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Prevalence of Self-Medication with Antibiotics Among Bahri University Medical Students, Sudan 2022

Received: 18 March 2024     Accepted: 16 April 2024     Published: 28 April 2024
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Abstract

Background: Antibiotics are medications that eliminate life threating infections from the body. It’s one of the most reported medications that used without doctor’s prescription. The prevalence of self-medication with antibiotics is quite high in developing countries as opposed to developed countries. It is linked with negative outcomes on individual and community health. In addition to its central part in increasing the global problem of antibiotic resistance. In Sudan, despite the overall acceptable level of knowledge regarding antibiotic resistance. Few studies have been carried out to assess prevalence of self-medication. Objective: To evaluate the prevalence of self-medication with Antibiotics among fourth- and fifth-year medical students at University of Bahri. Method: This is a descriptive cross-sectional study. Conducted among 226 medical students. Selected from fourth- and fifth-year medical students at university of Bahri using google form questionnaire. Then analyzed by using SPSS (statistical package for social science) version 25. Result: We found in this study approximately 82.7% of 4th and 5th year medical students at University of Bahri are using antibiotics without prescription. Amoxicillin and azithromycin are the most two common utilized antibiotics without prescription. In addition, we found the main sources of information and knowledge about appropriate dose regarding the self-medication with antibiotics are the academic experience more than (26%) and pharmacist recommendation more than (50.4%). And we found the awareness of the adverse effects of antibiotics without prescription demonstrated by 85.4% of the students. Conclusion: The study concludes that prevalence of self-medication with antibiotics among 4th and 5th year medical students at University of Bahri is high, despite of their awareness of adverse effects.

Published in Journal of Family Medicine and Health Care (Volume 10, Issue 2)
DOI 10.11648/j.jfmhc.20241002.11
Page(s) 18-22
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Self-Medication, Antibiotics, Prescription, Antimicrobial Resistance, Sudan

1. Introduction

1.1. Background

Antibiotics are medications that eliminate life threating infections from the body. They are on the top list of the most requested drugs . The use of antibiotics is much higher in African countries where infectious diseases are quite common . Using of medications to overcome one’s symptoms without doctor’s prescription is known as self-medication. It is always linked to annoying symptoms that are not considered life threating by the individual to reach a health delivering facility. As a consequence, this may delay the appropriate management. Which will lead to more complications and unfavorable outcomes in addition to the economics burden as many drugs will be used without clinical improvement . Antibiotics are found to be one of the most medications that used by the individuals without medical prescription which had led to emergence of antibiotics resistant bacteria and magnifying the problem of antimicrobial resistance in the community which have been associated with increase mortality worldwide . For the individual this also carrying the risk of medications adverse effects and interactions with other long-term medications . Antimicrobial resistance which is considered as a direct effect of antibiotics miss use. Its worldwide problem that could led to 10 million death every year by 2050 .
Self-medication with antibiotics is global phenomena. African countries reported high incidence of self-medication which is facilitated by many factors; availability of the antibiotics which purchased from pharmacies, market stalls, or street vendors and lack of awareness regarding the consequences of self-medications .
In Sudan, despite the overall acceptable level of knowledge regarding antibiotic resistance . Few studies have been carried out to assess prevalence of self-medication. This study was conducted to evaluate the knowledge of medical student about the danger of self-medication and identify the many reasons that lead to self-medication with antibiotics at Bahri University.

1.2. Objectives

General Objective: To evaluate prevalence of self-medication with antibiotics among fourth- and fifth-year medical students at Bahri University.
Specific Objectives:
1) To estimate facilitators of self-medication with antibiotics.
2) To assess knowledge of self-medication with antibiotics.
2. Methods

2.1. Study Setting

Through a descriptive, cross-sectional design, the study performed in Bahri University, College of medicine. Targeting fourth- and fifth-year medical students.

2.2. Sampling

The sample size calculated using Solving formula: 𝑠𝑎𝑚𝑝𝑙𝑒 𝑠𝑖𝑧𝑒 = n/ (1+n x e*2) found to be 226 participant. Selected through probability simple random sampling. The data collected using Google form questionnaire contain factors measuring the knowledge of self-medication with antibiotics. All the data has been collected and analyzed using statistical package for social science (SPSS) version 25.

