| Abstract|| |
Background: Self-medication (SM) is defined as the use of medicines by individuals to treat self-diagnosed conditions or symptoms without professional consultation. SM is rampant in countries with limited access to health care and lack of stringent regulations and patient education. Without adequate knowledge and awareness, SM may prove fatal. However, if practiced correctly, it can save time and money. The present study was conducted with an objective to compare the patterns of SM in first-year and final-year dental students, at a tertiary care dental teaching institute in Delhi.
Materials and Methods: It was a quantitative, prospective, and descriptive cross-sectional study based on designed self-administered questionnaire, framed after consulting previous studies.
Results: The data were summarized as the number and percentage in the form of tables, graphs, and pie chart. Google percentage calculator was employed to calculate percentage and generate charts for pictographic representation of our results. Statistical analysis was done using SPSS software version 19, and Chi-square test was applied to identify the level of significance among variables.
Conclusions: SM is a regular practice by dental students and needs to be curbed at earliest. Such practice tends to influence their behavioral pattern of drug prescribing in future. There is a need to conduct regular continuing medical education and workshops to create awareness about risks and adverse consequences of SM to ensure rational and safe use of medicines including antibiotics. Committees should be constituted at hospital level to continuously monitor the dispensaries/pharmacy stores, to make sure that drugs are dispensed on authorized prescription. Dispensing personnel should be held accountable for every purchase made by the consumer.
Keywords: Dental students, drug prescribing, self-medication
|How to cite this article:|
Inder D, Kumar P, Akram MF, Manak S. A comparative study for the evaluation of self-medication practices among dental students in a tertiary care dental teaching institute in Delhi. J Educ Ethics Dent 2018;8:17-22
|How to cite this URL:|
Inder D, Kumar P, Akram MF, Manak S. A comparative study for the evaluation of self-medication practices among dental students in a tertiary care dental teaching institute in Delhi. J Educ Ethics Dent [serial online] 2018 [cited 2021 Apr 18];8:17-22. Available from: https://www.jeed.in/text.asp?2018/8/1/17/309668
| Introduction|| |
Self-medication (SM) is defined as the selection and use of medicines by individuals (or a member of the individual's family) to treat self-diagnosed condition or symptoms. It may include the reuse of a prescribed medicine for the same person, for the same problem, without professional consultation.,, The drugs used for SM are generally available over-the-counter (OTC), without need of prescription. Such drugs usually benefit, but are likely to cause adverse reactions.,
Correct SM practice can save time and money, in the absence of professional care. SM may be hazardous, if condition is undiagnosed/misdiagnosed or serious. In general, self-treatment is restricted to symptomatic relief only, for example, loperamide, if taken in acute diarrhea of infectious origin, will worsen the clinical condition.,
The phenomenon of SM is particularly rampant in few countries, based on access to health care, patient education level, and lack of stringent regulations, which leads to easy availability of prescription medicines OTC. This results in widespread use of such medicines leading to serious health problems.,, Many studies have reported that inappropriate SM may result in adverse drug reactions, prolonged suffering, and even drug dependency.,
SM is now increasingly being considered as a component of self-care. A high level of professional education is considered a predictive factor for SM. As per the reports of World Health Organization, a responsible SM can help prevent and treat ailments that do not require medical consultation and provides a cheaper alternative for treating common illnesses. Thus, individual gets opportunity to bear his/her prime responsibility with SM products.,,
Numerous SM studies on medical, pharmacy, and nursing personnel have been documented in literature.,, However, there is a paucity of literature on SM trend among dental students. Further, dental students in their 1st year are comparable to general population as far as the practice of SM is concerned. However, after 2nd year onward, they may differ from the general population because they are exposed to knowledge of drugs and diseases through pharmacology and other clinical subjects. Hence, the present study was planned with the objective of evaluating patterns of SM among first-year and final-year dental students.
| Materials and Methods|| |
This prospective, quantitative, descriptive cross-sectional study was conducted at a tertiary care teaching dental college in Delhi, North India. A pretested, self-administered questionnaire was designed after consulting previous studies on SM.,,, The questionnaire was accompanied by a consent form and an information sheet explaining the purpose of the study. The questionnaire consisted of twenty close-ended, multiple-choice questions. Some of the questions had multiple options to choose from. The pattern of drug use over the last 4 months was taken into consideration. Beyond this period, it is difficult to recall medication used for any indication.
The first part of questionnaire consisted of questions regarding demography of students such as age, gender, and year of the study course. The second part of the questionnaire consisted of questions related to reasons for SM, type of medicine used for SM, source of information regarding medication used, and type of outcome of SM. About 160 participants completely filled the questionnaire from January 2014 to January 2016. For better understanding, the exact meaning of certain terms, such as SM, antipyretic drugs, periodontal diseases, and halitosis, was explained to the students before the initiation of the study.
