1.0 Background of Study
The standard of living in every society is determined by an assessment of the cumulative development recorded in different sectors. Health, Education, Agriculture, Tourism, Aviation, Solid Mineral among others are sectors that drive development. The health sector occupies a sensitive position in this respect as the development of thesesectorsis essentially dependent on it. Therefore,the labour force must be a healthy one to be effective. Every good health care system aims to prevent human disease, injury, and disability; protect people from environmental health hazards and promotebehaviours that lead to good physical and mental health as well as assure availability of highquality health services (Encarta, 2009).
In recent times, human health hasbeen challenged and ravaged by several risky and unhealthy behaviours among which are smoking,illicit drug use, alcohol abuse, unhealthy diets, unsafe sex and also, self-medication. Of significant interest to this research is the disturbing trend of self-medication.
The practice of self-medication is a global phenomenon, which has become an issue under debate in health care (Danshana, 2014). Evidence from Sarahrood&Arzi(2010:32) showed that self-medication is not restricted to a region or race since both developing and developed countries are experiencing the menace of inappropriate self-medication.
Self-medication by definitionis the taking of drugs, herbs or home remedies on one‘s own initiative, or on the advice of another person, without consulting a medical doctor. World Health Organisation(2008) defines self-medication as ―the use of medications by a patient on his own initiative or on the advice of a pharmacist or a lay person instead of consulting a medical practitioner. Also, the World Self-Medication Industry, (WSMI, 2010) holds that ―self-medication is the treatment of common health problems with drugs especially designed and labeled for use without medical supervision and approved as safe and effective for such use‖. This makes self-medication activities central to many healthcare programmes.
Self-care and self-medication activities are central to many healthcare programmes, but the elements – for example good hygiene, appropriate levels ofnutrition and physical activity, risk avoidance and responsible use of nonprescription medicines – are diverse. To support self-care and responsible self-medication with nonprescription medicines, many countries and regions formed manufacturers and distributors associations during the last century. In 1970 the World Self-Medication Industry (WSMI) was also created to convey the social and economic value of self-care and responsible self-medication to global audiences. Working with the World Health Organisation and other Intergovernmental Organisations, WSMI demonstrated the importance of people (and not just patients) taking more responsibility for their own self-care and self-medication with nonprescription medicines. How well do people adhere to the rules of application is very fundamental in terms of appropriately treating their aliments with prescribed and non-prescribed drugs.
Afolabi (2012: 120) noted that craving for medicine and self-medication has been part of mankind from one generation toanother. In the same vein,Haak(1988)cited in Afolabi (2008: 7-14) opines that People generally hold the view that medicines should be used in the event of any sickness or discomfort. Beyond this, consumers are called upon to assume more responsibility for their health promotion and disease prevention practiceswhich motivated them to embrace self-medication without consulting a physician provided caution is applied.
In another observation, Ahmad, Parimalakrishnan, Patel, Kumar, Balkrishnan and Mohanta (2012) noted that, in India and perhaps other developing countries, ―a large number of people do not consult the physician when they fall sick. They either consult a drug store (retail pharmacy) and obtain medicine from the shelf, or consult a neighbour who may be having some tablets left over from his/her previous illness and thus procure the medicine from that neighbour‖. Barar (2005) stressed that ―even if the drugs in question are used correctly, there may be side effects and increased chances of drug reactions which may also affect adherence to treatment and quality of life‖.
In their view, Kalaiselvi, Ganesh, & Archana (2014: 32-36) opine that ―Self-medication among developing and developed nations may be due to the disparities in the cultural, economic, health care system and policies in each nation‖. These disparities are eminent in especially the health care system and policies that drive the system. In view of this, Martins, Miranda-Ada, Mendes, Soares, Ferreira(2002: 409) emphasizes the importance of careful drug history for General Practitioners and Physicians so as to be aware of what patients are taking before treatment commences especially where sub therapeutic doses are involved. This is where patients-caregiver communication becomes imperative.
