As a library, NLM provides access to scientific literature.

Inclusion in an NLM database

does not imply endorsement of, or agreement with, the contents by NLM or the National
Institutes of Health.
Learn more: PMC Disclaimer | PMC Copyright Notice

Patient Prefer Adherence. 2022; 16: 3157–3172. PMCID: PMC9733564

Published online 2022 Dec 5. doi: 10.2147/PPA.S390058 PMID: 36506105

Self-Medication Prevalence and Factors Associated with Knowledge and Attitude

Towards Self-Medication Among Undergraduate Health Science Students at GAMBY
Medical and Business College, Bahir Dar, Ethiopia
Ebrahim Abdela Siraj, 1 Ashagrachew Tewabe Yayehrad, 1 Abebe Tarekegn Kassaw, 2 Dagmawit Kassahun, 3
Eyerus Solomon, 3 Hadra Abdela, 3 Getasew Gizachew, 3 and Efrem Awoke 3

Abstract

Background

Reports indicate that health science students are among the frontline of self-medication
practitioners. The main objective of this study was to evaluate the self-medication (SM) practice and
associated factors with knowledge and attitude of undergraduate health science students at GAMBY
Medical and Business College, Bahir Dar, Ethiopia.

Methods

An institutional-based cross-sectional quantitative study was conducted using a self-administered

questionnaire from May to July, 2022. A stratified random sampling method was applied to collect
the data. The collected data were checked, and exported into SPSS 26. Descriptive statistics and
regression analysis were performed to determine the results and the associated factors. Variables
with p < 0.05 were regarded as significant.

Results
301 students (31 medicine, 163 pharmacy, and 107 medical laboratory students) responded (99%
response rate). 68.1% of the respondents had practiced SM at least once within the last six months.
58.8% had good knowledge, while 55.5% have a positive attitude towards SM. Headache (33.7%)
and cough (29.8%) were the primary disease conditions for SM. Analgesics (37.1%) and
antimicrobials (29.8%) are most frequently self-consumed agents. Being a medicine student (AOR =
3.872; 95% CI: (1.263–11.866); p = 0.018), not having health insurance (AOR = 2.431; 95% CI:
(1.383–4.274); p = 0.002), and not having a known medical illness (AOR = 2.241; 95% CI: (1.226–
4.127); p = 0.010) were independently associated with good knowledge. While, living in an urban
area was significantly associated with a positive attitude (AOR = 3.593; 95% CI: (1.404–9.197); p =
0.004).

Conclusion

The SM rate in GAMBY is significantly higher. Besides, not more than half the students had
acceptable knowledge and attitude towards SM. The college and the surrounding regulatory
authorities should consider ways of controlling and recapitalizing SM practices by the students.

Keywords: self-medication, health science students, knowledge, attitude, practice, Ethiopia

Introduction

Self-medication (SM) is accessing and using drug products for self-diagnosis, self-treatment, or
other purposes without a legal prescription or prescriber order. It is the selection and administration
of remedies to manage self-perceived disease conditions.1,2 The International Pharmaceutical
Federation (FIP) also defined this similarly as the use of medicines by people without a physician
order on their own ingenuity.3 It comprises obtaining drugs without physician order, accessing new
drugs with previous prescriptions, using left-over drugs from previous treatments, and the sharing of
medicines from others.4 Societal developments in literacy, economy, and access to technological
advancements, including social media outlets, are among the promoting factors for SM globally.5
Self-consumption of medicines is an issue with serious global implications even though the WHO
encourages proper SM for mild disease conditions.6 Irresponsible SM practice may bring numerous
potential health related jeopardies, for instance delay in proper diagnosis and treatment; failure to
identify contraindications, exposure to drug interactions, possibility of improper courses of therapy,
the risk of tolerance, dependence and abuse, etc.7,8 It may also lead to paradoxical health and
economic losses associated with serious consequences such as drug resistance, disease co-existence
and, the worst, mortality.9–11

Literacy level, socioeconomic status, access to health information and facilities, exposure to drug
promotions,awareness about disease, and health policies are some of the associating factors with SM
practice.12–15 Especially for health science students, information access, medicine availability,
promotions, previous experiences, self-confidence, and unused or left-over drugs at home all
significantly influence the practice.16,17 Level of education, family history, societal background,
legislative gaps, and availability of drugs are also reported as determinant factors.18,19 Advanced
academic and professional levels have been reported as the foremost factors for SM.20 Prescribers
21,22
and dispensers are the frontline to be exposed to SM due to their easy access to drugs.21,22 Since
today’s health students are the future health practitioners, investigating their SM habits and taking
corrective measures plays a significant role in how they will protect themselves and others from
improper drug utilization.23,24 Studies showed that health students do not visit health facilities or
health care providers for their health information.25 This may be due to the impact of advancements
in accessing social media information26,27 which is now ultimately increasing the prevalence of
SM.28 Study reports from Saudi Arabia,29 India,30 Uganda,31 Ethiopia.32,33 and Kuwait34 reveal a
significant prevalence of SM by health students.

SM practice without proper knowledge on their disease condition and complete information of drugs
to be used will bring serious health related consequences. The scenario may be difficult with the
case of illiteracy while it may be easier to manage in the case of college and university students if
appropriate effort is applied. SM practice is extensive with students and urgent remedial actions are
needed.35 SM is also an important health issue for these students as this habit may result in a lack of
an appropriate and timely management of their diseases by a specialized health care provider and
deferral in the effectiveness of their therapeutic course.36 Therefore, the current study intended to
evaluate the knowledge, attitude, practice, and associated factors on SM among the medical school
students at GAMBY Medical and Business College.

Methods and Materials

Study Area, Design and Period

The study was conducted in Amhara Regional State, Bahir Dar City. The study setting was GAMBY
Medical and Business College among undergraduate health science students. There were a total of
989 health science students in the college (Medicine: 110, Pharmacy: 537, and Medical Laboratory:
342 students). An institutional based cross-sectional study was conducted from May to July, 2022.

Target and Study Populations

All health science school students in GAMBY Medical and Business College were considered as
source population. The study subjects were health science students in GAMBY Medical and
Business College who were eligible for the study, willing to participate, and available during the
study period.

Study Variables

Knowledge, attitude and practice of the students towards SM were considered as dependent
variables while demographic characteristics were taken as predictor variables.

Sample Size Determination and Sampling Procedure

The SM practice for undergraduate health science students in the college was not done before.
Hence “p” is taken as 50% of the total number of medical school students. The adequate sample size
was then determined to be 384 using the following single population proportion formula.

where, n is the required sample size, z is the standard normal deviation at 95% confidence interval
(1.96), q = 1-p, and d is the margin of error tolerated (5%).

Since the total number of students in the school is less than 10,000, a population correction formula
was used to determine the sample size and the calculated final sample size became 276.65. Then,
considering a 10% non-response rate, the corrected total sample size became 304. Hence, 304 health
science students were included in this study. Two step stratified random sampling was used to
collect the data, ie, sampling from each department, and then sampling from each study year based
on the appropriate proportion of the respective field of study.

