|Year : 2021 | Volume
| Issue : 1 | Page : 82-86
Complementary medicine utilization and practices of self-medication in the field practice areas of a medical college of district Dakshina Kannada, Karnataka, India
Saurabh Kumar, Achal Shetty, Sowmya Bhat, Sudhir Prabhu, Oliver Dsouza, K Nishanth Krishna, Moira Dsouza, V Narayana
Department of Community Medicine, Father Muller Medical College, Mangalore, Karnataka, India
|Date of Submission||05-Jun-2020|
|Date of Decision||02-Sep-2020|
|Date of Acceptance||12-Sep-2020|
|Date of Web Publication||08-Apr-2021|
Dr. Saurabh Kumar
Department of Community Medicine, II Floor B Block, Father Muller Medical College, Mangalore, Karnataka
Source of Support: None, Conflict of Interest: None
INTRODUCTION: Complementary modalities have been established globally but lack of sufficient data on their utilization patterns hinders the mainstreaming with the existing health care delivery system. The concerning issues are especially of self-medication and usage of complementary medicines with or without the usage of allopathic drugs.
AIM: The study aims to find out the prevalence of complementary medicine utilization and prevalence of self-medication amongst the people in the field practice areas of the medical college.
MATERIALS AND METHODS: Community-based cross-sectional study was conducted from November 2018 to January 2019. The International questionnaire for the use of Complementary and alternative systems of Medicine was used to interview the 451 study participants. The results were expressed in percentages and proportions. Chi-square test was used to find out the association of sociodemographic variables with the use of complementary medicine and self-medication practices.
RESULTS: Overall prevalence of utilizing the complementary medicine services were found to be 17.7%. About 14.6% and 2.9% of the study participants visited ayurvedic and homeopathic practitioners, respectively for the past 12 months. A significantly higher proportion of the rural population was utilizing the services of the complementary system of medical practitioners. Other sociodemographic variables were not found to be associated with the utilization of complementary medicine services. The prevalence of self-medication practices was found to be 25.9%.
CONCLUSION: The prevalence of complementary medicine utilization was lower than the prevalence of self-medication practices. Rural area study participants accessed more services of a complementary system of medical practitioners.
Keywords: Alternative medicine, complementary medicine, self-medication
|How to cite this article:|
Kumar S, Shetty A, Bhat S, Prabhu S, Dsouza O, Krishna K N, Dsouza M, Narayana V. Complementary medicine utilization and practices of self-medication in the field practice areas of a medical college of district Dakshina Kannada, Karnataka, India. BLDE Univ J Health Sci 2021;6:82-6
|How to cite this URL:|
Kumar S, Shetty A, Bhat S, Prabhu S, Dsouza O, Krishna K N, Dsouza M, Narayana V. Complementary medicine utilization and practices of self-medication in the field practice areas of a medical college of district Dakshina Kannada, Karnataka, India. BLDE Univ J Health Sci [serial online] 2021 [cited 2021 Apr 14];6:82-6. Available from: https://www.bldeujournalhs.in/text.asp?2021/6/1/82/313353
Complementary medicine also called an alternative system of medicine represents a group of varied medical and health care systems, practices, and products that are not considered to be a part of conventional allopathic medicine. It includes treatment modalities such as herbal medicines, naturopathy, Ayurveda, homeopathy, acupuncture, and many more. It encompasses a variety of approaches, knowledge, and beliefs incorporating plant, animal, and/or mineral-based medicines, spiritual therapies, manual techniques, and exercises applied alone or in combination to treat or prevent illness or maintain well-being.,
There are visible side-effects with allopathic medicine in a subset of patients in a short duration of time itself. This may be concerning to the people; further complementary medicine specialists/registered/unregistered self-proclaimed practitioners will be more approachable as they are omnipresent in India.
Self-medication which is defined as the treatment of common ailments with medicines designed and labeled for the use without medical supervision and approved as safe and effective for such use is also a concern nowadays., Patients may be concerned with the adverse effects of allopathic medicine, which may force them to go for self-medication, especially of complementary medicines, which are freely available and are not even covered under some sort of regulation like Schedule H for allopathic drugs. Many of the complementary modalities have been established globally, but there is a substantial lack of research-based evidence regarding complementary medicine's interactions with allopathic drugs.