2.3. Ethical Consideration

Obtained from community department in Bahri University. All students who participated have been informed about the objectives of the questionnaire and verbal consents were taken.
3. Results
A total number of 226 participants were recruited. Around half of them 48.7% age between 21- 23. Also 54.9% were female. As illustrated in table 1.
Table 1. Sociodemographic characteristics of the participants.

Variable

Frequency

Percent %

Gender

Male

102

45.1

Female

124

54.9

Age

18- 20

18

7.5

21- 23

110

48.7

24- 26

98

43.8

Year of college entry

2015

124

54.9

2016

102

45.1

Data shows that a considerable number of participants using antibiotics without prescription 82.7%. with azithromycin found to be the most overused one 74.8%
Table 2. Antibiotics type and triggering complain.

Variable

Frequency

Percent %

Use of antibiotics without prescriptions

Yes

186

82.7

No

40

17.3

Reason for using antibiotics

Distrust of doctors

6

2.7

Likely symptoms

5

2.2

Reduce treatment cost

53

23.5

Through your academic experience

123

54.4

I don’t use antibiotic without prescription

39

17.3

Triggering complains for antibiotic use

Nasal congestion

90

39.8

Cough

111

49.1

Fever

122

54

Diarrhea

94

41.6

Sore throat

172

76.1

Runny nose

68

30.1

Pain

69

30.5

What antibiotic you are commonly use

Co-trimoxazole

23

10.2

Amoxicillin

146

64.6

Azithromycin

169

74.8

Metronidazole

103

45.6

Penicillin

37

16.4

Who determine the exact antibiotic for you

Friend opinion

20

8.8

Old prescription

20

8.8

Parents' opinion

24

10.6

Pharmacist's Recommendation

52

23

Through your academic experience

110

48.7

Majority of the respondent 54.4% stop the antibiotics only after complete the prescribed course.
Table 3. Antibiotics durations.

Variable

Frequency

Percent %

follow the instruction that came with antibiotics and understand it

Yes

132

58.8

No

32

14.6

Maybe

62

26.5

How do you know the appropriate dose of antibiotics

Consult a friend

21

9.3

From Internet

22

9.7

From your academic experience

60

26.5

Parental advice

9

4.0

Pharmacist advice

114

50.4

When did you stop the prescribed antibiotic course

After complete the prescribed course of antibiotics

123

54.4

Whenever symptoms disappear

73

32.3

After few days of recovery

30

13.3

Did you change the dose of antibiotic during the treatment

Yes

83

37.6

No

143

62.4

85.4% already knew the side effect of using antibiotics without consulting a doctor.
Table 4. Side effects of using antibiotics without prescription.

