Self-medication practice among undergraduate medical students in a tertiary care medical college, West BengalI Banerjee1, T Bhadury2
1 Department of Pharmacology, Murshidabad Medical College, Behrampore, India
2 Department of Medicine, AMRI Hospitals Limited, Kolkata, West Bengal, India
Background: Self-medication is a widely prevalent practice in India. It assumes a special significance among medical students as they are the future medical practitioners. Aim: To assess the pattern of self-medication practice among undergraduate medical students. Settings and Design: Tertiary care medical college in West Bengal, India. Material and Methods: A cross-sectional questionnaire-based study was conducted among the undergraduate medical students. Results: Out of 500 students of the institute, 482 consented for the study and filled in the supplied questionnaire. Fourteen incomplete questionnaires were excluded and the remaining 468 analyzed. It was found that 267 (57.05%) respondents practiced self-medication. The principal morbidities for seeking self-medication included cough and common cold as reported by 94 students (35.21%) followed by diarrhea (68 students) (25.47%), fever (42 students) (15.73%), headache (40 students) (14.98%) and pain abdomen due to heartburn/ peptic ulcer (23 students) (8.61%). Drugs/ drug groups commonly used for self-medication included antibiotics (31.09%) followed by analgesics (23.21%), antipyretics (17.98%), antiulcer agents (8.99%), cough suppressant (7.87%), multivitamins (6.37%) and antihelminthics (4.49%). Among reasons for seeking self-medication, 126 students (47.19%) felt that their illness was mild while 76 (28.46%) preferred as it is time-saving. About 42 students (15.73%) cited cost-effectiveness as the primary reason while 23 (8.62%) preferred because of urgency. Conclusion: Our study shows that self-medication is widely practiced among students of the institute. In this situation, faculties should create awareness and educate their students regarding advantages and disadvantages of self-medication.
Keywords: Medical students, self-medication, study
William Osler once commented, "The desire to take medicine is perhaps the greatest feature which distinguishes man from animals". This desire is perhaps the key factor for the practice of self-medication which can be defined as obtaining and consuming drugs without the advice of a physician either for diagnosis, prescription or surveillance of treatment. 
Self-medication is widely practiced worldwide and often considered as a component of self-care.  However, unlike other components of self-care, self-medication has the potential to do good as well as cause harm since it involves the use of drugs. The World Health Organization (WHO) has appropriately pointed out that responsible self-medication can help prevent and treat diseases that do not require medical consultation and provides a cheaper alternative for treating common illnesses.  The practice of self-medication must be based on authentic medical information otherwise irrational use of drugs can cause wastage of resources, increased resistance of pathogens, and can lead to serious health hazards such as adverse drug reaction and prolonged morbidity.  In developing countries like India, self-medication is a common practice as it provides a low-cost alternative for people who cannot afford the high cost of clinical service and also as many drugs are dispensed over the counter without prescription from a registered medical practitioner. 
Self-medication assumes a special significance among the medical students as they are the future medical practitioners and have a potential role in counseling the patients about the advantages and disadvantages of self-medication. Medical students also differ from the general population because they are well-exposed to the knowledge about diseases and drugs. A literature search was conducted which consisted of a Medical Literature Analysis and Retrieval System Online (MEDLINE) database search (accessed on 16.4.2010) and a World Wide Web search (Search engine: Google, accessed on 16.4.2010) using the following keywords: Self-medication, medical students, study. The search revealed that few studies have been conducted to ascertain the self-medication practice among medical students. ,,,,,,, In these studies, the prevalence of self-medication practice was found to vary among medical students of different countries. Headache, common cold and cough, fever, abdominal pain have been mentioned as the primary morbidities for seeking self-medication. The drugs predominantly used included analgesics, antibiotics, antipyretics. The reasons for seeking self-medication as mentioned in the majority of the literature are mild nature of illness, prior experience of treating similar illness, economic considerations. However, since the majority of these studies were conducted outside India, ,,,,, the pattern of self-medication among medical students of India remained unexplored.
Our study was conducted against this backdrop with the aim to assess the pattern of self-medication practice among the undergraduate medical students.
This was a cross-sectional, questionnaire-based study.
