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PRACTICES OF COMMUNITY RESIDENTS ONSELFMEDICATION WITH ANTIBIOTICS

A Thesis Presented to the Faculty of theCOLLEGE OF NURSING

Pamantasan ng Lungsod ng MaynilaIntramuros, Manila

In Partial Fulfillment of the Requirement for the CourseNURSING RESEARCH

ECLEVIA, BEA MARIE E.LLANTINO, COLETTE III S.MEDIDAS, ELAIZA MAE V.

RAMOS, ART CHRISTIAN M.SANCHEZ, ALEXANDRA AGNES A.

TINAYA, RENZ NICOLE ROSS C.

October 5, 2013


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Pamantasan ng Lungsod ng Maynila

University of the City of Manila

Intramuros, Manila

COLLEGE OF NURSING

RECOMMENDATION

This,

X Thesis _____ Research Project

_____ Dissertation _____ Feasibility study

entitled: "PRACTICES OF COMMUNITY RESIDENTS ON SELF

MEDICATION WITH ANTIBIOTIC".

was prepared and submitted by ECLEVIA, BEA MARIE E.; LLANTINO,

COLETTE III S.; MEDIDAS, ELAIZA MAE V.; RAMOS, ART CHRISTIAN M.;

SANCHEZ, ALEXANDRA AGNES A.; TINAYA, RENZ NICOLE ROSS C. in

partial fulfillment of the requirements for the degree ofBachelor of Science in

Nursing has been examined and hereby recommend forORAL EXAMINATION.

____________________________ ________________________

Maria Andrea L. Endeno, M.A.N. Ma. Teresa S. Abila, M.A.N.

Nursing Research Adviser Nursing Research Professor


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Pamantasan ng Lungsod ng Maynila

University of the City of Manila

Intramuros, Manila

COLLEGE OF NURSING

APPROVAL SHEET

This,

X Thesis _____ Research Project

_____ Dissertation _____ Feasibility study

entitled: "PRACTICES OF COMMUNITY RESIDENTS ON SELF

MEDICATION WITH ANTIBIOTIC"

was prepared and submitted by ECLEVIA, BEA MARIE E.; LLANTINO,COLETTE III S.; MEDIDAS, ELAIZA MAE V.; RAMOS, ART CHRISTIAN M.;SANCHEZ, ALEXANDRA AGNES A.; TINAYA, RENZ NICOLE ROSS C. inpartial fulfillment of the requirements for the degree ofBachelor of Science inNursing has been examined and hereby recommend forORAL EXAMINATION.

Approved by the committee on Oral Examination on OCTOBER 5, 2013 with a

grade of:

____Excellent

____Highly satisfactory

____Satisfactory

____Needs Improvement

_________________________ ___________________________

Marilyn S. Agravante, M.A.N. Dr. Raymond M. FernandezPanel Member Panel Member

_____________________________Ma. Teresa S. Abila, M.A.N.Nursing Research Professor


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ACKNOWLEDGEMENT

The success of this study will not be achieved without the help of the

following individuals. Without them, the researchers might not be able to meet

their desired goals in doing this undertaking. The researchers want to give their

outmost gratitude for your invaluable help and support.

To Prof. Maria Andrea L. Endeno, our research adviser, for sharing her

knowledge for the improvement of this study. Thank you for your patience,

understanding and encouragement throughout this endeavour despite of the

shortcomings of the group. Your cheerfulness always boosts our confidence to

strive harder and meet our objectives.

To our research professor, Prof. Ma. Teresa S. Abila, for diligently

moulding our group in the process of conceptualizing, writing , validating and

even correcting the errors within our paper. We are very honoured to have you

as our research professor. We are thankful for imparting your expertise not only

on our group but to the whole class as well.

To our dear panel, Prof. Marilyn S. Agravante, Prof. Sonny A. Pura and

Dr. Raymond M. Fernandez, for your vital inputs and tremendous comments and

suggestions for the improvement of our work. This will not be a commendable

paper without your help.

To Prof. Marilyn S. Agravante, our class adviser, for guiding, counselling,

and believing that our block can overcome the challenges and hindrances that


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v

we might face. Your motherly love has been always touching our hearts to

become a better person than who we are today.

To Prof. Ronald L. Singson, thank you for assisting us in translating our

research questionnaire. Your proficiency has helped us lessen our work load.

To Brgy. Chairman Armando C. Enaje Sr., for allowing us to conduct our

study in their baranggay. Thank you for sharing with us information and statistics

necessary to our study. We are also thankful for ensuring our safety during our

ocular survey and the day of our survey proper. Your cooperation is very much

appreciated. `

To BSN 4-3, our loving and hardworking classmates, for the unity and

cooperation despite of the obstacles that we have faced. Thank you for the

shared laughters, tears and experiences. We may not be the best, but still we are

the happiest!

To our ever supportive families, for sheltering us during our overnight

sessions. You have always been our inspiration in fulfilling and reaching our

dreams. Thank you for your patience, trust, love and support.

And most especially, to our Almighty God for giving us the daily strength,

wisdom and knowledge. Your provisions are unfailing and Your guiding hands

are overwhelming. Thank you for allowing this undertaking to be done. Your

presence during difficult times is more than enough for us to persevere for our

future. Thank You Lord, everything is being lifted to Your name.

With much appreciation,

SMA Group


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ABSTRACT

TITLE: Practices of Community Residents on SelfMedication with

Antibiotics.

RESEARCHERS: Eclevia, Bea Marie E.

Llantino, ColetteIII S.

Medidas, Elaiza Mae V.

Ramos, Art Christian M.

Sanchez, Alexandra Agnes A.

Tinaya, Renz Nicole Ross C.

SCHOOL: Pamantasan ng Lungsod ng Maynila

DEGREE: Bachelor of Science in Nursing

ADVISER: Maria Andrea L. Endeno, MAN

NUMBER OF PAGES: 132

Self medication with antibiotics is the human behavior in which an

individual uses non-prescribed antibiotics to treat untreated and often

undiagnosed medical ailments. It can also be the intermittent or continued use of

prescribed antibiotics for chronic or recurrent symptoms or diagnosed diseases.

People who practice this greatly vary from race to race, age to age, and

economic status. In an effort to assess the current trend with regards to self

medication with antibiotics, this research study was undertaken.

This research endeavor entitled as Practices of Community Residents on

Self Medication with Antibiotics aimed to assess the practices of community

residents regarding self medication with antibiotics. This research study was


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vii

conducted by means of a survey which made use of a pre made questionnaire

form. The conclusions reached by this study were the following, reasons for

practicing self medication with antibiotic was to improve condition. The

condition most treated with antibiotics was respiratory infections. Dosages of

antibiotics were known by means of experience, and changes in the dosage were

done to improve ones condition. The very highly practiced duration of taking

antibiotics was after the recovery.

These findings may be of use for future researchers to develop a health

educational material addressing and modifying the misconceptions and

misguided expectations of community residents regarding selfmedication with

antibiotics.


