Self-Medication Practice in Limmu Genet, Jimma Zone, Southwest Ethiopia: Does Community Based Health Insurance Scheme Have an Influence?

1.1. Background

Providing useful and effective healthcare to the community is essential to keep good health as well as a vital agenda of life. In low- and middle-income countries (LMICs), rural inhabitants especially have poor access to modern healthcare infrastructures and low affordability of drugs and medical supplies [1]. Therefore, most people acquire diseases easily. Consequently, episodes of illness are haphazardly treated by self-medication. But the means of self-treatment vary from person to person depending on several factors. The main care of illness is self-care, the oldest and most abundantly used behavior that affects the health of individuals either negatively or positively [1, 2].

Thus, self-medication can be defined as the use of drugs to manage self-diagnosed health complaints or symptoms or the usual use of a prescribed drug for chronic or acute diseases or disease manifestations. According to some studies, the demand of patients is increasing for efficient drugs available without prescription [3, 4]. However, inappropriate self-medication leads to resources wastage, increases microbial resistance, and could generally result in serious health hazards such as adverse drug reaction and persistent suffering [5].

Medicines for self-medication are often called “nonprescription” or “over-the-counter” (OTC) medicines, which are claimed as safe, effective for use, and available without a medical professional’s prescription. In some countries, OTC products are available and dispensed by supermarkets and other outlets. On the other hand, medicines that require a doctor’s prescription are called prescription products [6].

Self-medication is a form of self-care, which is basically performed to treat illnesses, with the ability to relieve illnesses at this stage. Self-medication is used by a significant number (proportion) of the population. It is affected by socioeconomic and demographic health facilities and economic factors. Although some healthcare providers exhibit negative understanding and perspectives towards self-medication, the World Health Organization (WHO) recognizes the existence of a valid role of it. There are a number of reasons why self-medication gets focus. The transition of the trend of diseases especially chronic ones with attendant shift from cure to care is becoming a large-scale transition. In addition, the inaccessibility (failures) of the healthcare system with its uneven distribution of drugs, unaffordable price, and the issue of curative stance of drugs is notable [7, 8]. Also, patient-related factors anticipate inappropriate antimicrobial use and contributed to the increasing prevalence of antimicrobial resistance (AMR). For instance, self-medication with antimicrobials by patients contributes to the problem of AMR [9]. Moreover, it might be associated with some risks such as drug interactions, adverse drug reactions, increased polypharmacy, incorrect diagnosis, and drug dependence [3, 10, 11].

Community based health insurance (CBHI) is defined as a mechanism that households in a community (the population in a village, a district, or other geographical areas, or a socioeconomic or ethnic population group) use to finance or cofinance the current and/or capital costs associated with a given set of health services and enable them to have some involvement in the management of the community financing scheme and organization of health services [12]. It aims to improve access to healthcare and to protect households from pocket-payment related risks. It incorporates a wide range of nonprofit schemes providing risk pooling to cover a part of or all healthcare related costs. To their minimum or maximum level, CBHI schemes target households that generate their income from the informal economy and are excluded from legal and formal social protection. Also, having a membership is therefore usually voluntary. Basically, the schemes encourage active decision-making and management. Consequently, building on mutual aid and unity, risk sharing is as inclusive as possible and membership premiums are independent of the individual health status. Nevertheless, payments are usually flat rates and, thus, are not adjusted and are requested according to the financial capacity of individuals [13, 14]. Therefore, being a CBHI scheme member might be one of the elements for self-medication prevalence in the study area.

Moreover, limited access to health information and education on medications and diseases might be linked with hazardous drawbacks to communities in rural areas. Lack of trained pharmacists/professionals creates favorable environment for self-medication. Even though SMA is somehow important to treat minor ailments, wrong self-medication practice may cause serious adverse drug reactions and possible fatal consequences. For instance, currently, AMR is becoming globally prevalent, mainly in LMICs [15]. For this reason, the transmission of new forms of resistant pathogens could be fast and can easily spread intercontinentally. World health leaders have described AMR as “nightmare bacteria” that “pose a catastrophic threat” to people in every country in the globe [16]. Therefore, the issues of drug availability, preference, and proper use are a vital issue to the global community [17].

