the-counter drugs; quality of health care; difficult access to health care services in poor countries.5
There are many public and professional concerns about irrational use of drugs. The prevalence rate is high all over the world up to 68% in European countries, 57% in USA, 92% in adolescence of Kuwait. The prevalence rate of self medication and self care are 31% in India, 59% in Nepal and 51% in Pakistan6. A study was conducted to assess the prevalence of self-medication in Brazilian children. The finding showed self medication ranging from 7.1 to 53.2%for different age groups.5
A study was conducted to describe and examine the pattern of medication use among adolescence in Kuwait. The result showed that prevalence of self medication among high school students was 92% and concluded that self medication tend to increase with age and differed between male and female students. Few students consulted pharmacist for information on drugs.7
A news paper report regarding the self medication practices pointed that a 19-year-old girl consumed pills 4 times without consulting a gynecologist. She experienced abdominal cramps, skin allergies and vomiting sensation and was hospitalized. Adolescents prefer to use the morning after pill without consulting a medical practitioner. 8
Self medication is dangerous and it has wide range of ill effects. The ill effects include bleeding in the stomach, acidity, nausea, vomiting, diarrhea, constipation, dizziness, rashes, and headaches, dryness in the mouth, stomach pain, and blurred vision, ringing in the ear, restlessness, confusion, reduced concentration, and allergic reaction like swelling of lips, face, and tongue. It may also increase blood pressure which counteract the effect of some blood pressure medicines, cardiacfailure.5
6.1 NEED FOR THE STUDY
Self- medication is a problem that exists world-wide. The practice of taking medications to treat without consulting a doctor is hazardous to man and an apparent public health problem. In developing country like India the system of self-medication is flourishing due to various factors like socioeconomic factors, lifestyle, previous experience of treating a similar illness, ready access to drugs and the increased potential to manage mild illness through self-care. Self-medication is a problem that has the potential to harm society at a large as well as individual patient. Self-medication provides a lower cost alternative for people who cannot afford the cost of clinical services which all contribute to the spread of self-medication.9
Self-medication begins in early adolescence, often during the middle school years. By the age of 16, nearly all adolescents have taken medicine independently. There is considerable variation, however, in the age at which independent self-care is achieved, as well as in the accuracy of medication and dosage selection.10
Stoelben and colleagues evaluated the medication knowledge of a group of 53 adolescents in Dresden, Germany. Fifty-six percent of the students had taken at least one medication during the previous 2 weeks, with the most common agents being analgesics and antipyretics. Girls reported taking significantly more medications than boys. Despite the relative frequency of medication use; these students had little understanding of common medication information. On a test of medication knowledge, the mean score was only 5.74 ± 1.89 out of a possible 13. Forty-seven percent were able to select the correct definition for an antibiotic, but only 6% could define analgesic. Sixty-two percent of the students said they read the package insert for prescription drug information, with physicians listed as the second most commonly used information source. On the assessments of drug knowledge, girls performed significantly better than boys (p<0.05). Parental education had no influence on medication knowledge. In spite of their relatively low scores on the medication knowledge test, 55% of the students rated their knowledge as satisfactory, 19% as good, and 11% as sufficient. One student labeled his knowledge as very good and one as bad. The results suggest that while self-medication is common among adolescents, they may have significant knowledge deficits which may predispose them to medication misuse and/or adverse effects.10
A survey was conducted among 86 adolescents between 10 and 14 years of age about their medication use.Eighty-eight percent of the subjects reported having access to medicine in their household. Despite their access, 64% reported that they had asked a parent or guardian for the last dose of medicine that they took, while 36% took medicine independently. When asked to choose an appropriate medication for common illnesses, 62% of the students were able to correctly identify antipyretics for a headache. Analgesics were appropriately identified by 87% of the subjects, but only 15% were able to select appropriate therapy for menstrual pain. The selection of cough and cold products was made appropriately by 50-60% of the students.10
The frequency of self-medication was assessed in an international cross-sectional survey of 123,227 students in 2003. In this study health behavior in school-aged children database was utilized to identify medication use characteristics in three age groups: 11, 13, and 15 years. In all 28 countries included in the database, analgesic use was higher in girls than boys. Use of analgesics for headaches increased by age, but medications for inability to sleep or nervousness declined. Use of medications for stomachache increased by age in girls, but decreased in boys. Data from the United States revealed analgesic use for headache in 48.9% of boys and 65.9% of girls, with medication for stomachache used in 20.5% of boys and 34.6% of girls, while medications for sleeplessness or nervousness were used in 10% or less.7
