Self-prescription of Paracetamol by Medical and Science Students at a Public University in Riyadh, Saudi Arabia

Khalid A Bin Abdulrahman^1*, Shahad Hameed AlShammari², Wejdan Abdullah Alshakarah², Hanan Rafat A Bukhari², Ahad Marei Alenazi² and Norah Saud Al Towaim²

^*Correspondence: Khalid A Bin Abdulrahman, Department of medical education, College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia, Email:

Author info »

Introduction

Paracetamol is a pharmacological drug used for a wide range of reasons such as agony, distress, pain, and febrility.1 Even though it has a large percentage of helpful relieving effects, it can counteract some drugs resulting in some blood disorders which were reported by some users of paracetamol.1 It was shown that paracetamol is one of the major commonly used drugs in self-prescribing situations frequently practiced among university students worldwide [1-3].

The World Health Organization (WHO, 1998) and the International Pharmaceutical Federation (FIP, 1999) define self-medication as “a practice by which an individual selects and uses medicines to treat symptoms or minor health problems, recognized as such by themselves” [4]. If self-medication is practiced appropriately, in situations managed by over-the-counter (OTC) products, it may be beneficial for individuals, as it is cost-efficient and excludes the need to go through the hassle of booking a consultation appointment with a large fee when they do not need medical attention or their illness is not severe enough to seek medical attention. However, inappropriate self-medication may lead to harm; as mentioned previously drug-drug interactions with paracetamol lead to blood disorders. In addition, a high dose of paracetamol can lead to liver damage or renal tubular necrosis [1,2,5,6]. Thus, people should seek information on the OTC drugs they may be using. They discovered, in both the cross-sectional studies done in Aseer [7] as well as the public sector university in Dammam [6], that pharmacists are mostly sought for information when it comes to OTC drugs.

Despite the significant prevalence of paracetamol use among university students worldwide, it has continued to be misused [6,7]. There is also a lack of published articles describing the prevalence of self-prescription in Saudi society. Some studies have been published to assess the prevalence of self-prescription among students. Some of those studies ranged from 2013-to 2018 with only one or two articles published within each year, each of them in different cities. The high prevalence of self-prescription was proved using many articles [3,8-10]. This study aimed to measure the prevalence of self-prescription of paracetamol consumption among undergraduate medical and science students at IMSIU in Riyadh, Saudi Arabia. Therefore, this study will help to take a step towards regulating self-prescribed paracetamol consumption to avoid the side effects.

Method

This is cross-sectional study was performed among students of science and medical colleges of IMSIU located in Riyadh, the capital of Saudi Arabia, between September to November 2020.

Participants and eligibility criteria

The study included students of medical and science undergraduates. This segment was identified as the target population of the study. 6 Students from other colleges were excluded.

Sample size and sampling procedure

The survey was distributed among consenting students through email, text messages, and social media to fill. It was sent repeatedly on consecutive weeks to remind those who did not have time to answer the first time around. The sample size was calculated by the formula:

Sample size= Z2 p(1-p)/d2

Where “Z” is a constant of 1.96 with a confidence level set at 95%, “d” is an alpha margin of error kept at 5%, and “p” is the prevalence of self-medication which was assumed to be 0.73%. 3 The sample size was then found to be 303.

Research instrument

A questionnaire was designed by reviewing four of the available research literature [1,11-13]. It was conveniently designed in both Arabic and English languages for all individual preferences. The questionnaire was divided into two sections of close-ended questions. Section one is demographic information including gender, major, and academic year, in addition to self-prescription of paracetamol in the same section. Regarding the answer to the last question, section two is different, where a response of “no” has a section with only one question concerning the reason behind their choice. On the other hand, a response of “I don’t remember” ends the questionnaire for them. Finally, an answer of “yes” takes them to section two, an important section consisting of questions related to students’ beliefs about selfmedication practice, the type of pain they prescribe paracetamol to themselves for, checking the bottle before using it, knowing the correct dose, hazards of overdosing, drug-interactions knowledge, and sharing the drug with friends. As well as an additional question concerning medical students only, feeling confident enough to diagnose their underlying condition.

Data analysis

The responses were analyzed using SPSS software version 24 for frequency counts and calculations of prevalence which were reported in terms of a 95% confidence level.

