1.

0 CHAPTER ONE: INTRODUCTION

1.1 Background information Self-medication is the selection and use of medicines chosen by the patient for the treatment of an illness or the treatment of symptoms that the patient has perceived himself. (WHO 2010). It is further described by WHO that: Self-medication includes several forms through which the individual him/herself or the ones responsible for him/her decide, without medical evaluation, which drug they will use and in which way for the symptomatic relief and "cure" of a condition; it involves sharing drugs with other members of the family and social group, using leftovers from previous prescriptions or disrespecting the medical prescription either by prolonging or interrupting the dosage and the administration period prescribed. Medicines for self-medication are often called non-prescription or over the counter (OTC) and are available without a doctors prescription through pharmacies. In some countries OTC products are also available in supermarkets and other outlets. Medicines that require a doctors prescription are called prescription products (Rx products).Self-medication with OTC medicines is sometimes referred to as responsible self-medication to distinguish this from the practice of purchasing and using a prescription medicine without a doctors prescription.

Despite the growing research interests in self-medication, little information has been available about its major determinants especially in developing countries like Uganda. Self-medication is prevalent widely all over the world. With people getting over the counter drugs from pharmacies and drug shops without medical personnels prescription and evaluation. Peoples knowledge about drugs among different persons of all walks of life and it reveals that: knowledge of common drugs is exercised, though not uniformly but widely spread. People in all parts of the world encounter the same common health problems in roughly the same frequency. It does not seem to matter where or how they live. Common colds, headaches, digestive problems and body aches and pains do not discriminate by nationality, culture or climate. The drugs most
1

commonly used are antibiotics, anti-protozoal drugs and pain-killers. The increasing knowledge and availability of these drugs over the counter has probably contributed to the increase in selfmedication. In Uganda, however a number of pharmacies are available, with the increasing knowledge and business scope in Uganda, NDA (National Drug Authority) has seen the number of pharmacies in Uganda rise steadily from the 1990s. There are currently 12 manufacturers involved in the production of medicinal products and supplies such as tablets, hard gelatin capsules, injectable, liquid mixtures, and surgical gauze among others. The number of pharmacies and drug shops has grown in the last five years from 216 and 2,700 in 2004 to 425 and 4,370 respectively in 2008 (www.ugandainvest.go.ug). This has been one of the major contributing factors to increase in self-medication. Responsible self-medication can help, prevent and treat ailments that do not require medical consultation and reduce the pressure on medical services for the relief of minor ailments. These potential benefits seem to be of a particular interest in the financially less privileged countries with limited health resources, like Uganda.

However the knowledge on the dangers of self-medication has not yet spread amongst people of the world so clearly for them to start evaluating a self-medication over going to a professional health worker for evaluation and treatment.

1.2 Statement of the problem All people have unique health needs and yet they suffer from a vast spectrum of diseases. Hence, people all over Uganda as a whole and Kabarole district need a clear and safe provision of health care services especially medication under professional medical supervision, evaluation and prescription. The government under the Ministry Of Health has at least addressed this problem by putting up a regional referral hospital, health centers and health educating people. However, inspite of all this, many of the people in Kabarole do not get to utilise these services, but have increasingly opted to self-medicate themselves and the people around them without professional medical intervention. The National Drug Authority in 2010 estimated that in every 10 people 8 self-medicate or buy drugs over the counter. This could be attributed to the increase in number of pharmacies and drug shops in the region, expensive treatment from clinics and long distances to health facilities. This has led to many health problems like increase in drug resistance, poor compliance, over and under dosing, drug poisoning and toxicity reactions. The discrepancy thus is that a large number of people are self-medicating, people around them and using old prescription drugs from hospitals and clinics compared to those that actually seek professional health medication and administration of drugs. Thus the purpose of this research is to answer the following questions: i) What factors facilitate the increase in self-medication amongst the people of Kabarole? ii) iii) What are the effects of self-medication? What can be done to reduce the surge of self-medication?

1.4 Significance and justification of the study. It is hoped that the findings in this research will be used by MOH and DHO office, NGOs, NDA and all other sectors that are responsible for the provision of drugs and treatment of people. The study will identify the needs in provision of drugs and find the loopholes in the existing structure. By identifying drug provision alternatives, the research will identify possible areas of intervention which will improve professional medical treatment of the ill. Data generated will help planners and policy makers to put organizational or institutional arrangements which will improve the provision of professional medical evaluation, management and prescription of drugs to persons. The data will add to the existing knowledge for academic purposes and will stimulate further research by earmarking the research gaps.

1.5 Objectives of the study. 1.5.1 General objective To assess the factors and effects of self-medication of people in Kabarole. 1.5.2 Specific objectives. To establish peoples knowledge on drugs. To establish the extent of self-medication. To find out which people self-medicate most. Which illnesses do people self-medicate for? To assess the major sources of health care provision. To determine which drugs are used for self-medication, mainly. To find out sources of drugs used in self-medication.
4

1.6 Theoretical framework.

Increased mortality

Poor quality life

Drug toxicity

Treatment failure

Under dose

Over dose

Poor prognosis

Increased expenditure

Drug resistance

Wrong drug consumption

Poor adherence

Financial burden

SELF-MEDICATION

Health workers

Human being

Socio-economic status

Environment

Political

Poor patient relations

ILLNESSES

BELIEFS

Poor

rich

Increased number of drug provison centres eg pharmacies

Education level

Insufficient Human resource human resource

Poor drug knowledge and usage

Take remaind ers old prescript ion drugs

Buy drugs for selfmedication when they fall sick.

increased market competition Few health facilities Cheap drugs on market

2.0 CHAPTER TWO: LITERATURE REVIEW.

2.1 Knowledge attitudes and practices about self-medication. Self-care may be defined as the care taken by individuals towards their own health and wellbeing, including the care extended to their family members and others. ( IAPO - International Alliance of Patients Organizations. A Survey of Patient Organizations Concerns. Summer 2006). It is said that every patient has at least two prescribers his own doctor and himself, while many have additional prescribers in the form of friends, well-wishers etc. ( Mohamed Saleem T.K 2011) (Tumusiime Kabwende Deo; 2008) defined self-medication as a new form of mob justice. He further said that it was a way in which people were manifesting their loss of faith in the existing health care system in Uganda. Furthermore, research made by (MOH KENYA 2001) indicated that the hierarchy of medical power which stretches from professional experts to lay adults to children reflects an unequal distribution of medical knowledge between these groups. However, (Uganda and Division of vector Borne Diseases 2001) noted that due to the ideology of childhood and of medical expertise as described above, knowledge about the proper use of medication including potent hospital medicines is easy.