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TABLE OF CONTENTS

Page

Preliminaries

Title Page i

Recommendation ii

Approval Sheet iii

Acknowledgement iv

Abstract vi

Table of Contents viii

List of Appendices x

List of Figures xi

List of Tables xii

CHAPTER I INTRODUCTION

Background of the Study 1

Statement of the problem 3

Hypothesis 4

Significance of the Study 4


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ix

Scope and Limitation 5

CHAPTER II THEORETICAL FRAMEWORK

Review of Related Literature and Studies 7

Synthesis 23

Conceptual Framework 27

Conceptual Paradigm 28

Definition of Terms 29

CHAPTER III METHODOLOGY

Research Design 32

Research Locale 33

Samples and Sampling Technique 33

Instrumentation 34

Data Gathering Procedure 37

Statistical Analysis of Data 38

CHAPTER IV Results and Discussion

CHAPTER V Summary, Conclusion, and Recommendations

Summary 85


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LIST OF FIGURES

Figure Title Page

1 Conceptual Paradigm 28

2 Highest Educational Attainments of the Respondents 39

3 Monthly Family Income of the Respondents 40


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LIST OF TABLES

Tables Titles Page

1 Extent of Self-Medication of Antibiotics Practices in Terms of

Reasons

42

2 Extent of Self-Medication of Antibiotics Practices in Terms Of

Conditions

44


Dosage

46


Dosage Change

48


Duration

50

6 Anova Results on the Significant Difference on SMA Practices

on Reasons When grouped According to Highest Educational

Attainment

52

7 Post Hoc Tukey

Experience vs Education

53

8 Anova Results on the Significant Difference on SMA Practiceson Reasons When grouped According to Monthly Family

Income

54


on Conditions When grouped According to Highest

Educational Attainment

56

10 Post Hoc Tukey HSD

Respiratory Infections vs Education

57


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xiii


on Conditions When grouped According to Monthly Family

Income

58

12 Post Hoc Tukey

Respiratory Infections vs Monthly Family Income

59

13 Post Hoc Tukey

Gastrointesinal Problems vs Monthly Family Income

61


on Dosage When grouped According to Highest Educational

Attainment

62

15 Post Hoc Tukey

Package Checking vs Highest Educational Attainment

63

16 Post Hoc Tukey

Community Health Practitioners vs Highes Educational

Attainment

64

17 Post Hoc Tukey

Family and Friends vs Highest Educational Attainment

65

18 Post Hoc Tukey

Internet vs Highest Educational Attainment

66

19 Post Hoc Tukey

Advertisements vs Highest Educational Attainment

67


on Dosage When grouped According to Monthly Family

Income

69

21 Post Hoc Tukey

Package Checking vs Monthly Family Income

70

22 Post Hoc Tukey

Community Health Practitioners vs Monthly Family Income

71

23 Post Hoc Tukey

Internet vs Monthly Family Income

72


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xiv


on Dosage Changes When grouped According to Highest

Educational Attainment

73

25 Post Hoc Tukey

Insufficient Supply vs Education

73


on Dosage Changes When grouped According to Monthly

Family Income

74

27 Post Hoc Tukey

Insufficient Supply vs Income

75


on Duration When grouped According to Highest Educational

Attainment

76

29 Post Hoc Tukey

Consumed Supply vs Education

77

30 Post Hoc Tukey

Completion of Treatment vs Education

79

31 Anova Results on the Significant Difference on SMA Practiceson Duration When grouped According to Monthly Family

Income

80

32 Post Hoc Tukey 32After a Few Days vs Monthly Family Income

81

33 Table 33Post Hoc TukeyCompletion of Treatment vs Monthly Family Income

83


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1

Chapter I

Introduction

Background of the Study

The irrational use of antibiotics has been documented all over the world.

World Health Organization (WHO) estimates that more than half of all medicines

are prescribed, dispensed or sold inappropriately, and that half of all patients fail

to take them correctly. Incorrect use may take the form of overuse, underuse,

and misuse of prescription or nonprescription medicines.

Self-medication has always been a part of normal practice in human life

since the ancient times. It is a practice where an individual treats certain

conditions and ailments with medicines usually available even without presenting

prescriptions. But the question is, do people really know the proper usage of

these medications? Are they able to apply appropriate management when

adverse effects arise? Are these people competent enough in complying with the

proper course of treatment regimen?

Education is an important aspect in ones life. The level of education of an

individual directly affects his decisions, choices, lifestyle, and behaviors. With a

greater emphasis on health, people with higher level of education are more

conscious and aware about health, health seeking behaviors and health

maintenance. Insufficient knowledge may lead to inappropriate actions

addressing health problems. This is true especially in practicing self-medication

of antibiotics. One might have experienced the efficacy of a drug on a certain


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2

symptom. Thus, this phenomenon becomes remarkable and habitual once the

experienced symptom occurs again. Multi-drug resistance may follow since the

bacteria either adapts to the ability of the antibiotic or die in a phenomenon

known as selective pressure.

Students taking health related courses have a great responsibility in

influencing the choices and actions that their clients may take. Self-medication

assumes a special significance among these students as they are the future

health practitioners and have a potential role in counseling the patients about the

advantages and disadvantages of self-medication.

During one of the researchers related learning experience ina community

health center in Manila, a patient directly asked one of them which and what type

of antibiotic is best to take for treating an ailment that is being experienced

instead of consulting a physician. The researchers, being a level two nursing

students back then were not in the proper position and had limited knowledge to

answer prior patients queries. Given this fact, the researchers were prompted to

select community residents as the respondents of this study.

Honestly, even health care professionals practice self-medication to

improve and prevent acquiring diseases since they are more vulnerable

considering the stressful environment they are into. Families and friends of the

researchers have also practiced self-medication, and this fact has further

encouraged the researchers to choose and conduct this study. As a future

member of the health care team, the researchers aim to make an improvement


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with this problem realizing that even the lives of their own loved ones may be

placed in jeopardy.

The researchers would like to emphasize the importance of providing the

appropriate health education rendered by medical related practitioners and

students regarding antibiotic usage, treatment and adverse effects. Ultimately,

the researchers of this study hopes to modify and improve the practices of

community residents concerning Self-Medication of Antibiotics (SMA).

Statement of the Problem

The aim of the study was to determine the practices of community

residents towards Self-Medication of Antibiotics.

Specifically, this study sought to answer the following questions:

1. What is the profile of the respondents according to:

1.1 highest educational attainment; and

1.2 monthly family income?

2. To what extent do the respondents manifest the following Self-

Medication of Antibiotics practices:

2.1 reasons;

2.2 conditions;

2.3 dosage; and


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2.4 duration?

3. Is there a significant difference in the manifested Self-Medication of

Antibiotics (SMA) practices among community residents when they are

grouped according to profile?

Hypothesis

The null hypothesis was tested at 0.05 level of significance.

Ho: There is no significant difference in the manifested Self-medication of

Antibiotics (SMA) practices of the community residents when they are grouped

according to profile.

Significance of the Study

The research study was both relevant and significant in a number of ways

to a group of people like the following:

Community Residents. The study may increase community residents

awareness about the inappropriate practices regarding self-medication of

antibiotics. Ultimately, the researchers aim to modify and improve their practices

with regards to antibiotic treatment and usage.

Community Health Workers. This study may help the community health

workers to identify the common practices of community residents towards self-

medication of antibiotics. The results of this undertaking may serve as a guide in

developing community programs addressing and correcting self-medication of

antibiotics practices of the community residents.


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5

Nursing Students. As a health care provider for the patients well-being

and safety, this study may emphasize improvement in the health teachings

among patients regarding antibiotic usage, treatment compliance as well as its

adverse effects.

Barangay Officials. In partnership with the health officers of the

community, programs regarding antibiotic treatment, usage and adverse effects

may be developed in cooperation with the health care workers in their barangay.

Future Researchers. This study may be utilized as a guide for future

researchers with similar undertakings. The results that would be presented in this

study may contribute in establishing further researches with regards to SMA

practices focusing on a different locale and respondents.

Scope and Limitation

This research study is a descriptive correlational type of research which

made use of survey method. This investigation was done to define the difference

of community residents SMA practices when grouped according to demographic

profile such as educational attainment and monthly family income. The

instrument was adapted from a structured questionnaire and data were collected

in a course of a week.

This research investigation covered respondents residing in Barangay 598

of District VI. This research which has laid out a parameter was strictly defined by

the following qualifications. First, the respondents must be at least 18 years of

age and above; have self medicated with antibiotics; and were willing to


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participate in this study. Second, respondents should have at least resided for

two years in the barangay.

The study focused on community residents practices towards self -

medication of antibiotics; other factors related to self-medication were not

emphasized in this study and is to be of another future endeavor. In connection

with this, an output of a health educational material correcting the

misconceptions about selfmedication of antibiotics practices will be of another

future undertaking.


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7

Chapter II

Theoretical Framework

Antibiotics and usage of antibiotics

The invention of antibiotics to cure diseases especially infections are the

most innovated medicine in the history of medicine, but as time goes by, sudden

decrease of effectiveness has been to account because of misuse and overuse

of antibiotics. Due to this unusual event, bacteria have been able to adapt to this

antibiotics and able to withstand the effectiveness of the antibiotic and still it is an

ongoing process of the bacteria to be able to resist and develop so called drug

resistance to some of the antibiotics (Gangle, 2005).

