30.Dr. Nadia Az Zahra.cdr INTRODUCTION Self-care has been dened by World Health Organization (WHO) as activities undertaken by individuals, families & communities for managing health and health related 1 problems. An essential component of self-care is 'self- medication'. Self-medication (SM) is an age old practice and has gained tremendous global importance in the recent past, due to its rising prevalence and because it not only reduces the burden on health services effectively, but also improves compliance of patients and consequently the disease 2 outcome. It can be dened as the use of drugs to treat self- diagnosed disorders or symptoms, or the intermittent/ continued use of a prescribed drug for chronic or recurrent 3disease or symptoms. Promoting a sense of responsibility in an individual about their own health through health education and making them aware that professional care is not necessary for minor illness 4 are the keys that lead to this concept. In 1978, the Declaration of Alma-Ata recognized the involvement of individuals in achieving the optimum health. Also, in 1986, The Ottawa declaration emphasized the central role of individuals and 5communities in contributing to health. Self-medication is a tool to accomplish this. Unfortunately, now-a-days, health is being commoditized and pharmaceuticalized. Health is being treated as a state which can be maintained by consumption of medicines, if one has the capital to invest. People conveniently “reach for the pill” at the rst sign of ill health. It has become a common practice for patients to use medicines without the supervision of healthcare professionals. This limits the opportunity for ongoing patient follow-up & safety monitoring, thereby increasing the risk of premature abandonment of treatment, up-titration leading to potentially dangerous dosing, and wastage of medication. Conversely, incomplete information by the patient about the self-administered drugs during reconciliation can cause unintended drug interactions, failure to apprehend adverse drug events and redundant therapy. 6 This consequently increases the health-care costs. Furthermore, drug resistance has become a worldwide concern. Irrational use of antibiotics has resulted in the spread of resistant pathogens, termed as “nightmare bacteria” which pose a “catastrophic threat” across the 7,8 continents. Great English philosopher-physician Sir William Osler has rightly said that “one of the rst duties of the physician is to educate the masses when not to take the medicines”. Ironically, the concept of 'Rational' and 'Responsible' self-medication is drifting towards an 'Irrational' and 'Indiscriminate' use of drugs. EVALUATION OF THE PRACTICE OF SELF MEDICATION AMONG OUTPATIENTS AT NALANDA MEDICAL COLLEGE, A TERTIARY CARE TEACHING HOSPITAL OF PATNA Original Research Paper Dr. Nadia Az Zahra Junior Resident, Department of Pharmacology, Nalanda Medical College & Hospital, Patna. Pharmacology BACKGROUND: There is no separate over the counter (OTC) category in India. Drugs that are not included in the list for prescription-only drugs are pictured as non-prescription drugs. Prescription-only drugs are those that fall under Schedule H, H1 & Schedule X of drugs and cosmetics rules 1945.The OTC Drug market is thincreasing internationally and India ranks 11 in the global OTC market. In spite of the existing rules & regulations, in the absence of a clear denition & legal recognition to OTC products & ease of access to various medications, it seems difcult to curb the rising tendency towards self-medication which is highly prevalent in India. OBJECTIVE: To evaluate the practice of self-medication and nd out the indications, reasons, category of drugs used, source of information for self-medication, knowledge about the purchased medicine and public opinion regarding self-medication practice in a tertiary care hospital of Patna. MATERIALS AND METHODS: A questionnaire based cross sectional observational study was carried out at Nalanda Medical College & Hospital, Patna among 602 patients for a period of 4 months from April 2019 to July 2019. Descriptive data analysis was done and reported in frequencies and percentage. RESULTS: Prevalence of self-medication in our study was found to be 55%. Frequency of self-medication was found to be once in 39% of the patients. Main reason for self-medication was cost effectiveness(25%) followed by previous experience(24%), the indications most commonly being pain(32%) followed by respiratory infections(17%). We found analgesics (34%) to be the most commonly used drug for self-medication. Around 30% of the patients had some knowledge about the medicines purchased. Most of them(61%) believed that it is an acceptable practice in case of minor illness. CONCLUSION: Self-medication appears to be a double-edged sword. Our study reects the prevalence and practice of self- medication in this area. Imparting knowledge about frequently used medications, conditions to be considered as a minor illness, the upsurge of antibiotic resistance, importance of package inserts & expiry dates, advantage of consulting a medical practitioner in contrast to a pharmacist at medical stores and pros & cons of self-medication as a whole, would denitely help balance this concept. ABSTRACT KEYWORDS : self-medication, prescription-only drugs, over the counter(OTC) drugs VOLUME-9, ISSUE-3, MARCH-2020 • PRINT ISSN No. 2277 - 8160 • DOI : 10.36106/gjra Dr. Sanjay Kumar* Professor & Head of the Department of Pharmacology, Nalanda Medical College & Hospital, Patna. * Corresponding Author Dr. Afzal Ahmad Assistant Professor, Department of Biochemistry, GS Medical College & Hospital, Hapur, U.P. Dr. Jwala Kumar Junior Resident, Department of Pharmacology, Nalanda Medical College & Hospital, Patna. Dr. Shubhra Bishwas Junior Resident, Department of Pharmacology, Nalanda Medical College & Hospital, Patna. 