REVISTA DE LA UNIVERSIDAD DEL ZULIA. 3ª época. Año 12 N° 33, 2021

I.V. Kramar et al.// The prevalence of parental self-medication practice in Volgograd, 323-337

DOI: http://dx.doi.org/10.46925//rdluz.33.23

The prevalence of parental self-medication practice in Volgograd

I.V. Kramar *

A. B. Nevinsky **

K. O. Kaplunov ***

ABSTRACT

The aim of the study is to study the prevalence, determinants, and reasons for parents

using oral medications to treat their children in Volgograd (Russia). Materials and

methods. An instant simultaneous cross-sectional anonymous survey of 390 mothers of

children aged 1 to 14 years was conducted during October-March 2018-2019 in the city of

Volgograd (Russia). Criteria for inclusion in the study: mothers of children older than 1

year. Exclusion criteria: other legal representatives of children (fathers, grandmothers,

guardians, etc.); women with one child under the age of 1 year; mothers of children with

chronic diseases; persons with medical education. The data obtained were analyzed using

the STATISTICA-10 software package. To build models of logistic regression, the Student

t-test was evaluated for independent samples (to assess the differences between the

obtained data) and the χ2 criterion for the assessment of categorical differences. Results: it

was found that 71.0% of mothers used the practice of self-medication of children, while its

frequency depended only on the level of family income (χ2 = 7.077, p = 0.030) and did not

depend on the age of the respondents (χ2 = 0.211, p = 0.976), education (χ2 = 2.626, p =

0

.270), the number of children in the family (χ2 = 2.819, p = 0.421). Most often, antipyretic

drugs (93.8%), decongestants (72.9%), antiallergic drugs (49.5%), enterosorbents (44.4%),

immunomodulators (26.7%), antibiotics (7.9%) were used for self-medication. Using the

logistic regression model, it was shown that the main determinant of self-medication in

children is delayed treatment of parents for medical help (OR = 0.27, p <0.001). Conclusion.

The high frequency of self-medication dictates the need for further research to understand

this phenomenon.

KEY WORDS: self-medication; children; parent role.

*

Professor, Head of the Department of Children's Infectious Diseases, Volgograd State Medical

University, Ministry of Health of the Russian Federation, Volgograd, Russia. ORCID:

https://orcid.org/0000-0001-6913-2835 . E-mail: lubov-kramar@yandex.ru

*

Assistant, Department of Pediatric Infectious Diseases, Volgograd State Medical University,

Ministry of Health of the Russian Federation, Volgograd, Russia. ORCID: https://orcid.org/0000-

002-3135-0068

0

*

** Candidate of Medical Sciences, Associate Professor, Department of Pediatric Infectious

Diseases, Volgograd State Medical University, Ministry of Health of the Russian Federation,

Volgograd, Russia. ORCID: https://orcid.org/000-0002-4758-917 Х

Recibido: 22/01/2021

Aceptado: 19/03/2021

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Prevalencia de la práctica de la automedicación de los padres en

Volgogrado

RESUMEN

El objetivo del estudio es estudiar la prevalencia, los determinantes y las razones por las que

los padres usan medicamentos orales para tratar a sus hijos en Volgogrado (Rusia).

Materiales y métodos. Se realizó una encuesta anónima transversal simultánea instantánea

de 390 madres de niños de 1 a 14 años durante octubre-marzo 2018-2019 en la ciudad de

Volgogrado (Rusia). Criterios de inclusión en el estudio: madres de niños mayores de 1 año.

