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1.0 CHAPTER ONE: INTRODUCTION
1.1 Background information
Self-medication is the selection and use of medicines chosen by the patient for the treatment of
an illness or the treatment of symptoms that the patient has perceived himself. (WHO 2010). It is
further described by WHO that: “Self-medication includes several forms through which the
individual him/herself or the ones responsible for him/her decide, without medical evaluation,
which drug they will use and in which way for the symptomatic relief and "cure" of a condition;
it involves sharing drugs with other members of the family and social group, using leftovers from
previous prescriptions or disrespecting the medical prescription either by prolonging or
interrupting the dosage and the administration period prescribed.”
Medicines for self-medication are often called ‘non-prescription’ or ‘over the counter’ (OTC)
and are available without a doctor’s prescription through pharmacies. In some countries OTC
products are also available in supermarkets and other outlets. Medicines that require a doctor’s
prescription are called prescription products (Rx products).Self-medication with OTC medicines
is sometimes referred to as ‘responsible’ self-medication to distinguish this from the practice of
purchasing and using a prescription medicine without a doctors’ prescription.
Despite the growing research interests in self-medication, little information has been available
about its major determinants especially in developing countries like Uganda.
Self-medication is prevalent widely all over the world. With people getting ‘over the counter’
drugs from pharmacies and drug shops without medical personnel’s prescription and evaluation.
People’s knowledge about drugs among different persons of all walks of life and it reveals that:
knowledge of common drugs is exercised, though not uniformly but widely spread. People in all
parts of the world encounter the same common health problems in roughly the same frequency. It
does not seem to matter where or how they live. Common colds, headaches, digestive problems
and body aches and pains do not discriminate by nationality, culture or climate. The drugs most
1
commonly used are antibiotics, anti-protozoal drugs and pain-killers. The increasing knowledge
and availability of these drugs over the counter has probably contributed to the increase in self-
medication.
In Uganda, however a number of pharmacies are available, with the increasing knowledge and
business scope in Uganda, NDA (National Drug Authority) has seen the number of pharmacies
in Uganda rise steadily from the 1990’s. There are currently 12 manufacturers involved in the
production of medicinal products and supplies such as tablets, hard gelatin capsules, injectable,
liquid mixtures, and surgical gauze among others. The number of pharmacies and drug shops has
grown in the last five years from 216 and 2,700 in 2004 to 425 and 4,370 respectively in 2008
(www.ugandainvest.go.ug). This has been one of the major contributing factors to increase in
self-medication.
Responsible self-medication can help, prevent and treat ailments that do not require medical
consultation and reduce the pressure on medical services for the relief of minor ailments. These
potential benefits seem to be of a particular interest in the financially less privileged countries
with limited health resources, like Uganda.
However the knowledge on the dangers of self-medication has not yet spread amongst people of
the world so clearly for them to start evaluating a self-medication over going to a professional
health worker for evaluation and treatment.
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1.2 Statement of the problem
All people have unique health needs and yet they suffer from a vast spectrum of diseases. Hence,
people all over Uganda as a whole and Kabarole district need a clear and safe provision of health
care services especially medication under professional medical supervision, evaluation and
prescription. The government under the Ministry Of Health has at least addressed this problem
by putting up a regional referral hospital, health centers and health educating people.
However, inspite of all this, many of the people in Kabarole do not get to utilise these services,
but have increasingly opted to self-medicate themselves and the people around them without
professional medical intervention.
The National Drug Authority in 2010 estimated that in every 10 people 8 self-medicate or buy
drugs over the counter. This could be attributed to the increase in number of pharmacies and
drug shops in the region, expensive treatment from clinics and long distances to health facilities.
This has led to many health problems like increase in drug resistance, poor compliance, over and
under dosing, drug poisoning and toxicity reactions.
The discrepancy thus is that a large number of people are self-medicating, people around them
and using old prescription drugs from hospitals and clinics compared to those that actually seek
professional health medication and administration of drugs.
Thus the purpose of this research is to answer the following questions:
i) What factors facilitate the increase in self-medication amongst the people of
Kabarole?
ii) What are the effects of self-medication?
iii) What can be done to reduce the surge of self-medication?
3
1.4 Significance and justification of the study.
It is hoped that the findings in this research will be used by MOH and DHO office, NGO’s, NDA
and all other sectors that are responsible for the provision of drugs and treatment of people.
The study will identify the needs in provision of drugs and find the loopholes in the existing
structure.
By identifying drug provision alternatives, the research will identify possible areas of
intervention which will improve professional medical treatment of the ill.
Data generated will help planners and policy makers to put organizational or institutional
arrangements which will improve the provision of professional medical evaluation, management
and prescription of drugs to persons.
The data will add to the existing knowledge for academic purposes and will stimulate further
research by earmarking the research gaps.
1.5 Objectives of the study.
1.5.1 General objective
To assess the factors and effects of self-medication of people in Kabarole.
1.5.2 Specific objectives.
To establish people’s knowledge on drugs.
To establish the extent of self-medication.
To find out which people self-medicate most.
Which illnesses do people self-medicate for?
To assess the major sources of health care provision.
To determine which drugs are used for self-medication, mainly.
To find out sources of drugs used in self-medication.
4
1.6 Theoretical framework.
5
Increased mortality
Treatment failure Under dose
Wrong drug consumptionDrug resistance Poor adherence Financial burden
Over dose Poor prognosis Increased expenditure
Poor quality life
SELF-MEDICATION
Health workers Human being Socio-economic status Environment Political
Poor patient relations
Poor drug knowledge and
usage
Increased number of
drug provison centres eg
pharmacies
PoorILLNESSES BELIEFS
Education level
rich
Take remainders old prescription drugs
Buy drugs for self-
medication when they
fall sick. Cheap drugs on market
Insufficient Human
resource
human resource
Few health facilities
Drug toxicity
increased market competition
2.0 CHAPTER TWO: LITERATURE REVIEW.
2.1 Knowledge attitudes and practices about self-medication.
Self-care may be defined as the care taken by individuals towards their own health and well-
being, including the care extended to their family members and others. ( IAPO - International
Alliance of Patients’ Organizations. A Survey of Patient Organizations’ Concerns. Summer
2006).