Antibiotic resistance is a worldwide problem, and several studies have

reported remarkably high prevalence of antibiotic resistant in low and middle

income countries (Okeke, Laxminaryan, Bhutta, Duse, Jenkins, OBrien, Pablos

Mendez, Klugman, 2005). This becomes especially important when high

resistance coincides with high burden of infectious illness. Thus, resistance

undermines the access to effective antibiotic treatment, because in many settings

the inexpensive, firstline antibiotics are no longer effective (Bhutta, 2008). This

means that the cost increases, both for the patient and the health system. For the

individual patient, the cost of secondline treatments can be impossible to meet,

thereby limiting access to effective treatment for vulnerable groups (Whitehead,

Dahlgren, Evans, 2001). The emerging antibiotic resistance threatens to turn


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back time to a situation where treatable infections once again become incurable

(Cars, Hogberg, Murray, Nordberg, Sivaraman, Lundborg, So, Tamson, 2008).

The underlying cause of this increasing development of multi resistance of

some bacteria to antibiotics are associated with non prescription use thus

adverse drug reactions take place, masking of underlying infectious processes,

development of multiple drug resistance (Morgan, 2011).

The irrational use of antibiotics has been documented all over the world.

World Health Organization (WHO) estimates that more than half of all medicines

are prescribed, dispensed or sold inappropriately, and that half of all patients fail

to take them correctly. Incorrect use may take the form of overuse, underuse,

and misuse of prescription or non prescription medicines (World Health

Organization, 2010). Rational use of medicines means that patients receive

medication appropriate to their clinical needs, in doses that meet their own

individual requirements, for an adequate period of time, and at the lowest cost to

them and their community. Irrational use includes use of antibiotics for non

bacterial illnesses and non-adherence to recommended dosing regimens, hence

preventing desired therapeutic outcomes from being achieved and potentially

increasing antimicrobial resistance. It also includes use of expensive and

frequently unsafe formulation such as injections when less expensive oral

formulations would be more appropriate. When antibiotics are indicated, the

prescriber should choose the appropriate drug, dose, and duration of effective

agent, preferably with the narrowest spectrum and few side effects. Access to

affordable health care is limited in many low and middle income countries; hence


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people practice on self medication of antibiotics and get them directly from

pharmacies, or markets (WHO, 2010).

The usage of antibiotics has been the most emergence factor of the

development of drug resistance. The use of any antibiotics for treatment of

infection, in any dose, time of use, forces the bacteria to either adapt to the ability

of the antibiotic or die in a phenomenon known as selective pressure. If the

bacteria are able to adapt to the drug, it carries a gene or DNA which will be

passed on and multiplied rapidly (Tenover, as cited by Hoa, 2006). For this

reason, improving the use of antibiotics thereby reduce the selective pressure of

antibiotics and increase the effectiveness of the antibiotics throughout the

treatment of any infection.

SelfMedication of Antibiotics Practices

SelfMedication of Antibiotics

Self-medication is common among countries whose

prescription is not that too strict and the drugs are available over the

counter. It is well established that antibiotics are used indiscriminately

throughout our society. This has led to antibiotic resistance and has

disturbed the microbial ecosystem and diseases like water-borne and

other infectious diseases developed from bacterial resistant drugs.

Infections have become severer, resistant to treatment and prolonged. As

treatment fails, the infectivity from an ill individual is prolonged and there is


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a chance of increased drug resistant of some bacteria and if worst not

benn able to be treated (Zdziarski, 2003).

Selfmedication antibiotics can be defined as the use of antibiotics

to without any consultation of a professional, with or without prescription to

treat self-diagnosed disorders, or recurrent symptom of disease. (Awad,

Eltayeb, Matowe, Thalib, 2005).

The rates of self-medication of antibiotics conducted in Jordan

(23%) were relatively high (Al-Azzam, 2007). The self-use of antibiotics is

also very common in Sudan (48%) while it is not very high in the said

neighborhood in India where it has been quoted as 18% (Saradamma,

2000).Zafar, Syed, Waqar, Zubairi, Vaqar, Shaikh, Yousaf, Shahid,

Saleem (2008) identified in their study, Self Medication amongst

university students of Karachi: prevalence, knowledge, and attitudes., the

prevalence of selfmedication of any drugs among university students in

Karachi, Pakistan were 76%. Based on the study of Zafar et al., (2008),

the most common symptoms for the practice of self medication of any

drugs were headache (72.4%), flu (63.5%), and fever (55.2%). Similar

study was also conducted witch special focus on self medication of

antibiotics. Khan (2011) identified in his study, Self Medication of

Antibiotics: Practices among Pakistan students in Sweden and Finland,

that the self medication of antibiotics was primarily practiced for

headache (0%), flu (8%), and fever (70%). The difference between the

result of the symptoms were probably due to the fact that the study


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conducted by Khan (2011) was exclusively for the practice of self

medication of antibiotic while in the study of Zafar et. al., (2008) was

primarily conducted on self medication of any drugs. Khan (2011)

identified that the most commonly used drugs were analgesics (74%) and

antibiotics (100%) against Zafar et al (2008) 88.3% and 35.2%

respectively.

Furthermore, Khan et al., (2011) identified that the only legitimate

reason for the practice of self medication of antibiotics were emergence

of situation (18%), cost effectiveness (88%), and trivial nature of the

illness (82%) which has similar notions to the study conducted by Zafar et

al., (2008) in which quotes prior experience (50.3%) and trivial nature of

illness (48.2%) as the most important factors for the practice of self

medication of antibiotics.

Prior knowledge of antibiotics, older age, and higher allowance are

risk factors for selfmedication of antibiotics. Furthermore, they identified

that the prior knowledge of antibiotics probably has led to a false sense of

confidence in self diagnosis and self medication of antibiotics, also

they identified that their prior knowledge of antibiotic plus easyaccess to

purchasing antibiotics without prescription under the loose regulatory

system might have encourage the respondents to self medicate

antibiotics. They also added that self medication of antibiotics rate in

older students could be cumulative illness episodes and prior experience

of self medication of antibiotics contributes to practicing self


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medication of antibiotics. Lower allowance indicative of lower self

medication antibiotics rate (Pan et al., 2012).

Age of respondents does not affect their level of knowledge

towards antibiotics usage. This implies that the age groups have the same

quantity of health information regarding antibiotics usage. In Filipino

culture, the older generations are usually the source of beliefs; as they

were considered as primary care giver of a family. Thus if they have

misconceptions such as pertaining to antibiotics usage, this will be passed

on from one generation to another generation. Hence, the level of

understanding of the young population remains to be the same with that of

the old age (Avenir, 2013).

This observation can be attributed to the theory proposed by

Granovetter (as cited by Avenir, 2013) which explains the impact of ties in

a relationship between an individual and a network member. Having

strong ties with an individual may have a tendency to share same

information and knowledge about health issues.

Schillinger et al., (as cited in Avenir, 2013) indicated that an

individual capacity to obtain, process, and understand basic health

information has a direct relationship with educational attainment.

Delschlegel et al., (as cited in Avenir 2013) identified that the

population level of comprehensiveness may have difficulty in reading


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medical terminologies, prescription instructions, and other patient

education material having lower educational attainment.

According to Hansen (as cited by Avenir 2013) individuals who had

higher education level were expected to think and learn beyond the facts

from developed complex understanding of information and theories

formulated from multiple sources.

David Cuttler (Harvard University) noted that there is a well-known,

large, and persistent association between education and health. The level

of awareness of better educated individuals is higher. Also, they are more

able to comprehend and comply to different instructions on different

environmental setting. Thus, education greatly affects the health-seeking

behaviors of an individual.

Having a higher income means having exposed to multimedia

widespread of health information. They have the ability to access internet

resources; acquire books, and journals through health maintenance

organization. Conversely, very low income earners that not to prioritize

health information because this group tends to focus on their daily needs

(Avernir, 2013). Furthermore, low income families have limited access to

resource. They have greater risk of lower achievements in education and

have poorer developmental health outcomes, compared to higher income

families (Taylor and Fraser, as cited by Avenir, 2013).


