Self-medication practice in Ethiopia: a systematic review

Figures & data

Figure 1 Flow diagram of study selection.

Table 1 Study characteristics

Study	Area	Subjects	Design	Sample size	Sampling technique
Abay and Amelo^Citation71	Gondar University, northwest Ethiopia	Medical, pharmacy, and health science students	Cross-sectional	414 students	Stratified sampling followed by random sampling
Tenaw and Tsige^Citation73	Addis Ababa, central Ethiopia	Customers of community pharmacies	Cross-sectional	918 respondents from 24 community pharmacies	Multistage stratified sampling followed by convenience sampling
Worku and Mariam^Citation10	Jimma, southwest Ethiopia	Residents of Jimma town	Community-based cross-sectional survey	352 respondents	Systematic random sampling
Ararsa and Bekele^Citation74	Jimma, southwest Ethiopia	Private pharmacy clients	Community-based cross sectional study	398 clients	Systematic random sampling
Befekadu et al^Citation68	Jimma University Specialized Hospital, Jimma, southwest Ethiopia	Pregnant women attending antenatal care	Hospital-based cross- sectional study	315 pregnant women	Random sampling
Jaleta et al^Citation75	Sire town, west Ethiopia	Inhabitants of Sire town	Community based cross-sectional study	423 households	Systematic random sampling
Abrha et al^Citation76	Kolladiba town, northwest Ethiopia	Heads of households	Community based cross-sectional study	261 respondents	Systematic random sampling
Eticha and Mesfin^Citation6	Mekelle, north Ethiopia	People who came to community pharmacies for self-medication	Cross-sectional study	270 clients	Convenience sampling
Mossa et al^Citation13	Worabe town of Silte Zone, south Ethiopia	Residents of Worabe town	Community-based cross-sectional survey	405 households	Multistage stratified sampling followed by random sampling
Bekele et al^Citation70	Arsi University, Asella	Health science students	Cross-sectional study	548 students	Stratified sampling followed by random sampling
Mihretie^Citation15	Bahir Dar, northwest Ethiopia	Urban dwellers of Bahir Dar town	Community-based cross-sectional survey	595 households	Two-stage cluster sampling followed by random sampling
Abeje et al^Citation69	Bahir Dar, northwest Ethiopia	Pregnant mothers attending antenatal care	Institution-based cross-sectional study	510 pregnant women	Multistage stratified sampling followed by systematic random sampling
Deressa et al^Citation77	Butajira, southern Ethiopia	Rural communities of Butajira	Cross-sectional study	630 households with malaria cases	Simple random sampling
Sado and Gedif^Citation78	Nekemte town and surrounding rural areas, western Ethiopia	Household heads	Cross-sectional study	820 household heads	Cluster sampling followed by systematic random sampling
Hailemichael et al^Citation72	Harar, eastern Ethiopia	Harar Health Sciences College students	Institution-based cross-sectional study	237 students	Two-step stratified sampling followed by simple random sampling techniques
Angamo and Wabe^Citation5	Jimma, southwest Ethiopia	Medical sciences students in Jimma University	Cross-sectional study	403 students	Random sampling
Gutema et al^Citation11	Mekelle, north Ethiopia	Health sciences students of Mekelle University	Cross-sectional study	283 students	Two-stage stratified random sampling methods
Ali et al^Citation79	Addis Ababa, central Ethiopia	Private pharmacy customers seeking self- medication	Cross-sectional survey (quantitative and qualitative)	400 clients	NR
Suleman et al^Citation80	Asendabo, southwest Ethiopia	Residents of Asendabo town	Community-based cross-sectional study	1,257 individuals (242 households)	Systematic random sampling
Gedif^Citation81	Butajira, southern Ethiopia	Residents of Butajira town	Community-based cross-sectional study	4,861 households	Random sampling
Abula and Worku^Citation2	Gondar, Kolladuba, and Debark towns, northwest Ethiopia	Residents of Gondar, Kolladuba, and Debark towns	Community-based cross-sectional survey	10,170 individuals (1,880 households)	Systematic random sampling

Abbreviation: NR, not reported.

