Sudan Journal of Medical Sciences Volume 16, Issue no. 3, DOI 10.18502/sjms.v16i3.9696 Production and Hosting by Knowledge E Research Article Assessment of Self-medication Practices During COVID-19 Pandemic in Hyderabad and Karachi, Pakistan Mudassar Iqbal Arain1, Saira Shahnaz2, Ramesha Anwar3, and Khurram Anwar4 1Department of Pharmacy Practice, Faculty of Pharmacy, University of Sindh, Jamshoro, Pakistan 2Department of Pharmacy Practice, Faculty of Pharmacy, Nazeer Hussain University, Karachi, Pakistan 3Department of Pharmacy Practice, Faculty of Pharmacy, University of Karachi, Karachi, Pakistan 4Isra Dental College, Hyderabad, Pakistan ORCID: Mudassar Iqbal Arain: https://orcid.org/0000-0002-1797-9927 Abstract Background: Lack of appropriate treatment for COVID-19 infection led the general population of Pakistan toward self-medication and symptomatic treatment; almost 80% of the population collected medications for future use during pandemic. Thus, the current study aimed to assess the use of medication as symptomatic treatment preventive strategy. Methods: This descriptive cross–sectional study was conducted on a local population of Hyderabad and Karachi, Sindh, Pakistan. The study duration was six months (April– September 2020). A total of 698 responders were selected via random sampling method. The number of participants were recruited based on 95% confidence interval with 5% margin error. Data were transferred into analysis sheet descriptively. Results: Most participants responded to the use of different over-the-counter (OTC) products for headache. The use of antibiotics with prescription due to allergic conditions, cough, respiratory tract infections including sore throat, and urinary tract infections was also found among the majority. Few respondents had self-medication practice with sedatives due to difficulty in falling asleep, and 9.5% had self-medication practice due to pain. About 20.8% of the population agreed that lockdown was a contributing factor in the self-medication practice. Conclusion: Pharmacists and healthcare professionals are advised to counsel the general public regarding the use of medication. A close collaboration is required at this stage to fight against COVID-19 and preventing the situation from worsening. Keywords: self-medication, covid-19, Hyderabad, Karachi, Pakistan How to cite this article: Mudassar Iqbal Arain, Saira Shahnaz, Ramesha Anwar, and Khurram Anwar (2021) “Assessment of Self-medication Practices During COVID-19 Pandemic in Hyderabad and Karachi, Pakistan,” Sudan Journal of Medical Sciences, vol. 16, Issue no. 3, pages 347–354. DOI 10.18502/sjms.v16i3.9696 Page 347 Corresponding Author: Mudassar Iqbal Arain; email: mudassarpk@live.com Received 23 July 2021 Accepted 05 September 2021 Published 30 September 2021 Production and Hosting by Knowledge E Mudassar Iqbal Arain et al.. This article is distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use and redistribution provided that the original author and source are credited. Editor-in-Chief: Prof. Mohammad A. M. Ibnouf http://www.knowledgee.com mailto:mudassarpk@live.com https://creativecommons.org/licenses/by/4.0/ https://creativecommons.org/licenses/by/4.0/ Sudan Journal of Medical Sciences Mudassar Iqbal Arain et al. 1. Introduction The World Health Organization (WHO) defines self-medication (SM) as utilization of a medication without being prescribed by a healthcare professional to target symp- toms that are self-recognized [1]. SM includes usage of medication through direct purchase from pharmacies, reusing previously prescribed medicines, or buying over- the-counter (OTC) medications from medical stores/pharmacies [2]. The most commonly self-prescribed medications are analgesics, antipyretics, sedative drugs, certain com- mon antibiotics, supplements, herbal medicines, and homeopathic remedies. COVID-19 broke in as an infection in the late 2019, since then 30,905,162 confirmed cases were reported till the mid of 2020 [3, 4]. The WHO declared this situation as pandemic in the beginning of 2020. The pandemic and the fear of getting infected increased with the number of cases. COVID-19 has influenced the entire world with the confusion to preventive measures and no available treatment [5]. Cases of SM increased due to lack of appropriate guidelines to establish safety and treatment [6]. More number of people started SM practice to treat symptoms of infections such as cold, flu, and to strengthen their immunity in 2020 regardless of their knowledge, level of education, and socioe- conomic status [7]. The literature supports high levels of SMs among underdeveloped countries where the healthcare systems are costly and difficult to approach. Despite the fact that WHO stresses on rational prescribing practices and avoiding OTC medication among general population, this practice is constantly rising. SM may cause resistance to microorganisms and serious health risks with adverse drugs reactions, prolonging the morbidities [8]. Compared to other developed countries, the doctors-to-patients ratio in Pakistan was low. Researchers and healthcare professionals are continuously searching for solution to combat the symptoms of COVID-19 [9]. Most countries in the world went into a lockdown, confining general public to their homes, so people could rely only on social media for updates and information related to the pandemic [10– 12]. According to a recent report in March 2020, a 10-fold increase in the number of cases was noted only in the span of three months. The total deaths reported were six times more than the previous record [12]. The lack of a recognized treatment for the infection led people toward SM and symptomatic treatment, almost 80% of the population collected medication for future use during the pandemic. Thus, the current study aimed to assess the use of medication as symptomatic treatment preventive strategy. DOI 10.18502/sjms.v16i3.9696 Page 348 Sudan Journal of Medical Sciences Mudassar Iqbal Arain