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Avenir (2013) stated that very low income earners have the highest

mean in terms of perceived appropriateness of self medication

antibiotics, in which very low income earners do not want to compromise

work or income earning activities so they have a habit of using available

and affordable alternative antibiotics to prevent the development of illness.

They have a judgment that consultation perse is very expensive

Many economists have attributed these correlations to the effects of

education, arguing that more educated people are better able to

understand and use health information, and are better placed to benefit

from the healthcare system

(http://www.nber.org/reporter/spring03/health.html)

Maarten Wolbers suggested that it is a known fact that less well-

educated people have higher unemployment rates than better educated

people. A possible explanation of this finding is job competition: employers

prefer higher over lower educated workers for jobs that were previously

occupied by lower-educated employees. As a consequence, the lowest

educated became unemployed.

G. Scott Thomas revealed that there is a clear correlation between

a person's educational attainment and his or her earning power. He stated

that adults with bachelor's degrees in the late 1970s earned 55 percent

more than adults who had not advanced beyond high school. That gap

grew to 75 percent by 1990 and is now at 85 percent. Moreover,


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Education Voters of Pennsylvania suggested that over a lifetime, an 18

year old who does not complete high school earns approximately

$260,000 less than an individual with a high school diploma and

contributes about $60,000 less in lifetime federal and state income taxes.

Angus Deaton of National Bureau of Economic Research found out

that lower mortality and morbidity is associated with almost any positive

indicator of socioeconomic status, a relationship that has come to be

known as "the gradient". Socioeconomic status is a fundamental causeof

health. Studies frequently endorse measures to improve health through

manipulating socioeconomic status, not only by improving education but

also by increasing or redistributing incomes.

Ecob R. Smith stated that the effect of income on the health

measures is comparable to that of the other socio-economic variables in

combination. The shape of the relationship found between income and

health is compatible with worse health in countries with greater income

inequality, without the need to postulate any direct effect of income

inequality itself

Reasons for SelfMedication with Antibiotics

Self medication with antibiotics is a worldwide problem as it

contributes to the rise of Multi Drug Resistant Organisms (MDRO).

Reasons behind self medication with antibiotics varies in case to case

basis. Agyeman, Donkor, Nartey, and Tetteh Quarcoo in their study


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entitled Self Medication Practices with Antibiotics Among Tertiary Level

Students in Accra, Ghana: A Cross Sectional Study (2012), observed that

reasons for selfmedication with antibiotics were, it was less expensive

compared to medical care in the hospital and medical care in hospitals

were associated with long delays. On the other hand, in the study

Evaluation of Antibiotic Self Medication Pattern Amongst Undergraduate

Students of Ahmadu Bello University (Main Campus), Zaria by Musa,

Olayeni, and Olayinka (2010), they reported that reasons given for

practice of selfmedication with antibiotics included assumed knowledge

on antibiotics, prior experience on use, and lack of time to go for

consultation.

However, as suggested by Al-Azzam, Al-Horani, Al-Husein,

Alzoubi, and Masadeh in their study Self Medication with Antibiotics in

Jordanian Population (2007), the main reason for self-medication with

antibiotics as reported by the participants was their previous experience

on the efficacy of treatment. Moreover, Misatis study Prevalence and

Factors Influencing Self Medication with Antibiotics Among Adult

Outpatients Attending Kenyatta National Hospital (2012) observed that

the common reasons for selfmedication with antibiotics were to avoid a

more serious infection, avoidance to pay for the physician/tests and lack of

time to visit a physician. Furthermore, Ahmed, Angamo and Wabeds Self

Medication with Antibiotics and Antimalarials in the Community of Silte


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Zone, South Ethiopia (2012) found out that majority of the respondents

practiced selfmedication to avoid waiting time at health facilities.

In addition, reasons for self medication with antibiotic includes

previous successful experience, saving time and money, and information

obtained from health professionals, lay people, and printed materials as

proposed by de Crespigny, Hiller, Suryawati and Widayatis Self

Medication with Antibiotics in Yogyakarta City Indonesia: A Cross

Sectional Population-Based Survey (2011).

Conditions for Practicing Self-Medication of Antibiotics

There are many different health conditions that contribute and

affect the behavior of an individual to self-medicate using antibiotics.In the

study of Mohanna (2010), the minor ailments reported as the most

common reasons for SMA were respiratory tract infections (e.g. common

cold, sore throat, and sinusitis) as well as gastrointestinal infections which

are often managed with antibiotics but requires no antibiotic treatment for

the reason that those conditions are known to be viral of origin. This

increases the prevalence of SMA in children in Yemen as well as in other

countries like Jordan, Palestine, Turkey and Europe, as cited in study of

Al-Azzam (2007) entitled as Self-medication with antibiotics in Jordanian

population. As a result, the incidence of drug-resistance worldwide is

alarmingly high. Thus, SMA has the potential to harm society at large, as

well as the individual patient.


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Nalini (2010), identified factors that lead to SMA among

respondents in Karnataka, India which were perceived as respiratory

infections (66.7%), gastrointestinal diseases (23.4%), and systemic

diseases (7.7%) and skin diseases (2.6%). In the study, researchers found

out that inadequate knowledge regarding those health conditions

prompted the respondents to self-medicate using antibiotics. Thus, they

have agreed that proper health education regarding those diseases can

lessen the occurrence of SMA not only in their locale but also globally.

Also, Fadare and Tamuno (2011, Antibiotic self-medication among

university medical undergraduates in Northern Nigeria) recognized other

health situations such as diarrhea (24.6%), sore throat (20.3%), fever

(17.4%), cough (8.7%), catarrhal (5.8%), toothache (5.8%), and body

aches (2.9%). These diseases are perceived as mild clinical conditions

which prompted respondents to resort to SMA.The dilemma with this

practice is that fever and other similar symptoms which could be due to

viral conditions are usually mismanaged with antibiotics creating a

possibility for the development of drug-resistanceamong respondents in

Northern Nigeria.

A study in Rural Africa entitled Self Medication in Rural Africa: The

Nigerian Experience regarding self-medication of antibiotics identified 16

common ailments for SMA in the four rural communities they studied,

namely: spots and pimples, eczema, conjunctivitis, stomachaches,

toothache, earache, diarrhea, body aches, sore throat, wounds and cuts,


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sores and ulcers, boils, common colds, ringworm, and whitlow. The

treatment habits of the respondents through consultation of a medical

doctor were compared to the treatment habit of community members

through SMA. In this study, they found out that a total of 736 individuals

who were given with questionnaires and a total of 552 individuals,

representing 75% responded. Only,0.6% said they that the often consulted

the doctor, while 99.4% were always resorting to self-medication(Arikpo,

G.E., Eja, M.E., K.H. Enyi-Idoh, K.H., 2010).

In addition, Oh AL, Hassali MA, Al-Haddad MS, Sulaiman SA,

Shafie AA, Awaisu AA. (2011) cited in his study entitled Public

Knowledge and Attitudes towards Antibiotic Usage: A cross-sectional

study among the general public in the state of Penang, Malaysia that

most of the respondents practice self-medication of antibiotics due to fever

(40.7%) and respiratory infections (22.9%). Half of the respondents in

Penang, Malaysia expect a prescription of antibiotics for common colds

and cough, and that they believe that taking antibiotics when having cough

or colds can give them a quick relief from their illness or symptom.

Moreover, the study of Kumar N, Kanchan T, Unnikrishnan B,

Rekha T, Mithra P. (2013) entitled Perceptions and Practices of Self-

Medication among Medical Students in Coastal South Indiahighlighted

that the various indications for self-medication of antibiotics reported are

fever (75.1%), followed by headache (64.7) and cough/cold (58.7). The

author identified that sore throat (31.6%) is the most common indication


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for self-medication with antibiotics. Even though majority of the individuals

have a higher level of education they tend to practice self-medication of

antibiotics for the above identified illnesses because the illnesses are too

trivial for consultation followed by their confidence to self-medicate using

antibiotics. Moreover, it was also found out that 35.3% of the participants

reported not to have completed the entire course of antibiotic regimen and

stopped medication when the symptom subsided and they use old

prescriptions for the same illness as the source of information about the

drug.