It was also noted that; people are overwhelmingly satisfied with the non-prescription medicines they use to the point where many believe that OTC medicines can be as effective for the relevant condition as prescription medicines. (South Africa. 2001. South African Healthcare and the Proprietary medicine industry. W. Duncan Reekie, D.R. Scott. S Afr Med J 2002) Most medical knowledge is distributed over the community, and everybody knows some treatments for the illnesses from which they or their family members commonly suffer (Whyte 2009; Pearce 2010; Sindiga et al . 2010)

2.2 Prevalence and extent of self-medication (Der Pharmacia letter 2011) noted that patients receive adequate medication for their clinical needs, at doses corresponding to individual requirements, and at the lowest possible cost for the patient and the community. Taking this definition into account an effective drug treatment requires patient compliance and consultation with a medical professional together with close follow-up, conditions rarely attained. Irrational drug use and especially self-medication with antibiotics is common throughout the world.

On the treatment patterns, Malest Afro (2002) et al cited that the majority of people relied on selfmedication. In comparison studies carried out in Ethiopia, Peru, Zambia, Uganda showed that women are the majority involved in self-medication. ( Juliet Kanyesigye 2004). Similarly,( World Bank 2007), showed that a third to a half of those who fall ill do not seek care at modern health units but use home remedies, locally purchased drugs or traditional healers. The results of a study may by (FAP/UNIMEP, 2003-2004) confirmed that the prevalence of selfmedication in children and adolescents is a real and frequent practice, independently on socioeconomic data. Home and self-treatment is a central part of culture in societies where people are used to taking treatment into their own hands (Whyte 1988; Van der Geest and Whyte 1989; Adome et al. 1996) and that the average household had almost 30 different medications on hand, only five of which were likely to be prescriptions (WJM-western journal of medicine 2008 November). Females practiced more self-medication than men (Solomon worku,(2010) as also found out in Mexico(2008) that identified women as the fundamental element in consumption of drugs and employment of self-medication. 2.3 Analysis on illnesses commonly leading to self-medication. People throughout the world suffer common health problems and their symptoms in roughly the same frequency. Surveys conducted in numerous countries indicate that 9 out of every 10 people suffer from at least one aspect of unwellness during the course of any 4-week period. (world self-medication industry 2 2009).

The most frequent use of medication on hand was for skin, followed by respiratory and gastrointestinal. Medications purchased were mainly for respiratory, central nervous system, gastrointestinal, and general systemic problems, respectively.(Roney James G Jr. and Nall M.L.-Stanford research institute August 2001) also (IAPO - International Alliance of Patients Organizations. A Survey of Patient Organisations Concerns. Summer 2006); noted the same. Elderly living independently often self-medicate for common problems such as fever, mild pain, colds, allergies, indigestion-gas, constipation and insomnia. ( Der Pharmacia Lettre, 2011). 2.4 Analysis of drugs used in self-medication. Analgesic/antipyretic and non-hormonal anti-inflammatory agents were the most commonly selfprescribed drugs, which indicates that self-medication is usually associated with the symptomatic treatment of pain. (WHO November 28, 2011). 2.5 Factors leading to self-medication. Socio-economic and demographic factors are often related to self-medication, but vary greatly from country to country. Self-treatment with western medicine has been linked to high socioeconomic status (Kamat and Nichter 1998).

The increase in self-care is due to a number of factors viz. socioeconomic factor, life style, ready access to drugs, the increased potential to manage certain illness through self-care, public health and environmental factors, greater availability of medicinal products and demographic and epidemiological factors. ( Sydney: National prescribing service Ltd:2008.)

In addition, access to good and effective medical interventions is often limited due to poor hospital facilities; service fees; poverty and hunger; and illiteracy. (Laura Shireman, Paul S Pottinger and Kayode K Ojo 2010). In the second instance, private clinics have also taken advantage of the disparity that gripped patients running away from government hospitals, by inventing their own exploitative antics. The new policy in many private clinics is the assumption that every person that visits the clinic must be sick and must take home some medicine usually well stocked in a pharmacy next door. ( Tumusiime Kabwende Deo 9 september 2009).
8

It was also noted that the urge of self-care, feeling of sympathy towards family members in sickness, lack of health services, poverty, ignorance, misbelieves, extensive advertisement and availability of drugs in other than drug shops are responsible for growing trend of selfmedication. (Al Shifa College of Pharmacy, 1998) The new policy in many private clinics is the assumption that every person that visits the clinic must be sick and must take home some medicine usually well stocked in a pharmacy next door. However, With the mandatory consultation fees going to as much as 25,000/= in some clinics, every patient can be sure to part with no less than 40,000/= for a single visit. As a way of beating the exploitation by medics, many people have now resorted to self-medication. (Tumusiime Kabwende Deo 2010)

Furthermore, poor diagnostic ability compounded by a limited knowledge of appropriate management result in the increase of self-medication and low rate of health care utilization.( Dr. Afolabi Adedapo Olanrewaju). While other people have a feeling that their ailment is beyond the knowledge of western trained doctors. ( Annuals of African Medicine 2008)