Table 2 Prevalence of self-medication

Study	Subjects	Recall period	Prevalence of self-medication in those who faced an illness
Abay and Amelo^Citation71	Medical, pharmacy, and health science students	2 months	38.5%
Worku and Mariam^Citation10	Residents of Jimma town	1 month	27.6%
Befekadu et al^Citation68	Pregnant women attending antenatal care	During current pregnancy	20.1%
Jaleta et al^Citation75	Inhabitants of Sire town	2 weeks	27.16%
Abrha et al^Citation76	Head of households	2 weeks	62.8%
Mossa et al^Citation13	Residents of Worabe town	3 months	16.9%
Bekele et al^Citation70	Health science students	3 months	77.1%
Mihretie^Citation15	Urban dwellers of Bahir Dar town	2 weeks	12.8%
Abeje et al^Citation69	Pregnant mothers attending antenatal care	During the current pregnancy	36%
Sado and Gedif^Citation78	Household heads	1 month	35%
Hailemichael et al^Citation72	Harar Health Sciences College students	NR	62%
Angamo and Wabe^Citation5	Medical sciences students in Jimma University	2 months	45.89%
Gutema et al^Citation11	Health Sciences students of Mekelle University	3 months	43.24%
Suleman et al^Citation80	Residents of Asendabo town	2 weeks	39%
Gedif^Citation81	Residents of Butajira town	2 weeks	17%
Abula and Worku^Citation2	Residents of Gondar, Kolladuba, and Debark towns	2 weeks	27.5%

Abbreviation: NR, not reported.

Table 3 Common illnesses leading to self-medication, reasons to practice self-medication, and factors associated with self-medication