It is said that every patient has at least two prescribers his own doctor and himself, while many
have additional prescribers in the form of friends, well-wishers etc. ( Mohamed Saleem T.K
2011)
(Tumusiime Kabwende Deo; 2008) defined self-medication as a new form of ‘mob justice’. He
further said that it was a way in which people were manifesting their loss of faith in the existing
health care system in Uganda.
Furthermore, research made by (MOH KENYA 2001) indicated that the hierarchy of medical
power which stretches from professional experts to lay adults to children reflects an unequal
distribution of medical knowledge between these groups. However, (Uganda and Division of
vector Borne Diseases 2001) noted that due to the ideology of childhood and of medical expertise
as described above, knowledge about the proper use of medication including potent hospital
medicines is easy.
It was also noted that; people are overwhelmingly satisfied with the non-prescription medicines
they use – to the point where many believe that OTC medicines can be as effective for the
relevant condition as prescription medicines. (South Africa. 2001. South African Healthcare
and the Proprietary medicine industry. W. Duncan Reekie, D.R. Scott. S Afr Med J 2002)
Most medical knowledge is distributed over the community, and everybody knows some
treatments for the illnesses from which they or their family members commonly suffer (Whyte
2009; Pearce 2010; Sindiga et al . 2010)
6
2.2 Prevalence and extent of self-medication
(Der Pharmacia letter 2011) noted that patients receive adequate medication for their clinical
needs, at doses corresponding to individual requirements, and at the lowest possible cost for the
patient and the community. Taking this definition into account an effective drug treatment
requires patient compliance and consultation with a medical professional together with close
follow-up, conditions rarely attained. Irrational drug use and especially self-medication with
antibiotics is common throughout the world.
On the treatment patterns, Malest Afro (2002) et al cited that the majority of people relied on self-
medication. In comparison studies carried out in Ethiopia, Peru, Zambia, Uganda showed that
women are the majority involved in self-medication. ( Juliet Kanyesigye 2004).
Similarly,( World Bank 2007), showed that a third to a half of those who fall ill do not seek care at
modern health units but use home remedies, locally purchased drugs or traditional healers.
The results of a study may by (FAP/UNIMEP, 2003-2004) confirmed that the prevalence of self-
medication in children and adolescents is a real and frequent practice, independently on
socioeconomic data.
Home and self-treatment is a central part of culture in societies where people are used to taking
treatment into their own hands (Whyte 1988; Van der Geest and Whyte 1989; Adome et al.
1996) and that the average household had almost 30 different medications on hand, only five of
which were likely to be prescriptions (WJM-western journal of medicine 2008 November).
Females practiced more self-medication than men (Solomon worku,(2010) as also found out in
Mexico(2008) that identified women as the fundamental element in consumption of drugs and
employment of self-medication.
2.3 Analysis on illnesses commonly leading to self-medication.
People throughout the world suffer common health problems and their symptoms in roughly the
same frequency. Surveys conducted in numerous countries indicate that 9 out of every 10 people
suffer from at least one aspect of unwellness during the course of any 4-week period. (world
self-medication industry 2 2009).
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The most frequent use of medication on hand was for skin, followed by respiratory and
gastrointestinal. Medications purchased were mainly for respiratory, central nervous system,
gastrointestinal, and general systemic problems, respectively.(Roney James G Jr. and Nall
M.L.-Stanford research institute August 2001) also (IAPO - International Alliance of
Patients’ Organizations. A Survey of Patient Organisations’ Concerns. Summer 2006);
noted the same.
Elderly living independently often self-medicate for common problems such as fever, mild pain,
colds, allergies, indigestion-gas, constipation and insomnia. ( Der Pharmacia Lettre, 2011).
2.4 Analysis of drugs used in self-medication.
Analgesic/antipyretic and non-hormonal anti-inflammatory agents were the most commonly self-
prescribed drugs, which indicates that self-medication is usually associated with the symptomatic
treatment of pain. (WHO November 28, 2011).
2.5 Factors leading to self-medication.
Socio-economic and demographic factors are often related to self-medication, but vary greatly
from country to country. Self-treatment with western medicine has been linked to high socio-
economic status (Kamat and Nichter 1998).
The increase in self-care is due to a number of factors viz. socioeconomic factor, life style, ready
access to drugs, the increased potential to manage certain illness through self-care, public health
and environmental factors, greater availability of medicinal products and demographic and
epidemiological factors. ( Sydney: National prescribing service Ltd:2008.)
In addition, access to good and effective medical interventions is often limited due to poor
hospital facilities; service fees; poverty and hunger; and illiteracy. (Laura Shireman, Paul S
Pottinger and Kayode K Ojo 2010). In the second instance, private clinics have also taken
advantage of the disparity that gripped patients running away from government hospitals, by
inventing their own exploitative antics. The new ‘policy’ in many private clinics is the
assumption that every person that visits the clinic must be sick and must take home some
medicine usually well stocked in a pharmacy next door. ( Tumusiime Kabwende Deo 9
september 2009).
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It was also noted that the urge of self-care, feeling of sympathy towards family members in
sickness, lack of health services, poverty, ignorance, misbelieves, extensive advertisement and
availability of drugs in other than drug shops are responsible for growing trend of self-
medication. (Al Shifa College of Pharmacy, 1998)
The new ‘policy’ in many private clinics is the assumption that every person that visits the clinic
must be sick and must take home some medicine usually well stocked in a pharmacy next door.
However, With the mandatory consultation fees going to as much as 25,000/= in some clinics,
every patient can be sure to part with no less than 40,000/= for a single visit. As a way of beating
the exploitation by medics, many people have now resorted to self-medication. (Tumusiime
Kabwende Deo 2010)
Furthermore, poor diagnostic ability compounded by a limited knowledge of appropriate
management result in the increase of self-medication and low rate of health care utilization.( Dr.
Afolabi Adedapo Olanrewaju). While other people have a feeling that their ailment is beyond the
knowledge of western trained doctors. ( Annuals of African Medicine 2008)
2.6 Sources of drugs for self-medication and health care.
(Solomon Worku 2000) revealed that about one third of drugs were left over past prescription
unlike in France (Dr.Pierre Leforte 2011) which showed that drugs were obtained from other
individuals.
More than 60% of people have bought drugs as over the counter (New Vision 4/03/2012 page
11) from pharmacies and drug shops.
