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Ateneo de Iloilo-SMCS, Atria Park District, San Rafael, Mandurriao Iloilo City
Abstract
Exactly ninety years ago, penicillin - the first antibiotic - was discovered. It took only
five generations for it to become obsolete. This is precisely what happens when drugs of
this kind are misused, underused or overused. The World Health Organization (WHO)
reported that very high rates of antibiotic resistance were observed worldwide and this is
suspected to cause common healthcare associated and community-acquired infections.
At the national level, there is little data regarding the prevalence of self-medication,
largely due to lack of priority for the collection of statistical data and analysis on the topic
whether on the side of the Department of Health (DOH) or the Food and Drug
Association. In Iloilo City, studies relating to self-medication are also very limited.
This study was therefore pursued with the aim of contributing to the medical body of
knowledge and providing data for local authorities in creating strategies and regulations
pertaining to self-medication. The researchers aimed to provide answers to the following
questions: What is the prevalence of self-medication among residents of Iloilo city? What
antibiotics do the self-medicating residents use? What factors predispose people to self-
medicate? Where do they acquire the antibiotics they use? What symptoms are they self-
medicating for?
A survey conducted with 384 respondents from 11 barangays, showed that a significant
number of residents in Iloilo City self-medicated with the use of antibiotics, especially
amoxicillin, in the past twelve months and did so in order to avoid extra costs associated
with professional medical diagnosis and prescription. This raises concerns about the
widespread inappropriate use of antibiotics among residents in Iloilo City, which could
lead to unintended consequences such as antimicrobial resistance.
Keywords:
Self-medication, Antibiotics, Antibiotic Resistance, Iloilo City
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Introduction
Penicillin, the first antibiotic, has now become obsolete. It is an antibiotic used to
treat bacterial infections especially those caused by Staphylococcus and Streptococci
(Lyon & Skurry, 1987). It became ineffective shortly after it gained extensive use in the
1940’s (Abraham, E.P., & Chain, E., 1940). Currently, on a global scale, more than 95%
of Staphylococcus aureus are resistant to penicillins (Bisht, et. al., 2009). This is precisely
what happens when drugs of this kind are misused.
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Moreover, repeated irrational use can result in immense wastage in national
health budgets, failure of treatments, and loss of credibility among health professionals
due to substandard care (The Association of Southeast Asian Nations, 2017).
Medical researchers in the past have investigated the local scene on self-
medication and produced relevant studies surrounding this practice.
Hardon’s (1987) study found that perceived severity of the illness influenced the
method of medication among a village in Luzon. Respiratory issues were considered
severe if symptoms such as runny nose and cough with either white or yellow sputum
were present. Otherwise, it was believed not to be severe.
Another study by Lansang (1991) entitled A Drugstore Survey of Antibiotic Use in
a Rural Community in the Philippines was revealed that written prescriptions were only
available to more than half of of the 6,404 antibiotic drug transactions reported. It was
observed that customers who did present written prescriptions for antibiotics only bought
75% of the number of tablets or capsules prescribed due to financial reasons.
There exists, therefore, a need to conduct further testing to validate the effects of
known determinants of self-medication, and also to determine whether there are other
determinants that have not yet been identified.
At the national level, there are limited data regarding the prevalence of self-
medication, largely due to lack of priority for the collection of statistical data and analysis
on the topic whether on the side of the Department of Health (DOH) or the Food and
Drug Association.
“There are indeed drug stores that sell [antibiotics] without prescription, although
we do monitor them, but we do not put them into statistics”, disclosed by the FDA
Supervisor of Region 6. Furthermore, they also acknowledged the lack of extensive
research on the subject conducted within the City of Iloilo.
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In Iloilo City, studies relating to self-medication are also limited. One study on
the topic was conducted in 1987 by Amatril, et al. regarding self-medication patterns
between Barangay Progreso, Lapuz and Barangay Dangulaan, Anilao. The study found
that both rural and urban communities would often self-medicate for common ailments
such as fever and cough.
