key: cord-0289476-j7vhyikz authors: Sujan, M. S. H.; Haghighathoseini, A.; Tasnim, R.; Islam, M. S.; Salauddin, S. M.; Hasan, M. M.; Uddin, M. R. title: Self-medication practices and associated factors among COVID-19 recovered patients to prevent future infections: A web-based survey in Bangladesh date: 2022-05-19 journal: nan DOI: 10.1101/2022.05.14.22275075 sha: 409d4abdc1dbbde916f2bee8e3b2354a3bd0244a doc_id: 289476 cord_uid: j7vhyikz Background: Human health is largely affected by self-medication in both ways, adversely and favorably, as evidenced by the COVID-19 pandemic. The fear of spreading COVID-19 among health workers and hospital environments has led many Bangladeshi people to practice self-medicate for as a preventive strategy against this disease. Consequently, this practice entails an improper and injudicious use of medicine to cure self-recognized symptoms. To date, the COVID-19 has no effective treatment. The lack of a cure for COVID-19 and the continual progression of the diseases in educational settings induce a substantial population to practice self-medication. Therefore a study of self-medication practices is necessary for the framework of the pandemic. This study aimed to estimate the prevalence and factors associated with self-medication to prevent or manage future COVID-19 infections among recovered COVID-19 patients. Methods: This cross-sectional study was conducted from September 2020 to February 2021 using an e-survey along with 360 participants. Data were collected using a pre-tested self-reported questionnaire. Descriptive statistics and correlations analysis were performed in the study.Results: Among 360 participants, males were 69.7% , and females 30.3%. The prevalence of self-medication is 11%, and monthly family income, residence, education, occupation, and previous history of SM are the associated factors. Among the participants, 29.7% use antibiotics, and 30% use herbal products or drugs as medication. Conclusion: The present study found SMP is moderately prevalent among COVID-19 recovered patients. To minimize the rate of SMP, adequate health care access systems and public education should be introduced, and media & community should be engaged in rational use of medication. The COVID-19 pandemic has sparked a global lockdown, leaving people with the impression that their only option is self-help, self-care, and self-medication (1). This preventive measures for COVID-19 has also been seen in this country (3) . However, lack of swift response, shortage of hospital beds, lack of medical clinics, insufficient test capability (qRT-PCR), (4) the proliferation of unauthenticated treatment procedures placed people in a dilemma to choose professional care. However, people who are seeking suitable measures to fight the virus, especially people who had already developed some symptoms similar to COVID-19 or recovered from it may get influenced by the COVID-19 related infodemic. Additionally, a substantial number of recovered COVID-19 patients keep practicing it to prevent or manage future infections with the same medicine they used to treat themselves earlier or known to be effective in preventing COVID-19 (5) . Consequently, the practice of self-medication among the general public is increasing (6) . While in low or middle-income countries, including Bangladesh, the incidence of selfmedication may be greater without consultation with trained healthcare professionals (7). Self-medication (SM), as defined by the WHO, means the selection and use of medicines to treat self-recognized symptoms or disorders without consulting a doctor (8) . Also, the use or reuse of previously prescribed or unused medications, direct drug purchases without consultation, and inappropriate medication of over-the-counter (OTC) drugs are often included (9) . SM is a significant global problem affecting developing and developed countries (10) . Different studies show that SM is a widespread practice with a worldwide prevalence of 32.5-81.5% (11) . SM is widespread but dangerous approach to the management of illnesses that can lead to severe illness, delays in the diagnosis of medical disorders, or enhance the risk of complications (12) . The probable reason for extravagance in SM in this country includes past treatment experience with the same symptoms, readily drug availability, halted accessibility to healthcare facilities, socio-cultural or religious values, comparatively high hospital treatment rates, suggestions from friends/family/media (7), ignorance behavior and poverty. In addition, the doctor-patient ratio in Bangladesh is currently as low as it puts the country second from the bottom, among South Asian countries, according to the WHO (13) . The socio-economic disparity among people and feeling of helplessness during this pandemic has further increased the unequal access to healthcare since early 2020 (14) . Due to frequent symptoms of pain or soreness of the throat, dry cough, severe headache, fever, fatigue, muscle aches, or breathlessness, people started taking the medication without COVID-19 diagnoses or tests (7) . Moreover, people diagnosed with COVID-19 are also doing so during the early stages of COVID-19, hoping that the symptoms will not be developed into severe illness. Furthermore, individuals who recovered from it also demonstrated the practice of self-medication to mitigate post-COVID-19 complications. However, arbitrary use of medicaments can have several risks and side effects, including poisoning, misdiagnosis, medication error (ME) (15) , adverse drug reactions (16), endorse drug . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted May 19, 2022. ; https://doi.org/10.1101/2022.05.14.22275075 doi: medRxiv preprint addiction, promoting drug toxicity, increasing pathogens resistance (12) , potentially lifethreatening adverse effects, inappropriate dosage, and unreasonable drug use may even lead to death (17) . Although, 0.1% of self-medication-related complications will be tons in number, that would be challenging to deal with for the current health care system, which is currently battling against COVID-19. However, researchers anticipated that the practice of SM among COVID-19 infected and recovered patients, as well as mass people, will be substantially high following the pandemic (1), (Onchonga, Omwoyo, and Nyamamba 2020) . Therefore, the present study aimed to investigate the prevalence and associated factors of self-medication practice among COVID-19 recovered patients to prevent or manage future infections of it. A cross-sectional e-survey was conducted from September 2020 to February 2021. A purposive sampling technique was utilized in this study. The study took each participant about 10-12 minutes to complete the entire survey. At first, 402 people took part in the study. After deleting incomplete responses and participants who replied but did not infect with COVID-19, 360 responses were included in the final analysis. A self-reported questionnaire developed in Bangla (the participant's native language) was utilized to collect data during the study. Following the completion of all questions in the Google Form, a shareable link was provided. The survey link was shared on several community-based online forums to elicit replies from individuals who had recovered from COVID-19. . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted May 19, 2022. ; https://doi.org/10.1101/2022.05.14.22275075 doi: medRxiv preprint A pilot test was conducted with 35 participants within the same population (target group) to check the questionnaire's acceptability, validity, and transparency before moving on to the next phase. Minor changes were made to the questionnaire after the pilot testing. Those questions with responses were not included in the final analysis. An informed consent statement outlining the purpose and process and the right to refuse participation in the study was attached to the first page of the questionnaire. Individuals were requested to obtain written informed permission before being asked, "Are you willing to take part in this study voluntarily and spontaneously?" A blank survey form was automatically submitted if the person replied 'no'. If the person replied 'Yes,' he/she was allowed access to the full form of the survey. In the study, the exclusion criteria for participation were individuals below 18 years old, with no COVID-19 infection confirmation, and severe psychological problems (as this can cause memory biases). In the present study, socio-demographic information was collected by asking questions about sex (male/female), age (younger adults >18-39 years, middle-aged >40 years), residence (rural/urban), occupation (unemployed/employed), education (tertiary/equal or below secondary), smoking habit (yes/no). Depending on their monthly total family income in Measures related to self-medication were obtained from previous studies (2) , (20) as well as by asking questions as follows: "What was your Action after identifying the symptoms of COVID-. CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted May 19, 2022. 19?" (Waiting for cure/ Consulting with doctor/ Self-medication), "Do you have health care professionals in family members?" (yes/no), "Do you have the Previous history of selfmedication?" (yes/no), "Do you think self-medication is harmful?" (yes/no), "Prescription of medication given by? " (Myself/Physician/Specialist), "Knowledge on self-medication? " (Sufficient/Insufficient), " Self-medicating medicine?" (Antibiotic/ Doxycycline/ dexamethasone/ Ivermectin/Favipiravir), "Do you use Herbal products/drugs for treatment?" (yes/no), "What was your reason to practice self-medication ?" (Familiar medicine/ Mild symptoms/ To save time/Readily available/ To get the quick result/Financial crisis). Microsoft Excel 2019 and IBM SPSS Statistics version 25 were used to analyze the data. Microsoft Excel is used to clean, code, and sort data. SPSS software was used to perform descriptive statistics (e.g., frequencies, percentages, means, standard deviations, and so on). For the regression analysis, a p-value of less than 0.05 was considered significant. The study was conducted following the Institutional Research Ethics and Human Involvement Guidelines (Helsinki declaration). The Ethical Review Committee gave their approval for the study. Formal ethical approval was granted from Ethical Review Committee, Jahangirnagar University [BBEC, JU/M/ COVID-19 (7)4]. The purpose of this study, as well as i) the methods and objectives of the current investigation, ii) data confidentiality and anonymity, and iii) the flexibility to withdraw response from the study at any moment, were all documented in the first phase of the questionnaire. . