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 Table of Contents  
Year : 2017  |  Volume : 16  |  Issue : 2  |  Page : 99-103

Adverse drug event following self-medication among ambulatory care patients in a tertiary Hospital in Ebonyi State

1 Department of Community Medicine, Federal Teaching Hospital, Abakaliki, Ebonyi State, Nigeria
2 Department of Family Medicine, Federal Teaching Hospital, Abakaliki, Ebonyi State, Nigeria

Date of Web Publication18-Jan-2018

Correspondence Address:
Dr. Chihurumnanya Alo
Department of Community Medicine, Federal Teaching Hospital Abakaliki, Ebonyi State
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ajmhs.ajmhs_45_16

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Background: An adverse drug event (ADE) is defined as any injury, including physical harm, mental harm, or loss of function due to medication. Little is known about ADEs in ambulatory care settings. Self-medication by definition is the practice of taking medicines by individuals to treat self-recognized symptoms or illness. Aim: The objective of this study was to find out the prevalence of ADEs that occurred as a result of self-medication among ambulatory care patients in our center. Methodology: A cross-sectional study where a paper-based, pretested, semi-structured interviewer administered questionnaire was used to gather information from 398 adult patients attending the general outpatient clinic of a tertiary hospital. Data analysis was performed using Epi Info 7 and all statistical significance was set at P < 0.05. Results: The study had 398 respondents of which 161 (40.45%) and 237 (59.55%) were males and females, respectively. Mean age and the standard deviation was 37.17 ± 14.91. The frequency of self-medication was 375 (89.7%) and the frequency of those who have had at least one episode of ADE following self-medication was 88 (22.11%). Females, (207) significantly practiced self-medication than males (150), Z = 4.19, confidence interval (8.45, 23.49), P = 0.00002. ADE following self-medication occurred more in females (50) than in males, (38) and was not associated with self-medication. The majority of the symptoms reported were itching (47.73%), blurring of vision (14.77%), and abdominal pain. Conclusion: ADEs happen following self-medication among ambulatory patients, especially in women and among the married.

Keywords: Adverse, ambulatory, drug, ebonyi, self-medication

How to cite this article:
Alo C, Alo NC, Oguejiofor NC, Akamike IC. Adverse drug event following self-medication among ambulatory care patients in a tertiary Hospital in Ebonyi State. Afr J Med Health Sci 2017;16:99-103

How to cite this URL:
Alo C, Alo NC, Oguejiofor NC, Akamike IC. Adverse drug event following self-medication among ambulatory care patients in a tertiary Hospital in Ebonyi State. Afr J Med Health Sci [serial online] 2017 [cited 2019 May 20];16:99-103. Available from: http://www.ajmhs.org/text.asp?2017/16/2/99/223585

  Introduction Top

An adverse drug event (ADE) is defined as any injury including physical harm, mental harm, or loss of function due to medication.[1] It can also be defined as an event that could have been avoided by more appropriate measure.[2],[3] There is extensive information on preventable ADEs, especially in acute care, but little is known about ADEs in ambulatory care settings.[4] Some studies have reported frequency estimates of preventable drug-related hospital admissions, but a substantial part of ADEs occur in ambulatory care settings.[5],[6] While many of these may not always require hospital admission, they, however, present serious implications for patients and strain health-care resources.[5],[6] It is also difficult to determine which medication will result in an ADE at any given time.

Self-medication by definition is the practice of taking medicines by individuals to treat self-recognized symptoms or illness [7] without the prescription of a health practitioner. It has been shown that in developing communities, self-medication is a very common practice.[8] Self-medication has increased markedly during the past decade, not only because of the growing costs of prescription drugs but also a trend toward increasing the empowerment of patients.[9]

Ambulatory care is any medical care delivered on an outpatient basis and includes both primary and specialty care.[10] Primary care settings account for the majority of drug prescriptions in many countries. The epidemiology of ambulatory care medication-related adverse events differs from that of inpatient care events. The occurrence of these events lie with the patients because they are responsible for both obtaining their medicines and administering their medications.[10] In addition, detection and tracking of ADEs in the ambulatory setting become more difficult because these patients have to source their medication from multiple sources such as pharmacies, laboratories, and specialty services who are involved in patient care.

