|Year : 2015 | Volume
| Issue : 3 | Page : 318-323
Assessment of self-medication among dental students in Pune city, Maharashtra: A cross-sectional survey
Dheeraj Deepak Kalra1, Prajna V Kini2, Rinku D Kalra3, Vinod R Jathanna4
1 Department of Public Health Dentistry, Sinhgad Dental College and Hospital, Pune, India
2 Department of Palliative Medicine, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
3 Department of Oral and Maxillofacial Surgery, Yerala Dental College and Hospital, Navi Mumbai, Maharashtra, India
4 Department of Conservative and Endodontics, Manipal College of Dental Sciences, Mangalore, Karnataka, India
|Date of Web Publication||14-Sep-2015|
Dheeraj Deepak Kalra
Department of Public Health Dentistry, Sinhgad Dental College and Hospital, Room No. 8, Vadgaon Bk., Pune - 411 041, Maharashtra
Source of Support: None, Conflict of Interest: None
Introduction: In the recent years, there has been an increasing trend in self-medication with nonprescription (over-the-counter) drugs available in pharmacies and retail outlets. There are both advantages and disadvantages of self-medication. Data pertaining to the prevalence of self-medication among dental students in India is scarce. Aim: To determine the level of self-medication among the dental students. Materials and Methods: Descriptive cross-sectional questionnaire study was conducted on 548 dental students from I BDS to IV BDS, interns, and postgraduate students, in classroom setting in census type, hand delivery of questionnaires was done. Out of that, 494 questionnaires were returned duly filled and analyzed. Data analysis were done using SPSS software (v 22.0, IBM). Results: A total of 40.9% of respondents indulged in self-medication. Both male and female dental students equally had a habit of taking medicines on their own. The most common drugs used for self-medication were antipyretics (46.56%), followed by analgesics (40.08%), and cough syrups (18.02%). Cold (19.43%) was the major indication for self-medication, followed by (18.02%) a cough, and (16.19%) was a fever. Most common reason not to see a doctor was that there is no need to see a doctor because of a simple disease (31.58%) followed by the need for a quick relief (20.45%). The predominant guiding sources of information for students was media (magazines and internet) (38.06%) and books (39.88%). Conclusion: The majority of students indulged in the practice of self-medication though they had poor knowledge of the benefits and risks.
Keywords: Drug therapy, over-the-counter, self-care, self-medication
|How to cite this article:|
Kalra DD, Kini PV, Kalra RD, Jathanna VR. Assessment of self-medication among dental students in Pune city, Maharashtra: A cross-sectional survey. J Indian Assoc Public Health Dent 2015;13:318-23
|How to cite this URL:|
Kalra DD, Kini PV, Kalra RD, Jathanna VR. Assessment of self-medication among dental students in Pune city, Maharashtra: A cross-sectional survey. J Indian Assoc Public Health Dent [serial online] 2015 [cited 2020 Jan 26];13:318-23. Available from: http://www.jiaphd.org/text.asp?2015/13/3/318/165283
| Introduction|| |
Self-medication can be defined as obtaining and consuming drugs without the advice of a physician either for diagnosis, treatment or monitoring.  In the recent years, there has been an increasing trend in self-medication with nonprescription (over-the-counter [OTC]) drugs available in pharmacies and retail outlets.  Self-medication is endemic in developing countries.  Some studies in India report a rising incidence.  A major problem with self-medication with antimicrobials is the emergence of human pathogens resistance. 
Advertisements for OTC medicines are legal in many countries, including India. The antibiotics are on top of the list of self-administered drugs in countries that do not control their commercialization.  It is reported that easiness of obtaining drugs without a prescription can especially increase the inappropriate use of antibiotics.  Although there have been many regulations in India to regularize sale of OTC, however, temporal trends and regional differences are important triggers for action and investigation, and benchmarking by comparisons between countries should be an important stimulus to quality improvement. 
Dental students are future prescribers of drugs and so it is important to find out how rational their drug use is. They differ from the general population because they are exposed to knowledge about disease and drugs. Because of the existing knowledge of common medicines prescribed and the knowledge of pharmacology taught as a subject in II BDS, there are high chances that the dental students may indulge in self-medication practices. So the research question arises whether dental students have a self-medication habit for common ailments. Also, data pertaining to the prevalence of self-medication among dental students in India is scarce. With this background, the aim of this study was to determine the level of self-medication among dental students.
| Materials and methods|| |
This study was a cross-sectional questionnaire study, carried out at Sinhgad Dental College and Hospital, Pune, Maharashtra, India, in the month of April 2014. A proposal was submitted to the Institutional Research Board (IRB) to obtain permission prior to the start of the study in the prescribed format. The proposal was reviewed by 2 blinded reviewers. Permission to carry out the study was obtained (IRB Letter no. SDCH/IRB/IN/2013-14/83).