Thus, this research was born out of the need to explore the prevalence of self-
medication practices of residents in Iloilo City. The researchers aimed to provide answers
to the following questions: What is the prevalence of self-medication among residents of
Iloilo city? What antibiotics do the self-medicating residents use? What are the factors
that predispose people to self-medication? Where do they acquire the antibiotics they
use? What symptoms are they self-medicating for?
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Materials and Methods
This is a descriptive, cross sectional research with the use of survey methods. It
“presents a picture of the specific details of a situation, social setting, or relationship”
(Neuman, 2007) by way of describing people’s practices, predispositions, and sources of
acquisition in their exercise of self-medication. To the extent that this study involved a
singular wave of data collection, it is therefore a cross sectional research as it enabled the
researchers to gather the necessary information from their respondents on several
occurrences (Bryman, 2008). Generally speaking, this research design also allows for
data collection in which information is gathered through interviews or through the use of
questionnaires (Sarantakos, 1993).
This research sought to conduct the investigation within the city of Iloilo from
December 2017 to January 2018, through a survey method with the use of questionnaires.
According to Neuman (2007), survey research allows the researchers to develop an
instrument - a survey questionnaire - that can measure the variables included in the study.
Probing personal interviews were also conducted in order to substantiate responses in the
survey questionnaire.
The instrument was subjected to content validation, pilot testing, and reliability
testing. A panel of experts was constituted consisting of Hiligaynon and English linguists,
a research methods expert, a pharmacist, a licensed physician, and a statistician. The
instrument was revised based on the recommendations of the members of the said panel
and was subjected to a pilot testing in Oton, Iloilo last December 16, 2018. After the
responses were collected, the data were subjected to reliability testing. The internal
consistency of the instrument was measured using Cronbach’s alpha, which is a measure
of internal consistency whereby the closeness of each item to one another is determined
(Triola, 2012). The test revealed that the Cronbach’s alpha of the instrument was 7.9
which signifies that it was was highly reliable. The actual administration of survey was
ensued immediately after the reliability of the instrument was established.
The study employed a multi-stage sampling method. In the first stage, sample
barangays were chosen from the 180 total barangays in Iloilo City. In the second stage,
households were randomly sampled from each chosen barangay. Finally, in the third
stage, a simple random sampling of individuals was used in order to identify specific
respondents from each household.
The sample size was computed using the following Cochran’s sample size
determination formula:
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A total of three hundred and eighty four (384) respondents were sampled from
different barangays in Iloilo City. A total of eleven barangays representing each district
were included in the survey. The distribution of samples is reflected in the table below.
Respondents were given Informed Consent Forms explaining to them the nature
and intent of the survey. Each of them signed a conforme stating that they agreed to
participate in the study and that data gathered from them were going to be used for
academic purposes only. If a respondent is below 18 years of age, they were instructed to
ask for consent from an available parent or guardian.
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Results and Discussions
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Highest Educational Attainment
Never went to school 1 0.26%
Some elementary 4 1.04%
Elementary graduate 30 7.81%
Some high school 45 11.72%
High school graduate 123 32.03%
Some college 52 13.54%
College graduate 125 32.55%
Finished graduate
school 4 1.04%
Monthly Income
0-2000 124 32.29%
2001-5000 66 17.19%
5001-10000 97 25.26%
10001-above 97 25.26%
Head of Household
Yes 174 45.31%
No 210 54.69%
Number of people in household
Mode 4
Table 2 exhibits the tabulated values and corresponding percentage values socio-
economic and demographic factors of respondents.
Age ranges included people aged 15-75, in which the mean age was 44 years old.
Laborers were presented to represent a large portion of among the 384 respondents
(18.49%). Among the 384 respondents, 137 were male and 247 were female. Civil Status
was classified into 4 groups, with Married as the most common (57.29%). Furthermore,
32.29% estimated their income to be 0- 2000 Php per month. A majority of the
respondents ranged from high school graduates to college graduates. There seemed to be
an equal distribution of respondents who claimed to be head of their household. 45.31%
agreed to be the head of household while 54.69% said otherwise. There was an average
of 4 persons per household among respondents.