Ethical consideration

The study was approved by the IMSIU research ethics committee (project number 115-2020; approval date, 08 Dec 2020). All writing is done in accordance with the ethical principles of the declaration of Helsinki. A brief description of the study was included with the survey link, with a full explanation on the survey’s front page. Participants were told consent was given by filling out the survey. Throughout the study, consent of all participants and data were gathered in complete confidence.

Results

The total number of participants was 331 students. Eight of them were ineligible and the particular reason for this circumstance is that they were from other majors. Three hundred twenty-three (323) participants underwent the analysis. Two hundred forty-nine (77.1%) of them were females. All of the participants are from either Medicine or Science College at IMSIU. The number of medical students was 141 (44%). The participants were from the first to the fifth academic year Table 1.

Table 1: Characteristics of Study Participants (N= 323).

After the statistical validation of the data collected from the respondents, it indicated that (58.8%) of the students practiced self-prescription paracetamol consumption in the last month. The prevalence was more among females (45.8%). The results showed that the prevalence of selfprescription paracetamol consumption was high among medical students (63.1%) compared with science students (55.5%) Table 2.

Table 2: Comparison of self-prescribed paracetamol among gender and major groups.

Figure 1 showed the reasons for not taking the paracetamol without a prescription. Most students (67.80%) did not have any disease in the last month that required medicine, 13.90% of students had other reasons for not taking paracetamol. In addition, 7.83% were afraid of the side effects of the medicine. Six percent of the students abstain from taking the medication without a prescription because they are afraid of the wrong use of the drug. A very small percentage of the participants were afraid of the wrong diagnosis or medication for their symptoms. Table 3 illustrated the reasons for taking paracetamol without a prescription; one hundred four (55%) participants agreed that there was no need to see a doctor due to a minor illness. Given that the students experienced previous symptoms and have experience on how to take the medication indicated a percentage of 51.1%. Reasons which are quick pain relief, time-saving, and expected to receive the same medication from doctors, formed average percentages among students (41.1% - 23.7% -33.7%). The clinic location does not cause a problem for students; therefore, it showed the lowest percentage, which was 2.6% of responses. Most of the participants agreed that the diseases that prompted students to use paracetamol were headaches, migraines, toothache, and fever. Menstrual pain was one of the highest rates, as it was (55.3 %) for female students. Most of the students (81.1%) checked the information on medications before self‐medicating, and none of them mentioned that they did not understand the information at all. The knowledge of the correct dose was mentioned by 78.4% of students. More than 76% of students knew the dangers of paracetamol overdose; however, 61% had no idea about paracetamol drug interactions. Over one-half of the students (57.4%) thought that paracetamol may harm a person's health. A high percentage of students (72.6 %) shared drugs with others. Predominantly, students self-medicating drugs relied on the type of disease to be treated and the drug to be used. Out of the 89 medical students who answered the last question, 50% of medical students did not feel confident to practice self-diagnosis Table 4.

Table 3: Responses to reasons and problems for self-prescribing paracetamol (N=190).

Table 4: Responses to the questions related to awareness of self-prescribed paracetamol and attitude toward self-medication.

Figure 1: Reasons for not taking self-prescribed paracetamol in the last month.

Discussion

This study was carried out among students of science and medical colleges at IMSIU in Riyadh, Saudi Arabia. The prevalence of self-prescribed paracetamol consumption in the last month of both medical and science colleges, combined, was reported at 58.8%. Which is higher than the percentage found in the previous study done in Dammam, 26%.6 On the contrary, it is a slightly lower result compared to the studies done in Jeddah, Aseer, and Madinah [3,7,13]. Furthermore, the prevalence of self-prescribed paracetamol in the college of science alone was reported at 55.5%. This represents the science field’s self-prescription of paracetamol in Saudi Arabia since there was a lack of data in previous studies for their population. However, a study conducted in Peradeniya on the science population at a percentage of 77% of self-prescription, a considerably higher rate than our current study [10].

