الفهرس 
Introduction and Aim of the studyOnly 14 pages are availabe for public view
 |  | from | 144 |  |  |
| | | from | 144 | | |
Abstract
Self-medication among university students population is a highly prevalent public health problem worldwide, particularly in developing countries. SM leads to serious consequences such as drug misuse/abuse and adverse drug reactions which causes harmful health hazards. Accordingly, SM among university students constitutes a crucial health problem that needs intervention.The WHO advocates specialized education programs for university students who are at stage of learning and their knowledge and attitudes are amenable to modification. That is why; targeting this young population is a good starting point to introduce proper health concepts such as rational drug use.
The present study was conducted aiming to study the prevalence of SM among Alexandria University students and the effect of an educational intervention on their SM knowledge, attitudes and practices. The specific objectives were to estimate the prevalence of SM among university students, to identify possible determinants associated with SM among university students, to assess the knowledge, attitudes, and self-reported practices regarding self-medication, and to plan, implement, and assess the impact of an educational program on knowledge, attitudes and practices of university students concerning SM.
A cross-sectional study was conducted among 400 university students (350 from University of Arts and 50 from Faculty of Medicine) of Alexandria University, followed by an intervention study (one group pre/post-test design).For the intervention study, a subsample (100) was selected from the original sample. The data collection tools and methods included: a pre-designed self-administered structured questionnaire and an intervention program. The questionnaire comprised five sections to collect data from students about: personal data, health related data,knowledge about SM and sources of advice on SM, attitude of students towards SM and SM practices. A health education program was designed and implemented among students based on the results of the pre-test and consisted of four educational sessions with the following topics: OTC medications and problems of SM, what you need to know before taking OTC medications, OTC medication safety basics, and antibiotics and analgesics as common OTC medications. Then, KAP of the students were reassessed using the same questionnaire.
Data were coded, entered, and analyzed using the Statistical Package for Social Sciences (SPSS) version 20 software. Statistical analysis was performed and both descriptive and analytical statistics were calculated.Descriptive statistics included for example the arithmetic mean. Analytical statistics were performed using 5% level (p<0.05) as cut off value for statistical significance and included Chi-square and Mont Carlo exact test. Analytical tests were used to compare differences in variables before and after implementing the intervention. They included: Friedman’s Test, Wilcoxon signed-rank test, Mann-Whitney U test and Mc-Nemar test. Multiple logistic regression analysis was used to predict the most possible determinants associated with SM among university students.
The current study revealed the following main results:
1. characteristics of university students:
The age of students ranged from 17 to 29 years with mean age 20.1± 1.9 years.
Most of non-medical students (84.0%) and 42% of medical students were females.
Less than two-thirds (65%) of students were enrolled in the first study grade.
Most of students had fathers and mothers with university and post-graduate education and had non-working mothers.
About 30% of students’ working fathers were engaged in professional work, 18.2% in semi-professional, and 17.0% in clerical work. Fathers of medical students were engaged in professional and semi-professional occupations more than non-medical students who had more fathers engaged in manual and clerical work.
About 21.8% of students had family member(s) studying medical and/or paramedical sciences and 30.2% had family member(s) working as healthcare professionals.
Medical students had higher rates of family members studying medical and/or paramedical sciences and more working as healthcare professionals.
About 71% of students reported having acute condition(s) at the time of interview, while 45% had chronic conditions and only about 21% were healthy.
2. Prevalence of self-medication among university students:
There was a high prevalence of SM (79.5%) among university students.
The prevalence of SM among medical and non-medical students was nearly the same (80% and 79.4% respectively).
3. Knowledge of university students about self-medication:
The most common source of advice or information about SM with drugs was self-decision in 55.2% of students, followed by parents (43.8%), pharmacists (40.8%) and old prescriptions (28%).
About one quarter (24.5%) of students had poor level of knowledge about SM, while 55% and 20.5% of them had fair and good levels, respectively, with total mean knowledge score of 59.1 ± 16.1.
About half (50.5%) of students had poor level of medication knowledge compared to 38.5% and 11% who had fair and good levels, respectively.
The mean knowledge score of medical students was significantly higher compared to non-medical students regarding knowledge about drugs in general, drug-drug/drug-food interactions, drug precautions and drug contraindications.
