Zeid et al.

Bulletin of the National Research Centre

https://doi.org/10.1186/s42269-020-00351-7
(2020) 44:92
Bulletin of the National
Research Centre

RESEARCH Open Access

Prevalence and associated risk factors of

self-medication among patients attending
El-Mahsama family practice center, Ismailia,
Egypt
Wael Zeid, Madeha Hamed, Nadia Mansour and Rokaya Diab*

Abstract
Background: Self-medication is defined as taking medications without the physician’s prescription. It is a worldwide
public health problem, especially in countries with limited resources. Although self-medication can reduce waiting time
and save money, it may carry some potential risks, e.g., antibiotic resistance or inappropriate management
with subsequent complication. A limited number of self-medication studies have been conducted in Egypt.
Objectives: To determine the prevalence of self-medication practices and to identify the factors associated
with self-medication
Methods: A cross-sectional study was conducted on 160 patients. The sample was randomly selected from
those who attended the El-Mahsama family practice center, Ismailia, Egypt, from November 2018 to February 2019. The
center is affiliated to the Suez Canal University and provides preventive and curative services to a rural community. The
participants were interviewed using a semi-structured questionnaire including sociodemographic scale and self-
medication knowledge and behavior. Data was analyzed using descriptive and analytic statistical methods.
Results: Frequency of self-medication among the study sample has reached 96%. More than half of the participants
(53.6%) reported that the first reason behind using self-medication was cost saving. Meanwhile, the most prevalent
conditions that make them use these medications by themselves were headaches (17%), aches and pain (other than
headache) (39.2%), and fevers (11.8%). The most frequent self-administered drugs were analgesics (59.5%) and
antibiotics (23.5%).
Conclusion: Prevalence of self-medication is high among all socioeconomic levels of patients attending the El-
Mahsama family practice center, which serves a rural community in Ismailia governorate, Egypt.
Keywords: Self-medication, Over the counter, Self-care, Self-management, Prescription-only medicines

Introduction medicine (Torres et al. 2019). Methods of self-medication

Self-medication is defined as the use of medicines to may include buying drugs by reutilizing a previous pre-
treat self-diagnosed disorders without any medical con- scription, taking medicines on advice of relative or others,
sultation (Sarahroodi et al. 2012). It may involve over-the- or consuming leftover medicines already available at home
counter (OTC) medications, prescription-only medicines (Helal and Abou-ElWafa 2017). Self-medication is a global
(POM), or the use of complementary and alternative phenomenon and potential contributor to human patho-
gen resistance to antibiotics (Bennadi 2013). However, its
* Correspondence: [email protected] patterns vary between countries depending on various fea-
Department of Family Medicine, Suez Canal University, Kilo 4.5 Round Road, tures, e.g., socioeconomic factors, medical knowledge,
Ismailia 41522, Egypt

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Zeid et al. Bulletin of the National Research Centre (2020) 44:92 Page 2 of 5

