Pa ge 1 Pa ge 1 American Journal of Chemistry and Pharmacy (AJCP) Patterns of Health Complaints and Perception of the Role of Pharmacists Among Clients Visiting Community Pharmacies in Lagos State, South-West Nigeria Promise Olaitan Ernest-Otaru1, Tinuola Omotomilayo Odugbemi1, Aloysius Obinna Ikwuka2*, Francis Chigozie Udeh2 Volume 4 Issue 1, Year 2025 ISSN: 2834-0116 (Online) DOI: https://doi.org/10.54536/ajcp.v4i1.4310 https://journals.e-palli.com/home/index.php/ajcp Article Information ABSTRACT Received: January 03, 2025 Accepted: February 01, 2025 Published: March 10, 2025 Health complaints and its patterns differ generally in the population. The public perception of community pharmacies and drug vendors as a one-stop facility for almost all health complaints and services is a major determinant of the type, quantity, quality, effectiveness, and success of healthcare as they encourage irrational use of drugs and poor utilization of health facilities. In addition, the existing high prevalence of self-medication encouraged by the constant displays, advertisement, and access to over-the-counter drugs contribute to the problem. The aim of this study was to assess the patterns of health complaints and perception of the role of pharmacists among clients visiting community pharmacies in Agege Local Government Area (LGA) of Lagos State. A descriptive cross-sectional study of 305 adults visiting community pharmacies in Agege LGA using a multi-stage stratified sampling technique was used. Data was collected using an interviewer-administered questionnaire and analyzed using SPSS Version 23. The Chi-square test was used to test the association between socio-demographic and socio-economic characteristics (independent variables) and perception of the role of pharmacists (dependent variable) of the study participants at a significance level of p<0.05. Among the study participants, the mean age was 36.83±11.89 years, the majority were females, married, from the Yoruba tribe, living with family members, employed, and earning below the poverty level of US$2 per day. The patterns of health complaints ranged from minor ailments like pain (21.0%), multiple symptoms (13.1%), upper respiratory tract infections (11.5%), and fever (8.9%) to more major conditions like gastrointestinal disorders (6.6%) and non-communicable diseases like hypertension, diabetes mellitus, and hyperlipidemia (11.1%). The majority (83.0%) of the study participants have a positive perception of the role of pharmacists, as 77.7% of them believed that pharmacists should be able to advise them on their medications, and 56.7% believed they should be able to report any drug-related adverse effect to a pharmacist. The socio-demographic and socio- economic characteristics of the study participants have no statistically significant association with their perception of the role of pharmacists in community pharmacies (p>0.05). The patterns of health complaints at community pharmacies ranged from minor to more serious complaints that were related to age groups and income status. Therefore, community pharmacies should be stocked with over-the-counter as well as prescription-only drugs. Keywords Community Pharmacies, Health Complaints, Lagos State, Nigeria, Patterns, Perception, Pharmacists 1 College of Medicine, University of Lagos, Lagos State, Nigeria 2 College of Medicine and Health Sciences, American International University West Africa, Banjul, The Gambia * Corresponding author’s e-mail: aloysiussweet@yahoo.com INTRODUCTION Pharmaceutical care has recently become a vital element of national healthcare systems. When data from this sector is accurately gathered, it can significantly aid in compiling healthcare statistics and tracking disease trends, spread, and prevalence. In Nigeria, community pharmacies serve as private drug retail centers overseen by licensed pharmacists, offering a variety of primary healthcare (PHC) services alongside traditional medication dispensing (Bradley, 2013; Ihekoronye, 2020). In low- and middle-income countries (LMICs), community pharmacists in these private drugstores are instrumental in monitoring the health of both children and adults, as people often visit these pharmacies for minor health issues. This trend is driven by the accessibility of over- the-counter drugs and a growing preference for self- diagnosis and self-treatment (Zawahir, 2021; De Tran, 2019). In these settings, community pharmacists generally interact with 11–30 patients daily, with each consultation lasting an average of 4.8 minutes (Ayele, 2018; Yusuff, 2021). Community pharmacies have expanded their services beyond dispensing medications; they now offer counseling, healthcare advice, and affordable medication options, all while prioritizing confidentiality and adherence to medical ethics (Ihekoronye, 2020). As they normally open late and are often available on weekends, community pharmacies make healthcare accessible without appointments. The types of complaints presented at community pharmacies vary depending on factors like location, demographics, seasons, and prevailing public health concerns in the host community and environs. Common complaints include detailed symptom information, with cases such as diarrhea in infants and adults and flu being prevalent in economically disadvantaged regions (Nguyen, 2023; Nafade, 2019). Flu is a serious public health threat in regions with impoverished populations and poor healthcare accessibility (Nguyen, 2023). Other frequent issues in LMICs include aches, migraines, physical injuries, fever, allergies, insect bites, skin rashes and reactions, cardiovascular disorders, and other respiratory and gastrointestinal upsets, with common Pa ge 2 https://journals.e-palli.com/home/index.php/ajcp Am. J. Chem. Pharm. 