et al. 2. Materials and Methods A descriptive cross–sectional study was conducted among the local population of Hyderabad and Karachi, Sindh, Pakistan. The duration of study was six months (April– September 2020). A total of 698 responders were selected from various retail pharma- cies via random sampling method. Retail pharmacies were selected based on patients’ flow. The number of participants were recruited based on 95% confidence interval with 5% margin error. Patients aged >18 years and visiting one of the selected retail phar- macy were included. Verbal consent was also taken from the responders before filling the questionnaire. The questionnaire was divided into three parts: sociodemographic information; SM practices; and knowledge regarding COVID-19. The questionnaire was validated among 50 participants and necessary changes were made. Data were trans- ferred descriptively into the analysis sheet. 3. Results Of the 698 respondents, 56.2% were male while 43.8% were female. Based on their age, patients were divided into three categories: 19.3% were in the group of 18–38 years, 43.4% in 39–59 years, and 37.3% in >60 years. Moreover, about 43.7% of the responders were illiterate while 56.3% were educated (Table 1). The responders were also questioned about their current jobs – 28.2% were unemployed, 53.5% had a private job, and 18.3% had a government job. TABLE 1: Demographic information. Variable Frequency Percentage Gender Male 393 56.2% Female 305 43.8% Age (yr) 18–38 134 19.3% 39–59 302 43.4% ≥60 260 37.3% Education Illiterate 304 43.6% Literate 394 56.3% Job status Unemployed 197 28.2% Private job 373 53.5% Government job 127 18.3% DOI 10.18502/sjms.v16i3.9696 Page 349 Sudan Journal of Medical Sciences Mudassar Iqbal Arain et al. The main objective of the study was to assess the prevalence of SM practice and the reason thereof. Majority of the participants responded to the use of different OTC products – 23.3% for the headache and seasonal cough and cold symptoms. However, the use of antibiotics with prescription due to allergic conditions, cough and respiratory tract infections including sore throat, and urinary tract infections was also found among the majority. Few respondents practiced SM with sedatives due to difficulty in falling asleep, while 9.5% had it due to pain (Table 2). TABLE 2: Reasons of self-medication. Reason Frequency Percentage P-value OTC products for common illness Headache 163 23.3% 0.004 Cold 135 19.4% 0.005 Fever 107 15.4% 0.034 Use of antibiotics for infective symptoms Allergy 25 3.7% 0.013 Cough 45 6.5% 0.001 Respiratory infection 93 13.4% 0.005 Urinary tract infection 42 6.1% 0.001 Others Sleeping problem 18 2.6% 0.021 Body ache/ muscular pain 66 9.5% <0.001 Factors involved in the use of SM during the pandemic were assessed and respon- dents were asked about the basic reasons behind the off-prescription use of medication: majority of them were afraid of getting infected in case of going out and seeking medical advice, 30.5% were afraid of getting the COVID-19 infection. During the peak of pandemic, a large number of countries observed lockdown confining people to their homes for months, this is considered as one of the contributing factors in the rising SM practice; about 20.8% of the respondents agreed to this, 5.5% stated the long waiting hours at the clinics as their reason for practicing SM, while 12.6% practiced SM based on their previous knowledge and experience with the disease (Table 3). TABLE 3: Factors of self-medication in context of COVID-19. Factors Frequency Percentage Due to minor problem 88 12.6% Lockdown 145 20.8% Busy schedules of doctors 68 9.7% Fear to get COVID-19 213 30.5% Previous knowledge regarding the problem 88 12.6% High fees 58 8.4% Time wastage 38 5.5% DOI 10.18502/sjms.v16i3.9696 Page 350 Sudan Journal of Medical Sciences Mudassar Iqbal Arain et al. 4. Discussion SM practice is a major issue that worsens scenarios of health-related problems. The prevalence of SM has been increasing continuously in the past decades [13]. According to a study, SM practice with different OTC products and antibiotics has increased from 36.2% in 2019 to 60.4% in 2020 [14]. Moreover, the use of SMs for symptomatic treatment and based on the past experience of a patient is not a new phenomenon, this finding of ours is in line with the results of another study [15]. The majority of people were afraid to go out in the pandemic and more number of males were observed using medication with medical advice [16, 17]. After the pandemic broke, a vast majority of population was left jobless. Bamgboye et al. determine self-education practice and factors affecting them, and had similar results as that of our study [18]. While SM due to common symptoms, respiratory tract infection, and due to fear was practiced only after the onset of pandemic, those practicing SM based on their past experience were doing so even before the lockdown and pandemic [19]. The WHO recommends the use of precautionary measures during the pandemic, however, it does not recommend SM for the symptoms of COVID-19 and related factors [20]. Despite this, frequent use of antibiotics was found among the studied population [21–22]. The use of medication for different symptoms were in accordance with the study. 5. Conclusion The study aimed to find the prevalence of SM during COVID-19. Pharmacists and healthcare professionals are advised to counsel the population regarding the use of medication. A close collaboration is required at this stage to fight against COVID-19 and preventing the situation from worsening. Acknowledgements The authors acknowledge all supporting staff and faculty members who guided them throughout the research work. Ethical Considerations Verbal consent was taken from all responders prior to extracting data. DOI 10.18502/sjms.v16i3.9696 Page 351 Sudan Journal of Medical Sciences Mudassar Iqbal Arain et al. Competing Interests None. 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