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ORIGINAL ARTICLE
Year : 2018  |  Volume : 7  |  Issue : 2  |  Page : 103-107

A community-based cross-sectional study on the use of medication among young children in the rural areas of Assam


Department of Community Medicine, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS), Shillong, Meghalaya, India

Date of Web Publication6-Jun-2018

Correspondence Address:
Dr. Madhur Borah
Department of Community Medicine, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS), Shillong - 793 018, Meghalaya
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2277-8632.233840

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  Abstract 


Introduction: Management of childhood illness is different from that of adult diseases. Medications during infancy and early childhood should be very cautiously used. Therefore, this study was conducted to determine the different patterns of medication use among the children up to 2 years of age in a rural community.
Materials and Methods: This was a community-based cross-sectional study conducted in a rural area of Assam where we randomly selected 380 children below 2 years of age.
Results: Among 380 children, 203 reported suffering from any disease in the last 2 months. Total 105 children (51.7%) were treated with allopathic medicines while 66 children (32.5%) were treated with AYUSH medication and 32 (15.8%) were treated with home remedies. Antipyretics were (24%) the most common drug used followed by oral rehydration salt (21.5%) (ORS) and antibiotics (15.5%). Parents of 44 children (21.7%) practiced self-medication. Only in 62.5% of the cases, full compliance to prescribed medicines was seen.
Conclusion: High prevalence of traditional therapy, self-medication, and noncompliance among the children in a rural area indicated the role of health education to parents, especially the mothers.

Keywords: Antipyretics, AYUSH, compliance, cross-sectional study, infants, rural, self-medication


How to cite this article:
Borah M. A community-based cross-sectional study on the use of medication among young children in the rural areas of Assam. J NTR Univ Health Sci 2018;7:103-7

How to cite this URL:
Borah M. A community-based cross-sectional study on the use of medication among young children in the rural areas of Assam. J NTR Univ Health Sci [serial online] 2018 [cited 2018 Dec 18];7:103-7. Available from: http://www.jdrntruhs.org/text.asp?2018/7/2/103/233840




  Introduction Top


Infancy and early childhood is the period of rapid growth and development of a child. This period is different from adulthood in terms of many physiological and metabolic activities. Therefore, manifestation of different morbidity conditions also occur differently in infants and toddlers compared to adults.[1] The common diseases of early childhood, such as malnutrition, diarrhea, acute respiratory infection (ARI), measles, are unique because apart from them being the major causes of mortality during early childhood these diseases had long-lasting effect on the growth and development of the surviving children.[2] Hence, proper management of childhood diseases is very important to reduce infant and childhood mortality and childhood morbidity. But the management of childhood illness is different from that of adult diseases. Medications for children are also different from those for the adults.[3]

Irrational drug use, especially that of antimicrobials, is a major challenge of pediatric medication. It is a risk factor for development of antimicrobial drug resistance. Studies have shown that there is widespread practice of inappropriate prescription of antibiotics to children.[4],[5] There is also higher incidence of medication errors in children and infants.[6] In India, over-the-counter medications as well as traditional and herbal medicines for children are readily available, but their use is generally not evidence-based and is often inappropriate.

Medications during infancy and early childhood should be very cautiously used because there may be very serious side effects of certain medicines. For example, sulfonamides causes kernicterus in newborns, chloramphenicol is associated with gray baby syndrome. In the past, it was a big tragedy when in utero exposure to thalidomide leading to the birth of congenitally deformed infants (phocomelia).[7]

In rural areas of Assam, there is a high incidence of infant mortality [8] also high incidence of morbidity among the infants and young children.[9] the pattern of medication of infants and young children plays an important role in defining their health status. So, this study was conducted in a rural block of Kamrup district of Assam with the objective to determine the different patterns of medication used among the children aged up to 2 years.


  Materials and Methods Top


This was a community-based cross-sectional study conducted in Boko Bangaon Community development block of Kamrup district of Assam. This block is situated around 85 km west of Guwahati city. This rural block is populated mostly by tribal communities such as Bodo and Kachari. For our study, we randomly selected 10 villages in the block. Then a house-to-house survey was conducted in those villages to collect data on 400 children below 2 years of age. Out of them, 20 children were excluded from the study. Hence, 380 children aged under 2 years formed the study group. The parents of those children were interviewed using a predesigned pretested questionnaire on any medication use for the child in the last 2 months. Any available prescription and medicine were also examined and recorded. Information regarding family income, educational status, and other sociodemographic data were also collected. The study period was from January 2013 to July 2013.

