ABSTRACT
Reducing maternal mortality is key to
achieving the Millenium Development Goals in Nigeria. However, self-medication
is one of several health seeking behaviours that threatens the life of pregnant
women attending clinic and undermine the achievement of improved maternal
health. Though self medication in general has received research attention, not
much is known about the reasons that prompt pregnant women attending clinic to
self-medicate and the disease conditions for which self medicated drugs are
used to treat. This research explored the phenomenon of self-medication among pregnant
women attending clinic in Calabar municipal, in the Cross river state of Nigeria.
Using a questionnaire survey, 300 pregnant women attending clinic were
interviewed on the factors that cause them to self-medicate, the disease
conditions treated with self-medication, the most commonly self medicated
drugs, and their knowledge of the potential effects of self-medication. The
research revealed that self-medication was high among respondents (68.3%), even
though most respondents (77.7%) remained informed of the potentially negative
effects on the mother and the foetus. Perceived non-seriousness of disease
conditions (37.3%), familiarity with certain drugs (22.8%), low cost of
self-medicated drugs (25.1%) and dissatisfaction with health service delivery
(11.5%) were some of the main factors that predisposed respondents to
self-medicate. This research also found that headaches (44.8%), cold and flu
(17.7%), stomach problems (14.2%) and body pains (10.9%) were the most commonly
treated disease conditions, often treated with analgesics (46.4%), herbal drugs
(23.5%), antibiotics (18.4%), and antacids (11.6%). Based on these findings,
the research concludes by recommending that government intervention programs
should go beyond pregnant women attending clinic and target family members and
relatives, since they are influential as trusted sources of drugs, and drug
information. In addition, this research recommends that the government of Nigeria
initiate a mobile health delivery system for self-employed pregnant women
attending clinic, which will target these pregnant women attending clinic at
their work places and through that reduce the reluctance and inconvenience that
these pregnant women attending clinic experience in seeking professional health
services.
CHAPTER ONE
INTRODUCTION
1.0 BACKGROUND TO THE STUDY
Self-medication
can be defined as the use of drugs to treat self-diagnosed disorders and
symptoms, or the intermittent or continued use of a prescribed drug for chronic
or recurrent disease or symptoms (Donkor et al., 2012). As a phenomenon,
self-medication is manifested when people use over the counter medications to
resolve usually perceived minor health challenges (Afolabi, 2008; Figueiras,
Caamaño, & Gestal-Otero, 2000).
Self-medication
is a global problem, common in developed, developing, and under developed
countries. In 1990, it was estimated that between 70% and 90% of all illness
episodes were handled by some form of self-treatment before it came to the
attention of health professionals (Segall, 1990). Afolabi (2008) estimates that
in the United Kingdom approximately 50% of all health care among people occurs
as some form of self-medication. Self-medication has also been reported as a
health behavior among people in Spain (Figueiras et al., 2000). Similarly,
selfmedication has been reported as a common health behavior in different
developing countries in general, including Nigeria, Zambia, and other countries
in Asia like India, and Vietnam (Afolabi,
2008; Banda et al., 2007; Fakeye, Adisa, &
Musa, 2009; Malan & Neuba, 2011; Okumura, Wakai, & Umenai, 2002; Rahman
et al., 2008; Yusuff & Omarusehe, 2011).
The preceding
information implies that as a health behavior, self-medication is not limited
to a particular group of people but rather transcends race, age, occupational
status, gender, culture, and other such categorisations (Afolabi, 2008). This
notwithstanding, self-medication has been argued to be especially prevalent
among people living in areas with high incidence of malaria (Akanbi, Odaibo,
Afolabi, & Ademowo, 2005). Elsewhere, self-medication with specific drugs
like antibiotics has been shown to be highly prevalent in developing countries,
with the exception of a few developed countries (Donkor et al., 2012).
Figueiras et al. (2000) in a study of socio-demographic factors associated with
self-medication in Spain also associated selfmedication with women, people
living in large cities, and people who live alone.
The prevalence
of self-medication is informed by a variety of factors that may differ from
country to country. On the whole however, self-medication in more developed
countries may be as a result of the increasing de-regulation of previously
restricted drugs. This is because, a wide variety of drugs are now available
over the counter for the treatment of a variety of health challenges
(Blenkinsopp & Bradley, 1996; Bradley & Blenkinsopp, 1996). On the
other hand, self-medication in developing countries may be as a result of a
variety of factors including the higher cost involved in seeking professional
care in hospitals; poverty; the considerable long time spent in hospitals in
order to seek health care; cultural beliefs in the efficacy of other
traditional methods; as well as poor regulation and easy availability of drugs
outside formal and regulated environments (Afolabi, 2008; Donkor et al., 2012;
Figueiras et al., 2000).
The negative effects
of self-medication are diverse and may include effects such as treatment
failures, drug toxicity, and increase in treatment cost, prolonged
hospitalization periods and increase in morbidity. What makes self-medication
more dangerous in developing countries is that the basic knowledge concerning
the pharmacological properties of these drugs and how they may affect those who
practice it are not well known (Abasiubong et al 2012). The adverse effects of
self-medication become more serious when the self-medicating person is a
pregnant woman (Abasiubong et al 2012). Self-medication by pregnant women
attending clinic especially in the first trimester of pregnancy can cause some
serious effects to the unborn baby and the mother. These effects may include
malformation of children, or hindrance in normal growth of the baby, defects in
the development of the reproductive organs, urinary retention, intersex,
undescended testis and other problems with the urethral (Abasiubong et al
2012).
