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 Table of Contents  
ORIGINAL ARTICLE
Year : 2022  |  Volume : 1  |  Issue : 4  |  Page : 112-117

Prevalence and patterns of self-medication during COVID-19 pandemic amongst pharmacy students in Jeddah, Saudi Arabia. Cross-sectional study


King Abdulaziz University-Faculty of Pharmacy, Pharmacy Practice Department, P.O. Box 80260, Jeddah 21589, Saudi Arabia

Date of Submission01-Mar-2022
Date of Acceptance05-Oct-2022
Date of Web Publication31-Dec-2022

Correspondence Address:
Dr. Aisha F Badr
King Abdulaziz University, Faculty of Pharmacy, Pharmacy Practice Department, P.O. Box 80260, Jeddah 21589
Saudi Arabia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/sjcp.sjcp_6_22

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  Abstract 

Objective: Self-medication prevalence and characteristics during the ongoing pandemic have been assessed and documented in some countries for COVID-19 treatment; little is known of this practice among pharmacy students who are estimated to have higher knowledge of medications and their use. This study aims to assess self-medication prevalence and pattern during COVID-19 pandemic in this population. Materials and Methods: following IRB approval, a descriptive, cross-sectional study was implemented, and a survey link was distributed among pharmacy students enrolled at King Abdulaziz University, from 1/1/2021 to 17/2/2021. Questionnaire items included (1) students’ demographic, (2) self-medication prevalence during the pandemic, (3) medications, vitamins and supplements used (pre and post infection), (4) source of information, and (5) how long they used the medication for. Results: A total of 270 students completed the survey (39.9% response rate). Majority were between 21–23 years of age (63.7%), female (70%), and single (97%). A total of 149 (55.2%) students practiced self-medication during COVID-19 pandemic. Most used supplements were vitamin C (38.9%), followed by multivitamins (22.2%) and vitamin D (18.1%). Most used OTC medication was paracetamol (26.3%) whereas, most prescription medication used was anxiolytics (4.8%), and antibiotics (3.3%). Most relied on personal knowledge for their practice (77.18%) and continued taking the supplement for less than a month (56%). Moreover, 9.3% (n = 25) were tested positive for COVID-19 and self-medicated with: vitamin C 44% (n = 11), zinc 24% (n = 6), and aspirin 12% (n = 3). Conclusion: Although most used supplements and OTC medications during the pandemic; there was a minority who did use prescription medications, such as anxiolytics, antibiotics and antidepressants which raise concerns over their unattended use and mandate awareness of risks associated with these medications.

Keywords: COVID-19, pandemic, pharmacy, self-medication, students


How to cite this article:
Badr AF, Alghamdi L, Baraidah H, Alsulami R. Prevalence and patterns of self-medication during COVID-19 pandemic amongst pharmacy students in Jeddah, Saudi Arabia. Cross-sectional study. Saudi J Clin Pharm 2022;1:112-7

How to cite this URL:
Badr AF, Alghamdi L, Baraidah H, Alsulami R. Prevalence and patterns of self-medication during COVID-19 pandemic amongst pharmacy students in Jeddah, Saudi Arabia. Cross-sectional study. Saudi J Clin Pharm [serial online] 2022 [cited 2023 Feb 2];1:112-7. Available from: http://www.sjcp.org/text.asp?2022/1/4/112/366505


  Introduction Top


Self-medication is defined by The World Health Organization (WHO) as the use of medication without physician consultation or the reuse of a previous prescription medication for known symptoms.[1] Self-medication comes in many forms in which a person decides for themselves and/or people responsible for, without medical evaluation or diagnosis, which medication they will use for the symptomatic treatment of a specific condition. Furthermore, it may involve either sharing medications with family and friends, using leftover from previously prescribed medications or purchasing others from the local pharmacy.[2]

Many people practice self-medication due to ease of access of OTC medications or prescription medications that are available at home or are easily obtained from community pharmacies in some countries, including Saudi Arabia.[3],[4],[5] This in addition to small cost, in comparison to costly and time-consuming consultations to patients makes such practice attractive to many.[6]

Inappropriate practice of self-medication can have major impact on individual health; such as adverse effects, drug-drug interaction peril, delay in attending professional help, masking symptoms or drug abuse.[7] These medications include Over the Counter (OTC) medication, prescription medications, and supplements (e.g. minerals and vitamins).[1]