ADEs have been shown to be principally caused by preventable medication errors which constitute a relevant health problem.[11],[12] It is believed that these medication errors result from Doctors, Pharmacists, and nurses who are responsible for prescribing and administering these drugs.[13] However, in many cases, the mistake comes from patients themselves or their caregivers who help them in the administration of the medication.[13] It is seen that any preventable event that may cause or lead to inappropriate medication use (including those that harm patients and those that do not) while the medication is in the control of the patient or the consumer could be considered a medical error.[13] The objective of this study was to find out the prevalence of ADEs that occurred as a result of self-medication among ambulatory care patients in our center.

  Methodology Top

This was a cross-sectional study carried out in a tertiary hospital that offers primary, secondary, and tertiary care. Primary care and ambulatory care services are offered through the general outpatient department (GOPD) of the hospital. The hospital serves communities in Ebonyi State and its environs. The GOPD takes care of adult patients only because the hospital also has a Department of Pediatrics. Adult population aged 18 years and above who attend the general outpatient clinic of the hospital was the target of this study. The sample size was calculated using the formula for calculating samples size when the population is >10,000 (N = Z 2 pq/d 2). The calculated sample size was 404, but 398 questionnaires were completely and correctly returned for analysis. The sampling method used for selection was systematic random sampling method. The GOPD is visited daily by an average of 150 patients. Thus, we expected 13, 500 patients during the study 3 months and as such giving a sampling interval of 33.41. Thus, every 33rd patient was selected and if the patient consented, the patient was recruited into the study. Data were collected using a paper-based semi-structured, pretested, interviewer administered questionnaire. Information on demographic characteristics, history of self-medication, history of ADE following self-medication, a description of the adverse event, and drugs used for self-medication was collected. The data were analyzed using statistical software Epi Info 7. All statistical calculations are statistically significant at P < 0.05, and 95% confidence interval (CI). Ethical clearance was received by the Research Ethics Committee of the institution.

  Results Top

A total of 398 respondents participated in the study of which 161 (40.45%) and 237 (59.55%) were male and female, respectively. The mean age and standard deviation of the respondents were 37.17 ± 14.91. The respondents were either living in the urban area 245 (61.56%) or in the rural area, 153 (38.44%). The married, 223 (56.02%) were more in number followed by the single, 158 (39.70%) and the widowed, 17 (4.27%). Those who had no formal education, 20 (5.03%) were the least in number followed by those who had up to primary education, 52 (13.07%), secondary education, 160 (40.20%) and tertiary education, 166 (41.71%) [Table 1].
Table 1: Demographic characteristics of the respondents

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The frequency of self-medication among the respondents was 375 (89.7%) and the frequency of those who have had at least one episode of ADE following self-medication was 88 (22.11%). Females, (207) significantly practiced self-medication than males (150), Z = 4.19, CI (8.45, 23.49), P = 0.00002 [Table 2]. An adverse event following self-medication occurred more in females (50) than in males, (38). However, the difference in this proportion was not statistically significant, Z = 1.66, CI = (−2.14, 29.41), P = 0.0972 [Table 2]. ADE was not associated with self-medication, χ2 = 0.67, P = 0.55, sex, χ2 = 0.34, P = 0.55, place of residence, χ2 = 3.77, P = 0.05, and educational level, χ2 = 3.79, P = 0.05. However, the married were more likely to have ADE following self-medication more than the single or widowed, χ2 = 6.87, P = 0.03 [Table 3]. The symptoms more frequently reported during an ADE were itching (47.73%), followed by blurring of vision (14.77%), abdominal pain (12.5%), and skin eruptions (11.36%), whereas the least were rigor (1.14%) and swollen mouth (1.14), [Table 4].
Table 2: Frequency of self-medication and adverse drug reaction and the same segregated by sex

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Table 3: Association between adverse drug event following self-medication and sex, place of residence marital status and level of education

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Table 4: The symptoms reported by respondents that had drug reaction following self-medication

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  Discussion Top

The study findings showed that most people practiced self-medication (89.7%). This result is consistent with other findings that reported prevalence as 85%,[14] 92.3%,[15] and 78.95%.[16] The prevalence of ADE following self-medication in our study was found to be higher than the findings from other studies that reported 3.9%,[17] 0.12%,[18] and 23.6%,[19] but similar to the findings of Taché et al. where they reported a frequency 25% ADE following self-medication.[10] However, Schmiedl et al. also reported that 53.8% of the ADEs was due to over the counter drugs.[17] The study finding may be higher than the result reported as there are no strong systems available for monitoring and reporting ADEs following medication either prescribed by Doctors, any other health worker or by the patients themselves in our setting. It is possible that what we are seeing is just a tip of the iceberg. ADEs also happen in the communities and they are often not reported, especially in developing countries were ADEs do not have monitoring systems.[20],[21]