Variable

Frequency

Percent %

Do you know the side effects of using antibiotic without consulting a doctor

Yes

194

85.4

No

32

14.6

Did you feel any side effects when you use antibiotic

Yes

88

38.5

No

138

61.5

Actions you take when feeling of these side effects

Did not do anything

166

73.5

consulted the doctor

15

6.6

I stopped using the antibiotic

33

14.6

Switched to another antibiotic

12

5.3

4. Discussion
The utilization of antibiotics without doctor’s prescription is now becoming a global problem. Existing mainly in developing countries. After data were analyzed 82% of the recruited participant had report self-medication with antibiotics. This high prevalence goes in line with community-based study carried out in Khartoum state found that 81.8% of the population were using antibiotic without prescription . This high reported percent will affect the students and all the society negatively and in long term will accelerate emergence of antibiotic resistant bacteria. Also, this will impact the country economy with negative burden. Wide spread of self-medication with antibiotics could be attributed to cultural perspective of Sudanese people in intending to self-medicate with herbs and traditional therapy. Therefore, this may facilitate and encourage the idea of self-medication with antibiotics. On the other hand, countries like Saudi Arabia and Karachi reported much lower prevalence 34% and 50.1% respectively .
Amoxicillin and azithromycin were found to be the most utilized antibiotics. Azithromycin used in treating tonsilitis which is quite common in Sudan that give it the familiarity in resolving sore throat. Which is the main triggering complains behind azithromycin un prescribed utilization as reported from our participants. Similarly, amoxicillin and amoxicillin/potassium clavulanate were the most utilized antibiotics in other study . As in any developing country where people who already facing financial problem trying to keep more money through avoiding meeting doctors, reducing treatment cost was one of the two most common reasons for using antibiotics without prescription along with academic experience. other study reported saving time, previous successful experience and avoid hassle of going to doctor . Similar to other studies we find out that sore throat, fever and cough were the most common triggering factors for self-medication with antibiotics. The respondents reported that pharmacist recommendation and academic experience, 50.4% and 26% respectively. As the main source of information about determining the appropriate antibiotic and the required dose. However, this is considered inappropriate utilization of knowledge as neither pharmacist nor medical students are allowed to prescribe antibiotics as this may danger their lives and lead to unfavorable outcomes. They are also the top reported source of information in other studies . In this study, the main source of “prescription only” and “Over-the-counter” medicines was private sector pharmacy, which seems consistent with local study that targeted Khartoum state population . This emphasizing the need for more regulatory actions from the authorities.
Limitation
1) Poor response of student to fill form questionnaire due to bad internet network in the country.
2) The study was limited by a definite time, so no time to increase our sample size.
5. Conclusion
The study conclude that majority of the participants utilize antibiotics without doctor’s prescription which is serious issue need to be amended to avoid the negative impact on health and economy. Amoxicillin and azithromycin were found to be the most utilized antibiotics. With sore throat, fever and cough as the most common triggering factors for self-medication with antibiotics. This study could be the triggering point to raise student and community awareness regarding self-medication with antibiotics.
6. Recommendation
We recommend:
1) Raise the individual and community awareness regarding the ideal use of antibiotics and the draw backs of self-medication with antibiotics through educational programs.
2) Increase awareness of students about risks of self-medication by holding awareness lectures at university.
3) Educate students about the importance of consulting a doctor before using antibiotics.
4) Warn students of their belief that they are able to treat diseases without consulting a doctor.
5) Encouraging students to conduct awareness campaigns about the dangers of self-medication and its impact on human health.
Abbreviations
SPSS: statistical package for social science
Author Contributions
Ayat Abdelmahmoud Ahmed Abdelmahmoud: Conceptualization, Methodology
Osama Mohammed Noraldaym Elfaki: Software, Writing – original draft
Mustafa Magbol: Formal analysis
Musab Fathelrahman Mukhtar Osman: Resources
Ahmad Izzoddeen: Writing—reviewing and editing
Najla Ahmed Ginawi: Supervision
Data Availability Statement
Obtainable from the corresponding author on reasonable request.
Conflicts of Interest
The authors declare no conflicts of interest.
References
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[2] Sannathimmappa, M. B., Nambiar, V., & Aravindakshan, R. (2021). A cross-sectional study to evaluate the knowledge and attitude of medical students concerning antibiotic usage and antimicrobial resistance. International Journal of Academic Medicine, 7(2), 113-119.
[3] Alhomoud F, Aljamea Z, Basalelah L. "Antibiotics kill things very quickly"—consumers' perspectives on non-prescribed antibiotic use in Saudi Arabia. BMC Public Health. 2018; 18(1): 1177.
[4] Mousnad Mohamed Awad et_al. Assessment of Knowledge and Attitude toward AntibioticUse and Resistance among Students of InternationalUniversity of Africa, Medical complex, Sudan. 2019.
[5] Gupta, M. K., Vohra, C., & Raghav, P. (2019). Assessment of knowledge, attitudes, and practices about antibiotic resistance among medical students in India. Journal of family medicine and primary care, 8(9), 2864.
[6] Zulu, A., Matafwali, S. K., Banda, M., & Mudenda, S. (2020). Assessment of knowledge, attitude and practices on antibiotic resistance among undergraduate medical students in the school of medicine at the University of Zambia. Int J Basic Clin Pharmacol, 9(2), 263-270.
[7] Marzan, M., Islam, D. Z., Lugova, H., Krishnapillai, A., Haque, M., & Islam, S. (2021). Knowledge, attitudes, and practices of antimicrobial uses and resistance among public university students in Bangladesh. Infection and drug resistance, 519-533.
[8] Piddock LJV. Reflecting on the final report of the O'Neill review on antimicrobial resistance. Lancet Infect Dis. 2016; 16(7): 767–768.
[9] Bin Nafisah S, Bin Nafesa S, Alamery AH, et al. Over-the-countt3er antibiotics in Saudi Arabia, an urgent call for policy makers. J Infect Public Health. 2017; 10(5): 522–526.
[10] Al-Azzam SI, Al-Husein BA, Alzoubi F, et al. Self-medication with antibiotics in Jordanian population. Int J Occup Med Environ Health. 2007; 20(4): 373–380.
[11] Radyowijati A, Haak H. Improving antibiotic use in low-income countries: an overview of evidence on determinants. Soc Sci Med. 2003; 57: 733–744.
[12] Magbol, M., Osman, M. F. M., Ahmed, M. A. A. M., Alneama, M. A. B., Hassieb, M. A. A. (2024). Assessment of Knowledge, Attitude and Practice of Antibiotic Resistance among Medical Student at Al-Zaiem Al-Azhari University, December 2021 – July 2022. Int Internal Med J, 2(1), 01-06.
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[15] Shah S, Ahmad H, Rehan R, Najeeb S, Mumtaz M, Jilani M et al. Self-medication with antibiotics among non-medical university students of Karachi: a cross-sectional study. BMC Pharmacology and Toxicology. 2014; 15.
Cite This Article
  • APA Style

