This study indicates that practicing self-medication (SM) is common in Syria, with a prevalence of 67.3% in the preceding three months’ period. While this prevalence rate is higher than those in Jordan (42.5%) [4], Brazil (16.1%) [9] and Ethiopia (50.2%) [15], it is notably lower than that of Lebanon (79.1%) [6], Palestine (87%) [7], Egypt (73%) [3], Vietnam (83.3%) [8] and Pakistan (84.4%) [16]. This variation might be explained by different recall periods, healthcare services, economic situation, and social and cultural factors.
Association between socio-demographic factors and self-medication was minor in this study. Practicing self-medication was slightly higher among females than males. Although a strong correlation was found between gender and SM in many studies, no significant association was found in this study. This also remains a worldwide point of debate because females were more involved in self-medication practice in some societies [6, 9, 17], while males were predominant in others [8, 18].
Self-medication practice was more prominent in ages younger than 40 years old, and a strong correlation was found between age and SM. This contradicts with a study conducted in Egypt in which self-medication was prevalent in ages older than 40 years old [3], while it correlates with other studies held in Saudi Arabia [17], Lebanon [6], and Brazil [9] which also revealed a predominance in younger ages.
In this study, higher monthly income was related to the practice of self-medication, unlike the results of studies conducted in Ethiopia [15] and China [19] which showed a correlation with lower income. Moreover, residents of the city were more likely to practice self-medication than those of the countryside, which relates to a study conducted in Erbil [20]. This might be justified by the abundance of pharmacies in cities compared to countryside, which facilitates access to drugs.
Analgesics, antipyretics, and antibiotics were the most drug classes used in self-medication. This resembles the findings of a Lebanese study, in which acetaminophen-based analgesics (48.7%), nonsteroidal anti-inflammatory drugs (24.6%), and antibiotics (8.8%) were the most used drugs in self-medication [6], but differs from the results of another study conducted in Syria which indicated that the use of antitussives and vitamins was more common than antibiotics [11]. These dissimilarities might be justified by difference between the studies populations, as the latter only targeted undergraduate medical students, so their medical knowledge might have played a role in them using less antibiotics. This high prevalence of antibiotics use should be repressed as antibiotic resistance is jeopardizing public health in Syria [21] and government should fight the unprescribed use of antibiotics.
Headache, cough/flu, and body aches were the main conditions to treat. These findings came in concordance with these of a study in Saudi Arabia [17] in which headache, flu and cough were the predominant indications. However, fever was also a predominant indication in Saudi Arabia, while suffering from body aches was more common in our study.
The leading reasons for self-medication were mildness of the illness and elevated costs of medical consultations, followed by having previous knowledge or experience of the illness. Similar reasons were evident in other studies [3, 6, 7]. The increased fear of high treatment costs is justified by the deterioration of economic status in Syria in shade of the current war [22]. This highlights the importance of increasing individual basic income and improving health insurance systems in controlling the practice of self-medication.
Pharmacists were the main source of advice on which drugs to use in self-medication. Their role as an alternative to medical consultation was also prominent in other studies [3, 6, 15]. This can be justified by the expensiveness of healthcare services, prolonged waiting periods in clinics and hospitals, and abundance of, and ease of access to, pharmacies. Therefore, optimizing the quality and speed of healthcare services, especially during the initial visits to the ER and family physicians may decrease the need to practice self-medication. Moreover, the role of pharmacists in limiting self-medication risks and ensuring the proper use of medications should be emphasized.
More than half of the respondents stated that they read the associated medication pamphlets (package inserts), compared with only one-third in an Eritrean study [15]. Furthermore, half of participants lacked knowledge about side effects of used medications. This was also noted in a study held in Lebanon where 64.5% of the participants lacked this knowledge [6]. This questionable difference between percentages of people who read the pamphlets and those who knew the side effects of used drugs in this study might be justified by ineffective reading of pamphlets on backgrounds of the low educational level of the participants. Both of these findings can be addressed by training and encouraging physicians and pharmacists to explain the probable side effects of medications and emphasizing the need to report them as they may be harmful and require drug cessation.
The majority declared that self-medication helped them alleviate their symptoms. The effectiveness of self-medication was also noted in a study held in China with 94.5% of the participants noticing an improvement [19]. This might encourage the action of practicing self-medication as beneficial outcomes were frequently gained. In case of self-medication failure, more than half of the participants have indicated that they would visit healthcare facilities for medical consultation. This good attitude was more prevalent than other actions such as double dosing or repeating the same medication and was correlated with the results of other studies [15].
Fortunately, about two thirds declared that self-medication is not safe and more than half would not recommend other people to self-medicate. This contradicts an Indian study in which the majority of people who self-medicated considered self-medication harmless and would advise others to self-medicate [18].
Limitations of this study
This study was conducted in a single healthcare center. However, it is one of the largest in Damascus, the capital of Syria, and it receives patients from all over the country. Furthermore, this is a cross-sectional study so it does not address the difference in self-medication patterns among different seasons.
Using surveys depends on self-reported data and is subject to individuals’ response. Also, the nature of face to face interviews might have made people reluctant to admitting wrong attitudes, but emphasizing on the confidentiality of participants identity and data might have limited this effect. Moreover, the study has focused on the three months period preceding the interview, which may increase the effect of recall bias.
Surprisingly, the participants in the study were mostly of low educational level. Therefore, the results of this study may not reflect the attitudes and practices of people with higher education and further studies are needed to investigate their practices.