Self-Medication Use and Its Associated Factors Among Elderly Patients At University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia, 2024

Technical Summary: Self-Medication Use and Its Associated Factors Among Elderly Patients at University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia, 2024

Problem Statement
Self-medication, defined as the use of medications without a physician's prescription or medical organization approval, presents a significant global health challenge. While it can offer benefits such as increased access to pharmaceuticals and reduced government expenditure for minor conditions, it carries substantial risks including inaccurate self-diagnosis, delayed therapeutic intervention, adverse drug reactions (ADRs), drug interactions, and the masking of severe diseases. The elderly population is particularly vulnerable due to age-related physiological changes in pharmacokinetics and pharmacodynamics, the high prevalence of comorbidities (e.g., diabetes, hypertension, cardiovascular disease), and a higher rate of medication consumption. Despite the known risks, there is a scarcity of comprehensive studies regarding self-medication practices and their determinants among the elderly in Ethiopia. This study addresses this gap by evaluating the prevalence and associated factors of self-medication among elderly patients at the University of Gondar Comprehensive Specialized Hospital.

Methodology

• Study Design and Setting: An institutionally based cross-sectional study was conducted between June 10 and August 27, 2024, at the University of Gondar Comprehensive Specialized Hospital in Northwest Ethiopia.
• Population: The target population consisted of elderly patients (age >65 years) visiting the chronic Outpatient Department (OPD). Inclusion criteria required patients to be present during data collection and have a history of medication use. Exclusion criteria included patients under 65, those who were critically ill, or those unable to hear or speak.
• Sampling and Sample Size: A simple random sampling technique was employed. The initial sample size was calculated using a single population proportion formula (assuming 50% prevalence due to a lack of prior Ethiopian studies) and adjusted for a finite population (<10,000) and a 10% non-response rate, resulting in a target of 219. Ultimately, 200 participants were included in the final analysis (response rate: 91.32%).
• Data Collection: Data were gathered via face-to-face interviews and medical record reviews using a structured questionnaire administered by three qualified professionals (one nurse and two pharmacists). The instrument covered socio-demographics, self-medication practices (frequency, symptoms, drug types, sources), and awareness levels. Interviews lasted 30–60 minutes.
• Data Analysis: Data were entered using EpiData and analyzed with SPSS version 25. Descriptive statistics summarized the findings. Bivariable and multivariable binary logistic regression models were used to identify factors associated with self-medication. Variables with a p-value <0.2 in bivariate analysis were entered into the multivariable model. Significance was set at p < 0.05. Multicollinearity was checked (VIF = 2.25), and model fitness was confirmed (Hosmer and Lemeshow p = 0.425).

Key Results

• Prevalence: A high prevalence of self-medication was observed, with 167 out of 200 participants (83.5%) reporting the practice.
• Demographics: The majority of participants were aged 65–75 (65.5%). Regarding education, 29.5% had primary schooling, 21.5% had secondary/preparatory schooling, and 23.5% had no formal education.
• Clinical Drivers: Fever and headache were the most common reasons for self-medication (62%).
• Medication Types: Analgesics were the most frequently used drug class (58.7%), followed by antacids (25.15%).
• Sources: Medications were primarily obtained from private pharmacies (82 individuals) or as leftover prescriptions (34 individuals).
• Associated Factors (Multivariable Analysis):
  • Gender: Female participants were significantly more likely to practice self-medication than males (AOR = 3.26; 95% CI: 1.612–6.592).
  • Income: Participants with a monthly income above 5,000 Ethiopian Birr were more likely to self-medicate compared to those with lower incomes (AOR = 6.0; 95% CI: 2.5–12.24).
  • Education: Contrary to some expectations, having a secondary or preparatory education level was associated with a higher likelihood of self-medication compared to elementary or illiterate status (AOR = 3.224; 95% CI: 1.084–5.595). Note: The abstract and results section present this as a positive association, while the discussion notes that higher education can sometimes be protective; the statistical finding in this specific study indicates secondary/preparatory education was a risk factor.
• Awareness: 69.3% of participants claimed to have knowledge about the drugs they used, though 30.5% did not inquire about them. 72.5% reported no issues with self-medication, while 27.5% experienced side effects or ineffective treatment.

Significance and Claims
The authors assert that this study provides a comprehensive understanding of self-medication practices among the elderly in the study area, serving as a baseline reference for future research. The findings highlight that self-medication is a widespread practice in Gondar, driven by factors such as gender, income, and educational status. The study claims that the results will aid in bridging the gap between policy development and implementation regarding medication access.

The paper concludes that to ensure safe practices, medical professionals must educate older patients on the risks and benefits of self-medication. Furthermore, the authors recommend robust measures by drug regulatory authorities to prevent the dispensing of drugs without proper prescriptions and the establishment of national standards for medication access. They emphasize that in a developing context like Ethiopia, where literacy rates are low and over-the-counter access is broad, regulatory intervention is critical to mitigate the risks of side effects and drug misuse.

Limitations Acknowledged by the Authors
The study acknowledges several limitations:

1. Scope: It focused on modern medications, excluding traditional medicines, which may lead to an underestimation of total self-medication prevalence.
2. Bias: Reliance on participant recall introduces potential recall bias. Additionally, social desirability bias may have influenced participants to underreport behaviors perceived as inappropriate, though indirect questioning was used to mitigate this.
3. Generalizability: As a single-center study, the findings may not be fully representative of all elderly populations in Ethiopia.