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American Journal of  Medical 
Science and Innovation (AJMSI) 

Prevalence, Self-Medication Practices, and Knowledge Levels on Analgesic Among 
Residents of  Nalut, Libya: A Cross – Sectional Study  

Aminah Issa Masud Aljerbi1, Amira Saleh Khalifa Bagni1*, Assma Nagi Aissa Wareg2, 
Nada Faisal Ali Suleiman2, Fatimah Mohammed Yousuf  Askar2

Volume 1 Issue 1, Year 2022
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Article Information ABSTRACT

Received: November 19, 2022

Accepted: December 08, 2022

Published: December 08, 2022

Self-medication (SM) has become an increasingly important symptom management option 
for common conditions today. Irrational SM practice leads to incorrect diagnosis and a risk 
factor for disease exacerbation and serious health consequences. Hence responsible SM is 
vital for better health outcomes. In the present community- based study, we explored the 
prevalence the SM practice among residents, frequency, outcome, distribution of  different 
level of  knowledge about Paracetamol, aspirin, and ibuprofen analgesics. Cross-sectional 
study was conducted among randomly selected 1218 participants depending on multi-stage 
random sampling technique. The sample was taken among the consumers of  community 
facilities in Nalut- Libya.  Data were analyzed using SPSS; Chi-square test was performed to 
indicate significance, frequency, percentage. A total of  1218 residents completed the survey, 
prevalence of  SM practiced was 12.95%, The mean age of  participants was 25±30, ranged 
from 18 to 41 and above years. Most of  residents 834 (68.5%) were in undergraduate level, 
725 (59.5%) were employing and 559 (45.9%) were in low income level and 170 (14%) had 
chronic diseases. There is no statistically significant deference between the level of  knowl-
edge to paracetamol, Aspirin and ibuprofen analgesics among participants and their age (X² 
=0.954, P= 0.812). Most the participants had poor knowledge toward paracetamol, Aspirin 
and ibuprofen analgesics.

Keywords
Analgesic Knowledge, 
Self-Medication, Prevalence, 
Nalut, Libya

1 Faculty Member Department of  public health, college of  medical technology, Nalut university, Libya 
2 Bachelor’s degree, Department of  public health, college of  medical technology, Nalut university, Libya
* Corresponding author’s e-mail: bagniamirasaleh@gmail.com

INTRODUCTION
In the midst of  escalating health care costs globally, 
SM is becoming an increasingly important option for 
common conditions. Despite the benefits of  practicing 
SM depends on responsible implementation. According 
to the (WHO,2000). SM is also defined as “the use of  
drugs to treat self-diagnosed disorders or symptoms”. 
They are often called SM (over-the counter medicines) 
(OTC) and can be purchased at pharmacies without 
a doctor’s prescription (Azhar et al.,2013). Medicines 
that do not require a prescription play a major role in 
self-care, which provides individuals with the option to 
make independent decisions about their health. Drug 
education and culture have an important role in educating 
consumers and providing them with the correct rules for 
using medicine to avoid the risks that can result from 
the indiscriminate use of  medicines (Stosic et al.,2011). 
The misuse of  analgesic’s or taking them indiscriminately 
and without medical advice has many risks for all age 
groups, as some medicines cannot be given to the patient 
together. Or they may need to adjust their doses, So the 
specialist doctor is the only one who is able to prescribe 
the appropriate medicine, as he takes into account all the 
precautions are necessary (Mohammed,2016). Most types 
of  analgesics share the same side effects, which stomach 
pain, nausea, vomiting, dizziness allergic reactions and 
skin rashes. These effects can be considered short- term, 
as they can appear on some without the other. As for 
the side effects that result from the continuous and 
excessive use of  sedatives, they are often related to the 
kidneys, liver and are severe (Ali et al.,2018). A study to 

evaluate the indication for the use of  non-steroidal ant 
inflammatory drugs, to what extent the public is aware 
of  their side effects, the sample size is 9062 participants 
from the American public, and the results showed that 
ibuprofen –based drugs are the most used and 26% of  
respondents used more than the recommended dose, 
15% reported daily use of  analgesics and 49% did not 
know about possible side effects (Wilcox et al.,2005). 
There are many medicines that contain paracetamol, so 
you must read the ingredients of  the medicine and not 
take more than one medicine that contains paracetamol, 
and taking it may cause an increase in the effectiveness 
of  warfarin (an anticoagulant drug) and the risk of  
bleeding increases, and paracetamol should not be taken 
with epilepsy and tuberculosis medicines (NHS,2019). In 
the study (Kontogiorgis et al.,2016) entitled “Assessment 
of  consumer’s knowledge and Attitudes towards Over-
the-Counter Analgesic Drugs”, the researchers used 
a sample of  participants individuals was frequented 
community pharmacies, and a questionnaire was used 
as a data collection tool. The aim of  the study is to 
bridge the knowledge gap regarding people’s beliefs and 
attitudes related to the use of  paracetamol. The results 
showed that 11.1% of  the participants believed that 
the maximum permissible dose. More than a third of  
participants thought that paracetamol had no side effects. 
A large proportion of  the participants ranged between 
9.9% and 33.7% the difference between paracetamol 
and non-steroidal anti-inflammatory drugs was not 
known. The results also showed a relationship between 
the rate of  paracetamol use and the gender and age of  

