| Abstract|| |
Aim: The aim of this study was to determine the prevalence of self-medication practices among dental out patients presenting at a tertiary health care center in Ibadan, and to determine factors that are associated with these practices.
Materials and Methods: All patients presenting over a 4-month period, who consented to participate in the study, had a semi-structured questionnaire, highlighting age, sex, income and educational qualification, history of past practice of self-medication, substances used and reasons for resorting to self-medication administered to them.
Data obtained were analyzed with the SPSS 12.0.1 software. Frequency tables were generated and statistical relationship between the variables was analyzed using the Chi-square test. Statistical significance was set at P>0.05.
Results: There were 108 (38.03%) males and 176 (61.97%) females. A total of 139 (48.9%) of the respondents claimed that they have been involved in self-medication. 54.7% of the people involved in self-medication were female, while 41.7% were male. There was a statistically significant difference in self-medication between males and females (P=0.001). 71.2% of the respondents had post-secondary education and only 28.8% had secondary education or less.
Conclusion: Self-medication practices were quite high in this study, and these practices were also prevalent among the educated people. Drug control enforcement needs to be intensified and dental public health education needs to be given greater priority in the overall public health campaigns.
Keywords: Ibadan, non-doctor consultation, self-medication
|How to cite this article:|
Adedapo HA, Lawal AO, Adisa AO, Adeyemi BF. Non-doctor consultations and self-medication practices in patients seen at a tertiary dental center in Ibadan. Indian J Dent Res 2011;22:795-8
Non-doctor consultation and self-medication are defined as obtaining treatments and drugs without the advice of a physician, either for diagnosis, prescription or surveillance.  Non-doctor prescriptions and non-doctor consultation practices are said to be common in developing countries. These have been attributed to poor socioeconomic status, high cost of procuring modern medical treatments and difficulties that often arise in accessing modern health care. 
|How to cite this URL:|
Adedapo HA, Lawal AO, Adisa AO, Adeyemi BF. Non-doctor consultations and self-medication practices in patients seen at a tertiary dental center in Ibadan. Indian J Dent Res [serial online] 2011 [cited 2013 Dec 5];22:795-8. Available from: http://www.ijdr.in/text.asp?2011/22/6/795/94671
People suffering from physical discomfort or emotional distress in different societies have different ways of helping themselves, or of seeking help from other people.  In remote and impoverished areas, western health care, including dental care, is often part of a pluralistic medical system available that exists with traditional medicine, which includes self-care with medicinal plants and consultation with specialized traditional healers.  A major drawback of these alternative medical practices is the lack of clinical evaluation of the condition by a trained medical professional, which could result in missed diagnosis and delays of appropriate and effective treatments and increased risk of drug toxicity as result of under- and overdosing and, also, adverse drug interactions. 
Awad et al.,  in a community-based study in Khartoum Sudan, found that 73.9% of the people in their study population had used drugs without a doctor's prescription during the month prior to their study. Abasaeed,  in the United Arab Emirates, also found that 44% of the people who used antibiotics obtained them without a doctor's prescription.
However, only few studies , have examined other non-doctor consultations and treatment practices, apart from self-prescribed drugs. The aim of this study was to determine the prevalence of non-doctor consultations and self-medication practices among dental out patients presenting at a tertiary health care center in Ibadan, and to determine factors associated with these practices.
| Materials and Methods|| |
Semi-structured questionnaires were administered to 284 respondents in this study. Questions highlighting age, gender, income and educational qualification, history of past practice of self-medication, substances used and reasons for resorting to self-medication were asked in the questionnaires.
The respondents consist of patients seen at the Dental Centre, University College Hospital, Ibadan. The hospital is a tertiary center that serves as a referral center and is the only tertiary dental center in Ibadan, one of the most populous cities in Nigeria. All patients presenting over a 4-month period who consented to participate in the study were enrolled. Patients under the age of 10 years were excluded while parents of patients below 16 years were required to assist in completing the questionnaire.
Data obtained were analyzed with the SPSS 12.0.1 version software. Frequency tables were generated and statistical relationship between the variables was analyzed using the Chi-square test. Statistical significance was set at P<0.05.
| Results|| |
A total of 284 patients participated in the study, consisting of 108 (38.03%) males and 176 (61.97%) females. The ages of the respondents ranged between 13 and 78 years, with a mean age of 36.30 ± 18.42 years.
A total of 139 (48.9%) of the respondents claimed that they had been involved in non-doctor treatments previously. [Figure 1] shows the gender distribution of the respondents. About 54.7% female respondents were involved in non-doctor treatments, while 41.7% were males, and this was statistically significant (P=0.001).
|Figure 1: Sex distribution of respondents with self-medication practices|
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The most common non-doctor treatment undertaken by respondents was the use of self-prescribed orthodox medication, and 62 of the 139 (44.6%) respondents involved volunteered that they have used self-prescribed orthodox medications [Figure 2]. Other non-doctor treatments used include topical application of concentrated alcohol (21.6%), use of warm saline mouth wash (14.4%), visit to local tooth healer (12.2%) and use of battery water (2.9%). The most used self-prescribed class of orthodox drug was antibiotics (35%), followed by analgesic (25%).
41.4% of those who had participated in non-doctor treatments claimed that they opted for non-doctor treatments because of easy access to these modes of treatment, 31% claimed they were afraid of dental treatments while 24% were prompted by family members and friends; only 3.4% claimed that these were cheaper options for them. 17.1% of the females who have been involved in non-doctor treatments were afraid of dental treatment, while only 12.0% of the men involved in non-doctor consultation were afraid of dental treatments.