2.6 Sources of drugs for self-medication and health care. (Solomon Worku 2000) revealed that about one third of drugs were left over past prescription unlike in France (Dr.Pierre Leforte 2011) which showed that drugs were obtained from other individuals. More than 60% of people have bought drugs as over the counter (New Vision 4/03/2012 page 11) from pharmacies and drug shops. 2.7 People that self-medicate most. (WHO 2010) noted that self-medication provides a cheap alternative to people who cannot afford to pay medical practitioners. Hence, self-medication being the first response to illness among people. (Solomon Worku 2000) . Infact, Hesse (2009) et al clearly pointed out that women spend a large proportion of household income on medicines for self-medication than men.
9

2.8 Sources of information about drugs used in self-medication. Whether one lives in a developing country or in a developed one, the sources of information are similar. A person may seek advice from an older person in your household who possesses the knowledge of simple herbal remedies for common illnesses (Nepal, 2002) or with a pharmacist because they can provide a good help to assess the symptoms and spend time explaining how to use the medication properly (Brazil 1997, Singapore 2005). Or one may purchase an OTC medicine based on a previous medical recommendation (Mexico, 2009). Product labels are also a good source of information for the consumer and should always be easily accessible. In China for example, 70% of the consumers select the OTC medicine through reading the specifications before purchase. ( IAPO - International Alliance of Patients Organizations. A Survey of Patient Organisations Concerns. Summer 2006). Television advertising appears to have a limited impact with respect to overall non-prescription medicine use: in Brazil (2007), 81% of consumers disagreed with the statement: I customarily purchase medicines advertised on TV. In Italy, between 1977 and 1987 a period known in Europe for its large increase in television advertising, visits to physicians increased by 20% while the use of OTC medicines increased by only 2%. There were similar results in all the major European countries. (Brazil. 2010. Prevalence and factors associated with selfmedication.) Today the internet is emerging as a major source of information on health issues and (with appropriate quality control) offers great promise in helping people with self-care.

10

3.0 CHAPTER THREE: STUDY AREA

3.1 District of study: Kabarole district.
3.2 Geographical

location.

Kabarole district is found in western Uganda, and it lies between latitudes (00 15N and 10 00N) and longitude (300 00E 310 15E). Lying at an altitude of 1300-2300metres above sea level, and occupying a total area of 1,814km of which 1569km is covered by land and 198km is covered by water/wetlands. The district is bordered by Ntoroko district to the north, Kibaale district to the Northeast, Kyenjojo district to the east, Kamwenge district to the south west, Kasese district to the south, the democratic republic of Congo to the south west. Fort portal, the chief town of the district lies approximately 320km by road west of Kampala, the capital city of Uganda. 3.3 Population In 2002, the population of kabarole district was estimated at 356,900 with a population growth rate at 30% annually. It is estimated that in 2010, the population of kabarole district was approximately 452,100. 3.4 Tribe/ ethnic composition. The Batoro, Batuku and Basongora ethnicities constitute about 52% of the population. The Bakiga constitute 25%, followed by the Bakonjo and the Bamba. The major languages spoken are Rutooro, Rukiga and Runyankore. 3.5 Climate and weather. The district has a good climate with temperature ranging from 20C to 30C and rainfall ranging 1200mm-1500mm per annum. The district has cool temperatures ranging from 22C-25C and has bimodal rainfall, ranging from 1200mm-1500mm per annum.

11

3.6 Administration. Kabarole has the following administration units which are: (1) municipal council, (02) counties, (03) town councils, (15) sub-counties, (03) divisions, (81) parishes and (582) villages.

3.7 Communication The most used method of communication in the district is mouth to mouth. Other media used include: radios, mobile phones, television and others. The district has tarmac roads but most roads to rural areas are murram, rural feeder, secondary and community roads some of which when rainy may be impassable.st 3.8 Health infrastructure. There are 60 health facilities across the district these include: 3 hospitals, 3 health center IV , 23 health center III and 31 health center II and currently 8 new health center II are fully functional.388 village health teams (VHTs) have been established since 2006 and 61 VHT parish leaders. The district also has NGO hospitals and health centres namely Virika hospital, kabarole hospital, and Mitandi, Rambia, Kiamara, Ngombe orthodox, Mpanga growers, Nkuruba, lillah clinic, Kihembo dispensary, kiko, kiruhura, Yerya and Toro kahuma all health units.

12

4.0 CHAPTER FOUR: METHODOLOGY OF THE STUDY

4.1 Introduction This chapter describes the methods used in the study, it includes: Study design Study population Sampling procedures Selection of the procedures Study of the variables Data collection tools Pre-testing of data collection tools Data processing and analysis Ethical considerations Study limitations.

4.2 Study design A cross sectional study design was carried out in fort portal town for a period of two weeks on the subject of factors influencing the pattern of self-medication in fort portal region. 4.3 Area of study The area of study is Fort portal town, which is a major town of kabarole district , located in western Uganda. 4.4 Study population The study consisted of peasant farmers, business men and women, mothers, adoloscents, teenagers, students, house wives, local council leaders, teachers, and students. Of all people
13

chosen randomly, only 126 accepted to be interviewed using semi-structured questionnaires. Of those interviewed, only 95 managed to fill in the questionnaires correctly.

4.5 sampling procedure Fort portal town was chosen because of the researchers convenience. Since there was no literature partaking the prevalence of self-medication in Kabarole district, a pilot study done in kataraka village in Fort-portal yielded a prevalence of 64%, hence this was used to determine the minimum sample size; using the formulae; ;

where n= minimum sample size, z=1.96 at 95% confidence interval obtained from standard statistical table of normal distribution, p= estimated prevalence of non-adherence in a given population (64% or 0.64), q= precision; i.e. number of adherence in a given population (1-p or 0.15) and d=margin of error (0.025); hence n=98 with the minimum sample size known,126 respondents were selected. The selection of a sample was based on the existing Ugandan administrative structure of LCs. The survey was carried out in 3 divisions of fort portal using systematic random sampling i.e., east, west and south division(s) with at least 42 people sampled in each, hence making a total of 126 respondents. 4.6 Data collection tools. Data was collected using questionnaires that had both open ended and closed ended questions. This was administered to various age groups and both female and male respondents of varying age groups. The questionnaire had different parts: the socio-demographic profile, income, expenditure, cost sharing and health seeking patterns. 4.7 Pre-test of data collection tools. The data collection tools were pre-tested on 14 randomly selected people in fort portal town, to test the suitability of the questions, corrections were made and a final copy was printed. 4.8 Ethical considerations An introductory letter from fort portal school of clinical officers was presented to various local council heads, who allowed the researcher to access information from various parishes/ sub-

14

counties. Respondents consent was sought before interview to gain maximum co-operation before starting data collection.