2.7 People that self-medicate most.
(WHO 2010) noted that self-medication provides a cheap alternative to people who cannot
afford to pay medical practitioners. Hence, self-medication being the first response to illness
among people. (Solomon Worku 2000)
. Infact, Hesse (2009) et al clearly pointed out that women spend a large proportion of household
income on medicines for self-medication than men.
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2.8 Sources of information about drugs used in self-medication.
Whether one lives in a developing country or in a developed one, the sources of information are
similar. A person may seek advice from ‘an older person in your household who possesses the
knowledge of simple herbal remedies for common illnesses’ (Nepal, 2002) or with a pharmacist
because they can ‘provide a good help to assess the symptoms’ and ‘spend time explaining how
to use the medication properly’ (Brazil 1997, Singapore 2005). Or one may purchase an OTC
medicine ‘based on a previous medical recommendation’ (Mexico, 2009).
Product labels are also a good source of information for the consumer and should always be
easily accessible. In China for example, 70% of the consumers select the OTC medicine through
reading the specifications before purchase. ( IAPO - International Alliance of Patients’
Organizations. A Survey of Patient Organisations’ Concerns. Summer 2006).
Television advertising appears to have a limited impact with respect to overall non-prescription
medicine use: in Brazil (2007), 81% of consumers disagreed with the statement: “I customarily
purchase medicines advertised on TV”. In Italy, between 1977 and 1987 – a period known in
Europe for its large increase in television advertising, visits to physicians increased by 20%
while the use of OTC medicines increased by only 2%. There were similar results in all the
major European countries. (Brazil. 2010. Prevalence and factors associated with self-
medication.)
Today the internet is emerging as a major source of information on health issues and (with
appropriate quality control) offers great promise in helping people with self-care.
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3.0 CHAPTER THREE: STUDY AREA
3.1 District of study: Kabarole district.
3.2 Geographical location.
Kabarole district is found in western Uganda, and it lies between latitudes (00 15”N and 10
00”N) and longitude (300 00”E 310 15”E). Lying at an altitude of 1300-2300metres above sea
level, and occupying a total area of 1,814km² of which 1569km² is covered by land and 198km²
is covered by water/wetlands.
The district is bordered by Ntoroko district to the north, Kibaale district to the Northeast,
Kyenjojo district to the east, Kamwenge district to the south west, Kasese district to the south,
the democratic republic of Congo to the south west.
Fort portal, the chief town of the district lies approximately 320km by road west of Kampala, the
capital city of Uganda.
3.3 Population
In 2002, the population of kabarole district was estimated at 356,900 with a population growth
rate at 30% annually. It is estimated that in 2010, the population of kabarole district was
approximately 452,100.
3.4 Tribe/ ethnic composition.
The Batoro, Batuku and Basongora ethnicities constitute about 52% of the population. The
Bakiga constitute 25%, followed by the Bakonjo and the Bamba. The major languages spoken
are Rutooro, Rukiga and Runyankore.
3.5 Climate and weather.
The district has a good climate with temperature ranging from 20°C to 30°C and rainfall ranging
1200mm-1500mm per annum. The district has cool temperatures ranging from 22°C-25°C and
has bimodal rainfall, ranging from 1200mm-1500mm per annum.
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3.6 Administration.
Kabarole has the following administration units which are: (1) municipal council, (02) counties,
(03) town councils, (15) sub-counties, (03) divisions, (81) parishes and (582) villages.
3.7 Communication
The most used method of communication in the district is mouth to mouth. Other media used
include: radios, mobile phones, television and others. The district has tarmac roads but most
roads to rural areas are murram, rural feeder, secondary and community roads some of which
when rainy may be impassable.st
3.8 Health infrastructure.
There are 60 health facilities across the district these include: 3 hospitals, 3 health center IV , 23
health center III and 31 health center II and currently 8 new health center II are fully
functional.388 village health teams (VHTs) have been established since 2006 and 61 VHT parish
leaders.
The district also has NGO hospitals and health centres namely Virika hospital, kabarole hospital,
and Mitandi, Rambia, Kiamara, Ngombe orthodox, Mpanga growers, Nkuruba, lillah clinic,
Kihembo dispensary, kiko, kiruhura, Yerya and Toro kahuma all health units.
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4.0 CHAPTER FOUR: METHODOLOGY OF THE STUDY
4.1 Introduction
This chapter describes the methods used in the study, it includes:
Study design
Study population
Sampling procedures
Selection of the procedures
Study of the variables
Data collection tools
Pre-testing of data collection tools
Data processing and analysis
Ethical considerations
Study limitations.
4.2 Study design
A cross sectional study design was carried out in fort portal town for a period of two weeks on
the subject of factors influencing the pattern of self-medication in fort portal region.
4.3 Area of study
The area of study is Fort portal town, which is a major town of kabarole district , located in
western Uganda.
4.4 Study population
The study consisted of peasant farmers, business men and women, mothers, adoloscents,
teenagers, students, house wives, local council leaders, teachers, and students. Of all people
13
chosen randomly, only 126 accepted to be interviewed using semi-structured questionnaires. Of
those interviewed, only 95 managed to fill in the questionnaires correctly.
4.5 sampling procedure
Fort portal town was chosen because of the researcher’s convenience. Since there was no
literature partaking the prevalence of self-medication in Kabarole district, a pilot study done in
kataraka village in Fort-portal yielded a prevalence of 64%, hence this was used to determine the
minimum sample size; using the formulae; n= z ² pqd ²
;
where n= minimum sample size, z=1.96 at 95% confidence interval obtained from standard
statistical table of normal distribution, p= estimated prevalence of non-adherence in a given
population (64% or 0.64), q= precision; i.e. number of adherence in a given population (1-p or
0.15) and d=margin of error (0.025); hence n=98 with the minimum sample size known,126
respondents were selected.
The selection of a sample was based on the existing Ugandan administrative structure of LCs. The
survey was carried out in 3 divisions of fort portal using systematic random sampling i.e., east,
west and south division(s) with at least 42 people sampled in each, hence making a total of 126
respondents.
4.6 Data collection tools.
Data was collected using questionnaires that had both open ended and closed ended questions.
This was administered to various age groups and both female and male respondents of varying
age groups.