Though, World Self-Medication Industry classified self–medication as responsible or non- responsible and as a result, the behaviour cannot be considered entirely harmful (Porteous et al., 2005). The encouragement of self-medication is seen as giving patients every opportunity to take responsibility and build confidence in their ability to manage their own health. Supporting the above statement, WSMI (2010: 1-12) states that ―the responsible use of non-prescription drugs to treat any kind of illness without consulting a physician and the appropriate enforcement of national regulations to combat self-prescribed medicines is a welcome development. We support safe and effective use of such products without requiring the intervention of a physician‖.
In line with the above statement, the National Drug Policy of Nigeria (2005) also emphasizes that: Drugs that can be sold without prescription and used for the short-term relief of symptoms, without prior medical consultation and precise diagnosis, shall be drawn up and published by government; Such listed drugs shall satisfy the criteria for the selection of essential drugs, be effective for their condition of use, and have a wide margin of safety; The list shall be reviewed from time to time in the light of experience and available new information…
As stated above, it means that the phenomenon called self-medication has been accepted world over;whichis evident in several studies conducted on self-medication across the globe. Afolabi (2012: ) pointed out in a survey conducted in Poland that ―self-medication, while widespread, does not imply a negative attitude towards health professionals or the existing system of medical care, rather, it gives an individual the room to take charge of minor illness without necessarily visiting a physician. By so doing, people will begin to sense the positive benefit of self-care in the form of self-medication and apparentlyits contribution toward improvement of the efficiency of the overall health care system.
Self-medication is indeed a very common practice in Nigeriaamong the economically deprived communities and the economically advantageous ones.Severalstudies conducted revealed high prevalence of self-medication in Nigeria. For instance, Afolabi(2008: 120) in a study of market women in a suburban community of Lagos, Nigeria reported 95-98%; OmolaseC., Afolabi A., Omolase B.(2008: 8-14) established that 79% of ophthalmic patients and 85% of patients in the general out patients‘ clinic admitted self-medication. Bamgboye E., Amoran O., YusufO. (2006), in a study of workers in a tertiary hospital in Nigeria reported a prevalence of 73%. The study of Onajole&Bamgbala (2004) established in Lagos, that 71% of their respondents admitted to drug misuse. From the aforementioned studies, several reasons were advanced for why people indulge in the practice.
According to World Health Organization (WHO), the practice of self-medication without medical consultations is to enable effective and quick relief of symptoms; and also to reduce the burden on health-care service centres, which are often understaffed and inaccessible in remote rural areas (Phalke, Phalke, D., &Durgawale(2006). This is reflected in a revised version of the National Drug Policy in Nigeria. The document statesthat, ―Self-medication is especially useful in any situation where access to health care facilities is limited. It can offer the advantage of providing quick and effective relief that does not require medical attention, thereby relieving pressure on medical personnel and freeing them to devote more time to serious problems‖.
Phalkeet al. (2006: 34-35) states these reasons:
The urge of self-care, feeling of sympathy towards family members in sickness, lack of time, lack of health services, financial constraint, ignorance, misbeliefs, extensive advertisement and availability of drugs in other than drug shops are responsible for growing trend in self-medication.
In additon, Zafar, Syed, Waqar, Zubairi, Vaqar, Shaikh, Yousaf, Shahid, Saleem (2008:214-217) added that:
The availability of drugs together with poor awareness leaves the layman uninformed about the potentially lethal effects of some of these drugs. Also, the lack of a good primary health care system coupled with cost issues causes the generalpublic to approach various other doors instead of a doctor to seek help for a problem.
However, it istherefore evident that self-medication in itself is an acceptable practice but often comes with a caveat. In this circumstance, adequate knowledge and accurate information is needed to be able to use drugs effectively, to avoid risk and possible side effects that come with inappropriate self-medication pattern. This is evident in studies conducted in Switzerland and Nigeria respectively revealing that nearly one third of the population lacked sufficient drug knowledge, and consequentlythis lack of knowledge could lead people into misuse of drugs which is common with its side effects (Lam, Catarivas, Munco, & Launder, 1994). Furthermore, the availability of Over the Counter (OTC) drugs makes it easier for people to indulge in any form of self-medication. In this case,the buyer diagnoses his/her own illness and buys a specific drug to treat it which is medically wrong (WHO, 2004). This however, poses a lot of public and professional concern about the misuse and abuse of self-medication in most especially developing countries.