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted May 19, 2022. A total of 360 participants were included in the final analysis. Among them, 69.7% were male and 30.3% were female. believe that self-medication is harmful. The majority of the respondents (30.6%) took paracetamol, and antibiotic (29.7%) to treat their symptoms, and 70% of the respondents didn't take any herbal products/drugs for their treatment. Self-medication was found to be strongly associated with the participants' residence in this study. People living in the rural area (17.8%) score a significantly higher rate of self-medication than people in urban areas, and only 9.7% of urban participants practiced SM. But the age and sex were not significantly associated with self-medication. The previous history of selfmedication was found significantly associated with self-medication. Respondents with prior selfmedication history (21.0%) score higher than respondents with no self-medication history. Moreover, 90.3% of the respondents believe that self-medication is harmful to health and didn't . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted May 19, 2022. self-medicate, and 17.6% of the respondents believe that self-medication is not harmful to health and continued self-medicating themselves. About 83.6% of the respondents practice selfmedication by their own decision, and a large proportion (58.6%) of participants have sufficient self-medication related knowledge. The main causes of self-medication was the familiar medicine for used for previous diseases (35.3%). Among the participants (15.7%) used herbal medicine as alternative medicine, and (35.3%) practice it as the medicine was familiar to them due to previous use, and (12.5%) use it to get quick results. . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted May 19, 2022 The purpose of this study was to estimate the prevalence, causes, and determinants of selfmedication practices for COVID-19 prevention and/or treatment in Bangladesh. Though the world health organization (WHO) recommends self-medication for minor illnesses (2), our study looked into self-medication for perceived COVID-19 prevention/treatment. To the best of our knowledge, this is the first study on the objective of COVID-19 related self-medication practices . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted May 19, 2022. ; https://doi.org/10.1101/2022.05.14.22275075 doi: medRxiv preprint among recovered COVID-19 patients, though there have been previous studies on selfmedication practices other than COVID-19 in Bangladesh and elsewhere. People have long been concerned with their health and have practiced self-medication since ancient times. Although there are numerous advantages and disadvantages of practicing selfmedication, it all relies on who uses it and how it is utilized for self-treatment. While this is undeniable, self-medication without consulting with certified health professionals may be more common in low-and middle-income countries. SMP is common in most sections of Bangladesh, regardless of socioeconomic class or educational attainment (7) . SM may be a low-cost alternative for people in impoverished countries like Bangladesh to avoid the high expense of clinical services and many medications available over the counter (OTC) without a prescription (21) . However, to the best of the author's knowledge, there is no current evidence on the prevalence of SMP among COVID-19 recovered patients in Bangladesh. In addition, there is a dearth of knowledge globally regarding this issue. However, in this study, we focused on self-medication practices among COVID-19 recovered patients in Bangladesh to estimate the prevalence of self-medication practices and the factors associated with them. This study found 11% self-medication practice among COVID-19 recovered patients, which is much less than a couple of studies previously conducted in Bangladesh among general populations (12), (7), among rural and urban people in India (22), (23) , among general populations in Pakistan (24) , in general resident in China (25), among health science students in Iran (26) , and among school students parents in Italy (27) . The prevalence is less than those studies may be because of different study settings, time, and target groups. Additionally, the present study conducted among the COVID-19 recovered patients who practiced SM to prevent or manage future infections of COVID-19, this could be another significant cause of low prevalence. As the study was conducted among COVID-19 recovered patients, therefore the patients are exceptionally concerned regarding the disease and many are afraid of practicing SM. Moreover, there was no effective treatment discovered to be practiced which could be another reason. However, according to this study, self-medication practice (SMP) has been found significantly associated with a person's residence, and the prevalence of SMP is higher among people living in the rural area than people living in urban areas. In contrast to a study in Ethiopia that revealed . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted May 19, 2022. ; https://doi.org/10.1101/2022.05.14.22275075 doi: medRxiv preprint that living in a city was strongly associated with self-medication (28) . SMP was shown to be more common among those living in large cities in a similar study in Spain (29) . Another study in rural parts of Portugal found a 21.5% prevalence of SMP among rural people (30) . This may be due to the lower literacy level among individuals living in rural areas. A study found Bangladesh, as one of the world's poorest countries, has extremely low educational attainment, especially among women (31) . Only 9% of boys and 5% of girls finish high school (31) in rural areas. This may be a cause of self-medication as a previous study found a significant association between a father's education and self-medication (32) . People living in rural areas might have to travel long distances and pay a lot of money to visit a doctor (33) , The majority of Bangladesh's rural areas lack a sufficient number of dispensaries, and those that do exist are ineffective due to a shortage of medical personnel and medications during the pandemic. SMP is found among people in lower socioeconomic status in this present study which is in line with a previous study in Tamil Nadu (34) . According to this study, unemployment was found to be significantly associated with self-medication. In contrast to a study in Tamil Nadu, where employed participants had a higher rate of self-medication (34) . Many residents in rural districts rely on daily wages to supplement their income because they commute to the city every day but due to COVID-19 lockdown, thousands of people lost their jobs and suffered from financial crisis to consult a doctor because of the high cost of medical consultations (35, 36) , these factors may also lead low socioeconomic status people into self-medication. Tertiary education or university graduates has been found to be significantly associated with selfmedication. According to a prior study conducted on adolescents, those with lower medical literacy are more prone to participate in inappropriate self-medication (37) . Another reason could be that educated people are more confident about the effects of medicines and practice it randomly as they believe this would be less harmful. Nonetheless, people who are sick frequently treat themselves, which is likely owing to the human survival instinct. People act on their health every day, all across the world, without consulting competent medical professionals. They make it a habit and a culture to take care of themselves. However, the present study found that SMP was significantly associated with the previous history of self-medication and it is higher among people who suffered from the same illness previously. According to a previous study among Bangladeshi students, the largest proportion . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted May 19, 2022. ; https://doi.org/10.1101/2022.05.14.22275075 doi: medRxiv preprint (38%) of students learned self-medication from an old doctor's prescription to treat present illness (38) . Prior studies in the same country found that previous prescriptions were the most important source of information and the most important factor of self-medication (39) and the pre-experience was one of the main causes for self-medication of antibiotics (40) . The findings that the majority of respondents got information regarding self-medication from previously prescribed medicines by doctors were consistent with research among Brazilian universities (41) . Inappropriate SMP can result from misplaced confidence, and individuals may be exposed to all of the risks involved with self-medication. According to studies from the United States, Asia, and Europe, 22-70% of parents have misconceptions regarding the proper usage and efficacy of antibiotics (40) . However, other factors, such as the opinions of family members, friends, neighbors, and advertisements, may have impacted the responders (39) . The fact that such a large percentage of people self-medicate on their initiative highlights the necessity for health care practitioners to launch an intensive public awareness campaign about the dangers of selfmedication. A further longitudinal study is needed to properly determine the association between self-medication and history of illness. In addition, in this study, we found that majority of the participants were aware of the dangerous effects of self-medication. According to a previous study conducted in the UAE, the majority of respondents (64.1 %) considered self-medication was safe (39) . Another survey found that 47% of participants believe self-medication is a form of self-care that should be encouraged (22) , which aligns