Study	Illnesses	Reasons	Factors
Abay and Amelo^Citation71	Fever and headache 24.8% Respiratory diseases 23.9% Gastrointestinal tract diseases 13.2% Diarrhea 8.9% Malaria 6.1% Pneumonia 6.1% Constipation 5.6% Eye disease 3.8%	Prior experience 35.4% Minor illness 30.5% Less costly 9.8% Emergency use 15.8%	Year of study (in which prevalence of self-medication increases)
Tenaw and Tsige^Citation73	Gastrointestinal 25.1% Headache/fever 24.9% Respiratory problems 21.4% Skin diseases/injuries 8.4% Eye infections/inflammations 7.1% Sexually transmitted diseases 2.6%	Minor illness 36.6% Emergency use 19.8% Prior experience 18.2% Less costly 12.6% For prevention of illness 11.2%	NR
Worku and Mariam^Citation10	Headache 13.2% Fever 21.7% Cough 21.7% Diarrhea 6.5% Abdominal pain 10.5% Dyspnea 1.3%	Less costly 35.7% Minor illness 33.3% Less waiting time 19.1% Prior experience 9.5%	NR
Ararsa and Bekele^Citation74	NR	Previous experience 30.16% Less costly 31.75% Minor illness 25.4% Emergency 6.35%	NR
Befekadu et al^Citation68	Cough 13.1% Typhoid 14.8% Headache 47.5% Common cold 1.6% Diarrhea 3.3% Anemia 13.1% Asthma 6.6%	Time-saving 44.3% Easily available 57.4% Know about drug and illness 13.2%	Self-medication experience (P=0.001) Maternal education (P=0.03) Age of respondents (P=0.005) Number of children (P=0.001) Place of residence (P=0.007)
Jaleta et al^Citation75	Headache 10.29% Fever 5.35% Cough or common cold 3.29% Diarrhea 3.29%	Less costly 31.82% Emergency use 22.73% Previous experiences 13.64%	No significant association
Abrha et al^Citation76	Headache or fever 30.9% Respiratory tract infection 23.2% Gastrointestinal disease 21.8% Malaria 8.7%	Less costly 44.5% Minor illness 31.1% Remoteness of health care facilities 1.2% Repetitiveness of symptoms 11.6% To save time 4.3% No benefit from modern health care 7.3%	NR
Eticha and Mesfin^Citation6	Headache or fever 20.7% Gastrointestinal disease 17.3% Respiratory tract infection 15.9% Eye disease 14% Skin disease/injury 13.1% Dysmenorrhea 11.3%	Emergency use 17% Minor illness 21.7% Prevention of illness 16.9% Prior experience 20.7% Less costly 20.2%	NR
Mossa et al^Citation13	Headache 38.5% Fever 35.9% Cough 14.1% Diarrhea 10.2% Abdominal pain 10.2% Joint and back pain 35.9% Nausea and vomiting 8.5%	Less costly 7.7% Minor illness 19.2% Avoiding waiting time 33.3% Distance of health facility 9% Emergency case 16.7%	Monthly income (P=0.006) (the higher the income, the more self-medication practice) Level of education (P=0.000) (self-medication practice increases as the level of education increases)
Bekele et al^Citation70	Headache/fever 56.5% Gastrointestinal disease 34.1% Respiratory tract infection 31.8% Eye disease 22.4% Skin diseases or injury 17.4% Sexually transmitted disease 10.4% Maternal/menstrual 29.2%	Disease not serious 44.1% Poor quality of service 27.1% Emergency use 24.7% Prior experience 23.4% Took pharmacology course 21.1% Saves time 20.3% Less expensive 19.4%	Sex (female) Field of study (midwives) Positive attitude for self-medication