With the ongoing COVID-19 pandemic, fear of getting infected and the circulation of infodemic has caused an international stockpiling to self-medicate with medications that were later confirmed to have little or no benefit for COVID-19 treatment or even poses more harm.[8] These medications include: hydroxychloroquine, azithromycin, ivermectrin and some vitamins and supplements.[9] Moreover, a cross-sectional study surveyed 626 citizens of Bangladesh with high socio-economic and education status; found that self-medication was estimated to be 88.33% during COVID-19 outbreak. Furthermore, the most frequently used medication for COVID-19 symptom-like treatment (without prescription) was ivermectin (77.15%), followed by azithromycin (54.15%) and doxycycline (40.25%) and (85.33%) did so without even a positive COVID-19 test.[10]

According to a recent study conducted in Kenya among healthcare workers, during the COVID-19 pandemic; the prevalence of self-medication had spiked from 36.2% before COVID-19 outbreak to 60.4% during it.[11] Moreover, a systematic review on self medication practive for COVID-19 management and prevention found that self medication practive varied greatly in the general population (between <4% and 88.3%), whereas it is higher in special population (between 33.9 and 51.3%).[12]

Although self-medication prevalence and characteristics during the ongoing pandemic have been assessed and documented in some countries for COVID-19 treatment; little is known of this practice among pharmacy students who are estimated to have higher knowledge of medications and their use. Thus this study aims to assess self-medication during COVID-19 pandemic prevalence as well as what medications, vitamins and supplements were used, reasons behind their practice, where they obtained the medication from, how long they used the medication for and finally observe if any of the used medications had helped prevent COVID-19 infection.


  Materials and Methods Top


Study design

This study was approved by the research ethics committee in King Abdulaziz University Faculty of pharmacy on 22.12.2020 (Reference No: PH-1442–49). A descriptive, cross-sectional study design was implemented. Questionnaire items were based on identified trends of previous research.[8] Content validity of the questionnaire items were validated by two assistant professors in the university in addition to 10 6th year students that were not included in the study. Questionnaire link was sent to pharmacy students at King Abdulaziz University (Jeddah, Saudi Arabia), via WhatsApp (most popular form of communication in Saudi Arabia) from 1/1/2021 to 17/2/2021. The aim of the study was explained to participants on the first section of the survey, and following electronic consent, respondents were directed to questionnaire items.

Sample size

The sample size was calculated using a single proportion population formula with a 95% confidence level. We hypothesized that 50% of the population would practice self-medication, with a 5% margin error. With a sample size of 677 pharmacy enrolled students; the estimated minimum sample size was 246 participants.

Questionnaire items

The questionnaire items included five main components; including (1) student demographic (age, gender, marital status and education level), (2) self-medication prevalence during COVID-19 pandemic (number of students practicing self-medication and duration of their practice -self-medication was defined prior to answering this section-), (3) medication(s) and/or supplements used (including: vitamins, minerals, OTC medications and prescription medications), (4) information source to use these medication(s) and/or supplements, (5) history of COVID-19 infection. Students were able to pick one or more of the following vitamins/minerals, OTC medications and prescription medications as well as the ability to type in any other(s) not listed in the questionnaire: multivitamins, vitamin C, vitamin D, zinc, paracetamol, NSAIDs, antacids, cough and common cold preparations, antihistamines, antibiotics, anxiolytics, anti-depressants, or none.

Outcome measures

The primary outcome was to document (1) self-medication prevalence during COVID-19 pandemic, (2) medication used (prescription and/or OTC) (3) vitamin and/pr supplement used, (4) reasons behind their, (5) where they obtained the medication from, (6) how long they used the medication for. Secondary outcome was to document any correlation observed between medications/vitamin used in preventing COVID-19 infection.

Data analysis

Descriptive statistics were used to present the results as frequencies and percentages for the categorical variables.


  Results Top


Respondent’s demographic

A total of 270 students (out of 677 enrolled pharmacy students) completed the online survey with 39.9% response rate. The majority were female (70%), between 21–23 years of age (63.7%), and single (97%). Most of our respondents were during their 4th and 5th year of PharmD program; (26.7%) and (25.2%) respectively. [Table 1]
Table 1: Student demographic characteristics section; (n=270)

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Primary outcome

Self-medication prevalence during COVID-19 pandemic

A total of 149 of 270 surveyed pharmacy students (55.19%) practiced self-medication during COVID-19 pandemic. Of these 149 students, all reported taking vitamins/and or supplements 100% (n = 149), just over half used OTC medications 52.35% (n = 78) and about 13.4% (n = 20) used prescription medications. [Table 2]
Table 2: Vitamins, supplements and medications used by students during COVDI-19; (n=149)

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Supplements and/or vitamins use during COVID-19 pandemic; (n = 149)

Vitamin C was the most used vitamin by students for during the pandemic

70.47% (n = 105), followed by multivitamins 40.27% (n = 60), and vitamin D 32.89% (n = 49). For minerals, zinc was most used 18.79% (n = 28). Others are listed in [Table 2].