satisfaction and people’s perception of disease, ready ac- (1) socioeconomic status and (2) self-medication assess-
cess to drugs, the increased potential to manage certain ment. The socioeconomic status section contained 7 do-
illnesses through self-care, and greater availability of medi- mains, with a total score of 84: education and cultural
cinal products (Abay and Amelo 2010; Klemenc-Ketiš domain (score = 30: highest level of education and ac-
et al. 2011). cess to health information), occupation domain (score =
Although self-medication can reduce the load on med- 10: occupation of husband and wife), family domain
ical services and save cost, it is far from being a com- (score = 10: residence, number of family members,
pletely safe practice (WHO 2005). Potential risks may number of earning family members, and education of
include incorrect self-diagnosis, delays in seeking med- children), family possessions (score = 12: refrigerator,
ical advice when needed, severe adverse reactions, dan- television, washing machine, mobile/phone, radio, car,
gerous drug interactions especially for older people with agricultural land, non-agricultural land for housing, shop
multi-morbidity, incorrect manner of administration, in- or animal shed, computer, internet, another house rather
correct dosage, incorrect choice of therapy, masking of a than living in, animals/poultry), economic (score = 5: in-
severe disease, and development of microbial resistance come sufficiency, governmental support, and taxes), home
(Ruiz 2010). sanitation domain (score = 12: services, e.g., water/electri-
Antibiotics resistance, one of the biggest threats to city/sewage, owned/rented, number of rooms, crowding
global health, may result from self-medication of antibi- index), and healthcare domains (score = 5: private/health
otics (Rather et al. 2017). The acceleration of antibiotic insurance/free governmental/traditional healers). The total
resistance and the decline in the development of new socioeconomic level was classified into very low, low, mid-
antibiotics to combat the problem have created signifi- dle, and high levels depending on the quartiles of the score
cant public health challenges to health policymakers, calculated (El-Gilany et al. 2012). The self-medication as-
health care workers, and the population around the sessment section covers the following items in the last 12
world (Gebeyehu et al. 2015). In many developing coun- months (Ilhan et al. 2009): frequency of self-use of medi-
tries including Egypt, antibiotics are unregulated and cations, diseases for which medicines were self-prescribed,
available over the counter without a prescription (Ven- drugs commonly used, sources of information, reason for
tola 2015). not consulting a doctor, and patients’ opinion about self-
Despite the potential risks of self-medication, and to medication practice. Pilot testing of tools was carried out
the best of our knowledge, few epidemiological data is on 20 persons out of the study sample to assess the under-
available about the prevalence of self-medication among standability and feasibility of the questionnaire. A Cron-
patients in our community. bach’s alpha of 0.66 with a moderate agreement (kappa =
0.76) and strong positive significant correlation (r = 0.93)
Methods between the socioeconomic levels and scores of both
A cross-sectional study was conducted on 160 partici- scales indicated the acceptable reliability and validity of
pants, who were selected by simple random sample from the tool of study (El-Gilany et al. 2012). The validity of the
the daily registry of patients who attended the El- self-medication assessment tool was pre-determined by
Mahsama family practice center, Ismailia, Egypt, from three experienced professors of family and community
November 2018 to February 2019. The sample size was medicine.
determined by using the equation of one proportion:
Data management
, where n = sample size, Zα/2
Data was analyzed using the Statistical Package for the
= 1.96 (the critical value that divides the central 95% of Social Sciences (SPSS), version 22 (IBM Corp., Chicago,
the Z distribution from the 5% in the tail), P = 88.2% IL, USA). Descriptive data was presented as numbers
(the prevalence of the outcome variable) (Kasim and and percentages. Fisher’s exact test and Pearson’s chi-
Hassan 2018), and E = 0.05, the margin of error (width squared test were used for statistical analysis of categor-
of confidence interval) (Charan and Biswas 2013). The ical variables. For all tests, a probability value of less
El-Mahsama family practice center was selected as a than 0.05 was considered.
study setting, because it is a primary health care center
providing preventive and curative services to a rural Results
community with different socioeconomic levels and dif- The participants’ mean age was 37.3 ± 12.2 years, and
ferent cultural backgrounds. Both genders above 18 the majority (89.4%) of them came from rural areas.
years, who live in El-Mahsama village, were included, About half of the families (48.8%) had less than five
while medical staff and drug addicts were excluded from members. Less than half of them (42.5%) depend on free
the study. Participants were interviewed using a semi- governmental health services as a usual source of health
structured questionnaire, which contains two sections: care. The skilled manual workers/farmers represent
Zeid et al. Bulletin of the National Research Centre (2020) 44:92 Page 3 of 5