Most (71.2%) of the respondents who had been involved in non-doctor treatments had post-secondary education, and only 28.8% had secondary education or less [Figure 3].
|Figure 3: Educational qualification of respondents involved in self-medication|
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There was, however, an inverse relationship between the income of respondents and non-doctor consultation practices, with 63% of those involved in self-medication earning 30,000 naira per month or less. Also, the number of respondents involved in self-medication dropped as the income increased [Figure 4].
Most (28.8%) of the respondents involved in self-medication were students, 20 (14.4%) were unemployed, 13 (9.4%) were civil servants while professionals and businessmen represented a total of 19 (13.7%). Other occupations such as trading, artisans, medical workers, retirees and youth corpers accounted for a total of 33.7% of the respondents involved in self-medication [Table 1].
Most respondents (69.2%) who were involved in self-medication had previous dental consultations compared with 63.4% of the respondents who were not involved in self-medication that had previous dental consultations.
| Discussion|| |
Non-doctor consultations were practiced by 48.9% of the respondents in this study. This was higher than the 42% reported by Afolabi et al.  in a study in Ondo state dental services. Although the proportion was lower than the 79% and 85% for ophthalmic  and general out patients,  respectively, reported in Owo, it is still disturbing considering the fact that Ibadan is a cosmopolitan city with a teaching hospital, a number of secondary dental care centers and quite a number of private dental clinics. Other studies in Sudan showed a higher prevalence of 81.8%  and 73.9%.  However, many European studies had a prevalence that was similar to our findings, with studies in France  and Spain  observing a prevalence of 46.1% and 48%, respectively.
More females were involved in non-doctor treatments compared with their male counterparts. This was in agreement with the study of Awad et al. in Sudan,  which found that females were more likely to be involved in the use of self-prescribed antibiotics. However, Mustafa et al.  in Turkey found that males were 1.24-times more likely to use self-prescribed antibiotics than females. It is generally believed that women are more health conscious and have better health practices than men,  but they also have lower pain  threshold and are more likely to be scared of dental procedures, and this may account for the significantly higher percentage of females who were involved in non-doctor treatments compared with males in this study. This is supported by the higher percentage of females who gave fear of dental treatments as their reason for non-doctor treatments compared with their male counterparts.
The most reported non-doctor treatment was the use of self-prescribed orthodox medications. This may be attributed to the ease with which drugs, including prescription drugs, can be obtained from pharmacy stores and drug vendors. This is a trend that is a source of concern, especially considering that the most self-prescribed orthodox medications were antibiotics. Inappropriate use of antibiotics has been reported to cause a myriad of problems, chief among which is the development of resistant strains.  Also, disturbing was the fact that unwholesome practices such as use of concentrated alcohol, use of battery water and visits to local tooth healer were still practiced by some of our respondents. Battery water is a caustic chemical and may cause oral ulcerations, while alcohol is a known carcinogen that may also make the oral mucosa more permeable to other carcinogens. 
Consultations with local tooth healers may be deleterious for several reasons. The local tooth healers are usually illiterates and are not likely to practice proper infection control measures; thus, the potential for spread of diseases such as HIV/AIDS and hepatitis B is high. Also, they give people false hope; hence, delay in seeking proper medical attention and the constituents of concoctions that they prescribe (which are usually not disclosed) may be caustic or even potentially carcinogenic.
Non-doctor treatments were more prevalent (71.2%) in the people with post-secondary education and in the lower income groups. This was corroborated by many other studies ,, that showed that socioeconomic and educational variables were major contributors to self-medication practices, with lower income and higher education being associated with the tendency to engage in self-medication. It possible that educated people have a vague idea of the cause of their dental ailments and an idea of what drugs to use; this may account for the high percentage of respondents who used self-prescribed antibiotics and analgesics in this study. This may, however, be a risky assumption, as they may not have adequate knowledge about appropriate dosing and drug interactions. Also, severe complications such as liver failure and upper gastrointestinal complications following overdosage of analgesia, secondary to acute dental pain, has been reported. , It also shows that general education does not necessarily translate to proper dental education and appropriate dental habits. The inverse relationship between income and non-doctor practices in this study seems to be contradictory to the finding that non-doctor practices were more common in people with post-secondary education, but this may be due to the fact that although these people are educated, most of them are in the low-income groups such as students and civil servants. This may be a pointer to the fact that affordability may be an important factor in oral health practices, giving the expensive nature of dental services in Nigeria where most people do not subscribe to health insurance. 
The fact that the major reasons for involvement in non-doctor treatments were easy accessibility and fear of dental procedures suggests that regulatory authorities, especially, The National Agency for Food and Drug Administration and Control (NAFDAC), need to ensure stricter regulations, particularly with prescription drugs such as antibiotics. Furthermore, public enlightenment programs need to be intensified to make people aware of the dangers inherent in non-doctor consultation practices. Dental services need to be made more accessible and affordable and dental professionals should receive continual training on providing patient-friendly services.
| Conclusion|| |
Self-medication practices were quite high in this study, but the most disturbing findings were the high prevalence of self-medication among educated people and the fact that people still indulged in some unwholesome practices such as use of concentrated alcohol, battery water and treatment by local tooth healers. Drug control policy enforcement needs to be intensified and dental services should be conducted in more patient-friendly environment. Also, public health education needs to be given greater priority in the overall public health campaigns.
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Ahmed Oluwatoyin Lawal
Department of Oral Pathology, University College Hospital, Ibadan
[Figure 1], [Figure 2], [Figure 3], [Figure 4]