4(1) 1-15, 2025 treatment requests for cold remedies, oral rehydration solutions, and pain relievers (Ihekoronye, 2020; Yusuff, 2021). Some other customers visit pharmacies to refill ongoing prescriptions. In many urban areas of Nigeria, including the Agege Local Government Area (LGA) of Lagos State, community pharmacies play a crucial role in addressing diverse health complaints. However, the specific patterns of these health complaints presented at these pharmacies are not completely understood. There is lack of clarity on patient perception of the role of pharmacists in these community pharmacies, which may hinder the optimal use of community pharmacies and potentially lead to poorer health outcomes. Patient satisfaction plays a crucial role in influencing perception and continued use of healthcare services. Studies have examined patient satisfaction across various healthcare settings, finding that factors like demographics, health status, medical care, communication with the patient, and patient expectations impact satisfaction (Ferreira, 2023). More specifically, patients’ satisfaction with community pharmacy services has been studied in some European countries where patients reported being highly satisfied (Cavaco, 2005; Edideco, 2000). However, a similar study in Nigeria reported that patients were unsatisfied with undue delay in drug dispensation (Afolabi, 2003). There is a growing interest in evaluating patients’ perception of the actual role of pharmacists in community pharmacies, with studies conducted in some countries in Europe e.g. Malta (Wirth, 2011), Bosnia and Herzegovina (Catic, 2013); in Africa e.g. Nigeria (Aderemi-Williams, 2017), Ethiopia (Fekadu, 2011); and in the Middle-East e.g. Saudi Arabia (Al-Arifi, 2012), United Arab Emirates (Akshar, 2014). The quality of service and effectiveness of community pharmacists’ primary healthcare (PHC) interventions depend largely on contextual variables such as patient health outcomes, duration per encounter, cost of drugs, the emotional concern of community pharmacists, the delivery of care by the community pharmacists, and the overall patient experience. These factors are important determinants of patients’ perception and acceptability of community pharmacists in local practice settings (Aderemi-Williams, 2017; Afolabi, 2003; Ekpenyong, 2018). From entering the pharmacy to obtaining medications and paying for them, every step influences patient satisfaction and the perception of the role of pharmacists in community pharmacies in rendering quality healthcare (Aderemi-Williams, 2017). Recognizing that the success of PHC and therapy are dependent on patient satisfaction and health outcomes, and that patients constitute an essential source of information about care effectiveness (Donabedian, 1992), this study therefore aimed to provide a comprehensive data on the patterns of health complaints and perception of the role of pharmacists in community pharmacies among clients visiting community pharmacies in Agege LGA of Lagos State, South-West Nigeria. MATERIALS AND METHODS Study Area The study was conducted in Agege Local Government Area (LGA) of Lagos State, South-West Nigeria. Agege LGA has a vibrant economy with several urban markets, about 35 community pharmacies, and an estimated population of 683,600 (City Population, 2024). The recorded population of residents above 15 years of age within the study area from a previously conducted census was 307,677 (City Population, 2024). The estimated number of community pharmacies in Agege and Ifako- Ijaiye LGAs (both in Lagos State) is 150, each of which receives 30 patients daily (Medpages, 2024). Study Design A descriptive, cross-sectional, community-based survey was conducted for six (6) weeks using a well-structured interviewer-administered questionnaire. Study Population The clients who visited community pharmacies within the Agege LGA within the study period constituted the study population. Sample Size A sample size of 305 was deduced from the total population using the Cochrane formula for single proportion formula, n = (Z2PQ)/d2 , in concordance with (Okeke, 2023a; Okeke, 2023b; Okoro, 2024a; Okoro, 2024b; Udeh, 2023). Where: n = minimum sample size when the population is greater than 10,000. Z = standard normal deviation usually set at 1.96 corresponding to a 95% confidence interval obtained from a standard statistical table of normal distribution. P = proportion of the population that visits community pharmacies in a similar study conducted among adult traders in Agege LGA with a non-response rate of 40%, and P was 85% = 0.85 (Afolabi, 2008). Q = 1 – P = 1 – 0.85 = 0.15 d = degree of accuracy desired (absolute precision) = 5.0% = 0.05 Therefore: n = (1.962×0.85×0.15)/0.052 = 195.9, approximately 196 It is ideal to consider a non-response after calculating the minimum sample size using the Cochrane sample size formula. Similar to another study (Afolabi, 2008), a non-response rate of 40% was considered to cover erroneously filled questionnaires, some study participants dropping out, or loss of data. To adjust the estimated minimum sample size for non- response and attrition, n = n0 / expected response rate = 196/0.6 = 326.67 ~327 sample size Pa ge 3 https://journals.e-palli.com/home/index.php/ajcp Am. J. Chem. Pharm. 