The use of medications for dysmenorrheal by adolescent girls has been studied by several investigators. A survey was conducted among 76 healthy adolescent girls with moderate to severe dysmenorrheal. The patients were interviewed upon enrollment into a clinical study of oral contraceptives for the treatment of dysmenorrheal. Symptoms were reported as moderate in 42% of the young women and severe in 58%. Seventy-three patients (93%) reported taking at least one medication for menstrual pain. The majority (91%) used OTC medications, but 21% reported obtaining additional prescription medications, including acetaminophen and codeine, ibuprofen and hydrocodone, and rofecoxib. A third of the patients used at least two types of medication, and 15% used three types. Approximately 70% took doses which were less than 50% of the recommended maximum daily dose. Fewer than 10% of the patients took the full daily dose.10
In a study of 650 adolescents with recurrent migraines or tension headaches, 22% were determined by investigators to be overmedicating with OTC analgesics (taking more than three doses per week for more than 6 weeks). Approximately 14% of the patients, all between 6 and 18 years of age, were self-medicating without telling their parents. The authors of the study reported that 85% of the adolescents were considered high-achievers. They suggested that these patients may be using OTC medications in place of exercising, eating better, or using other non-pharmacologic means of minimizing stress.10
A study was conducted on ‘self-medication and non-doctor prescription practices in Bokhara valley, western Nepal’. Questionnaire method was used to collect data from 142 respondents. Paracetamol, analgesics and antacids were the drugs most commonly prescribed drugs. A significantly higher proportion of young (<40 years) male respondents had used self-medication than other group. Average number of drugs used per person was 1.23 and stoppage of drug in between was due to economic restraints. Among the respondents 25% were students who practiced self-medication which was significant.11
A cross-sectional study was conducted on ‘assessment of self-medication practices among medical, pharmacy, and health science students in Gondar University, Ethiopia. The study aimed at assessing the magnitude and factors of self-medication. A questionnaire was used for the study. Out of 414 students, 213 reported at least one episode of an illness, and 82 of them practiced self-medication. Most drugs for self-medication were obtained from the pharmacy or drug shops; and the most commonly used drugs were paracetamol and non-steroidal anti-inflammatory drugs. Common reported illnesses were fever and headache (24.8%) followed by cough and common cold (23.9%). Prior experience and the non-seriousness of the illness were the top two reported factors for self-medication. Study concluded that, self-medication was practiced with a range of drugs from the conventional analgesics to antibiotics.12
These above studies shows the fact that even the younger generations are at the risk of the problems from self- medication which emphasizes the need for creating awareness. Though rise in self- medication practice is more in adult group it is found to be still more in student population where unsafe use of antibiotics, analgesics, antacid and vitamin supplement are common5.
In view of the above facts and interest in the topic, the researcher felt a great need to assess the knowledge and practices of self-medication among adolescents and to educate them by providing an information booklet.
6.2 REVIEW OF LITERATURE
One of the most important early steps in a research project is the conducting of the literature review. A literature review is an account of what has been published on a topic by accredited scholars and researchers. In writing the literature review, the purpose is to convey to the reader what knowledge and ideas have been established on a topic, and what their strengths and weakness are. A literature review discusses published information in a particular subject area and sometimes information in a particular subject area within a certain time period5
This chapter deals with the literature which is reviewed and relevant to the present study and organized under the following headings.
6.2.1 Studies related to prevalence of self medication
6.2.2Studies related to knowledge and practices of self medication
6.2.1Studies related to prevalence of self medication
Across sectional survey was conducted on 200 participants randomly selected from the coastal regions of south India. Each participant underwent a face to face interview with the help of a structured questionnaire the result reported self medication use by 71% of the subjects, which ranged from a frequency of at least one time to a maximum of 5 times and above. Lack of time (41.5%), minor illness (10.5%) and quick relief (10%) were cited as the most common reason for self medication use. The majority of the participants (93.5%) were not aware about the side effects of sm. Findings revealed females and people living in urban areas are more likely to use self-medication than males and people in rural areas.13
A descriptive study was conducted about self-medication among children and adolescents in Germany to investigate the prevalence and correlates of self-medication .17 450 children aged 0–17 years participated in the 2003-2006 German health interview and examination survey for children and adolescents. The result was 25.2% of participants reported self-medication. Self-medication accounted for 38.5% of total medicine use and included all medication classes. These clustered among drugs acting on the respiratory system (32.1%), alimentary tract and metabolism (21.6%), skin (14.2%) and nervous system (11.3%), as well as homoeopathic preparations (8.6%). Vitamin preparations were most frequently used with a weighted user prevalence of 4.7% followed by cough and cold medicines 4.4% and analgesics 3.7%. Overall use of aspirin among children <12 years old was 0.3%, particularly among children <6 years old. Use of self-medication was closely related to older adolescent ages of between 14 and 17 years, children with a poor health status, with no immigration background, from families with a higher household income and with mothers with a higher educational level .the conclusion was self-medication use is highly prevalent in Germany, particularly among children and adolescents from families with a higher socioeconomic status.14