Knowledge Of Risk Factors Of Self-Medication Among Student Nurses

INTRODUCTION
1.1 Background to the study
Self-medication can be defined as the process of obtaining and consuming drugs without the advice of a health provider for the treatment of medical conditions (Mandavi and Kapur, 2009). Self-medication also comprises of the use of the medications by the users for perceived health conditions/problems or the continued use of medicines formally prescribed earlier. The scope of the definition covers the treatment of family members including minors and elderly (WHO, 2011). Medicines for self-medication are often called Over the Counter (OTC) drugs. These are made available in pharmacies without prescription from a doctor (Pwar et al., 2009). The FDA (2006) defines Over the Counter drugs (OTCs) as drugs marketed for consumer use without the intervention of a health provider/professional in order to get access to the product. Regarding the classes of medicines, seemingly, people do not differentiate between prescription medicines and OTC drugs (Bjornsdottir et al., 2009). Medicines that need a doctor’s prescription are referred to as prescription products (FIP/WSMI, 2011). Many individuals in developed and developing nations treat most of the medical conditions via self- medication (Fuentes and Villa, 2010). Self-care patterns are not new, rather it is the long standing and most commonly used of all forms of behavior which affects individuals’ health. Different studies conducted in various parts of the world including the United States (Bent, 2009), the United Kingdom (Oborne, 2015), Spain (Carrasco-Garrido, 2009), Germany (Uehleke, 2011), France (Orriols, 2009), Mexico (Balbuena, 2009) Singapore (Chui, 2015), Turkey (Gul, 2010), Pakistan (Zafar, 2009), Jordan (Sawair, 2009), Kuwait (Awad, Al-Rabiy and Abahussain, 2009), Egypt (Sallam, 2009) and Sudan (Awad, 2015) vary in their findings of the percentage of individuals who practice self-medication, with prevalence rates ranging between 13% and 92%.
Research has shown that infectious bacterial diseases are fast becoming incurable as a result of the growing resistance to antibiotics (Chalker, 2011). A study conducted by Sarhroodi et al., (2010) found a causal relationship between practice of self medication and development of resistance as well as urge for a more restricted usage. The improper use of antibiotics for the treatment of infections is a global issue with implications on the treatment cost and development of bacterial resistant strains (Malhotra et al., 2010). According to the WHO (2011), improper use of antibiotics includes inappropriate antibiotic selection, inadequate antibiotic dosage and inadequate duration of use. In Nigeria, self-medication thrives among the ctizenry, although the law mandates presentation of a doctor’s prescription before dispensing and purchasing antibiotics (Misati, 2012). Findings have shown unexpectedly high prevalent levels of development of drug resistance in people living in geographically remote areas, and with very low levels of antibiotic exposure raising the question of the role of other factors in favoring the emergence and spread of antibiotic resistance (Bartoloni et al., 2014).
The frequent nature of resistance to ampicillin, chloramphenicol, oxytetracycline, and trimethoprim ranged between 45% and 96%, while the frequency of resistance to other hardly used antibiotics such as cefazolin, ciprofloxacin, and gentamicin, was less than 10% in Kenya, Zimbabwe and Ghana (Nys et al., 2014). According to WHO (2010), to use a non-prescription drug safely and properly, the patient must perform a number of activities normally carried out by the physician in charge of the patient’s treatment with a prescription drug. These activities may include accurate recognition of symptoms, setting therapeutic objectives, selecting a product to be used, determining an appropriate dosage and schedule, considering the person’s medical history, concomitant diseases and concurrent medications, and monitoring the response to the treatment and of possible negative effects. When performing any of the activities fails, negative effects of medication eventually develop.
This study also seeks to clarify why the spread and continuation of self-medication especially with antibiotics can occur regardless of the existing legal regulations guiding the access to antibiotics. Despite the gravity of risk associated with the problem of self-medication with drugs including antibiotics, no known study has been carried out in the study area among Universitystudent nursesand their awareness of the health implications of self-medication. This would bridge the gap in knowledge on self-medication within the area.