Data Collection Procedures

A pre-tested questionnaire, adapted from various previous studies, was prepared in English and
distributed to collect the relevant data. The questionnaire comprised of 4 main parts; demographic
information, knowledge related questions (seven question with yes/no labeling), attitude related
questions (seven questions with five levels of agree/disagree), and diverse questions of SM practice.
For the SM practice evaluating questions, respondents were asked to answer one most common
(prioritized) answer from the given alternatives. The questionnaire was modeled from those used in
previous studies37–39 and it was tested on a population of thirty students, and all ambivalent and
unclear questions were rephrased or removed. The relevant data were collected by group members
of the study after taking the consent from the participants using a printed paper-based questionnaire.

Data Processing and Analysis

Daily follow-ups and appraisals were done during the data collection for data completeness and
consistency. SPSS 26 was used to analyze the descriptive statistics. Bivariate and multivariable
logistic regression analysis was used in order to identify truly associated factors and control
confounding effects. Independent variables with a p-value of <0.25 were selected for multi-variable
logistic regression analysis. Odds ratio (OR) with 95% CI was then computed for each variable for
the corresponding P-value. The value of P < 0.05 was considered statistically significant.

Data Quality Control

The data collection tool was properly designed and developed. Pre-test was done out of the study
area. The data collector group was sufficiently trained by the first author. All the data collection
process and the collected data was reviewed and checked by the principal investigator.

Ethical Considerations

Ethical approval was obtained from the Ethical Review Committee of GAMBY Medical and
Business College. We got a permission letter from the college administration after the Department
of Pharmacy, Medical School, GAMBY Medical and Business College wrote a support letter to the
committee. All necessary briefings were done about the study and the participants who were willing
to participate and gave consent were included. In accordance with the Declaration of Helsinki,
confidentiality was maintained and no personal identifier of the respondents was used during the
study.

Operational Definitions

Self-medication practice: use of a drug substance to self-administer for the treatment of physical or
psychological ailment perceptions without prescriber consultation.

Good knowledge: knowledge score above the median score (4.0).37

Bad knowledge: knowledge score below the median value.37

Positive attitude: attitude score above 20.37

Negative attitude: attitude score below 20.37

Results

Socio-Demographic Characteristics of the Respondents

301 (31 medicine, 163 pharmacy, and 107 laboratory) of the 304 sample size responded to the study
(99% response rate). As shown in Table 1, among the respondents, 50.8% were female, 62.4% were
in the age group of 21–23 years, and 90.1% lived in urban areas. Regarding their education, 53.8%
were from the pharmacy department and more than s quarter (26.4%) were first year students. 67.7%
of the respondents did not have health insurance and 74.9% reported that they do not have a known
medical illness.
 Table 1

Socio-Demographic Features of the Respondents (n = 301)

Variables Frequency (%)

Medicine Pharmacy Laboratory Total

Gender Male 17 (11.4) 76 (51) 57 (37.6) 149 (49.5)

Female 14 (9.2) 87 (57.2) 51 (33.6) 152 (51.5)

Age 18–20 4 (16) 9 (36) 12 (48) 25 (8.3)

21–23 8 (4.2) 106 (56.1) 75 (39.7) 189 (62.8)

>23 19 (21.8) 48 (55.2) 20 (23) 87 (28.9)

Residence Urban 30 (11) 142 (52) 101 (37) 273 (90.7)

Rural 1 (3.6) 21 (75) 6 (21.4) 28 (9.3)

Year of Study 1st year 2 (2.6) 36 (46.2) 40 (51.3) 78 (25.9)

2nd year 8 (12.1) 33 (50) 25 (37.9) 66 (21.9)

3rd year 6 (9.2) 37 (56.9) 22 (33.9) 65 (21.6)

4th year 4 (8) 26 (52) 20 (40) 50 (16.6)

5th year 8 (20.5) 31 (79.7) 0 39 (13)

6th year 3 (100) 0 0 3 (1)

Insurance Beneficiary Yes 8 (8.3) 51 (53.2) 37 (38.5) 96 (31.9)

No 23 (11.2) 112 (54.6) 70 34.2) 205 (68.1)

Known Illness Yes 4 (5.4) 43 (58.1) 27 (36.5) 74 (24.6)

No 27 (11.9) 120 (52.9) 80 (35.2) 227 (75.4)

Students’ Knowledge About Self-Medication

The mean knowledge score in this study was determined to be 4.57 with a standard deviation of
3.27. As summarized in Figure 1, 177 (58.8%) of the students (83.9% of medicine, 61.3% of
pharmacy, and 47.7% of laboratory) had good knowledge. About 187 (62.1%) students accepted that
SM is self-consuming of drugs without a prescriber order. Only 108 (35.9%) agreed that SM may
not always be safe and effective. Nearly half of the students (46.5%) recognized that all drugs can
have adverse effects. As shown in Table 2, 198 (65.8%) of the respondents agreed that increasing or
decreasing doses by self could be risky and also a similar proportion of the respondents (66.8%)
believed that physician help must be sought for adverse events during SM. As can be seen from the
chi-square p-values, there are significant associations between knowledge and department of
respondents on the definition of SM (p = 0.001), on safety and efficacy of SM (p = 0.007), on the
risk of increasing or decreasing by self (p = 0.009), and on the threat of using drugs with unknown
ingredients in patients with known medical conditions (p = 0.022).

Table 2

Participant Students’ Knowledge Towards Self-Medication (n = 301)

Knowledge Related Questions Frequency (%) Chi-

Medicine Pharmacy Laboratory Total square

(P-
value)

SM is self-consuming of medication Yes 23 (23.3) 111 (59.4) 53 (28.3) 187 09.001

without prescriber advice. (62.1)

No 7 (10.8) 34 (52.3) 24 (36.9) 65

(21.6)

Do not 1 (2.0) 18 (36.7) 30 (61.2) 49

Know (16.3)

SM may not always be safe and effective. Yes 7 (6.5) 62 (57.4) 39 (36.1) 108 0.007
(35.9)

No 11 (8.9) 75 (61.0) 37 (30.1) 123

(40.9)

Do not 13 (18.6) 26 (37.1) 31 (44.3) 70

Know (23.2)

All medications (prescription, OTC and Yes 10 (7.1) 86 (61.4) 44 (31.4) 140 0.160
herbal) may have adverse effects. (46.5)

No 8 (12.1) 33 (50.0) 25 (37.9) 66

(21.9)

Do not 13 (13.7) 44 (46.3) 38 (40.0) 95

Know (31.6)

Increasing or decreasing medication dose Yes 26 (13.1) 115 (58.1) 57 (28.8) 198 0.009
without a doctor consultation can be (65.8)
dangerous. No 3 (5.4) 26 (46.4) 27 (48.2) 56
(18.6)

Do not 2 (4.3) 22 (46.8) 23 (48.9) 47

Know (14.6)

In case of adverse effects, physician help Yes 26 (12.9) 102 (50.7) 73 (36.3) 201 0.165
Note: Statistically significant values are shown in bold (P-value <0.05).
Abbreviations: OTC, over-the-counter; SM, self-medication.
 Figure 1

Knowledge and Attitude of Students towards Self-Medication (% Frequency).