4(1) 1-15, 2025 Of this calculated sample size, only 305 individuals who agreed to participate were selected using a multistage stratified sampling method. Five wards (Isale/Idimangoro, Orile Agege, Darocha, Keke, and Okekoto) were balloted from the eleven wards in Agege LGA. Three community pharmacies were balloted from each ward, making a total of fifteen selected community pharmacies visited within six weeks for data collection. Inclusion and Exclusion Criteria Male and female adults, resident and non-resident clients visiting community pharmacies in Agege LGA were included in the study. Health professionals including medical doctors, nurses, and pharmacists currently working in other healthcare facilities and patent medicine vendors within Agege LGA were excluded in the study. Study Procedures One-on-one well-structured interviewer-administered developed Google form questionnaires containing a total of 33 questions, consisting majorly of closed-ended questions together with a few open-ended questions adapted from the literatures, were piloted and used as data collection tools for this study. Each questionnaire has three sections: Socio-demographic and socio-economic characteristics of the study participants Patterns of complaints of the study participants Perception of the role of pharmacists by the study participants Study Techniques and Data Collection A reserved area, free from interruption, was created within the pharmacy and used for the interview. Using a stratified random sampling method, clients who visited the pharmacies within the six weeks of the survey and were willing to participate were selected. On average, 50 questionnaires were administered weekly. From the in- flow of clients into the community pharmacy, an individual was approached every 20 minutes. Only a member of the research team was involved in administering and filling out the questionnaires on Google Forms. Upon successful data collection, questionnaires were cross-checked for adequacy of information, numbered, organized, and entered into a Microsoft Excel sheet for data analysis. Reliability of Study Techniques and Data Collection A pre-test of the data collection tool (questionnaire) was carried out among 30 clients (approximately 10% of the sample size) in two community pharmacies in a different LGA (Ikeja LGA). Some questions were later modified for clarity. Using the Pearson correlation coefficient (r), the test-retest reliability of the data was determined for this study. r>0.7 was obtained which was enough to justify the use of research instruments since 0.7 is the minimum score for a good test-retest (Kline, 2000). Data Analysis Statistical Package for Social Sciences (SPSS) version 23 software was used to validate and analyze the data. A 5% significance level (p-value) was considered significant. The socio-demographic and socio-economic characteristics of the study participants and their responses to questions were expressed in frequencies and percentages. The patterns of complaints were recorded and compared to the age groups and income status of the study participants. The perception of the role of pharmacists in community pharmacies was assessed using the eight (8) different response options in which they can select multiple choices that are appropriate. Six (6) out of the eight question options provided were appropriate responses while two (2) were inappropriate responses. The maximum obtainable score was 8 and the minimum was 0. Any respondent who scored >4 by choosing appropriate options was classified as having a positive perception, and any score ≤4 was classified as a negative perception. Bivariate analysis was conducted using Chi-square to determine the association between socio-demographic and socio-economic characteristics (independent variables) and perception (dependent variable). Ethical Considerations Ethical approval for the study was obtained from the Health Research and Ethics Committee (HREC) of the Lagos University Teaching Hospital (LUTH). A letter of introduction was obtained from the Department of Community Health and Primary Care in the College of Medicine, University of Lagos and this letter was presented to community pharmacies to seek permission from the related authorities of the community pharmacies which were involved in the study. The interviewer properly informed the participants of the nature of the study, its objectives, its confidentiality, its importance to the society, and an informed oral consent was obtained from all study participants. There were no financial benefits to the study participants. The participants were also assured that they could withdraw from the study at any time during the data collection stage without suffering any consequence if they choose not to participate further. RESULTS AND DISCUSSION A total of 305 individuals participated voluntarily in this present study, giving a 93.3% response rate from the anticipated 327 sample size. The obtained results are presented in tables and figures. Table 1: Socio-demographic characteristics of the study participants Variable Frequency (n=305) Percentage (%) Age group (years) < 20 6 2.0 Pa ge 4 https://journals.e-palli.com/home/index.php/ajcp Am. J. Chem. Pharm. 4(1) 1-15, 2025 20-24 21 6.9 25-29 73 23.9 30-34 64 21.0 35-39 47 15.4 40-44 24 7.9 45-49 19 6.2 50-54 18 5.9 55-59 14 4.6 ≥60 19 6.2 Mean±SD 36.83±11.89 Gender Male 138 45.2 Female 166 54.4 Transgender 1 0.3 Marital status Single 93 30.5 Married 201 65.9 Divorced/Separated 6 2.0 Widowed 5 1.6 Ethnicity Yoruba 202 66.2 Igbo 41 13.4 Hausa 33 10.8 Others 29 9.5 Living status With family 252 82.6 Alone 40 13.1 With non-family 13 4.3 The mean age was 36.83±11.89 years, the majority were young adults between the ages of 25 years and 44 years. Most were female - 166 (54.4%), majority (65.9%) were married, were of the Yoruba tribe (66.2%) and live with their family (82.6%). Table 2: Socio-economic characteristics of the study participants Variable Frequency (n) Percentage (%) Highest level of education completed Highest level of education completed 6 2.0 None 21 6.9 Vocational 73 23.9 Primary 64 21.0 Secondary Tertiary Employment status Employed Self-employed 139 45.6 Private employed 89 29.2 Government employed 30 9.8 Unemployed Student 26 8.5 Pa ge 5 https://journals.e-palli.com/home/index.php/ajcp Am. J. Chem. Pharm. 