1.2 Statement of problem
Self-medication put patients at serious risks which could cause major public health issues of drug resistance. Rising pathogen resistance to drugs and antibiotics, resulting from self-medication, remains a real issue of global concern (Awad et al., 2015). Regardless of public awareness and concern of health care providers/professionals, irrational use of antibiotics is increasing ranging from about 50% to almost a 100% (Gaash, 2009, Filho et al., 2014, Zafar et al., 2009). Fake drugs and medicines have worsened self–medication due to the easy access of fake drugs and medications. Counterfeiting of drugs was first mentioned at the WHO conference of professionals held in Nairobi in 1985 (WHO, 2015). Self-medication with antibiotics has been identified with late diagnosis of different conditions and this affects the result of the treatment process. It has been estimated that about 70% to 80% of cervical cancer cases are diagnosed at late stages (MOH, 2013) resulting from delay as patients treat themselves personally in light of getting better. A study conducted in France by Buccellato (2011) showed that the risk of negative reactions (17.6%) can be intense and result in hospitalization. More so, out of about 89% of university student nurses in Turkey who were well aware that self-medication was unhealthy, about 45% of them still practiced it (Buke et al., 2015). Similarly, about 87% of the university student nurses were indulging in self-medication with antibiotics in Karachi, Pakistan despite having awareness of the dangers of self-medication (Zafar et al., 2009). 42% of the participants were also aware of the fact that self-medication with antibiotics might cause negative effects.
The inherent risks of self-medication include drug resistance, inappropriate self-diagnosis, delays in seeking medical advice as at when needed, intense negative reactions, dangerous drug interactions, inappropriate manner of administration, wrong dosage, wrong choice of therapy (Talevi, 2010) and risk of over-dependence as well as abuse (Chalker, 2011). Excessive and wrong use of antibiotics has led to recurring infections and high emergence of antibiotic resistance which is a global issue with a strong impact on disease and death rates (Shubha, Savkar, and Manjunath, 2013) Therefore, self–medication when frequent, has many risks to the individual and causes a large social burden in terms of public health work and rise of drug resistance. More so, drugs used as home palliatives may be fake with difference in quality and wrong doses (Fadara and Tamuno, 2011). Infections are often self-medicated with antibiotics which could sometimes be inappropriately dosed. While this may provide some quick relief of some symptoms, it may hide some other symptoms which are latently present, and can cause resistance, complications and other negative side effects of long-term use of the antibiotics (Souza, 2011). It is against this background that this study was carried out.

1.3 Objectives of the study
The broad objective of this study is to assess the knowledge of risk factors of self-medication among student nursesin the University of Nigeria, NsukkaEnugu State. Specifically, this study seeks to;
1. To establish the prevalence of self-medication among student nurses of University of Nigeria, Nsukka, Enugu State
2. To determine the risk factors associated with the occurrence of self-medication among student nurses of University of Nigeria, Nsukka, Enugu State
3. To determine the drugs and antibiotics used in self-medication among student nurses of University of Nigeria, Nsukka, Enugu State
4. To determine the awareness level of health implications of self-medication among student nurses of University of Nigeria, Nsukka, Enugu State

1.4 Research questions
The research questions which guide the study were formulated as follows;
1. What is the prevalence of self-medication among student nurses of University of Nigeria, Nsukka, Enugu State?
2. What are the risk factors associated with the occurrence of self-medication among student nurses of University of Nigeria, Nsukka, Enugu State?
3. What drugs and antibiotics are used in self-medication among student nurses of University of Nigeria, Nsukka, Enugu State?
4. What is the awareness level of health implications of self-medication among student nurses of University of Nigeria, Nsukka, Enugu State

1.5 Hypothesis
HO1: Self-medication is not prevalent among student nurses of University of Nigeria, Nsukka, Enugu State
HO2: There are no risk factors associated with the occurrence of self-medication among student nurses of University of Nigeria, Nsukka, Enugu State

1.6 Significance of the study
The findings of this study will bridge the research and knowledge gap through the information provided that would be found useful for policy developers and administrators. The study shows the prevalence of self-medication among student nurses, especially with antibiotics. The Health institutions can use the results of this study as a basis for developing new strategies for community mobilization and training of health providers and workers and also to implement effective intervention and control measures. The public can also use the information to educate themselves on dangers of self-medication and employ the appropriate strategies to create awareness that would cause a change in behaviour and eventually reduce the rate of self-medication.

1.7 Scope of study
The focus of this study is to assess the knowledge of risk factors of self-medication among student nursesin the University of Nigeria, NsukkaEnugu State. Variable considered were the prevalence of self-medication among student nurses, the risk factors associated with the occurrence of self-medication among student nurses, the drug types and antibiotic types used in self-medication among student nurses, and the awareness level of health implications of self-medication. This guided the study with the target of Universitystudent nurses in Enugu state, with the case study being University of Nigeria, Nsukka.

1.8 Limitations of the study
The paucity of literature in this area of study was compensated by some relevant literatures from related studies. The researcher encountered some limitations among the student nurses. Some of the respondents were reluctant to fill the questionnaire because they did not fully understand the questionnaire; hence, the researcher spent more time explaining the questions in simple terms to ensure fill participation of all the respondents. The researcher also incurred financial expenses in the process of carrying out the data collection and distribution of the research instruments. Lastly, the study was limited in scope in the terms of the area of the study. This study was limited to student nurses of University of Nigeria, Nsukka in Enugu State.

1.9 Operational definition of terms
SELF-MEDICATION is a human behavior in which an individual uses a substance or any exogenous influence to self-administer treatment for physical or psychological ailments. The most widely self-medicated substances are over-the-counter drugs used to treat common health issues at home, as well as dietary supplements.
RISK FACTOR, a risk factor or determinant is a variable associated with an increased risk of disease, infection or condition.
Student is primarily a person enrolled in a school or other educational institution who attends classes in a course to attain the appropriate level of mastery of a subject under the guidance of an instructor and who devotes time outside class to do whatever activities the instructor assigns that are necessary. In this case, student nurses enrolled in University of Nigeria, Nsukka, Enugu State.

1.10 Organization of the Study
This study is organized into five chapters. Chapter one included the background of the study, research problem, research objectives and questions as well as limitation of the study. Chapter two contains the literature review. Chapter three includes the methodology and study area. Chapter Four contains the results and discussion of key findings of the study. Chapter Five finally looks at the summary, conclusions, and recommendations based on the findings.