Social factors influencing the acquisition of antibiotics without prescription in Kerala State, south India

We investigated the magnitude of self-medication with antibiotics in a peri -urban area of Southern Kerala State, India and factors influencing this pr actice. First, a random sample of 400 households was surveyed in one primar y health centre area near Trivandrum. We found 69.3% (95% CI = 64.8-73.8) o f households had at least one person using a pharmaceutical product during the two-week recall period; antibiotics formed almost 11% of the medicines consumed. Next, pharmacy based interview and observation data were collecte d from 405 antibiotic purchasers sampled from 11 out of the 12 private phar macies in the area. Seventy-three of these 405 customers purchased antibiot ics without a prescription (18%; 95% CI = 14.3-21.7). By combining the hous ehold survey and pharmacy observations, we estimate that almost half of 1% (0.41%; 95% CI = 0.24-1.16) of the population, or four people per 1000, is engaged in self-medication using antibiotics in Kerala in any two-week peri od. Our data show that people least likely to follow this practice are from higher:her income families, having more education and higher status occupa tions and receiving the benefits of medical insurance. Conversely, logistic regression analysis indicated that risk of buying antibiotics without a sc ript was associated with education at secondary level or below, the percept ion that it is expensive to consult a doctor and low satisfaction with medi cal practitioners. Keralites' self-medication patterns are interpreted broa dly using social, cultural, historical and economic perspectives. Solutions to the problem of antibiotic misuse are suggested, proceeding on several f ronts: among practitioners, suppliers and marketeers of medicines, and amon g the population of pharmaceutical consumers themselves. (C) 2000 Elsevier Science Ltd. All rights reserved.