The results showed that the prevalence of selfprescription paracetamol consumption was high among medical students at 63.1%. Previous studies recorded a range of 66% to 87% of medical students in Saudi Arabia [3,8,9,13-17]. This study is slightly lower than the range of those many former studies. The difference in prevalence between science and medical colleges within universities correlates to the confidence level of medical students to self-prescribe the drug. Which is mostly coming from their knowledge of indulging in prescriptions to other patients in the future? Another reason could be the feasibility to access community pharmacies and obtaining paracetamol from the pharmacist without needing an actual prescription [6,13,17]. Further research is needed to establish the reasoning. In this study, a considerable percentage has shown that in instances of quick pain relief, time-saving, as well as the same expectation to receive the same medication from a doctor is further shown in multiple previous studies [3,6,8,10]. A study in the University Peradeniya also has shown self-prescribing due to previous experiences at 66%, along with a study in the University of Jazan [8,10].

The results showed that 81.1% of students check the bottle before using it and 78.4% of students know the correct dose. Coupled previous studies in, Aseer, Saudi Arabia, have shown a similar percentage [7]. The study in BP Koirala institution states that 49.3% of the students mentioned the correct dose of paracetamol [1]. The awareness of the toxic drug interactions in this study was admittedly higher than average albeit previous studies have admitted having low knowledge about the OTC analgesic side effects [1,2,5,11]. Previous studies respondents have agreed that self-medication could be harmful and is associated with adverse effects a notable percentage, in contrast, this study has shown a percentage of 85.8% of respondents concluding that self-medication depends on the underlying cause of use [6,8].

University students, especially medical and applied science students, are exposed to many psychological pressures accompanied by physical symptoms such as tension headaches, back pain, and other symptoms that make them resort to taking painkillers available in pharmacies and some commercial markets [17,18]. As for the female students, let's not forget about menstrual pain, which is why young women take painkillers such as paracetamol [19]. It is natural for medical students to be more careful to be aware of the side effects of chemical drugs compared to other students. This is because medical students take courses within the medical curriculum such as pharmacology, biochemistry, and pathology that contribute to the amount of impact on their daily behavior regarding medication intake and its side effects [20]. And even though paracetamol is a relatively safe analgesic, so we find it more common worldwide, awareness of its side effects and the drugs that interact and are affected by them are important things that people should be aware of [21]. It may not be surprising that many people do not read the drug information about the medicine leaflet and ignore it. Either because they used to take the drug in the past or because they took it on the advice of a trusted person, a friend, or a relative [22].

Conclusion

The findings of this study indicate that the selfprescription of paracetamol is prevalent among undergraduates in the medical and science fields of IMSIU. Although the students exhibited some awareness of self-prescription, it is highly encouraged for the university faculty to intervene and advance through educational efforts to reduce consumption and bring awareness to self-medication. Further studies on the use of paracetamol or self-medication by using a larger population and a good sample design may be started.

Limitations

The study has some limitations that deserve mentioning. A convenience sample was used; there was no randomization of the sample. Thus, the sample is not representative and the results cannot be generalized. Because of the lack of responses from male students. As well as, the questionnaire which was sent through social media may cause some bias. Therefore, further research is needed to investigate and replicate the findings of this study.

Acknowledgement

The writers of this publication would like to thank the study participants and thank Marwa Al-Abbas for their assistance in the analysis of the data.

Disclosure

The authors report no conflicts of interest in this work.

Financial Support

This is a self-funded project.

References

1. Yadav AK, Rai BK, Budhathoki SS, et al. Self-prescription of paracetamol by undergraduate students in BP koirala institution of health sciences. J Nepal Med Assoc 2016; 55:11-15.

Indexed at, Google Scholar

2. Chakraborty T, Baidya M, Chakraborty A, et a. Paracetamol-A self-medicated popular drug abuse by young student community. Biomed Pharmacol J 2009; 2.

Indexed at, Google Scholar

3. Ibrahim NK, Alamoudi BM, Baamer WO, et al. Self-medication with analgesics among medical students and interns in King Abdulaziz University, Jeddah, Saudi Arabia. Pak J Med Sci 2015; 31:14-18.

Indexed at, Google Scholar, Cross Ref

4. Galato D, Galafassi LD, Alano GM, et al. Responsible self-medication: Review of the process of pharmaceutical attendance. Braz J Pharm Sci 2009; 45:625-633.