The instrument to record responses was a self-designed pretested questionnaire. The questionnaire had two sections. Section I gathered socio demographic information about the study participants such as age, gender, year of education, distance to a medical store, and last visit to a physician. Section II had set of 18 questions which were mainly closed ended but given an option others as open ended to fill up any information which was not covered in the options given for each question. Questions 10-18 were dichotomous having responses as yes or no.
A pilot survey was carried out among 25 dental students (who were not included in the main study) to find out the validity and inherent flaws in designing of the questionnaire. Construct and content validity of the questionnaires was checked after thorough discussions with an expert, as per the recommendations and suggestions of the expert, two questions were modified from general to specific. After modification, the questionnaire had a greater degree of specificity and validity. The operational definition for self-medication was "Any event of use of OTC or prescription medicines without consulting a doctor."
Sample size determination was done using single proportion formula as n = (z/m)^2 × P (1 − P), where z is 1.96 (for 95% confidence level), and P stands for the prevalence of the dependent variable in the pilot study. Assuming 50% prevalence of self-medication in the study population, the minimum sample size was obtained as 384. However in this study, all students present on the day of study and those who gave consent to participate in this study were included. A total of 548 students were included in the study using a census type of population survey.
The distribution of questionnaire was done in a classroom setting for classes I to IV BDS. All students in the classroom were explained the nature and purpose of the study. However, participation was kept anonymous and voluntary. Appropriate instructions about filling the questionnaire were given. A classroom session after college working hours was arranged for interns. For postgraduate students, the questionnaires were hand delivered. All filled questionnaires were collected back on the same day. Out of the total 494 students returned the questionnaires duly filled. Other students (54) did not participate in this study.
The data obtained was compiled on a Microsoft Excel sheet. Data analysis were done using SPSS software (v 22.0, IBM). Percentage and frequencies of responses were calculated. Comparison of responses of questions with independent variables such as age, gender, year of education (classes I-IV BDS, internship, and postgraduation), distance to a medical store, and last visit to a physician was done using Chi-square test.
| Results|| |
Out of the total (548), 494 students returned the questionnaires duly filled, giving a response rate of 90.14%. The mean age of the respondents was 21.47 (range 18-27). There were 128 male students and 366 female students who participated in the survey [Table 1].
[Table 2] shows responses obtained from the questionnaire. It is seen that almost 40.9% of respondents answered that they take medicines on their own without seeing a doctor. Fifty-six percent of the respondents bought a medicine without a prescription. Multiple responses were allowed to the questions in [Table 3]. Most common reason not to see a doctor was that there is no need to see a doctor because of a simple disease (31.58%) followed by the need for a quick relief (20.45%).
[Table 4] shows that media (magazines and internet) and books followed by own decisions are the most common source of information about medications. [Table 5] shows conditions where respondents take medicines on their own it is seen that most common condition, where self-medication was followed, is cold, cough, and menstrual pain. [Table 6] shows the kind of medicines frequently used by the respondents. Most frequently used medicine was antipyretics (46.56%), followed by analgesics (40.08%), and cough syrups.
Regression curve [Figure 1] obtained when curve estimation is done between the year of education and response to the question. "Do you take medicines on your own without seeing a doctor?" As the year of education increases, there is a higher prevalence of self-medication. As the curve drops from no to yes (no coded as 2 and yes coded as 1) as we move from I BDS to IV BDS (coded as 1 to 4, interns as 5 and postgraduate students as 6).
|Figure 1: Regression curve obtained on comparison of year of study and the responses to the question do you take medicines on your own without seeing a doctor|
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Comparison of practice of self-medication was done with independent variables such as age, gender, year of education (classes I-IV BDS, internship, and postgraduation), distance to a medical store, and last visit to a physician using Chi-square test. Comparison of the practice of self-medication with age, gender, distance to a medical store, and last visit to a physician did not reveal a statistical significant difference (P > 0.05). [Table 7] shows a comparison of the year of education and practice of self-medication. It is seen that a high number of I BDS students (83.51%) did not practice self-medication. However, the trend of self-medication increases as the year of education increases. During the internship, there is a practice of prescribing medicines to the patients. About 78.65% interns practiced self-medication.
|Table 7: Comparison of year of education and practice of self-medication |
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| Discussion|| |
This study shows a prevalence of self-medication among dental students, which accounts for almost 40.9%. The high educational and literacy level of the studied respondents may be the reason. This is quite low when compared to studies done globally where a higher level of self-medication practice was seen, maximum being 98% in Palestine.  There has been a high variation in the level of self-medication practice as many local factors such as legislative aspects, drug dispensing without valid prescriptions, and availability of OTC drugs play a role. Overall many studies have shown a higher prevalence of the practice of self-medication among medical, dental, and paramedical students. Sawalha  concluded that self-medication was very common among An-Najah students. Similar results were found in a study done by Shankar et al.  where self-medication was found to be 59%. Similar results were found in studies done Zafar et al.,  James et al.,  Yousef et al.  However, a true comparison of percentages is not possible because these studies were carried out among medical students and health care professionals. Data for comparison from studies carried out among dental students are very minimal.
