NATURE OF SELF MEDICATION AMONG PREGNANT WOMEN ATTENDING ANTENATAL CLINIC

ABSTRACT

Reducing maternal mortality is key to achieving the Millenium Development Goals in Nigeria. However, self-medication is one of several health seeking behaviours that threatens the life of pregnant women attending clinic and undermine the achievement of improved maternal health. Though self medication in general has received research attention, not much is known about the reasons that prompt pregnant women attending clinic to self-medicate and the disease conditions for which self medicated drugs are used to treat. This research explored the phenomenon of self-medication among pregnant women attending clinic in Calabar municipal, in the Cross river state of Nigeria. Using a questionnaire survey, 300 pregnant women attending clinic were interviewed on the factors that cause them to self-medicate, the disease conditions treated with self-medication, the most commonly self medicated drugs, and their knowledge of the potential effects of self-medication. The research revealed that self-medication was high among respondents (68.3%), even though most respondents (77.7%) remained informed of the potentially negative effects on the mother and the foetus. Perceived non-seriousness of disease conditions (37.3%), familiarity with certain drugs (22.8%), low cost of self-medicated drugs (25.1%) and dissatisfaction with health service delivery (11.5%) were some of the main factors that predisposed respondents to self-medicate. This research also found that headaches (44.8%), cold and flu (17.7%), stomach problems (14.2%) and body pains (10.9%) were the most commonly treated disease conditions, often treated with analgesics (46.4%), herbal drugs (23.5%), antibiotics (18.4%), and antacids (11.6%). Based on these findings, the research concludes by recommending that government intervention programs should go beyond pregnant women attending clinic and target family members and relatives, since they are influential as trusted sources of drugs, and drug information. In addition, this research recommends that the government of Nigeria initiate a mobile health delivery system for self-employed pregnant women attending clinic, which will target these pregnant women attending clinic at their work places and through that reduce the reluctance and inconvenience that these pregnant women attending clinic experience in seeking professional health services. 

CHAPTER ONE
INTRODUCTION
1.0 BACKGROUND TO THE STUDY
Self-medication can be defined as the use of drugs to treat self-diagnosed disorders and symptoms, or the intermittent or continued use of a prescribed drug for chronic or recurrent disease or symptoms (Donkor et al., 2012). As a phenomenon, self-medication is manifested when people use over the counter medications to resolve usually perceived minor health challenges (Afolabi, 2008; Figueiras, CaamaƱo, & Gestal-Otero, 2000). 

Self-medication is a global problem, common in developed, developing, and under developed countries. In 1990, it was estimated that between 70% and 90% of all illness episodes were handled by some form of self-treatment before it came to the attention of health professionals (Segall, 1990). Afolabi (2008) estimates that in the United Kingdom approximately 50% of all health care among people occurs as some form of self-medication. Self-medication has also been reported as a health behavior among people in Spain (Figueiras et al., 2000). Similarly, selfmedication has been reported as a common health behavior in different developing countries in general, including Nigeria, Zambia, and other countries in Asia like India, and Vietnam (Afolabi,
2008; Banda et al., 2007; Fakeye, Adisa, & Musa, 2009; Malan & Neuba, 2011; Okumura, Wakai, & Umenai, 2002; Rahman et al., 2008; Yusuff & Omarusehe, 2011). 

The preceding information implies that as a health behavior, self-medication is not limited to a particular group of people but rather transcends race, age, occupational status, gender, culture, and other such categorisations (Afolabi, 2008). This notwithstanding, self-medication has been argued to be especially prevalent among people living in areas with high incidence of malaria (Akanbi, Odaibo, Afolabi, & Ademowo, 2005). Elsewhere, self-medication with specific drugs like antibiotics has been shown to be highly prevalent in developing countries, with the exception of a few developed countries (Donkor et al., 2012). Figueiras et al. (2000) in a study of socio-demographic factors associated with self-medication in Spain also associated selfmedication with women, people living in large cities, and people who live alone. 

The prevalence of self-medication is informed by a variety of factors that may differ from country to country. On the whole however, self-medication in more developed countries may be as a result of the increasing de-regulation of previously restricted drugs. This is because, a wide variety of drugs are now available over the counter for the treatment of a variety of health challenges (Blenkinsopp & Bradley, 1996; Bradley & Blenkinsopp, 1996). On the other hand, self-medication in developing countries may be as a result of a variety of factors including the higher cost involved in seeking professional care in hospitals; poverty; the considerable long time spent in hospitals in order to seek health care; cultural beliefs in the efficacy of other traditional methods; as well as poor regulation and easy availability of drugs outside formal and regulated environments (Afolabi, 2008; Donkor et al., 2012; Figueiras et al., 2000). 

The negative effects of self-medication are diverse and may include effects such as treatment failures, drug toxicity, and increase in treatment cost, prolonged hospitalization periods and increase in morbidity. What makes self-medication more dangerous in developing countries is that the basic knowledge concerning the pharmacological properties of these drugs and how they may affect those who practice it are not well known (Abasiubong et al 2012). The adverse effects of self-medication become more serious when the self-medicating person is a pregnant woman (Abasiubong et al 2012). Self-medication by pregnant women attending clinic especially in the first trimester of pregnancy can cause some serious effects to the unborn baby and the mother. These effects may include malformation of children, or hindrance in normal growth of the baby, defects in the development of the reproductive organs, urinary retention, intersex, undescended testis and other problems with the urethral (Abasiubong et al 2012). 