Like other
developing countries, self-medication is a major health concern in Nigeria and
has become increasingly common since 1985 when health facility user fees were
introduced, making people to self-medicate in order to avoid paying
consultation fees and transport costs (Salisu and Prinz, 2009). Nonetheless,
there remains very little research on self-medication among pregnant women
attending clinic. In the light of the foregoing, this research used
quantitative research techniques to deetermine the various self-medication practices
among pregnant women attending clinic in Nigeria and explore the knowledge of pregnant
women attending clinic on the adverse effects self-medication may have on them,
the unborn child and the country as a whole.
Van Den Boom,
Nsowah-Nuamah, & Overbosch, (2008) and Donkor et al. (2012) indicate that
there are difficulties in accessing medical care in several places in Nigeria.
Consequently, selfmedication (including traditional and herbal medicines) is a
common practice among Nigeriaians especially among the poor. Self-medication
using traditional or herbal medicines is also common. Salisu and Prinz (2009)
also argue that it is common for Nigeriaians, when ill, to selfmedicate first
instead of seeking professional medical support from health personnel and
health centres. This behaviour among the general Nigeriaian populace is mainly
to reduce cost of consultation and the cost of transportation to and from the
hospitals or health care facilities especially for the rural areas where
residents have to travel for considerable distances to access health facilities
(Salisu and Prince, 2009). Consequently, difficulties and inconveniences in
accessibility to and use of professional health care is a significant challenge
for the government of Nigeria to overcome. This includes the challenge of
reducing self-medication and promoting good health seeking behaviour among the
general Nigeriaian populace (Van Den Boom et al., 2008).
Self-medication
is one of the most significant social attitudes that negatively affect the
health of pregnant women attending clinic in Nigeria. In a report on Nigeria‟s
Millennium Development Goals (MDGs), the National Development Planning
Commission of Nigeria (NDPC) revealed that one of the main challenges that Nigeria
has faced in achieving the goal of improving maternal health has been poor
health seeking behaviours especially among the poor (NDPC, 2010). These poor
health seeking behaviours include choosing to self-medicate and also
self-medicating with traditional herbal medicines instead of attending a health
facility to be diagnosed and treated accordingly. The Nigeria Maternal Health
Survey (NMHIS) and the Nigeria Statistical Service (GSS) both reveal that when
faced with an ailment, some pregnant women attending clinic prefer to
self-medicate first and only seek professional health services when the
situation worsens (NMHIS and GSS, 2009). This, according to the Ministry of
Health (MOH) has led to poor health seeking behaviour among some pregnant women
attending clinic in Nigeria, resulting in delays in, and late presentation of
health problems
(MOH,
2008).
In view of the
above, this research investigated and analysed the various reasons and factors
underlying self-medication among pregnant women attending clinic in Nigeria;
disease conditions for which pregnant women attending clinic in Nigeria usually
self-medicate; the knowledge and attitudes of pregnant women attending clinic
regarding the potential negative effect of self-medication; and the
socio-economic factors and predictors of self-medication among pregnant women
attending clinic in Nigeria. These are all interesting issues, information on
which will help to resolve the problem of self-medication among pregnant women
attending clinic and in the process promote maternal and foetal health in Nigeria.
The following
research questions guided this study:
1. What
factors inform the practice of self-medication among pregnant women attending
clinic?
2. Which
particular diseases or disease conditions are treated with self-medicated drugs
among pregnant women attending clinic?
3. Which
drugs are most often used in self-medication among pregnant women attending
clinic?
4. What
do pregnant women attending clinic know about the possible side effects of
self-medication on the pregnant woman and the unborn child?
Generally, this
study sought to explore the phenomenon of self-medication among pregnant women
attending clinic in the Ejisu – Juaben Municipality in Nigeria.
Specifically,
the study sought to:
1. Explore
the factors that inform the practice of self-medication.
2. Ascertain
the disease conditions treated with self-medicated drugs.
3. Ascertain
the drugs that are most often used in self-medicating among pregnant women
attending clinic
4. Investigate
the level of awareness and knowledge of pregnant women attending clinic about
the possible side effects of self-medication on unborn children.
Improving
maternal health and reducing infant mortality are two important health related
goals of Nigeria‟s Millennium Development Goals (MDGs) (NDPC, 2010). In order
to achieve these
two important
goals, it is essential that all stake holders work together to eliminate the
various factors, including self-medication, that work against and hinder the
wellbeing of pregnant women attending clinic in Nigeria (NDPC, 2010).
Understanding and managing self-medication attitudes and by so doing promoting
medication safety among pregnant women attending clinic will go a long way in
achieving both goals.
Thus, this
study, with its focus on assessing self-medicating attitudes among pregnant
women attending clinic in Nigeria is significant, since knowledge and
information from the research can be
adopted by health professionals and other stake holders in improving the health
of the mother and child. This can ultimately reduce the rate of morbidity and
mortality among women and children and hence contribute towards the achievement
of Nigeria‟s Millennium Development Goals.
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