Lastly, according to Becker (2003) health in the Filipino culture was

based on the principle of balance and harmony whereas Filipinos view

health as a result of being in balance, while illness was the result of an

imbalance. Filipinos also believed in controlling their ailment by treating

the symptoms that they are experiencing or more on a symptomatic

approach in treating illnesses. It was also found out that Filipinos believed

in keeping the body strong by being clean, orderly and appropriate in

social situations to maintain balance, and therefore health. Filipinos also

do many things to maintain and restore health among those are treatment

with the use of medicines but using home remedies as treatment is also

common in the Filipino culture.


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Dosage

One of the most important factors that affect the effectivity of an

antibiotic treatment is the dosage. It determines the prescribed amount to

be administered and at the prescribed time in order to attain optimal

therapeutic effect of a drug. According to Dr. Laurence Knott (2013),

appropriate dosage of antibiotics is based on the patients age, weight,

hepatic and renal function, and severity of infection because they affect

the absorption of the drug. Under-dosing may lead to bacterial resistance

in serious infection while over-dosing may result in toxicity and adverse

effects. Thus, the exact or prescribed dosage should be taken into

consideration to avoid undesirable effects.

Samaniego (2011) reported in her news article entitled Its a fact:

The Use of Antibiotics is often Abused that Dr. Rontgene M. Solante,

President of the Philippine Society of Microbiology and Infectious Disease

(PSMID) said that misuse of antibiotics has been a major problem in the

Philippines. It is the number one cause of the emergence of superbugs or

the antibiotic-resistant bacteria that is detrimental to humanity and is now

becoming a global threat. Common inappropriate practices in the

Philippines with regards to antibiotic usage are self-medication, skipping a

dose of antibiotic, sudden cessation from the treatment and using of over-

the-counter antibiotics. According to Dr. Solante, instead of consulting for

the doctor to obtain prescription, some people use previous prescription of


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past experience, or ask for advice and suggestions from their relatives and

friends in buying antibiotics (Samaniego, 2011).

Pan et al. (2012) suggested in their study that information about

antibiotic like the dosage is obtained from package insert only that the

group without prior knowledge about antibiotics has low understanding

about the instruction in the package insert. Also, majority from this group

decided the type of antibiotics they will and the dosage by themselves.

Moreover, Bakr stated in his study in 2012 entitled Antibiotic Purchasers

International Network for the Rational Use of Drugs (INRUD), people

who purchase antibiotics intend to read the package inserts. Furthermore,

mDhil Editorial Team stated in their article Perils of Self Medication! that

information about health and medicines like antibiotics are now readily

accessible on the internet, and also in magazines and editorials. However,

in the study of Kalyango, Rutebemberwa, Karamagi, Mworozi, Ssali,

Alfven, and Peterson (2013), Community Health Workers (CHW) were

allowed to prescribe medications like antimalarial and antibiotics and the

dosage. Nevertheless, CHW needs to assure that the caregivers or the

significant others understand the dosing regimens.

Some people who are self-medicating with antibiotics tend to

change the dosage for some reasons. In fact, in the study of Pan et al.

(2012), 55% participants of the study engaged in the alteration of

antibiotics and dosage during the course of treatment. University students

who participated in the study belong to ages 18 to 36. Some of the


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students believed that higher doses result in faster recovery and 274 of

the students believe that lower doses result in adverse reaction. Also,

Bakr (2012) reported that the people taking antibiotics believe that if they

minimize the dosage, side effects could be avoided.

The study of Esimone, Nworu, and Udeogaranya in 2007 entitled

Utilization of antimicrobial agents with and without prescription by out-

patients in selected pharmacies in South-eastern Nigeria was conducted

to assess the dosing errors associated with self-medication of antibiotics

among patients by getting their orders with or without prescription in the

out-patient pharmacies. From 4,128 outpatients who were involved in the

study, 42.2% came with prescription from qualified medical personnel and

57.8% came without prescription. High level of under-dosing is observed

in regimen filled without prescription.

Duration of Use

According to Dr. Solante, one of the common practices of the

improper use of antibiotics is the cessation of taking antibiotics even

before the course of treatment is completed. Individuals who are self-

medicating with antibiotics stop the treatment once they feel betters.

Another reason for why people fail to complete the treatment is that others

cant afford to buy all the antibiotics prescribed due to financial constraints.

Eventually, they will stop medicating when there is no antibiotics left

(Samaniego, 2011).


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In the global survey on non-compliance with antibiotic therapy for

acute community infections, 10% to 44% of the people reported that they

do not finish taking antibiotics in required duration because they already

feel better even before the course of treatment was completed (Avenir as

cited from Kadas, 2012). Moreover, it was found in a study in the study of

Buke, Ciceklioglu, Emertcan, Eren, and Hosgor-Limoncu in 2003 entitled

Rational Antibiotic Use and Academic Staff that 15.6% of the educated

group of people, excluding the population from the Medicine department,

use antibiotics until the symptoms disappeared regardless of the

prescribed duration for taking the drug.

However, in the study of Pan et al. conducted in Southern China

about the self-medication of antibiotic practices of university students, the

rise of adverse reactions towards antibiotics use is the reason why people

stop taking antibiotics. Furthermore, it was found in the study of Bakr that

some individuals treating with antibiotics believe that it is necessary to

discontinue using antibiotics as soon as possible to avoid side effects.

Also, some believe that adults can stop the treatment with antibiotics

anytime but children cannot.

Likewise, in the study of Dixon in 2009 entitled Cultural Traditions

and Healthcare Beliefs of Some Older Adults, Filipino elders who have

spent the majority of their lives in Canada may be more accepting of

Western biomedical views. More traditional Filipino approaches integrate

concepts of illness as being a humoral imbalance between hot and cold in


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the body system, divine retribution for sins of omission or commission, the

role of evil spirits or witches exacting punishment for wrongful deeds and

the consequences of such natural events as cold drafts, thunder, lightning

or typhoons. Filipino concept of health is based on the principle of balance

(timbang). Specific disorders are perceived to be caused by an excess

intake of one type of food. Hot foods such as meat are thought to cause

arthritis and hypertension. Cold foods such as many fruits and vegetables

may bring about cancer and anemia.

Synthesis

The researchers believe that each and every literature discussed in this

research was relevant on the present study. The researchers related and

differentiated these researches based on the problem and design of this study.

The most parallel and related studies used were from China written by

Pan H et al. in 2012 entitled Prior Knowledge, Older Age, and Higher Allowance

Are Risk Factors for Self-Medication with Antibiotics among University Students

in Southern Chinawhich the research tool was adapted and modified and from

Philippines written by Avenir in 2013 entitled Knowledge towards Antibiotic

Usage vis a vis Perceived Appropriateness of Self Medication among

Patients. The two studies were similar with this current study in terms of the

following: (1) both studies measured the reasons for self-medication of antibiotics

as with the present study. Meanwhile, these studies differ with the current study

observing the following parameters: (1) The current study focused on defining the


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practices of the respondents on self-medication of antibiotics, and did not

concentrate on the factors and level of awareness towards antibiotic usage. (2)

Ready-made survey questionnaires were personally distributed to the community

residents of Barangay 598, District VI Metro Manila, whose age is at least

eighteen years and was able to self-medicate using antibiotics . (3) The

respondents of Avenirs research were out patients who consulted in selected

doctors clinic (4)while the respondents of the online survey conducted by Pan

were the students of Shantou University (STU) in Eastern Guangdong, China. (5)

In addition to this, the respondents of the study from Pan were both users and

non-users of antibiotics for self-medication purposes.

The studies from South Carolina written by Mainous et al. in 2009 entitled

Availability of Antibiotics for Purchase Without a Prescription on the Internet

and from Nigeria written by Esimone et al. in 2007 entitled Utilization of

Antimicrobial Agents With and Without Prescription by Out-Patients in Selected

Pharmacies in South-eastern Nigeriaare the least related. They are related with

the current study in terms of the sources and non-prescribed use of antibiotics for

self-medication purposes. Mainous et al., conducted an internet search using 2

major search engines (Google and Yahoo) to gather the data needed in their

study while the study from Esimone et al. conducted a survey that was carried

out daily in selected community pharmacies for a period of 90 days.

