Muhammad Tukur Umar*, Aluefua Omobhude Fidelis

Department of Pharmacology and Therapeutics, Faculty of Basic Clinical Sciences, College of Health Sciences, Usmanu Danfodiyo University, Sokoto, Nigeria




Self-medication refers to selection and use of medicines by individuals to treat self-recognized illness and symptoms. It is widely practiced globally and often regarded as part of self-care.  Though, unlike the other elements of self-care, it acts as a double-edged sword with the ability to do good as well as exposure to hazards because it employs use of drugs. The objective of this study was to assess prevalence of antibiotic self-medication among paramedical students of Usmanu Danfodiyo Sokoto, Nigeria. It was questionnaire-based, cross-sectional study involving undergraduate paramedical students in a Nigerian University. Participants were selected by multistage sampling technique and data generated was analyzed using SPSS version 20. Majority of the respondents were males and singles, 64(68%) and 84(89.4%) respectively.  Age ranged 18-25 years for majority of respondents, 87(92.6%). Eighty one point nine percent self-medicate with antimicrobials and penicillin was the most used antibiotic group 58(61.7%), and among the penicillin group, amoxicillin was the commonly used, 17(18.1%). There was no statistically significant association between gender, marital status and course of study with self-medication (X1=0.06, P=0.81; X1=0.028, P=0.87 and X3=2.28, P=0.52 respectively). Conclusion: A high proportion of self-medication with antimicrobials was observed among the respondents of the study. However there was no statistically significant association of the medication with gender, marital status or course of study.

Keywords: Antimicrobials, Nigeria, paramedical students, self-medication, University.


Self-medication refers to selection and use of medicines by individuals to treat self-recognized illness and symptoms.1It is widely practiced globally and often regarded as a part of self-care.  Though, unlike the other elements of self-care, it acts as a double-edged sword with the ability to do good as well as exposure to hazards because it employs use of drugs.2It is much easier, to circumvent the trouble of seeing a medical doctor and the cost involved by self-medication, especially in financial and human resources constrained circumstances such as low and middle income countries. In most parts of the world, it is commonly practiced as over 50% of antibiotics are purchased without prescription3. Exorbitant costs of health care services, poor accessibility to health facilities, unregulated distribution of drugs, and inequality in the spread of health care services provide fertile grounds for self-medication4,5. Self medications for whichever purpose poses a serious public health challenge worldwide and contribute immensely to development of deadly antimicrobial resistance irrespective of age or gender1. The magnitude of antibiotics self-medication is higher with population in developing countries among the young and literates6,7. Use of antibiotics for self-medication is considered as a injudicious use of antibiotics8. Antibiotics resistance which may arise from self-medication currently poses one of the most important health issue globally9. This is more common in developing countries, where antibiotics are freely purchased over the counter without prescription10.

Reasons for antibiotics resistance are multifaceted which include human factors such as self-medication11. Socioeconomic status, life styles and easy accessibility to drugs have been shown to influence self-medication12. Widespread use of antibiotics in agriculture as growth promoters and prophylaxis in livestock has been implicated in promoting resistance13. The consumption of antibiotics via these processes account for 63,000 to 240,000 tons of annual global use and through food chain, resistance can be transmitted from animals to humans14, 15. In Nigeria antibiotics are purchased over the counter16. It is however, unfortunately not without attendant dire consequences. These penalties include but not limited to masking symptoms of serious illness, fatal adverse drug reactions, wrong diagnosis, and susceptibility to addiction, risks of under or over dosage and poly pharmacy2. This is more so, with emerging more worrisome-the antimicrobial resistance. This has started rearing its ugly head year’s ago17. If left unchecked, it will take this generation back to pre antibiotics era of course with deadly outcome. This study therefore, aimed at assessing the prevalence of antibiotic self-medication among paramedical students of Usmanu Danfodiyo Sokoto as future key players in healthcare delivery.


