Perception and Practices of Self-Medication among University Students in Lahore, Pakistan

Organization, self-medication is de�ned as the “use of over-the-counter medication to treat self-diagnosed symptoms or disorders or for the continuous and re-use of prescribed medications for recurrent diseases.” Objective: To compare the perception and practice of self-medication among medical and non-medical students at the University of Lahore, Pakistan. Methods: It is a comparative cross-sectional study with non-probability convenient sampling technique. Five hundred and eighty four students participated in this survey. The data were collected through questionnaire. Results: 98.6% of the students were self-medicating; 50.1% were medical and 49.9% were non-medical students. The frequency of medical students knowing more about the medicines they consumed needed a prescription, and self-medication is not safe to treat the illness is higher than in non-medical students. Personal knowledge was the main source and time saving was the main cause of self-medication. The frequency of medical students reading the lea�et is higher in medical than in non-medical students. The frequency of painkillers is higher in non-medical students compared to medical students. The most frequent indications for self-remedy in both groups were headache, fever, cough & common cold. Conclusions: The frequency of self-medication was high among the students of the University of Lahore. The population may be educated against the harmful effects of self-medication and authorities should monitor pharmacies that are part of the self-medication process.

survey. They were uniformly split up into two groups; 292 students in group A (healthcare students) and 292 students in group B (non-healthcare students). 98.6% of the respondents were self-medicating; 50.1% were from healthcare and 49.9% were from the non-healthcare group. The basic demographic information of healthcare and non-healthcare students is shown in Table 1. In both groups, the number of students in the 17-22 years old category was signi cantly more as compared to the students of 23-28 years of age (p-value=0.001). The frequency of female students was substantially higher in contrast to male students in the healthcare group (p-value=0.000).

M E T H O D S
employees directly involved in healthcare services (90.9%) than in non-healthcare services (62.9%) [10]. Our neighboring countries have quoted prevalence of selfmedication as 60% in India [11], and 78% in Nepal [12]. Few studies concerning self-medication conducted in Pakistan show a prevalence of % [13]. The estimated level of 68.8 self-remedy with antibiotics was 31.0% in Lithuania [14]. In a London study, analgesics used were reported to be 34.8% by females and 21.4% by males [15]. It is shown that in South Asian nations including India, Nepal, Bangladesh, and Pakistan, 50% of antibiotic purchase is made through overthe-counter drug sales, which is a signi cant factor in promoting self-remedy in those countries and it is also reported that more than 80% of all antibiotics purchased in underdeveloped countries are without a doctor 's prescription [16]. In Pakistan, the majority of prescriptiononly medicines are available over the counter without a prescription [17]. However; there is a large variation among the different population groups with varying levels of socioeconomic status and education. The present survey aimed to compare the perception and practices of selfmedication among healthcare and non-healthcare students at the University of Lahore, Pakistan.
Five hundred and eighty-four students participated in this R E S U L T S The reverse was seen in non-healthcare participants. A signi cantly higher number of students in the healthcare g ro u p i n co n t ra st to t h e n o n -h e a l t h c a re g ro u p acknowledged the importance of having a prescription before visiting the pharmacy (p-value=0.000). Knowledge of reading drug lea ets before drug use was observed more among healthcare students (p-value=0.000) Table 2. It was also found that the difference in personal knowledge was signi cantly higher in healthcare pupils as compared to non-healthcare pupils (p-value=0.000). However, friends This is a comparative cross-sectional survey-based study conducted over nine months, from March to December 2022, at the University of Lahore, Pakistan. A nonprobability convenient sampling technique was adopted. Healthcare students (MBBS) and Non-healthcare students (Engineering) of both genders were included in the study. However, sick students taking medication advised by a doctor were excluded from the survey. Ethical approval of the study was taken from the Ethical Committee of the University of Lahore (No. ERC/99/22/02, dated 17-02-2022). The data were collected through a selfadministrated questionnaire [3,8,18]. The survey questionnaire reliability was checked by conducting a pilot study and calculating the Cronbach's alpha coe cient value as 0.474 [19]. Each participant was approached by the principal investigator (PI) for an interview after verbal written consent. Data from the completed forms were entered and statistical package for social sciences (SPSS) version 20.0 was used for data analysis. Both descriptive and inferential statistics were used for data analysis. The comparison between healthcare and non-healthcare students was completed in the analysis by applying the student's t-test for quantitative data and the Chi-square test for qualitative data as appropriate. p-value ≤ 0.05 was considered as the signi cant effect. medical and non-medical students in the last 6 months.
Headache was the most frequently encountered symptom (33.7%) in the study groups. Antipyretics were taken more frequently by the non-healthcare students as compared to healthcare students but the reverse was observed in cases of heartburns/ulcers and other drugs like disorders of digestive systems, toothache, menstruation problems, contraception, insomnia, and hemorrhoids (p-value<0.05). Figure 2. as a source of self-remedy were more with non-healthcare students as compared to healthcare counterparts (p-value=0001) Table 3.  The prevalence of self-medication as found in this study is 98.6%. This result is consistent with some other studies conducted in Pakistan and abroad [20,21]. But lower prevalence is shown in other surveys conducted in various underdeveloped countries such as 68.1% in Ethiopia, 78.6% in India, 67.7% in Saudi Arabia, and 62.9% in Egypt [22,23] This difference in the prevalence of self-remedy could be due to many factors like the design of the study, the age group of the participants, sex, cultural practices, and legal implications. People in Pakistan can buy over-the-counter medications without any restriction as drug stores do not follow the pharmacy laws in Pakistan [24]. Such practice is also common in many other developing countries [25]. The ndings of the present study show that medical students practiced self-medication more than non-medical students most probably due to medical knowledge and exposure of the medical students. The current study also shows that the practice of self-remedy is decreasing with increasing age for both medical and non-medical students and this nding is matching with the nding of another study conducted by Kassa et al.,  Several reasons for self-medication were narrated by the participants. But in non-healthcare students, time-saving and privacy, as well as economic reasoning, were important driving factors for self-remedy as compared to healthcare students (p<0.05). Table 4. The most commonly used drugs for self-medication were painkillers and antibiotics by both healthcare and nonhealthcare students. The proportions of different types of self-remedies were signi cantly more common in nonmedical students as compared to the medical students except for drugs used for cold and u Figure 1. revealed that fever, headache, and sore throat were the most common motives for self-medication among students [31]. Khan et al., from Karachi have reported that easy availability and minor ailments were two major reasons for self-remedy among medical students [29]. The most common neurological complaint in the present study is headache (33.7%). A systematic review of three Arab countries, Saudi Arabia, Qatar, and Oman have reported that the prevalence of headache in the public sector varied from 8 to 83.6%. The second most frequent indication for self-medicating was cough and cold/ u. Most people in our population are familiar with these symptoms and perceive that colds usually present with mild symptoms. They often tend to self-medicate rather than make the effort to book an appointment for a medical consultation. Or they visit the nearby pharmacy to purchase a few tablets of Rigix and Paracetamol. Similar ndings have been found in another study [32].