One of the uniqueness of this study is the assessment of practices of

community residents on Self-Medication of Antibiotics (SMA). Extent of practices


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on SMA were later grouped according to the respondents profile to define the

significant differences among each category.

Conceptual Framework

Figure 1 illustrates the relationship of the variables of the study. The box

on the left represents the profile of the community residents classified according

to educational attainment and monthly family income. The box in the right

corresponds to the practices of the community residents regarding SMA, which is

consisted of reasons, conditions, dosage and duration of antibiotics.

The difference in the manifested practices in relation to self-medication of

antibiotics of community residents when they were grouped according to profile is

represented by a straight line connecting the profile box and the SMA practices

box.


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Conceptual Paradigm

Figure 1

Practices of Community Residents on Self-Medication of Antibiotics

Self-Medication

Antibiotics Practices

Reasons

Conditions

Dosage

Duration

Community Residents

Educational

Attainment

Monthly Family

Income


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Definition of Terms

The following terms were used in the research study and were defined

operationally in the context of the study.

Community Residents: It refers to a population residing in Barangay 598

Zone 59, Old Sta. Mesa, Manila; 18 years old and above; practicing self-

medication of antibiotics; and has a willingness to participate in the conduct of

the study.

Highest Educational Attainment: It refers to the highest degree of

education of an individual. This includes the following categories:

Elementary Graduate/Undergraduate: It refers to community

residents who are either graduate or undergraduate in elementary.

High School Graduate/Undergraduate: It refers to community

residents who are either graduate or undergraduate in high school.

College Graduate/Undergraduate: It refers to community

residents who are either graduates or undergraduate in college.

Self-Medication of Antibiotics: It is the human behavior in which an

individual uses non-prescribed antibiotics to treat untreated and often

undiagnosed medical ailments. It can also be the intermittent or continued use of

prescribed antibiotics for chronic or recurrent symptoms or diagnosed diseases.

Self-Medication of Antibiotics Practices: It is the practices of

community residents towards SMA, in terms of:


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Reasons: It is the explanation or cause why community residents

resorted in SMA practices (e.g. high cost of hospital consultation).

Condi t ions: It refers to the health conditions that prompted

community residents to self-medicate using antibiotics. (e.g.

respiratory infections).

Dosage: It refers to a specific quantity of a therapeutic drug or

agent, in this case antibiotics, taken at any one time or at specified

intervals.

Durat ion: It is the course of or the period of continuous treatment

using antibiotics.

The following terms were used in the research study and were defined

lexically in the context of the study.

Monthly Family Income: It refers to the total family income (e.g. salaries and

wages, commissions, retirement income and other forms of compensation) for a

period of one month. According to the Family Income and Expenditure Survey

(FIES) conducted by the National Statistics Office (NSO) last 2009, the standard

ABCDE socioeconomic classification of monthly family incomes in the Philippines

is categorized into the following ranges; 100,000/month and above (Families

belong to Class A and B, or high income earners), 20, 000 - 100,000/month

(Families belong to Class C or middle income earners), 10,000 -

20,000/month (Families belong to Class D which are the working poor or low


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income earners), and 10,000/month and below (Families belong to Class E or

very low income earners).


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Chapter III

Methodology

Research Design

Practices of community residents towards self-medication of antibiotics

were discussed in this study and as a result, descriptive-correlational research

design was utilized. Descriptive research helps provide answers to the questions

of who, what, when, where, and how associated with a particular research

problem; it cannot conclusively ascertain answers to why. According to Labaree

in 2013, descriptive research is used to obtain information concerning the current

status of the phenomena and to describe "what exists" with respect to variables

or conditions in a certain situation.

The Association for Educational Communications and Technology (2001)

stated that descriptive research utilizes data collection and analysis techniques

that yield reports concerning the measures of central tendency, variation, and

correlation. The combination of its characteristic summary and correlational

statistics, along with its focus on specific types of research questions, methods,

and outcomes is what distinguishes descriptive research from other research

types.Meanwhile, descriptive correlational research as proposed by James Keyin 1997 aims to determine the extent of the relationship between two or more

variables.

This study determined the extent of the community residents practices on

self-medication of antibiotics. Differences in the respondents SMA practices


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when they were grouped according to profile such as highest educational

attainment and monthly family income were also discussed.

Research Locale

The study was conducted in Barangay 598, Zone 59 of District VI Metro

Manila. It has a population of 11, 788 and is reported as the largest barangay in

District VI (Census of Population and Housing, 2010; see Appendix D). It is

headed by Chairman Armando E. Enaje Senior, together with seven barangay

kagawads. Pamana Health Center (PHC) is located within Barangay 598, where

the researchers were exposed for their related learning experience as second

year students. Barangay 598 is one of the 8 barangays (barangays 598-605) that

receives the services rendered by PHC.

The livelihood of community residents in the said barangay were mostly

computer rental shops, karinderya, sari-sari stores, and mini dry and wet

markets. Commonly used modes of transportation were jeepneys and tricycles.

Bystanders of all ages were very common in that area. Nearby prominent

landmarks include San Juan River, San Juan City Hall, Kingdom Hall of

Jehovahs Witnesses and Ramon Magsaysay Memorial Medical Center.

Sample and Sampling Technique

There are a total of 11, 788 community residents living in Barangay 598

Zone 59, Old Sta. Mesa, Manila. The researchers interviewed a total of 120

respondents which are chosen through a purposive sampling technique. It is

selected based on the knowledge of a population and the purpose of the study.


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In this case the samples should be a resident of Barangay 598 Zone 59, Old Sta.

Mesa, Manila, at least 18 years old and above, they should be practicing self-

medication of antibiotic and willing to participate in the conduct of the study.

The sampling technique automatically catered all community residents

who satisfied the criteria on the one-week period. This allowed the researchers to

have an adequate number of samples which represents the entire population.

Instrumentation

The questionnaire was adapted from the study of Pan et al., in 2012

entitled Prior Knowledge, Older Age, and Higher Allowance are Risk Factors for

Self-Medication with Antibiotics among University Students in Southern China,

however only certain items which are applicable in the present study will be used.

This includes items number 4, 5, 11, 12, 13, and 19 in the original questionnaire.

Instead of frequency checklist, the present endeavor was modified into a Likert

Scale. Permission for adaptation of the questionnaire from the author was

secured through email correspondence (Please see Appendix A). It was

developed in English language and translated in Filipino by a PLM graduate of

education major in Filipino and now a professor of Holy Trinity College Quezon

City to make it more appropriate to the community setting. It consisted of six

parts.

Part I of the questionnaire obtains the demographic profile of the

community residents. It includes the educational attainment and monthly family

income. Educational attainment was classified as elementary graduate or


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undergraduate, high school graduate or undergraduate and college graduate or

undergraduate.

Educational Attainment Interpretation

Elementary Graduate /Undergraduate

Low level of understanding

High School Graduate /Undergraduate

Middle level of understanding

College Graduate /Undergraduate

High level of understanding

While family income every month is categorized as class A and B

(100,000/month and above), class C (20, 000 - 100,000/month), class D (10,000

- 20,000/month) and class E (10,000/month and below).

Part II consists of one item concerning the reasons for self-medication with

antibiotics. It comprises of six choices that will help them identify their rationale

for antibiotic usage. It was item number four in the original questionnaire.

Part III includes one item regarding the conditions for self-medication with

antibiotics. It consists of five conditions they had that motivated them to use

antibiotics. It was item number five in the original questionnaire.

Class Family Income Every Month Interpretation

A and B 100,000/month and above High income earner

C 20, 000 - 100,000/month Middle income earner

D 10,000 - 20,000/month Low income earner

E 10,000/month and below Very low income earner


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Part IV contains two items about the dosage for self-medication with

antibiotics. It comprises of seven sources from where they found out the desired

amount of the antibiotic they are going to take and a follow-up question to those

respondents who changed the dosage of their antibiotic consumption. The three

choices are the reasons for their antibiotic dosage changes. It was item numbers

11, 12 and 13 in the original questionnaire.

Part V includes one item pertaining to the duration for self-medication with

antibiotics. It consists of five choices that identify the length of time of their

antibiotic usage. It was item number 19 in the original questionnaire.