    Abdelmahmoud, A. A. A., Elfaki, O. M. N., Magbol, M., Izzoddeen, A., Osman, M. F. M., et al. (2024). Prevalence of Self-Medication with Antibiotics Among Bahri University Medical Students, Sudan 2022. Journal of Family Medicine and Health Care, 10(2), 18-22. https://doi.org/10.11648/j.jfmhc.20241002.11

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    ACS Style

    Abdelmahmoud, A. A. A.; Elfaki, O. M. N.; Magbol, M.; Izzoddeen, A.; Osman, M. F. M., et al. Prevalence of Self-Medication with Antibiotics Among Bahri University Medical Students, Sudan 2022. J. Fam. Med. Health Care 2024, 10(2), 18-22. doi: 10.11648/j.jfmhc.20241002.11

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    AMA Style

    Abdelmahmoud AAA, Elfaki OMN, Magbol M, Izzoddeen A, Osman MFM, et al. Prevalence of Self-Medication with Antibiotics Among Bahri University Medical Students, Sudan 2022. J Fam Med Health Care. 2024;10(2):18-22. doi: 10.11648/j.jfmhc.20241002.11

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  • @article{10.11648/j.jfmhc.20241002.11,
      author = {Ayat Abdelmahmoud Ahmed Abdelmahmoud and Osama Mohammed Noraldaym Elfaki and Mustafa Magbol and Ahmad Izzoddeen and Musab Fathelrahman Mukhtar Osman and Najla Ahmed Ginawi},
      title = {Prevalence of Self-Medication with Antibiotics Among Bahri University Medical Students, Sudan 2022
    },
      journal = {Journal of Family Medicine and Health Care},
      volume = {10},
      number = {2},
      pages = {18-22},
      doi = {10.11648/j.jfmhc.20241002.11},
      url = {https://doi.org/10.11648/j.jfmhc.20241002.11},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.jfmhc.20241002.11},
      abstract = {Background: Antibiotics are medications that eliminate life threating infections from the body. It’s one of the most reported medications that used without doctor’s prescription. The prevalence of self-medication with antibiotics is quite high in developing countries as opposed to developed countries. It is linked with negative outcomes on individual and community health. In addition to its central part in increasing the global problem of antibiotic resistance. In Sudan, despite the overall acceptable level of knowledge regarding antibiotic resistance. Few studies have been carried out to assess prevalence of self-medication. Objective: To evaluate the prevalence of self-medication with Antibiotics among fourth- and fifth-year medical students at University of Bahri. Method: This is a descriptive cross-sectional study. Conducted among 226 medical students. Selected from fourth- and fifth-year medical students at university of Bahri using google form questionnaire. Then analyzed by using SPSS (statistical package for social science) version 25. Result: We found in this study approximately 82.7% of 4th and 5th year medical students at University of Bahri are using antibiotics without prescription. Amoxicillin and azithromycin are the most two common utilized antibiotics without prescription. In addition, we found the main sources of information and knowledge about appropriate dose regarding the self-medication with antibiotics are the academic experience more than (26%) and pharmacist recommendation more than (50.4%). And we found the awareness of the adverse effects of antibiotics without prescription demonstrated by 85.4% of the students. Conclusion: The study concludes that prevalence of self-medication with antibiotics among 4th and 5th year medical students at University of Bahri is high, despite of their awareness of adverse effects.
    },
     year = {2024}
    }
    