The questionnaire had different parts: the socio-demographic profile, income, expenditure, cost
sharing and health seeking patterns.
4.7 Pre-test of data collection tools.
The data collection tools were pre-tested on 14 randomly selected people in fort portal town, to
test the suitability of the questions, corrections were made and a final copy was printed.
4.8 Ethical considerations
An introductory letter from fort portal school of clinical officers was presented to various local
council heads, who allowed the researcher to access information from various parishes/ sub-
14
counties. Respondents consent was sought before interview to gain maximum co-operation
before starting data collection.
4.9 Data collection and analysis
Data was collected from 10:00am to 5:00pm Monday-Friday for 10 days by distributing
questionnaires to the respondents. It was analysed using tables, bar graphs, pie- charts and simple
statements.
4.10 Limitations of the study.
Lack of enough time than initially planned by the researcher as the study proved more
demanding than anticipated.
Lack of co-operation from some of the respondents who either refused to be interviewed
or pretended not to know anything about self- medication.
Insufficient funds.
The scotching sun shine as it required to stand under the sun in ceratin areas for long.
People were very busy with customers and the researcher seemed like wasting their time.
It was difficult gaining trust from some respondents.
The researcher’s mobility was hindered by lack of a potent transport system.
15
CHAPTER FIVE: STUDY FINDINGS
5.0 Introduction
Presented are the findings from 120 respondents instead of the targeted sample of 120.
5.1 Demographic characteristics.
Table1: Sex of respondents
n=120
Sex frequency Percentage %
Male 45 37.5
Female 75 62.5
Total 120 100
From the table 1, above; less than two thirds of the respondents 75(62.5%) were females while
45(37.5%) were made.
Table 2: Age of the respondents
n=120
Age of respondents Number of respondents Percentage %
15-19 3 2.50
20-24 15 12.50
25-29 40 33.33
30-34 35 29.17
35-39 17 14.17
40 and above 10 8.33
Total 120 100%
16
From the table above, a third of the respondents 40(33.3%) were between the age group of 20-24
followed by 35(29.17%) who were between 25-29.
Table 3: Tribe of respondents
A question was asked to determine the respondent’s tribe and these were the findings;
n=120
Tribe Frequency Percentage(%)
Bakiga 29 24.2
Batooro 41 34.2
Banyankore 14 11.7
Bamba 08 6.7
Bakonjo 17 14.2
Batuku 01 0.8
Basongora 00 00
Others 10 8.3
Total 120 100
According to table 3; less than a third of the respondents 41(34.2%) were Batooro followed by
the Bakiga who constituted only 29(24.2%).
Table 4: Occupation of respondents
A question was asked to ascertain the occupation of respondents, and these were the findings;
n=120
Occupation Frequency Percentage(%)
None 07 5.80
Farmer 25 20.8
Market vendor 16 13.3
Boda boda cyclist 08 6.7
Students 39 32.5
Housewife 13 10.8
17
Business personnel 09 10
total 120 100
According to the table above, more than a quarter 39(32.5%) of the respondents were students,
followed by 25(20.8%) farmers who were farmers. The least were07(5.80%) for those who had
no jobs.
Table 5: Education level of respondents.
n=120
Education level Frequency Percentage(%)
Tertiary 8 6.7
Secondary A’ level 10 8.3
Secondary O’level 39 32.5
Primary 58 48.3
Nursery/kindergarten 1 0.8
Not educated 05 4.1
Total 120 100
According to the table above, more than a third of the respondents 58(48.3%) had stopped at
primary education and many 39(32.5%) who had dropped out from secondary O’level. However,
very few 8(6.7%) had achieved tertiary education.
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5.2 Knowledge on self-medication.
Fig 1: Respondents having knowledge on self-medication.
n=120
Yes18%
No83%
21(17.50%) responded “Yes” and 99(82.5%) said “No”.
Table6; Frequency of respondents who defined self-medication.
n=120
Answer Number of respondents Percentage of respondents (%)
It is the taking of medication
without medical persons
intervention
10 8.3
It is the medicating of self
without any prescription
09 7.5
It is the buying of drugs from a
shop, pharmacy, drug shop or
clinic and taking them based
on one’s own evaluation and
sickness.
03 2.5
Don’t know 99 82.5
Total 120 100
19
According the table above; majority of the respondents 99(82.5%) did not know what self-
medication was, however 10(8.3%) said it was the taking of medication without medical persons
intervention.
Figure2: Frequency of self-medication.
n=120
Rarely11%
Quite often63%
Very often26%
According to the pie chart above, it showed that: 13(11%) of the respondents rarely self-
medicated, 31(26%) of the respondents self-medicated quite often and 76(63%) of the
respondents very often self-medicated. Meaning that a vast number of people self-medicate very
often.
5.3 Health seeking behaviour
Table7: Health seeking behavior.
n=120
Health seeking behavior Frequency Percentage(%)
Stay home and treat themselves or
family members
51 42.5
Go to traditional healer 11 9.2
Go to nearby clinic 25 20.8
Go to hospital 33 27.5
Total 120 100
20
From the table above; more than a third of the respondents 51(42.5%) said they stay home and
treat themselves or family members, and the least 11(9.2%) said they go to traditional healers.
Table8: Reasons why people may not go to hospitals or clinics when they or their family
members fall sick.
n=120
Reasons why people don’t go to
hospitals/clinics.
Frequency Percentage(%)
Don’t want 3 2.5
Long distance to health facility 2 1.7
Expensive to get medical help 60 50
Prefer self-medicating to going to
hospital/clinic
55 45.8
Total 120 100
In the table above: majority of respondents said they felt it was expensive to get medical help,
followed by 55(45.8%) who preferred self-medicating to going to hospital/clinic.
Figure 3: Advise on how to use drugs after prescription
n=120
Yes77%
No23%
21
From the pie chart above, it shows that: 92(77%) of the respondents are advised and given
information on the drugs they are given and only 28(23%) of the people said they were not
advised on how to use the drugs very clearly.
5.4 Habit on prescribed drugs.
Table 9; Frequency of following prescriptions.
n=120
Question Frequency Percentage(%)
Yes 103 85.8
No 17 14.2
Total 120 100
From the table above, it clearly shows that 103(85.8%) of the respondents follow the
prescriptions and only 17(14.2%) do not promptly follow the prescriptions.