OTC medications use during COVID-19 pandemic; (n = 149)

For Over-the-Counter medications; paracetamol (acetaminophen) was the most reported medication used by students during COVID-19 pandemic 47.65% (n = 71), followed by NSAIDs 18.12% (n = 27), and anti-histamine 16.78% (n = 25). Others are listed in [Table 2].

Prescription medications use during COVID-19 pandemic; (n = 149)

Anxiolytics were the most used prescription medication by students during COVID-19 pandemic 8.72% (n = 13), followed by antibiotics 6.04% (n = 9) and antidepressants 1.34% (n = 2). [Table 2].

Duration of self-medication practice during the pandemic; (n = 149)

Majority of pharmacy students reported that they practiced self-medication during COVID-19 pandemic for less than one month 37.58% (n = 56), followed by one to three months 35.57% (n = 53). Additionally, 11.41% (n = 17) continued taking supplements/medication for 7 months to present [Figure 1].
Figure 1: Duration of self-medication practice during the pandemic; (n = 149)

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Source of information for self-medication practice during the pandemic; (n = 149)

Personal knowledge was the major Source of information about OTC, supplements, or prescription medication use during COVID-19 pandemic 77.18% (n = 115) followed by family and friends 65.77% (n = 98). To a lesser extent, students relied on social media 36.24% (n = 54) and health care providers (particularly doctors and pharmacists) 32.21% (n = 48). [Figure 2]
Figure 2: Source of information for self-medication practice during the pandemic; (n = 149)

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Secondary outcome

Self-medication use for COVID-19 infection; (n = 25)

Among the surveyed 270 pharmacy students, 9.3% (n = 25) were tested positive for COVID-19. Moreover; 92% (n = 23) of these students continued self-medication practice for both treatment and prophylactic purposes; using mainly vitamin C 44% (n = 11), zinc 24% (n = 6), and aspirin 12% (n = 3). Other vitamins and medications are listed in [Table 3].
Table 3: Self-medication practice among students for COVID-19 infection. (N= 25)

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  Discussion Top


It is well documented that COVID-19 outbreak has led to an increase in self-medication practice among different populations including healthcare providers.[12] As far as we know, this is the first study to assess prevalence and pattern of SM during COVID-19 pandemic amongst pharmacy students. This population is most prone to rely on self-knowledge and are thought to rely on evidence-based information; however since they are still students harm can outweigh benefit with self-medication.[4]

In our powered study, over half respondents (55.19%) practiced self-medication during COVID-19 pandemic since it’s spread in Saudi Arabia. This number has increased greatly compared to the Dammam study who reported (19.61%) self-medication practice in pharmacy students, two years before the pandemic.[4]

All students who did report self-medicating at the time of the survey, reported taking supplements and/or vitamins. Majority of students used vitamin C (70.47%), which is known to be the most commonly self-medicated vitamin used internationally; before and during COVID-19 outbreak; as it is believed to boost the immune system.[13],[14],[15]

Students also reported multivitamins use 40.27% (n = 60). Many studies have reported multivitamin’s vital role as immune-stimulants and antioxidants, and therefore is thought to help in cell repairing and healing properties. Moreover, 32.89% of students also reported prophylactic use of vitamin D.[16]

Due to lockdown and limited sun exposure, there were some recommendations on assessing vitamin D level as well assure citizens are having a diet rich in vitamin D, and supplementation as necessary.[15],[17] Although this may come with no harm, consulting the doctor and having the right dose is mandated for proper estimation of vitamin D deficiency and/or insufficiency.

In a study conducted in Aseer region; vitamin C, D and multivitamins had the highest percentage of use in COVID-19 prophylaxis.[18] According to another study conducted to view the role of supplement on prevention of COVID-19, the deficiency of vitamin D had been associated with a high susceptibility to COVID-19, and high doses of vitamin C can decrease the severity and extent of symptoms in patients with common cold.[15] These results may have encouraged the students to take the supplement as prophylaxis.

Zinc was also reported to be used by 18.78% of students. Self-medication with supplementary minerals such as zinc (Zn) is related to enhancing innate and adaptive immunity in the course of a viral infection.[19] Despite the beneficial effects of zinc in immune response, long-term high-dose consumption may result in unwanted effects.[20]

Moreover, over half students reported taking OTC medications; particularly paracetamol (47.65%), followed by NSAIDs (18.12%), and antihistamine (8.05%) (n = 25). The use of these classes is not properly explored in research and should not be used for a prolonged period due to risks associated with liver toxicity and other side effects.[18],[19]

Furthermore, our study did note a minority, 7.4% (n = 22) who self-medicated with prescription medication. Surprisingly, anxiolytics were the most used prescription medication by students during COVID-19 pandemic 8.72% (n = 13), followed by antibiotics 6.04% (n = 9) and antidepressants 1.34% (n = 2). However, we cannot establish if these prescription medications were acquired from the pharmacy or used from left-over medication available at home.