Usmanu Danfodiyo University is among the second generation Universities created in 1975. It is located in Sokoto seat of Usmaniyya caliphate. Paramedical students include Nursing, Radiography, Medical laboratory Science and Pharmacy. The first three are located in the College of Health Sciences while the last one is a faculty on its own. The trainings involve preclinical and clinical phases. At the preclinical stage, students are taught mainly basic medical courses, and proceed to the clinical levels at the Teaching Hospital which serves as referral centre for the neighboring states of Kebbi, Zamfara, Kano, Katsina and even Niger republic. The hospital is managed by various cadres of health professionals. The present study is a cross sectional descriptive study.

The respondents were selected by multistage sampling technique as follows:

Stage 1: Respondents were stratified based on course of study into nursing, pharmacy and radiography

Stage 2:  Total number of students was obtained from in each department/faculty by their study levels

Stage 3: Total number of respondents to be selected from each department and level by proportionate allocation

Stage 4: Actual respondents who participated in the study from the department/level were selected by sampling interval

Questionnaire design, Validation and Data collection

The semi-structured questionnaire was derived from previous studies18, 19, 16. It was reviewed by experts and tests were carried out for construct and content validity among students of faculty of Medical Laboratory Science. Areas of ambiguity were identified and addressed appropriately before administering. It comprised of 3 sections. Section A, contained questions on demographic characteristics, section B focused on reasons for self-medication and section C awareness of hazards associated with self-medication. The questionnaires were distributed to the volunteers and asked to fill and collected on the spot by one of the researchers (Fidelis). Those that could not fill promptly were given the next day to complete.


Only registered students duly confirmed by the respective administrative offices of the concerned departments were recruited for the survey. Participation in this study was purely voluntary. This was clearly mentioned to the participants.


Crude descriptive statistics was calculated for the components of the questionnaire. We used Chi-square Pearson’s test to ascertain association of antimicrobial self-medications with gender, marital status and course of study. Analyses were based on P<0.05 and SPSS version 20 was used.


One hundred and fifteen questionnaires were administered and retrieved. After data cleaning, 94 were analyzed, of whom majority were males and singles, 64(68%) and 84(89.4%) respectively. The mean age was 22±0.1 years and most of the respondents’ age ranged 18-25 years, 87(92.6%). As a group, penicillin was the most used antibiotic group, 58(61.7%), and among the penicillin group, amoxicillin was the commonly used and recorded as, 17(18.1%). Respondents using metronidazole accounted for 17(18.1%) shown in Table 1. On where the respondents purchased drugs, 44(46.8%) bought from Pharmacists’ store while 24(25.5%) from ‘Chemists’ and only 1(1.5%) from street hawkers. The rest obtained drugs from hospital pharmacy and patent medicine stores 7(7.5%) and 18(19.2%) respectively. Headaches, skin rashes and dizziness were the serious  adverse effects experienced by the respondents (52.9%) each and 17.7% respectively. Association between gender, marital status and course of study with self-medication were recorded. (X1=0.06, P=0.807, df=1; X1=0.028, P=0.868, df=1; X3=2.281, P=0.516, df=3 respectively).


A high response rate recorded which could be attributed to on spot administration and collection of data. Female respondents constituted minority in our study which differs from the findings of similar works.20, 21 Girl child education is still an obstacle in this part and most part of northern Nigeria and always reflects in enrolments in tertiary level of education and other formal sectors of economy22. The proportion of respondents who self-medicate with antibiotics observed in this study was quite higher than Southern India and China where it was reported as 39.3 and 47.9% respectively23, 24. Antibiotics are sold over the counter in Nigeria and may be responsible for the high percentage recorded in the study. This is really worrisome and regulatory bodies saddled with the responsibility of monitoring drugs need to develop a policy frame work to curtail this menace by striking a balance between control and access to antimicrobials to vast majority especially in areas where healthcare manpower is overstretched.