4.9 Data collection and analysis Data was collected from 10:00am to 5:00pm Monday-Friday for 10 days by distributing questionnaires to the respondents. It was analysed using tables, bar graphs, pie- charts and simple statements. 4.10 Limitations of the study. Lack of enough time than initially planned by the researcher as the study proved more demanding than anticipated. Lack of co-operation from some of the respondents who either refused to be interviewed or pretended not to know anything about self- medication. Insufficient funds. The scotching sun shine as it required to stand under the sun in ceratin areas for long. People were very busy with customers and the researcher seemed like wasting their time. It was difficult gaining trust from some respondents. The researchers mobility was hindered by lack of a potent transport system.

15

CHAPTER FIVE: STUDY FINDINGS

5.0 Introduction Presented are the findings from 120 respondents instead of the targeted sample of 120. 5.1 Demographic characteristics. Table1: Sex of respondents n=120 Sex Male Female Total frequency 45 75 120 Percentage % 37.5 62.5 100

From the table 1, above; less than two thirds of the respondents 75(62.5%) were females while 45(37.5%) were made. Table 2: Age of the respondents n=120
Age of respondents 15-19 20-24 25-29 30-34 35-39 40 and above Total Number of respondents 3 15 40 35 17 10 120 Percentage % 2.50 12.50 33.33 29.17 14.17 8.33 100%

16

From the table above, a third of the respondents 40(33.3%) were between the age group of 20-24 followed by 35(29.17%) who were between 25-29.

Table 3: Tribe of respondents A question was asked to determine the respondents tribe and these were the findings; n=120
Tribe Bakiga Batooro Banyankore Bamba Bakonjo Batuku Basongora Others Total Frequency 29 41 14 08 17 01 00 10 120 Percentage(%) 24.2 34.2 11.7 6.7 14.2 0.8 00 8.3 100

According to table 3; less than a third of the respondents 41(34.2%) were Batooro followed by the Bakiga who constituted only 29(24.2%). Table 4: Occupation of respondents A question was asked to ascertain the occupation of respondents, and these were the findings; n=120 Occupation None Farmer Market vendor Boda boda cyclist Students Housewife Frequency 07 25 16 08 39 13
17

Percentage(%) 5.80 20.8 13.3 6.7 32.5 10.8

Business personnel total

09 120

10 100

According to the table above, more than a quarter 39(32.5%) of the respondents were students, followed by 25(20.8%) farmers who were farmers. The least were07(5.80%) for those who had no jobs.

Table 5: Education level of respondents. n=120

Education level Tertiary Secondary A level Secondary Olevel Primary Nursery/kindergarten Not educated Total Frequency 8 10 39 58 1 05 120 Percentage(%) 6.7 8.3 32.5 48.3 0.8 4.1 100

According to the table above, more than a third of the respondents 58(48.3%) had stopped at primary education and many 39(32.5%) who had dropped out from secondary Olevel. However, very few 8(6.7%) had achieved tertiary education.

18

5.2 Knowledge on self-medication. Fig 1: Respondents having knowledge on self-medication. n=120

Yes 17% No 83%

21(17.50%) responded Yes and 99(82.5%) said No.

Table6; Frequency of respondents who defined self-medication. n=120 Answer Number of respondents Percentage of respondents (%)

It is the taking of medication without medical persons intervention It is the medicating of self without any prescription It is the buying of drugs from a shop, pharmacy, drug shop or clinic and taking them based on ones own evaluation and sickness. Dont know

10

8.3

09 03

7.5 2.5

99 120

82.5 100

Total

19

According the table above; majority of the respondents 99(82.5%) did not know what selfmedication was, however 10(8.3%) said it was the taking of medication without medical persons intervention.

Figure2: Frequency of self-medication. n=120

Rarely 11% Very often 26% Quite often 63%

According to the pie chart above, it showed that: 13(11%) of the respondents rarely selfmedicated, 31(26%) of the respondents self-medicated quite often and 76(63%) of the respondents very often self-medicated. Meaning that a vast number of people self-medicate very often.

5.3 Health seeking behaviour Table7: Health seeking behavior. n=120

Health seeking behavior Stay home and treat themselves or family members Go to traditional healer Go to nearby clinic Go to hospital Total 11 25 33 120 9.2 20.8 27.5 100 Frequency 51 Percentage(%) 42.5

20

From the table above; more than a third of the respondents 51(42.5%) said they stay home and treat themselves or family members, and the least 11(9.2%) said they go to traditional healers.

Table8: Reasons why people may not go to hospitals or clinics when they or their family members fall sick. n=120
Reasons why people dont go to hospitals/clinics. Dont want Long distance to health facility Expensive to get medical help Prefer self-medicating to going to hospital/clinic Total 120 100 3 2 60 55 2.5 1.7 50 45.8 Frequency Percentage(%)

In the table above: majority of respondents said they felt it was expensive to get medical help, followed by 55(45.8%) who preferred self-medicating to going to hospital/clinic.

Figure 3: Advise on how to use drugs after prescription n=120

No 23%

Yes 77%

21

From the pie chart above, it shows that: 92(77%) of the respondents are advised and given information on the drugs they are given and only 28(23%) of the people said they were not advised on how to use the drugs very clearly.

5.4 Habit on prescribed drugs. Table 9; Frequency of following prescriptions. n=120

Question Yes No Total Frequency 103 17 120 Percentage(%) 85.8 14.2 100

From the table above, it clearly shows that 103(85.8%) of the respondents follow the prescriptions and only 17(14.2%) do not promptly follow the prescriptions.