Criterios de exclusión: otros representantes legales de los niños (padres, abuelas, tutores,

etc.); mujeres con un hijo menor de 1 año; madres de niños con enfermedades crónicas;

personas con educación médica. Los datos obtenidos se analizaron mediante el paquete de

software STATISTICA-10. Para construir modelos de regresión logística, se evaluó la prueba

t de Student para muestras independientes (para evaluar las diferencias entre los datos

obtenidos) y el criterio χ2 para la evaluación de diferencias categóricas. Resultados: se

encontró que el 71,0% de las madres utilizaba la práctica de la automedicación de los hijos,

mientras que su frecuencia dependía solo del nivel de ingreso familiar (χ2 = 7.077, p = 0.030)

y no dependía de la edad de los encuestados. (χ2 = 0.211, p = 0.976), educación (χ2 = 2.626, p =

0

.270), el número de hijos en la familia (χ2 = 2.819, p = 0.421). Para la automedicación se

utilizaron con mayor frecuencia antipiréticos (93,8%), descongestionantes (72,9%),

antialérgicos (49,5%), enterosorbentes (44,4%), inmunomoduladores (26,7%), antibióticos

(

7,9%). Utilizando el modelo de regresión logística, se demostró que el principal

determinante de la automedicación en los niños es el retraso en el tratamiento de los padres

por ayuda médica (OR = 0,27, p <0,001). Conclusión. La alta frecuencia de la automedicación

dicta la necesidad de realizar más investigaciones para comprender este fenómeno.

PALABRAS CLAVE: automedicación; niños; papel de padre.

Introduction

Every child has the right to free medical care in the Russian Federation, which is

provided in state and municipal healthcare institutions in the manner prescribed by the

legislation of the Russian Federation (Article 10 of the Federal Law of July 24, 1998 No. 124

-

FZ “On Basic Guarantees of the Rights of the Child in the Russian Federation”) (On basic

guarantees of the rights of the child in the Russian Federation, 1998).

According to the WHO definition, the term self-medication is understood as the

rational use by the patient himself of drugs on the market for the prevention or treatment of

lung diseases before providing professional medical care (World Health Organization:

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Guidelines for the regulatory assessment of Medicinal Products for use in self-medication,

2000). In practice, the concept of self-medication also includes the treatment of other

family members, including children (Du and Knopf, 2009; Eldalo, 2013). Children are more

often consumers of drugs than adults, which is due to both the anatomical and

physiological characteristics of the child's body and the structure of their incidence (Santos

et al., 2009). The most common medications in pediatrics are antipyretics and antibiotics

(

Sharif et al., 2015).

If the child's parent (guardian) gives him a medication, then he assumes all the risks

associated with its use. How and in what ways parents treat their child, how well they

follow the recommendations set out in the instructions for drugs - all these questions lie in

the ethical and legal field of possible violations of the rights of the child (Lantos, 2015;

Araujo, 2019). Improper use of drugs can be dangerous for children, since the stages of

absorption, metabolism, excretion, and even exposure in child acceptors are different

compared to adults (Pediatric dosage handbook, 2009).

Attitude to self-medication in pediatrics splits into two clearly opposite poles of

opinion. On the one hand, most media articles, Internet sites, television and radio

broadcasts continuously encourage parents to self-medicate in the field of pediatrics. The

phrase “see a doctor immediately at the first sign of a disease” is most appropriate for

pediatric practice. Doctors - pediatricians are also only negative about the possibility of

self-medication of children. Health managers also consider the practice of self-medication

categorically unacceptable. At the same time, the few studies available show that a

significant proportion of parents independently give medicines to their children without a

doctor’s prescription (Umerova et al., 2010; Alekseeva et al., 2017; Kulik et al., 2019).

Responsible self-medication has been officially recognized abroad and is considered

as part of the modern healthcare system aimed at developing the population’s responsibility

for their health, improving education on self-help and self-prevention, allowing citizens to

realize the right to independently protect their health (Sonam et al., 2011). The introduction

of the concept of self-medication in the Russian Federation is still undergoing a stage of

public discussion, and these issues in pediatrics remain poorly understood (Reutskaya et

al., 2006; Okonenko et al., 2009). Data from 140 studies conducted worldwide were

analyzed in the most comprehensive systematic review of global self-medication practices

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presented by Dnyanesh Limaye in 2017, however, not a single Russian study was included

in this meta-analysis (Dnyanesh Limaye, 2017).

The aim of the study is to study the prevalence, determinants and reasons for using

oral medications to treat children with parents living in the city of Volgograd.

