|Year : 2016 | Volume
| Issue : 2 | Page : 180-184
Assessment of abuse of self-medication for oral and dental problems among 21–60 years aged populace residing in the rural areas of Belgaum Taluk, Karnataka, India: A questionnaire study
Sweta Gandhi1, Rahul A Gandhi2, Abhishek Singh Nayyar2
1 Department of Public Health Dentistry, VSPM Dental College and Hospital, Nagpur, Maharashtra, India
2 Department of Oral Medicine and Radiology, Saraswati-Dhanwantari Dental College and Hospital and Post Graduate Research Institute, Parbhani, Maharashtra, India
|Date of Web Publication||20-Dec-2016|
Abhishek Singh Nayyar
44, Behind Singla Nursing Home, New Friends Colony, Model Town, Panipat - 132103, Haryana
Source of Support: None, Conflict of Interest: None
Background: The practice of self-medication has been recognized since ages. There has been enough literature available regarding it being there for medical illnesses; however, there is a dearth of information about it for dental causes. Hence, this study was designed to determine the abuse of self-medication for dental illnesses and the reasons for resorting to it. Materials and Methods: This study was conducted in 10 taluks of Belgaum district. Totally, 230 consenting respondents were selected by random sampling from 10 villages and interviewed with the aid of 18-point, closed-ended question-based, semi-structured questionnaire. Results: Odontalgia was the most common reason for which people resorted to self-medication (57.69%). 70% of the respondents did not have the knowledge about the dose, duration, side effects, and interactions of drugs they had used. Paracetamol was the most commonly used drug for self-medication. Conclusion: Analgesics were the most common drugs abused for self-medication. Adequate health education of the populace was found mandatory to make people aware of the use and misuse of drugs, especially analgesics, and regarding the potential adverse effects they can show, especially when used repeatedly, or on a chronic basis. Furthermore, dental health-care services were supposed to be made readily available and affordable so that self-medication among rural patients could be reduced to the barest minimum.
Keywords: Dental illnesses, rural population, self-medication
|How to cite this article:|
Gandhi S, Gandhi RA, Nayyar AS. Assessment of abuse of self-medication for oral and dental problems among 21–60 years aged populace residing in the rural areas of Belgaum Taluk, Karnataka, India: A questionnaire study. Arch Med Health Sci 2016;4:180-4
|How to cite this URL:|
Gandhi S, Gandhi RA, Nayyar AS. Assessment of abuse of self-medication for oral and dental problems among 21–60 years aged populace residing in the rural areas of Belgaum Taluk, Karnataka, India: A questionnaire study. Arch Med Health Sci [serial online] 2016 [cited 2017 Mar 25];4:180-4. Available from: http://www.amhsjournal.org/text.asp?2016/4/2/180/196207
| Introduction|| |
Health-seeking behavior is a typical response seen in individuals in the presence of illnesses, especially when pain is the attending feature. This response for optimal wellness and recovery is usually a function of individual, societal, and environmental factors. Self-medication is an age-old practice. Urge of self-care, feeling of sympathy toward family members and individuals known, in sickness, lack of adequate infrastructure for optimal health-care services, poverty, ignorance, misbelieves, extensive information available from various sources regarding drugs with intentional portray of their being effective in specific illnesses in the media as marketing strategies without highlighting their adverse effects and their easy accessibility are the main factors responsible for the ever-rising trend of self-medication. In developing countries like India, easy availability of a wide range of drugs coupled with inadequate health services results in an increased proportions of drugs being abused as self-medication.
Self-medication is the treatment of common illnesses with drugs which are approved as being safe and effective for use without medical supervision. Drugs for self-medication are popularly called as nonprescription or “over-the-counter” drugs. Indeed, the role of self-medication cannot be completely denied in the existing health-care scenario where the doctor-population ratio according to the World Health Organization (WHO) guidelines is still too less, however, it has been commonly observed that drugs normally used as self-medication are most commonly abused and lead to associated adverse effects on repeated and long-term unintentional usage to cure an illness symptomatically.
The easy accessibility to the commonly abused drugs further adds to this problem, the more so, in the developing countries and especially in the rural backdrop, where the market freely supplies even the prescription medicines, supposed to be taken under strict medical supervision, without a prescription, due to lack of strict implementation of regulations and monitoring by drug regulatory authorities. The reuse of leftover medicines for curing similar illnesses in future, if need arises, and a reckless discontinuation of the drugs after getting symptomatic relief are other significant areas of concern.
Despite the growing research interest in self-medication, little information has been available about its major determinants, especially in developing countries. In a country like India, most of the country's population lives in villages, and paradoxically, most of the country's doctors are in urban areas.