4. Attitude of university students against self-medication:
About 47.8% of students had positive attitude against SM, while 52% had neutral attitude and only 0.2% had negative attitude, with total mean attitude score of 74.5±9.9.
There was no significant difference between the mean general attitude score of medical and non-medical students (75.1±10.6 vs. 74.4±9.1, p=0.601).
There were significant differences between medical and non-medical students in some attitudes particularly awareness of diseases and treatment.
More than one third (36%) of medical students agreed that SM is acceptable for medical students.
5. Self-reported self-medication practices:
As regards the health complaints reported to be frequently self-medicated by university students, respiratory complains were most common (90%) followed by neurological (79.8%), pain and musculoskeletal (74.2%), gastrointestinal (67.9%), dermatological (66%), eye complaints (23.6%), hematological (17%), and cardiovascular (10.4%).
The most commonly used drugs for SM reported by university students were respiratory medications (90%), analgesics (85%), GIT medications (67.9%), topical preparations (62.6%), antibiotics (54.4%) and herbals (42.1%). Other drugs included: vitamins/ supplements (32.7%), antipyretics (34%), eye drops (26.7%), CNS medications (14.8%), corticosteroids (12.3%), antiallergic medications (11%) and CVS medications (10.1%).
Antibiotics were taken every few months by 49.7% of self-medicated students and taken more than 5 times per year by 16.8% of them. Those who reported SM by antibiotics every few weeks and nearly all time constituted 6.9% each. Self-medicating students who took antibiotics and did not complete the full antibiotic course of treatment either by taking antibiotics when required or less than week constituted 68.2% and 26% respectively compared to only 5.7% who took antibiotics for more than a week.
Self-medicating students who took analgesics more than 5 times per year and nearly all time constituted 30.4% and 22.6% respectively. Those students who self-medicated by analgesics for more than a week constituted 20.4%.
Corticosteroids were taken every few months by 48.7% of self-medicated students and taken nearly all the time by 10.3% of them. Among students who were self-medicating by corticosteroids during the last year, 92.3% took corticosteroids when required compared to only 5.1% who took them more than week.
More non-medical students than medical students consumed CNS medications (16.2% vs. 5%, respectively). The most common self-medicated CNS medications were sedatives (9.7%), sleeping pills (8.2%), anxiolytics (7.5%), antidepressants (3.5%) and anti-migraines (1.3%). The percent of students who took them more than 5 times per year and nearly all time was 19.1% and 17% respectively. Among students who were self-medicating by anxiolytics during the last year, 20.8% took anxiolytics nearly all time. Self-medicating students who took CNS medications for more than a week constituted 12.9%
The most commonly used topical preparations by self-medicating students were acne topical preparations(32.1%) andfacial whitening creams (28.9%). About 29.1% of self-medicating students took topical treatments nearly all time.
The main source of obtaining self-medicated drugs by studied students was buying drugs without prescription from pharmacies (77%). Parents andusing previous leftover drugs at home represented 45.9 % and 42.1% respectively.
The majority (90.2%) of students stored medications in home pharmacy, 80.8% kept medications for future use without disposal and 47% shared medications with other people in the past 6 months. There were no differences between medical and non-medical students.
6. Factors associated with self-medication:
Logistic regression analysis revealed that father’s occupation as clerical, family member working as healthcare professional, medication sharing practice, and total SM knowledge score were the significant independent factors that affected SM among students.
7. Effect of educational program:
There were significant differences between pre and post intervention KAP scores:
The mean knowledge score showed significant increase (p=0.000) in the immediate test and three months post-intervention in all domains of knowledge about SM.The general knowledge score showed significant increase from 69.8±17.5 in pretest to 92.6 ± 9.3 in immediate test and 92.5±11.7 in three months post-intervention.
The mean attitude score showed significant increase (p=0.000) in the immediate test and three months post-intervention in all domains of attitudes against SM.The general attitude score showed significant increase from 75.1± 10.6 in pretest to 81.0± 10.9 in three months post-intervention.
There was a significant decrease in percents of students who practiced SMfrom 95% pre-intervention to 50% three months post-intervention, who stored medications at home from 92% pre-intervention to 64% three months post- interventionand who shared medications from 38% pre-intervention to 11% three months post intervention(p=0.000).