1

. Methods

.1. Study design

A cross-sectional anonymous study was conducted from October 2018 to March

2019 in Volgograd (Russia).

1

.2. Study conditions

Prior to the study, positive permission was obtained from the Regional Research

Ethics Committee (registration number IRB 00005839 IORG 00049000) at the State

Institution “Volgograd Medical Scientific Center”, protocol No. 111 of 04/05/2017.

Mothers of children - patients aged 1 to 14 years, who were admitted for treatment to

the Volgograd Regional Children's Clinical Infectious Diseases Hospital, were selected by

simple random sampling. If the mother had other children, then information was collected

only about the child admitted to hospitalization.

Each randomly selected mother who gave preliminary oral consent to the

questionnaire received an envelope from the representative of the research group, including

an information sheet, an informed consent form, a questionnaire. The information sheet

indicated the objectives and methodology of the study; it was also reported to everyone that

the study was voluntary and anonymous and that information about the study participant

would not be personally identifiable; it was reported that the participation was free of

charge (neither the researchers nor the respondents receive any remuneration and

preferences for participating in the study).

Each profile consisted of two sections. The first included data on the main

demographic characteristics of respondents (age, level of education, number of children,

level of material income of the family). The second section contained questions of a medical

nature, including the number of episodes of acute infectious diseases in a child over the

previous year, tactics of parents' behavior in case of a disease, trust in the appointments of a

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local pediatrician, and the practice of using oral medications independently without a

doctor’s appointment.

1

.3.Compliance criteria

To obtain the most uniform data from all legal representatives in the study, it was

decided to include only mothers with children older than 1 year. This decision was made

due to the fact that mothers, more than other family members, take part in the upbringing,

care and treatment of children. The presence of children older than 1 year implies that the

mother has a certain experience in caring for a sick child.

Inclusion Criteria:



mothers of children over the age of one year of life;

permanent residence of the child in the family with parents;

the absence of documented chronic diseases in the child;

lack of parents' (mother / father) of medical education.

Non-inclusion criteria



mothers with children under 1 year old and over 14 years old;

the presence of a child's chronic (including allergic) diseases;

other representatives of the child (fathers, grandmothers, guardians, etc.);

the child does not live in the family (in childcare facilities with a round-the-clock

stay, in the family of grandmothers, other relatives, acquaintances);



at least one parent has a medical education);

persons who refused to answer the questionnaire.

1

.4. Description of compliance criteria

The criteria for compliance / non-compliance in all cases were established by the

researcher based on the collection and analysis of anamnestic data.

1

.5. Targets

The main indicator of the study was considered the proportion of parents who

answered positively to the question about the use of oral medications for the treatment of

children's health disorders before providing professional medical care.

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1

.6. Target measurement methods

Each woman who met the inclusion criteria and agreed to conduct a survey received

a questionnaire, which consisted of two sections. The first part included 4 questions about

the main demographic characteristics of the respondents (age, level of education, number of

children, level of material income of the family) and the question “Do you give any medicine

to your child yourself without consulting a doctor”. The second part of the questionnaire

contained 10 medical questions characterizing the process of self-medication;

questionnaires only for positive respondents were taken into account. The following

criteria were evaluated: the number of episodes of acute infectious diseases in a child for the

previous year, the tactics of parents' behavior in case of a disease, confidence in the

appointments of a local pediatrician, self-medication frequency for the previous year, causes

of self-medication, the main symptoms in which parents resorted to it, medications and

side effects, self-medication satisfaction.

1

.7.Statistical Procedures

.7.1. Principles for calculating sample size

The sample size was determined before the start of work. The size of the required

sample was 384 people, taking into account a confidence interval of 95%, and a possible 5%

error. In fact, 407 questionnaires were distributed, of which 17 were ruined or incorrectly

executed. Thus, 390 questionnaires were subjected to statistical processing.