Like other developing countries, self-medication is a major health concern in Nigeria and has become increasingly common since 1985 when health facility user fees were introduced, making people to self-medicate in order to avoid paying consultation fees and transport costs (Salisu and Prinz, 2009). Nonetheless, there remains very little research on self-medication among pregnant women attending clinic. In the light of the foregoing, this research used quantitative research techniques to deetermine the various self-medication practices among pregnant women attending clinic in Nigeria and explore the knowledge of pregnant women attending clinic on the adverse effects self-medication may have on them, the unborn child and the country as a whole. 

1.1 PROBLEM STATEMENT
Van Den Boom, Nsowah-Nuamah, & Overbosch, (2008) and Donkor et al. (2012) indicate that there are difficulties in accessing medical care in several places in Nigeria. Consequently, selfmedication (including traditional and herbal medicines) is a common practice among Nigeriaians especially among the poor. Self-medication using traditional or herbal medicines is also common. Salisu and Prinz (2009) also argue that it is common for Nigeriaians, when ill, to selfmedicate first instead of seeking professional medical support from health personnel and health centres. This behaviour among the general Nigeriaian populace is mainly to reduce cost of consultation and the cost of transportation to and from the hospitals or health care facilities especially for the rural areas where residents have to travel for considerable distances to access health facilities (Salisu and Prince, 2009). Consequently, difficulties and inconveniences in accessibility to and use of professional health care is a significant challenge for the government of Nigeria to overcome. This includes the challenge of reducing self-medication and promoting good health seeking behaviour among the general Nigeriaian populace (Van Den Boom et al., 2008).

Self-medication is one of the most significant social attitudes that negatively affect the health of pregnant women attending clinic in Nigeria. In a report on Nigeria‟s Millennium Development Goals (MDGs), the National Development Planning Commission of Nigeria (NDPC) revealed that one of the main challenges that Nigeria has faced in achieving the goal of improving maternal health has been poor health seeking behaviours especially among the poor (NDPC, 2010). These poor health seeking behaviours include choosing to self-medicate and also self-medicating with traditional herbal medicines instead of attending a health facility to be diagnosed and treated accordingly. The Nigeria Maternal Health Survey (NMHIS) and the Nigeria Statistical Service (GSS) both reveal that when faced with an ailment, some pregnant women attending clinic prefer to self-medicate first and only seek professional health services when the situation worsens (NMHIS and GSS, 2009). This, according to the Ministry of Health (MOH) has led to poor health seeking behaviour among some pregnant women attending clinic in Nigeria, resulting in delays in, and late presentation of health problems
(MOH, 2008). 
In view of the above, this research investigated and analysed the various reasons and factors underlying self-medication among pregnant women attending clinic in Nigeria; disease conditions for which pregnant women attending clinic in Nigeria usually self-medicate; the knowledge and attitudes of pregnant women attending clinic regarding the potential negative effect of self-medication; and the socio-economic factors and predictors of self-medication among pregnant women attending clinic in Nigeria. These are all interesting issues, information on which will help to resolve the problem of self-medication among pregnant women attending clinic and in the process promote maternal and foetal health in Nigeria. 

1.2 RESEARCH QUESTIONS
The following research questions guided this study:
1.  What factors inform the practice of self-medication among pregnant women attending clinic?
2.  Which particular diseases or disease conditions are treated with self-medicated drugs among pregnant women attending clinic?
3.  Which drugs are most often used in self-medication among pregnant women attending clinic?
4.  What do pregnant women attending clinic know about the possible side effects of self-medication on the pregnant woman and the unborn child? 

1.3 OBJECTIVES OF STUDY
Generally, this study sought to explore the phenomenon of self-medication among pregnant women attending clinic in the Ejisu – Juaben Municipality in Nigeria. 
Specifically, the study sought to:
1.      Explore the factors that inform the practice of self-medication.
2.      Ascertain the disease conditions treated with self-medicated drugs.
3.      Ascertain the drugs that are most often used in self-medicating among pregnant women attending clinic
4.      Investigate the level of awareness and knowledge of pregnant women attending clinic about the possible side effects of self-medication on unborn children.

1.4 SIGNIFICANCE OF STUDY
Improving maternal health and reducing infant mortality are two important health related goals of Nigeria‟s Millennium Development Goals (MDGs) (NDPC, 2010). In order to achieve these
two important goals, it is essential that all stake holders work together to eliminate the various factors, including self-medication, that work against and hinder the wellbeing of pregnant women attending clinic in Nigeria (NDPC, 2010). Understanding and managing self-medication attitudes and by so doing promoting medication safety among pregnant women attending clinic will go a long way in achieving both goals. 

Thus, this study, with its focus on assessing self-medicating attitudes among pregnant women attending clinic in Nigeria is significant, since knowledge and information from the research can be adopted by health professionals and other stake holders in improving the health of the mother and child. This can ultimately reduce the rate of morbidity and mortality among women and children and hence contribute towards the achievement of Nigeria‟s Millennium Development Goals.  

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Item Type: Project Material  |  Attribute: 64 pages  |  Chapters: 1-5
Format: MS Word  |  Price: N3,000  |  Delivery: Within 30Mins.
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