This study aimed to estimate the knowledge, causes, prevalence, and determinants of self-medication practices for the prevention and/or treatment of COVID-19 in Nigeria. To the best of our knowledge, this study is novel in Nigeria as far as COVID-19 is concerned, although there are previous studies on self-medication practices other than COVID-19 both in Nigeria and elsewhere.
The estimation and quantification of the knowledge level, prevalence, and the reasons for self-medication practices for COVID-19 perceived treatment or prevention, as well as associated determinants, are of great importance due to their consequent effect on the fight to control and mitigate the disease. Our study has demonstrated sufficient knowledge for self-medication among respondents, namely as high as 96.7%. This finding is similar to previous studies in Nigeria and overseas, where a sizeable proportion of the respondents had sufficient knowledge of self-medication (8, 11, 12, 17). From our study, the prevalence of self-medication for COVID-19 treatment or prevention was 41%. This finding was comparably higher than what was earlier reported in Togo (18). We also observed a prevalence of above 30% among respondents <24 years, that attained below tertiary education, of Islamic faith, and with insufficient knowledge of self-medication. Our findings were similar to previous studies on self-medication (19). The reason for the high prevalence was attributed to the ease of access to OTC drugs, the presence of unregistered medicine stores, and pharmacies (14-15).
Our study identified the reasons for self-medication for perceived treatment or prevention of COVID-19 in Nigeria, as fear of stigmatization or discrimination, fear of being quarantined or self-isolation, fear of infection, or contact with a suspected or known case of COVID-19. The list of reasons also included a delay in receiving treatment at the health facilities, influence of friends, unavailability of drugs for the treatment, and influence of media. The others were self-medication were emergency illness, delay in receiving hospital services, distance to the health facility, and proximity of the pharmacy. We acknowledge the fact that some of our findings are different from those reported previously by earlier studies for self-medication, although these were not for COVID-19. Nevertheless, most of our findings have also been previously reported elsewhere. For instance, emergency illness had been reported as a reason for self-medication (17, 20); others were delay in receiving treatment at health facilities and hospital services (17, 18, 21), the influence of friends (20, 22), unavailability of drugs, distance to the health facility, proximity of the pharmacy to home and charges at a health facility (17, 20), as well as stigmatization (18) and influence of the media (18, 23).
Our findings indicated that out of those who self-medicated for the perceived treatment or prevention of COVID-19, more than half of the participants had prescribed the drugs by themselves, over one-third got their prescriptions from medical personnel and some others got theirs either directly from the pharmacies or through recommendation by friends. These findings were in line with studies on self-medication in Nigeria, Pakistani, Eritrea, Iran, and Saudi Arabia (19, 21, 9, 25-26). As with other studies (12, 21, 26), ours showed that of all those who self-medicated in the last three months, more than half, only self-medicated once, while others indulged in self-medication at least once a week. As our results suggested, the possible reason for this huge difference between those who self-medicated once and those who did so at least once a week, might be attributed to either side effects, or the relief from symptoms of the disease.
The most common drugs used for self-medication in the perceived treatment or prevention of COVID-19 were Vitamin C and Multivitamins, as well as antimalaria drugs other than Hydroxychloroquine/Chloroquine. Others were Amoxicillin, Ciprofloxacin, Herbal products, Erythromycin, Metronidazole, and Hydroxychloroquine & Chloroquine. The possible explanation for the high usage of Vitamin C and Multivitamin by the participants might be because Vitamin C had been reported to have significant potency and efficacy in the management of COVID-19 (27, 28), as well as the availability of these products without restriction and control. Furthermore, the claim of a possible association between COVID-19 and Malaria might be responsible for the high consumption of antimalaria drugs among the study participants.
The disaggregation of Hydroxychloroquine and Chloroquine from other antimalaria drugs was informed by the non-randomized trial conducted in French which seemed to suggest a positive outcome in the treatment of COVID-19 patients, particularly those that received Hydroxychloroquine (600 mg/day) (29), and the claim by the American President, Donald Trump that he used Hydroxychloroquine to prevent COVID-19 infection (30). Like other self-medication studies (14, 17-19), our study showed that some of the participants also used antibiotics, such as Amoxicillin, Ciprofloxacin, Erythromycin, and Metronidazole either as a perceived treatment or prevention of COVID-19. In our study, 10.2% of the participants used herbal products for similar purposes. This could be explained by the fact that traditional medicines were frequently used in Nigeria for the treatment of diseases (31, 32), and also because of the availability and low cost of herbal products in African countries (18). It is interestingly worthy of note, that the WHO has welcomed innovations around the world, including traditional medicines/herbal products in the search for potential treatments for COVID-19 (33).
Pharmacy and patent medicine vendors were identified as a significant source of drugs and substances used for self-medication among our study participants. Our results agreed with those reported by other studies in Nigeria and across the globe (9, 12, 14, 21, 25). The explanations might include the fact that most of the study participants were of high socioeconomic status in terms of employment, educational attainment, and monthly income. Another prominent reason for high pharmacy patronage of self-medication drugs was the inability of government or relevant authorities to regulate and control the pharmacy and patent medicine stores, such that medications were and are still being dispensed and purchased at these stores without check (14, 15). The significant side effects identified in our study were body rashes and worsened conditions. Others were yellowish eyes, swollen face, vomiting of blood, and severe diarrhea. These findings are consistently similar to those reported by a study that was conducted in Tanzania (17).
Self-medication for COVID-19 prevention and/or perceived treatment was significantly associated with gender, educational attainment, and knowledge level on SM in our study. The odds of SM among those who had sufficient knowledge were 64% lesser compared with those with insufficient knowledge. A likely possibility would be that the knowledgeable members might be more fearful of the bad adverse reactions associated with self-medication (20). Our study also indicated that the odds of SM for the COVID-19 were significantly lower among males by 79% than among females. This result was in agreement with those reported by some other studies on self-medication practices (34, 35), but in disagreement with the findings of some other studies (9, 20).