However, illegal scandalmongers of drugs are prevalent in several LMICs. Thus, the use of these drugs from informal sources increases the chances of self-medication and home drug storage. The availability of drugs at home has enabled an extent of self-medication for illnesses. For that reason, handling unnecessary dangerous and bacterial resistant medicines from illegal and informal sources is important to consider the manners of drug availability to consumers [18].

As per studies in Ethiopia, the magnitude of self-medication varied from 12.8% to 77.1%, with an average of 36.8%. The type of illness that leads to self-medication, sources of information for self-medication, and drugs or category of drug products that are commonly self-administered need to be understood to design interventions [7, 19]. Some recent studies also revealed that antibiotics can be easily purchased without prescription and are accessible from kiosks (small local shops in Ethiopia). In addition, self-medication is still used more often for self-limiting illnesses and antibiotics are usually used by consumers. All these scientific findings have shown that antibiotics are not only highly consumed but also irrationally used. They also indicate that Ethiopia still faces some challenges related to regulatory enforcement from socioeconomic, demographic, and patient-related health facilities and policy related concerns [2, 7, 19, 20].

A study conducted in Butajira (Southern Ethiopia) indicated that 15% of people with perceived illnesses performed self-medication [21]. In another study conducted in Addis Ababa and Central Ethiopia, the magnitude of self-care was as high as 50%. Low severity/pain of illness or diseases and poverty were the major reasons for self-medication [2].

In previous studies, the association between being a CBHI member and the self-medication trend has not been studied yet in Ethiopia. Therefore, this study aimed to assess the prevalence and the nature of these practices in the CBHI members and nonmembers levels, which is important to devise appropriate educational, regulatory, and administrative measures.

2.1. Study Setting

A community based comparative cross-sectional study was conducted in a community in Limmu Genet town from February to March 2016, because in the town there are a number of private pharmacies and governmental hospitals which provide both preventive and curative services for communities in and out of the catchment areas. Limmu Genet is located 425 kms and 75 kms southwest of Addis Ababa, the capital of Ethiopia, and Jimma, the capital of Jimma Zone, respectively. It has a total surface area of 1200 hectares. It is bounded by Sokoru in the east, Gomma in the west, Limmu Sakka in the north, and Kersa in the south. The total projected population of the town from the 2007 Central Statistical Agency (CSA) census report is 12,674. The town has a temperature within the range of 30°C and an average annual rainfall of 800–2500 mm³ and is at an altitude of 1750–2000 m above sea level.

2.2. Participants, Sample Size, and Sampling Techniques

All households found in Limmu Genet town during the study period were used as the source population of the study. The study population was selected from community health insurance members and nonmembers, found in Limmu Genet town during the study period, who were regarded as the source population of the study. Based on eligibility criteria of households, members and nonmembers of CBHI were the study units. All community health insurance members and nonmembers were included in the study. All community health insurance members aged below 18 years were excluded. After this, 422 study participants were recruited in the study.

The multistage systematic sampling technique was used to select participants for data collection from the community. After the sample size was determined, the systematic random sampling technique was applied. Systematic random sampling was used to select study participants.

2.3. Data Collection Procedure and Instruments

Data collection tools were adapted from various literatures after a thorough revision of them. The questions and statements were grouped and arranged according to the particular objectives that they could address. The instruments included both closed-ended and open-ended questionnaires.

Data was collected on self-medication for both the health insurance members and the nonmembers. One questionnaire took an average of 20–30 minutes for a person. Patient characteristics such as sociodemographics and history of drug use were recorded.

2.4. Data Analysis

Data were analyzed using SPSS version 20. Descriptive statistics were used to illustrate proportions, tables, and means. Rates of total self-medication were calculated for each of the variables considered. Statistical analysis was carried out using Pearson’s CBHI square with values of P < 0.05 taken as significant.