Odontalgia, i.e., toothache, is a painful condition which is frequently associated with self-medication with commonly available analgesics. Many patients present to the dental clinics also for treatment; however, prior to seeking treatment, most of these patients are seen to have been resorting to repeated abuse of self-medication with nonprescription analgesics (NPAs) and some, unintentionally, overdose too, on these products in case symptoms exceed or in lure of getting immediate relief.
The practice of self-medication has been extensively researched, but there is a dearth of information about its modality among dental patients in developing countries. Hence, this study was planned to determine the prevalence of the practice of self-medication for oral and dental problems among 21–60 years old people residing in the rural areas of Belgaum taluk. The objectives of the study were to assess the abuse of self-medication, to evaluate awareness about self-medication, and to evaluate the risk factors among rural population about self-medication of Belgaum taluk, Karnataka, India.
| Materials and Methods|| |
The study was conducted among 230 permanent residents aged 21–60 years from selected villages of Belgaum taluk, Karnataka, India. The study protocol was approved by the Institutional Review Board. The participants were explained about the study, and informed consent was obtained. They were interviewed and the information obtained was entered in an 18-point, closed-ended question-based, semi-structured questionnaire.
The reliability of the questionnaire was established using a pilot test by collecting data from 10 subjects, not included in the sample. Their feedback was then analyzed by intraclass correlations which were found to be 0.91 and 0.95 with Cronbach's alpha coefficient values of 0.70 and 0.74, indicative of an acceptable reliability level. The validity of the questionnaire was evaluated by two pilot studies conducted. The subject experts were provided access to the measurement tool and asked to provide feedback on whether the questions used were able to extract information intended correctly or not. The data were then analyzed providing a validity coefficient alpha of 0.74. After this, minor revisions were done to derive the final questionnaire to be used for the study.
The study was carried out from December 2011 to February 2012. The quota sampling was done by nonprobability version of stratified sampling. In this, a total of 10 villages having similar sociodemographic profile were selected, and the population was first segmented into subgroups. The formula used for calculation of the sample was:
p was the prevalence as revealed by a previous study;
q was 1 − p; and
d was the available error - 6.
A house-to-house survey was conducted in the area and continued till a final sample size of 230 was obtained. The subjects aged between 21 and 60 years, included both males and females, and the ones who were willing to participate in the study were only included in the study, while subjects who were unable to provide accurate history and the subjects who did not give informed consent were excluded from the study.
Statistical analysis was done using SPSS version 14: SPSS Inc., 233 South Wackier Drive, 11th Floor, Chicago, USA. The frequency distributions and percentages were examined for each answer.
| Results|| |
In the sample studied, 51.3% of the participants were male while 48.7% were female, and among them, 40% of the participants were found to be illiterate, 8.1% primary school, 5.6% middle school, 15.65% high school, 18.69% preuniversity college, and 11.96% graduates and above [Table 1].
|Table 1: Demographic split-up of the participants who had succumbed to the practice of self-medication|
Click here to view
63.91% of the participants experienced dental problems while 36.09% had not experienced any dental problem in the past, and among these, 42.17% of the participants visited a dental surgeon for consulting their problems while 57.83% had not been to any dental surgeon for their problem. 21.76% of the participants visited their family physician for their problems.
70.74% of the participants had taken medications for their problems while 12.25% had used paste, 4.76%, powder, and 12.25% were found not to have taken anything for their dental problems. Furthermore, 33.33% of the participants had purchased medication without a prescription while 44.21% had followed old prescriptions and 20.40% had followed prescriptions of family members or friends [Table 2].
|Table 2: Participants who had purchased medication without prescription, followed old prescriptions, followed prescriptions of family members or friends|
Click here to view
30.27% of the participants had used balm, 28.95%, clove, 15.78%, eucalyptus oil and camphor while 25% had used lime, jaggery, coal, tobacco, salt, salt in combination with oil as home remedies. The majority of them had taken medications for odontalgia comprising 57.69% of the participants followed by tooth mobility, 19.23%, decay, 14.42%, swelling and/or ulcer, 8.65%, both toothache and tooth mobility, 8.65%, and more than two problems simultaneously, 18.26% [Table 3].
59.61% of the participants stopped using medications after relief of their complaint while 40.39% of the participants were found to continue the medication even after relief of the complaint for which they were using the medication. 30% of the participants had knowledge about dose, duration, side effects, and interactions of drugs in use. Among these, 38.04% of the participants did not even remember the name of drug they had used, while among the 61.95% participants who remembered the name of drug, paracetamol was the most commonly used drug taken by 22.80%, followed by crocin, 19.29%, Imol, 21.05%, Nimsee, 8.77%, Brufen, 5.26%, Disprin, 5.26%, Vicks Action 500, 7.01%, Diclomol, 5.26%, Bruzen MR, 3.50%, and Duoflam, 1.75% [Table 4].
