Presenter Dr Joyeuse UKWISHAKA Co-authors Christian UMUHOZA MD, - PowerPoint PPT Presentation

Presenter Dr Joyeuse UKWISHAKA Co-authors Christian UMUHOZA MD, MMed Jean Claude KABAYIZA MD, MMED, PhD Peter Cartledge MBChB, MRCPCH, PCME, MSc Natalie McCall MD, MPH, FAAP

• Self-care • Self-medication – Benefits and risks • Responsible self-medication • A worldwide practice encountered in both the adult and pediatric population. 2

In Rwanda:  Self-medication(including traditional medication) is being used even in children  There is increase in antibiotic resistance  There is no recognized list of OTC/non- prescription drug 3

General objective To determine the use of self-medication in children in Private and Public Health Facilities in Rwanda. Specific objectives 1. Determine the percentage of reported use of self- medication among parents to their children. 2. Identify common drugs used, source of information/advice in self-medication. 3. Determine the factors associated with the parental decision to self-medicate their children. 4

Study design: Cross-sectional study Study sites – Ruhengeli Hospital OPD and in-patients – Legacy clinic/Kigali – Muhima Health Center/Vaccination clinic Study population – Parents of children aged up to 10 years Study period – From July to September 2018 with all sites being visited twice . 5

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(n: number of respondents) 7

Item Classification Frequency Percentage Site of interview Private 51 33.1% Public 103 66.9% Origin Kigali 92 59.7% Outside Kigali 62 40.3% Relationship Mother 133 86.4% Other 21 13.6% Marital status of parent Married 145 94.2% Single (+ Separated, Widowed) 9 5.8% Age of parent ≤30 60 39% >30 94 61% Education level Advanced 77 50% Basic 77 50% Economic status High 45 29.2% Low and Middle 109 70.8% Health insurance Private 60 39% Mutuelle de santé/None 94 61% Number of children under 10yrs 1 48 31.2% >1 106 68.8% 8

Modern Medicine Traditional medicine Participants 51% of participants 16% of participants choice on type of self-medication Most used drugs Paracetamol (72%) Self- collected herbs and plants (95%) Source of advice Myself (51%) Relatives/ friends before deciding (61%) to use self- medication 9

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• Confidence – Modern medication self- prescriber ˃ traditionnal self-medication providers (p=0.005) • Barriers to consultation – Modern medication self- prescriber ˃ traditionnal self-prescribers (p=0.028) • The participants who did not self-medicate believed that self-medications do not work and can be dangerous. 11

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Use of medication w/o prescription Yes No OR (CI) P-value Adjusted OR (CI) P-value (n=120) (n=34) N (%) N (%) Number of > One 92 (86.8%) 14 (13.2%) 4.6 (2.10- <0.001 4.74 (1.94-11.58) 0.001 children <10yrs 10.48) One 28 (58.3%) 20 (41.7%) Origin Kigali 78 (84.8%) 14 (15.2%) 2.65 0.013 2.23 (0.91-5.46) 0.078 (1.21-5.78) Outside Kigali 42 (67.7%) 20 (32.2%) Site of interview Private 44 (86.3%) 7 (13.7%) 2.23 0.080 1.09 (0.32-3.67) 0.886 (0.89-5.55) Public 76 (73.8%) 27 (26.2%) Economic status High 39 (86.6%) 6 (13.3%) 2.24 (0.86- 0.094 1.79 (0.53-6) 0.342 5.87) Low/Moderate 81 (74.3) 28 (25.7) Age of parent >30 77 (81.9%) 17 (18.1%) 1.79 0.136 0.82 (0.32-2.09) 0.679 (0.83-3.86) <30 43 (71.7%) 17 (28.3%) Education level Advanced 61 (79.2%) 16 (20.8%) 1.16 0.699 (0.54-2.49) Basic 59 (76.6%) 18 (23.4%) Relationship Mother 104 (78.2%) 29 (21.8%) 1.12 0.837 (0.37-3.31) Other 16 (76.2%) 5 (23.8%) Marital status Married 113 (77.9%) 32 (22.1%) 1.00 0.991 (0.20-5.09) Single 7 (77.8%) 2 (22.2%) Health insurance Private 47 (78.3%) 13 (21.7%) 1.04 0.922 (0.47-2.27) 13 Mutuelle de 73 (77.7%) 21 (22.3%) santé/None

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Parents who use Parents who use OR (95%CI) p-value Adjusted OR(CI) p-value only Modern self- only Traditional medication self-medication (n=61) (n=19) N (%) N (%) Site of interview Private 33 (97.1%) 1 (2.9%) 21.21 <0.001 0.61 0.778 (2.66-169) (0.02-18.16) Public 28 (60.9%) 18 (39.1%) Education level Advanced 43 (95.5%) 2 (4.4%) 20.3 (4.24- <0.001 2.38 0.453 97.12) (0.24-22.92) Basic 18 (51.4%) 17 (48.6%) Economic status High 30 (96.7%) 1 (3.2%) 17.41 (2.18- 0.001 4.75 (0.32- 0.257 138.77) 70.28) Low /Moderate 32 (63.2) 18 (36.7) Health insurance Private 38 (95%) 2 (5%) 14.04 (2.96- <0.001 2.78 0.440 66.42) (0.20-37.44) Mutuelle de 23 (57.5%) 17 (42.5%) santé/none Age of parent >30 49 (89.1%) 6 (10.9%) 8.84 (2.78- <0.001 5.78 0.025 28.08) (1.25-26.68) ≤30 12 (48%) 13 (52%) Origin Kigali 46 (90.2%) 5 (9.8%) 8.5 (2.65-27.82) <0.001 8.2 0.012 (1.58-43.12) Outside Kigali 15 (51.7%) 14 (48.2%) Number of children >one 49 (79%) 13 (21%) 1.88 (0.59-5.98) 0.281 <10yrs One 12 (66.6%) 6 (33.3%) Relationship Other 11 (84.6%) 2 (15.4%) 1.87 0.442 (0.37-9.29) Mother 50 (74.6%) 17 (25.4%) Marital status Married 59 (76.6%) 18 (23.4%) 1.63(0.14- 0.693 19.14) 15 Single 2 (66.7%) 1 (33.3%)

Our study Other studies Comments • Reason of using self- Reported reasons: In Rwanda people use • medication need to give emergency self-medication despite • need to give emergency medication having life insurance • medication having experience with (Mutuelle de Santé & Other no strong reasons to the drug others) • choose self-medication: perceiving their children • High consultation fees as having mild symptoms • • Lack of insurance Long waiting time • • geographic access Long distance • Cost,... • • Factors associated with the Italy: higher education, Few predicting factors in use of self-medication younger parents our population • • • Having more than one Spain: middle social class General education to the • child less than 10 years Germany: lower whole population to education level minimise risks of self- medication 16

• We found a considerable number of self-medication use despite being non-regulated • Even with health insurance, people use self-medication Limitations • Response biases and recall biases • No analysis of comparison between three groups of respondents in terms of type of used drugs in self- medication (use of only western vs. only traditional vs. both). 17

Conlusion • Self-medication which is a worldwide practice is also common in Rwanda. • Parents are involved in this practice for their children regardless of their socio-demographic background Recommendations • Promote responsible self-medication; this implies providing necessary information about the medicines and use medicines that are approved for use in self-medication • Set up a list of OTC drugs for use in self-medication by MOH • Set rules and control measures on local pharmacies about drugs allowed to be dispensed without a prescription 18

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