Self Medication Practice Among Urban Slum Dwellers in Udupi Taluk, Karnataka, India

Abstract

Objective: To estimate the prevalence and associated factors of self-medication among slum dwellers, and to explore the perception of community pharmacists' on self-medication practices in Udupi taluk of Karnataka state in India.Methods: A quantitative survey among 300 randomly selected slum dwellers and in-depth interviews with community pharmacists and pharmacy practice experts were conducted during January-April 2016. Descriptive and analytical methods were used to estimate the prevalence and to identify associated factors. Thematic analysis was carried out on qualitative data. Results:The prevalence of self-medication practice was 47%. Factors such as gender, recent experience of an illness, and stocking medicines at home were significantly associated with self-medication practice. Self-medication practices were high for common ailments and for the illnesses they perceived as 'mild' (66%). Community pharmacists (87%) were the main source of information on medication. The majority (76%) of participants were ignorant about the expiry date of the medicines. The qualitative data highlighted pharmacist's' role to promote consultation with a physician, and educating patients on completion of treatment course and possible drug reactions. Conclusion:Self-medication practices found to be common among slum-dwellers due to reasons such as lesser awareness, easy availability of overthe-counter medications, and limitations related to universal access to health. There is a need to improve the awareness of dangers of selfmedication to the general public and strengthen the mechanism to monitor dispensing of medicines without prescriptions.

Antimicrobial Resistance, Politics, and Practice in India

“…Following the rise of NDM-1, reports increasingly appeared across India of infants dying from drug-resistant bacterial infections that could not be treated by even the last resort antibiotics (Hall et al, 2018). This set NDM-1 on track to represent the role of LMICs in the surge of new forms of AMR, with countries such as India presented as offering the "perfect" conditions for an escalation of the crisis (Laxminarayan & Chaudhury, 2016;Lübbert et al, 2017;McGettigan et al, 2019;Pranav et al, 2017;Ranganathan, 2017;Reardon, 2014). Such ideas circulating the pan-national imaginary of the global (but yet localized) problem of AMR require, we posit, considerable critical analysis.…”

“…A feature of the Indian microbial milieu is the widespread availability of antibiotics, without prescription and without state regulation (and enforcement; Pranav et al, 2017;Shet et al, 2015). This is a characteristic feature of many LMICs and their challenges in terms of AMR (see Francetic, 2019).…”

The Spectre of Superbugs: Waste, Structural Violence and Antimicrobial Resistance in India

“…You can educate kids to wash their hands with soap after defecating, but if the water is contaminated, and people routinely defecate outdoors in proximity to residential dwellings, such programs will have limited efficacy. Further, there is often little appreciation by the authorities and NGOs for the rules, cultural norms and power relations in slum communities, which shape access to urban spaces (Doshi 2012;McFarlane 2008;Pranav et al 2017). This is also the case with slum development programs that tend to overlook everyday health-seeking behavior and the geographical dispersion of livelihoods, especially when tied to waste economies in the informal sector (see Ananthakrishnan and Patil 2013).…”

“…In seeking treatment for such infections and other faecal-oral and respiratory illnesses, people often resort to antimicrobials. In India these antimicrobials (antibacterial, antiviral and antifungal) are easily obtained over the counter, often with little understanding of the type and dosage required to treat infections (Pranav et al 2017;Orzech and Nichter 2008). The potential overuse and certain misuse without expert guidance inevitably results in heightened overall antimicrobial load and selective pressure, which accelerates the local and global problem of resistance (see Hall et al 2018).…”