1

.7.2. Statistical methods

Statistical analysis of the obtained data was carried out using the STATISTICA

program, version 10.0 (StatSoft Inc., USA). To assess the quantitative indicators, we used

the determination of the mean value of the sign, standard deviation, median, t-student

criterion with a confidence interval of 95%. To evaluate nonparametric parameters, Student

t-test was used for independent samples, Pearson's criterion χ2 at p <0.05.

The influence of independent variables on the indicator of interest to us (the positive

practice of self-medication) was assessed by constructing a model of multivariate logistic

regression. To this end, variables reaching P≤0.25 in a two-dimensional analysis were

included in the multivariate direct logistic regression model. In this case, the following

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characteristics evaluated in the point system were evaluated: age of full years (18-25 years -

1

, 26-30 years - 2, 31-35 - 3, older than 36 years - 4 points); the level of education was

evaluated in 3 categories (secondary -1; secondary special - 2, higher - 3); the number of

children in four categories (one - 1, two - 2, three - 3, four or more - 4); the frequency of

episodes of acute infectious disease during the previous twelve months (2-3 episodes - 1, 4-6

times - 2, 7 or more times - 3); see a doctor on the first day of the disease (yes - 1, not always

-

2, never - 3); trust in appointments of the local pediatrician (yes, always - 1, no, never - 2,

not always - 3 points). The results of the logistic regression model were presented as

adjusted odds ratio (OR) coefficients taking into account 95% confidence intervals (CI). P

<0.05 was taken as a statistically significant level of probability.

2

. Results

63 participants were interviewed in the preliminary selection, 156 of them did not

5

meet the inclusion criteria, 407 mothers agreed to participate in the survey. 17 of these

questionnaires were found to be incorrectly completed (damaged). Thus, the total number

of respondents evaluated was 390 people. 277 of them indicated that they independently

give medicine to children in case of their illness without consulting a doctor, which

amounted to 71.0% (group I); 113 women answered negatively to the question posed - 29.0%

(

II group of respondents).

We can conclude from the data presented in table 1 that both groups of parents were

very close in basic sociological characteristics. Women aged 25 to 35 years (61.4 and

2.8%), with 1 or 2 children (88.1 and 86, 7%), with higher education (55.6 and 46.9% for

6

groups, respectively) prevailed in both groups. In the first group, 17.3% of respondents had

below-average income, in the second - 13.3%; above average 7.2 and 14.1%, respectively.

However, the study of differences by the χ2 criterion showed that the level of family income

in the group of mothers practicing self-medication was significantly lower (χ2 = 7.077, p

<0.05).

We analyzed data on the incidence of children, while 60.3% of respondents in the

first group reported that in the year preceding the study, their child suffered from 2 to 3

episodes of SARS, 30.3% indicated 4-6, and 9, 3% replied that their child had more than 7

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times with acute respiratory infections. In the comparison group, these were 66.1%, 25.7%,

and 6.2%, respectively (χ2 = 2.359, p = 0.308).

The main demographic characteristics of the respondents are presented in Table 1.

Table 1. Demographic characteristics of respondents

Self-medication practice

Yes

(I group)

No

(II group)

Characteristic

Feature

absolute

49

%

absolute

%

Age

1

2

8-25 years old

6-30 years old

17,7

19

32

39

23

16,8

81

89

58

29,2

32,1

20,9

28,3

34,5

20,4

31-35 years old

36 years and older

Values of χ2 criterion between groups 0.211, p = 0.976

Amount of children

1

child

children

and more children

124

120

22

44,8

43,3

7,9

59

39

11

52,2

34,5

9,7

2

3

4

11

4,0

4

3,5

Values of the χ2 criterion between groups 2.819, p = 0.421

The level of education

Secondary education

Vocational

47

76

17,0

27,4

21

39

18,6

34,5

education

Higher education

154

55,6

53

46,9

The values of the χ2 criterion between groups of 2.626, p = 0.270

Family income

Below the average

Middle

48

209

20

17,3

75,5

7,2

15

82

18

13,3

72,6

14,1

Above the average

Values of χ2 criterion between groups 7.077, p = 0.030

It was found that parents practicing self-medication were 2 times less likely to seek

medical help immediately after the illness of the child. To the question: “Do you always see

a doctor on the first day of illness?” in the first group, the following answers were received:

yes, always - 30.7%, not always - 65.3%, no, never - 3.9%. In the group not practicing self-

medication, those were 64.6%, 33.6% and 1.7%. These differences were statistically

significant (χ2 = 9.21, p <0.001).

