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Research Article | DOI: https://doi.org/10.31579/2768-2757/012
School of Pharmacy, College of Health and Medical Sciences, Haramaya University, Ethiopia.
*Corresponding Author: Lemlem Niguse, School of Pharmacy, College of Health and Medical Sciences, Haramaya University, Ethiopia.
Citation: L Niguse, T Sosengo. (2021) Knowledge and Reasons for Use of Analgesic Medications among Haramaya University College of Health and Medical Science Students, Harar Town, East Ethiopia. Journal of Clinical Surgery and Research. 2(2) DOI: 10.31579/2768-2757/012
Copyright: ©2021 Lemlem Niguse, This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Received: 07 March 2021 | Accepted: 23 April 2021 | Published: 30 April 2021
Keywords: analgesic medications; paracetamol; ibuprofen; diclofenac
Background: Analgesics, NSAIDs and opioids, commonly known as painkillers, are substances which work in various ways to relieve different types of pain experienced in the body. Approximately 25% of the patients taking non-steroidal anti-inflammatory drugs face several adverse events even in case of prescribed drug and several cases of deaths are reported.
Objective: The aim of this study is to assess knowledge and reasons for use of analgesic medications at Haramaya University, College of Health and Medical Science students of Harar town, Eastern Ethiopia from March 1 2020 to February, 2021.
Method: Institution based cross sectional study was conduct from March 1, 2020 to February 30, 2021. Data was collected using self-administered structured questionnaire prepared in English. Stratified sampling and simple random sampling was used to select the study participants. A total sample size of 317 was taken. Then the collected data was coded, entered and analyzed by using statistical package for social science version 23. The result is presented using tables.
Results: The 90.5% of participants had used analgesic in their life time and the 63.8% them had used analgesic in the last six months. The analgesic usage prevalence in of the study is Ibuprofen (28.7%), Diclofenac (25.7%) and Paracetamol (21.7%). The 78.5% of the respondents reported that large dose of Paracetamol may cause liver. With regard to the use of alcohol with paracetamol, the 77.8% of the respondents replied that alcohols should be avoided when Paracetamol is being taken. The 60.7% of the respondents were aware of the daily maximum dose of Paracetamol. The 78.3% of respondents replied that long time use of codeine can cause addiction. In the current study the 32.4%, 13.2%, and 12.5 %, of the respondents took analgesics for the reason of headache, menstrual pain and fever pain management respectively. The 38.7% of the respondents chose the analgesics due to previous experience, the 19.9% by reading a publication and the 17.5% based on recommendations from others.
Conclusion: This study showed the majority of the participants used analgesics for different reasons mainly for management of headache, menstrual pain and fever. Significant proportions of the study participants lack the appropriate knowledge about analgesics usage of analgesics.
Analgesics, NSAIDs and opioids, commonly known as painkillers, are substances which work in various ways to relieve different types of pain experienced in the body. They are also drugs which reduce or relieve the sensation of pain without producing loss of consciousness or parallel depression of other senses [1].
Non-steroidal anti-inflammatory drugs (NSAIDs) and paracetamol (acetaminophen), are the most commonly used over the-counter (OTC) drugs in the world. Over-the-counter analgesics represent a convenient solution for self-care and are generally safe if used in appropriate dosage [2]. Opioids are often the next logical step following NSAIDs in the management of acute pain and cancer-related chronic pain. They also may be an effective treatment option in the management of chronic non-cancer pain [3].
Treatment with analgesic drugs for longer period and/or with a dose exceeding maximum recommended doses has been associated with cardiovascular (CV), renal, myocardial infarction and kidney disease, both acute and chronic kidney diseases and GI complications including bleeding gastric or duodenal ulcers and GI obstructions and perforations [4, 5].
In a retrospective analysis of a rheumatoid arthritis patient database done in Stanford university school of medicine in California, USA, showed OTC ibuprofen and naproxen users had a relative risk for serious GI complications of approximately 3.5 compared with NSAID nonusers and it is estimated that 1%–2% of continuous NSAID users experience a clinically significant upper GI event per year [6].
Prevalence of analgesic drugs use related peptic ulcer has significantly increased and has been associated with increased morbidity and mortality [7, 8].