The use of anxiolytics and antidepressants was alarming since these classes of medications should only be used under direct supervision. Results also may suggest undiagnosed anxiety and depression in this population; given psychological academic stress during the pandemic. Future studies should investigate how these medications were acquired and if it resulted in any harm. Also, periodic academic mentoring should assess these students and refer to a psychologist as necessary.[21]

Antibiotic self-medication was reported by 6.04% of pharmacy students. A recent restriction of dispensing antibiotics without prescription was passed and reinforced in Saudi Arabia in 2018.[22] We believe the new restrictions helped decrease the misuse and self-medication practice of antibiotics overall.

On the other hand, most pharmacy students reported self-medication practice for less than 30 days 37.58% (n = 56), followed by one to three months 35.57% (n = 53). Only 11.41% (n = 17) continued taking supplements/medication for 7 months to present. A study pulished during the same period of this survey, stated that 32% of pharmacy students were experiencing mild anxiety, 22% moderate anxiety, and 19% severe anxiety. Moreover, statistical significance in anxiety level was seen in students living alone, previously diagnosed with mental illness, and within their 4th pharmacy academic year.[21]

Furthermore, Personal knowledge was the major Source of information for self-medication practice during the pandemic 77.18% (n = 115) followed by family and friends 65.77% (n = 98). To a lesser extent, students relied on social media 36.24% (n = 54) and health care providers (particularly doctors and pharmacists) 32.21% (n = 48). Although self-knowledge was expected in this population, given their pharmacy-academic background; we were surprised that social media was reported more than health-care providers influencing their practice. This was reported heavily in the current pandemic, raising an alarming power of these platforms. Rampant COVID-19 related infodemics or rumors have been reported to contributing to public’s self-medication for both prophylaxis and treatment of COVID-19.[8],[23],[24],[25]

Finally, among all surveyed 270 pharmacy students, only 9.3% (n = 25) were tested positive for COVID-19, and 92% (n = 23) of them practiced self-medication for COVID-19 treatment; using mainly vitamin C 44% (n = 11), zinc 24% (n = 6), and aspirin 12% (n = 3).

We believe that the public should develop appropriate healthcare-seeking behavior, particularly for acquiring prescription medications such as antibiotics, anxiolytics, and antidepressants. Infodemics, and rumors spread by social media influencers should be regulated as well as penalized by health authorities.

Limitation

The result cannot be generalized to the population since the study was limited to pharmacy students at King Abdulaziz University which introduces convenient sampling bias. This was an observational study at the time of COVID-19 pandemic and results only translate to the period the study was conducted in.


  Conclusion Top


Our study is the first to assess self-medication among pharmacy students during COVID-19 pandemic, which was perceived in over half respondents. Although most were deemed to be safe; using vitamin and OTC medications some used prescription only medications such as anxiolytics, antibiotics and antidepressants which raise concern and mandate awareness of risks associated with their use.

Acknowledgement

We would like to thank all pharmacy students who helped answer the questionnaire items. Your valuable contribution was the core of this research.

Financial support and sponsorship

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors

Conflict of interest

Authors declare that there is no conflict of interest

Statement of ethics

This study was approved by the research ethics committee in King Abdulaziz University Faculty of pharmacy on 22.12.2020 (Reference No: PH-1442–49). All participating students were above 18 years of age and consent was gathered prior to answering questionnaire items. The statement included “By checking the box below you are agreeing to be part of this research. No identifiable information will be gathered, and all responses will be treated with confidentiality”

Author contribution

L.A.A., H.O.B., R.F.A., A.F.B. designed the study and the methodology, collected the data, and wrote the manuscript. All members have contributed in various degrees to the analysis. A.F.B is the supervisor of L.A.A., H.O.B., R.F.A., who were PharmD students at King Abdulaziz university, Faculty of pharmacy at the time of data collection and analysis. A.F.B. have critically reviewed and approved the final draft and are responsible for the content and similarity index of the manuscript. This work is the outcome of contribution of the whole team. All Authors approve of this manuscript in its final format.

Data availability statement

The authors confirm that the data supporting the findings of this study are available within the article. Further enquiries can be directed to the corresponding author.



 
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