Student’s Attitude Towards Self-Medication

The mean attitude score of the respondents was 20.86 with s standard deviation of 5.16. As
presented in Figure 1, 167 (55.5%) of the students have positive attitudes. The attitude level between
the respondents of the three departments is similar; 54.8%, 58.9%, and 50.5% for medicine,
pharmacy, and laboratory students, respectively, for a positive attitude. There was also the absence
of a statistically significant association from the chi-square analysis on their attitude (agreement or
disagreement) towards all the presented attitude-related questions (p > 0.05). As shown in the
results (Table 3), 73 (24.3%) strongly agreed and 33 (11.0%) agreed that SM is part of self-care. 157
(52.2%) of the students responded positively to the need for training on the use of SM. 91 (30.2%)
strongly agreed and 33 (11.0%) agreed on the ability of health science students to self-diagnose
medical conditions, while only half (50.1%) of the respondents disagreed on the ability of health
science students to self-treat different diseases. 139 (46.2%) agreed on recommending SM for
others.

Table 3

Attitude of Students to Self-Medication (n = 301)

 Attitude Related Questions Frequency (%) Chi-
Medicine Pharmacy Laboratory Total square
(p-
value)

SM is part of self-care. Strongly 10 (13.7) 34 (46.6) 29 (39.7) 73 0.574

Agree (24.3)

Agree 6 (18.2) 17 (51.5) 10 (30.3) 33

(11.0)

Neutral 4 (8.2) 29 (59.2) 16 (32.7) 49

(16.3)

Disagree 5 (6.5) 46 (59.7) 26 (33.8) 77

(25.5)
Strongly 6 (8.7) 37 (53.6) 26 (37.7) 69
Disagree (22.9)

No need of training about SM. Strongly 13 (12.3) 57 (53.8) 36 (34.0) 106 0.510
Agree (35.3)

Agree 5 (9.8) 33 (64.7) 13 (25.5) 51

(16.9)

Neutral 1 (5.0) 8 (40.0) 11 (55.0) 20 (6.6)

Disagree 7 (9.9) 39 (54.9) 25 (35.2) 71

(23.6)

Strongly 5 (9.4) 26 (49.1) 22 (41.5) 53

Disagree (17.6)
Medical students are able to diagnose Strongly 8 (8.8) 44 (48.4) 39 (42.9) 91 0.391
different diseases. Agree (30.2)

Agree 4 (12.1) 20 (60.6) 9 (27.3) 33

(11.0)

Neutral 1 (2.9) 21 (61.8) 12 (35.3) 34

(11.3)
Abbreviations: OTC, over-the-counter; SM, self-medication.

Student’s Practice of Self-Medication

The SM pattern of the students is presented in Table 4. 205 (68.1%) of the study participants
practiced SM at least once within the last six months. About 84 (41.0%) of them did not know
whether their medications need prescription or not. Here, a significant association was observed
between department and SM practice (p = 0.004). Anti-pain (37.1%) and antimicrobial (29.8%)
drugs were the most commonly self-consumed groups of medications (Figure 2). Whereas, disease
perceptions with headache (33.7%) and cough and common cold (29.8%) were the commonly self-
treated medical conditions (Figure 3). 83 (40.5%) of them used self-information for their SM
practice. A significant association was also observed on their sources of medications (p = 0.008)
where 163 (79.5%) of them accessed it in pharmacies while 13 (6.4%) got it from herbalists. The
reason for most of the respondents (58.0%) for using SM is need of quick relief. About two-thirds
(67.8%) of the respondents with a history of SM did not experience any adverse effect related to
their medications. This also resulted in a significant association in SM practices with medicine,
pharmacy, and laboratory students (p=0.015). Most of the students (64.4%) felt confident while
using SM as part of their health care.
Table 4

Self-Medication Practice of Students (n = 205)

SM Practice Evaluating Questions Frequency (%) Chi-

Medicine Pharmacy Laboratory Total square

(p-
value)

How frequently did you visit the Once 11 (14.7) 41 (54.7) 23 (30.7) 75 0.629
pharmacy for SM in the last 6 (36.6)
Months? Twice 5 (9.1) 31 (56.4) 19 (34.5) 55
(26.8)

3 times 3 (11.5) 16 (61.5) 7 (26.9) 26

(12.7)

4 times 0 (0.0) 5 (83.3) 1 (16.7) 6 (2.9)

5 times 0 (0.0) 1 (33.3) 2 (66.7) 3 (1.5)

>5 times 5 (12.5) 22 (55.0) 13 (32.5) 40
(19.5)

Do you know your medicines need Yes 12 (9.9) 80 (66.1) 29 (24.0) 121 0.004
prescription? (59.0)

No 12 (14.3) 36 (42.9) 36 (42.9) 84

(41.0)

Which of the following drugs have Antibiotic 3 (4.9) 38 (62.3) 20 (32.8) 61 0.214
you taken for SM during the last 6 (29.8)
months? Anti-pain 12 (15.8) 38 (50.0) 26 (34.2) 76(37.1)
Anti- 6 (13.3) 25 (55.6) 14 (31.1) 45
allergies (22.0)
Cough 1 (9.1) 9 (81.8) 1 (9.1) 11 (5.3)
Drugs

Others 2 (16.7) 6 (50.0) 4 (33.3) 12 (5.8)

The indications have you taken SMs Headache 8 (11.6) 37 (53.6) 24 (34.8) 69 0.321
for without prescription during the (33.7)

Note: Statistically significant values are shown in bold (P-value <0.05).

Abbreviation: SM, self-medication.
 Figure 2

Percentage of medications self-consumed by students.

Figure 3

Percentage of medical conditions for self-medication.

Factors Associated with Student’s Knowledge of Self-Medication

Department of the responding students, being an insurance beneficiary, and having a known illness
are statistically associated independent variables with s student’s level of knowledge about SM (
Table 5). From the regression analysis results it is observed that being a medicine student had a
3.872 times more positive effect on knowledge than being a medical laboratory student (AOR =
3.872, 95% CI: (1.263–11.866); P = 0.018). Pharmacy students also had s 2.491 times better
knowledge than laboratory students (AOR = 2.491; 95% CI: (0.853–7.279)), even though the
association was not statistically significant (p = 0.095). Students that have health insurance
demonstrated 2.431 times worse knowledge that lead them to practice SM than students that do not
have health insurance (AOR = 2.431; 95% CI: (1.383–4.274): P = 0.002). Students that have a
medical illness had 2.241 times poorer knowledge about SM practice than students that do not have
a medical illness (AOR = 2.241; 95% CI: (1.226–4.127); P = 0.010).
 Table 5

Associated Independent Variables with Knowledge About Self-Medication

Variables Good Knowledge Poor Knowledge 95% CI for EXP(B) p-value

N (%) N (%)

Department Medicine 26(83.9) 5(16.1) 3.872 (1.263–11.866) 0.018

Pharmacy 100 (61.3) 63 (38.7) 2.491 (0.853–7.279) 0.095

Laboratory 51 (47.7) 56 (52.3) 1

Insurance Beneficiary Yes 37 (38.5) 59 (61.5) 1 0.002

No 140 (68.3) 65 (31.7) 2.431 (1.383–4.274)

Known Illness Yes 29 (39.2) 45 (60.8) 1 0.010

No 148 (65.2) 79 (34.8) 2.241 (1.226–4.127)

Note: Statistically significant at 95% CI and p<0.05.