Figure4: Frequency of respondents who keep remainders of prescription drugs for later
usage.
n=120
Yes82%
No18%
From the pie-chart above, 98(82%) of the respondents keep remainders of prescription for later
usage while 22(18%) of the respondents simply discard them off.
22
5.5 Drug provision
Table10: Where people usually get drugs from.
n=120
Source of drugs Frequency Percentage (%)
Home 18 15
Clinic 39 32.5
Pharmacies 31 26.7
Hospital 35 29.2
Total 120 100
The table above shows; that majority of the respondents 39(32.5%) get drugs from the clinic
followed by 35(29.2%) who get drugs from the pharmacy.
5.6 Drug usage.
Table11: Types of drugs used.
n=120
Response Number of respondents Percentage (%)
Anti-malarials 20 16.7
Anti-helminthes 10 8.3
Pain killers 67 55.8
Anti-biotics 21 17.5
Anti-fungals 01 0.8
Anti-histamines 01 0.8
Total 120 100
23
From the table above; More than a half of the respondents 67(55.8%) use pain killers for self-
medication followed by 21(17.5%) who used anti-biotics. The least used drugs were anti-fungals
and anti-histamines which both constituted 1(0.8%) of the respondents.
Table12: Preparations of drugs.
A question was asked to find out the use of particular preparations of drugs for self-medication.
n=120
Form of preparation Frequency Percentage (%)
Tablets 80 66.7
Capsules 21 17.5
Syrups 13 10.8
Pastes 05 4.2
Shampoos 0 0
Lonzeges 0 0
Pessaries 1 0.8
Others 0 0
Total 120 100
According to the table above; Majority of the respondents 80(66.7%) used tablets followed by
capsules 21(17.5%).
Table13: Colours of drugs commonly used for self-medication.
A question was asked to assess which colours of drugs are commonly used in self-medication.
n=120
Colour of drug Frequency Percentage(%)
Red 25 20.8
Black 1 0.8
Black and red 22 18.3
White 45 37.5
24
Yellow 6 5
Pink 15 12.5
Green 6 5
others 00 00
Total 120 100
Form the table above; more than a quarter of the respondents use white drugs for self-
medication, followed by red coloured drugs 25(20.8%).
Table14: Illnesses for self-medication.
A question was asked for which illness do they self-medicate for and the following is what was
found out;
n=120
Illness Frequency Percentage(%)
Headache 31 25.8
Abdominal pain 18 15
Allergic reactions 02 1.7
Common cold 18 15
Cough 15 12.5
Febrile illnesses/ fever 31 25.8
Backache 05 4.2
Total 120 100
From the table above; both headache and febrile illnesses/ fever constituted majority of
respondents 31(25.8%) each as reasons for self-medication while the least 05(4.2%) was
backache.
Table15: Cost of drugs.
A question was asked to ascertain the cost of drugs which are used to self-medicate.These were
the findings;
n=120
25
Cost of drugs (Ug. Shs.) Frequency Percentage (%)
50-500 78 65
500-1000 21 17.5
1000-5000 18 15
5001 and above. 03 2.5
Total 120 100
According to the table above; more than a half of the respondents 78(65%) bought drugs that
cost 50-500Ug.Shs, with the least 03(2.5%) buying drugs that cost 5001Ug.Shs. and above.
Figure 5: Source of drug information.
n=120
radio
telev
ision
newsp
aper
magazi
ne
bill board
villag
e educati
on
drug s
ellers
medica
l pers
onnel
old prescri
ption notes0.00%
5.00%
10.00%
15.00%
20.00%
25.00%
30.00%
35.00%
media of information
perc
enta
ge o
f res
pond
ents
.
According to the bar graph above; a third of the respondents 40(33.3%) said they got drug
information from medical personnel followed by 23(19.2%) said they got drug information from
drug sellers and the least 1(0.8%) said they got their drug information from either billboards or
magazines.
26
5.7 Effects of self-medication.
Figure6; Benefit of self medication
A question was asked to assess whether the respondents felt that self-medication was of benefit.
All they required to answer/ check was either “Yes” or “No” and these were the findings.
n=120
According to the pie-chart above, 43(36%) of the respondents said they felt that self-medication
was of benefit to them while 77(64%) of the respondents said that they felt that self-medication
was of not much benefit to them.
Of the 43(36%) of the respondents who answered “yes” above, another question was asked to
clear out what the exact benefit(s) were.
27
YES36%
NO64%
Table16: Exact benefit from self-medication.
A question was asked to those who responded “YES” on knowledge of exact advantages of self-
medication and these were the findings.
n=43
Response Frequency Percentage(%)
It is cheaper than going to a clinic 12 25.5
I get a feeling of responsibility over my
health and that of my family members.
07 14.9
Get a feeling of satisfaction that I’ve
tried to treat myself/ a family member
14 29.8
It saves time of going to a
hospital/clinic
10 21.2
Total 43 100
From the table above; of the 43(36%) respondents who had answered “Yes” about satisfaction
from self-medication, most of them 14(29.8%) said they got a feeling of satisfaction that they’ve
tried to treat themselves and or a family member, while the least 07(14.9%) said they got a
feeling of responsibility over their health and that of the family members.
Figure7: Knowledge on disadvantages of self-medication.
n=120
28
YES39%
NO61%
According to the pie-chart above; 47(39%) of the respondents answered YES while 73(61%) of
the respondents answered NO as partakes their knowledge on disadvantages of self-medication.
Table17: Specific disadvantages self-medication.
A question was asked to the respondents who answered “YES” regarding their knowledge on
self- medication and these were the findings.
n=47
Response Number of respondents Percentage(%)
Medicating myself or a family
member may not be curative enough
without medical help.
10 21.3
I don’t know whether I use the
correct treatment.
13 27.7
I may over or under dose myself or a
family member.
24 51.0
total 47 100
According to the table above, 10(21.3%) said that medicating themselves or a family member
may not be curative enough without medical help and 13(27.7%) of the respondents said they
didn’t know whether they use the right treatment while 24(51.0%)of the respondents said they
paused a risk of either under or over dosing themselves or their family members.
29
Figure8: Satisfaction with self-medication.