Mihretie^Citation15	Respiratory tract disease 58.8% Diarrhea 41.2% Fever 17.6% Headache 11.8% Gastrointestinal tract disease 5.9%	Previous experience 82.2% Minor problem 17% Less costly 11.8% Emergency use 5.9%	No significant associations
Abeje et al^Citation69	NR	Less costly 6.25% Minor illness 22.6% Saves time 11.7% Prior experience 48.4%	Gravida (multigravida) (P<0.05) Maternal illness (current illness) (P<0.05) Location of antenatal care service (rural) (P<0.05)
Deressa et al^Citation77	Malaria 100% (study done on self-treatment of malaria only)	Prior experience 50.9% Less costly 23.6% Saves time 10.9% Peer influence 5.5% Minor illness 1.8% Dissatisfaction with health services 1.8%	NR
Hailemichael et al^Citation72	Headache or mild pain 47.3% Gastrointestinal problems 30.8% Eye and ear symptoms 29.1% Vomiting 6.3%	Knowledge about the disease/drug 37% Time-saving 29% Less costly 19% Increase in confidence 19%	Student’s year of study (as study year increased, prevalence of self-medication increased)
Angamo and Wabe^Citation5	Headache 36.85% Abdominal pain 30.55% Cough 23.16% Fever 6.32%	Prior experience 46.32% Minor illness 25.26% Time-saving 24.21% Low cost 4.21%	NR
Gutema et al^Citation11	Headache 51.56% Cough and common cold 44.8% Dysmenorrhea (painful menses) 20.3% Dyspepsia/heartburn 17.2% Fever 14.1% Diarrhea 10.9% Constipation 9.4% Cough and chest pain (like pneumonia) 7.8% Skin problems 3.13%	Prior experience 39.1% Mildness of illness 37.5% Time-saving 15.6% Less costly 4.7% Lack of interest in medical services 1.56%	Sex (female) Specific field of study (pharmacy students practiced self-medication more frequently than medical and other paramedical students) Study year (increases with year of study)
Ali et al^Citation79	Respiratory symptoms 22.8% Gastrointestinal symptoms 18% Abdominal pain 17%	Prior experience 61.8% Advised by pharmacists 24.8% Others use for similar cases 18.3% Know about it 12.3%	NR
Suleman et al^Citation80	Fever 40.6% Headache 23.1% Cough and cold 11.2% Eye disease 4.2% Gastric pain 4.2% Diarrhea 3.5% Abdominal pain 2.1%	Less costly 10.7% Minor illness 41.1% Saves time 12.5% Remoteness of health care facility 12.5% Low quality of modern health care 23.2%	NR
Gedif^Citation81	Headache 22.1% Fever 20.8% Diarrhea 10.3% Malaria 9% Eye disease 8.7% Respiratory tract complaints 8.4%	Minor illness 25.2% Prior experience 23.5% Neighbors/relatives recommend 20% Less costly 11.3%	Ethnicity (Meskan subgroup)
Abula and Worku^Citation2	Cough and cold 23.9% Fever 9.5% Headache 8.5% Gastric pain 8.3% Diarrhea 5.6% Eye disease 5.4%	Less costly 37.4% Minor illness 29.9% Saves time 14.8% Less benefit from health institution 13.6% Remoteness of modern health care 4.3%	NR