with other studies from Ethiopia and Karachi (24, 42) . According to a telephone survey in the USA, 58 % of people were unaware of the potential health risks associated with antibiotic use (43) . SMP has found to be significantly associated with knowledge of an individual given by prescription of medication. In contrast to a prior study among adolescents, participants with lower medication awareness were more prone to engage in inappropriate self-medication (37) . Though, there are several advantages to appropriate self-medication, including rising patient access to medication and relief, the patient's prominent participation in their health care, improved use of physicians' and pharmacists' skills, and lowered (or at least optimized) government burden due to health expenditure in this pandemic associated to the treatment of minor health conditions (44) . However, Self-medication, on the other hand, is far from being a . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted May 19, 2022. ; https://doi.org/10.1101/2022.05.14.22275075 doi: medRxiv preprint perfectly safe activity, especially in the event of irresponsible self-medication. Erroneous selfdiagnosis, postponement in seeking medical advice when needed, occasional but severe adverse reactions, dangerous drug interactions, incorrect method of administration, wrong medication, inappropriate preference of treatment, masking of severe disease, and the risk of dependence and abuse are all potential risks of self-medication (44) . Government officials should keep a careful eye on the rules and regulations governing the sale of pharmaceuticals from pharmacies. To adequately educate people about the adverse effects of self-medication, a holistic approach should be used, including sufficient awareness and education on self-medication and stricter regulations on pharmaceutical advertising. These programs might be conducted online due to pandemic-related restrictions. The World Health Organization (WHO) and epidemiologists from many countries have anticipated that the COVID-19 pandemic will last for years and have a significant socioeconomic and psychosocial influence on people's lifestyles and behavior. Without appropriate scientific proof, a variety of medicines were utilized to treat respiratory and COVID-19-related symptoms. Antibiotics and paracetamol were the most commonly used pharmaceuticals, while Doxycycline, dexamethasone, Ivermectin, Favipiravir, and even traditional treatments were widely used. They were used as COVID-19 preventives to treat suspected symptoms, and even after a positive COVID-19 diagnosis. This study may provide information to health educators, planners, and other health professionals that will aid in the reduction of SM and the promotion of positive and responsible medicine. A comprehensive nationwide survey and surveillance of mass population self-medication should be conducted to safeguard them from potential hazards, overuse shortages, and unjustified financial engagement during the COVID19 outbreak. There is no study outside constraints, and this study has some limitations as well. Firstly, the study was cross-sectional in its nature, therefore, the causality of factors could not be established. In this regard, a longitudinal study is required to better understand the practice of self-medication among COVID-19 recovered patients. Secondly, the study employed an online-based selfreporting method, which could have been influenced by a variety of biases, including perceived benefits and episodic memory biases. Thirdly, due to the inflexibility of reaching out to persons . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted May 19, 2022. ; https://doi.org/10.1101/2022.05.14.22275075 doi: medRxiv preprint who had recovered from COVID-19 and their refusal to engage in this study freely, the study enrolled only a few participants. SMP has become a significant public health concern in Bangladesh, particularly during the COVID-19 pandemic. This study revealed a considerable number of COVID-19 recovered patients who practiced self-medication to prevent or manage the future occurrence of COVID-19. One in every eleven participants who recovered from COVID-19 practice self-medication. It is necessary to maintain constant knowledge and sensitization about the dangers of selfmedication. Our findings should be viewed with caution and should not be construed as a piece of advice to self-medicate or to use these medications in the hopes of improving symptomatology. Before taking any medication, always seek medical advice and consultation. We anticipate that these findings will help healthcare policymakers make better decisions about how to improve pharmaceutical care and save lives. 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The authors did not receive any financial support from any public/private organizations or other funding agencies for this study. The data that support the fndings of the current study are available from the corresponding author upon reasonable request. All authors declare that they have no potential conflict of interest in the dissemination of the study's findings.