Abbreviations: CI, confidence interval; EXP(B), exponentiation of the B coefficient.

Factors Associated with Student's Attitude Towards Self-Medication

The only observed significantly associated independent variable with the student's attitude in this
study was area of residence of the students (Table 6). Students from urban areas have a 3.593 times
better attitude towards SM than students living in rural areas (AOR = 3.593; 95% CI: (1.404–
9.197); P = 0.004).

Table 6

Associated Independent Variables with Attitude Towards Self-Medication

Variables Good Knowledge Poor Knowledge 95% CI for EXP(B) p-value

N (%) N (%)

Residence Urban 146 (53.5) 127 (46.5) 3.593 (1.404–9.197) 0.004

Rural 23 (82.1) 5 (17.9) 1

Note: Statistically significant with 95% CI and p<0.05.

Abbreviations: CI, confidence interval; EXP(B), exponentiation of the B coefficient.
Discussion

Self-Medication Prevalence

The present study revealed that the prevalence of SM at GAMBY Medical School students was
68.1%. This is a very significant number which is almost consistent with similar study reports from
Rift Valley University (72.7%),7 Qassim University (63.9%),29 Wollo University, Ethiopia
(64.98%),32 and Indian Colleges (57.1–92.0%).40 But, the prevalence is considerably higher than
similar study reports of the Arabian Gulf University, Bahrain (44.8),22 universities in Kuwait
(35.9%),34 Zabol University, Iran (57.1%),41 and among students and other population groups in the
developed western regions such as German (8%),42 France (17%),43 USA (22%),44 United Kingdom
(39.2%),45 Spain (45%),46 Italy (53.4%),47 and Norway (54%).48 Still, there are some studies
indicating a higher prevalence of SM among health science students in those European and other
developed countries such as Serbia (79.9% and 81.3%),3,49 Slovenia (92.3%),50 and Australia
(91.7%).51 From these reports, it can be posed that SM is a commonly practiced part of health care
all over the world, in varying degrees. Generally, SM prevalence is reported to be higher in
developing than developed countries. The welfare status, income per capita, better quality health
care, and more efficient drug supply management system can be listed as the main factors. In
addition, educational level and specialty, socio-economical differences, acquired knowledge about
specific disease perceptions, and other related sociodemographic variations could be reasons for the
similarity and differences among those reports.41 By any means, the results of this study generally
show an urgency of vigilant monitoring and regulation of the drug use pattern, drug delivery
systems, distribution and dispensing practices, especially in developing countries like Ethiopia, to
avert SM and related adverse events in a timely manner.

Knowledge About Self-Medication and Associated Factors

SM has nowadays turned out to be a global habit, where individuals are apt to bargain for over-the-
counter (OTC) drugs just based on symptom perceptions. The fortune and infortunate effects
consequently after SM have shown SM is a global public health concern.52 Health science students,
especially those in medicine and pharmacy professions are expected to have well equipped
knowledge regarding appropriate drug use. They are expected to be medication experts as they take
numerous drug-related courses that may well upsurge students’ knowledge and understanding about
drug utilization principles.33 Unfortunately, not more than 58.8% of the respondents in this survey
had good levels of knowledge regarding SM. The overall knowledge score result is consistently
lower like those investigations in India,53 Riyadh54 and Taiwan.55 This is even less than similar
studies in other academic institutions of Ethiopia such as Debre Markos University (64.6%)56 and
University of Gondar (67.6%).33 Similarly, it is significantly at a lower level compared with other
global reports like Oman (75%)57 and Osun State (91%).58 However, it is better than a study report
from public and private universities in Kuwait where 53.5% of the students in the study failed to
score the median value34 and the case of Iran where only 16% and 35% of medicine and pharmacy
students achieved good scores regarding drug information.41 These differences may be due to the
level of education and field of study of respondents, the level and experience of the academic
institutions, or other socio-demographic variables of the respondents. Unsatisfactory knowledge
level of health science students results in unsuitable medication consumption. Accordingly,
promoting knowledge of students and the general public regarding medication use can aid the
aptitude of using medication cautiously. Hence, knowledge enrichment mediations using campus-
based seminars, evidence-based brochures, and self-instructional modules can be applied.53

SM has not only pros, but also cons. Should it have been practiced with great responsibility, it can
be a suitable substitute to manage minor illnesses as part of self-care. However, its unfortunate
application can lead to unexpected destructive outcomes. Its use inappropriately due to insufficient
knowledge about drug side-effects may be one major reason for such misadventures.59 Based on the
results of this study, only 35.9% agreed that SM may not always be safe and effective. Additionally,
less than half of the students (46.5%) knew that all medications, whether prescription, OTC, or
herbal drugs can have adverse effects. The proportion of respondents who knew the danger of
increasing or decreasing medication dose without a prescriber consultation, the need of physician
help in case of adverse events, and the dangerousness of using medications with unknown
substances were also not adequate. This finding was similar with research done in Sudan where
54.7% of the participants have no information about the effects of medicines they used.60 In another
similar study, only 14.43% of students knew the side-effects of drugs they had taken as SM.59 Such
results are indicative of animated shortcomings in the knowledge of health science students about
drugs which are commonly being self-medicated. Thus, hard work is needed to maximize students’
awareness on the side-effects, precautions, and necessary measurements of scenarios for reducing
incidences, early detection, and treatment of side effects as they occur. Creating sufficient awareness
about the different adverse effects, risk of drug interactions, and antibiotic resistance among health
science students will not only ensure nonviolent SM practices but also will benefit the society.30

Various associated factors may affect the knowledge level of students about SM. In one study, there
was a significant association between knowledge and the age of the participants.53 On another
similar investigation, it was significantly associated with the field of study (department), year of
entrance (level of education or class year), and the history of SM or previous ailments.41 Gender is
also reported as a possible associating factor.34,50 Similarly, in this study, being a medicine student,
not being an insurance beneficiary, and not having a known illness are positively associated with a
good level of knowledge about SM.

Attitude Towards Self-Medication and Associated Factors

In this study, only 55.5% of the students have positive attitudes. This is in-line with survey reports in
Gondar21 and Eritrea.39 However, it is considerably lower than study reports of similar surveys in
Asella of Ethiopia,33 South Tamilnadu,30 Riyadh54 and Bahrain22,61 as most of the respondents in
these studies demonstrated a positive attitude towards practicing SM. According to the result of this
research, more than one-third of the respondents agreed that SM is part of self-care while almost
half of them responded positively for the need of training about SM. Consistently, 40% of
respondents from a study in India agreed with this statement.59 A similar study in Iran also reported
that 41.2% of health science students believed that SM is part of self-care and 67.7% students agreed
with the need of training about SM.41
91 (30.2%) respondents strongly agreed and 33 (11.0%) agreed on the ability of health science
students to self-diagnose medical conditions, while only half (50.1%) of the respondents disagreed
on the ability of health science students to self-treat different diseases. This is nearly similar with the
investigation in India, where 52.9% of undergraduate health science students in a tertiary care
hospital confidently prescribed medicines on their own to themselves, their friends, and family
members.62 The belief of self-diagnosis and self-treatment is not limited only to the developing
countries, but it is also prevalent in developed western regions with various degrees of prevalence.
Earlier study reports revealed that 39.2% of the health science students in the United Kingdom45 and
about 22% of health students in the USA44 agreed on the appropriateness of self-prescribing. 46.2%
of the respondents under this study recommend SM for others. This is higher than the case in Eritrea
(35.9%)39 but importantly lower than the reports in southern India (64%)63 and northern Uganda
(68.2%).64

