This study examined the practice and predictors of self-medication among adults in both urban and rural areas of Sri Lanka three decades after market economic reforms. The study found that self-medication was more prevalent in urban areas (12.2%) compared to rural areas (7.9%). Conditions of acute onset and short duration were common reasons for self-medication. Predictors of self-medication differed between settings and included factors like household size, drug availability, symptom count, and satisfaction with medical services. The study concluded self-medication is a initial response for less severe diseases based on past experience and recommended its findings be used to shape policy and education programs.

1. Practice and Predictors of selfmedication among urban and rural
adults in Sri Lanka, three decades
after Market Economic Reforms
Dr. Pushpa Ranjan Wijesinghe
MD- Rostov (General Medicine)
MSc, MD-Colombo (Community Medicine)
MPH-New Zealand ( Bio-security)

2. Background
• Practice of self-medication in communities in varying
•
•
•
•
degrees
Increased private sector involvement in health &
pharmaceutical care since 1977
Increased utilization of private health / pharmaceutical
care for out patient conditions
Competition of the pharmaceutical companies for a
larger share of over the counter drug market
What is the status of self-medication in settings of
contrasting health and pharmacy care infra-structure in
this context ?

3. Objective
• To describe the current practice and predictors of
self-medication in a selected urban and rural area
in Sri Lanka
Methods
• Study design
• A community based cross –sectional study
• Study Population
• Adults over 18 years of age, irrespective of sex ,
permanently residing in the selected districts over a
period of 1 year

4. Urban district
8 Urban Council areas
Rural district
Stratification
n= 900
n= 900
30 GN divisions
PSU
7 Regional Council (PS ) areas
PPS
30 GN divisions
PSU
30 Households per a
GN division
Voters list
30 Households per a
GN division
1 individual per house
(900)
Kish Table
1 individual per house
(900)

5. Study Instruments
• Interviewer administered questionnaire (IAQ)
• Validated Likert scale to assess the Perceived
satisfaction with available pharmacy services
– Access, Continuity, General Satisfaction of services
– Availability , Affordability, Efficacy of drugs
– Inter-personal explanation, Considerateness
• Validated Likert scale to assess the perceived
access to allopathic medical care
–
–
–
–
Availability of services,
Regularity and acceptability of services
Affordability of services
Concern for clients

6. SOCIO DEMOGRAPHIC FACTORS
BELIEFS & ATTITUDES
ACCESS
FACTORS
Enabling factors
Predisposing factors
Medication use
Need variables
ACTUAL OR PERCEIVED MORBIDITY
Anderson and Newman’s health services
utilization model

7. Practice of medication use
urban (n=863)
Prevalence of medication use
(95% confidence interval )
33.9%
(30.7%-37.1 %)
Urban ( n =293 )
Rural (n=846)
35.3%
(32. 1-38.5)
Rural ( n=846)
Only allopathic medicine users
91.4%
84.6%
Only traditional medicine users
3.8%
12.4%
Both allopathic and traditional
medicine users
4.8%
3.0%
urban (n=863)
Rural (n=846)
Prevalence of self medication *
12.2%
(10% -14.4%)
7.9%
(6.1%-9.7%)
Self medication as a proportion
of medication use *
37.2%
25.6%
* P < 0.05

8. Practice of self-medication
Urban
Rural
Conditions of Acute onset and short duration
58%
67%
Perceived non-severity of the condition for
physician consultations
55%
64%
Previous satisfactory response of the same
drug to a similar condition
53%
60%
Self-medication without any symptom
09%
12%
Using previous prescriptions for self
medication for purchasing drugs
37%
-
-
45%
Self-medication with one drug
49%
73%
Self-medication with 2 drugs
28%
18%
Using labels/blister packs of previously used
drugs for purchasing drugs

9. Predictors of self medication
Urban
Predisposing variables
Household number ≤ 2
Non-affirmation of drugs
availability at informal places
Need Variables
Symptoms ≤ 2
Enabling Variables
Adjusted OR ( 95% CI)
Rural
Adjusted OR ( 95% CI)
4.3 ( 1.1-17.5)
-
0.3 (0.1-0.8)
-
Adjusted OR ( 95% CI)
7.9 (3.4-18.9)
Adjusted OR ( 95% CI)
Adjusted OR ( 95% CI)
2.4 (1.1-5.8)
Adjusted OR ( 95% CI)
Higher satisfaction with
acceptability of medical
services
0.96 (0.93-0.98)
-
Affordability of medical
services
-
0.4 (0.2-0.7)
Technical competence of
pharmacy staff
-
2.8 (1.1-7.3)

10. Conclusion & recommendations
• Self-medication is more prevalent in the urban setting
• Prevalence of SM is lower than global estimates
• Self-medication with 1-2 drugs selected on previous
experience is an initial individual response for diseases of
acute onset and perceived to be of less severity
• Lower symptom count is a need variable acting as a proxy
measure of perceived severity of the morbidity
• Self medication is dependent on characteristic access
measures unique in the two specific settings
• Findings should be utilized to
– Shape policy changes related to implementation of the CDD act
– Design IEC programs for consumers moving towards selfmedication
– Enhance the capacity of rural pharmacists/assistants as the first
contact points in the rural sector

11. Limitations
• Less valid data as compared to data collected in
a prospective follow up study using a diary
method
• Non-objective measurement of the severity of
the condition
• Social desirability bias due to use of public health
midwife for data collection
• Perceived access measures to health care and
pharmaceutical services reflect general rather
than specific context