Parts II to V assessed the extent of self-medication of antibiotic practices

of the respondents using the following rating scale:

Scale Response Range Interpretation

4 Always 3.25-4.00 Very Highly

Practice

3 Often 2.50-3.24 Highly Practice

2 Sometimes 1.75-2.49 Low Practice

1 Never 1.00-1.74 Very Low Practice

It is interpreted that the higher the score, the higher the extent of the self-

medication of antibiotics practices.


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Data Gathering Procedure

The researchers first visited the chosen research for formalities that

includes the letter asking permission for their community to be the locale of the

study. The researchers wrote a letter to the Barangay Chairman asking

permission to conduct a survey among community residents in Barangay 598

Zone 59, Old Sta. Mesa Manila, particularly, those who are at least 18 years old

and above, and practicing self-medication of antibiotics. Proper permit and letter

was sought to conform to the standards and procedures of the research

undertaking. An introductory letter was also attached to the questionnaire to

discuss the purpose of the study and to ensure the respondents confidentiality.

Aside from the introductory letter, the researchers conducted the survey

themselves via house-to-house to be able to explain, clarify the queries of the

respondents regarding the study and to make sure that each respondents is

really self-medicating using antibiotics. After a one-week period of survey, the

researchers gathered 120 respondents.

Then, after valid questionnaire forms were gathered, the data was tabulated and

organized after. Then, statistical treatment was applied for facilitation of analysis

and interpretation of data results.


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Statistical Analysis

The study utilized Statistical Package for Social Sciences version 20.0 for

data analysis and processing. Specifically the software was used for the following

purposes:

For Problem Number 1, frequency and percentage distribution was utilized

to identify the profile of the respondents.

For Problem Number 2, weighted mean was utilized to identify the

respondents practices towards self medication of antibiotics.

For Problem Number 3, OneAnalysis of Variance (ANOVA) was utilized

to measure the difference between the respondents practices towards self -

medication of antibiotics when grouped according to profile variables


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Chapter IV

Results and Discussions

Problem No. 1What is the profile of the respondents according to:

1.1 Highest Educational Attainment

Figure 2Highest Educational Attainment of the Respondents

Figure 2 illustrates the highest educational attainment of the

respondents. It describes that the majority (50%, n=60) of the respondents

reached high school (secondary) level of education. Thirty five percent (n=42)

reached college (tertiary) level while 15% (n=18) of the respondents reached

elementary (primary) level.


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The result conveyed that most of the respondents were able to reach

high school due to the fact that the age included in this study was 18 years old

and above.

The Census of Population and Housing (2010) indicated in their study

that of the total household population aged five years and over, 19.1% had

finished at most high school level, 11.7% attained elementary education, and

10.1% were able to attain college level.

1.2 Monthly Family Income

Figure 3Monthly Family Income of the Respondents

Figure 3 shows the distribution of the respondents in terms of their

monthly family income. Most of the respondents (60%, n=72) falls in Category E

interpreted as the very low income earners producing Php 10, 000/month and


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below. This is followed by the Category D or the low income earners (25%,

n=30), followed by Category C or the middle income earners (13%, n=15), and

lastly Category A/B or the high income earners (4%, n=3).

The more probable cause of low family income is unemployment and

unavailability of jobs provided. Moreover, most of the jobs (e.g., pedicab driver,

store owners) available within this barangay have low wages.

To support this, Brooks (2002) stated in his study that high rate of

population growth, lack of access to land, insufficient job creation in industry, and

a history of inappropriate economic policies contributed to high unemployment

and underemployment. Real wages were low, having declined at about 3 percent

per year since 1960, and relatively weak labor unions were unable to

substantially affect the deterioration of workers' earning power.

Problem No. 2 - To what extent do the respondents manifest the following

Self-Medication of Antibiotics practices:

2.1 Reasons

Table 1 represents the extent of self - medication of antibiotics practices in

terms of reason. The table reveals that the respondents reason for SMA was to

improve the condition or the prognosis of the symptoms being experienced and

has a weighted mean score of 3.43 with a verbal interpretation of very highly

practiced which ranked first. Experiences on the efficacy of antibiotics based on

previous encounter ranked second and have a verbal interpretation of very highly

practiced accounting for 3.34 weighted mean score. Economy or being able to


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save money ranked third and has a verbal interpretation as highly practiced with

a weighted mean score of 2.96. Lack of time in consulting a doctor ranked fourth

and is interpreted as highly practiced with a weighted mean score of 2.9.

Knowledge about antibiotics ranked as the fifth reason for practicing SMA with a

weighted mean of 2.60 and has a verbal interpretation of highly practiced.

Table 1Extent of Self-Medication of Antibiotics Practices in Terms of Reasons

Items WeightedMean

Interpretation Rank

1.Economy 2.96 HighlyPracticed

3

2. Knowledge 2.60 HighlyPracticed

5

3. Experience 3.34 Very HighlyPracticed

2

4. Prognosis 3.43 Very HighlyPracticed

1

5. Time 2.91 HighlyPracticed

4

*Legend:1.00-1.74= Very Low Practiced 2.50-3.24= Highly Practiced1.75-2.49= Low Practiced 3.25-4.00= Very Highly Practiced

Table 1 represents the extent of self - medication of antibiotics practices in

terms of reason. The table reveals that the respondents reason for SMA was to

improve the condition or the prognosis of the symptoms being experienced and

has a weighted mean score of 3.43 with a verbal interpretation of very highly

practiced which ranked first. Experiences on the efficacy of antibiotics based on

previous encounter ranked second and has a verbal interpretation of very highly


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practiced accounting for 3.34 weighted mean score. Economy or being able to

save money ranked third and has a verbal interpretation as highly practiced with

a weighted mean score of 2.96. Lack of time in consulting a doctor ranked fourth

and is interpreted as highly practiced with a weighted mean score of 2.91.

Knowledge about antibiotics ranked as the fifth reason for practicing SMA with a

weighted mean of 2.60 and has a verbal interpretation of highly practiced.

It can be seen from this table that the respondents most frequent reason

for practicing SMA was because they want an improvement in the symptoms or

conditions that they have experienced. This is mainly a preventive technique to

avoid the occurrence of more serious infections and diseases. The respondents

may have assumed that through SMA, further complications can be treated and

prevented hence lesser money will be consumed.

Previous encounters ranked as the second most practiced reason for

SMA. Prior experiences on the efficacy of certain treatment or medications have

caused these respondents to settle or apply the same drug regimen. These

practices also enable the respondents to save money instead of paying

physicians, laboratory tests and other hospital expenses. People have had

limited time for consulting physicians and this reason has led them to practice

SMA. Knowledge on antibiotics ranked as the least practiced reason for

performing SMA. It may be suggested that since these respondents were mostly

high school graduates, theyre understanding, awareness and level of knowledge

on antibiotics and SMA were also limited.


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Similarly, Misati (2012) observed that the common reasons for self-

medication of antibiotics were to avoid a more serious infection, avoidance to pay

for the physician/tests and lack of time to visit a physician. Also, in 2012,

Agyeman observed that reasons for self-medication of antibiotics were, it was

less expensive compared to medical care in the hospital and medical care in

hospitals were associated with long delays. On the other hand Musa (2010)

reported that reasons given for practice of self-medication using antibiotics

included assumed knowledge on antibiotics, prior experience on use, and lack of

time to go for consultation.

2.2 Conditions

Table 2Extent of Self-Medication of Antibiotics Practices in Terms Of Conditions

Items WeightedMean

Interpretation Rank

1. Respiratory Infections 3.20 HighlyPracticed

1

2. Systemic Manifestations 2.71 HighlyPracticed

3

3. Gastrointestinal Problems 2.05 Low Practiced 44. Skin Wounds 2.98 Highly

Practiced2


Based on the findings on Table 2, respiratory infections with a weighted

mean of 3.20, skin wounds with a weighted mean of 2.98, and systemic

manifestations with a weighted mean of 2.71 have a verbal interpretation of

highly practice and ranked 1st, 2nd, and 3rdrespectively. Whereas, gastrointestinal


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problems with a weighted mean of 2.05 has a verbal interpretation of low practice

and ranked 4th.