The students were categorized into two groups:
- Group 1: First-year dental students (n = 81)
- Group 2: Final-year dental students (n = 79).
The questionnaires were distributed in the classrooms and collected immediately after completion. The survey being descriptive, the data were summarized as the number and percentage and depicted in tables, graphs, and pie chart using Google percentage calculator. The data were analyzed statistically using SPSS software version 19. Chi-square test was applied to identify the significant association among variables. P < 0.05 was considered statistically significant.
| Results|| |
The results obtained from the study are as following:
- Demographic characteristics of the study groups are shown in [Table 1]
- The percentage of awareness regarding the drug used for SM in both the study groups is shown in [Table 2]. Overall, Group 2 was more involved in SM practice compared to Group 1, which may be due to the introduction of pharmacology as a subject along with other clinical subjects from 2nd year onward during dentistry course
- Comparison of various factors affecting SM is depicted in [Figure 1]
- The sources of drug information used by both the groups are depicted in [Figure 2]
- Diseases for which SM practiced in both the study groups are summarized in [Table 3]
Headache remained the most common indication compelling SM, followed by fever in both the groups. Cough and cold are the third most common indications for SM.
- The type of drugs used in SM is depicted in [Figure 3] and [Figure 4] for Group 1 and Group 2, respectively.
|Figure 3: Type of medication used for self-medication (first-year dental students)|
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|Figure 4: Type of medication used for self-medication (final-year dental students)|
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The most common drugs used for SM have emerged out to be nonsteroidal anti-inflammatory drugs (NSAIDs) in both the groups. Surprisingly, not a single student ever practiced systemic antibiotics and laxatives as SM. A significant percentage of students from both the groups used herbal/unani/alternate medicine by their own, without consultation.
| Discussion and Conclusions|| |
SM is a rising concern among health-care students, leading to serious health consequences., It influences professional decision-making for prescriptions, among future doctors. Indirectly, such attitude affects the right counseling of their patients.,
The present study has been conducted exclusively on the dental students from 1st year and final year, pursuing degree from a reputed dental college in Delhi, India. The prevalence of SM (calculated using frequencies dialog window in SPSS version 19) is 73%, with a confidence interval of 99% (P < 0.05) in the present study. The result is statistically significant among the students of final year, irrespective of exposure to pharmacology subject. Globally, the prevalence of SM is as low as 38.2% (Ethiopia) to as high as 98% (Palestine).,
A total of 160 dental students participated in the study.
The findings of this study revealed that the majority of the students self-medicate. The nature and type of medicines used vary among senior and junior students. Sixty percent of male students in the 1st year and 51% of female students in the final year have been found to be in practice of SM [Table 1]. All students in the final year (100%) have been found to be aware of the concept of brand drug, generic drug, and OTC medicine in comparison to 1st year where only brand name concept was known to 50% of students. A significant percentage of (93%) final-year students have practiced SM before course completion in comparison to first-year students (29%). Eighty-seven percent of students in the final year have been in a habit of reading the instructions on package inset/drug strip in comparison to 1st year (40%) [Table 2].
In both the groups, final year and first year, the indication of SM has been found to be headache (94% vs. 83%, respectively) and fever (37% vs. 36%, respectively), followed by cough and cold (34% vs. 14%, respectively). Surprisingly, among both the groups, not a single student (0%) self-medicated for treating constipation and for body building purpose [Table 3].
Minor illness (97% vs. 82%, respectively) and constraint of time (95% vs. 90%, respectively) have been the most significant factors among final-year students compelling SM in comparison to first-year students [Figure 1].
The most common source of drug information among final year students has been found to be media in the form of television, internet or published drug information (35%), followed by past prescription (33%). Among first-year students, medical personnel (26%) have been the most sought source of drug information followed by past prescription (24%) [Figure 2].
The type of medication used most for SM, among final-year and first-year students, has been found to be analgesics–antipyretics, i.e., NSAIDs (59% vs. 70%, respectively), followed by antihistamine (17% vs. 10%, respectively). About 5% of students among final year and 10% of students among 1st year have self-practiced unani/herbal/alternate medicine [Figure 3] and [Figure 4].
The present study has revealed that SM practice is very much rampant among final-year dental students compared to first-year students. The contributing factors for SM have been found to be acquisition of knowledge of pharmacology along with other clinical subjects, their day-to-day dealing with patients during their clinical postings, and learning prescription of drugs as a part of curriculum., Even some studies have reported the above-mentioned factors to be responsible for SM.,
It is observed that preferring SM for minor illnesses might compel to take of excessive or inadequately low doses, sometimes wrong diagnosis, leading to delay in seeking professional opinion. Easy accessibility to drug store may be related to the white lab coat worn by doctors. Students have been found to misuse white coat for easy purchase of drugs without prescription, as white coat imparts professional look.