The only observed significantly associated independent variable with the attitude of students
towards SM in this study was the area of residence of the students. Students are similar in their
attitude towards SM in all other parameters except being significantly higher for students from urban
residency. Similar studies in Eritrea39 and Egypt65 also revealed that being from urban areas was an
independent predictor for SM. The fact that residence may be associated with SM remains in that
lots of the rural communities have little or no access to modern healthcare due to the irregular or
insufficient facility distributions. Numerous reasons related with the social, economic, and cultural
perception towards diseases and their perceived responses to indigenous medications around where
they live can also affect SM patterns of the rural society.65–67 Another similar study in Bangladesh
also revealed the impact of the cultural, socio-economical, geographical, and traditional distinction
over the plain land population towards their SM practices. This study also suggested that such
associations bring important policy implications. Hence, the government bodies, notably the
Ministry of Health, should implement awareness raising initiatives among the rural people about the
dangers of SM.38

The Pattern of Self-Medication Practice

Common Illness and Medications for Self-Medication Medications for pain management were the
most frequently used among others followed by antimicrobial drugs. Whereas, disease perceptions
related with headache and coughing were the commonly self-treated medical conditions. This result
is consistent with other similar studies of health science students in Ethiopian higher educational
institutions such as Arsi University,33 University of Gondar,37,68 Private Health Science Colleges in
Gondar,69 and Mekelle University.70 There are also confirming reports from Bahrain,22 Eritrea,39
Saudi Arabia,71 and India30,53,62 on the frequently used SM groups and perceived disease
conditions. Similarly, analgesics and antibiotics were the two foremost self-medicated drugs in
Nigerian students,72 whereas non-steroidal analgesic, anti-inflammatory, and antipyretic drugs were
the most frequently used OTC drugs for self-treating fever and headaches in Nepal.73 In a study
among students in Kuwait, similar findings were found on the causative medical conditions for SM
and higher rates of consumption of pain killer medicines but antibiotics were self-consumed by only

34
2.9% of the students.34 Conversely, SM using oral antibacterial agents outweighs those with oral
anti-inflammatory agents and antipyretics among medical and paramedical students in India40,59 and
Iran.41

The most common medical conditions perceived as initiatives for SM in this study were typically
self-limiting “minor illnesses” which are listed primarily in most study reports as the most frequent
indications for self-treatment.22 Moreover, stress-induced headache and other associated health
perceptions are common among college students due to educational loads, especially in medicine
and health science students. They may also be victims of the common cold and other cough
inducing illnesses due to their living environmental conditions, especially in institutions of less-
developed countries where facilities are not well-furnished. The antimicrobial SM report for this
study is not a negligible figure. The unlimited and excessive antimicrobial self-consumption in this
study and other similar reports may be due to the inadequate regulation of the dispensing practice.

Source of Information and Medication Access 40.5% of the respondents in this study relied on self-
information for their SM practice. Other studies also comply with this result.39,70 This is obvious
since they are health science students and the familiarity with diseases and therapeutics persuades
them to attain self-confidence to treat themselves without consulting prescriber professionals.
Family or friends with a health professional background can also impact students’ SM practice as
they could advise purchasing medications related to their symptoms without being diagnosed. A
study on SM practice of adults in Wolaita Soddo town, southern Ethiopia confirmed this assertion as
more than 75% of the respondents were advised by pharmacists and other health professionals for
SM.74

In the current study, 79.5% of the students collected their medications from pharmacies. This is
common that most self-medicated drugs are purchased from drug retail outlets. Survey reports from
other study areas in Ethiopia,33,68–70 Australia,51 Eritrea,39 and Bangladesh38 also indicated that
drug retailers are the primary sources of SM access. This is also an indication of the gaps in
regulatory performances in those study areas. Unless revitalized in a timely manner, such dispensing
malpractices by drug retailers could be among the leading predictors to irrational drug use, drug
resistance, and consequent health hazards in general. 6.4% of the respondents got their drugs from
traditional herbal producers. Almost s similar proportion of respondents also accessed medications
from herbalists in one other study in Ethiopia.70 This should also not be undermined as unknown
drug content, unevaluated concentrationd, and unjustified dosage may lead to serious adverse
effects. Concomitant use of the traditional and the conventional medicines during SM may also
bring in unexpected adverse events.

Reasons for Self-Medications and Experience of Adverse Effect The need for quick relief and saving
time were the most frequently mentioned reasons for SM by the students. Health science students in
Bahrain also reported the need for time saving as a primary reason for SM.22 Perception in the
mildness of the illness, similarity of disease conditions with previous symptoms and incapability to
afford health care costs were also reported as the major reasons for SM practice in other similar
studies.75,76 Conversely, saving time and money are the least common reasons for health science
students in Eritrea where previous experience and perceived sufficient knowledge towards SM were
the prior reasons.39 However, self-treating perceived illnesses based on past experiences or with
perceived knowledge without accurate diagnosis could lead to misdiagnosis, missed therapeutics,
and subsequent unwanted health problems. Practicing SM to save time and money may also result in
costing the irreplaceable health and life. One-third of the respondents with a history of SM
experienced some adverse effect related to their medications. This is a significant number as at least
a few and less-serious cases could happen with higher prevalence of SM practice. The report in the
current study is significantly higher than that of Eritrea39 and south India.63 This difference may be
from misinterpretation of symptoms and side effects as an adverse effect. Whatever the case, the
report should not be neglected and appropriate measures should be outlined to prevent further
losses.

Relaxed availability and accessibility of medications, including those prescription-only drugs from
drug retail outlets, might be allied to the lack of strict legislation concerning medicine utilization in
developing countries. This regulation gap could subsidize to an increased prevalence of SM
practice, thus resulting in irrational drug use, possibility of resistance development, and harmful life
conspiracy at large.39 Students in the health departments are the future health practitioners, health
leaders, health policymakers, and decision makers. Hence, investing in them about appropriate use
of medicines and OTCs is reimbursing in the generation for a better health management system that
will come tomorrow. Studies should be promoted to attract government attention in order to
diminish the factors promoting SM in low income and developing countries.

Conclusion

From this study a significantly higher prevalence of SM practice was seen among health science
students in GAMBY. The proportion of students with good knowledge and a positive attitude level is
low. This result implies that students need more awareness regarding SM. Giving induction training
about the consequences of SM to decrease the practice, to improve students’ knowledge, and to
upgrade their attitude level should be one target of intervention in higher educational institutions.
Appropriately regulated dispensing practice of medications with adequate counseling and with
prescriptions only when needed should be applied. Suitable supportive supervision and gap filling
from responsible bodies related to SM are recommended to overcome SM associated problems.
Further investigations are needed on the prevalence, impact, risks, and associated factors regarding
the practice of SM and consumption pattern of OTC medications.