The finding of this study showed that penicillin as a group was the most commonly used for self- medications. This was in accordance with the observations made by Fadare and Tamuno25. This may be explained by the  fact that Penicillin were among the earlier antibiotic that are still clinically relevant currently because of their broad spectrum antibacterial activities, less side effects, affordability, safety profile and efficacy26. Among the penicillin group, amoxicillin was the most frequently cited, a finding reechoing reports in previous studies19,20,21. Saving money, time and presence of left over drugs as reasons for self-medication were quite higher than 44, 19 and 16% respectively reported in Karachi27. This may be explained by prevailing economic recession being experienced in the country. A good proportion of participants admitted lack of confidence in health care providers prompted them to self-medication which differed from finding in Lagos28. On the awareness of dangers associated with self-medication, the finding of this study was higher than 51.2% reported in India29. This is really encouraging and strengthens hope of improved rational drug use as the respondents were the future captains of health care delivery system. It was encouraging that majority of respondents procured their drugs from approved designations. Previous study in the study area had documented that non-medical students of University tend to purchase their drugs from unauthorized outlets30.

There was no association observed between antibiotic self-medication with gender, marital status or course of study. This finding was different from what was documented earlier that female students were more inclined to self-medication than their male counterpart19, 24.


This study has revealed high prevalence of antimicrobial self-medication among undergraduate paramedical students of Usmanu Danfodiyo University. No association was established of the self-medication with gender, marital status or course of study. There is need for intervention study to stem the tide of self-medication.