Keeping these things in mind, we conducted this study to find out the utilization practices of complementary medicine and self-medication among the people residing in rural and urban field practice areas of medical college.
| Materials and Methods|| |
Using a cross-sectional study design, this study was conducted in the field practice areas of the Department of Community Medicine, Father Muller Medical College, Mangalore. Mangalore is the coastal city in the District of Dakshina Kannada, Karnataka, India. Thumbay is the rural field practice area, about 17 km away from the institution and Jyothinagar is the urban field practice area, about 10 km from the institution. The study duration was from November 2018 to January 2019. The study was started after obtaining the ethics committee approval from the Institution Ethics Committee vide number FMMCIEC/CCM/706/2018-29.11.2018.
The sample size was calculated using the open epi software. With the prevalence of the use of complementary medicine about 49% (p) and confidence limits as 5% (d) and design effect (DEFF) of 1, the sample size came out to be 467 with a 20% nonresponse rate.
All the adults >18 years of age consenting to be a part of the study were included in the study. The family was selected by random sampling from the existing family folders maintained at the rural and urban health training centers. The informed written consent of the study participants was obtained before the administration of the interview schedule. The study did not involve any laboratory diagnostic tests or administration of medicines to participants. The respondents were briefed about the purpose of the study. The head of the family was interviewed. In case the head of the family was not present, the oldest person present in the home was interviewed. Only one person was interviewed per family. The number of families from urban and rural areas was selected based on the probability proportionate size sampling method. The educational qualification attained was categorized as illiterate, literate those who were at least able to read, write, and speak in any one language, primary - 1st–5th class, secondary - 6th–10th class, higher secondary - 11th–12th class, and graduate and above. Above the poverty line (APL) and below poverty line (BPL) status of a family was determined on the basis of the ration card of the family.
ICAM questionnaire-International Questionnaire to measure the usage of complementary and alternative medicine was used for collecting the data in the field practice areas. ICAM was already validated in the Indian scenario earlier.
The results were expressed in percentages and proportions. Appropriate tests of an association like the Chi-square test was used to find out the association of sociodemographic variables with the use of complementary medicine and self-medication. The data was analyzed using Statistical Package for the Social Sciences version 23 and p value < 0.05 was considered as statistically significant.
| Results|| |
Out of the total 470 families visited, we could get a response from only 451. About 154 (34.1%) from the urban area and 297 (65.9%) from the rural area participated in the study. Of 451 respondents, 127 (28.2%) were males and 324 (71.8%) were females, respectively. About 245 (54.3%) of the participants had the highest educational qualification up to primary to secondary standard but a sizeable number of the study participants were found to be illiterate 97 (21.5%). The most common religion practiced was found to be Hinduism followed by Islam and Christianity among the study participants. About 103 (22.8%) and 328 (72.7%) of the study participants belonged to the BPL and APL socioeconomic classes, respectively. The poverty line status of twenty families could not be ascertained due to the nonavailability of ration cards as quoted by the study participants [Table 1].
Only 15 (3.3%) of the study participants perceived their health state as poor in the past 1 year. Majority of the study participants reported their health state as good to very good 331 (63.4%) [Table 1].
Very few study participants visited an Ayurvedic health care practitioner in the past 1 year 66 (14.6%). The study participants visiting Homeopathy health care practitioners were still less with about 13 (2.9%) only doing so in the past 1 year. Accessing the osteopaths, acupuncturists, herbalists, and spiritual healers were not very common in the study population. The overall prevalence of accessing the alternative system of medicine was found to be 17.7%. The majority of the study population visited registered medical practitioners 205 (45.5%) for various medical conditions in the past 12 months.
A significantly higher number of study participants were following the alternate system of medicine compared to that of the urban area. The prevalence of utilization of Ayurvedic, Yoga, and Naturopathy, Unani, Siddha, and Homeopathy (AYUSH) system was about 2.7% in urban areas and 15.1% in rural areas. Age, sex, poverty line socioeconomic status, religion, and education of the respondents were not found to be associated with the utilization of the complementary system of medicine [Table 2].
|Table 2: Association of sociodemographic variables with the utilization of complementary medicine services by study participants|
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About 11 (2.4%) and 15 (3.3%) participants believed and practiced in Meditation and Yoga each.