Figure4: Frequency of respondents who keep remainders of prescription drugs for later usage. n=120

No 18%

Yes 82%

From the pie-chart above, 98(82%) of the respondents keep remainders of prescription for later usage while 22(18%) of the respondents simply discard them off.

22

5.5 Drug provision Table10: Where people usually get drugs from. n=120
Source of drugs Home Clinic Pharmacies Hospital Total Frequency 18 39 31 35 120 Percentage (%) 15 32.5 26.7 29.2 100

The table above shows; that majority of the respondents 39(32.5%) get drugs from the clinic followed by 35(29.2%) who get drugs from the pharmacy.

5.6 Drug usage. Table11: Types of drugs used. n=120

Response Anti-malarials Anti-helminthes Pain killers Anti-biotics Anti-fungals Anti-histamines Total Number of respondents 20 10 67 21 01 01 120 Percentage (%) 16.7 8.3 55.8 17.5 0.8 0.8 100

23

From the table above; More than a half of the respondents 67(55.8%) use pain killers for selfmedication followed by 21(17.5%) who used anti-biotics. The least used drugs were anti-fungals and anti-histamines which both constituted 1(0.8%) of the respondents.

Table12: Preparations of drugs. A question was asked to find out the use of particular preparations of drugs for self-medication. n=120
Form of preparation Tablets Capsules Syrups Pastes Shampoos Lonzeges Pessaries Others Total Frequency 80 21 13 05 0 0 1 0 120 Percentage (%) 66.7 17.5 10.8 4.2 0 0 0.8 0 100

According to the table above; Majority of the respondents 80(66.7%) used tablets followed by capsules 21(17.5%).

Table13: Colours of drugs commonly used for self-medication. A question was asked to assess which colours of drugs are commonly used in self-medication. n=120
Colour of drug Red Black Black and red White Frequency 25 1 22 45 Percentage(%) 20.8 0.8 18.3 37.5

24

Yellow Pink Green others Total

6 15 6 00 120

5 12.5 5 00 100

Form the table above; more than a quarter of the respondents use white drugs for selfmedication, followed by red coloured drugs 25(20.8%).

Table14: Illnesses for self-medication. A question was asked for which illness do they self-medicate for and the following is what was found out; n=120
Illness Headache Abdominal pain Allergic reactions Common cold Cough Febrile illnesses/ fever Backache Total Frequency 31 18 02 18 15 31 05 120 Percentage(%) 25.8 15 1.7 15 12.5 25.8 4.2 100

From the table above; both headache and febrile illnesses/ fever constituted majority of respondents 31(25.8%) each as reasons for self-medication while the least 05(4.2%) was backache.

Table15: Cost of drugs. A question was asked to ascertain the cost of drugs which are used to self-medicate.These were the findings; n=120
25

Cost of drugs (Ug. Shs.) 50-500 500-1000 1000-5000 5001 and above. Total

Frequency 78 21 18 03 120

Percentage (%) 65 17.5 15 2.5 100

According to the table above; more than a half of the respondents 78(65%) bought drugs that cost 50-500Ug.Shs, with the least 03(2.5%) buying drugs that cost 5001Ug.Shs. and above.

Figure 5: Source of drug information. n=120

35.00% percentage of respondents. 30.00% 25.00% 20.00% 15.00% 10.00% 5.00% 0.00%

media of information

According to the bar graph above; a third of the respondents 40(33.3%) said they got drug information from medical personnel followed by 23(19.2%) said they got drug information from drug sellers and the least 1(0.8%) said they got their drug information from either billboards or magazines.

26

5.7 Effects of self-medication. Figure6; Benefit of self medication A question was asked to assess whether the respondents felt that self-medication was of benefit. All they required to answer/ check was either Yes or No and these were the findings. n=120

YES 36% NO 64%

According to the pie-chart above, 43(36%) of the respondents said they felt that self-medication was of benefit to them while 77(64%) of the respondents said that they felt that self-medication was of not much benefit to them. Of the 43(36%) of the respondents who answered yes above, another question was asked to clear out what the exact benefit(s) were.

27

Table16: Exact benefit from self-medication. A question was asked to those who responded YES on knowledge of exact advantages of selfmedication and these were the findings. n=43
Response It is cheaper than going to a clinic I get a feeling of responsibility over my health and that of my family members. Get a feeling of satisfaction that Ive tried to treat myself/ a family member It saves time of going to a hospital/clinic Total 43 100 10 21.2 14 29.8 Frequency 12 07 Percentage(%) 25.5 14.9

From the table above; of the 43(36%) respondents who had answered Yes about satisfaction from self-medication, most of them 14(29.8%) said they got a feeling of satisfaction that theyve tried to treat themselves and or a family member, while the least 07(14.9%) said they got a feeling of responsibility over their health and that of the family members.

Figure7: Knowledge on disadvantages of self-medication. n=120

28

YES 39% NO 61%

According to the pie-chart above; 47(39%) of the respondents answered YES while 73(61%) of the respondents answered NO as partakes their knowledge on disadvantages of self-medication.

Table17: Specific disadvantages self-medication. A question was asked to the respondents who answered YES regarding their knowledge on self- medication and these were the findings. n=47
Response Medicating myself or a family member may not be curative enough without medical help. I dont know whether I use the correct treatment. I may over or under dose myself or a family member. total 47 100 24 51.0 13 27.7 Number of respondents 10 Percentage(%) 21.3

According to the table above, 10(21.3%) said that medicating themselves or a family member may not be curative enough without medical help and 13(27.7%) of the respondents said they didnt know whether they use the right treatment while 24(51.0%)of the respondents said they paused a risk of either under or over dosing themselves or their family members.

29

Figure8: Satisfaction with self-medication. A question was asked as to whether respondents were satisfied with self-medication and all they required to answer was either YES or NO. n=120

satisfaction with self-medication

YES 36% NO 64%

According to the pie-chart above, 43(36%) of the respondents said they were satisfied with selfmedication, however the majority 77(64%) of the respondents said they were not satisfied.