Frequency Percentage
Used Antibiotics without Doctor’s Prescription
(n=384) (%)
No 232 60.42%
Yes 152 39.58%
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Table 3 presents the respondents’ use and consumption of antibiotics. Based on a
survey of 384 respondents from eleven barangays in Iloilo City, it was found that 232 or
60.42% did not use antibiotics without a doctor’s prescription in the last twelve months,
while 152 or 39.58% had self-medicated with antibiotics in the same period.
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Table 5 indicates that Amoxicillin and Cephalexin were found to be the most
frequently used in self-medication. Amoxicillin was found to have been used by 147 or
96.71% of the self-medicating respondents, while 44 or 28.95% of them had used
Cefalexin. A number of people admitted that they have become accustomed to using
amoxicillin because it was prescribed to them by a dentist in the past in order to prevent
infection from tooth extraction or other previous dental procedures.
During interviews, several respondents directly associated symptoms such as
toothache to the use of amoxicillin. This implies that antibiotics are being constantly
being reused for self-medication. This may be due to a cultural belief that certain
antibiotics are always the go-to drugs for certain symptoms. One respondent asserted that
as soon as the pain has subsided, it is acceptable to cease the full dosage. Dosage
compliance was thus discovered as a major issue among self-medicating respondents.
Another example of such is when amoxicillin has proved successful in treating a
symptom such as cough, the user would tend to take amoxicillin whenever the same
symptom would occur, thereby increasing that person’s chance of developing resistance
to amoxicillin, while simultaneously decreasing that person's tendency to seek medical
attention.
Highest Educational
13.727 0.56 0.189 0.1859
Attainment
Among the factors presented, only Average Monthly Income was found to have a
significant positive relationship with the practice of self-medication. This relationship,
however, is a weak relationship, and as such, has a relatively minimal effect on self-
medication.
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It can be concluded that antibiotic self-medication practices of the residents of
Iloilo City are not affected by occupation, sex, civil status, highest educational
attainment, and whether or not an individual is the head of household.
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Table 7c. External Factors for People’s Self-Medication with Antibiotics
Percentage
Frequency Percentage (%) of Self-
External Influence Medicating
(n=384) (%)
People (152)
family 51 13.28% 33.55%
friends 28 7.29% 18.42%
neighbors 16 4.17% 10.53%
workmates 4 1.04% 2.63%
others 2 0.52% 1.32%
Among the reasons listed under personal experience, 90 or 59.21% of the self-
medicating respondents reported to have had experienced similar symptoms before and
had used the same antibiotics prescribed to them in the past. Also, 32 or 21.05% said that
they chose to self-medicate because they got used to using antibiotics regularly.
During the interviews with the respondents, many have reasoned out that the
practice of self-medication was naandan, or was learned from the behavior of family
members when presented with a similar illness. For many, this practice has become a
norm adopted and shared from generation to generation.
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Sources of Acquisition of Antibiotics
Table 8. Sources where Antibiotics were Acquired
Percentage
Frequency Percentage (%) of Self-
Sources Medicating
(n=384) (%)
People (152)
Drugstores/Pharmacies 68 17.71% 44.74%
Community Health Centers 2 0.52% 1.32%
Barangay Health Center 28 7.29% 18.42%
Friends, Family, Co-workers 4 1.04% 2.63%
Leftover Medication 4 1.04% 2.63%
Sari-Sari Stores 73 19.01% 48.03%
others 12 3.13% 7.89%
Another surprising finding was that medical representatives roamed around the
area to sell drugs, including antibiotics to them. This is an alarming discovery as medical
representatives are prohibited from selling and administering drugs such as antibiotics to
unlicensed businesses outside of the healthcare industry. The researchers found a box of
Cotrimoxazole displayed publicly for sale inside a vulcanizing shop in one of the
barangays.
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Symptoms for which People Self-Medicated
When asked about the symptoms or illnesses respondents were self-medicating for,
64 or 42.11% of them confirmed that it was for toothache. The actual results are presented
below.