Abbreviation: NR, not reported.

Table 4 Drugs used in self-medication, where they are obtained, and who suggests their use

Study	Drugs	Source	Suggested by
Abay and Amelo^Citation71	Paracetamol 46.3% Analgesics 24.4% Antacids 12.2% Anthelmintics 10.9% Antibiotics 4.8% Antimalarials 3.7%	Pharmacy or drug shop 72% Friends 5.9% Drugs left over from prior use 3.6% Home remedies 8.5%	Reading material 30.5% Advice from pharmacist 25.6% Advice from friend 19.5% Advice from clinician without prescription 13.4% Advice from traditional healers 3.7%
Tenaw and Tsige^Citation73	Analgesics/antipyretics 33.1% Antimicrobials 26.4% Gastrointestinal drugs 17.7% Respiratory drugs 9.7% Oral rehydration salts 0.6%	DROs (study subjects those who came to community pharmacies)	Clinicians, but without formal prescriptions 39% Friends, relatives, or neighbors 23.5% Pharmacy professionals 15.4% Labels, leaflets, or promotional materials 20%
Worku and Mariam^Citation10	NR	DROs 52.4% Open market 19% Left over from past prescription 11% Neighbor 9.6% Kiosk 7.1%	NR
Ararsa and Bekele^Citation74	Analgesics/antipyretics 28.94% Antimicrobials 28.13% Anthelmintics 17.56% Gastrointestinal drugs 15.2%	DROs (study subjects those who came to community pharmacies)	Drug outlets 48.2% Previous experience 30.52% Other health professional 11.25% Friend 6.83%
Befekadu et al^Citation68	Paracetamol 41% Aspirin 14.7% Chloramphenicol 13.1% Iron 11.5% Tetracycline 4.9% Amoxicillin 6.6% Cough syrup 9.8% salbutamol 6.6%	Private drug-retail outlets 85.2% Neighbors/friend 19.1% Shops 14.8%	Client 39.3% Pharmacist/druggist 34.4% Husband 18% Neighbor 4.9%
Jaleta et al^Citation75	Analgesics 40.96% Antibiotics 24.1% Traditional medicine 20.48% Antimalarials 4.81% Anthelmintics 3.61%	Drug-retail outlets 84.84% Neighbors 9.09% Left over from past prescription 6.06%	Dispensers 40.48% Previous experience 39.29% Health professional other than dispensers 10.71% Neighbors 9.52%
Abrha et al^Citation76	Analgesics/antipyretics 34.1% Antibiotics 24.7% Gastrointestinal drugs 22.4% Antimalarial drugs 8.2%	Drug vendor and pharmacy 69.5% Shops 16.5% Leftover drugs from previous illness 8.1% Neighbors and relatives 5.9%	NR
Eticha and Mesfin^Citation6	Analgesics/antipyretics 20.8% Gastrointestinal drugs 17.5% Respiratory drugs 14.9% Oral rehydration salts 14.2% Vitamins 11.1% Antimicrobials 8.4%	NR	Pharmacy professionals 22.9% Clinicians without formal prescriptions 20.6% Friends, neighbors, or relatives 18.5% Labels, leaflets, or promotional materials 12.8% Traditional healers 12.5%
Mossa et al^Citation13	Antibiotics 61.53% Antimalarials 38.02% Traditional medicine 26.92%	Neighbors 5.1% Left over from past prescription 7.7% Kiosks 17.9% Drug-retail outlet 59%	NR
Bekele et al^Citation70	Antibiotics 59.9% Analgesics/antipyretics 47.8% Gastrointestinal drugs 28.8% Drugs for RTIs 24.7% Vitamins 22.1% ORS 16.7%	Drug-retail outlets 61.5% Shop/supermarkets 29.8% Relatives/friends 24.1% Left over from previous use 19.1%	Own experience 51.5% Pharmacy professionals 32.8% Previous prescription 27.1% Friends 21.4% Family 17.1%
Mihretie^Citation15	Amoxicillin 61.1% Cotrimoxazole 27.8% Ampicillin 11.1% Ciprofloxacin 5.6% This study assessed self-medication practices with antibiotics only	Drug-retail outlet 82.4% Friends or relatives 17.6%	Physician/nurse 11.8% Pharmacist 82.4% Friends or relatives 17.6% Reading 11.8%
Abeje et al^Citation69	NR	Pharmacy/drug shop 56.2% Leftover drugs 16.4% Friends/relatives 4.7% Self-prescribed herbal preparations 30.5% Market areas 2.3%	NR
Deressa et al^Citation77	Chloroquine 54.8% Sulfadoxine–pyrimethamine 43.2% Primaquine 3% (self-treatment of malaria only)	Malaria-control program 47.6% Private clinic 26.8% Health post 20.5% Health center 17.5% Pharmacy 5.9% Health station 2.1% Market or any shop 1.4% Drug shop 1%	NR
Sado and Gedif^Citation78	Antibiotics 33% Anti-inflammatories/analgesics 32% Gastrointestinal tract drugs 17% Cough preparations 2%	NR	NR
Hailemichael et al^Citation72	Antibiotics 47% Painkillers 37% Vitamins and minerals 10% Cough syrup 7%	NR	Previous prescription 33.9% Pharmacist 24.6% Textbooks/internet 21.6% Friends/family 16.9%
Angamo and Wabe^Citation5	Analgesics 49.38% Antimicrobials 35.8% Antacids 7.41%	Drug outlets 92.63% Shops/supermarkets 3.16% Relatives/friends 3.16% Leftover medicines 1.05%	Individual respondents themselves 34.74% Family 27.37% Friends 20.00% Health professionals 17.89%
Gutema et al^Citation11	Paracetamol 48.4% NSAIDs 42.2% Antibiotics 17.2% Cough syrup 12.5% Antacids 7.8% Topical agents 4.7% Herbal remedies 4.7% Anthelmintics 4.7%	Drug-retail outlet 40.63% Friend/relative 15.63% Open market 14.1% Drug leftovers 7.8% Traditional medicine 7.8% Kiosk (small shops) 1.56%	Self-decision 64% Family/friends 31.25% Media and reading material 14.1% Pharmacist/druggist 9.4% Prescribers without prescription 7.8%
Ali et al^Citation79	Antibiotics 35.5% Gastrointestinal medicines 19.3% Respiratory drugs 15.3%	NR	NR
Suleman et al^Citation80	NR	Home remedies 17.5% Drug outlets 5.6% Private clinics 5.6% Shops 4.2% Past prescription leftovers 3.5% Market 2.1% Neighbors 0.7%	NR

Abbreviations: DROs, drug retail outlets; NR, not reported; NSAIDs, nonsteroidal anti-inflammatory drugs; RTIs, respiratory tract infections; ORS, oral rehydration salt.

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