|Year : 2022 | Volume
| 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
Aisha F Badr, Lama Alghamdi, Hanar Baraidah, Ruba Alsulami
King Abdulaziz University-Faculty of Pharmacy, Pharmacy Practice Department, P.O. Box 80260, Jeddah 21589, Saudi Arabia
|Date of Submission||01-Mar-2022|
|Date of Acceptance||05-Oct-2022|
|Date of Web Publication||31-Dec-2022|
Dr. Aisha F Badr
King Abdulaziz University, Faculty of Pharmacy, Pharmacy Practice Department, P.O. Box 80260, Jeddah 21589
Source of Support: None, Conflict of Interest: None
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|| |
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. 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.
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.,, This in addition to small cost, in comparison to costly and time-consuming consultations to patients makes such practice attractive to many.
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. These medications include Over the Counter (OTC) medication, prescription medications, and supplements (e.g. minerals and vitamins).
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. These medications include: hydroxychloroquine, azithromycin, ivermectrin and some vitamins and supplements. 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.
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. 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%).
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|| |
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. 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.
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.
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.
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.
Descriptive statistics were used to present the results as frequencies and percentages for the categorical variables.
| Results|| |
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]
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)|
Click here to view
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)|
Click here to view
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)|
Click here to view
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)|
Click here to view
| Discussion|| |
It is well documented that COVID-19 outbreak has led to an increase in self-medication practice among different populations including healthcare providers. 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.
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.
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.,,
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.
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., 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. 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. 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. Despite the beneficial effects of zinc in immune response, long-term high-dose consumption may result in unwanted effects.
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.,
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.
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. 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.
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.,,,
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.
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|| |
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.
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”
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.
| References|| |
Anonymous. WHO guidelines for the regulatory assessment of medicinal products for use in self-medication: General information. WHO Drug Inf2000;141:18-26.
Lee CH, Chang FC, Hsu SD, Chi HY, Huang LJ, Yeh MK Inappropriate self-medication among adolescents and its association with lower medication literacy and substance use. Plos One 2017;12:e0189199.
Al-Ghamdi S, Alfauri TM, Alharbi MA, Alsaihati MM, Alshaykh MM, Alharbi AA, et al
. Current self-medication practices in the kingdom of Saudi Arabia: An observational study. Pan Afr Med J 2020;37:51.
Albusalih FA, Naqvi AA, Ahmad R, Ahmad N Prevalence of self-medication among students of pharmacy and medicine colleges of a public sector university in Dammam City, Saudi Arabia. Pharmacy 2017;5:51. Available from: https://www.mdpi.com/2226–4787/5/3/51
Aljadhey H, Assiri GA, Mahmoud MA, Al-Aqeel S, Murray M Self-medication in central Saudi Arabia. Community pharmacy consumers’ perspectives. Saudi Med J 2015;36:328-34.
Shaghaghi A, Asadi M, Allahverdipour H Predictors of Self-Medication Behavior: A Systematic Review. Iran J Public Health 2014;43:136-46. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4450680/
Ruiz ME Risks of self-medication practices. Curr Drug Saf 2010;5:315-23.
Ahmad S, Babar MS, Essar MY, Sinha M, Nadkar A Infodemic, self-medication and stockpiling: a worrying combination. East Mediterr Health J 2021;27:438-40.
Baracaldo-Santamaría D, Pabón-Londoño S, Rojas-Rodriguez LC Drug safety of frequently used drugs and substances for self-medication in COVID-19. Ther Adv Drug Saf 2022;13:20420986221094141.
Ferdous MZ, Islam MS, Sikder MT, Mosaddek ASM, Zegarra-Valdivia JA, Gozal D Knowledge, attitude, and practice regarding COVID-19 outbreak in bangladesh: an online-based cross-sectional study. Plos One 2020;15:e0239254.
Onchonga D, Omwoyo J, Nyamamba D Assessing the prevalence of self-medication among healthcare workers before and during the 2019 SARS-cov-2 (COVID-19) pandemic in Kenya. Saudi Pharm J 2020;28:1149-54.
Quincho-Lopez A, Benites-Ibarra CA, Hilario-Gomez MM, Quijano-Escate R, Taype-Rondan A Self-medication practices to prevent or manage COVID-19: A systematic review. Plos One 2021;16:e0259317.
Hiedra R, Lo KB, Elbashabsheh M, Gul F, Wright RM, Albano J, et al
. The use of IV vitamin C for patients with COVID-19: A case series. Expert Rev Anti Infect Ther 2020;18:1259-61.
Shahbaz U, Fatima N, Basharat S, Bibi A, Yu X, Hussain MI, et al
Role of vitamin C in preventing of COVID-19 infection, progression and severity. AIMS Microbiol 2022;8:108-24.
Bauer SR, Kapoor A, Rath M, Thomas SA What is the role of supplementation with ascorbic acid, zinc, vitamin D, or N-acetylcysteine for prevention or treatment of COVID-19? Cleve Clin J Med 2020. doi: 10.3949/ccjm.87a.ccc046.
Chambial S, Dwivedi S, Shukla KK, John PJ, Sharma P Vitamin C in disease prevention and cure: An overview. Indian J Clin Biochem 2013;28:314-28.
Dhatt SS, Kumar V, Neradi D, Sodavarapu P, Meetei TT, Goni V Need for testing and supplementation of vitamin D3 after release of COVID-19 lockdown in patients with increased musculoskeletal pain. Indian J Orthop 2021;55:1046-9.
(2) (PDF) Knowledge of Dietary Supplements among Women in the Aseer Region of the Kingdom of Saudi Arabia [Internet]. [cited 2022 Sep 6]. Available from: https://www.researchgate.net/publication/343577119_Knowledge_of_Dietary_Supplements_among_Women_in_the_Aseer_Region_of_the_Kingdom_of_Saudi_Arabia
. [Last accessed on 2022 Sep 21].
Hunter J, Arentz S, Goldenberg J, Yang G, Beardsley J, Lee MS, et al
. Choose your shortcuts wisely: COVID-19 rapid reviews of traditional, complementary and integrative medicine. Integr Med Res 2020;9:100484.
Rahman MT, Idid SZ Can zn be a critical element in COVID-19 treatment? Biol Trace Elem Res 2021;199:550-8.
Badr A, Binmahfouz L Impact of COVID-19 pandemic on mental health among pharmacy students at King Abdulaziz University, Jeddah, Saudi Arabia. Mediterr J Soc Sci 2020;11: 2039-9340.
Al-Jedai AH, Almogbel Y, Eljaaly K, Alqahtani NM, Almudaiheem HY, Awad N, et al
. Restriction on antimicrobial dispensing without prescription on a national level: impact on the overall antimicrobial utilization in the community pharmacies in Saudi Arabia. Plos One 2022;17:e0271188.
Gaviria-Mendoza A, Mejía-Mazo DA, Duarte-Blandón C, Castrillón-Spitia JD, Machado-Duque ME, Valladales-Restrepo LF, et al
. Self-medication and the ‘infodemic’ during mandatory preventive isolation due to the COVID-19 pandemic. Ther Adv Drug Saf 2022;13:20420986221072376.
Islam MS, Sarkar T, Khan SH, Mostofa Kamal AH, Hasan SMM, Kabir A, et al
. COVID-19-related infodemic and its impact on public health: A global social media analysis. Am J Trop Med Hyg 2020;103:1621-9.
Badr AF, Humedi RA, Alfarsi NA, Alghamdi HA Rapid antigen detection test (RADT) for pharyngitis diagnosis in children: Public and pharmacist perception. Saudi Pharm J 2021;29:677-81.
[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3]