Abbreviations

FIP, International Pharmaceutical Federation; KAP, Knowledge, Attitude and Practice; OTC, over-
the-counter.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception,
study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took
part in drafting, revising or critically reviewing the article; gave final approval of the version to be
published; have agreed on the journal to which the article has been submitted; and agree to be
accountable for all aspects of the work.

Disclosure

The authors report no conflicts of interest in this work.

References

1. Montast NC, Bagher H, Geraud T, Lapeyre-Mestre M. Pharmacovigilance of self-medication. Therapie.

1997;52(2):105–110. [PubMed] [Google Scholar]

2. Sharif SOL, Bugaighism MSR, Sharif RS. Self-medication practices among pharmacist sin UAE. Pharmacol Pharm.
2015;6(09):4a. doi: 10.4236/pp.2015.69044 [CrossRef] [Google Scholar]

3. Lukovic JA, Miletic V, Pekmedzovic T, Trajakovic C, Ratkovic N, Aleksic DGA. Self-medication practices and risk
factors for self-medication among medical students in Belgrade, Serbia. PLoS One. 2014;9:1–14. doi:
10.1371/journal.pone.0114644 [PMC free article] [PubMed] [CrossRef] [Google Scholar]

4. Zafar SN, Syed R, Waqars ZAJ, et al. Self-medication amongst university students of Karachi: prevalence, knowledge
and attitudes. J Pak Med Assoc. 2008;58(4):214. [PubMed] [Google Scholar]

5. Gyawali S, Shankar PR, Poudel P. Knowledge, attitude and practice of self-medication among basic science
undergraduate medical students in a medical school in western Nepal. J Clin Diagnost Res. 2015;9(12):Fc117. [PMC free
article] [PubMed] [Google Scholar]

6. Ocan M, Obuku EA, Bwanra F, Akana D, Ricnard SO. Household antimicrobial self-medication: a systematic review
and meta-analysis of the burden, risk factors & outcomes in developing countries. BMC Public Health. 2015;15(1):11. doi:
10.1186/s12889-014-1340-7 [PMC free article] [PubMed] [CrossRef] [Google Scholar]

7. Beyene A, Getachew E, Dobecni A, Poulos E, Abdurahman KAM. Knowledge attitude and practice of self-medication
among pharmacy students of rift wallet university, Abichw campus, Addis Ababa, Ethiopia. J Heal Medinformat.
2017;2(269):2. [Google Scholar]

8. Alsows M, Elayeh E, Jalil MA. Evaluations of self-medication practice among pharmacy students in Jordan. Jordan J
Pharm Sci. 2018;11(1):1–10. [Google Scholar]

9. Hughes CM, Elnay MC, Fleming GF. Benefits and risks of self medication. Drug Saf. 2001;24(14):1027–1037. doi:
10.2165/00002018-200124140-00002 [PubMed] [CrossRef] [Google Scholar]

10. Chalker J. Improving antibiotic prescribing in HaiPhong province Viet Nam: the “antibiotic dose” indicator. Bull World
Health Organ. 2001;79:313–320. [PMC free article] [PubMed] [Google Scholar]

11. Sharif SI, Ibrahim OH, Mouslli LWR. Evaluation of self-medication among pharmacy students. Am J
PharmacolToxicol. 2012;7(4):135–140. [Google Scholar]
12. Ramadan M, Eltaweel A, El Nakhal T, Hemead H, Maraqa A, Abish DE. Self-medication among undergraduate
medical students of Alexandria faculty of medicine: were do we stand. Int J Med Students. 2018;6(2):52–55. doi:
10.5195/ijms.2018.41 [CrossRef] [Google Scholar]

13. Sandhu S, Suryani Y, Dwiprahasto IA. A survey of antibiotic self-medication and over the counter drug use among
undergraduate medical students in Yogyakarta, Indonesia, South-East. Asian J Trop Med Public Heal. 2017;48(6):1290–
1298. [Google Scholar]

14. Zhu X, Pan H, Yang Z, Cui B, Zhang D, Ba-Thein W. Self-medication practices with antibiotics among Chinese
university students’. Public Health. 2016;1(130):78–83. doi: 10.1016/j.puhe.2015.04.005 [PubMed] [CrossRef] [Google
Scholar]

15. Gelayee DA. Self-medication pattern among social science university students in Northwest Ethiopia. J Pharm.
2017;2017:8680714. [PMC free article] [PubMed] [Google Scholar]

16. Hussian S, Malik F, Hamed A, Ahmads RH. Exploring health seeking behaviour, medicine use and self-medication in
urban and rural Pakistan southern. Med Rev. 2010;3(2):32–35. [Google Scholar]

17. Klemanc-ketis z Kersnik J, Kersnik J. Sources and predictors of home kept prescription drugs. Int J Clin Pharmacol
Ther. 2010;48(11):705–707. doi: 10.5414/CPP48705 [PubMed] [CrossRef] [Google Scholar]

18. Habeeb GE. Common Patient symptoms: patterns of self-treatment and prevention. J Missippi State Med Assoc.
1993;34(5):179–181. [PubMed] [Google Scholar]

19. Seam M, Reza O, Bhatta R, et al. Assessing the perceptions and practice of self-medication among Bangladesh;
undergraduate pharmacy students. Pharmacol. 2018;6(1):6. [PMC free article] [PubMed] [Google Scholar]

20. Martins AP, da Costa Miranda A, Mendes Z, Soares MA, Ferreira PNA. A self-medication in a Portuguese urban
Population: a Prevalence study. Pharm Epidemiol Drug Safty. 2002;11(5):409–414. doi: 10.1002/pds.711 [PubMed]
[CrossRef] [Google Scholar]

21. Abay SM, Amelo W. Assessment of self-medication practices among medical, pharmacy, health science students in
Gondar University, Ethiopia. J Young Pharm. 2010;293:306–310. doi: 10.4103/0975-1483.66798 [PMC free article]
[PubMed] [CrossRef] [Google Scholar]

22. James H, Handu SS, Al KKA, Ottom S, Sequeira RP. Evaluations of the knowledge, attitude and practice of self-
medication among first year medical students. Med Princ Pract. 2006;15(4):270–275. doi: 10.1159/000092989 [PubMed]
[CrossRef] [Google Scholar]

23. Awad AZ, Eltayeb IB, Capps PA. Self-medication practices in Khartoum state, Sudan. Eur J Clin Pharmacol.
2006;62940:317–324. doi: 10.1007/s00228-006-0107-1 [PubMed] [CrossRef] [Google Scholar]

24. Michelle P. An examination of awareness of over the counter no steroidal anti-inflammatory drugs and adverse events.
UMI. 2011;9:121–125. [Google Scholar]

25. Brener ND, Gowda VR. Us college students reports of receiving health information on college campuses. J Am Coll
Health. 2001;49(5):223–228. doi: 10.1080/07448480109596307 [PubMed] [CrossRef] [Google Scholar]

26. Hanauer D, Dibbl E, Fortin JCN, Col NF. Internet user among community college students: implication is designing
health care interventions. J Am Coll Heal. 2004;52(5):197–202. doi: 10.3200/JACH.52.5.197-202 [PubMed] [CrossRef]
[Google Scholar]
27. Escoffery C, Miner KR, Adame DD, Butler S, Cormick MC, Mendell E. Internet use for health information among
college students. J Am Collage Health. 2005;53(4):183–188. doi: 10.3200/JACH.53.4.183-188 [PubMed] [CrossRef]
[Google Scholar]