Table 9. Symptoms that People Self-Medicated for
Percentage
Frequency Percentage (%) of Self-
Symptoms Medicating
(n=384) (%)
People (152)
Abdominal Pain 6 1.56% 3.95%
Cough 47 12.24% 30.92%
Fever 25 6.51% 16.45%
Headache 23 5.99% 15.13%
Nasal Congestion 5 1.30% 3.29%
Sore Eyes 3 0.78% 1.97%
Sore Throat 16 4.17% 10.53%
Wound 54 14.06% 35.53%
Toothache 64 16.67% 42.11%
others 27 7.03% 17.76%
Conclusions
This study found that a significant portion of residents in Iloilo City self-
medicated with the use of antibiotics in the last twelve months. Two in every five
residents in Iloilo City purchased and consumed antibiotics without the guidance of a
licensed doctor/pharmacist. Furthermore, two in every five of these self-medicating
people did so for about two to three times in the past year. A vast majority of them were
found to have self-medicated with the use of Amoxicillin as a specific type of antibiotic.
Furthermore, certain factors were found to have predisposed these people to self-
medicate. 62.50% of them used antibiotics without prescription in order to avoid paying
extra for doctor’s consultation fees, while 32.24% of them wanted to avoid the cost of
expensive branded medicine. Around 33.55% of these individuals admitted to being
influenced by family members to use antibiotics without a doctor’s prescription. It was
also found that 59.21% of them self-medicated with antibiotics because of an experience
with the use of antibiotics to treat prior similar symptoms.
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Interestingly, 48.03% of self-medicating residents admitted that they acquired
their antibiotics from sari-sari stores, while 44.74% of them said they got it from
legitimate drug stores or pharmacies.
Finally, this study revealed that self-medicating residents of Iloilo City used
antibiotics in order to treat certain symptoms. About 42.11% of them used antibiotics in
order to treat toothache, while 35.53% used it for wounds, and 30.92% of them used
antibiotics for cough treatment.
The results show that a significant number of self-medicating residents used
antibiotics without prescription in order to avoid paying more for consultation fees and
avoid paying for expensive branded medicine that a doctor may potentially prescribe. The
inclination to self-medicate also appears to be greatly motivated by the influence of
family members and prior experience with the use of antibiotics in treating similar
symptom. These behaviors and choices reflect cost-avoidance, which is consistent with
the idea that self-medication is a rational action.
Bypassing professional medical consultation and relying instead on
recommendations from family members and antecedent experience with antibiotics as
basis for informing their decision to self-medicate may be construed as a ‘satisficing’
behavior. By self-medicating, people are still able to achieve their expected utility, albeit
only sub-optimally, without expending a lot of financial resources in the process. The
perfect scenario is that an individual achieves perfect utility by receiving treatment for a
symptom or illness. However, this is attained at a high cost - doctor’s fees, cost of
medicine, etc. Self-medicating individuals use antibiotics without prescription in order to
achieve treatment while saving money. It must be realized, however, that this
‘satisficing’ behavior comes at a great risk. In the absence of proper diagnosis and
prescription from a licensed physician, a self-medicating individual could end up treating
a wrong medical condition, or underusing or overusing a drug. This practice could
potentially contribute to the growing global trend of antibiotic resistance. This raises
concerns about the widespread inappropriate use of antibiotics among residents in Iloilo
City which could lead to unintended consequences such as antimicrobial resistance.
Stricter implementation of the laws and regulations surrounding the distribution of
antibiotics among business establishments should be imposed, most especially legal
stipulations that prohibit the sale of prescription antibiotics and other prescription drugs
in sari-sari stores and other establishments that are not licensed and have no professional
medical supervision. Likewise, strict sanctions should be imposed among those who
distribute prescription antibiotics illegally. The government should strengthen its
campaign against antimicrobial resistance and raise awareness regarding proper usage of
antibiotics with particular focus on the adverse effects of antibiotic self-medication.
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