30

Table18: Desire to learn more about drugs and self-medication. A question was asked as to whether they desired to learn more about self-medication, and these were the findings. All they required to answer was either YES or NO. n=120 Response Yes No Total Frequency 118 02 120 Percentage(%) 98.3 1.7 100

According to the table above; 118(98.3%) of the respondents said YES to learning more about self-medication and only 02(1.7%) of the respondents denied the opportunity to do so.

Table19: Respondents recommendations. Respondents were asked to give their own recommendations on aiding to reduce self-medication. These were the findings; n=120
Response Government should try putting up more health facilities Government and local leaders should regulate prices imposed by private clinics and hospitals. Common drugs should be made more available to health facilities. People should learn the habit of seeking medical care. People should be taught through health education the dangers and advantages of 11 9.2 17 14.2 10 8.3 23 19.2 Number of respondents 31 Percentage(%) 25.8

31

self-medication

People should employ other methods like wet sponge/ cloth for fevers and headache and avoid using of drugs they least know about. People should go for regular checkups and avoid falling seek very often, hence predisposing them to self-medicate. Total

09

7.5

19

15.8

120

100

According to the table above; more than a sixth of the respondents 31(25.8%) said that government should try pitting up more health facilities, followed by 23(19.2%) who said that government and local leaders should regulate prices imposed by private clinics and hospitals.

While the least said that people should employ other methods like wet sponge/ cloth to bring down fevers and headaches and avoid using drugs they least know about.

32

CHAPTER SIX: DISCUSSIONS, CONCLUSIONS AND RECOMMENDATIONS.

6.0 Discussion 6.1 Demographic data of respondents. Majority f the respondents 75(62.5%) were female and 45(37.5%) were male. Meaning that more women were compounded in the research than men, may be due to the nature of jobs men entail in, that may not give them the time to relax and participate in other activities. This result however contradicts a study done by Mohamed saleem T.K 2011 where a majority male respondents were found compared to females. More than a quarter of the respondents 40(33.33%) were aged 25-29 followed by 35(29.17%) who ranged 30-34 years. This shows that the majority of the population is in an economically productive age group hence predisposing them to the dangers of various occupations which may propel them to self-medicate. This finding correlates to a study done by Afolabi 2008 that found a majority respondents between the age of 25-34. Majority of the respondents were Batooro 41(34.2%) followed by the Bakiga 29(24.2%) these findings do match with findings wiith a study done by Wikipedia 2010, showing a majority Batooro with a rivaling number of Bakiga and the least being the basongora and the batuku who constitute 01(0.8%) and 00(00%) respectively. This may show a deviation however in the

33

population where the same study by Wikipedia free encyclopedia 2010 estimated at least 5% of the population were Batuku or Basongora. Majority of the respondents were students 39(32.50%) followed by peasant farmers 25(20.80%) of the total number respondents with a considerable number of 16(13.30%). This was not surprising as many of the respondents had more than one occupation, especially the students who also entailed themselves in other economic activities, and the few number of market vendors explains the little time they have as they attend to their customers which is in agreement with Juliet Kanyesigyes study in 2004 which found that majority of people in Kabale (Uganda) were peasant farmers.

Majority of the respondents had attended primary school education 58(48.3%) followed by 39(32.5%) had achieved secondary olevel education, and only 8(67%) had attained tertiary training and only one (0.8%) had never attended school. This shows the high number of primary school drop outs and attendance level as well as a reduce olevel education pattern and increased drop out level which is stipulated by a reduced 8(6.7%) respondents who attended Alevel and a further reduction in tertiary school attendance. This study however contradicts a study done by Azeem. A.K 2011 USA where majority of the respondents had completed/ were attending tertiary education.

6.2 Knowledge of self-medication. Majority of the respondents 99(82.5%) dont have knowledge about the term self-medication and only 21(17.5%) have heard about the term self-medication. This shows a gross deficit in knowledge about self-medication and predisposes the population more to its dangers. However knowledge of self-medication is more manifested amongst the educated, this findings cohere with a study done by Lukman Thalib in Nigeria 2005 which found out that knowledge on self-medication was directly proportional the level of education. Among those who have knowledge on self-medication, all of them had a genuine idea about selfmedication with the majority 10(8.3%) saying;

34

It is the taking of medicines without medical persons intervention. This definition is very close to the WHO 2010 definition which says; Self-medication includes several forms through which the individual him/herself or the ones responsible for him/her decide, without medical evaluation, which drug they will use and in which way for the symptomatic relief and "cure" of a condition; it involves sharing drugs with other members of the family and social group, using leftovers from previous prescriptions or disrespecting the medical prescription either by prolonging or interrupting the dosage and the administration period prescribed. This may also show a sensible understanding of self-medication within a small population mainly the very educated and a harsh lacking of knowledge of self-medication amongst the least

educated. This correlates to a study done in China in 2003 by Davis Wu for the Chinese selfmedication market and urban consumers that sighted a majority people with little or no knowledge about self-medication and especially among the least educated. 6.3 Frequency of self-medication. Majority of the respondents 76(63%) self-medication/ used un-prescribed drugs quite often, followed by 31(26%) who self-medicated very often and the least 13(11%) rarely self-medicated. This implies that there are still a large number of people who self-medicate quite often and very often as noted by Universidade Estadal de Compinos (UNICAMP) in 2004, that said majority of individuals still medicate quite often or even very often. 6.4 Health seeking behavior From the study 51(42.5%) people said when they/ family members fall sick, they stay home and treat themselves/ family members, 33(27.5%) and 25(20.8%) go to hospitals and clinics respectively at the least 11(9.2%) go to traditional healers. This shows that majority of people do not go immediately to hospitals or clinics when they fall sick but rather self-medicate themselves/ family members. However, these findings disagree with a study done in India by the world health organization 2008 that revealed a majority of people go to shamans(traditional healers in India) when they fall sick.