28. Ryan AWS, Wilson S. Internet health care: do self-diagnosis sites do more harm than good? Expert Opin Drug Safety.
2008;7(3):227–229. doi: 10.1517/14740338.7.3.227 [PubMed] [CrossRef] [Google Scholar]

29. Alduraibi R, Altowayan WM. A cross sectional survey: knowledge, attitudes, and practices. BMC Health Serv Res.
2022;22(1):1–10. doi: 10.1186/s12913-022-07704-0 [PMC free article] [PubMed] [CrossRef] [Google Scholar]

30. Sundararajan A, Thangappan AK. Knowledge, attitude and practice of self medication among undergraduate medical
students in a teaching institution. Int J Basic Clin Pharmacol. 2018;7(12):2414–2419. doi: 10.18203/2319-
2003.ijbcp20184857 [CrossRef] [Google Scholar]

31. Niwandinda F, Lukyamuzi EJ, Ainebyona C, Ssebunya VN, Murungi GAE. Patterns and practices of self-medication
among students enrolled at Mbarara University of Science and Technology in Uganda. Integr Pharm Res Pract. 2020;9:41.
[PMC free article] [PubMed] [Google Scholar]

32. Zewdie S, Andargie AKH, Kassahun H. Self-medication practices among undergraduate University Students in
Northeast Ethiopia. Risk Manag Healthc Policy. 2020;13:1375. doi: 10.2147/RMHP.S266329 [PMC free article]
[PubMed] [CrossRef] [Google Scholar]

33. Bekele SA, Argaw MD, Yalew AW. Magnitude and factors associated with self-medication practices among university
students: the case of Arsi University, College of Health Science, Asella, Ethiopia: cross-sectional survey based study. Open
Access Libr J. 2016;3(6):1–5. [Google Scholar]

34. Mitra AK, Imtiaz A, Al-ibrahim YA, Bulbanat MB, Mutairi MFA, Musaileem SFA. Factors influencing knowledge and
practice of self-medication among college students of health and non-health professions. IMC J Med Sci. 2018;12(2):57–
68. doi: 10.3329/imcjms.v12i2.39662 [CrossRef] [Google Scholar]

35. Khandelwal S, Deb DGJ. Practice of self-medication among medical students in Manipal. Int Res J Pharm Appl Sci.
2013;3(5):175–179. [Google Scholar]

36. Kalyan VS, Sudhakar K, Srinivas P, Sudhakar GV, Pretab KV. Evaluation of self-medication practices among
undergraduate dental students of tertiary care teaching dental hospital in south India. J Educ Ethics Dent. 2018;12(2):57–
68. [Google Scholar]

37. Bekele KM, Abay AM, Mengistu KA, et al. Knowledge, attitude, and practice on over-the-counter drugs among
pharmacy and medical students: a facility-based cross-sectional study. Integr Pharm Res Pract. 2020;9:135–146. doi:
10.2147/IPRP.S266786 [PMC free article] [PubMed] [CrossRef] [Google Scholar]

38. Saha A, Marma SKK, Rashid A, et al. Risk factors associated with self-medication among the indigenous communities
of Chittagong Hill Tracts, Bangladesh. PLoS One. 2022;17:1–16. [PMC free article] [PubMed] [Google Scholar]

39. Araia ZZ, Gebregziabher NK, Mesfun AB. Self medication practice and associated factors among students of Asmara
College of Health Sciences, Eritrea: a cross sectional study. J Pharm Policy Pract. 2019;2:1–9. [PMC free article]
[PubMed] [Google Scholar]

40. Kumar R, Goyal A, Padhy BM, Gupta Y. Self-medication practice and factors influencing it among medical and
paramedical students in India: a two-period comparative cross-sectional study. J Nat Sc Biol Med. 2016;7:143–148. doi:
10.4103/0976-9668.184700 [PMC free article] [PubMed] [CrossRef] [Google Scholar]
41. Hashemzaei M, Afshari M, Koohkan Z, Bazi A, Rezaee R, Tabrizian K. Knowledge, attitude, and practice of pharmacy
and medical students regarding self-medication, a study in Zabol University of Medical Sciences; Sistan and Baluchestan
province in south-east of Iran. BMC Med Educ. 2021;21:1–10. [PMC free article] [PubMed] [Google Scholar]

42. Du Y, Knopf H. Self-medication among children and adolescents in Germany: results of the National Health Survey for
Children and Adolescents (KiGGS). Br J Clin Pharmacol. 2009;68(4):599–608. doi: 10.1111/j.1365-2125.2009.03477.x
[PMC free article] [PubMed] [CrossRef] [Google Scholar]

43. Bretagne J, Richard-Molard B, Honnorat C, Caekaert ABP, Barthélemy P. Gastroesophageal reflux in the French
general population: national survey of 8000 adults. Press Med. 2006;35:23–31. doi: 10.1016/S0755-4982(06)74515-8
[PubMed] [CrossRef] [Google Scholar]

44. Roberts LW, Hardee JT, Franchini G, Stidley CASM, Siegler M. Medical students as patients: a pilot study of their
health care needs, practices, and concerns. Acad Med. 1996;71:1225–1231. doi: 10.1097/00001888-199611000-00019
[PubMed] [CrossRef] [Google Scholar]

45. Hooper C, Meakin RJM, Jones M. Where students go when they are ill: how medical students access health care. Med
Educ. 2005;39(6):588–593. doi: 10.1111/j.1365-2929.2005.02175.x [PubMed] [CrossRef] [Google Scholar]

46. Carrasco-garrido P, De AAL, Barrera VH, et al. Predictive factors of self-medicated analgesic use in Spanish adults: a
cross-sectional national study. BMC Pharmacol Toxicol. 2014;15:1–9. [PMC free article] [PubMed] [Google Scholar]

47. Garofalo L, Di GG, Angelillo IF. Self-medication practices among parents in Italy. BioMed Res Int. 2015;2015. doi:
10.1155/2015/580650 [PMC free article] [PubMed] [CrossRef] [Google Scholar]

48. Hem E, Stokke G, Tyssen R, Grønvold NT, Vaglum PEØ, Ekeberg Ø. Self-prescribing among young Norwegian
doctors: a nine-year follow-up study of a nationwide sample. BMC Med. 2005;3(1):16. doi: 10.1186/1741-7015-3-16 [PMC
free article] [PubMed] [CrossRef] [Google Scholar]

49. Petrovi AT, Stilinovi N, Kusturica MP. Self-medication perceptions and practice of medical and pharmacy students in
Serbia. Int J Environ Res Public Health. 2022;19(3):1193. [PMC free article] [PubMed] [Google Scholar]

50. Klemenc-keti Z, Kersnik J, Cross Sectional A. Study of sex differences in self-medication practices among university
students in Slovenia. Coll Antropol. 2011;35:329–334. [PubMed] [Google Scholar]

51. Williams AA, Crawford K. Self-medication practices among undergraduate nursing and midwifery students in
Australia: a cross sectional study. Contemp Nurse. 2016;6178. [PubMed] [Google Scholar]