A question was asked as to whether respondents were satisfied with self-medication and all they
required to answer was either YES or NO.
n=120
NO64%
YES36%
satisfaction with self-medica-tion
According to the pie-chart above, 43(36%) of the respondents said they were satisfied with self-
medication, however the majority 77(64%) of the respondents said they were not satisfied.
30
Table18: Desire to learn more about drugs and self-medication.
A question was asked as to whether they desired to learn more about self-medication, and these
were the findings. All they required to answer was either YES or NO.
n=120
Response Frequency Percentage(%)
Yes 118 98.3
No 02 1.7
Total 120 100
According to the table above; 118(98.3%) of the respondents said YES to learning more about
self-medication and only 02(1.7%) of the respondents denied the opportunity to do so.
Table19: Respondents recommendations.
Respondents were asked to give their own recommendations on aiding to reduce self-medication.
These were the findings;
n=120
Response Number of respondents Percentage(%)
Government should try putting up more
health facilities
31 25.8
Government and local leaders should
regulate prices imposed by private
clinics and hospitals.
23 19.2
Common drugs should be made more
available to health facilities.
10 8.3
People should learn the habit of seeking
medical care.
17 14.2
People should be taught through health
education the dangers and advantages of
self-medication
11 9.2
31
People should employ other methods
like wet sponge/ cloth for fevers and
headache and avoid using of drugs they
least know about.
09 7.5
People should go for regular checkups
and avoid falling seek very often, hence
predisposing them to self-medicate.
19 15.8
Total 120 100
According to the table above; more than a sixth of the respondents 31(25.8%) said that
government should try pitting up more health facilities, followed by 23(19.2%) who said that
government and local leaders should regulate prices imposed by private clinics and hospitals.
While the least said that people should employ other methods like wet sponge/ cloth to bring
down fevers and headaches and avoid using drugs they least know about.
32
CHAPTER SIX: DISCUSSIONS, CONCLUSIONS AND
RECOMMENDATIONS.
6.0 Discussion
6.1 Demographic data of respondents.
Majority f the respondents 75(62.5%) were female and 45(37.5%) were male. Meaning that more
women were compounded in the research than men, may be due to the nature of jobs men entail
in, that may not give them the time to relax and participate in other activities. This result
however contradicts a study done by Mohamed saleem T.K 2011 where a majority male
respondents were found compared to females.
More than a quarter of the respondents 40(33.33%) were aged 25-29 followed by 35(29.17%)
who ranged 30-34 years. This shows that the majority of the population is in an economically
productive age group hence predisposing them to the dangers of various occupations which may
propel them to self-medicate. This finding correlates to a study done by Afolabi 2008 that found
a majority respondents between the age of 25-34.
Majority of the respondents were Batooro 41(34.2%) followed by the Bakiga 29(24.2%) these
findings do match with findings wiith a study done by Wikipedia 2010, showing a majority
Batooro with a rivaling number of Bakiga and the least being the basongora and the batuku who
constitute 01(0.8%) and 00(00%) respectively. This may show a deviation however in the
population where the same study by Wikipedia free encyclopedia 2010 estimated at least 5%
of the population were Batuku or Basongora.
33
Majority of the respondents were students 39(32.50%) followed by peasant farmers 25(20.80%)
of the total number respondents with a considerable number of 16(13.30%). This was not
surprising as many of the respondents had more than one occupation, especially the students who
also entailed themselves in other economic activities, and the few number of market vendors
explains the little time they have as they attend to their customers which is in agreement with
Juliet Kanyesigye’s study in 2004 which found that majority of people in Kabale (Uganda)
were peasant farmers.
Majority of the respondents had attended primary school education 58(48.3%) followed by
39(32.5%) had achieved secondary o’level education, and only 8(67%) had attained tertiary
training and only one (0.8%) had never attended school. This shows the high number of primary
school drop outs and attendance level as well as a reduce o’level education pattern and
increased drop out level which is stipulated by a reduced 8(6.7%) respondents who attended
A’level and a further reduction in tertiary school attendance. This study however contradicts a
study done by Azeem. A.K 2011 USA where majority of the respondents had completed/ were
attending tertiary education.
6.2 Knowledge of self-medication.
Majority of the respondents 99(82.5%) don’t have knowledge about the term self-medication
and only 21(17.5%) have heard about the term self-medication. This shows a gross deficit in
knowledge about self-medication and predisposes the population more to its dangers. However
knowledge of self-medication is more manifested amongst the educated, this findings cohere
with a study done by Lukman Thalib in Nigeria 2005 which found out that knowledge on
self-medication was directly proportional the level of education.
Among those who have knowledge on self-medication, all of them had a genuine idea about self-
medication with the majority 10(8.3%) saying;
“It is the taking of medicines without medical persons’ intervention.”
This definition is very close to the WHO 2010 definition which says;
34
“Self-medication includes several forms through which the individual him/herself or the ones
responsible for him/her decide, without medical evaluation, which drug they will use and in
which way for the symptomatic relief and "cure" of a condition; it involves sharing drugs with
other members of the family and social group, using leftovers from previous prescriptions or
disrespecting the medical prescription either by prolonging or interrupting the dosage and the
administration period prescribed.”
This may also show a sensible understanding of self-medication within a small population
mainly the very educated and a harsh lacking of knowledge of self-medication amongst the least
educated. This correlates to a study done in China in 2003 by Davis Wu for the Chinese self-
medication market and urban consumers that sighted a majority people with little or no
knowledge about self-medication and especially among the least educated.
6.3 Frequency of self-medication.
Majority of the respondents 76(63%) self-medication/ used un-prescribed drugs quite often,
followed by 31(26%) who self-medicated very often and the least 13(11%) rarely self-medicated.
This implies that there are still a large number of people who self-medicate quite often and very
often as noted by Universidade Estadal de Compinos (UNICAMP) in 2004, that said majority
of individuals still medicate quite often or even very often.
6.4 Health seeking behavior
From the study 51(42.5%) people said when they/ family members fall sick, they stay home and
treat themselves/ family members, 33(27.5%) and 25(20.8%) go to hospitals and clinics
respectively at the least 11(9.2%) go to traditional healers. This shows that majority of people do
not go immediately to hospitals or clinics when they fall sick but rather self-medicate
themselves/ family members. However, these findings disagree with a study done in India by
the world health organization 2008 that revealed a majority of people go to
shamans(traditional healers in India) when they fall sick.