The use of herbal/unani/alternate medicine drugs for SM may be related to common belief in Indian society that these drugs are safe and free from adverse effects, irrespective of the dose., In congruence with other studies, analgesic–antipyretic group, i.e., NSAIDs, has been the most common drug class used for SM followed by antihistamines.
The teachers and parents play an important role in inculcating best medicine practices. As these students are future dental practitioners, SM as a regular practice by them should be curbed, as their behavior may influence their pattern of drug prescribing. Senior students should be a role model for junior students for inculcating prescribing pattern. There is a need to conduct regular continuing medical education and workshops to sensitize and create awareness about risks and adverse consequences of SM, to ensure rational and safe use of drugs including antibiotics.
Stringent hospital and pharmacy policies must be framed to control SM. Committees should be constituted at hospital level for continuous monitoring of dispensaries/pharmacy stores, to dispense drugs for authorized prescription only. Dispensing personnel should be held accountable for every purchase made by the consumer.
Limitations of study
The main limitation of our study is the smaller sample size (n = 160); therefore, the results cannot be generalized. Educational background of the parents of the participants, socioeconomic status, cultural practices, and belief system of participants in allopathic and herbal/alternate medicine could not be incorporated in the study. These aspects may be helpful to conduct further studies on a large sample, which will help in guiding and formulating important policies and strategies, to educate the community regarding SM.
The authors are grateful to the dental students of our institution for participating in this study.
Financial support and sponsorship
Conflict of interest
There are no conflicts of interest.
| References|| |
Atray M, Kumar R. Self medication pattern and its comparison among medical and non-medical college students of Udaipur, India. Int J Curr Res Rev 2013;5:36-43.
Nandha R, Chhabra MK. Prevalence and clinical characteristics of headache in dental students of tertiary care teaching dental hospital in Northern India. Int J Basic Clin Pharmacol 2011;2:51-5.
Aditya S. Self-medication among dental undergraduate students: A growing concern. Int J Pharm Sci Res 2013;4;1460-5.
Klemenc-Ketis Z, Hladnik Z, Kersnik J. Self-medication among healthcare and non-healthcare students at university of Ljubljana, Slovenia. Med Princ Pract 2010;19:395-401.
Afolabi AO, Akinmoladun VI, Adebose IJ, Elekwachi G. Self-medication profile of dental patients in Ondo state, Nigeria. Niger J Med 2010;19:96-103. [Full text]
Kalyan VS, Sudhakar K, Srinivas P, Sudhakar G, Pratap K, Padma TM. Evaluation of self-medication practices among undergraduate dental students of tertiary care teaching dental hospital in South India. J Educ Ethics Dent 2013;3:21-5. [Full text]
Corrêa da Silva MG, Soares MC, Muccillo-Baisch AL. Self-medication in university students from the city of Rio Grande, Brazil. BMC Public Health 2012;12:339.
Guille C, Sen S. Prescription drug use and self-prescription among training physicians. Arch Intern Med 2012;172:371-2.
Longman LP, Martin MV. The use of antibiotics in the prevention of post-operative infection: A re-appraisal. Br Dent J 1991;170:257-62.
Qato DM, Alexander GC, Conti RM, Johnson M, Schumm P, Lindau ST, et al.
Use of prescription and over-the-counter medications and dietary supplements among older adults in the United States. JAMA 2008;300:2867-78.
Verma RK, Mohan L, Pandey M. Evaluation of self – Medication among professional students in North India. Proper statutory drug control must be implemented. Asian J Pharm Clin Res 2010;3:60-4.
Donatsky O. Epidemiologic study on recurrent aphthous ulcerations among 512 Danish dental students. Community Dent Oral Epidemiol 1973;1:37-40.
Pratibha PK, Prerna J, Meena AK, Bhat KM. Association of reccurent apthous ulcers with stress among students in an Indian dental institution. Natl J Integr Res Med 2012;3:141-7.
Porter SR, Scully C, Pedersen A. Recurrent aphthous stomatitis. Crit Rev Oral Biol Med 1998;9:306-21.
World Health Organization. Guidelines for the Regulatory Assessment of Medicinal Products for Use in Self Medication. Geneva: World Health Organization; 2000.
World Health Organization. Report of the WHO Expert Committee on National Drug Policies. Geneva: World Health Organization; 1995.
Gutema GB, Gadisa DA, Kidanemariam ZA, Berhe DF, Berhe AH, Hadera MG, et al
. Self-medication practices among health sciences students: The case of Mekelle university. J Appl Pharm Sci 2011;1:183-9.
Badiger S, Kundapur R, Jain A, Kumar A, Pattanshetty S, Thakolkaran N, et al.
Self-medication patterns among medical students in South India. Australas Med J 2012;5:217-20.