23.8% among men, while about the two thirds (63.7%) of Table 1 Items related to self-medication in the study sample
the women were unemployed/housewives. About 57.5% (n = 153)
of the families have only one earning person. Regarding Variables n (%)
the crowding index, about 55% of the participants had Reasons for self-medication
more than one person in each room. Families who can Cost saving 82 (53.6)
just meet their routine expenses represent 44.4% of the
Convenience 68 (44.4)
overall families. The majority (80.6%) of the participants’
Lack of trust in doctor 3 (2)
families receive governmental support. Regarding the
level of socioeconomic status (SES), 56% and 42% had Symptoms/conditions that warranted use of self-medication
moderate and low levels respectively. Aches and pains 60 (39.2)
Figure 1 showed that 96% of the participants have used Headache 26 (17)
medications without any medical consultations or super- Fever 18 (11.8)
vision, mainly to alleviate pain and fever. As shown in
Sore throat 14 (9.2)
Table 1, about half of them owed that to save money;
A runny nose 13 (8.5)
however, two thirds of them (62.7%) perceive self-
medication as an unacceptable practice. Furthermore, Cough 6 (3.9)
information sources include recommendation by com- Nasal congestion 5 (3.3)
munity pharmacists (23.5%), previous doctor’s prescrip- Vomiting 1 (0.7)
tions (20.9%), or the patient’s own experience (18.3%). Diarrhea 1 (0.7)
The most frequent self-administered drugs were analge-
Skin wounds 1 (0.7)
sics (59.5%) and antibiotics (23.5%). Table 2 showed no
Others* 8 (5.2)
statistically significant association between the socioeco-
nomic status of the participants and usage of self- Information source
medications (P = 0.56). Recommendation by community pharmacists 36 (23.5)
Previous doctor’s prescription 32 (20.9)
Discussion Own experience 28 (18.3)
The present study revealed a very high prevalence of
Opinion of family members 20 (13.1)
self-medication (96%), compared to the previously re-
Opinion of friends 21 (13.7)
ported prevalence in other Egyptian studies. A recent
systematic review included some Egyptian studies con- Recommendation by net citizens 16 (10.5)
ducted in different cities from 1995 to 2014 (Kasim and Patient opinion about self-medication on self-health care
Hassan 2018). The review demonstrated that the preva- Good practice 13 (8.5)
lence of medication abuse among the Egyptian popula- Acceptable practice 44 (28.8)
tion before twenty-first century ranged from 21.1 to
Not acceptable practice 96 (62.7)
Drugs involved in self-medication
Analgesics 91 (59.2)
Antibiotics 36 (23.5)
Anti-histamines 11 (7.2)
Weight gain and weight reducing agents 11 (7.2)
Multivitamins 4 (2.6)
*Others include dizziness, epigastric pain, low back pain, and dysuria)

Table 2 Association between socioeconomic level and using of

self-medication in the study sample (n = 160)
Variables Socioeconomic level P value
Very low (n = 4) Low (n = 67) Middle (n = 89)
Using self-medication, n (%)
Yes 4 (100) 66 (98.5) 83 (93.3) 0.56a
No 0 1 (1.5) 6 (6.7)
Fig. 1 Frequency of self-medication in the study sample (N = 160)
P values are based on Fisher’s exact test. Statistical significance at P < 0.05
a
Zeid et al. Bulletin of the National Research Centre (2020) 44:92 Page 4 of 5