4(1) 1-15, 2025 Retired 12 3.9 Unemployed (due to lack of job) 9 3.0 Estimated monthly income in Naira (N) N500,000 8 2.6 LGA of residence in Lagos State Agege 274 89.8 Ifako-Ijaiye 12 3.9 Alimosho 8 2.6 Ojodu 5 1.6 Ota 2 0.7 Surulere 1 0.3 Eti-Osa 1 0.3 Ikeja 1 0.3 Isolo 1 0.3 Majority of the study participants reside within Agege LGA of Lagos State - 274 (89.8%), had completed the tertiary level of education – 175 (57.4%), and were employed - 258 (84.6%). Most - 204 (66.9%) earned below US$2 per day, out of which 22 (7.2%) earned below the prevailing minimum wage (as of the time of data collection) of 30,000 naira approved by the Federal Government of Nigeria. As of today, the minimum wage in Nigeria has been increased to 70,000 naira by the Federal Government of Nigeria. Table 3: Types of complaints among study participants, other reasons for visits to community pharmacies S/No. Types of complaints Frequency (n=305) Percentage (%) Pains 64 21.0 Multiple symptoms 40 13.1 Upper respiratory tract infections 35 11.5 Non-communicable diseases (NCDs – hypertension, diabetes mellitus, hyperlipidemia) 34 11.1 Fever 27 8.9 Gastrointestinal tract (GIT) disorders 20 6.6 Refill of prescriptions 17 5.6 Genital infections 14 4.6 Need for supplements 13 4.3 Dermatological conditions 11 3.6 Hormonal related issues 9 3.0 Need for OTC drugs 6 2.0 Ear infection 4 1.3 Eye infection 3 1.0 Other eye problems 3 1.0 Insomnia 3 1.0 Shortness of breath 1 0.3 Other complaints (BPH, erectile dysfunction, cramps) 1 0.3 Pa ge 6 https://journals.e-palli.com/home/index.php/ajcp Am. J. Chem. Pharm. 4(1) 1-15, 2025 Pain was highly prevalent among this population aside other complaints as it was reported by 21.0% of the study participants. Other symptoms with high prevalence were multiple symptoms (13.1%), upper respiratory tract infections (11.5%), non-communicable diseases (hypertension, diabetes mellitus, and hyperlipidemia) 11.1%, and fever 8.9%. Figure 1: Previous (3-6 months) health complaints of the study participants Figure 2: Health complaints of the study participants by age group The commonest health complaints of the study participants in the past three to six months were collected, recorded, and compared with their present health complaints. The majority of the study participants have had multiple symptoms (34.4%), pains in different parts of the body (12.1%), complaints of non-communicable disease (11.8%) which was almost similar (in percentage) to complaints of upper respiratory tract infections (10.5%). Other health complaints were GIT disorders (4.6%), fever (3.3%), genital infection (5.2%), eye infection (2.0%), shortness of breath (1.0%), insomnia (3.0%), ulcer related issues (0.3%), and hormonal related issues (0.3%). The majority of the old adult respondents complained of having non-communicable diseases and many of them were there to fill their prescriptions. Next to them were the middle-aged adults. Conversely, the majority of the young adult respondents complained of pains and upper respiratory tract infections. Multiple symptoms were presented across all the age groups. A lower percentage of the elderly adult respondents presented multiple Pa ge 7 https://journals.e-palli.com/home/index.php/ajcp Am. J. Chem. Pharm. 4(1) 1-15, 2025 symptoms while a higher but similar percentage of the young adults and middle-aged adults presented it. In addition, the highest percentage of those who complained of genital infection were the elderly adults followed by middle-aged adults, and GIT disorders were also more common among the elderly adult respondents. Figure 3: Health complaints of the study participants by income status Pain was the most frequently reported health complaint in both income groups (living below poverty line and living above poverty line), with a slightly higher percentage in those living below poverty line. The percentage is over 20% for both groups, making it the dominant complaint across all categories. Both groups reported a notable percentage of upper respiratory tract infections, with slightly higher percentages among those living above poverty line. The respondents complained of multiple symptoms while a lower percentage of the middle-income respondents and upper-income respondents presented it. The highest percentage of those who complained of genital infection was the upper-income respondents followed by middle- income respondents. Moreover, the highest percentage of those who complained of genital infection was the upper-income respondents followed by middle- income respondents, and GIT disorders were also more common among the middle- and upper-middle-income respondents. Table 4: Perception of the role of community pharmacists by the study participants S/No. Types of complaints Frequency (n=305) Percentage (%) Advise me on the drugs I am using 237 77.7 Report to them if I react to a drug 173 56.7 Seek advice from them if the condition is not serious enough to visit a physician 153 50.2 Provide information on the use of drugs and answer my drug-related questions 98 32.1 Help monitor and provide information on my health progress with the medication 77 25.2 Provide extended services like health screening services, BP monitoring, and blood sugar monitoring mainly in community