Factors affecting medication administration for the children among care givers in rural ares at Bani-suef

Introduction

Self-medication is the treatment of common health problems with medicines especially designed and labeled for use without medical supervision and approved as safe and effective for such use. Medicines for self-medication are often called ‘nonprescription’ or ‘over the counter’ (OTC) and are available without a doctor’s prescription through pharmacies; in some countries OTC products are also available in supermarkets and other outlets. Medicines that require a doctor’s prescription are called prescription product (Hockenberry & Wilson, 2018).

According to target eight of the Millennium Development Goal (MDG), essential drugs should be accessible and affordable in developing countries with the appropriate information and communication,in line with this, self-medication (SM) is one of the contributors for rational drug use (Central Agency for Public Mobilization and Statistics (CAPMAS), 2017)

Self-Medication is defined as the selection and use of medicinal products by the consumer to treat self-recognized illnesses , its symptoms,  the intermittent ,continued use of a medication prescribed by a physician for a chronic or recurring disease or symptom (Shehnaz, et al, 2014).

The developing countries, most episodes of illnesses are treated by self-medication this is due to easy availability of a wide range of drugs commercially and owing to inadequate availability of health services, with a surge of drug resistance being reported widely in the recent times, the irrational use of drugs by the community without a valid doctors’ prescription has become a prime cause of concern and needs to be addressed immediately(Selvaraj et al, 2014). Also includes the selection of a medication for a chronic or recurrent condition by the patient, after an initial diagnosis and prescription by a physician.  Self-medication also. regards as the administration of medicinal products to family members, specially infants and children   (Singh, et al., 2013).

Factors affecting self medication administration are variuos as urge of self-care, feeling of sympathy towards family members in sickness, poverty, ignorance, misbelieves, extensive advertisement and availability of drugs in other than drug shops are responsible for growing trend of self-medication. The nature and extent of self-medication varies in different cultural, social and educational contexts. The issue of self-medication in children is different as in majority of cases it is not the child who is self-medicating but the parents who are responsible for self-medicating their children (TaK. et al., 2011). The harmful consequences of self-medication include treatment failure, antibiotic resistance, prolonged hospitalization, drug toxicity and increase in treatment cost (Mohamed, 2017).

From point of view of consumers Self-medication (SM) has major benefits such as self-reliance and decreased expense. However, inappropriate practice can have potential dangers such as incorrect self-diagnosis, dangerous drug to drug interactions, incorrect manner of administration, incorrect dosage, incorrect choice of therapy, masking of a severe disease, and/or risk of dependence and abuse (Coleman, et al., 2019). Self-medication practices cannot be considered as entirely harmful. Drugs classified as “over the counter” can be purchased without prescription and many a times might save time and money for the patients. Deprived regions, and other hard to reach areas where there is a huge shortage of human health work force, patients are still dependent on self-medication practices for minor symptoms(Selvaraj et al., 2014).

Monitoring systems, a partnership between patients, physicians, community health nurse and pharmacists and the provision of education and information to all concerned on safe self-medication, are proposed strategies for maximizing benefit and minimizing risk (Bennadi, 2013).

 Self-medication is an age-old practice. Urgency of self care  can be attributed to different factors such as, feeling of sympathy towards family members in sickness, lack of health services, poverty, ignorance, misbeliefs, extensive advertisement and availability of drugs in other than drug shops are responsible for growing trend of self-medication. World Health Organization is promoting practice of self-medication for effective and quick relief of symptoms without medical consultations and reduce burden on health care services,  which are often understaffed and inaccessible in rural and remote areas (Patil et al., 2014).

World Health Organization(WHO) points out that responsible self-medication requires the medicinal product to be supported with information describing how to take the medicine, possible side effects, monitoring, possible interactions, warnings, duration of use, should also be noted that since herbal medicines are regulated as over-the-counter (OTC) medicinal products, self-medication only medicines/drugs, dietary supplements, functional or health food in most countries, the use of herbal medicines also constitutes a potential case of responsible-self-medication, provided that they are supported by the appropriate information (Jalilian, et al., 2013)

Finally, the nurse must be prepared to teach clients about the limits and benefits of cultural health care practices. The community health nurse should provide individual and family assessment of care giving based on scientific evidence   Community health nurse should provide sound health education about healthful practices regarding care of each illness that should be based on each unique cultural groups (Allender .et al., 2014)

Aim of study

To assess factors affecting self-medication administration among caregivers in rural areas in Bani-Suef.