The females in our study were found to report the practice of self-medication significantly more than male. Daban et al. also found the same results.[22] The females also reported more ADEs than the males, though this was not significant. In another study, the researchers found that ADEs significantly occurred more in the women.[23] Daban et al.in their study also concluded that there are social determinants that can affect the consumption of prescribed and nonprescribed medicine.[22] This could explain why the females reported practicing self-medication more than males. Our result also suggest that it is important in an ambulatory care setting, where people have access to prescription drugs without the prescription of a health worker, asking about a history of adverse event following medication should be done knowing that it may not have been reported and that it may occur again if the offending drug is used or the same medication error occurs again. The other characteristics such as age, place of residence, and educational level were found to have no association with ADEs following self-medication. However, it has been shown that ADEs occur more frequently in the elderly.[4] The married in the study significantly reported ADEs more than the single and widowed. This could be another social determinant.[22] The important application of this result is the opinion that clinicians should have an index of suspicion that these variables are pointers to the fact that those visiting the Outpatient Department could be practicing self-medication and may have had an ADE. ADEs have cost implications to individuals and cost of hospital care and so its prevention shoud be cost effective.[6],[24] This is because ADEs have been found to be a cause of hospital admissions and visits to the emergency department.[11] The cost of treating ADEs or adverse drug reactions can be demanding in health care.[13],[24] This could have some unpleasant effect on the economy of families and communities at large. ADEs can also result in mortality which can be life-threatening or even have a mortality rate of about 0.07%.[23] ADEs are preventable [24] and therefore should not lead to hospital admissions and unnecessary health expenditure.[25]

The most common symptoms experienced by those were itching, blurring of vision, abdominal pain, and joint pains. This is a reflection of the organs that are commonly affected during an ADE. This includes the skin, eye, gastrointestinal tract, and musculoskeletal system. Studies have also found that most ADEs affect the GIT, the skin, the central nervous system, and the musculoskeletal system.[3],[17] ADEs can also affect single organs such as the liver, kidneys, and any other organ.[26] It is therefore important that the public be educated on the dangers of self-medication and to equally direct attention to strategies that will effectively control the availability of drugs to the public.

  Conclusion Top

ADEs happen the following self-medication among ambulatory patients, especially in women and among the married.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Bates DW, Cullen DJ, Laird N, Petersen LA, Small SD, Servi D, et al. Incidence of adverse drug events and potential adverse drug events. Implications for prevention. ADE Prevention Study Group. JAMA 1995;274:29-34.  Back to cited text no. 1
Hallas J, Jensen KB, Grodum E, Damsbo N, Gram LF. Drug-related admissions to a department of medical gastroenterology. The role of self-medicated and prescribed drugs. Scand J Gastroenterol 1991;26:174-80.  Back to cited text no. 2
Thomsen LA, Winterstein AG, Søndergaard B, Haugbølle LS, Melander A. Systematic review of the incidence and characteristics of preventable adverse drug events in ambulatory care. Ann Pharmacother 2007;41:1411-26.  Back to cited text no. 3
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World Medical Association General Assembly. WMA statement on self-medication. Available from: https://www.wma.net/policies-post/wma-statement-on-self-medication/. [Last accessed on 2016 Jun 11].  Back to cited text no. 7
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Eickhoff C, Hämmerlein A, Griese N, Schulz M. Nature and frequency of drug-related problems in self-medication (over-the-counter drugs) in daily community pharmacy practice in Germany. Pharmacoepidemiol Drug Saf 2012;21:254-60.  Back to cited text no. 9
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Garfield S, Barber N, Walley P, Willson A, Eliasson L. Quality of medication use in primary care – Mapping the problem, working to a solution: A systematic review of the literature. BMC Med 2009;7:50.  Back to cited text no. 11
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Schmiedl S, Rottenkolber M, Hasford J, Rottenkolber D, Farker K, Drewelow B, et al. Self-medication with over-the-counter and prescribed drugs causing adverse-drug-reaction-related hospital admissions: Results of a prospective, long-term multi-centre study. Drug Saf 2014;37:225-35.  Back to cited text no. 17
Jose J, Rao PG. Pattern of adverse drug reactions notified by spontaneous reporting in an Indian tertiary care teaching hospital. Pharmacol Res 2006;54:226-33.  Back to cited text no. 18
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  [Table 1], [Table 2], [Table 3], [Table 4]

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