Significant proportion of NSAIDs users takes the drugs at a dosage exceeding the maximum dose, a warning or contraindication for the use of the drugs or concurrently with interacting medications [9].
In both developed and developing countries, there is a growing problem of OTC NSAIDs misuse has been reported especially among high school and university students due to the lack of knowledge regarding their proper use [10]. Studies conducted to assess students’ knowledge on the use of NSAIDs have been conducted worldwide shows a lack of sufficient knowledge regarding correct use of NSAIDs among University students [11-13]. Lack of knowledge about proper use of NSAIDs lead to increased morbidity and mortality, increased risk of unwanted effects such as adverse drug reactions, unnecessary hospital admissions and visits and many other consequences.
Despite this fact, no study has been done that assess knowledge and reason about use NSAIDs Haramaya University, college of health and medical sciences students. Therefore, this study assessed knowledge and reasons for use of analgesics among CHMS students.
Study area and Period
The study was conduct from February 1, 2020 to February, 2021 among College of Health Medical Science students in Harar town, Haramaya University, Eastern Ethiopia. Harar town is located at 525 kilometers east of the capital city, Addis Ababa. Currently a total of 1130 as regular students at Haramaya University CHMS.
Study design
Institution based cross sectional study design was conducted to assess knowledge and reasons for use of analgesic medications among Haramaya University College of Health and Medical Science.
Population
Source population
All students who were attending their education at Haramaya University College of Health and Medical Science
Study population
All selectee students who were attending their education at College of Health and Medical Science and willing to participate in the study.
Sample size determination
The required sample size is calculated by formula:
n =(Zα/2)2 P(1-P)d2n =(1.96)2×0.5(1-0.5)(0.05)2= 384
Where:
Prevalence (p) use analgesic 50%, (Z) = standard normal distribution value at 95% confidence level of Z = 1.96 and margin of error (d) = 5%.
Since the total study population is less than 10,000, correction formula is used to determine the sample size.
Finite population correction (FPC) = n1+nN
Where n= 384
N=Total population of our study= 1130
FPC = 3841+3841130 = 288
To compensate for possible missing of information and errors, 10% of the size was add. Hence sample the final sample size = 288 + 28.8= 317
Sampling technique
The first sample was select using lottery methods. Using a proportionate allocation, a total sample size were divide to each regular program departments of CHMS.
ni= NiN×n
where i = 1, 2, ..., k where, k is the number of strata and
ni is sample size of the ith stratum
Ni is population size of the ith stratum
N is the total number of students in CHMS
n is the total sample size
Based on that, the required sample from each department;
Nurse = 89/1130 * 317 = 25
Midwifery =103 /1130*317 = 29
Clinical pharmacy =114/1130 *317 =32
Medical Laboratory Science =84/1130*317 =24
Environmental health =64/1130*317 =18
Psychiatry nurse =66/1130*317 =18
Public health =83/1130*317 = 25
Medicine =520/1130*317 = 146
Finally, simple random sampling was use to select the study participants for this study.
Data collection instrument and technique
Data was collect using self-administered structured questionnaire which is prepared in English. Participation was on voluntary basis and confidentiality was maintained.
Data quality control
To ensure data quality, the questionnaire was pretested on selected sample and subsequent correction and modification was done depending up on the finding. Finally, the collected data was reviewed and checked for completeness before the data analysis.
Data processing and analysis
The collected data was coded and analyzed by using SPSS version 24. The result was presented by tables, graphs and charts.
Ethical consideration
Before commencing data collection ethical clearance & approval letter was obtained from College of Health and Medical Sciences Haramaya University and was submitted to each department and then the permission letter was obtained from the respective deparments. The researcher has given full information on the purpose and objectives of the study to the study participants in order to empower the study participants to make informed decisions on whether to participate or not.
Operational definition
Analgesic: substances which work in various ways to relieve different types of pain experienced in the body.
Assessment: Evaluation and measurement of knowledge and practice about a particular matter.
Knowledge: Awareness or understanding about something overall information.
Reason: The motive or rationale for the use or application of particular subject.