35

A half of the respondents 60(50%) said that it was expensive seeking medical help, while 55(45.8%) said that they just preferred self-medication over going to hospital. This revealed that just as much as private clinics were a lot more extensively spread, they insult a fear amongst the locals through their financial exploitation and very high costs. This corresponds to a study done by Tumusiime Kabwende Deo 9/sept/2008 research that revealed private clinics had taken advantage of the disparity that gripped patients running away from government hospitals by inventing their own income exploitive tactics. 6.5 Advise on how to use drugs on prescription More than half the respondents 92(77%) respondents said that they are advised on how to use drugs. This however indicates a good source of knowledge and good direction on how to use drugs by health workers who prescribe the drugs. This finding correlates to a study done by The World Self-Medication Industry 2010 that found a majority of respondents in Canada got advise on drug usage from their physicians after prescription.

6.6 Habit on use of prescribed drugs. 103(85.8%) of the respondents said they strongly follow drug prescriptions and advise on how to use them. This indicates a good respect for drugs used from health facilities and pharmacies and a result that many of the people who actually bought drugs or got drugs from health facilities and pharmacies, did follow prescription, unlike those who buy drugs from kiosks and those who just get drugs from home/ a friend/family member. This study agrees with a study done in China 2004 that stipulated; many of the consumers take their oral medicines strictly as directed in the appropriate doses at the right time. On the other hand however, it was seen that many of the respondents 98(82%) do keep remainders of prescription drugs for later usage. Thus implying that many people have lots of remainders of drugs and a failure by many to complete dosages with demerits of poor cure rates and an increased exposure to expired drugs. This finding correlates to a study done by A. O.Afolabi 2008 that revealed a majority of respondents keep remainders of prescription drugs for later usage.

36

6.7 Drug provision The biggest number of respondents 39(32.5%) get drugs from clinics followed by 35(29.2%) who get drugs from the hospitals. Thus many people have a comfort zone to seek drugs and medical help from clinics due to their extensive existence and easy access compared to hospitals. This study correlates with a study done by A.O Afolabi in Nigeria 2008 that found out a majority of people is get their medications from hospital/pharmacy. The study pointed out that more than a quarter of the respondents 45(37.5%) actually bought drugs from clinics rather than from drug shops or pharmacies, this clearly confirms that majority of the people often attend private clinic services than going to hospital and hence getting most of their drugs from the former.

6.8 Specific drug use. The fact that majority of the respondents 67(55.8%) used more painkillers for self-medication, followed by antibiotics 21(17.5%) and antimalarial drugs 20(16.7%). This corresponds to the severity and belief of people to manage pain as a minor and very common ailment as well as the extensive availability plus knowledge about them, like panadol. These findings correlate to study done by Mohamed saleem T.K 2011 that found a majority of respondents use more of analgesics. A vast majority of 80(66.7%) respondents did cohere with the fact that tablets are much more used in self-medication than any other preparation. This explains the extensive availability of

many drugs in tablet form and the belief amongst many that tablet drugs have a very positive therapeutic effect. Another finding that could benefit the study is the attribute of colours of drugs and frequency they are used. It was seen that most respondent; 45(37.5%) said they preferred using the white coloured drugs, followed by red coloured drugs 22(18.3%). This matched the belief that white drugs were considered to be pure and the red colour was synonymous to blood, hence replacing blood. This is a new finding and previous researchers had not discovered.

37

6.9 Reason for self-medicating as per illness Both headache 31(25.8%) and febrile illnesses/fevers 31(25.8%) struck the majority of respondents and presented the main problem for self-medication followed by abdominal pain 18(15%). This shares out the frequency and discomfort often caused by these illnesses, hence propelling people to quickly manage them promptly mainly by just buying drugs like antibiotics and pain killers. This study however deviates from a similar study done in Australia by World Self-medication Industry (WSMI) 2006 that ranked common cold as the most commonly selfmedicated illness.

6.10 Cost of drugs. Drugs costing between 50Ugx-500Ugx constituted a majority of respondents use 78(65%). This shows that cheap drugs are much often used for self-medication unlike their costly counterparts. This finding correlates to a study done by Afolabi 2008 that found an increased demand and perpetual usage of cheaper drugs for self-medication unlike the more costly ones.

6.11 Source of information about drugs. Medical personnel were reported as the largest source of information about drugs 40(33.3%) of the respondents had this to claim, followed by drug sellers 23(19.2%). This means that medical persons are still the greatest source of drug information in the community. This study coheres with a study done by Dr.Afolabi.O.A in Nigeria 2008; that revealed a majority of respondents did obtain their drug information from hospitals through health workers, since they felt that medical personnel were rich in medical and drug knowledge. 6.12 Benefit of self-medication. A majority respondents 77(64%) said they felt little benefit from self-medicating despite their continuation to do so. Only 43(36%) of the respondents agreed to benefit from self-medication with the majority 14(29.8%) of them said that they get a feeling of satisfaction that they atleast tried to treat themselves or a family member or friend. this is not surprising as many of the health facilities are not easily accessible and little time is got to go for treatment in hospitals since a lot

38

of bureaucracy in hospitals. This study correlates to a study done by Juliet Kanyesigye 2004 that found the same. 6.13 Disadvantages of self-medication. A majority 73(61%) of the respondents did not know the disadvantages of self-medication as opposed to only a minute number 47(39%) who have a clue. This may explain a lacking of knowledge of drugs used and an insufficient knowledge distribution. Of the respondents who said they knew, a majority 24(51.0%) of them said; they may either give an under or over dose, followed by 13(27.7%) who said they were not sure whether they used the correct treatment. This explains a knowledge deficit between the educated and the little educated on self-medication. All these may predispose to self-medication dangers like drug resistance and toxicity. This finding relates to a study done for South Africa 2004 by the World selfmedication industry (WSMI) that despite the knowledge on some disadvantages of selfmedication, they still found the urge to utilise an opportunity of self-treatment. 6.14 Satisfaction with self-medication. Majority 77(64%) of the respondents said they were not satisfied with self-medicating . This implies that people are crippled due to the long queues in government hospitals and high costs in private clinics, hence resorting to buying drugs or using old prescription drugs for treatment. This study however deviates from a study done in South Africa 2004 by the World selfmedication industry (WSMI) that noted more than a half of the people believed that nonprescription drugs over the counter are much safer than drugs prescribed by Physicians.