Dental surgeons, 37.41%, pharmacists/chemists, 40.81%, friends, 10.20%, family members, 14.96%, and television, 3.40%, were the common sources of information about the drugs used while unavailability of dental surgeons, 19.04%, followed by the belief of loosening of teeth and weakening of eyesight, 18.36%, were the major reasons for indulging in self-medication and not reporting to the dental surgeons/doctors for the consultation of the problems [Table 5].
| Discussion|| |
In the present study, 40% of the respondents were illiterate while 11.96% were above graduate suggesting that ignorance, illiteracy, and lack of education might be the reasons for self-medication. Although in another study, self-medication was found to be higher in well-educated participants, and this could be an expected observation as information about medicines is easily available through the media, Internet, and direct-to-consumer advertising as well. Nearly 80% of the respondents had income below 7015/- and so were in the low-income strata having poor access to dental treatments owing to economic constraints.
Among the total 230 subjects, 63.91% of the respondents had experienced some or other dental problems, suggesting that dental diseases are highly prevalent. Less than half of the respondents, 42.17%, visited the dental surgeons thinking that loss of tooth is one of the natural processes related to aging in life and does not require any treatment. 21.76% of the respondents were so ignorant that they visited the family physicians for dental problems. Since physicians are easily accessible, people along with their medical problems also turn-up to them for their dental health-care needs. Among these, 37.41% of the respondents had taken drugs prescribed by their family physicians while 33.33% felt that the illness was too mild that they had purchased medication on their own without any prescription.
44.21% of the respondents felt that they had previous experience of a similar illness, and even if they go to a doctor, they will be prescribed similar medications; thus, they followed old prescriptions while 20.40% followed prescriptions of family members or friends since they had similar problems and were cured by taking the same drugs. This can be a dangerous practice as what suits one's constitution might not suit all, and the combination of drugs could also affect adversely. Furthermore, if one keeps taking the same drugs, the body develops tolerance and higher doses are required.
There are cultural factors too in play since the respondents had been born into a culture where specific types of medications, especially herbal, were being taken from an early age. Many respondents, while acknowledging the significance of modern medicines, considered herbal remedies, more appropriate to treat their illnesses. The pharmacists in Belgaum taluks also commonly stocked herbal and ayurvedic medications, making these drugs easily accessible. Herbs were considered safe and devoid of adverse effects by most of the respondents. This may not always hold true as the possibility of interactions is always supposed to be kept in mind.
The majority of the respondents took medication for odontalgia, 57.69%, followed by tooth mobility, 19.23%, tooth decay, 14.42%, for both toothache and tooth mobility, 14.42%, and for more than two problems simultaneously, 18.26%. The duration of the use of drugs was not specifically enquired into, but in general, drugs were stopped as symptoms improved. Even 59.61% of the respondents were found to discontinue the use of medication after relief of the complaint without completing the course of treatment. Economic constraints were commonly cited as the reason for such discontinuation of the treatment.
Of the 230 respondents, most astonishing observation from our study was that 70% of the respondents were not even aware of the side effects and interactions of the drugs they used. Even more surprising was the fact that 38.04% of the respondents did not even remember the name of the drug used by them with many of them having difficulty in recalling precisely the name of the drug used.
Paracetamol, 22.80% followed by Imol, 21.05%, Crocin, 19.29%, Nimsee, 8.77%, Vicks Action 500, 7.01%, and other nonsteroidal anti-inflammatory drugs were the drugs most commonly used. Paracetamol and analgesics were the most commonly used class of drugs which was similar to the findings in the literature., In the present study, 63.59% of the respondents admitted to self-medication. The previous studies on self-medication for common illnesses in India show in a range between 31.3% and 82%.,, In a survey, the prevalence of self-medication with analgesics for dental pain was 21.37%. A similar survey done by Baños et al. on self-medication with analgesics for dental pain revealed the prevalence to be 70%.
In our study, we found that 40.81% of the respondents took advice from the pharmacists for their dental pain, which was quite high when compared with a previous study which showed 22.4% of the pharmacists dispensing antibiotics and NPAs without any referral, while in another study, a still higher number of the respondents, 57.46%, were found seeking advice from the pharmacists for their dental pain. The present study highlights that pharmacists are no more dispensers of medications to the patients but their role has expanded to giving medications to them. This is a matter of great concern since short-term pain relief means patient will postpone consulting dental surgeons or physicians, thereby missing the opportunity to diagnose a disease in early stages and getting adequate treatment and in case of dental problems, this leading to increasing morbidity as the teeth which could have been saved with timely intervention, then will be needed to be extracted.