The study was conducted in a tertiary care district medical college and hospital in West Bengal.
During the study period five batches (2005-06, 2006-07, 2007-08, 2008-09 and 2009-10) of MBBS students were available in the institute, each batch comprising 100 students. All the 500 students were considered eligible for participating in the study.
Sample size calculation
The minimum sample size (N) was calculated using the Cochran formulae:  N = Z 2 pq / d 2
where N is the sample size,
p is the prevalence of self-medication taken as 50%,
q = (1 − p),
Z is the standard normal deviation (usually set at 1.96, which corresponds to the 95% confidence interval), and d is the desired degree of accuracy set at 0.05 to tolerate a 5% error. Accordingly, the calculated minimum sample size N= 384, 20% non-response rate was added to the final sample size. Thus, N = 384 + 20/100(384) = 384 + 76.8= 460.8. For better precision, we took an additional 40 of them. Thus, a total of 500 students studying in the institute were considered to be eligible to participate in the study.
Prior permission was obtained from the ethics committee of the institution for conducting the study. The purpose of the study was explained to the participating students and confidentiality was ensured. Informed consent was obtained from every student before filling the questionnaire.
All the undergraduate medical students were contacted during the scientific session of the annual college program held in the second week of May 2010. Out of 500 students, 18 students were found absent. The purpose of the study was explained to the remaining 482 students, all of whom consented to the study. After obtaining informed consent, they were asked to fill up a printed, semi-structured questionnaire. The questionnaire was designed and pretested on 50 internees (Batch 2004-05) who were not included in the study. The questionnaire contained questions regarding demographic information, whether the student sought self-medication in the preceding month, illness for which the medication was used, drug/ drug group used by them and the reason for not consulting a healthcare professional [Annexure 1]. For the purpose of the study, certain operational terms were defined. Self-medication was defined as the use of medicine for self-treatment without consulting a healthcare professional. A healthcare professional was defined as a person:
The returned questionnaires were checked for completeness of data. The data obtained from the completed questionnaires were analyzed in the computer by using Statistical Package for Social Sciences (SPSS) program Version 10. Descriptive data were expressed as percentage, frequency and mean±S.D. Chi-square test was used for testing statistical significance. A P value less than 0.05 was considered to be statistically significant.
A total of 468 students successfully completed the questionnaire. (Flow of participants shown in [Figure 1].) The mean age of the respondents ± S.D was 21.03±4.82 years. The total number of male students (372) outnumbered their female counterparts (96) (P<0.001). A total of 267 (57.05%) students reported having practiced self-medication during the preceding month with 200 males (53.76%) and 67 females (69.79%) (P<0.006). It was found that the prevalence of self-medication varied significantly among different years of students as evidenced by the fact that 79.31% of final-year students practiced self-medication compared to 41.67% of first-year students (P<0.0001). The details of the pattern of self-medication as practiced by the study population have been enumerated in [Table 1].
It was found that cough and common cold (35.21%) was the predominant morbidity for which students practiced self-medication. Other causes of morbidity prompting the students to practice self-medication included diarrhea, fever, headache, pain in the abdomen due to heartburn/ peptic ulcer. Drugs or drug groups commonly used for self-medication included antibiotics (31.09%) followed by analgesics, antipyretics, antiulcer agents, cough suppressants, multivitamins, and antihelminthics. However, the choice of drugs varied among students of different years [Table 2], [Figure 2]. The final-year students used antibiotics more (37.68%) than first-year students (22.5%) but the difference was not statistically significant (P<0.15). Among the reasons given for practicing self-medication, 126 (47.19%) respondents felt that their illness was mild while 76 (28.46%) preferred self-medication as it is time-saving. About 42 students (15.73%) reported that cost-effectiveness was the primary reason for self-medication while 23 (8.62%) preferred because of urgency.
The present study indicates that self-medication is widely practiced (57.05%) by the undergraduate students of the institute. In studies conducted among first-year medical students in Bahrain (2006),  about 44.8% of students practiced self-medication while in Karachi, the percentage is 76%.  A study conducted among medical students in Karnataka revealed 53% students practicing self-medication.  However, dearth of data regarding the incidence of self-medication practice in the Indian population creates difficulty in comparing the extent of self-medication among undergraduate students of the institute in the national perspective.