InNigeria, easy availability of a wide range of drugs in the midst of inadequate public health services results in increased proportions of drugs being used as self-medication as opposed to drugs being prescribed by physicians. Though, Sharma, Verma, Sharma & Kapoor (2005: 37-45) pointed out that, ―OTC drugs are meant for self-medication and are of proven efficacy and safety, however, their improper use due to lack of knowledge about their side effects and interactions could have serious implications‖. It is more dangerous and suicidal especially in extreme ages (children and old ages) and during special physiological conditions like pregnancy and lactation. This is because there is always risk of unknown interactions between active ingredients present in OTC drugs and prescription medicines as well as increased risk of worsening of existing disease pathology.More worrisome is theincorrect use of essential drugs among university students. Therefore, it is imperative to acknowledge the fact that the university environment is also part of the larger society made up of people with diverse sociocultural background especially the youth. Youth in any society occupy a delicate and sensitive position within the population structure. Thus unhealthy health-seeking behaviour becomes a common phenomenon, particularly the practice of self-medication among University students.
The misuse of non-prescribed drugs amongst students has become a serious problem. Awad&Eltayeb (2007: 1249-1255) reported that ―about 60-80 % of health problems are self-medicated which placed antibiotics self-medication pattern among undergraduate students in Nigeria at 56%‖. Olayemi, Olayinka, Musa (2010) and Sapkota, Coker, Rosembog, Atkinson, Sweet, Sopeju, Ojo, Otivhia, Ayepola, Shirman, Pottinger, &Ojo (2010) also demonstrated that in every four female students in Ekiti State, Southwest Nigeria, self-medication with antibiotics occur for the purpose of treating menstrual pain‖. Studies have suggested that self-medication practice is one of the remote causes of drug addiction which can also lead to drug abuse;the effects on an individual therefore form the basis for its cumulative effects on the society.
For instance, in countries (especially Nigeria) where drug addiction is a public health problem, there is a great challenge in getting skilled human power and the country will get a burden in the health delivery by spending the significant figure of the health budget to the problem. Inappropriate self-medication (as studies have revealed) as one of the remote causes of drug addiction is not only a health problem but also a situation that brings social, economic and political crisis for a country. Good health affects several aspects of life and personal well-being which translate into a healthy population.A healthy population will have high work productivity, and thereby contribute to the improvement of country‘s living standards. Poor health on the other hand, makes people unable to work full-time and thus their income level is reduced, which will affect their livelihood and they will not be able to get their basic needs including health services (Gidey, Taju, &Hagos, 2006).
The trend of self-medication in tertiary institutions in Nigeria cannot be overemphasizedand Kogi State University is not an exception. For instance, studies by Achema, Odira, and Umerah(2014: 65-67) have identified the practice of self-medication among undergraduates of the University. 92% of therespondents (students) have good knowledge of it, but these studies didnot concentrate on the role of communication campaigns targeted at addressing inappropriate use of medicine. The studies also ascertain that various behavioural vices such as lesbianism, homosexual act and intake of dangerous substances (which could have a dangerous aftermath effecton students‘ health and academics) are common practices among undergraduates. This informed the choice of the University in order to appraise the communication campaigns towards establishing its effectiveness as intended.
Kogi State University which is the study area of this research is located inAnyigba, the eastern zone of the state. It was established in 1999 by the administration of Late Prince AbubakarAudu, the former governor of the State. Presently, it has eight (8)
Faculties including the Faculty of Medicine. To be specific, cases of self-medication among undergraduate students of the University are alarming. According to medical report of Kogi State University Clinic (2015), several adverse cases have been recordedinvolving students: Cases such as increased resistance of pathogens, adverse reaction to anti-malarial drugs, and drug addiction among others, all are due to self-medication. The Document further states:
Students suffer from the negative effects of self-medication as a result of poor knowledge and practice of self-medication, and these students often use antimalarial, multivitamins, antibiotics and herbal remedies which have after effect on the student‘s health and academics as a result of poor knowledge of self-medication or usage of drugs.