In the present study, nonaccessibility of the doctors was cited to be the most common cause for nondoctor personnel prescribing the drugs accounting to about 19.04% of the cases. Other reasons cited were superstitious beliefs such as loosening of the teeth and weakening of the eyesight in 18.36% of the cases. Furthermore, visits to the dental surgeons were supposed to be expensive, and this was one of the most important reasons as to why 16.32% of the respondents had not approached for dental treatment.
In several studies, it has been found that an inappropriate self-medication results not only in wastage of resources but also leads to resistance in pathogens, drug dependence in case of certain types of drugs, and severe adverse drug reactions owing to their repeated and chronic use over time. On the other hand, if used appropriately, self-medication is seen to save lives in acute medical conditions and certain emergencies. It is now accepted that self-care in the form of responsible self-medication can be beneficial for the patients. The WHO has also pointed out that responsible self-medication can help prevent and treat ailments that do not require medical consultation every time and provides a cheaper alternative for treating common illnesses. However, it is also emphasized that self-medication must be accompanied by appropriate health-care information and should be practiced judiciously.
Studies on self-medication show that it is influenced by many factors including education, family, society, law, availability of drugs, and exposure to advertisements, highlighting, therefore, the need for a proper check and assurance at all levels to practice it the way it is supposed to be so that it can reduce burden on the patients as well as health-care providers while simultaneously serving the society as a bane and not a boon in the form of a bane.
| Conclusion|| |
Analgesics are the most common drugs abused for self-medication. The study revealed that mistaken beliefs about medicines and undesirable attitude toward self-medication were the main reasons as to why people resorted to this unsafe practice. It was also noted that there was insufficient public awareness regarding the consequences of indulging in self-medication and a lack of strict implementation of regulations and monitoring by drug regulatory authorities was further adding to this problem. It could thus be concluded that adequate health education of the populace was found mandatory to make people aware of the use and misuse of drugs, especially the analgesics and the potential adverse effects, they can have, when used repeatedly or on a chronic basis. Furthermore, dental health-care services were supposed to be made readily available and affordable so that self-medication among rural patients could be reduced to the barest minimum.
To all the patients who contributed to the study without whom this study would not have been feasible.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Sule SS, Ijadunola KT, Onayade AA, Fatusi AO, Soetan RO, Connell FA. Utilization of primary health care facilities: lessons from a rural community in Southwest Nigeria. Niger J Med 2008;17:98-106.
Albany NY. WHO Guidelines for Developing National Drug Policies. Geneva: World Health Organization; 1988. p. 31-2.
Montastruc JL, Bagheri H, Geraud T, Lapeyre-Mestre M. Pharmacovigilance of self-medication. Therapie 1997;52:105-10.
Raz R, Edelstein H, Grigoryan L, Haaijer-Ruskamp FM. Self-medication with antibiotics by a population in northern Israel. Isr Med Assoc J 2005;7:722-5.
Ernst E. Harmless herbs? A review of the recent literature. Am J Med 1998;104:170-8.
Multicenter study on self-medication and self-prescription in six Latin American countries. Drug Utilization Research Group, Latin America. Clin Pharmacol Ther 1997;61:488-93.
Arrais PS, Coelho HL, Batista Mdo C, Carvalho ML, Righi RE, Arnau JM. Profile of self-medication in Brazil. Rev Saude Publica 1997;31:71-7.
Lal V, Goswami A, Anand K. Self-medication among residents of urban resettlement colony, New Delhi. Indian J Public Health 2007;51:249-51.
Durgawale PM. Practice of self medication among slum-dwellers. Indian J Public Health 1998;42:53-5.
Phalke VD, Phalke DB, Durgawale PM. Self medication practices in rural Maharashtra. Indian J Community Med 2006;31:34-5.
Ali MF, Prasant MC, Safiya T, Dipak S, Amol C. Self medication with analgesics for dental pain: A cross sectional survey. Indian J Pract Dr 2011;6:18-20.
Baños JE, Bosch F, Toranzo I. Self-medication with analgesics. A study on odontalgia. Med Clin (Barc) 1991;96:248-51.
Kiyingi KS, Lauwo JA. Drugs in the home: Danger and waste. World Health Forum 1993;14:381-4.
Clavijo HA, Baquero JA, Ulloa S, Morales A. Self-medication during pregnancy. World Health Forum 1995;16:403-4.
World Health Organization. Report of the WHO Expert Committee on National Drug Policies. Geneva: World Health Organization; 1995.
Kafle KK, Gartulla RP. Self Medication and its Impact on Essential Drugs Schemes in Nepal: A Socio-Cultural Research Project; 1993.
Habeeb GE Jr., Gearhart JG. Common patient symptoms: Patterns of self-treatment and prevention. J Miss State Med Assoc 1993;34:179-81.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]