The above results signifies that majority of the respondents self-medicates

with antibiotics when they suffer from respiratory infections (runny nose, nasal

congestion, cough, sore throat), systemic infections (fever, aches and pains), and

skin wounds rather than when they are suffering from gastrointestinal problems

(vomiting, diarrhea, stomach ache). The Filipino culture approached their health

symptomatically which means that they view their self as healthy individuals if

they are not experiencing any symptoms of any illness. Filipinos also believe in

eradicating their illness or symptoms completely as soon as possible. In addition

to that, they usually treat their conditions specifically respiratory infections,

systemic manifestations and skin wounds with antibiotics rather than

gastrointestinal problems which are frequently treated by home remedies like

herbal medicines.

This is supported by the study of Nalini (2010) in India, where respiratory

infections, systemic manifestations and skin wounds are identified as the most

common factors that driven community residents in practicing self-medication of

antibiotics as their treatment for the said conditions. This is also similar with the

study of Mohanna (2010), where he reported respiratory infections such as

cough, common cold, sore throat, nasal congestion, runny nose and the like as

the most common minor ailments which provoke community residents to resort in

self-medication using antibiotics.


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Moreover, according to Becker (2003) health in the Filipino culture was

based on the principle of balance and harmony. Health was a result of being in

balance, while illness was the result of an imbalance. Aside from that, Filipinos

believed in controlling their illness by treating the symptoms that they are

experiencing or more on a symptomatic approach in treating illnesses. Filipino

people also believed in keeping the body strong by being clean, orderly and

appropriate in social situations to maintain balance, and therefore health.

Pan et al. (2012) believed that prior knowledge regarding drug and regimen lead

to a false sense of confidence in self-diagnosis and self-management resorting in

using the similar treatment that was effective to them, thus, resorting in self-

medication of antibiotics.

2.3 Dosage

Table 3Extent of Self-Medication of Antibiotics Practices in Terms of Dosage

Items Weighted Mean Interpretation Rank1. Package Checking 2.46 Low Practiced 42. Community HealthPractitioners

2.84 Highly Practiced 3

3. Family and Friends 3.06 Highly Practiced 24. Internet 1.28 Very Low Practiced 75. Experience 3.18 Highly Practiced 1

6. Estimating Dosage 2.00 Low Practiced 67. Advertisements 2.23 Low Practiced 5



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illness episodes and prior experience of self medication of antibiotics

contributes to practicing selfmedication of antibiotics.

Furthermore, Samaniego reported in his article in 2011 that according to

Dr. Solante, instead of consulting for the doctor to obtain prescription, some

people use previous prescriptions of past experience, or ask for advice and

suggestions from their relatives and friends in buying antibiotics.

2.4 Dosage Change

Table 4Extent of Self-Medication of Antibiotics Practices in Terms of Dosage

Changes

Items Weighted Mean Interpretation Rank1. Improve Conditions 3.60 Very High Practiced 12. Reduce SideEffects

2.45 Low Practiced 2

3. Insufficient Supply 2.40 Low Practiced 3*Legend:

1.00-1.74= Very Low Practiced 2.50-3.24= Highly Practiced1.75-2.49= Low Practiced 3.25-4.00= Very Highly Practiced

The weighted mean showing the extent of self-medication of antibiotics

practices in terms of dosage change is shown in table 4. It was found out that to

improve conditions with a weighted mean of 3.60 and a verbal interpretation of

very high practice ranked first as their reason for changing dosage. This was

followed by reduce side effects, with the weighted mean of 2.45 and a verbal

interpretation of low practice ranked second. Furthermore, insufficient supply,

with a weighted mean of 2.40 and a verbal interpretation of low practice ranked

third.


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Improvement of condition is the main reason why most of the respondents

change doses to become free from the underlying symptoms they are

experiencing. Filipino culture health is regarded to be symptomatic. The

respondents of this study perceived that they are healthy if they dont experience

symptoms. Consequently, this results to the development of multi drug resistance

to antibiotic among the respondents. According to WHO in 2010, incorrect use

may take the form of overuse, underuse, and misuse of prescription or non

prescription medicines. Rational use of medicines means that patients receive

medication appropriate to their clinical needs, in doses that meet their own

individual requirements, for an adequate period of time, and at the lowest cost to

them and their community. Irrational use includes use of antibiotics for non

bacterial illnesses and non-adherence to recommended dosing regimens, hence

preventing desired therapeutic outcomes from being achieved and potentially

increasing antimicrobial resistance.

2.5 Duration of Use

The assessment of the extent of self - medication of antibiotics practices

with regards to duration is represented in this table. It was observed that the

course of after the recovery with a weighted mean of 3.54, and symptoms

disappeared with a weighted mean of 3.32 have a verbal interpretation of very

highly practiced and was ranked as 1st, and 2ndin that order. On the other hand,

consumed supply with a weighted mean of 2.59 has a verbal interpretation of

highly practiced and was ordered as 3rd. Meanwhile, completion of treatment with


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Table 5Extent of Self-Medication of Antibiotics Practices in Terms of Duration

ItemsWeighted

MeanInterpretation Rank

1. After a few days 2.25 LowPracticed 5

2. Symptoms disappeared 3.32Very HighlyPracticed

2

3. After the recovery 3.54Very HighlyPracticed

1

4. Consumed supply 2.59Highly

Practiced3

5. Completion of treatment 2.33Low

Practiced4

*Legend:

1.00-1.74= Very Low Practiced 2.50-3.24= Highly Practiced1.75-2.49= Low Practiced 3.25-4.00= Very Highly Practiced

a weighted mean of 2.33, and after a few days with a weighted mean of 2.25

have a verbal interpretation of low practice and was ranked as 4 th, and 5th

accordingly.

Based on the findings stated above, it could be interpreted that majority of

the community residents take antibiotic for only a short period of time, specifically

after they feel better which could also be interpreted as the absence of symptoms

or the return of balance. This could be attributed to the Filipino culture wherein

health is equated with symptoms. In view of this fact, Filipinos consider

themselves well or healthy if they are not experiencing any symptoms and vice

versa. This is why the highest practised length of duration regarding self

medication with antibiotics is a few days after the recovery which is equated to

being symptoms free.


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According to Samaniego (2011), as cited in the collated article of Barbara

Dixon entitled as Cultural Traditions and Health Care Beliefs of some Older

Adults (2009), Filipinos concept of health is based on the principle of balance.

Specific disorders are perceived to be caused by an excess intake of one type of

food. Hot foods such as meat are thought to cause arthritis and hypertension.

Cold foods such as many fruits and vegetables may bring about cancer and

anemia. Moreover, as mentioned by Dr. Solante, one of the common practices

of the improper use of antibiotics is the cessation of treatment even before the

course is completed. The reasons for stopping the medication are financial

constraints and that the patient taking the antibiotic is feeling better.

Furthermore, in the global survey on non-compliance with antibiotic

therapy for acute community infections, 10% to 44% of the people reported that

they do not finish taking antibiotics in required duration because they already feel

better even before the course of treatment was completed (Avenir as cited from

Kadas, 2012). Likewise, it was found in a study in the study of Buke, et al in 2003

entitled Rational Antibiotic Use and Academic Staff that 15.6% of the educated

group of people, excluding the population from the Medicine department, use

antibiotics until the symptoms disappeared regardless of the prescribed duration

for taking the drug.

Problem No. 3 Is there a significant difference in the respondents

practices on Self-Medication of Antibiotics practices when they are

grouped according to profile?


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3.1 Reasons

Table 6Anova Results on the Significant Difference on SMA Practices on Reasons

When grouped According to Highest Educational Attainment

EducationalAttainment

f-Value p-Value Decision Interpretation

1. Economy 2.37 0.09 Accept There is nosignificantdifference

2.Knowledge

1.00 0.37 Accept There is nosignificantdifference

3.Experience

3.42 0.04 Reject There is asignificant

difference4. Prognosis 0.42 0.41 Accept There is no

significantdifference

5. Time 0.11 0.11 Accept There is nosignificantdifference

*Legend: p-value < 0.05 significant; p-value > 0.05 not significant

Based on the findings on Table 6, experience with an f-Value of 3.42 and

an equivalent p-Value

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