In recent times, Kogi State University has been identified as a ground where social vices thrive largely among undergraduate students. These vices which are behaviourally situated may have been triggered by the use of various drug addicted substances and could be traced to harmful self-medication practices. Research have shown that self-medication among students of the University is one of the remote causes of drug addiction. This attitude and behaviour expert say could have serious implications on their health, academic, family members and the nation at large. In view of the above, efforts have been madeby the university clinic to this subtle means of youth (students) destruction, in creating self-medication awareness campaigns through posters and radio talk show programmes, but these campaigns have largely been ineffective. Also, a number of studies have been carried out among Undergraduates in the University, revealing largely, the extent of self-medication with respect to specific cases of adverse reactions.
In order to stem the tide of all forms of drug abuse (inappropriate self-medication inclusive) in Nigeria, media campaigns on illicit drug use and self-medication have been embarked on by the National Drug Law Enforcement Agency (NDLEA), National Agency for Food and Drug Administration and Control (NAFDAC) and other stakeholders. All of them are geared towards creating awareness and sensitizing the people on possible means of avoiding risky behaviour toward self-treatment. The main reason for the media campaigns against self-medication is premised on the fact that people need information on the dangers associated with taking the initiative in treating themselves without consulting a doctor. So, in order to discourage behaviours that could increase inappropriate use of drugs among students, communication is key to creating the much needed awareness to influence a change of behaviour.
Acknowledging the importance of communication, Obaje (2016: 2) submits that, ―effective communication is a sine qua non in the healthcare continuum as it directly affects the quality of patient care, safety, satisfaction and medical outcomes‖. He states:
The central place of communication in the health care process is increasingly being recognized as critical to the success of the entire healthcare system. It is required not just for successful interaction between individuals and their healthcare providers but also between healthcare providers themselves. Improving the quality of communication is thus synonymous to improving patient outcomes. Communication between healthcare provider and their consumer affects every aspect of the health operations.
The above statement therefore demonstrates the strength of communication as indispensable in curbing not just inappropriate self-medication behaviour, but also other aspects of behaviour change related to health in general. As rightly put by Hybels and Weaver (1998: 5), ‗To live is to communicate. To communicate is to enjoy life more fully‘. Without the capacity for sophisticated channels for sharing knowledge, both within and between generations, advanced civilization would not exist (Hargie and Dixon, 2004). More specifically, it is often necessary to impart information on the wider public in order to reach mass audiences, such as in public health campaigns. Effective health campaigns require diverse communication skills and strategies such that will help knowledge and understanding, towards making choice and informed decisions.
It is believed therefore, that if media campaigns are properly designed and executed,with effective campaign of delivering understandable and credible messages, it will form a major link in the communication processes geared towards achieving attitudinal or behavioural changes;more so that scholars in previous studies explained the phenomenon within the scope of scientific/medical reasoning (Coffman, 2002).The message must be designed to capture the right audience attention and disseminatedin such a way that are capable of influencing or causing a change in the audience attitudes.
1.2 Statement of the Research Problem
This study aims to appraise the health communication campaigns on self-medication amongst undergraduate students of Kogi State University, Anyigba. From a standpoint of World Self-Medication Industry (2010), self-medication in itself is an acceptable practice but often comes with a caution, emphasizing that if symptoms persist after three days, a doctor should be consulted. Drawing line between self-medication and drug abuse thus becomes an issue worthy of note. This is owing to the fact that Osemene&Lamikara (2012), Raginald, Kevin, Henry, Chukwuma, Kenechi(2014), Achema, Odira, Umerah (2014) emphasized that ‗Self-medication is one of the remote causes of drug addiction‘. The upsurge in drug abuse amongst students of tertiary institutions consequently necessitates an empirical investigation, owing to the fact that several studies have emphasised on the danger associated with self-medication.
