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.

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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

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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.

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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.

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(n: number of respondents)

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%

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

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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.

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Use of medication w/o prescription Yes (n=120) No (n=34) OR (CI) P-value Adjusted OR (CI) P-value

N (%) N (%)

Number of children <10yrs > One 92 (86.8%) 14 (13.2%) 4.6 (2.10- 10.48) <0.001 4.74 (1.94-11.58) 0.001 One 28 (58.3%) 20 (41.7%) Origin Kigali 78 (84.8%) 14 (15.2%) 2.65 (1.21-5.78) 0.013 2.23 (0.91-5.46) 0.078 Outside Kigali 42 (67.7%) 20 (32.2%) Site of interview Private 44 (86.3%) 7 (13.7%) 2.23 (0.89-5.55) 0.080 1.09 (0.32-3.67) 0.886 Public 76 (73.8%) 27 (26.2%) Economic status High 39 (86.6%) 6 (13.3%) 2.24 (0.86- 5.87) 0.094 1.79 (0.53-6) 0.342 Low/Moderate 81 (74.3) 28 (25.7) Age of parent >30 77 (81.9%) 17 (18.1%) 1.79 (0.83-3.86) 0.136 0.82 (0.32-2.09) 0.679 <30 43 (71.7%) 17 (28.3%) Education level Advanced 61 (79.2%) 16 (20.8%) 1.16 (0.54-2.49) 0.699 Basic 59 (76.6%) 18 (23.4%) Relationship Mother 104 (78.2%) 29 (21.8%) 1.12 (0.37-3.31) 0.837 Other 16 (76.2%) 5 (23.8%) Marital status Married 113 (77.9%) 32 (22.1%) 1.00 (0.20-5.09) 0.991 Single 7 (77.8%) 2 (22.2%) Health insurance Private 47 (78.3%) 13 (21.7%) 1.04 (0.47-2.27) 0.922 Mutuelle de santé/None 73 (77.7%) 21 (22.3%) 13

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Parents who use

• nly Modern self-

medication (n=61) Parents who use

• nly Traditional

self-medication (n=19) OR (95%CI) p-value Adjusted OR(CI) p-value

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

Our study Other studies Comments Reason of using self- medication

• need to give emergency

medication Other no strong reasons to choose self-medication:

• High consultation fees
• Lack of insurance
• geographic access

Reported reasons:

• need to give emergency

medication

• having experience with

the drug

• perceiving their children

as having mild symptoms

• Long waiting time
• Long distance
• Cost,...
• In Rwanda people use

self-medication despite having life insurance (Mutuelle de Santé &

• thers)

Factors associated with the use of self-medication

• Having more than one

child less than 10 years

• Italy: higher education,

younger parents

• Spain: middle social class
• Germany: lower

education level

• Few predicting factors in
• ur population
• General education to the

whole population to minimise risks of self- medication

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• 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).

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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

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