Self-medication of Ayurvedic, Homeopathy, over the counter drugs, and herbal substances was observed in 6.2%, 0.7%, 9.2%, and 8.2% of study participants, respectively. Self-medication was mainly done for the management of acute conditions by the patients. Overall self-medication across all the systems of medicine was found to be 25.9%. It was observed that higher proportions of the Christian population never used self-medication. The practice of self-medication was not found to be associated with any other sociodemographic factors such as sex, age, area of residence, educational qualification, and socioeconomic status [Table 3].
|Table 3: Association of sociodemographic variables with self-medication practices of the study participants|
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| Discussion|| |
The current study revealed the prevalence of accessing the AYUSH services to be about 17.7%. The most common modality accessed by the study participants was Ayurveda followed by Homeopathy. This is in concurrence with the findings of Singh et al. who observed that about 14% patients were availing AYUSH treatment, although the analysis of the WHO-SAGE survey revealed that 11.7% respondents used traditional medicine as a frequent source of care. National Sample Survey (NSS) survey of 2014 showed even lesser utilization of AYUSH services. NSS revealed that AYUSH care was used by about 6.7% and 7.1% of patients in rural and urban India, respectively. Priya and Shweta observed a higher utilization of AYUSH by the households. They observed that more than 60% of households utilized AYUSH services in five states and up to 30%–60% in about six states. Only five states were having <30% of households utilizing AYUSH services. These estimates might not be comparable due to variability in survey years and recall periods. In our study, the recall period was 12 months.
Complementary medicine usage was relatively high among elderly patients 4.1% and 4.8% in rural and urban India, respectively, across various age groups while homeopathy care was relatively more common among children (under five years), particularly in urban areas 4.8%. Compared to males, the use of AYUSH care among females was relatively high in rural India, whereas no such gender-differential was observed in urban areas
Self-medication of allopathic drugs was found to be about 9.2%. Similar results were observed by Kalaiselvi et al. in urban areas of Puducherry.A study from Sri Lanka by Wijesinghe et al. also had reported 12.2% and 7.9% prevalence of self-medication to allopathic drugs from the urban and rural areas, respectively, before 2 weeks of interviews. In our study, the timeline of 12 months was considered. In contrast, Ramkumar et al. observed a higher 57.7% prevalence of self-medication over the counter allopathic drugs in the rural area of Pondicherry. The timeline of self-medication considered had been the variable factor in most of the studies, hence comparisons of the prevalence of self-medication across the studies were difficult.
Including drugs of all systems of medicine and herbal substances, the overall self-medication prevalence was found to be 25.9%. Comparable results were seen in the study by Lal et al. in urban Delhi where the prevalence of self-medication among those who suffered any illnesses in the previous 1 month was 31.3%.Another study in an urban slum of Delhi by Durgawale showed that self-medication was practiced by 34.5% of respondents and was similar across various age groups.
The lower prevalence of self-medication may be attributed to the presence of the health centers from the government and private where free medications were being dispensed to the patients.
The study had reported a similar prevalence of self-medication across age groups, sex, area of residence, socioeconomic status, and educational qualifications of the participants. There was no significant determinant except for religion for the use of self-medication in our study [Table 3], though across other studies, sociodemographic variables were found to be affecting the self-medication. None of the study participants following Christianity practiced any self-medication. However, due to lesser proportions of the study participants belonging to Christianity in our study, the results might not be generalizable. Kalaiselvi et al. observed a higher prevalence among males. Education was found to be associated with the use of self-medication in many studies.,, The prevalence of self-medication had been observed to be higher in more educated and illiterate people, in various studies, respectively. The prevalence of self-medication was found to be higher in older people in other studies though.,,
There were some limitations observed in our study. There was a possibility of recall bias as the study took into account the lization of complementary medicine and practices of self-medication over a period of the past 12 months as per the I-CAM questionnaire. Further, being a cross-sectional study, it precluded the assessment of seasonal patterns affecting self-medication. Access to pharmacies, source of self-medication, and sales of over the counter drugs were not addressed in our study.
| Conclusion|| |
The overall prevalence of the use of complementary medicine was less than the prevalence of self-medication in the field practice area of our institution. The study participants residing in the rural areas were more likely to utilize complementary medicine services, but none of the other sociodemographic factors had any effect on the usage of complementary medicine or practices of self-medication.
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Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3]