A half of the respondents 60(50%) said that it was expensive seeking medical help, while
55(45.8%) said that they just preferred self-medication over going to hospital. This revealed that
just as much as private clinics were a lot more extensively spread, they insult a fear amongst the
locals through their financial exploitation and very high costs. This corresponds to a study done
35
by Tumusiime Kabwende Deo 9/sept/2008 research that revealed private clinics had taken
advantage of the disparity that gripped patients running away from government hospitals by
inventing their own income exploitive tactics.
6.5 Advise on how to use drugs on prescription
More than half the respondents 92(77%) respondents said that they are advised on how to use
drugs. This however indicates a good source of knowledge and good direction on how to use
drugs by health workers who prescribe the drugs. This finding correlates to a study done by The
World Self-Medication Industry 2010 that found a majority of respondents in Canada got
advise on drug usage from their physicians after prescription.
6.6 Habit on use of prescribed drugs.
103(85.8%) of the respondents said they strongly follow drug prescriptions and advise on how to
use them. This indicates a good respect for drugs used from health facilities and pharmacies and
a result that many of the people who actually bought drugs or got drugs from health facilities and
pharmacies, did follow prescription, unlike those who buy drugs from kiosks and those who just
get drugs from home/ a friend/family member. This study agrees with a study done in China
2004 that stipulated; “many of the consumers take their oral medicines strictly as directed in the
appropriate doses at the right time.”
On the other hand however, it was seen that many of the respondents 98(82%) do keep
remainders of prescription drugs for later usage. Thus implying that many people have lots of
remainders of drugs and a failure by many to complete dosages with demerits of poor cure rates
and an increased exposure to expired drugs. This finding correlates to a study done by A.
O.Afolabi 2008 that revealed a majority of respondents keep remainders of prescription drugs
for later usage.
6.7 Drug provision
The biggest number of respondents 39(32.5%) get drugs from clinics followed by 35(29.2%)
who get drugs from the hospitals. Thus many people have a comfort zone to seek drugs and
medical help from clinics due to their extensive existence and easy access compared to hospitals.
36
This study correlates with a study done by A.O Afolabi in Nigeria 2008 that found out a
majority of people is get their medications from hospital/pharmacy.
The study pointed out that more than a quarter of the respondents 45(37.5%) actually bought
drugs from clinics rather than from drug shops or pharmacies, this clearly confirms that majority
of the people often attend private clinic services than going to hospital and hence getting most of
their drugs from the former.
6.8 Specific drug use.
The fact that majority of the respondents 67(55.8%) used more painkillers for self-medication,
followed by antibiotics 21(17.5%) and antimalarial drugs 20(16.7%). This corresponds to the
severity and belief of people to manage pain as a minor and very common ailment as well as the
extensive availability plus knowledge about them, like panadol. These findings correlate to study
done by Mohamed saleem T.K 2011 that found a majority of respondents use more of
analgesics.
A vast majority of 80(66.7%) respondents did cohere with the fact that tablets are much more
used in self-medication than any other preparation. This explains the extensive availability of
many drugs in tablet form and the belief amongst many that tablet drugs have a very positive
therapeutic effect.
Another finding that could benefit the study is the attribute of colours of drugs and frequency
they are used. It was seen that most respondent; 45(37.5%) said they preferred using the white
coloured drugs, followed by red coloured drugs 22(18.3%). This matched the belief that white
drugs were considered to be pure and the red colour was synonymous to blood, hence replacing
blood. This is a new finding and previous researchers had not discovered.
6.9 Reason for self-medicating as per illness
Both headache 31(25.8%) and febrile illnesses/fevers 31(25.8%) struck the majority of
respondents and presented the main problem for self-medication followed by abdominal pain
18(15%). This shares out the frequency and discomfort often caused by these illnesses, hence
propelling people to quickly manage them promptly mainly by just buying drugs like antibiotics
and pain killers. This study however deviates from a similar study done in Australia by World
37
Self-medication Industry (WSMI) 2006 that ranked common cold as the most commonly self-
medicated illness.
6.10 Cost of drugs.
Drugs costing between 50Ugx-500Ugx constituted a majority of respondents’ use 78(65%). This
shows that cheap drugs are much often used for self-medication unlike their costly counterparts.
This finding correlates to a study done by Afolabi 2008 that found an increased demand and
perpetual usage of cheaper drugs for self-medication unlike the more costly ones.
6.11 Source of information about drugs.
Medical personnel were reported as the largest source of information about drugs 40(33.3%) of
the respondents had this to claim, followed by drug sellers 23(19.2%). This means that medical
persons are still the greatest source of drug information in the community. This study coheres
with a study done by Dr.Afolabi.O.A in Nigeria 2008; that revealed a majority of respondents
did obtain their drug information from hospitals through health workers, since they felt that
medical personnel were rich in medical and drug knowledge.
6.12 Benefit of self-medication.
A majority respondents 77(64%) said they felt little benefit from self-medicating despite their
continuation to do so. Only 43(36%) of the respondents agreed to benefit from self-medication
with the majority 14(29.8%) of them said that they get a feeling of satisfaction that they atleast
tried to treat themselves or a family member or friend. this is not surprising as many of the health
facilities are not easily accessible and little time is got to go for treatment in hospitals since a lot
of bureaucracy in hospitals. This study correlates to a study done by Juliet Kanyesigye 2004 that
found the same.
6.13 Disadvantages of self-medication.
A majority 73(61%) of the respondents did not know the disadvantages of self-medication as
opposed to only a minute number 47(39%) who have a clue. This may explain a lacking of
knowledge of drugs used and an insufficient knowledge distribution.
38
Of the respondents who said they knew, a majority 24(51.0%) of them said; they may either give
an under or over dose, followed by 13(27.7%) who said they were not sure whether they used the
correct treatment. This explains a knowledge deficit between the educated and the little educated
on self-medication. All these may predispose to self-medication dangers like drug resistance and
toxicity. This finding relates to a study done for South Africa 2004 by the World self-
medication industry (WSMI) that despite the knowledge on some disadvantages of self-
medication, they still found the urge to utilise an opportunity of self-treatment.