26 X GJRA - GLOBAL JOURNAL FOR RESEARCH ANALYSIS Focusing on India, we see that there is no separate over the counter (OTC) category. In spite of the existing rules & regulations, in the absence of a clear denition & legal recognition to OTC products & ease of access to various medications, it seems difcult to curb the rising tendency towards self-medication. Various community-based studies have determined the prevalence of self-medication in India 9,10 ranging from 12% to as high as 73%. Recently, the Drugs Consultative Committee (DCC) has decided to dene, classify and lay down specic provisions for the regulation for approval, distribution & sale of OTC drugs in the country. Various studies are being conducted targeting self- medication. The objectives of this study were to evaluate the practice of self-medication in the patients attending the OPD of Nalanda Medical College & Hospital, Patna. An attempt was made to nd out the indications, reasons, category of drugs used, source of information for self-medication, knowledge about the purchased medicine and public opinion regarding self-medication practice was also examined. MATERIALS AND METHODS A questionnaire based cross-sectional study was conducted involving face to face interviews amongst the patients attending outpatient department of Nalanda Medical College & Hospital, Patna. It was a 4 month study from April 2019 to July 2019. The purpose and details of the study were explained to the patients prior to the initiation of data collection. Those who were willing to participate in the study and gave informed consent, with address proof of residency in Bihar, who understood Hindi or English were eligible to participate in the study. Those having communication problem, severe illness or mentally challenged were excluded from the study. On behalf of children below 12 years of age, response to the questionnaire was obtained from their parents. Self-medication for this study was considered as the use of medicines in the last 4 months for which a doctor was not consulted. A total of 1150 patients were approached and out of them 602 (52.3%) were found to be practicing self-medication and were included in our study. Descriptive data analysis was done & reported in frequencies and percentage. RESULTS Among 602 participants, the frequency of self-medication was found to be once in 39% (234/602) of the patients, twice in 26.4% (159/602), more than twice in 22% (133/602) of the patients while 76 (12.6%) of them were not sure. Paracetamol(19%) was the most common self-medicated analgesic antipyretic, Amoxycillin(16%) was the most common antibiotic while Cetirizine(10%) was most common antihistaminics (12%). Consumption of ORS was more common for diarrhoea as compared to vomiting. ORS power was not even dissolved in 1Litre of water by 18.6%(112/602) of the patients. Opinion about the practice of SM was also sought and we found that 61.5%(370/602) of the participants believed that it is an acceptable practice in case of minor illness, 61 of them considered it a good practice and should be encouraged while 122 participants thought it should be avoided. 49 participants did not have any view about this. VOLUME-9, ISSUE-3, MARCH-2020 • PRINT ISSN No. 2277 - 8160 • DOI : 10.36106/gjra Table 1. Demographic characteristics of the study group(n=602) DEMOGRAPHIC FACTORS CATEGORIES FREQUENCY(%) GENDER Male Female 387(64.3) 215(35.7) AGE <20 years 20-35 years 36-60 years >60 years 48(7.9) 191(31.7) 296(49.2) 67(11.1) EMPLOYMENT STATUS Employed Unemployed Student Farmer 294(48.8) 198(32.8) 67(11) 43(7) EDUCATIONAL LEVEL Illiterate Primary High School Intermediate Graduate Post Graduate 83(13.7) 82(13.6) 165(27.4) 133(22) 115(19) 24(4) Table 2.Indications for self-medication (n=776) INDICATIONS FREQUENCY(%) Pain (Headache,Musculoskeletal etc.) 248(31.9) Fever 96(12.3) Vomiting 61(7.9) Loose Motions 90(11.6) Cough/Cold/URTI 130(16.8) Constipation 19(2.4) Weakness 27(3.5) Acidity 94(12.1) Others(Eye/ENT/Skin Problems) 11(1.4) Table 3. Drug classes used for self-medication (n=1043) DRUG CLASS FREQUENCY(%) Analgesic & Antipyretics 360(34.5) Antacids & Other Gastrointestinal Drugs 268(25.7) Antibiotics 220(21) Antihistaminics 128(12.3) Multivitamins 35(3.3) Others (ORS, Probiotics, Corticosteroids, Lozenges etc.) 32(3) X 27GJRA - GLOBAL JOURNAL FOR RESEARCH ANALYSIS DISCUSSION The prevalence of self-medication in our study was found to be 52.3% (602/1150). A study done by Saharan in Mumbai reported self-medication prevalence of 85% which is higher than present study while in a study by Saba et al at Bengaluru, prevalence rate of self-medication was found to be 11,1240.5%. Our study showed that cost (25%), past experience with similar illness (24%) were the main reasons for SM. Our result is similar to studies done in Bangladesh which reported cost saving as reason other than minor illness for practicing self- 13medication. This nding is in contrast with another recent survey that revealed common reasons for self-medication as 14,15ailments being minor (85.2%). The indications for which majority of the individuals self- medicated was pain (32%) followed by cough and respiratory infections (17%). Similar to our result, pain & respiratory infections were the top symptoms in a study from urban and rural population of Islamabad and another study conducted 15,16in Mumbai. While in a study from urban & rural areas of Bangladesh, Western Nepal and Mumbai, pain (17%) and 11,13,17fever (15%) were the main symptoms. Our study revealed that pharmacy shop (39%) was the main source of obtaining drugs for self-medication followed by old prescriptions (18%), 16,18similar to other studies from rural Tamil Nadu & Pune. We found analgesics (34%) to be the most commonly used drug for self-medication similar to ndings in other 14,16,17,19 studies. 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