To estimate the independent effect of each of these variables on self-medication, further statistical analysis was carried out by linear regression. Initially, data showed that being a member of community insurance was found to be an important factor in self-medication and, in turn, community insurance might have influenced other variables.

2.5. Quality Control

There was regular cross-checking for the completeness of the questionnaires. The data collection tool was pretested for its validity. The data collection tool was first prepared in English and later translated to Afan Oromo local language to keep meaning consistency. To avoid information bias, pretest was conducted in the adjacent district town, and after getting feedback from the pretest we revised the tool to maintain validity.

2.6. Ethical Clearance

The ethical approval and clearance letter of permission was obtained from Jimma University; an official letter was obtained from the Department of Pharmacy. During data collection, all respondents were asked for their permission and informed consent was obtained prior to the interview. An official letter was sent to Limmu Genet’s health center and hospital. The confidentiality of the study participants was secured.

3.1. Sociodemographic Characteristics of the Respondents

This population-based survey examined three hundred and eighty-nine households which were sampled from three kebeles. Of the total 422 questionnaires distributed to be filled by respondents, 389 were filled completely and collected, which gave a response rate of 92.2%. The mean age of the respondents was 42.2 years (SD = 13.7). The minimum age was 18 and the maximum was 90. Since the interview was conducted with female household heads, 47.6% of the respondents were females. Regarding the respondents’ family monthly income, the majority, 37.0%, reported a monthly income of between 1001 and 1500 Ethiopian Birr (Table 1).

3.2. Characteristics of the Sick Person

From a total of 389 households, three hundred and eight (308) household members had faced health-related problems within the last two weeks prior to the study, translating to an illness prevalence of 91.8%. But the degree of illness varies from person to person. Among them, 241 (78.2%) treated themselves. No households reported more than one ill person. About 95.4% of the sick individuals were married. Females, 48%, reported less illness than males, 52%.

3.3. Perceived Illness Treated with Self-Medication with Drugs

Depending on the different socioeconomic and sociodemographic factors, the types, extents, and reasons for self-medication can vary from country to country. In this study, self-medicated participants were 237 with health problems out of 304 with illness conditions. This made self-medication’s prevalence 78.1%. Over 70% of CBHI members and 30% of nonmembers practiced self-medication. The most common types of ailments for which the respondents reported practicing self-medication were cough and fever (Table 3).

3.4. Extent and Reason for Self-Medication with Drugs

The major reasons listed by the self-medicated study participants are shown in Table 2. Concerning reasons of self-medication respondents, about 114 (67%) and 63 (70%) of CBHI members and nonmembers, had low cost alternatives in money and time, respectively. But only 6 (3%) of CBHI members had prior experience to the illness and/or the self-drug intake. About 56 (26%) and 21 (23%) CBHI members and nonmembers believed that self-medication is an emergency care, respectively.

3.5. Major Drug Classes Used for Self-Medication

Out of 241 self-medicated participants, the most commonly requested categories of drugs were analgesics/antipyretics (93, 38.5%), antimicrobials (91, 36.8%), antimalarials (28, 11.8%), anthelmintics (28, 11.8%), and traditional medicine (3, 1.0%) (Figure 1).

3.6. Sources of Information for the Practice of Self-Medication with Drugs

The two most usual sources of advice/information for self-medication were drug retail outlets (37.8%) and healthcare providers such as doctors, nurses, and health assistants, but without formal prescriptions (42.1%). Nevertheless, friends, neighbors, or relatives (2%) and 37.8% of the respondents obtained information by reading drug-related materials such as labels, leaflets, or promotional materials, while 18.0% of them reported obtaining such information by previous experience (Table 4).

3.7. Determinants of Self-Medication with Drugs

As shown in Tables 5 and 6, the result of crosstabs analysis revealed that, in some variables, significant associations were observed on the practice of SMA and community health insurance members and nonmembers.