Presentation icium turkey_2011

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Health & Medicine

Published on February 15, 2014

Author: lankansikh


Practice and Predictors of selfmedication among urban and rural adults in Sri Lanka, three decades after Market Economic Reforms Dr. Pushpa Ranjan Wijesinghe MD- Rostov (General Medicine) MSc, MD-Colombo (Community Medicine) MPH-New Zealand ( Bio-security)

Background • Practice of self-medication in communities in varying • • • • degrees Increased private sector involvement in health & pharmaceutical care since 1977 Increased utilization of private health / pharmaceutical care for out patient conditions Competition of the pharmaceutical companies for a larger share of over the counter drug market What is the status of self-medication in settings of contrasting health and pharmacy care infra-structure in this context ?

Objective • To describe the current practice and predictors of self-medication in a selected urban and rural area in Sri Lanka Methods • Study design • A community based cross –sectional study • Study Population • Adults over 18 years of age, irrespective of sex , permanently residing in the selected districts over a period of 1 year

Urban district 8 Urban Council areas Rural district Stratification n= 900 n= 900 30 GN divisions PSU 7 Regional Council (PS ) areas PPS 30 GN divisions PSU 30 Households per a GN division Voters list 30 Households per a GN division 1 individual per house (900) Kish Table 1 individual per house (900)

Study Instruments • Interviewer administered questionnaire (IAQ) • Validated Likert scale to assess the Perceived satisfaction with available pharmacy services – Access, Continuity, General Satisfaction of services – Availability , Affordability, Efficacy of drugs – Inter-personal explanation, Considerateness • Validated Likert scale to assess the perceived access to allopathic medical care – – – – Availability of services, Regularity and acceptability of services Affordability of services Concern for clients

SOCIO DEMOGRAPHIC FACTORS BELIEFS & ATTITUDES ACCESS FACTORS Enabling factors Predisposing factors Medication use Need variables ACTUAL OR PERCEIVED MORBIDITY Anderson and Newman’s health services utilization model

Practice of medication use urban (n=863) Prevalence of medication use (95% confidence interval ) 33.9% (30.7%-37.1 %) Urban ( n =293 ) Rural (n=846) 35.3% (32. 1-38.5) Rural ( n=846) Only allopathic medicine users 91.4% 84.6% Only traditional medicine users 3.8% 12.4% Both allopathic and traditional medicine users 4.8% 3.0% urban (n=863) Rural (n=846) Prevalence of self medication * 12.2% (10% -14.4%) 7.9% (6.1%-9.7%) Self medication as a proportion of medication use * 37.2% 25.6% * P < 0.05

Practice of self-medication Urban Rural Conditions of Acute onset and short duration 58% 67% Perceived non-severity of the condition for physician consultations 55% 64% Previous satisfactory response of the same drug to a similar condition 53% 60% Self-medication without any symptom 09% 12% Using previous prescriptions for self medication for purchasing drugs 37% - - 45% Self-medication with one drug 49% 73% Self-medication with 2 drugs 28% 18% Using labels/blister packs of previously used drugs for purchasing drugs

Predictors of self medication Urban Predisposing variables Household number ≤ 2 Non-affirmation of drugs availability at informal places Need Variables Symptoms ≤ 2 Enabling Variables Adjusted OR ( 95% CI) Rural Adjusted OR ( 95% CI) 4.3 ( 1.1-17.5) - 0.3 (0.1-0.8) - Adjusted OR ( 95% CI) 7.9 (3.4-18.9) Adjusted OR ( 95% CI) Adjusted OR ( 95% CI) 2.4 (1.1-5.8) Adjusted OR ( 95% CI) Higher satisfaction with acceptability of medical services 0.96 (0.93-0.98) - Affordability of medical services - 0.4 (0.2-0.7) Technical competence of pharmacy staff - 2.8 (1.1-7.3)

Conclusion & recommendations • Self-medication is more prevalent in the urban setting • Prevalence of SM is lower than global estimates • Self-medication with 1-2 drugs selected on previous experience is an initial individual response for diseases of acute onset and perceived to be of less severity • Lower symptom count is a need variable acting as a proxy measure of perceived severity of the morbidity • Self medication is dependent on characteristic access measures unique in the two specific settings • Findings should be utilized to – Shape policy changes related to implementation of the CDD act – Design IEC programs for consumers moving towards selfmedication – Enhance the capacity of rural pharmacists/assistants as the first contact points in the rural sector

Limitations • Less valid data as compared to data collected in a prospective follow up study using a diary method • Non-objective measurement of the severity of the condition • Social desirability bias due to use of public health midwife for data collection • Perceived access measures to health care and pharmaceutical services reflect general rather than specific context

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