In our study it was found that the practice of self-medication was more prevalent among females than males (P<0.006). This finding i.e. female preponderance in seeking self-medication was not considered in earlier studies conducted with a similar objective on medical students in India. However, in a study conducted to assess the sex difference in self-medication practices among university students in Slovenia (2011), the researchers failed to demonstrate any statistically significant difference between male (90.9%) and female (94.1%) students. 
It is generally expected that self-medication would be more prevalent in senior medical students as they are exposed to the knowledge about drugs and disease. A notable finding in our study is that final-year students practiced self-medication more frequently than first-year students (P value<0.001). This finding is in congruence with the study conducted in Slovenia (2010) by Klemenc-Ketis et al. Similar results were also reported in the study conducted by James et al.,  where medical students of Year 4 practiced self-medication more often than those of Year 2 (P value=0.02). This suggests that a higher level of medical education is associated with increased practice of self-medication. However, in the study conducted in Nagpur by Sontakke et al.,  the prevalence of self-medication among junior and senior medical students did not differ significantly.
Regarding the morbidities which prompted the medical students to practice self-medication, cough and common cold (35.21%) was most common followed by diarrhea, fever, and headache. In studies conducted among first-year medical students in Bahrain (2006),  headache was the most common one (70.9%) followed by cough/common cold, stomachache, and fever. Headache (72.4%) was also the most common morbidity among medical students seeking medication in the study conducted in Karachi.  In the study conducted in Ethiopia,  fever and headache were the most commonly reported symptoms for self-medication followed by cough and common cold.
The drugs which were frequently used for self-medication in our study were antibiotics (31.09%) followed by analgesics, and antipyretics. In the study conducted in Karachi,  analgesics were the most common (88.3%) followed by antipyretics and antibiotics; the study in Bahrain (2006)  also reported analgesics to be the most commonly used drug group (81.3%) with antibiotics contributing only 6% of the total share. The reason provided by the researchers for limited use of antibiotics in medical students in Bahrain is that the governments in the countries to which the study respondents belonged have strict regulatory policies about the prescription and over-the-counter (OTC) sale of antibiotics. However, some studies conducted in developing countries with similar intent have reported a higher use of antimicrobials for self-medication, especially where there is increased incidence of infectious diseases and antibiotics are freely available OTC. , This suggests that use of antimicrobials is high when there is lack of implementation of proper regulatory control over the OTC sale of these drugs.
Regarding reasons which provoked students for self-medication, mild nature of illness was the most common one (47.19%). The fact that those with a mild illness practiced self-medication has got serious implications as many diseases may initially appear to be mild but misdiagnosis and wrong treatment may invite serious health hazards. This finding is in congruence with the findings of the study conducted in Bahrain (2006)  where 45.5% of students preferred self-medication as it is time-saving while 25.4% preferred it due to minor nature of illness.
It is a common tendency among medical professionals to practice self-medication when they themselves feel sick. Although they can consult fellow physicians, due to busy lifestyle and a complex set of reasons including ego, they hesitate in seeking medical help from professional colleagues when they are ill. This particular practice however has its pros and cons. While responsible self-medication is a convenient alternative to treat minor illness as well manage acute emergency, inappropriate self-medication results in deleterious results. The practice of self-medication gets incorporated in the medical professionals right from their undergraduate days. In this situation further multicentric studies with the objective of evaluating the knowledge, attitude, practices of self-medication involving a wider section of the medical students (both undergraduates and postgraduates) across different medical colleges in the country is urgently needed to estimate the magnitude of self-medication in the medical fraternity. The findings of such multicentric studies could dictate the need of incorporating responsible self-education as an intrinsic component in medical curriculum.
Thus, our study shows that self-medication is widely practiced among the medical students of the institute with antibiotics being the most commonly used drug group and cough and common cold being the predominant morbidity for seeking self-medication. In this situation, faculties of the institute should create awareness and educate their students regarding advantages and disadvantages of self-medication. Our study also appreciates the need of conducting further multicentric studies involving wider sections of medical professionals to estimate the magnitude of self-medication practice in the medical fraternity.
[Figure 1], [Figure 2]
[Table 1], [Table 2]