6.15 Respondents desire to learn more about self-medication. Almost all the respondents 118(98.3%) agreed on the idea to actually provide them with knowledge on drugs and self-medication. This implies a great urge in the public to actually have some essential knowledge on common drugs and safe self-medication.

39

6.16 Conclusion Majority of people dont have knowledge about self-medication. The prevalence of self-medication is essentially very high in Kabarole district. The greater number seems to be spread much more in those with intermediate income, the very educated, females especially those above 30 years. Pain killers, anti-malarials and antibiotics are the drugs most commonly used for self-medication. Self-medication was more likely to be used than prescribed medication to treat headache, fever and abdominal pain. Tablets and white coloured drugs were most frequently used without prescription. Majority of respondents get drug information from medical personnel.
40

6.17 Recommendations Sensitization programs on self-medication and probable dangers should be emphasized both locally and widely at national level in order to change peoples attitudes positively.

Literacy of the population both locally and at national level should be encouraged.

The practice of community pharmacies should be encouraged especially in places where health care provision is limited. The presence of such professionals ensures that the practice of self-medication is accompanied by appropriate training on how to use drugs appropriately, safely and effectively.

41

The government should set-up and facilitates more health facilities as to improve on quality assurance.

Health workers should learn good drug provision services as in explaining to patients how to use drugs well and effectively in a right dose and right time.

The government should improve and try data basing all patients data as many hop from one health facility to another. This hence reduces on government expenditure and drug wastages.

Government should try to empower health workers more through perpetual trainings as to ensure good patient care and increased cure rates in the hands of professionals.

Good and healthy self-medication practices should be encouraged by all stake holders including the Ministry Of Health, District health officer and medical personnel in Kabarole.

REFERENCES
1. Juliet Kanyesigye 2004 The impact of structural adjusment programmes on womens changing health seeking patterns in Uganda: the case of kabale.

2. P Wenzel Geissler 2001 self-treatment by Kenyan and Ugandan Children and the need for school based education . Health policy and Planning Oxford Press 16(4): 364-371.

3. Mohamed saleem T.K 2011 Self -medication with over the counter drugs: A questionnaire based study Der Pharmacia Lettre, 2011, 3(1): 91-98.

4. Brazil. 1997. Research on habits and attitudes for purchasing and using OTC drugs. Fundaao

42

Instituto de Administraao.

5. Nepal. 2002. Self-Medication and non-doctor prescription practices in Pokhara valley, Western Nepal. PR Shankar, P Partha and N Shenoy. BMC Family Practice. 2002, 3:17.

6. South Africa. 1987. South African Healthcare and the Proprietary medicine industry. W. Duncan Reekie, D.R. Scott. S Afr Med J 1988; 74:205-208. IAPO - International Alliance of Patients Organizations. A Survey of Patient Organizations Concerns. Summer 2006. 8. Healthcare, Self-Care and Self-Medication. 14 National Surveys Reveal Many Similarities in Consumer Practices. WSMI. 1988.

7.

9. Mandavi Pramil Tiwarl and Vinay Kapur. Indian J. Pharm .pract1 (1), Oct-Dec, 2008.

10. Ministry of Health KENYA 2001.

11. Uganda and Division of vector Borne Diseases 2001.

12. Tumusiime Kabwende Deo 9 september 2008 Uganda: Self- medication - a new form of mob justice http:\www.africafiles.com Uganda Self -medication - a new form of mob justice.htm

13. South Africa. 2001. South African Healthcare and the Proprietary medicine industry. W. Duncan Reekie, D.R. Scott. S Afr Med J 2002

14. Whyte 2009; Pearce 2010; Sindiga et al . 2010 A research on African self-medication mayhem 24-26. 15. WJM-western journal of medicine 2008 November.

43

16. WHO November 28, 2011 (www.who.com/self-medication) and WHO 2010. 17. Sydney: National prescribing service Ltd:2008

18. Al Shifa College of Pharmacy, 1998 Research on effect of self-medication on teenage population 34-38.

19. A. O.Afolabi 2008 Factors affecting the pattern of self-medication in an adult Nigerian population. Annals of African Medicine 2008 vol7. 120-140.

20. Pharmacies in Uganda www.ugandainvest.go.ug.

21. The World Self-Medication Industry studies.

Appendix1; Work plan

Activities December Submission of the research topic to the academic registrar/ supervisor and corrections Writing the research Period: December 2011 to April 2012 January February March April

44

proposal and submission of the first draft Correction and submission of the second and final research proposal. Pretesting and fine tuning of the research instruments. Data collection analysis and writing of the first draft report Submission of the first draft report to the supervisor Corrections and submission of the second draft report to the supervisor Submission to the academic registrar

Appendix2: BUDGET

Item

Quantity

Unit price (UgShs)

Total price (UgShs.)

45

Stationary Pencil Paper(s) Ruler Pen(s) White wash 2 1 ream ruled 1 5 1 100 15000 1000 400 3000 200 15000 1000 2000 3000

Data collection tools (questionnaire) printing, typing and photocopy

10 pages each questionnaire

(each questionnaire) 500 printing @ page 5000 130000

(130 copies) 100 photocopying @ page.

Research proposal (printing and typing) Data management Final report typing\, printing and binding Contingency TOTAL

30 pages

500 each page

15000

-----------------------

-----------------------

40,000

65 pages

500 each page

32500

10% of budget

21120 232320

Appendix3: Map of Uganda showing kabarole district.

46

SUDAN

DEM.REP. CONGO

KENYA

RWANDA

TANZANIA

Map of Uganda showing kabarole district 1

Appendix4: Map of kabarole district

47

48