Self-medicated Drugs
knowing the need for a physician's prescription for medication [1].The current study demonstrates that 84.9% of healthcare pupils and 72.6% of non-healthcare pupils expressed that self-medication is safe to treat the illness. However, a low level of drug safety knowledge was reported by Alshahrani and associates, i.e. 24.8% of healthcare pupils and 36.2% of non-healthcare pupils [1]. In the present study, 64.0% of healthcare pupils and 49.0% of non-healthcare pupils read the lea et before using medicines. A higher proportion of both healthcare pupils and non-healthcare pupils were reading the lea ets in another study [27]. Personal knowledge came out to be a strong driving force for self-remedy in both healthcare and non-healthcare students. However, this factor was signi cantly more frequent in healthcare students as compared to non-healthcare counterparts (p<0.05).
Because of the easy availability of physicians' advice, medical students were seen as more prone to indulge in self-medication without a prescription. Similar results have been shown in another study from Karachi [28].Time savings is the most frequently cited justi cation for selfremedy among the study groups. Table 4. This result is consistent with earlier research from Madinah, Saudi Arabia [29]. Another study conducted in Saudi Arabia by Alshahrani and co-workers in the year 2019 also found the most frequent reason for self-remedy was a time-saving factor for both healthcare and non-healthcare students. We also found that the perception of medical students of not visiting the doctor and considering the ailment as milder was signi cantly more as compared to non-medical university fellows (p<0.05), an observation found in other studies also [1]. The subjects of the current study commonly used a variety of drug classes to treat various illnesses. (Figure 1). However, the selection of drugs is in uenced by the study discipline. Pain killers, antipyretics and antibiotics were more frequently used by the nonhealthcare students as compared to the healthcare counterparts Based upon a cross-sectional study in . Karachi, Khan et al., have reported an opposite trend. Antipyretic, analgesic and antibiotics were the most frequently used drugs used by the undergraduate medical students [29]. The emergence of antimicrobial medication resistance is a serious issue. 15% of the respondents in this research use antibiotics without a doctor's advice, despite the Ministry of Health's numerous efforts to educate people on the topic. This issue has been addressed by other researchers also [30]. In both groups of students, the leading indications for self-remedy were headache. Cough & common cold and fever, but the proportions of these ailments were slightly higher among medical as compared to non-medical students (Figure 2). A study conducted by Musa et al., in a private Medical College in Peshawar has also The present study suspected a high prevalence of selfremedy practice among university students at the University of Lahore. The frequency of medical students knowing medicines they consume need a prescription, potential adverse drug reactions and self-medication is not safe to treat the illness is signi cantly higher than nonmedical students. Personal knowledge was the main source of self-medication in both groups but notably more in medical than non-medical students. The frequency of medical students reading the lea et before taking medicines is higher than non-medical students. Timesaving was the main cause of self-medication in both medical and non-medical students.

S o u r c e o f F u n d i n g
The authors received no nancial support for the research, authorship and/or publication of this article.