Souza LA, da Silva CD, Ferraz GC, Sousa FA, Pereira LV. The prevalence and characterization of self-medication for obtaining pain relief among undergraduate nursing students. Rev Lat Am Enfermagem 2011;19:245-51.
Carneiro DS, Valoz Ferreira FE, Filho MS, Cardoso da Silva FA, Pereira CM. Self Medication in Dentistry Students at Paulista University. Vol. 16. Goiania-Goias: RFO Passo Fundo; 2011. p. 252-5.
Jagadeesh K, Chidananda KN, Sreenivas P, Revankar NS. Study on self-medication among 2nd
year medical students. Int J Basic Clin Pharmacol 2015;4:164-7.
Haque S, Alam NN, Mushroor S, Sultana N. Association between self-medication behavior and adherence among medical students in Dhaka, Bangladesh. Asian J Pharm 2017;11:S346.
Montgomery AJ, Bradley C, Rochfort A, Panagopoulou E. A review of self-medication in physicians and medical students. Occup Med (Lond) 2011;61:490-7.
Sontakke SD, Bajait CS, Pimpalkhute SA, Jaiswal KM, Jaiswal SR. Comparative study of evaluation of self-medication practices in first and third year medical students. Int J Biol Med Res 2011;2:561-4.
Ehigiator O, Azodo CC, Ehikhamenor EE. Self medication with antibiotics among Nigerian dental students. Tanz Dent J 2010;16:48-54.
Jain S, Malvi R, Purviya JK. Concept of self-medication: A review. Int J Pharm Biolo Arch 2011;2:831-6.
Banerjee I, Bhadury T. Self-medication practice among undergraduate medical students in a tertiary care medical college, West Bengal. J Postgrad Med 2012;58:127-31. [Full text]
Porteous T, Bond C, Hannaford P, Sinclair H. How and why are non-prescription analgesics used in Scotland? Fam Pract 2005;22:78-85.
Adedapo HA, Lawal AO, Adisa AO, Adeyemi BF. Non-doctor consultations and self-medication practices in patients seen at a tertiary dental center in Ibadan. Indian J Dent Res 2011;22:795-8. [Full text]
Sawalha AF. Assessment of self-medication practice among university students in Palestine: Therapeutic and toxicity implications. The Islam Univ J 2007;15:67-82.
Abay SM, Amelo W. Assessment of self-medication practices among medical, pharmacy, and health science students in Gondar university, Ethiopia. J Young Pharm 2010;2:306-10.
Akram MF, Manak S, Inder D, Alvi S. Self-medication practices and attitude among dental students of a Metro city of North India. Int Arch BioMed Clin Res 2018;4:118-21.
Bennadi D. Self-medication: A current challenge. J Basic Clin Pharm 2013;5:19-23.
Albasheer OB, Mahfouz MS, Masmali BM, Ageeli RA, Majrashi AM, Hakami AN. Self-medication practice among undergraduate medical students of a Saudi tertiary institution. Trop J Pharm Res 2016;15:2253-9.
Shamsudeen SM, Priya RS, Sujatha G, Muruganandhan J, Manikandan K. Self-medication with antibiotics: A knowledge, attitude, and practice appraisal of 610 dental patients in Chennai, India, from 2016 to 2017. J Educ Health Promot 2018;7:66.
Kasulkar AA, Gupta M. Self medication practices among medical students of a private institute. Indian J Pharm Sci 2015;77:178-82.
] [Full text]
James H, Handu SS, Al Khaja KA, Otoom S, Sequeira RP. Evaluation of the knowledge, attitude and practice of self-medication among first-year medical students. Med Princ Pract 2006;15:270-5.
Inder D, Kumar P. The scope of nano-silver in medicine: A systematic review. Int J Pharmacogn Chin Med 2018;2:000134.
Inder D, Kumar P. Sedative-hypnotic effect of ash of silver in mice: A reverse pharmacological study. J Tradit Complement Med 2014;4:268-71.
] [Full text]
Patel PM, Prajapati AK, Ganguly B, Gajjar B. Study on impact of pharmacology teaching on knowledge, attitude and practice on self-medication among medical students. Int J Med Sci Public Health 2013;2:181-6.
Kumar N, Kanchan T, Unnikrishnan B, Rekha T, Mithra P, Kulkarni V. Perceptions and practices of self-medication among medical students in coastal South India. PLoS One 2013;8:e72247.
Inder D, Pawan Kumar P. Pharmacovigilance in India: A rising concern towards safe medication. Use J Adv Res Med 2015;2:07-12.
Dr. Md Faiz Akram
Department of Pharmacology, FOD, Jamia Millia Islamia, Okhla, New Delhi - 110 025
Source of Support: None, Conflict of Interest: None
[Figure 1], [Figure 2], [Figure 3], [Figure 4]
[Table 1], [Table 2], [Table 3]