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To the question “Do you trust the appointments of your local doctor?” 149 (53.8%) of

the respondents in the first group answered “yes”, “not always” - 11.9% (33) and “no, never”

-

34.3% (95 women). In the comparison group, the level of trust was significantly lower,

and the answers were distributed as follows: “yes” - 70.8% (80), “not always” -24.8% (28),

“

no” - 4.4% (5 people) (χ2 = 10.87, p = 0.005).

To assess the most common causes of self-medication, respondents were asked to

select all or several reasons why the mother gave the medicine to the child without

consulting a doctor (Table 2).

Table 2. Factors associated with self-medication in children

Number of respondents

Reasons for the independent use of medicines

Familiar Symptoms

responding positively

№

absolute

%

1

The desire to alleviate the condition of the

160

57,8

child before the doctor’s visit

2

3

Sudden onset of symptoms at night

Not a serious condition of the child (does not

cause anxiety)

118

100

42,6

36,1

4

5

6

7

Confidence that the doctor will prescribe

these drugs anyway

71

25,6

20,9

10,5

6,5

There is no way to visit the clinic on the day

of illness of the child

58

29

18

Use of the medicine that remains of the last

time

Reasons for the independent use of medicines

It can be seen from the data that the most frequent reason for giving the child self-

medication was the appearance of familiar symptoms (57.8%), the desire to help the child

before the doctor’s visit (42.6%) and her sudden appearance at night (36.1%). Parents

indicated that they gave drugs to the child in the absence of alarming symptoms in only

25.6% of the questionnaires, and 10.5% indicated that they could not visit the clinic.

Eighteen mothers (6.5%) resorted to the use of drugs that remained in the home medicine

cabinet after treatment for previous episodes of acute respiratory viral infections, 58 people

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(

20.9%) were sure that they knew all the drugs that pediatricians prescribed for them in

case of acute respiratory infections.

To the question “How often do you independently give medicine to a child without

consulting a doctor”, 27.1% said that they do it once a year, 29.9% - 2 times a year, 8.3% -

once a month, and 34.6% of women indicated that they do this all the time (always when

the child falls ill).

The next step in our work was the evaluation of a set of drugs used for self-

medication. For this purpose, mothers were offered a choice of a list of 12 groups of

medicines, and it was necessary to choose all the drugs that at least once the mother gave

the child without medical prescriptions. The data obtained are presented in Fig. 1.

Figure 1. The number of drugs used by parents for self-treatment of children (%)

It was found that 6.1% of mothers surveyed gave the child 1 drug, 14.4% of the

respondents gave 2 drugs. The absolute majority indicated in answers to 3 or more groups

of drugs. The average number of drugs used by mothers for self-treatment was 6.5

medicines of various groups (CI 95% 2.55 - 6.12), which indicates a wide range of drugs

used.

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From the data in table 3 it follows that most often parents gave their children

antipyretic drugs (93.8%), decongestants (72.9%), antiallergic drugs (49.5%),

enterosorbents (44.4%). The following fact is also of concern: 22 mothers (7.9%) indicated

the independent use of antibiotics, and 74 (26.7%) indicated the use of immunomodulators.

Table 3. Frequency of parental use of drugs of various groups

№

The group of drugs noted by the respondent in

the questionnaire

The number of parents using

drugs for self-treatment of

children

absolute

%

1

Drugs to lower the temperature (ibuprofen,

acetaminophen, etc.).

260

93,8

41,5

2

Antitussive drugs (ambroxol, acetylcystein, etc.)

115

3

4

Vasoconstrictor drops in the nose

Herbal medicines (including herbal

preparations)

202

43

72,9

15,5

5

6

7

Antibiotics

Vitamins

Immunomodulators (isoprinazine, arbidol,

anaferon, etc.)