pharmacies 48 15.7 Function as a medical doctor 13 4.3 Give injections or drips 7 2.3 The majority of the study participants believed that a pharmacist should be able to give them advice on the drugs that they are using - 237 (77.7%), they should be able to report any drug reactions to the pharmacist - 173 (56.7%), and they should be able to seek advice from the pharmacist in conditions that are not serious enough to visit a physician - 153 (50.2%). However, the majority of the study participants did not expect a pharmacist to give injections or drips (97.7%), function as a medical doctor (95.7%), nor provide extended services like health screening services, BP monitoring, and blood sugar monitoring mainly in community pharmacies (84.3%). Table 5 shows that the majority of the study participants - 253 (83.0%), had a positive perception of the role of pharmacists in community pharmacies. Pa ge 8 https://journals.e-palli.com/home/index.php/ajcp Am. J. Chem. Pharm. 4(1) 1-15, 2025 Table 5: Overall perception of the role of pharmacists in community pharmacies by the study participants Variable Frequency (n) Percentage (%) Positive Perception 253 83.0 Negative Perception 52 17.0 Table 6: Association between socio-demographic characteristics and perception of the role of pharmacists in community pharmacies by the study participants Variable Positive Perception n=253 Negative Perception n=52 X2 df Fisher’s exact p-value Age group (years) 3.561 9 0.938 <20 5 (83.3%) 1 (16.7%) 20–24 16 (76.2%) 5 (23.8%) 25–29 59 (80.8%) 14 (19.2%) 30–34 53 (82.8%) 11 (17.2%) 35–39 40 (85.1%) 7 (14.9%) 40–44 22 (91.7%) 2 (8.3%) 45–49 15 (78.9%) 4 (21.1%) 50–54 14 (77.8%) 4 (22.2%) 55–59 12 (85.7%) 2 (14.3%) ≥60 17 (89.5%) 2 (10.5%) Gender 0.241 2 0.887 Male 115 (83.3%) 23 (16.7%) Female 137 (82.5%) 29 (17.5%) Transgender 1 (100.0%) - Marital status 1.138 2 0.566 Single 74 (79.6%) 19 (20.4%) Married 170 (84.6%) 31 (15.4%) Divorced/Separated/ Widowed 9 (81.8%) 2 (18.2%) Ethnicity 5.694 3 0.127 Yoruba 171 (84.7%) 31 (15.3%) Igbo 29 (70.7%) 12 (29.3%) Hausa 27 (81.8%) 6 (18.2%) Others 26 (89.7%) 3 (10.3%) Living status 1.421 2 0.491 Living with family 212 (84.1%) 40 (15.9%) Alone 31 (77.5%) 9 (22.5%) Living with non-family 10 (76.9%) 3 (23.1%) Please note: ** statistically significant (Fisher’s exact p-value), X2 – Chi squared, df - degree of freedom, p-value<0.05 Table 7: Association between socio-economic characteristics and perception of the role of pharmacists in community pharmacies by the study participants Variable Positive Perception n=253 Negative Perception n=52 X2 df Fisher’s exact p-value Level of education completed 3.309 4 0.508 There was no statistical significant association between any of the socio-demographic characteristics of the study participants and their perception of the role of pharmacists in community pharmacies as all p-values were above 0.05. However, the majority of them across the age classification had a positive perception of the role of pharmacists in community pharmacies. In addition, there was a close similarity between the perceptions of males (83.3%), and females (82.5%). Most of them (84.1%) who live with family had a positive perception. Pa ge 9 https://journals.e-palli.com/home/index.php/ajcp Am. J. Chem. Pharm. 4(1) 1-15, 2025 None 8 (66.7%) 4 (33.3%) Vocational 22 (81.5%) 5 (18.5%) Primary 7 (87.5%) 1 (12.5%) Secondary 72 (86.7%) 11 (13.3%) Tertiary 144 (82.3%) 31 (17.7%) Employment status 0.173 1 0.677 Employed 215 (83.3%) 43 (16.7%) Unemployed 38 (80.9%) 9 (19.1%) Estimated monthly income in Naira 4.158 4 0.385 N200,001 – N500,000 20 (71.4%) 8 (28.6%) Please note: **statistically significant (Fisher’s exact p-value), X2 – Chi-squared, df - degree of freedom, p-value<0.05 No statistical significant association exists between socio-economic characteristics and the perception of the role of pharmacists in community pharmacies by the study participants (p>0.05). However, most of the study participants had a positive perception of the role of pharmacists in community pharmacies regardless of their socio-economic status. The average age of 36.83 years obtained in this current study indicates that the study participants consisted predominantly of adults (25-39 years) opposing the study of (Ojha, 2023) where teenagers and young adults (18- 29 years) dominated. The dominance of adults in this current study can be related to the fact that adults within the 25-39 years age group are non-dependent and are much more active in earning for themselves (Korn, 1987; National Bureau of Statistics, 2021), predisposing them to several stressors that cause ailments, which make them visit the community pharmacies often for treatment. The slight female majority - 166 (54.4%) aligns with global trends where women are more likely to engage with healthcare services than men (Bertakis, 2000; Dluhos- Sebesto, 2021). The negligible transgender representation mirrors societal dynamics in Nigeria, where transgender individuals are a marginalized group, often leading to underreporting in surveys. The high percentage of married respondents - 201 (65.9%) can be attributed to the cultural importance of marriage in the Nigerian society, while the predominance of the Yoruba ethnicity - 202 (66.2%) can be attributed to the study location which is a Yoruba-dominated area as reported by (Okoro, 2024a; Okoro, 2024b). The finding that 252 (82.6%) of the study participants live with their family suggests a significant influence of family on the patterns of health complaints and perceptions of healthcare services (Omeire, 2017). Most 274 (89.8%) of the respondents reside in Agege LGA, which is a reflection of the targeted