The mean age of study participants was 21.47 years. The young age group of the respondents may also be contributory to the documented prevalence.  In this study, no gender based differences were observed with the practice of self-medication. Both male and female dental students equally had a habit of taking medicines on their own (P = 0.547). This is different to studies conducted by various authors, but the true comparison is not possible as these studies are done in the general population, some are in patients visiting OPD and few on medical and paramedical students. 
Younger age, educational level, exposure to advertisements, legislation, the importance attributed to a disease, and better social and economic background are documented risk factors for self-medication. ,,, In this study, only 11.34% self-medicated with antibiotics which is quite less when compared to studies done in China  which showed 47.8%, 19.9% in Palestine,  17.20% in Ethiopia,  and 21.2% in North India.  In contrast, Abay and Amelo  reported low use of antibiotics (4.8%). Use of antibiotics is high when there is a lack of implementation of proper regulatory control over the OTC sale of these drugs. This study shows that most common drugs used for self-medication were antipyretics (46.56%), followed by analgesics (40.08%), and cough syrups (18.02%). This is similar to studies done by James et al.  where paracetamol was always used. Sawalha stated that self-medication with analgesics; in particular, paracetamol was reported by 86.6% of the respondents.  In Western Nepal, the most commonly used drug for self-medication was paracetamol (43%) followed by some other analgesic  (23%). This lower result may be due to the fact that the drugs are obtained on prescription. 
As observed in this study, cold (19.43%) was the major indication for self-medication, followed by 18.02% cough, and 16.19% was a fever. Sallam et al. confirmed this by reporting that the most used self-medicating drugs were those drugs for pain relief and respiratory system.  Association of the European Self-Medication Industry has listed common diseases in self-medication as pain, allergy, colds, sore throats, coughs, and diarrhea.  OTC drugs such as antacids (9.6%) and energy supplements (8.6%) which include vitamins and minerals both recorded high rates in self-medication. Dabney and Hollinger in his study supported this finding by observing a high rate of OTC drugs (60%) in self-medication due to easy availability. 
Most common reason not to see a doctor was that there is no need to see a doctor because of a simple disease (31.58%) followed by the need for a quick relief (20.45%). Previous studies reported that the most common reason for self-medication is to save time and cost. 
The predominant guiding sources of information for students was media (magazines and internet) (38.06%) and books (39.88%) followed by own decision (30.16%). In a study by Gutema et al.  guiding sources were self-decision (64%), family/friends (31.25%), media and reading material (14.1%), and pharmacist (9.40%). In contrast, reading material was the major information source (30.5%) in a study on Gondar University students.  The practice of self-medication must be based on the authentic medical information otherwise irrational use of drugs can cause wastage of resources, increased resistance of pathogens, and serious health hazards such as adverse drug reactions and prolonged morbidity.  Though the use of media (television and internet) for gaining information about drugs was low in our study, strictness regarding pharmaceutical advertising that targets the youth is warranted.
The presence of home pharmacy is associated with self-medication as storage of medication at home with free access, and easy visualization of the products is a risk factor for self-medication.  In this study, 82.2% of students stored medicines at home.
This study has certain limitations. The data were obtained from students only from a dental college in Pune city, that is, of a specific region, so generalization cannot be made. Self-reported data is prone to recall bias and being self-reported could have led to under or over reporting. There could be a possible mutual influence between the students. This study did not record data from students with chronic diseases, which are more often associated with self-medication.
| Recommendations|| |
A proper statutory drug control policy must be implemented, rationally restricting the availability of drugs to the public. New guidelines for prescribing drugs for the physicians and a stronger drug supply system from chemists available only by submitting a valid prescription should be developed as soon as possible. Only then the risks and benefits of self-medication can be warranted. There is a need to educate the youth to ensure safe practices. Also, students must be educated about dangers of self-medication and indiscriminate use of drugs.
| Conclusion|| |
The majority of students indulged in the practice of self-medication, although they had an inadequate knowledge about the benefits and risks. This practice is common for treating clinical conditions that are either simple or previously experienced.
The authors extend their sincere thanks to all the participants who were involved in this study.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]