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the participants. The use of  aspirin may sometimes be 
accompanied by the emergence of  some unwanted side 
effects, and these effects may require a visit to the doctor. 
The most important side effects of  the use of  aspirin are 
the worsening of  the condition of  people with asthma, 
and it also affects blood clotting, as it is one of  the blood-
thinning drugs. Which may cause some problems related 
to bleeding in some people. Aspirin use also cause serious 
allergic reactions in some people who are allergic to 
aspirin, such as a rash (Kanaan & Gholami, 2021). Taking 
ibuprofen, for long periods or in high doses may lead to 
serious side effects. One of  the noticeable side effects 
of  taking it is swelling of  the leg or body (edema). This 
swelling is caused by excess fluids trapped in the body 
tissues. It can also cause digestive problems. If  a person 
takes ibuprofen regularly, the stomach loses its protective 
barrier, and over time this may lead to gastritis, stomach 
ulcers or perforation (Krasniqi et al .,2019). We conducted 
this study to determine the prevalence of  SM practice , 
and assess the knowledge level on analgesic (Paracetamol, 
Aspirin, Ibuprofen) among residents of  Nalut city , Libya.

MATERIALS AND METHODS 
Sample size and sampling method 
The present community-based cross-sectional study was 
carried out to explore the prevalence of  self-medication, 
participant’s level of  knowledge regarding paracetamol, 
aspirin and ibuprofen analgesic. The sample was taken 
among the consumers of  community facilities in Nalut - 
Libya. Cross-sectional study was conducted among 1218 
participants randomly selected depending on multi-stage 
random sampling technique. The study was conducted 
between February and July 2022 among residents aged 18 
to 41 and above years in Nalut, Libya. The institutional 
review board of  the Nalute University (NU) approved 
the study during 2022. Participation was voluntary. They 
had the participation of  option to choose either yes or 

no. Those who selected disagree option were directed to 
decline the participation section and finish participation.
A questionnaire-based cross, sectional study were used. 
The questionnaire consisted of  personal information 
(gender, age, level of  education, family income, 
occupation) and other question related to the knowledge 
level of  participation on paracetamol, aspirin and 
ibuprofen analgesic. The sample was taken randomly 
from 5 preparatory schools, 2 secondary schools and 3 
colleges affiliated with Nalut university and other facilities 
.Data were analyzed using statistical package of  social 
science (SPSS version )  Descriptive statistics(frequencies, 
percentages, mean, and standard deviation) were used 
to describe the categorical study and outcome variables 
chi-square test was used to describe the different  level 
of  knowledge about paracetamol, aspirin, and ibuprofen 
analgesic, and P value ≤ 0.05 were considered statistically 
significant.

RESULTS
The Prevalence of  SM is increasing globally, and its rational 
practice warrants the benefits. Overall, 12.95% have 
practiced SM among residents during this study. A total of  
1218 participants was included in the study , 321 (26.4%) 
were male and 897 (73.6%) were female, Moreover, the 
mean age of  participants was (25±30) ranged from 18 to 
41 years and above. Most of  participations 834 (68.5%) 
were in undergraduate level, 725(59.5%) were employing 
and 559 (45.9%) were in low-income level and 170 (14%) 
had chronic diseases (Table  1).
The participant’s answers about the use of  SM were 
collected among residents, and it was found that they 
use SM and analgesics without a prescription 819 
(67.2%), but the most use was observed in cases of  
necessity 1196 (98.2%), also when asked about reading 
the pharmaceutical leaflet, it was found that 836 (68.6%) 
does so before use. These percentages indicate to the 

Table 1: Socio-Demographic characteristics of  the study participants
Demographic variables Freq. (%)

Gender Male 321 26.4%
Female 897 73%

Age 18-20 267 22.1%
21-30 464 38.1%
31-40 242 19.8%
41years above 243 20%

Level of  Education High school 315 25.8%
Undergraduate 834 68.5%
Post graduate 69 5.7%

Occupation Student 397 32.6%
Employee 725 59.5%
Retired 13 1.1%
unemployed 83 6.8%

Family income by L.D Less than 450 84 6.9%
450 – 1000 475 39%
1000 – 3000 621 51%
More than 3000 38 3.1%