sampling within a specific locality. The level of educational attainment is commendable with over half (57.4%) of the respondents having completed tertiary education. This is indicative of the status of Lagos State as an educational hub in Nigeria, which might influence the lifestyle of the respondents and which in turn determines their patterns of health complaints at community pharmacies and their perception of the role of pharmacists in community pharmacies. With a higher number (84.6%) of employed respondents, majority (66.9%) of them earn below the current poverty line (US$2 per day). This economic constraint likely impacts their healthcare choices, such as reliance on over- the-counter (OTC) medications and self-medication, as evidenced in other parts of this current study. The income distribution further emphasizes the economic challenges faced by the respondents, with only 9.2% earning above ₦200,000 monthly, reflecting the prevalent income disparity. The patterns of health complaints indicate a broad spectrum of conditions are presented at community pharmacies, ranging from minor complaints like pain and fever to more significant health conditions like GIT disorders and non-communicable diseases (NCDs) e.g. hypertension, diabetes mellitus, hyperlipidemia. Metabolic disorders e.g. hypertension, adiposity, diabetes mellitus and dyslipidemia collectively known as Metabolic Syndrome Diseases (MSDs) are diseases related to one another and have very high morbidity and mortality rates (Ikwuka, 2015; Ikwuka, 2017a; Ikwuka, 2017c; Ikwuka, 2023c; Ikwuka, 2023f; Virstyuk, 2016). Adiposity (obesity) is a risk factor for hypertension. Obesity is also a risk factor for Non-Hodgkin lymphoma (Ikwuka, 2023e). Results obtained from different researches have shown that hypertension, adiposity, diabetes mellitus, dyslipidemia, asymptomatic hyperuricemia, systemic immune inflammation activation, and fibrogenesis can lead to kidney damage (Ikwuka, 2017d; Ikwuka, 2017e; Ikwuka, 2018c; Ikwuka, 2018d; Ikwuka, 2019a; Pa ge 10 https://journals.e-palli.com/home/index.php/ajcp Am. J. Chem. Pharm. 4(1) 1-15, 2025 Ikwuka, 2019c; Ikwuka, 2022; Ikwuka, 2023d; Virstyuk, 2017a; Virstyuk, 2018a; Virstyuk, 2019; Virstyuk, 2021a; Virstyuk, 2021b). The study identified that the most frequently reported health complaint among the respondents was pain. This aligns with the research of (Shehnaz, 2013) which explained that pain or ache management was the primary reason expatriate high school students sought help at community pharmacies. Similar to these findings, other studies conducted on adolescents in Malta and Tamil Nadu, India reported that pain was the second- highest complained symptom (Ellul, 2008; Arul, 2010). Pharmacies are often the first point of contact for patients experiencing pain, due to the accessibility of over-the- counter (OTC) medications and the convenience of pharmacy services, a point highlighted by (Ellul, 2008) where pharmacies were reported as the most prevalent source of medicines. This trend underscores the role of community pharmacies as crucial providers of immediate relief for minor ailments. Multiple symptoms were also commonly reported, reflecting the complexity of health conditions presented at community pharmacies. This may indicate either the presence of multi-factorial illnesses or the recurrence of inadequately treated conditions. The co-occurrence of symptoms suggests that many clients might be experiencing complex health issues, necessitating a comprehensive pharmaceutical care. Upper respiratory tract infections (URTIs) were another prevalent complaint. Other studies also reported symptoms related to URTI like cough and cold to be prevalent (Ellul, 2008; Arul, 2010). The incidence of URTIs is consistent with the seasonal occurrence of respiratory illnesses, especially in urban areas like Agege LGA. This finding is significant given the role that pharmacies play in managing symptoms of URTIs, such as coughs and colds, which are common reasons for self-medication. Urbanization has been associated with increased oxidative stress. Linked with the induction of oxidative stress are major free radicals. Among these major free radicals, superoxide anion, hydroxyl radical, and hydroperoxyl radical are of physiological significance. Non-radical of physiological significance is hydrogen peroxide (Ikwuka, 2023b). Increased oxidative stress can lead to mutation which is an alteration in the DNA sequence which produces new alleles (Ikwuka, 2023a). The complaints of NCDs like hypertension, diabetes mellitus, and hyperlipidemia by the respondents reflect the increasing burden of chronic diseases in Nigeria, particularly in urban areas. The growing prevalence of these diseases emphasizes the need for sustained management and the potential role of community pharmacists in providing ongoing monitoring and care. Nevertheless, there is also need for new and effective treatment options in patients with Metabolic Syndrome Diseases. Sodium- Glucose Linked Transporter 2 (SGLT-2) inhibitors e.g. Dapagliflozin and Glucagon-like Peptide 1 Receptor Agonists (GLP-1 RAs) e.g. Liraglutide have been found to improve the efficacy of treatment and clinical course of type 2 diabetes mellitus and hypertension in patients with such comorbidities (Ikwuka, 2017b; Ikwuka, 2018a; Ikwuka, 2018b; Ikwuka, 2019b; Ikwuka, 2021; Ikwuka, 2024; Virstyuk, 2017b; Virstyuk, 2018b; Virstyuk, 2018c). Complaints about fever were among the middle-range prevalent complaint. However, according to (Shehnaz, 2013), most of the respondents complained about fever. The complaint about fever could be indicative of underlying infections such as