The country needs to formulate strict guidelines regarding the drug sales and consumption. The law should strictly monitor adherence to the practices of over the counter and prescription medicine. The department of drug administration in Nepal is the authorized body to deal with the drug management systems of the country. 9 It has to regulate the drug distribution system strictly.
The over the counter drugs were often sold rampantly by untrained distributors and antibiotics also often prescribed without any prescription.10 The NSAIDs like paracetamol, nimesulide were commonly self-medicated due to ease of availability and the knowledge regarding their use. In many studies, NSAIDs including paracetamol were the most extensively consumed medication;4-6, 11-13 the fact similar to our study. Whereas in a study in Khartoum state of Sudan, analgesics including paracetamol second to antibiotics in terms of consumption.14 In Ebonyi state of Nigeria, multivitamins and anti-malarial drugs are on top, leaving behind analgesics and antibiotics.15
The antibiotics like cefixime, amoxicillin and azithromycin were self-medicated in a case each. Lack of knowledge about proper use of antibiotics is leading to antibiotic resistance.5,10,16 Latter has been an alarming problem in the Nepal. WHO has been working in it with strategic plans.17 The most common diseases include aches and gastritis which corresponds to many other studies done in other part of world.4,5,18 Body ache and headache were the most common presentation of many diseases like influenza, cold, musculoskeletal problems, dysmenorrhea, migraine, etc.19 The reason of SM of anti-gastritis medication after analgesics was extensive prevalence of gastritis in Nepal.20 The medication for gastritis is easily available in pharmacies. In contrast to our study, in many other studies, the most common illness seeking for SM was fever.4,5,11,12.
The pharmacists were most often consulted for medicine. Reason is their easy availability in pharmacy. In many other studies too, pharmacists were most often consulted for healthcare.4,11,13,21 Due to the inaccessibility to specialized care and consultants, pharmacists were sought for treatment of many illnesses. Shops of pharmacists are easily available next door. In rural areas they were the first person to provide medications in most instances.
Prevalence of SM in our study was 38.2% comparable as that of other studies.22,23 The high prevalence could be attributed to the easy availability of the drugs over the counter. People can google about their health problems due to development of information technology too3. They visit physicians and consultants as last resort. In contrast to our study which was done in urban population, the practice of SM in urban populations of Ebonyi state of Nigeria,15 was higher and urban Puducherry lower.11 This could be explained on the basis of different regions, health policy and determinants of health.
In contrast to other studies which project the cause of SM practice to be due to the lack of the knowledge,11,12 the education level was not significantly related to lack of knowledge in our study. As our study was done in the urban area, most of the respondents were literate. The recall period of six months in our research corresponds to many other similar researches4,12 but in Jammu13 one-year recall period was considered. We chose six months so that there won’t be any recall bias.
In our study, lack of knowledge about consultation to the physician was the major reason in 65% of subjects. Though education level wasn’t significantly related to SM practice, people expressed their lack of knowledge as the main factor. They weren’t aware about consultation to the general physicians denying fact that symptom could be more serious. Whereas in Nigerian and Srilankan studies, consideration of disease as minor was the main reason.6,12
Conclusion:
The practice of SM was high in Pokhara valley of Nepal. Paracetamol was the most extensively self-medicated drug. Headache and body ache were the most common condition seeker for SM. The pharmacists were consulted most often for SM due to lack of knowledge about the adverse events. Central as well as federal government needs to work a lot towards it to minimize the adverse consequences. It should formulate strict guidelines for the appropriate use of the medications. Drug regulatory agencies should work hand in hand with the experts in the related field to overcome the problem of misutilization of drugs.