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  • TY  - JOUR
    T1  - Prevalence of Self-Medication with Antibiotics Among Bahri University Medical Students, Sudan 2022
    
    AU  - Ayat Abdelmahmoud Ahmed Abdelmahmoud
    AU  - Osama Mohammed Noraldaym Elfaki
    AU  - Mustafa Magbol
    AU  - Ahmad Izzoddeen
    AU  - Musab Fathelrahman Mukhtar Osman
    AU  - Najla Ahmed Ginawi
    Y1  - 2024/04/28
    PY  - 2024
    N1  - https://doi.org/10.11648/j.jfmhc.20241002.11
    DO  - 10.11648/j.jfmhc.20241002.11
    T2  - Journal of Family Medicine and Health Care
    JF  - Journal of Family Medicine and Health Care
    JO  - Journal of Family Medicine and Health Care
    SP  - 18
    EP  - 22
    PB  - Science Publishing Group
    SN  - 2469-8342
    UR  - https://doi.org/10.11648/j.jfmhc.20241002.11
    AB  - Background: Antibiotics are medications that eliminate life threating infections from the body. It’s one of the most reported medications that used without doctor’s prescription. The prevalence of self-medication with antibiotics is quite high in developing countries as opposed to developed countries. It is linked with negative outcomes on individual and community health. In addition to its central part in increasing the global problem of antibiotic resistance. In Sudan, despite the overall acceptable level of knowledge regarding antibiotic resistance. Few studies have been carried out to assess prevalence of self-medication. Objective: To evaluate the prevalence of self-medication with Antibiotics among fourth- and fifth-year medical students at University of Bahri. Method: This is a descriptive cross-sectional study. Conducted among 226 medical students. Selected from fourth- and fifth-year medical students at university of Bahri using google form questionnaire. Then analyzed by using SPSS (statistical package for social science) version 25. Result: We found in this study approximately 82.7% of 4th and 5th year medical students at University of Bahri are using antibiotics without prescription. Amoxicillin and azithromycin are the most two common utilized antibiotics without prescription. In addition, we found the main sources of information and knowledge about appropriate dose regarding the self-medication with antibiotics are the academic experience more than (26%) and pharmacist recommendation more than (50.4%). And we found the awareness of the adverse effects of antibiotics without prescription demonstrated by 85.4% of the students. Conclusion: The study concludes that prevalence of self-medication with antibiotics among 4th and 5th year medical students at University of Bahri is high, despite of their awareness of adverse effects.
    
    VL  - 10
    IS  - 2
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Author Information
  • Faculty of Medicine, Bahri University, Khartoum, Sudan

  • Faculty of Medicine, Bahri University, Khartoum, Sudan

  • Faculty of Medicine, Alzaiem Alazhari University, Khartoum, Sudan

  • Field Epidemiology Training Program, Federal Ministry of Health, Khartoum, Sudan

  • Faculty of Medicine, Alzaiem Alazhari University, Khartoum, Sudan

  • Faculty of Medicine, Omdurman Islamic University, Khartoum, Sudan