malaria. The timing of this current study, conducted during a period with higher incidence of malaria, could explain the prominence of fever as a reported symptom. The correlation between seasonal changes and the incidence of fever points to the need for community pharmacies to be well-equipped to manage febrile illnesses. Comparison of the current health complaints reported by the study participants at community pharmacies to their previous (3 to 6 months) health complaints showed a recurrence or persistence of certain health conditions. This is evident from the close similarity in the percentages of some specific conditions, for example, upper respiratory tract infections accounted for 10.5% of previous health complaints, and 11.5% of current health complaints. Non-communicable diseases were reported in 11.8% of previous health complaints and in 11.1% of current health complaints. Many clients who visited community pharmacies complained of multiple symptoms, as reflected in 34.4% of previous health complaints and in 13.1% of current health complaints. It is also apparent that conditions such as pain, fever, gastrointestinal disorders, upper respiratory tract infections, non-communicable diseases, dermatological conditions, and genital infections occur more frequently than other health complaints such as eye infections, ear infections, and insomnia. The observed increase in cases of pain, fever, and gastrointestinal disorders may be related to the seasonal timing of data collection which took place in June, a period of frequent rainfall when many people were experiencing malaria symptoms (Ipadeola, 2024). Factors perceived as contributing to these febrile illnesses included stress, mosquito bites, unclean water, and rain (Das, 2024; Ipadeola, 2024). The results indicate that clients visiting community pharmacies may have a variety of reasons beyond seeking treatment for illnesses. Some visit to obtain supplements, which could be considered a preventive health measure, with 4.3% of respondents doing so. Approximately 5.6% of respondents were recorded visiting the pharmacy to fill or refill prescriptions, suggesting that some clients see a physician for diagnosis before visiting the pharmacy, and that prescription-only medicines (POMs) are still being obtained with a prescription. However, it is unclear whether all patients requiring POMs come with a doctor’s prescription. Figure 2 illustrates the patterns of health complaints by age groups. It can be inferred that pain was a significant health complaint in all age groups, but is highest among Pa ge 11 https://journals.e-palli.com/home/index.php/ajcp Am. J. Chem. Pharm. 4(1) 1-15, 2025 young adults between 25-44 years. Young adults were the highest to complain about fever and multiple symptoms. This indicates that antipyretic drugs purchased as OTC were mostly used by this group. Associating pain with fever, and multiple symptoms suggests that malaria which presents with symptoms such as pain, fever, and which has been reported to be associated with the rainy season which was the period this research was conducted, is predominant among young adults. Elderly adults visit community pharmacies frequently for NCDs. The data also indicates that complaints of genital infections were low among respondents between the age of 18-24 years and those above 60 years because the latter group includes the elderly who were already less active sexually. On the other hand, complaints about genital infections were high among respondents between the ages of 25-44 years (young adults). This finding indicates that even though the World Health Organization (WHO) reported a high incidence of sexually transmitted infections (STIs) among individuals between 15-49 years (WHO, 2024), those below 25 years were more cautious in preventing STIs, and those older than 25 years were more reckless sexually, supporting the findings of (Du, 2022) which stated that the incidence of age-standardized incidence rates (ASRs) of syphilis, chlamydia, gonorrhea, trichomoniasis, and genital herpes increased by 1.70% globally. The variety of health complaints decreases with age, and certain health complaints are more prevalent in specific age groups, for example, URTIs, pain, multiple symptoms, and fever are most common among young adults (25-44 years old), likely due to cumulative occupational exposure as this group is predominantly of working age (Korn, 1987). The association between health complaints of the study participants by income status showed that pain was the most frequently reported health complaint among individuals living below and above the poverty line, with an insignificantly higher percentage in the former group likely because many are in the non-dependent age group and face socio-economic vulnerabilities, leading them to undertake menial jobs or lower-tier employment (Fagerlund, 2023). Respondents below the poverty line complained less about fever and more about multiple symptoms, indicating that multiple symptoms are dominated by fever (pyretic symptoms) leading to the dispensing of antipyretic drugs and subsequently lowering the fever complaints. The high rate complaints of URTIs, and a slightly lower rate of GIT disorders in both groups are almost inseparable respectively. Other health complaints such as ear infections, eye infections, insomnia, and hormonal-related issues are less frequent across both groups but show slight variations, with some complaints like dermatological conditions, genital infections and hormonal-related issues being more prevalent among those living below the poverty line. Refill of prescriptions and complaints of NCDs were seen more often