Knowledge, use (misuse) and perceptions of over-the-counter analgesics in sub-Saharan Africa: a scoping review

ABSTRACT

Background

Over-the-counter (OTC) analgesics are safe for pain-management when used as recommended. Misuse can increase the risk of hypertension and gastrointestinal problems.

Objective

To conduct a scoping review of the uses and misuses of OTC analgesics in sub-Saharan Africa, to inform strategies for correct use.

Method

Following guidelines for conducting a scoping review, we systematically searched Pubmed, ResearchGate and Google Scholar databases for published articles on OTC analgesic drug use in sub-Saharan Africa, without restrictions on publication year or language. Search terms were ‘analgesics’, ‘non-prescription drugs’, ‘use or dependence or patterns or misuse or abuse’ and ‘sub-Saharan Africa’. Articles focusing on prescription drugs were excluded.

Results

Of 1381 articles identified, 35 papers from 13 countries were eligible for inclusion. Most were quantitative cross-sectional studies, two were mixed-methods studies, and one used qualitative methods only. About half (n = 17) the studies recorded prevalence of OTC drug use above 70%, including non-analgesics. Headache and fever were the most common ailments for which OTC drugs were taken. Primary sources of OTC drugs were pharmacy and drug shops, and family, friends and relatives as well as leftover drugs from previous treatment. The main reasons for OTC drug use were challenges in health service access, perception of illness as minor, and knowledge gained from treating a previous illness. Information regarding self-medication came from family, friends and neighbours, pharmacies and reading leaflets either distributed in the community or at institutions of learning. OTC drug use tended to be more commonly reported among females, those with an education lower than secondary level, and participants aged ≥50 years.

Conclusion

Self-medicating with OTC drugs including analgesics is prevalent in sub-Saharan Africa. However, literature on reasons for this, and misuse, is limited. Research is needed to educate providers and the public on safe use of OTC drugs.

KEYWORDS:

• Over the counter
• analgesics
• self-care
• self-medication
• Sub-Saharan Africa
• non-prescription drugs

Responsible Editor

Jennifer Stewart Williams

Responsible Editor

Jennifer Stewart Williams

Acknowledgments

We are grateful for the support of Dr Hannah Whiteman, Head of Strategic Research and Kate Perris from Library and Archive Service, at the London School of Hygiene and Tropical Medicine, for their help and support and Dr Nothando Ngwenya (AHRI) and Dr Agnes Ssali (MRC/UVRI&LSHTM) for their contributions to the design of this study.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Ethics and consent

N/A

Paper context

There is limited research on the use and misuse of OTC analgesics in low-income settings. We conducted the first scoping review on OTC analgesic use in sub-Saharan Africa, and found high prevalence of self-medication. This is likely to be due to ease of access and challenges accessing formal health care. Further research, including studies using qualitative methods, are needed to help understand patterns of use and misuse of OTC analgesics in the region, to inform policies to promote responsible use.

Additional information

Funding

This study was funded by the Institutional Strategic Support Fund (ISSF3), a Wellcome Trust Initiative, at the London School of Hygiene and Tropical Medicine.

Notes on contributors

Rachel Kawuma

RK and RSC undertook the review of all papers. HAW, SCF and JS provided advice and support during the review and analysis process. HAW, SCF and JS reviewed all drafts of the paper produced by RK and RSC. All authors approved the final version of the paper.