72%. However, according to the more recent studies insurance come some obstacles that hinder the full
conducted in Egypt, the reported prevalence has signifi- utilization of such insurance and therefore direct some
cantly increased to range from 81.1 to 86.4% (Sallam insured patients towards self-medication. For example,
et al. 2009; El-Nimr et al. 2015). As for other countries, patients have to wait for quite long times to see a doctor.
the reported prevalence varied widely from 45.4% in Also, some drugs might be unavailable sometimes, and
China (Lei et al. 2018), 42.5% in Jordan (Yousef et al. thus, patients quite often end up buying the medications
2008), 53.5% in Mexico (Balbuena et al. 2009), 65.1% in themselves. Moreover, regular, non-emergency health
Brazil (Bertoldi et al. 2014), 75% in Chile (Fuentes Albar- services are only available during usual working hours/
ran and Villa Zapata 2008), and 79.9% among university days, which force the employee to ask for sick leave and
students in Serbia (Lukovic et al. 2014). The variations this may not be easily granted (Yousef et al. 2008).
in the reported prevalence can be explained by the dif-
ference in populations, sample size, and study design. Limitations of the present study
But more importantly, the recall period in these studies The present study had some limitations. First, the recall
was only a few weeks or months, whereas in our study, bias may have affected our analysis, and although the
self-medication use was assessed during the past whole long recall period may add strength to our study, yet, it
year. This long recall period could explain the very high might also have caused confusion to the participants.
prevalence reported in our study. Second, the study was a regional study conducted at a
In the present study, the most commonly used drugs single health unit. Therefore, our results cannot be gen-
were analgesics and antibiotics. This is consistent with eralized and are not representing self-medication prac-
the findings of previous studies which reported that an- tice in Egypt. Third, since this was a cross-sectional
algesics and anti-inflammatories were highly used in study, each variable was measured only once and expos-
self-medication (Jerez-Roig et al. 2014; Domingues et al. ure and outcome are simultaneously assessed, so evi-
2017). In fact, Domingues et al. (2017) explained this by dence of any associations should be closely interpreted
the strong association between self-medication and the before a causal relationship could be established.
presence of minor diseases and conditions. Similarly,
El-Nimr et al. (2015) reported that the most com- Conclusion
monly used drugs were analgesics, followed by cough Frequency of self-medication among the study sample
and common cold preparations and vitamins and has reached 96%. There was no statistically significant
minerals. They also reported that over half of the par- association between the socioeconomic status of the par-
ticipants used antibiotics without a prescription. The ticipants and usage of self-medications.
same findings were reported in the systematic review
by Kasim and Hassan (2018). Acknowledgements
The authors would like to acknowledge all the participants for their
The socioeconomic score of the participants was not cooperation.
significantly associated with frequency of self-use of
medications, diseases for which medicines were self- Informed consent
Informed consent was obtained from the participants included in the study.
prescribed, drugs commonly used, sources of informa-
tion, reason for not consulting a doctor, or patients’ Authors’ contributions
opinion about self-medication practice. Additionally, This work was carried out in collaboration between all authors. MH was
responsible for choosing the tool of the study. RD and WZ designed the
self-medication was not associated with participants’ study, wrote the manuscript, and were involved in the subject selections and
economic and household characteristics, in terms of data collection. NM was responsible for the statistical analysis and revised
their occupation, the number of earning members of the the final manuscript. All authors read and approved the final manuscript.
family, their income, crowding index, and whether they
Funding
use governmental support. However, and contrary to No fund received
our findings, Chang and Trivedi (2003) suggested that
economic factors such as family size, income, and avail- Availability of data and materials
The datasets generated during this study are available from the
ability of health insurance may influence the self- corresponding author on reasonable request.
medication practice. Also, a large Mexican study found
that those who practiced self-medication usually had Ethics approval and consent to participate
All procedures performed in the study were in accordance with the ethical
lower income (Pagan et al. 2006). Meanwhile, medical standards of the institutional research committee.
insurance has been proposed as a key determinant for
self-medication (Hoai and Dang 2017). Some even sug- Consent for publication
Not applicable.
gested that broadening health insurance to cover over-
the-counter drugs may lead to a significant reduction in Competing interests
self-medication practice (Lei et al. 2018). With medical The authors announce that there is no conflict of interest.
Zeid et al. Bulletin of the National Research Centre (2020) 44:92 Page 5 of 5