  1. World Health Organization. The role of pharmacist in self-care and self medication; 2011.
  2. Hughes CM, Mc Elnay JC, Fleming GF. Benefits and risks of self medication. Drug Safety. 2001; 24(14):1027-37.
  3. Morgan DJ, Okeke IN, Laxminarayan R, Perencevich EN, Weisenberg S. Non-prescription antimicrobial use worldwide: A systematic review. Lancet Infect Dis. 2011; 11:692–701.
  4. Esimone CO, Nworu CS, Obina PU. Utilization of Antimicrobial agents with and without prescriptions by Out-patients in selected pharmacies in south-eastern Nigeria. Pharm World Sci. 2007; 29:655–60.
  5. Yousef AM, Al-Bakri AG, Bustajani Y, Wazaify M. Self-medication patterns in Amman, Jordan. Pharm World Sci. 2008; 30(1):24–30.
  6. Napolitano F, Izzo MT, Di Giuseppe G, Angelillo IF: Public knowledge, attitudes, and experience regarding the use of antibiotics in Italy. PloS One. 2013, 8 (12): e84177 10.1371.
  7. James H, Handu SS, Al Khaja KA, Otoom S, Sequeira RP: Evaluation of the knowledge, attitude and practice of self-medication among first-year medical students. Medical Principles and Practice. 2006; 15 (4): 270-5.
  8. Grigoryan L, Burgerhof JG, Haaijer-Ruskamp FM, Degener JE, Deschepper R, Monnet DL et al. Is self-medication with antibiotics in Europe driven by prescribed use? J Antimicrob Chemother. 2007; 59(1):152-6.
  9. Bell BG, Schellevis F, Stobberingh E, Goossens H, Pringle M. A systematic review and meta-analysis of the effects of antibiotic consumption on antibiotic resistance. BMC Infect Dis. 2014; 14:13.
  10. Olayemi OJ, Olayinka BO, Musa AJ, Evaluation of antibiotic self medication: Pattern amongst undergraduate students of ABU (main campus) Zaria. J App Sci Res. 2010; 2(1):35-38
  11. Ramanan L, Adriano D, Chand W, Anita KMZ, Heiman FLW, Nithima S. al. Antibiotics resistance – the need for global solutions Lancet. 2013;13(12):1057-1098
  12. World Health Organization. The Role of pharmacist in Heath Care System; 1998. Available from: [Accessed 29th August, 2017, 18:44]
  13. Ventola CL. The antibiotic resistance crisis: part 1: causes and threats. P T. 2015; 40(4):277–283.
  14. Landers TF, Cohen B, Wittum TE, Larson LE. A review of antibiotic use in food animals: perspective, policy, and potential. Public Health Rep. 2012; 127(1):4–22.
  15. Grace D. Review of Evidence on Antimicrobial Resistance and Animal Agriculture in Developing Countries, Evidence on Demand. International Livestock Research Institute. 2015. Available from: Accessed 19:38 9th September, 2017
  16. Eshiet UI, Essien GE, Effiong GS, Ekwueme C. Self-Medication with Antibiotics amongst Civil Servants in Uyo, Southern Nigeria. J Advances in Medical Pharmac Sci. 2015; 2(3):89-97.
  17. Aboderin OA, Abdu A, Odetoyin KW, Lamikara A. Antimicrobial resistance in Escherichia Coli strains from urinary tract infections isolates. J Nat Med Assoc. 2009; 101:1268-1273
  18. Kasulkar AA, Gupta M. Self medication practices among medical students of a private institute. Indian J Pharm Sci. 2015; 77(2):178-182.
  19. Nùnez N, Tiasierra-Ayala M, Gil-Olivares F. Antibiotic self medication in University students from Trujillo. MedicinaUniversitaria. 2016; 18(73):205-09
  20. Suleiman IS, Rubian SS. Antibiotics use with and without prescriptions in Healthcare students. American J Pharmacol Sci. 2013; 1(5):96-99
  21. Sarahroodi S, Arzi A, Sawalba AF, Ashtarinezhad A. Antibiotics Self medication among Southern Iranian University students. Int J Pharmacol. 2010; 6(1):48-52
  22. Nmadu G, Avidime S, Oguntade O, Dashe V, Abdulkarim B, Mandara M. Girl Child Education: Rising to the Challenge. African J Reproduc Heal. 2010; 14(3):107-12
  23. Kumar N, Kanchan T, Unnikrishna BT, Mithra P, Kulkarni V, Papanna MK, Holla R, Uppal S. Perceptions and practices of self medication among medical students in coastal south India. PLOS one. 2013; 8(8):e72247
  24. Zhu X, Pan H, Yang Z, Cui B, Zhang D, Ba-Thein W. Self medication practices with antibiotics among Chinese University students. Public Health. 2016; 130:78-83.
  25. Fadare JO, Tamuno I. Antibiotic self medication among University medical undergraduates in northern Nigeria. J Pub Heal Epidem. 2011; 3(5):217-220.
  26. Guqkaeva Z, Crago JS, Yesnogorodsky M. Next step in antibiotic stewardship: Pharmacist –provided penicillin allergy testing. J Clin Pharm Ther. 2017; 42(2): 509-512.
  27. Syed J, Hammah A, Rija BR, Sidra N, Mirrah M, Muhammad HJ Al. Self medication with antibiotics among non-medical University students of Karachi: a cross-sectional study. BMC Pharmacol Toxicology. 2014;15:74.
  28. Ogunnowo BE, Olunfulayo TF, Sule SS. Client perceptions of service quality at out- patient clinics of a General Hospital in Lagos, Nigeria. Pan African Medical J. 2015; 22:68.
  29. Gupta S, Singh M. Self medication among north Indian first year undergraduate healthcare students: a questionnaire-based study. Trop J Med Res. 2016; 19(2):162-167.
  30. Umar MT, Bello SO, Chika A, Jimoh AO, Sabir AA. Attitude of University students towards fake drugs in Sokoto Northwest, Nigeria. Int J Innov Res Dev. 2014; 3(9): 158-161.


Table 1: Antibiotics usage by respondents



N (%)


Ampicillin+ Cloxacillin









Penicillin G procaine























NB: Some respondents mentioned more than 1 drug


Table 2: Responses of Respondents on Reasons for Self-medication


Yes, N(%)


95% CI lower

95% CI higher

SM with antibiotics last 1 year      





To Save time





To Save money





Past successful use





Left over medicines





Academic knowledge





To avoid stress of seeing a doctor





The drug has worked successfully in acquaintances before





No need to consult a doctor for

minor illness





Unfavourable attitudes of health

care workers





Lack of confidence in health

care giver





Encounter with adverse drug effects following self-medication





Awareness that self-medication

can be harmful to health





SM= self-medication