Socio demographic characteristics
In this study 317 respondents were included. The 169 (53.30%) and 148(46.7%) of the respondents were male and female respectively. The majority, 97.4% of the study participants were at age group of 21 to 27 years. The 288(90.9%) of them were single and the 29(9.1%) them were married.
The 146(46.1%), 32(10.1%) and 29(9.1%) of the participants were from medicine, pharmacy and midwifery nurse departments respectively. The majority, 141(44.5%) and 83(26.2%) of the study participants were of fourth and fifth year students (Table 2).Socio demographic characteristics
In this study 317 respondents were included. The 169 (53.30%) and 148(46.7%) of the respondents were male and female respectively. The majority, 97.4% of the study participants were at age group of 21 to 27 years. The 288(90.9%) of them were single and the 29(9.1%) them were married.
The 146(46.1%), 32(10.1%) and 29(9.1%) of the participants were from medicine, pharmacy and midwifery nurse departments respectively. The majority, 141(44.5%) and 83(26.2%) of the study participants were of fourth and fifth year students (Table 2).
Prevalence of analgesics usage
The 288(90.8%) had used analgesics in their life time. And 201(63.8%) of the study participants had used an analgesic in the last six months.
From the participants who had used analgesics in the last six months, the 28.7%, 25.7%, 21.7% and 13.9% of the respondents used Ibuprofen, Diclofenac, Paracetamol and Tramadol respectively (Table 3).
The 277(87.3%) of the respondents stated that Paracetamol, Ibuprofen, Diclofenac, and Aspirin can be used to relieve pain. The 164(51.7%) respondents replied that Paracetamol, Ibuprofen, Diclofenac, and Aspirin are equally effective for relieving pain associated with inflammation. The 78.5% of the respondents reported that large dose of Paracetamol causes liver damage.
With regard to the use of alcohol with paracetamol, the 77.8% of the respondents replied that alcohols should be avoided when Paracetamol is being taken to decrease the risk of liver damage. The 60.7% of the respondents were aware of the daily maximum dose of Paracetamol.
In the present study, the 77.8% of the participants reported that alcohol should be avoided to decrease the risk of gastric irritation while taking Ibuprofen, Diclofenac, and Aspirin. The majority, 66.5%, of the respondents in this study replied that aspirin should not be used for the treatment of pain in patients with asthma and peptic ulcer disease. With respect to the use of opioids, the 78.3% of the respondents stated long time use of codeine can cause addiction. The 64.2% of respondents replied that they read the leaflet before taking analgesic (Table 4).
Reason for analgesic use
In the current study the 32.4%, 13.2%, and 12.5 % of the respondents took analgesics for the reason of headache, menstrual pain and fever pain management respectively. The 38.7% of the respondents chose the analgesics due to previous experience, the 19.9% by reading a publication and the 17.5% based on recommendations from others. With respect to a drug selection for the pain management, the 29.1% and 26.8 % of the respondents in this study reported that Paracetamol and Ibuprofen as drugs that they prefer for a pain management (Table 5).
This study showed the majority of the participants used analgesics for different reasons mainly for management of headache, menstrual pain and fever. Significant proportions of the study participants lack the appropriate knowledge about analgesics usage of analgesics. The study also showed that the majority of the participants used analgesics without a health professional consultation. Paracetamol is the most preferred drug for pain management in this study. The major reason for the choice of analgesics is primary the previous experience with the drug. All stakeholders including the college, CHMS, researchers, governments and all concerned bodies should give a better attention to close the knowledge gap about analgesics use seen in this study.
The author acknowledges Harmaya University College of health and medical Sciences for all positive co-operations for the undertaking of this study.
Declarations
Consent to publish: Not applicable
Funding: None
Competing interests: The author declare no competing interest.
Conflict of Interest: The authors declare no conflict of interest.
Author Lemlem Niguse involved in the conception and design of the study, participated in the literature searches, supervised data collection and analyzed data. Author Teshome Sosengo involved in the conception and design of the study, participated in the literature searches, analyzed data and wrote the manuscript. Both the authors approved the final manuscript.
Availability of data: All the data are available with the corresponding author, Lemlem Niguse.
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