According to Kogi State University Report (2015), students suffer from the negative effects of self-medication as a result of poor knowledge and inadequate information on the practice of self-medication.These students often use antimalarial, multivitamins, antibiotics and herbal remedies which have after effect on the student‘s health and academics as a result of poor knowledge of self-medication or usage of drugs. Although some campaigns have been embarked upon by the University clinic in creating awareness and sensitizing students on the effects of self-medication, yet the prevalence of self-medication practice is ever increasing. To this end, it is imperative to ask some pertinent questions: Are students of the university aware of these campaigns? If they are, how far have these campaigns altered their attitude and behaviour towards inappropriate self-medication practice?It is against this backgroundthat this studyappraised the health communication campaigns on self-medication among students of Kogi State University, Anyigba with a view to ascertaining the influence ofthe medical campaign strategies of the University clinic on undergraduate students.
1.3 Aimand Objectives of the study
The aim of this study is to improve on health communication campaigns geared towards reducing incidence of inappropriate self-medication among students of Kogi State University.The specific objectives are to:
1. Identify the sources of information on self-medication among students of Kogi State University.
2. Examine the nature and effectiveness of the health communication campaigns on self-medication in Kogi State University.
3. Assess the attitude of students towards self-medication inKogi State University.
4. Identify feasible communication approaches that can improve health communication campaigns and reduce the risk of self-medication amongst students of Kogi State University.
1.4 Research Questions
The study addressed the following research questions:
1. What are the sources of information on self-medication among students of Kogi State University?
2. Howeffective is the nature of the health communication campaigns on self-medication in Kogi State University?
3. What is the attitude of students towards self-medication in Kogi State University?
4. Are thereany feasible health communication approaches that can reduce the risk of self-medication amongst students of the University?
1.5 Scope and Limitation of the Study
The scope of this study is limited to appraising the health communication campaigns on self-medication among undergraduate students of Kogi State University, Anyigba. The University comprisesof youths who come from various socio-economic and cultural background.The University presently has eight (8) Faculties with 23,264 student enrolments (Academic Planning Unit, 2015). Also, this study was primarily restricted to the undergraduate students,witha view to ascertaining the influence of self-medication campaigns of the University on them. The study was carried out within the context of inappropriate self-medication and the role effective health communication can play so as to engender a positive behaviour change among students. Given the fragile nature and characteristics of the sampled population (students), regular and effective communication becomes central especially in university settings where youths constitute the majority of the population. The study was conducted between February and November, 2016.
This research work was limitedmainlyby the paucity of literature on the subject matter specifically from the perspective of communication scholars. Most of the previous researches consulted were conducted by medical scholars.Secondly, some respondents‘ reluctance to accept and fill the questionnaire was also an issue the researcher contended with;as students complained of lack of time which may have been one of the reasons why some of the questionnaires were not returned. Though, the situation was brought under control with the intervention of some of their lecturers who made it clear to them that filling the questionnaires would not take much of their time.
1.6 Significance of the Study
This research takes bearing from the study conducted by Achemaet al., (2014) who examined the knowledge and practice of self-medication among undergraduate students of Kogi State University. Given the fact that the findings showed high prevalence of self-medication, further research is required to find out why self-medication is still prevalent among undergraduate students in the university.Following the over 90% knowledge of the hazards inappropriate self-medication poses to human health and wellbeing, The study adds a fresh perspective on the issue of self-medication by evaluating the communication campaigns deployed towards creating awareness on the dangers of treating self-diagnosed ailment without consulting a physician.
In view of the above, this study contributes to the articulation of the media campaign role in creating sustained awareness on the problem of drug misuse among students of tertiary institutions. It shall serve as a data base to Development Communication researchers who may be interested in learning the global fight on inappropriate self-medication pattern and for future researchers, who may be embarking on similar research in future. Itwill also serve as a reference material for Government and Non-governmental Organizations, Policy Makers and Media Campaigns Planners in the field of healthcare services, particularly on self-medication.
Again, the research significantly adds to the body of knowledge of medicine usage among policy makers and students.It provides health workers with empirical evidence on the need to evolve comprehensive communication strategies and approaches aimed at making students not only knowledgeable about self-medication but also on the danger inherent in the misuse, abuse and over dependence thereby making informed choices of healthy lifestyle. All these, would help in improving the self-medication communication campaign.