22

110

74

7,9

39,7

26,7

8

9

Antiallergic drugs

Probiotics (bifidobacteria and lactobacilli)

Antispasmodics

Pancreatic enzymes

Enterosorbents (smecta, activated carbon,

enterosgel, etc.)

137

75

49,5

27,1

11,5

10,8

44,4

1

0

1

2

32

30

123

Satisfaction of parents with self-medication can be regarded as average, because only

a third of parents (37.5%) were completely satisfied with its results, while 61.7% did not

always get the desired result, 0.7% of respondents were not satisfied with self-medication.

Assessment of pair correlation coefficients showed the presence of a relationship

with the level P ≤ 0.25 for the following parameters: education (p = 0.238), income (p =

0

.028), the frequency of acute respiratory viral infections during the last year (p = 0.244),

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date of visit to the doctor in in case of acute illness (p = 0.001), the degree of trust in the

attending physician (p = 0.06). These indicators were used to build a logistic regression

model. The data obtained are presented in table 4.

Table 4. Logistic regression model of potential determinants of self-medication

Study factor

Odds ratio

OR

Confidence

interval

P value

(

95% CI)

The level of education

Family income

0,86

1,64

0,77

0,63-1,17

1,02-2,66

0,52-1,13

0,351

0,040

0,184

The frequency of acute respiratory

diseases in the year preceding the

survey

Seeing a doctor on the first day of

illness

0,27

0,17-0,43

<0,001

The results of multivariate logistic regression analysis showed that only one factor

was identified as being significantly related to parental self-medication - the practice of

consulting a doctor on the first day of a child’s disease (OR 0.27, p <0.001); while such

characteristics as the level of education, family income, high incidence rates of children

were not potential determinants of the use of drugs without a doctor’s prescription.

3. Discussion

3.1.Summary of the main research result

The data obtained showed that the majority of mothers (71%) resort to self-

medication of their children in case of acute respiratory infections.

3.2. Study Limitations

According to the results of studies conducted abroad, the level of self-medication of

the population significantly depends on socio-economic conditions and the main factor of

this phenomenon is financial restrictions, in particular, the lack of medical insurance and

the high cost of medical services (Al-Ghamdi et al., 2020; Aoyama et al.,, 2012; Awad et al.,

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2

006; Chang and Pravin, 2003; Pagán et al., 2006; Torres et al., 2019; Urrunaga-Pastor et al,

019). When evaluating our results, it is absolutely necessary to take into account the

2

cultural and socio-economic differences between the studied populations, as well as the

differences between the world's health systems, since these factors affect access to medical

care and medicines, their use.

3.3. Interpretation of study results

It was established that, despite the fact that medical care in the Russian Federation

is public and free, treatment by parents of children without consulting a doctor is common

practice (71%), and 34.7% of mothers are constantly self-medicating, which is comparable

to obtained in foreign studies. Perhaps for children with chronic diseases this figure will be

significantly higher. It was found that self-medication is not affected by factors such as the

mother’s age, her level of education, and the child’s susceptibility to frequent respiratory

infections.

Only 2 factors, such as family income and the practice of seeking medical help on the

first day of a child’s illness, affect the frequency of self-medication: parents with high family

income are less likely to self-medicate, while those who choose the tactics of monitoring the

course of the disease in a child are more likely to use drugs without consulting a doctor.

The absolute determinant of self-medication can only be considered a behavioral habit to

ignore seeking medical help immediately (on the first day) after a child’s illness.

Conclusion

The established high level of self-medication use dictates the need for informational

and educational activities for parents, including the provision of first aid in the event of an

acute illness in a child. In addition, further cross-sectional studies of self-medication are

needed to understand the prevalence of this phenomenon in the population.

Conflict of Interest Statement

The authors confirmed the absence of a reportable conflict of interests.

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I.V. Kramar et al.// The prevalence of parental self-medication practice in Volgograd, 323-337

DOI: http://dx.doi.org/10.46925//rdluz.33.23

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