Chronic diseases Yes 170 14%
No 1048 86%

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awareness of  the participants about the use of  analgesics 
and SM. Also, when asked about who guides them to use 
analgesics without a prescription, it turns out that they 
get analgesics from the pharmacist and the doctor at a 
high rate of  up to 782 (64.2%). The study showed a great 
diversity in the pain used analgesics, from head pain 468 
(38.4%), followed by tooth ache 319 (26.2%) than by 
coughing and high fever 187 (15.4%), back and muscle 
pain 82 (6.7%) and menstrual 84 (6.9%) (Table 2).
Most of  participant based on the knowledge total 
score 1218 participants had poor knowledge toward 
the paracetamol, aspirin and ibuprofen analgesics. 981 
(80.5%) of  the participants do not know the cases in 

which use of  paracetamol analgesic is not allowed, also 
980 (80.5%) of  the participants do not know the drug 
interactions of  the paracetamol analgesic, while 324 
(26.6%) of  the participants know what are the conditions 
in which the use of  paracetamol is contraindicated, and 
also 654 (53.7%) of  the participants do not know the 
recommended dose of  paracetamol. We notice a slight 
difference in the knowledge about aspirin between 
the participants compared to their knowledge about 
paracetamol analgesic. We find that 925 (75.9%) are 
not aware of  the side effects of  aspirin analgesic, and 
we also find that 950 (78%) of  the participants is not 
aware of  the drug interaction of  aspirin analgesic, while 

Table 2: Self-medication pattern among residents of  Nalut city, Libya.
Self-medication practice information Freq. (%)
Do you use any analgesic without a prescription?
Yes 819 67.2%
No 399 32.8%
When do you use analgesics?
As necessary 1196 98.2%
Always 22 1.8%
What do you do if  the pain has not stopped?
Consult a doctor or pharmacist 672 55.2%
Increase the dose of  the analgesic 309 25.3%
Use another pain reliever 237 19.5%
Who advises you to use analgesics when you buy it without a prescription?
The doctor or pharmacist 782 64.2%
TV or social media 100 8.2%
Family and friends 149 12.2%
No one 187 15.4%
Why do you usually use analgesics?
Head ache 468 38.4%
Tooth ache 319 16.2%
Cough, fever, or cold 187 15.4%
Back pain or muscle pain 82 6.7%
Painful menstruation 84 6.9%
Any other pain 78 6.4%
Do you read the medication leaflet before using it?
Yes 836 68.6%
No 382 31.4%

Table 3: Distribution of  different level of  knowledge on paracetamol, aspirin and ibuprofen analgesics. 
Different level of  Knowledge on Paracetamol, Aspirin, and Ibuprofen
Do you Know the recommended dose of

Paracetamol Aspirin  Ibuprofen
Yes 564(46.3%) 407(33.4%) 263(21.6%)
No 654(53.7%) 811(66.6%) 955(78.4%)
Do you know what are the side effects of

Paracetamol Aspirin  Ibuprofen
Yes 237(19.5%) 293(24.1%) 226(18.6%)
No 981(80.5%) 925(75.9%) 992(81.4%)
Do you know what are the cases in which it is forbidden to use

Paracetamol Aspirin  Ibuprofen
Yes 324(26.6%) 353(29%) 230(18.9%)
No 894(73.4%) 865(71%) 988(81.1%)
Do you know what drug interactions

Paracetamol Aspirin  Ibuprofen
Yes 238(19.5%) 268(22%) 236(19.4%)
No 980(80.5%)   950(78%) 982(80.6%)

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353 (29%) of  the participants is aware of  the cases in 
which the use of  aspirin analgesic is prohibited. In 
general, we note that the participant’s knowledge about 
ibuprofen does not constitute a significant difference 
between the participant’s knowledge about paracetamol 
and aspirin, and it is noted that 992 (81.4%) do not know 
the side effects of  ibuprofen analgesic, while only 236 
(19.4%) participants are aware of  the drug interactions 
of  ibuprofen, and the results find   263 (21.6%) of  the 
participants on the know the recommended dose of  

ibuprofen (Table 3).
Overall, participants (76.1%) of  the participants know 
drug interactions of  paracetamol and (65.3%) know drug 
interactions aspirin in other hand had negative knowledge 
toward the ibuprofen analgesic side effects (0.8%). There 
is no statistically significant difference between the level 
of  knowledge of  the use of  analgesic among participants 
and their age (X²=0.954, P=0.812). Most the participants 
had poor knowledge toward paracetamol, aspirin, and 
ibuprofen (Table 4). 