Received: 30 April 2020 Accepted: 3 June 2020 Torres NF, Chibi B, Middleton LE, Solomon VP, Mashamba-Thompson TP (2019)
Evidence of factors influencing self-medication with antibiotics in low and middle-
income countries: a systematic scoping review. Public health. 168:92–101
Ventola CL (2015) The antibiotic resistance crisis: part 1: causes and threats.
References Pharmacy and therapeutics. 40(4):277
Abay SM, Amelo W (2010) Assessment of self-medication practices among World Health Organization. Guidelines for the regulatory assessment of medicinal
medical, pharmacy, health science students in Gondar University. Ethiopia. products for use in self-medication. Geneva: World Health Organization;
Journal of Young Pharmacists. 2(3):306–310 2005. https://apps.who.int/iris/bitstream/handle/10665/66154/WHO_EDM_
Albarrán KF, Zapata LV (2008) Analysis and quantification of self-medication QSM_00.1_eng.pdf (Accessed 10 December 2018).
patterns of customers in community pharmacies in southern Chile. Pharmacy Yousef AM, Al-Bakri AG, Bustanji Y, Wazaify M (2008) Self-medication patterns in
world & science. 30(6):863–868 Amman. Jordan. Pharmacy World & Science. 30(1):24–30
Balbuena FR, Aranda AB, Figueras A (2009) Self-medication in older urban
Mexicans. Drugs & aging. 26(1):51–60 Publisher’s Note
Bennadi D (2013) Self-medication: a current challenge. Journal of basic and Springer Nature remains neutral with regard to jurisdictional claims in
clinical pharmacy. 5(1):19 published maps and institutional affiliations.
Bertoldi AD, Camargo AL, Silveira MP, Menezes AM, Assunção MC, Gonçalves H
et al (2014) Self-medication among adolescents aged 18 years: the 1993
Pelotas (Brazil) birth cohort study. Journal of adolescent health. 55(2):175–181
Chang FR, Trivedi KP (2003) Economics of self-medication: theory and evidence.
Health economics. 12(9):721–739
Charan J, Biswas T (2013 Apr) How to calculate sample size for different study
designs in medical research? Indian journal of psychological medicine. 35(2):121
Domingues PH, Galvão TF, Andrade KR, Araújo PC, Silva MT, Pereira MG (2017)
Prevalence and associated factors of self-medication in adults living in the
Federal District, Brazil: a cross-sectional, population-based study.
Epidemiologia e Serviços de Saúde. 26:319–330
El Gilany A, El-Wehady A, El-Wasify M (2012) Updating and validation of the
socioeconomic status scale for health research in Egypt. Eastern
Mediterranean Health Journal. 1:18(9)
El Nimr NA, Wahdan IM, Wahdan AM, Kotb RE (2015) Self-medication with drugs
and complementary and alternative medicines in Alexandria, Egypt:
prevalence, patterns and determinants. EMHJ-Eastern Mediterranean Health
Journal. 21(4):256–265
Gebeyehu E, Bantie L, Azage M (2015) Inappropriate use of antibiotics and its
associated factors among urban and rural communities of Bahir Dar City
Administration, Northwest Ethiopia. PloS one 10(9)
Helal RM, Abou-ElWafa HS (2017) Self-medication in university students from the
city of Mansoura, Egypt. Journal of environmental and public health. 2017
Hoai NT, Dang T (2017) The determinants of self-medication: evidence from
urban Vietnam. Social work in health care. 56(4):260–282
Ilhan MN, Durukan E, Ilhan SÖ, Aksakal FN, Özkan S, Bumin MA (2009) Self-
medication with antibiotics: questionnaire survey among primary care center
attendants. Pharmacoepidemiol Drug Saf. 18(12):1150–1157. https://doi.org/
10.1002/pds.1829
Jerez-Roig J, Medeiros LF, Silva VA, Bezerra CL, Cavalcante LA, Piuvezam G et al
(2014) Prevalence of self-medication and associated factors in an elderly
population: a systematic review. Drugs & aging 31(12):883–896
Kasim K, Hassan H (2018) Self-medication problem in Egypt: a review of current
and future perspective. Int J Cur Res Rev. 10(4):40–45
Klemenc-Ketiš Z, Hladnik Ž, Kersnik J (2011) A cross sectional study of sex
differences in self-medication practices among university students in
Slovenia. Collegium antropologicum. 35(2):329–334
Lei X, Jiang H, Liu C, Ferrier A, Mugavin J (2018) Self-medication practice and
associated factors among residents in Wuhan, China. International journal of
environmental research and public health 15(1):68
Lukovic JA, Miletic V, Pekmezovic T, Trajkovic G, Ratkovic N, Aleksic D, Grgurevic
A (2014) Self-medication practices and risk factors for self-medication among
medical students in Belgrade, Serbia. PloS one 9(12)
Pagan JA, Ross S, Yau J, Polsky D (2006) Self-medication and health insurance
coverage in Mexico. Health policy. 75(2):170–177
Rather IA, Kim BC, Bajpai VK, Park YH (2017) Self-medication and antibiotic
resistance: crisis, current challenges, and prevention. Saudi journal of
biological sciences. 24(4):808–812
Ruiz ME (2010) Risks of self-medication practices. Current drug safety. 5(4):315–323
Sallam SA, Khallafallah NM, Ibrahim NK, Okasha AO. Pharmacoepidemiological
study of self-medication in adults attending pharmacies in Alexandria, Egypt.
EMHJ-Eastern Mediterranean Health Journal, 15 (3), 683-691, 2009. 2009.
Sarahroodi S, Maleki-Jamshid A, Sawalha AF, Mikaili P, Safaeian L (2012) Pattern of
self-medication with analgesics among Iranian University students in central
Iran. Journal of family & community medicine. 19(2):125