6.14 Satisfaction with self-medication.
Majority 77(64%) of the respondents said they were not satisfied with self-medicating . This
implies that people are crippled due to the long queues in government hospitals and high costs in
private clinics, hence resorting to buying drugs or using old prescription drugs for treatment.
This study however deviates from a study done in South Africa 2004 by the World self-
medication industry (WSMI) that noted more than a half of the people believed that non-
prescription drugs over the counter are much safer than drugs prescribed by Physicians.
6.15 Respondents desire to learn more about self-medication.
Almost all the respondents 118(98.3%) agreed on the idea to actually provide them with
knowledge on drugs and self-medication. This implies a great urge in the public to actually have
some essential knowledge on common drugs and safe self-medication.
39
6.16 Conclusion
Majority of people don’t have knowledge about self-medication.
The prevalence of self-medication is essentially very high in Kabarole district.
The greater number seems to be spread much more in those with intermediate income, the very
educated, females especially those above 30 years.
Pain killers, anti-malarials and antibiotics are the drugs most commonly used for self-medication.
Self-medication was more likely to be used than prescribed medication to treat headache, fever
and abdominal pain.
Tablets and white coloured drugs were most frequently used without prescription.
Majority of respondents get drug information from medical personnel.
40
6.17 Recommendations
Sensitization programs on self-medication and probable dangers should be emphasized
both locally and widely at national level in order to change people’s attitudes positively.
Literacy of the population both locally and at national level should be encouraged.
The practice of community pharmacies should be encouraged especially in places where
health care provision is limited. The presence of such professionals ensures that the
practice of self-medication is accompanied by appropriate training on how to use drugs
appropriately, safely and effectively.
The government should set-up and facilitates more health facilities as to improve on
quality assurance.
Health workers should learn good drug provision services as in explaining to patients
how to use drugs well and effectively in a right dose and right time.
The government should improve and try data basing all patients’ data as many hop from
one health facility to another. This hence reduces on government expenditure and drug
wastages.
41
Government should try to empower health workers more through perpetual trainings as to
ensure good patient care and increased cure rates in the hands of professionals.
Good and healthy self-medication practices should be encouraged by all stake holders
including the Ministry Of Health, District health officer and medical personnel in
Kabarole.
REFERENCES
1. Juliet Kanyesigye 2004 The impact of structural adjusment programmes on women’s
changing health seeking patterns in Uganda: the case of kabale.
2. P Wenzel Geissler 2001 self-treatment by Kenyan and Ugandan Children and the need for
school based education . Health policy and Planning Oxford Press 16(4): 364-371.
3. Mohamed saleem T.K 2011 Self -medication with over the counter drugs: A questionnaire based
study Der Pharmacia Lettre, 2011, 3(1): 91-98.
4. Brazil. 1997. Research on habits and attitudes for purchasing and using OTC drugs. Fundaçao
Instituto de Administraçao.
5. Nepal. 2002. Self-Medication and non-doctor prescription practices in Pokhara valley, Western
Nepal. PR Shankar, P Partha and N Shenoy. BMC Family Practice. 2002, 3:17.
6. South Africa. 1987. South African Healthcare and the Proprietary medicine industry. W. Duncan
Reekie, D.R. Scott. S Afr Med J 1988; 74:205-208.
7. IAPO - International Alliance of Patients’ Organizations. A Survey of Patient Organizations’
Concerns. Summer 2006.
42
8. Healthcare, Self-Care and Self-Medication. 14 National Surveys Reveal Many Similarities in
Consumer Practices. WSMI. 1988.
9. Mandavi Pramil Tiwarl and Vinay Kapur. Indian J. Pharm .pract1 (1), Oct-Dec, 2008.
10. Ministry of Health KENYA 2001.
11. Uganda and Division of vector Borne Diseases 2001.
12. Tumusiime Kabwende Deo 9 september 2008 Uganda: Self- medication - a new form of mob
justice http:\www.africafiles.com Uganda Self -medication - a new form of mob justice.htm
13. South Africa. 2001. South African Healthcare and the Proprietary medicine industry. W.
Duncan Reekie, D.R. Scott. S Afr Med J 2002
14. Whyte 2009; Pearce 2010; Sindiga et al . 2010 A research on African self-medication
mayhem 24-26.
15. WJM-western journal of medicine 2008 November.
16. WHO November 28, 2011 (www.who.com/self-medication) and WHO 2010.
17. Sydney: National prescribing service Ltd:2008
18. Al Shifa College of Pharmacy, 1998 Research on effect of self-medication on teenage population
34-38.
19. A. O.Afolabi 2008 Factors affecting the pattern of self-medication in an adult Nigerian
population. Annals of African Medicine 2008 vol7. 120-140.
20. Pharmacies in Uganda www.ugandainvest.go.ug.
43
21. The World Self-Medication Industry studies.
Appendix1; Work plan
Activities Period: December 2011 to April 2012
December January February March April
Submission of the research
topic to the academic
registrar/ supervisor and
corrections
Writing the research
proposal and submission of
the first draft
Correction and submission
of the second and final
research proposal.
Pretesting and fine tuning
of the research instruments.
Data collection analysis
and writing of the first draft
report
44
Submission of the first
draft report to the
supervisor
Corrections and submission
of the second draft report to
the supervisor
Submission to the
academic registrar
Appendix2: BUDGET
Item Quantity Unit price (UgShs) Total price (UgShs.)
Stationary
Pencil
Paper(s)
Ruler
Pen(s)
White wash
2
1 ream ruled
1
5
1
100
15000
1000
400
3000
200
15000
1000
2000
3000
Data collection tools
(questionnaire) printing,
typing and photocopy
10 pages each
questionnaire
(130 copies)
(each questionnaire)
500 printing @ page
100 photocopying @
page.
5000
130000
Research proposal
(printing and typing)
30 pages 500 each page 15000
45
Data management ----------------------- ----------------------- 40,000
Final report
typing\, printing and
binding
65 pages 500 each page 32500
Contingency 10% of budget 21120
TOTAL 232320
Appendix3: Map of Uganda showing kabarole district.
46
Map of Uganda showing kabarole district 1
Appendix4: Map of kabarole district
47
KENYA
DEM.REP. CONGO
TANZANIARWANDA
SUDAN
48