Research questions

1. What are the factors affecting self- medication in rural areas? 
2. Is there is association between the sociodemographic data and self-medication? 

Subjects and Methods      

Design: Descriptive research design was used.

Settings: The study was conducted at two villages and their manors selected randomly in Beni-Suef governorate that was Baha in Beni-Suef governorate and Elnwera in Ihansia city where lack of medical access. The data are collected through home visit.

Sample A multi-stage random sample was used, it is made by dividing the governorate into districts, then select two districts randomly (Ihensia and Bani-Suef district), then the investigator makes a list of its villages (200 village); many of them have difficult access to medical care. Finally, the investigator selected randomly two villages. The selected villages are Baha that is covered one healthcare unit called Baha healthcare unit that has poor services and has 21653 of population number that located in the north west of Bani-suef district .The second village is Elnwera that is located in the east of Ihenasia district and has one health care unit called Elnwera healthcare unit and has 21880 of population number, the main job of these villages is agriculture.

Sample size

Using Epi-info software program at 95 % confidence level, frequency level at 86.4% acceptable margin of error 5%, for population size 21653 n₁=179 and for population size 218879 and for population size 21880 n₂=196  (Directorate of Health Affairs) and the investigator added 10% to total sample for exclusion after pilot (38 participant)Total sample N=375

Instruments for Data Collection:

 Three interviewing questionnaire included the following:

  Socio- demographic data of the caregivers’ and child questionnaire:

A-Child socio-demographic questionnaire

The questionnaire consisted of four questions such as age, gender, previous administration of self-medication and ranking of the child.

 B-Caregiver socio-demographic questionnaire

The questionnaire consisted of 12 questions such as education level, marital status, income, number of children in family, and type of family.

Most common self-medication questionnaire

The questionnaire was developed by the investigator after intensive reviewing of the literature of El Nimer (2015), Zeitlin, (2016) and Leifer (2018),. It was used for assessing the most common drug used for self-medication in rural areas and consisted of  eight (8) medication as antiemetics, antibiotics, antipyretic, bronchodilator, analgesics and antihistaminic

Factors Affecting Self-Medication Questionnaire

This part adopted from Arzi, et al., (2010), Siponen, (2013) to assess factors affecting self-nonprescription medication administration among children in rural areas. The questionnaire contained (30) questions. It consisted of five main parts containing closed question with two responses (yes&no):

• A-Child diseases factor: it consisted of four (4) statements such as sudden symptoms, time of symptoms occur at night, etc.
• B- Economic factor: it consisted of two (2) statements such as not enough income and increase price of physician examination.
• C- Health services factors: it consisted of six (6) statements such as the near hospital away10 kilos at least, time of outpatient clinics up to 11am, etc.
• D-Behavioral factors: it consisted of eleven (11) statements such as child plays well and use right dose of self-mediction etc.
• E- Other factors: it consisted of seven (7) statements such as stress from the family, no dangerous signs from uses self-medication without physician order, pharmacist enough from the physician examination, etc.

Scoring system

1. Each drug used for self-medication was took one score (1) and not used took zero score (0).
2. Each factor affecting in self-medication was took one score (1) and not used took zero score (0).

Validity; the questionnaire was reviewed for content validity by a five of experts in community health nursing. an official permission to carry out the study was obtained from the responsible authorities; faculty of Nursing, Ain-Shamis University, by the investigator to the administrators of the community health nursing, where the data were collected to conduct the study after an explanation of the purpose of the study.

Reliability: The investigator tested the internal consistency of the instruments; it is the administration of the same instruments to the same subjects

• Test -retest was (α= 0.727) for most common self medication (SM)drugs questionnaire
• Test-retest for factors affecting SM questionnaire was (α= 0.85))

Pilot study

A pilot study conducted on 10 % (38 mothers) of the sample to assure internal consistency, estimate the required time needed for answering the questionnaires and to identify the problems that may interfere with data collection. The pilot study was included in the sample after omitting the repeated questions of study tool. The time taken for every questionnaire to be completed was about 10-15 minutes for each caregiver.Caregiver who agreed to participate in the study is interviewed to complete the required tools. The investigator introduced her to the respondents, and explained the aim and objectives of the study to the caregiver in the study settings. Anonymity and confidentiality of the information gathered was ensured. This was repeated in each place of the study setting. 