among those living above the poverty line, which may be attributable to their socio-economic status and better access to healthcare services enabling them to manage chronic conditions. Those below the poverty line reported a broader range of symptoms, which indicate a more complex health burden and less access to preventive healthcare. The perception of the role of pharmacists in community pharmacies was assessed using eight different question options depicting user’s perception, from which they can select as many that are appropriate. A client’s understanding of the role of pharmacists in community pharmacies will help the client to align his/her expectations with the role of the pharmacist which will improve the quality of the services they receive. As described in Table 4, six out of the eight question options provided were appropriate responses while two were inappropriate responses. Respondents who scored >4 were classified as having a positive perception while those who scored ≤4 were classified as having a negative perception. In this current study, the perception of the role of pharmacists in community pharmacies was largely positive (83.0%), with 77.7% believing that pharmacists should provide advice on drug use. This finding is consistent with the study of (Awad, 2017; El-Kholy, 2022; Xuan, 2023), where 86.3%, 72.0%, and 76.1% of respondents respectively, believed that it is the role of pharmacists to counsel patients about their medications, highlighting the trusted position of pharmacists in the community especially for drug-related consultations. The high expectation for pharmacists to manage drug- related issues, including adverse reactions (56.7%), is higher than the 40.0% reported by (El-Kholy, 2022), and 54.8% reported by (Awad, 2017). This finding further emphasizes the community’s reliance on pharmacists for their pharmaceutical care. Interestingly, 50.2% of the study participants indicated they would seek advice from pharmacists for conditions not serious enough to warrant a visit to a physician. This finding agrees with the findings of (Xuan, 2023) where 67.5% of respondents agree to seek a pharmacist’s services in treating minor symptoms such as cough, cold, constipation, and diarrhea. This suggests significant trust in pharmacists as the first point of contact for minor health concerns. However, the expectation for pharmacists to perform roles beyond their traditional scope, such as health screening services (15.7%), functioning as medical doctors (4.3%) or giving injections or drips (2.3%) was notably low. This finding reflects a lack of awareness about the expanding roles of pharmacists in some healthcare settings or cultural norms that delineate the roles of different healthcare professionals, similar to the reports of (Akshar, 2014; Awad, 2017). Moreover, while a majority (83.0%) of the respondents had a positive perception of the role of pharmacists in community pharmacies, a lower proportion (17.0%) had a negative perception, indicating room for improvement in public education. This gap in understanding could be addressed through community outreach and educational programs designed to inform the public about the Pa ge 12 https://journals.e-palli.com/home/index.php/ajcp Am. J. Chem. Pharm. 4(1) 1-15, 2025 comprehensive services pharmacists can offer, including health screenings and chronic disease management. There was no statistical significant association between socio-demographic characteristics (e.g. age group, gender, marital status, ethnicity, living status) and socio-economic characteristics (e.g. level of education, employment status, estimated monthly income) with perception of the role of pharmacists in community pharmacies, suggesting that perception was generally consistent across different population groups. The close similarity in positive perception between males (83.3%) and females (82.5%) further supports this finding. However, those living with family members had a better positive perception (84.1%), which could be linked to family influence in shaping healthcare decisions and perception. However, one limitation of this current study should be pointed out. The fact that data collection was carried out in June characterized with rains may influence the patterns of health complaints. In other non-rainy, dry and dusty months, the patterns of health complaints may differ. CONCLUSION In conclusion, the recurrence of certain health complaints suggests that community pharmacies are a primary resource for ongoing care, particularly for chronic medical conditions. There is a need for better public education on the expanding role of pharmacists in healthcare delivery. Enhancing public awareness about the risks of self-medication and the comprehensive health services offered by pharmacists, as well as a stricter regulation and enforcement on drug sales and acquisition could lead to better health outcomes. Leveraging family dynamics and addressing the broader socio-economic challenges in the society could further improve the community’s approach to healthcare. Acknowledgments The authors express their gratitude to everyone who contributed in one way or the other to make this research a success. The authors are also grateful to all the men and women who participated in this research for their cooperation and support, which are highly appreciated. Conflict of Interest The authors hereby declare that they do not have any possible conflicts of interest. REFERENCES Aderemi-Williams, R. I., Igwe, C N., & Soremekun, R. O. (2017). Clients’ perception of community pharmacists’ services in Owerri, Imo State, Nigeria. 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