52. Behzadifar M, Behzadifar M, Aryankhesal A, et al. Prevalence of self-medication in university students: systematic
review and meta-analysis. East Mediterr Heal J. 2020;26:846–857. doi: 10.26719/emhj.20.052 [PubMed] [CrossRef]
[Google Scholar]

53. Gabriel DC, Balakrishna BB, Coll M, Brugada R, Parisi P, Striano P. Knowledge and practices of self-medication
among adolescents. Ann Clin Translat Neurol. 2021;8(9):1557–1565. doi: 10.1002/acn3.51382 [PMC free article]
[PubMed] [CrossRef] [Google Scholar]

54. Mannasaheb BA, Al-Yamani MJ, Alajlan SA, et al. Knowledge, attitude, practices and viewpoints of undergraduate
university students towards self-medication: an institution-based study in Riyadh. Int J Environ Res Public Health.
2021;18(16):16. doi: 10.3390/ijerph18168545 [PMC free article] [PubMed] [CrossRef] [Google Scholar]
55. Hsiao FY, Lee J-A, Huang W-F, Chen S-M, Chen H-Y. Survey of medication knowledge and behaviors among college
students in Taiwan. Am J Pharm Educ. 2006;70(2):30. doi: 10.5688/aj700230 [PMC free article] [PubMed] [CrossRef]
[Google Scholar]

56. Abebe D, Tenaw G, Dessalegn HFA, Franelee AZ. Knowledge, attitude and practice of self-medication among health
science students at DebreMarkos university, Northwest Ethiopia. J public Heal Epidemiol. 2017;9(5):106–113. doi:
10.5897/JPHE2017.0926 [CrossRef] [Google Scholar]

57. Al FM, Al BK, Hakami WO, Khan SA. Evaluation of self-medication practices in acute diseases among university
students in Oman. J Acute Dis. 2014;3(3):249–252. doi: 10.1016/S2221-6189(14)60056-1 [CrossRef] [Google Scholar]

58. Adebisi AA. Knowledge and Practice of self-medication among students of school of nursing in selected schools in
Osun State. Knowl Pract. 2016;4(4):1–10. [Google Scholar]

59. Patil SB, Vardhamane SH, Patil BV, Santoshkumar J, Binjawadgi AS, Kanaki AR. Self-medication practice and
perceptions among undergraduate medical students: a cross-sectional study. J Clin Diagnostic Res. 2014;8(12):10–13.
[PMC free article] [PubMed] [Google Scholar]

60. Isameldin E, Saeed AA, Mousnad MA. Self-medication Practice among patients living in Soba. Dspace Reposit.
2020;4:1–5. [Google Scholar]

61. Gaikwad NR, Patil ABKT. Comparative evaluation of knowledge, attitude and practice of self-medication among first
and second year medical students. J Datta Meghe Inst Med Sci Univ. 2010;5:157–162. [Google Scholar]

62. Rachamanti R, Bano Z. The pattern of self-medication practice among undergraduate medical students of tertiary care
hospital, Andhra Pradesh, India. Int J Basic Clin Pharmacol. 2017;6(12):2848–2852. doi: 10.18203/2319-
2003.ijbcp20175206 [CrossRef] [Google Scholar]

63. Badiger S, Kundapur R, Jain A, Kumar A, Patanashetty S, Thakolkaran NB. Self-medication patterns among medical
students in South India. AMJ. 2012;5(4):217–220. doi: 10.4066/AMJ.2012.1007 [PMC free article] [PubMed] [CrossRef]
[Google Scholar]

64. Ocan M, Bwanga F, Bbosa GS, et al. Patterns and predictors of self-medication in northern Uganda. PLoS One.
2014;9(3):e92323. doi: 10.1371/journal.pone.0092323 [PMC free article] [PubMed] [CrossRef] [Google Scholar]

65. Helal RM, Abou-Elwafa HS. Self-medication in University students from the city of Mansoura, Egypt. J Env Public
Heal. 2017;2017:1–7. doi: 10.1155/2017/9145193 [PMC free article] [PubMed] [CrossRef] [Google Scholar]

66. Arikpo G, Eja M. Self-Medication in Rural Africa. Internet J Heal. 2009;11(1):1–7. [Google Scholar]

67. Shah AP, Parmar SA, Kumkishan A, Knowledge, Attitude and Practice (KAP) Survey Regarding the safe use of
Medicines in rural area of Gujarat. Adv Trop Med Pub Heal. 2011;1(2):66–70. [Google Scholar]

68. Tesfaye ZT, Ergena AE, Yimer BT. Self-medication among medical and nonmedical students at the University of
Gondar, Northwest Ethiopia: a cross-sectional study. Scientifica. 2020;2020:1–5. doi: 10.1155/2020/4021586 [PMC free
article] [PubMed] [CrossRef] [Google Scholar]

69. Kifle ZD, Mekuria AB, Anteneh DA, Enyew EF. Self-medication Practice and Associated Factors among Private
Health Sciences Students in Gondar Town, North West. INQUIRY. 2021;58:1–10. [PMC free article] [PubMed] [Google
Scholar]
70. Gutema GB, Gadisa DA, Abebe Z, et al. Self-medication practices among health sciences students: the case of Mekelle
University. J Appl Pharm Sci. 2011;1(10):183–189. [Google Scholar]

71. Al-Qahtani AM, Shaikh IA, Shaikh MAK, Mannasaheb BA, Al-Qahtani FS. Prevalence, perception, and practice, and
attitudes towards self-medication among undergraduate medical students of Najran University, Saudi Arabia: a Cross-
Sectional Study. Risk Manag Healthc Policy. 2022;15:257–276. doi: 10.2147/RMHP.S346998 [PMC free article]
[PubMed] [CrossRef] [Google Scholar]

72. Esan DT, Fasoro AA, Odesanya OE, Esan TO, Ojo EF, Faeji CO. Assessment of self-medication practices and its
associated factors among undergraduates of a Private University in Nigeria. J Environ Public Health. 2018;2018:1–7. doi:
10.1155/2018/5439079 [PMC free article] [PubMed] [CrossRef] [Google Scholar]

73. Bhattarai N, Basyal D, Bhattarai N. Self medication practice among undergraduate pharmacy students in Kathmandu
Valley, Nepal. Int J Pharma Sci Res. 2014;5(11):737–746. [Google Scholar]

74. Mathewos T, Daka K, Bitew S, Daka D. Self-medication practice and associated factors among adults in Wolaita Soddo
town, Southern Ethiopia. Int J Infect Control. 2021;1:1–8. [Google Scholar]

75. Kassie AD, Bifftu BB, Mekonnen HS. Self-medication practice and associated factors among adult household members
in Meket district, Northeast Ethiopia, 2017. BMC Pharmacol Toxicol. 2018;19(5):4–11. doi: 10.1186/s40360-018-0205-6
[PMC free article] [PubMed] [CrossRef] [Google Scholar]

76. Mekonnen M, Zelalem D, Tezera N. Self-medication practice and associated factors among non-health professional
students of university. Hos Pal Med Int Jnl. 2018;2(6):347–353. [Google Scholar]