Indexed at, Google Scholar, Cross Ref

5. French DP, James DH. Reasons for the use of mild analgesics among English students. Pharm World Sci 2008; 30:79-85.

Indexed at, Google Scholar, Cross Ref

6. Albusalih FA, Naqvi AA, Ahmad R, et al. Prevalence of self-medication among students of pharmacy and medicine colleges of a public sector university in Dammam city, Saudi Arabia. Pharmacy 2017; 5:51.

Indexed at, Google Scholar, Cross Ref

7. Alshahrani SM, Alakhali KM, Al-Worafi YM, et al. Awareness and use of over-the-counter analgesic medication: A survey in the Aseer region population, Saudi Arabia. Int J Adv Appl Sci 2020; 7:130-134.

Indexed at, Google Scholar

8. Albasheer OB, Mahfouz MS, Masmali BM, et al. Self-medication practice among undergraduate medical students of a Saudi tertiary institution. Trop J Pharm Res 2016; 15:2253-2259.

Indexed at, Google Scholar

9. Khalid S, Khan AA, Sultana M. A cross sectional study to evaluate selfmedication practice among medical students. Pakistan J Public Health 2019; 9:82-85.

Indexed at, Google Scholar, Cross Ref

10. Samarawickrama A, Suraweera R, Sivayoganathan C, et al. A study on paracetamol consumption by undergraduate students in the faculty of allied health sciences, university of Peradeniya. Int J Sci Res  2014; 4:1-2250.

Google Scholar

11. https://zenodo.org/record/822215
12. Shafie M, Eyasu M, Muzeyin K, et al. Prevalence and determinants of self-medication practice among selected households in Addis Ababa community. PloS One 2018; 13:e0194122.

Indexed at, Google Scholar, Cross Ref

13. Kalra DD, Kini PV, Kalra RD, et al. Assessment of self-medication among dental students in Pune city, Maharashtra: A cross-sectional survey. J Indian Assoc Public Health Dent 2015; 13:318.

Indexed at, Google Scholar, Cross Ref

14. Aljaouni ME, Hafiz AA, Alalawi HH, et al. Self-medication practice among medical and non-medical students at Taibah University, Madinah, Saudi Arabia. Int J Acad Sci Res 2015; 3:54-65.

Google Scholar

15. Saeed MS, Alkhoshaiban AS, Al-Worafi A, et al. Perception of self-medication among university students in Saudi Arabia. Arch Pharm Practice 2014; 5.

Indexed at, Google Scholar

16. Babakor S, Ghamdi M. Prevalence and determinants of over-the-counter analgesics usage among patients attending primary health care centers in Jeddah, Saudi Arabia. J Young Pharm 2018; 10:91-97.

Indexed at, Google Scholar, Cross Ref

17. Al-Qahtani MF, Alsubaie ASR. Investigating stress and sources of stress among female health profession students in a Saudi University. J Multidiscip Healthc 2020; 13:477-484.

Indexed at, Google Scholar, Cross Ref

18. Almesned IS, Alqahtani NG, Alarifi JA, et al. Prevalence of primary headache among medical students at King Saud bin Abdulaziz University for health sciences, Riyadh, Saudi Arabia. J Family Med Primary Care 2018; 7:1193.

Indexed at, Google Scholar, Cross Ref

19. Moore RA, Wiffen PJ, Derry S, et al. Non-prescription (OTC) oral analgesics for acute pain - an overview of Cochrane reviews. Cochrane Database Syst Rev 2015; 2015:CD010794.

Indexed at, Google Scholar, Cross Ref

20. Al Essa M, Alshehri A, Alzahrani M, et al. Practices, awareness and attitudes toward self-medication of analgesics among health sciences students in Riyadh, Saudi Arabia. Saudi Pharm J 2019; 27:235-239.

Indexed at, Google Scholar, Cross Ref

21. Ejeikwu TM, Folashade W. Risk perception of paracetamol use among undergraduate students of University of Jos. Open Access Library J 2019; 6:1-0.

Indexed at, Google Scholar, Cross Ref

22. Islam MA, Al-Karasneh AF, Naqvi AA, et al. Public awareness about medicine information, safety, and adverse drug reaction (ADR) reporting in Dammam, Saudi Arabia. Pharmacy 2020; 8:222.

Indexed at, Google Scholar, Cross Ref