Table 4: Distribution of  different level of  knowledge about Paracetamol, Aspirin, and Ibuprofen
Variables High Knowledge Low knowledge X² P-value
Age
18  -  20 56(20.9%) 213(22.4%)

0.954 0.81221  -  30 105(39.2%) 359(37.8%)
31  -  40 57(21.3%) 185(19.5%)
41years& above 50(18.7%) 193(20.3%)
Gender
Female 181(76.1%) 716(73.1%)

0.882 0.348Male 57(23.9%) 264(26.9%)
Level of  education
High school 70(26.1%) 245(25.8%)

7.439 0.114Undergraduate 175(65.3%) 659(69.4%)
Postgraduate 23(8.6%) 46(4.8%)
Family income
Less than 450 18(8.0%) 66(6.7%)

1.136 0.768450   -   1000 82(36.3%) 393(39.6%)
1000 –  3000 119(52.7%) 502(50.6%)
More than 3000 7(3.1%) 31(3.16%)

It is noticeable from the Figure 1 there is a great lack(poor) 
knowledge about the most common analgesics among the 
residents of  the area. Where we find that the cumulative 
rate of  knowledge about paracetamol is 27.9% and the 
cumulative average of  knowledge about aspirin 27.1 and 

we see a significant decline knowledge about ibuprofen 
with a cumulative rate of  19.6% (Figure 1).

Participant’s level of  knowledge regarding Paracetamol, 
Aspirin, and Ibuprofen

Figure 1: Shows the knowledge toward the Paracetamol, Aspirin, and Ibuprofen analgesic’s

DISCUSSION
This study was conducted to evaluate the prevalence 
practice of  SM and knowledge toward paracetamol, 
aspirin, and ibuprofen analgesic among residents in 
Nalut city, Libya. This study included 1218 participants, 
whose ages ranged from 18 to 41 years and above. The 
prevalence of  SM in our study were found to be 1218 
(10.69%) of  them practices SM. There no statistically 
significant difference between the level of  knowledge 
to use of  analgesic among participants and their age 

(X²= 0.954, P=0.812). Most the participants had poor 
knowledge towards paracetamol, aspirin, and ibuprofen 
analgesics. It is clear from the study that sample members 
use of  analgesic when necessary 98.2%, and others 
always use them 1.8%, as these results agree with (Siddig 
et al .,2020). Also, that religion, it consults the pharmacist 
when they use sedatives 64.2%, and others does not 
consult the pharmacist 15.4%, either religion, it consults 
friends and family it was about 12.2%, and others, they 
use television and social media as a source of  information 

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8.2% (Karami et al.,2018). It is noted that religious 
participants read the medication leaflet of  the analgesic 
before use 68.6%, and whose participants do not read the 
medication leaflet of  the analgesic before using it 31.4%. 
The results of  the study show that the participants know 
the amount of  the recommended dose of  paracetamol 
analgesic 64.3%, 53.7% they do not know the amount of  
the recommended dose, this comes into agreement with 
the study (Zamir & Nadeem ,2016). Also, the participants 
know about the side effects of  paracetamol 19.5% and 
religion did not have knowledge about the side effects 
of  paracetamol analgesic 80.5%. About the participant’s 
knowledge on drugs interactions of  paracetamol 19.5% 
and religion do not have knowledge about it 80.5%. The 
participant’s knowledge about the recommended dose of  
aspirin 33.1% and religion do not know the recommended 
dose, 66%. Results of  the participant’s knowledge of  the 
side effects of  aspirin analgesic 24.1% and those who 
had no knowledge were 75.9% these results were in 
agreement with the studies (Rabee et al .,2021) knowledge 
of  participants about the ibuprofen recommended dose 
analgesic 21.6% and who do not know the recommended 
dose of  ibuprofen 78.4% (Sarganas et al .,2015). The 
results also expected us that the participants knowledge 
of  analgesic ibuprofen side effects 18.6% and those who 
did not have knowledge 81.4% (Muhammad et al ., 2021).

CONCLUSION
Through this study , the results shown that most of  the 
participant’s practice self-medication and , also there 
is poor knowledge about the use of  most common 
analgesics among the residents of  the area. So ,from the 
results we recommend  need to educate  the public about 
the use of  over-the-counter medications to increase 
knowledge and awareness.
The study had the limitation  that was important for the 
lack of  responsiveness and people’s consent in answering 
the questionnaire, So it was possible the sample size could 
have been greater, and many samples were excluded due 
to the neglect of  participants.  Also suggest conducting 
more research with regard to the practice of  home therapy 
with the use of  traditional medicine that is remarkably 
widespread in our country, Libya, and conducting future 
research with large samples in different cities in Libya. 
Inclusion of  the concept of  pharmaceutical culture in 
educational curricula to develop consumers’ awareness. 
For promoting rational self-medication practice, patient 
health awareness programs, community pharmacist 
assistance, continuing medical education programs for 
health care providers, and planned interventions in the 
media, such as newspapers, magazines, and television are 
required.

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