Why self-medication is on the rise

In 2010, the National Drug Authority (NDA) estimated that eight in every 10 people self-medicate or buy drugs over the counter. NDA attributes this to the increased number of pharmacies and drug shops, expensive treatment from clinics and long distances to health facilities.
Dr Emmanuel Tugaineyo, the Mbale Hospital director, says patients constantly use pain relievers and anti-malarial drugs whenever they suspect illness.

Dr Tugaineyo says people also buy anti-allergies, vitamins, laxatives, antacids and tonics, which can cause serious side effects.
“Self-medication doesn’t only lead to drug resistance, but also means postponement of treatment for actual disease as it continues to grow and this can increase chances of death,” he says.

Dr Tugaineyo advises health workers to carry out tests before administering treatment to patients.  He adds: “Treatment in hospitals is even cheaper than going to a clinic to buy drugs.” 

However, Dr Denis Kutosi, a medical officer from Gilgal Hospital in Mbale, says people are driven by myths that there is a pill for every illness.  “As medical professionals, we still have a task of sensitising the masses when to take medicines,” he says.

Mr Warren Wabulembo, the superintendent of Bulange Health Centre III in Namutumba District, says self-medication is responsible for increasing health problems such as the drug resistance, poor compliance, poisoning and toxicity reactions.

“Our people should know that all drugs are poisonous. They should use them [drugs] with caution and always with guidance from qualified people,” he advises.

Ms Olivia Nalinda, a health worker at Kalisizo hospital in Kyotera District, says patients resort to self-medication due to expensive treatment at some health facilities in their vicinity.

“Different hospitals have different rates yet some health centres have long queues which patients try to avoid,” she says. She cites scenarios where patients take overdose to relieve pain.

Mr Samuel Katumba, a health activist in Kalangala District, says lack of access to medical personnel is partly to blame.
He cites the remote islands in Kalangala, which lack public health centres and qualified medical professionals, forcing residents to find solace in the existing private drug shops.

“From one island to the nearby health unit, it costs between Shs40,000 and Shs80,000, which is expensive for ordinary islanders, who can only part with Shs20,000. What do you expect such a person to do?” he asks.

With chronic diseases such as diabetes, HIV/Aids, Mr Katumba says many patients find it easy to treat themselves from their homes given the period they spend with the disease.

“They [people] become well-versed with the right dosage and prescription,” he adds.

In Teso Sub-region, a number of people attest that they practise self-medication because of shortage of drugs in health facilities. 
“Health workers themselves send us to buy expensive drugs from clinics or pharmacies whenever there’s a shortage, a practice that discourages us from continuing to seek for their services,” Mr John Esanu, a resident of Soroti City, says.

Ms Joan Arienyo, a resident of Senior Quarters Ward in Soroti City, says the practice relieves patients from heavy medical bills that range from consultation fees, laboratory tests, labour and procurement of drugs, including admissions.

The assistant district health officer, Dr Martins Eyura, says self-medication is expensive in the long run.
Dr Nathan Onyachi, the director of Masaka Regional Referral Hospital, says sickness comes with a lot of panic and emotions which requires the help of a qualified doctor.

“People should always seek medical advice from qualified health workers via phone calls before making choice for drugs for themselves if they feel like they can’t handle the medical bills which in most cases push people into self- medication,” he says.

Dr Onyachi also advises people to practise physical exercises, adding that a physically fit body can easily fight some illnesses without necessarily taking medicine.

“As we conduct health education and teach our people the dangers of self-medication, there is also need to strengthen enforcement on the sale of certain drugs, not all drugs should be on the shelf for people to buy even without being prescribed by a qualified health personnel,” he adds.

NDA says
Dr Medard Bitekyerezo, the chairperson of NDA, says fighting self-medication requires concerted effort from all stakeholders.
He says drug shops should dispense drugs to only buyers who present medical forms from the doctors.

“That practice [self-medication] has led to poor treatment adherence and is slowly but surely causing unnecessary deaths. To reverse this trend, we must work together as stakeholders, and it shouldn’t be left to only NDA,” he says
Mr Francis Mukwaya of St Francis Medical Centre in Mpigi Town says some people, who self-medicate, end up losing their sights, breath, get heart attacks (cardiac arrests). 

“Youth in our area who use marijuana are the ones who mostly buy the painkillers. Some even become addicted to those drugs without knowing the danger they pose,” he says.
Ms Cathy Nasaazi, a nurse at Tendo Clinic in Butambala District, cites a recent incident, where a young girl who tried to abort using some tablets a colleague prescribed, died.
“Not all people you see in uniforms operating drugs shops are trained in this field. Many are just making money,” she says.

The vice
 Mr Alfred Besigensi, the acting Kabale District health officer, says about 90 per cent of patients in the district first buy pain killers or use natural herbs before visiting health centres.

Mr Besigensi says adverts are currently running on local radios asking pharmacy operators to stop selling drugs irresponsibly.
“Some patients under-estimate the gravity of ailments and opt for self-medication not knowing that treating a wrong illness leads to serious health challenges that may even result in death,” he says.
 

Kanungu District Health Officer Stephen Ssebude says cases of self-medication are many in his district and victims do not reveal that they have been using certain medicines before their health deteriorates.
“We have been engaging community members on radio talk shows to go for treatment at health centres instead of using traditional herbs,” Dr Ssebudde says.

The Kisoro District Health Officer, Dr Stephen Nsabiyunva, says   self-medication has complicated the fight against malaria.
“We still have an uphill task to win this battle [against malaria] because when people self-medicate, many fail take adequate doses required to cure malaria.

This has resulted in drug resistance,” he says.
Mr John Nangiro, a resident of Kakingol Village in Moroto District, says half of the population relies on self-medication due to shortage of health facilities.
“Like here, we only have clinics where a patient goes and explains to the attendant his illness and is given the drug there and then,” he says.

Ms Sarah Nakiru, another resident, says some patients simply shun health centres due to the arrogance of some health staff.
“We have witnessed a situation where nurses in government health facilities become tough and sometimes slap the patients. So, someone remains traumatised and fears to go back to the health facility,” she says.

Survey
A survey on self-medication carried out in northern Uganda in 2012, whose   findings are published on the website of National Centre for Biotechnology Information, United State National Library of Medicine found that a high proportion (75.7 per cent) of the respondents practised antimicrobial self-medication. 

Fever, headache, lack of appetite and body weakness were the disease symptoms most treated through self-medication (30.3 per cent). The commonly self-medicated antimicrobials were coartem (27.3 per cent), amoxicillin (21.7 per cent), metronidazole (12.3 per cent), and cotrimoxazole (11.6 per cent). 
Drug use among respondents was mainly initiated by self-prescription (46.5 per cent) and drug shop attendants (57.6 per cent). 

More than half (68.2 per cent) of the respondents would recommend self-medication to another sick person. A high proportion (76 per cent) of respondents reported that antimicrobial self-medication had associated risks such as wastage of money (42.1 per cent), drug resistance (33.2 per cent), and masking symptoms of underlying disease (15.5 per cent). 

Predictors of self-medication with antimicrobial agents included gender, knowledge, drug leaflets, advice from friends, previous experience, long waiting time, and distance to the health facility.

The study was approved by Makerere University School of Medicine Research and Ethics committee and Uganda National Council of Science and Technology.

Compiled by Al-Mahdi Ssenkabirwa, Olivier Mukaaya, Denis Edema, Ambrose Musasizi, Robert Muhereza, Sylvester Ssemugenyi, Leonard Mbishinzimana, Malik Fahad Jjingo, Steven Ariong, Wilson Kutamba, George Muron, Simon Peter Emwamu

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