Dr. Pushpa Ranjan Wijesinghe MD- Rostov (General Medicine) MSc, MD-Colombo (Community Medicine)

1. Practice and Predictors of self-medication among urban and rural adults in Sri Lanka, three decades after Market Economic Reforms Dr. Pushpa Ranjan Wijesinghe MD- Rostov(General Medicine) MSc, MD-Colombo (Community Medicine) MPH-New Zealand ( Bio-security)

2. Background • Practice of self-medication in communities in varying degrees • Increased private sector involvement in health & pharmaceutical care since 1977 • Increased utilization of private health / pharmaceutical care for out patient conditions • Competition of the pharmaceutical companies for a larger share of over the counter drug market • What is the status of self-medication in settings of contrasting health and pharmacy care infra-structure in this context ?

3. Objective • To describe the current practice and predictors of self-medication in a selected urban and rural area in Sri Lanka Methods • Study design • A community based cross –sectional study • Study Population • Adults over 18 years of age, irrespective of sex , permanently residing in the selected districts over a period of 1 year

4. 8 Urban Council areas Rural district Urban district 7 Regional Council (PS ) areas Stratification n= 900 n= 900 30 GN divisions PSU PPS 30 GN divisions PSU 30 Households per a GN division 30 Households per a GN division Voters list Kish Table 1 individual per house (900) 1 individual per house (900)

5. Study Instruments • Interviewer administered questionnaire (IAQ) • Validated Likert scale to assess the Perceived satisfaction with available pharmacy services • Access, Continuity, General Satisfaction of services • Availability , Affordability, Efficacy of drugs • Inter-personal explanation, Considerateness • Validated Likert scale to assess the perceivedaccess to allopathic medical care • Availability of services, • Regularity and acceptability of services • Affordability of services • Concern for clients

6. ACCESS FACTORS SOCIO DEMOGRAPHIC FACTORS BELIEFS & ATTITUDES Predisposing factors Enabling factors Medication use Need variables Anderson and Newman’s health services utilization model ACTUALOR PERCEIVED MORBIDITY

7. Practice of medication use * P < 0.05

8. Practice of self-medication

9. Predictors of self medication

10. Conclusion & recommendations • Self-medication is more prevalent in the urban setting • Prevalence of self-medication is lower than global estimates • Self-medication with 1-2 drugs selected on previous experience is an initial individual response for diseases ofacute onsetand perceived to be of less severity • Lower symptom count is a need variable acting as a proxy measure of perceived severity of the morbidity • Self medication is dependent on characteristic accessmeasures unique in the two specific settings • Findings should be utilized to • Shape policy changes related to implementation of the CDD act • Design IEC programs for consumers moving towards self-medication • Enhance the capacity of rural pharmacists/assistants as the first contact points in the rural sector

11. Limitations • Less valid data as compared to data collected in a prospective follow up study using a diary method • Non-objective measurement of the severity of the condition • Social desirability bias due to use of public health midwife for data collection • Perceived measures of access to health care and pharmaceutical services reflect general rather than specific context