Method for Data collection

• Study period: This study was conducted during the period starting from February 2019 to the end of April 2019.
• Approval: an official permission to carry out the study was obtained from the responsible authorities on the facultyof nursing –Minia university

Administrative Design:

Before starting the actual data collection, a written initial approval obtained from the research ethical committee of the faculty of Nursing and Minia University to obtain the administrative approval for conducting the study. The aims and the importance of the study were explained

Ethical consideration:

The oral agreement for participation of the subjects was taken after the aims of the study were explained. They were given an opportunity to refuse to participate and they were notified that they could withdraw at any time. Also, they were assured that, the information would be remained confidential and used for the research purpose only.

Statistical analysis:

The data obtained from the study tool were categorized, tabulated, analyzed and data entry was performed using the SPSS software (statistical package for social sciences version (IBM SPSS 25.0).  Descriptive statistics were applied (e.g. mean, standard deviation, frequency and percentage). Chi test was used to differentiate between two qualitative variables. A significant level value was considered when P < 0.05.

Results

Table (1): Distribution of the Caregiver According to Their Personal and Demographic Characteristics (n= 375).

Table (1): shows that, 72.5% of the caregivers' age is 25- < 35. Also, 29.1% of caregivers are illiterate. 85.6% of caregivers work and 62.9% of caregivers have 2- 3 child in the family.Regarding type of family 56.3% of caregivers lived in extended family 51.5% have insufficient income.

Table (2): Distribution of the health services factors related to affecting on self-medication administration among Care Giver in rural areas (n= 375).

Table (2): shows 97.1%, 95.7% and 93.1% of caregivers are waiting time is long in the physician clinics, available medication administered to all different diagnosis, and decreased number of physicians in MCH respectively. On the other hand, only 8.5% of caregivers are the near hospital away 10 kilos at least.

Table (3): Distribution of care giver behavioral factors affecting on self-medication administration among for care giver in rural areas (n= 375).

Table (3): explains behavioral factors as 98.7%,97,6%,96.8%,95.5%  are  use right dose of self-medication, suffering from the same symptoms last year, read and follow instruction of the medication, the child plays well respectively. On the other hand, only 6,9%, 28.3% are identify side effects of self-medication and apply  self-medication to solve health problem respectively.

Table (4): Distribution of other factors affecting on medication administration among care givers children in rural areas (n= 375).

Table (4): shows other factors of self- medication97.1%, 93.3%, 82.9%, reports If the child is still sick go to the doctor, Antipyretic and antibiotics present in the home all time and Increase uses of antibiotics respectively. On the other hand, the least reports are Stress from the family& Identify dangers of self-medication (49.6% &4.6%).

Table (5): Relation between Demographic Characteristicsof the Caregiver and Previous Administration of Self-Medication (n= 375).

Table (5): shows that, there is no statistically a significance difference between demographic characteristics of the caregiver and previous administration of self-medication.

Table (6): Relation between Personal Characteristics of the Child and Previous Administration of Self-Medication (n= 375).

*statistically significance differences at <.05

 Table (6): shows that, 93.0% of children who aged 5- < 7 years had previous history of self- medication administration than other child age group with statistically significance differences but no statistically significance differences between gender and ranking of the child with previous administration of self-medication significance differences between gender and age of the child with currently administered self-medication.

Table (7): Relation Between Demographic Characteristicsof the Caregiver and Currently the Child Taken Self-Medication (n= 375).

*statistically significance differences at <.05

Table (7): shows that, there is no statistically a significance difference between demographic characteristics of the caregiver and currently the child taken self-medication except type of family was statistically significance differences in which extended family used self-medication more than single family p – value ≤ .05.

Table (8): Relation between Demographic Characteristicsof the Caregiver and Number of Self-Medication Uses by the Pharmacist (n= 375).

*statistically significance differences at <.05**highly statistically significance differences at <.01

Table (8): shows that, 46.0% of caregivers who aged between 25- < 35 years administered self-medication less than 5 times than other age group respectively. Also, 52.2% of caregivers have sufficient income level administered self-medication less than 5 times. Also, there are statistically significance different with age and occupation P – value < .004 and .045 respectively.