Inclusion criteria

The children in the age group of 0-2 years whose parents were permanent resident of the village and whose parents gave informed consent were included in the study.

Exclusion criteria

Children with major congenital defect and systemic diseases and those children whose parents did not give informed consent were excluded from the study.

Ethical clearance

Obtained from medical college ethics committee.

Statistical analysis

Statistical analysis was done using Statistical Package for the Social Science (SPSS) version 17.0 (SPSS-Inc., Chicago, IL) software. Percentage and proportion were calculated.


  Results Top


A total 380 children of less than 2 years of age took part in the study. Out of them, 163 (42.8%) were male and 217 (57.2%) were female. Most of the children (118) belonged to the age group of 16-24 months [Table 1]. A total of 65 children were in the age group of 0-6 months of age. On analysis of sociodemographic variables of parents, it was found that 64.5% mothers were in the age group of 19-29 years, while 20.5% were teenage mothers. Most of the parents (60.5%) belonged to the lower middle socioeconomic status, joints families (67.4%), and Hindu religion (67.8%) [Table 2].
Table 1: Distribution of study subjects according to gender and age

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Table 2: Distribution of the children according to sociodemographic variables

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Among the total 380 children, 203 (53.4%) reported suffering from any disease in the last 2 months [Table 3]. The total number of episodes of various illnesses suffered by them during that period were 214. ARI (26.6%) was the most common illness among the children followed by diarrhea (17.5%) and fever (15.4%). More episodes of illness were found among males (total 136 episodes or 63.5%) than females (78 episodes or 36.5%). Among the 203 children, 105 (51.7%) were treated with allopathic medicines, while 66 (32.5%) were treated with AYUSH medication and 32 (15.8%) were treated with home remedies [Table 4].
Table 3: Distribution of the children according to episodes of different types of diseases

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Table 4: Distribution of children according to types of medication used

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Among the parents of the 203 children who reported any diseases during the study period, the parents of 127 children (62.5%) approached health-care providers for the treatment. While parents of 44 children (21.7%) practiced self-medication, and 32 children (15.8%) were treated with home remedies.

Antipyretics were (24%) the most common drug used among the children [Table 5] followed by oral rehydration salt (ORS) (21.5%) and antibiotics (15.5%). Twenty percent of the parents (34) reported development of adverse drug reactions during the treatment.
Table 5: Distribution of children according to use of different therapeutic categories of allopathic drugs (multiple response)

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When we checked the doctor's prescriptions available with the parents (total 96 prescriptions were found), it was revealed that only in 60 cases (62.5%) full compliance to prescribed medicines was seen. Noncompliance includes both inappropriate duration of treatment and dose noncompliance. The causes of noncompliance as reported by the parents were no proper instruction (44.5%) about dosage and duration of medicines, side effects (22.2%), and cost of medicine (33.3%). Among the 203 children, 18 were hospitalized during the study period (medication used during the hospital stay was not included in the analysis).


  Discussion Top


The study observed that out of 380 children, 53.4% developed any disease condition during the study period. ARI, diarrhea, and fever were the common diseases observed in this age group. More disease episodes were found among the males than the females. Similar findings were observed by the studies conducted in the rural areas among children.[9],[10],[11]

Out of the total 214 disease episodes reported, in 51.7% cases were treated with allopathic medicines, 32.5% cases treated with AYUSH medicines, and 15.8% cases were treated with home remedies. Zaki et al. also found high prevalence of traditional therapy and nonprescription medication use among infants.[12] High percentage of teenage mothers and illiteracy among the mothers might influence this treatment seeking behavior of parents in our study. Self-medication practices were seen in 21.4% cases. Nazir et al. in their study had found prevalence of parents-induced self-medication practices in 57% of the children aged under 5 years.[13] In our study, lower socioeconomic condition of parents might force them to buy medications from pharmacies or rely on home remedies rather than get appointment with doctors.

In the study, antipyretics were found to be the most common medicine used among the children followed by ORS and antibiotics. Various community-based studies had similar observations.[14],[15],[16] Only in 62% cases, full compliance with prescribed medicines were seen in the study. Absence of proper instructions to caregivers about medications, side effects of medicines, and cost of the medications were the major reasons for both dose and duration noncompliance. Other studies had mentioned similar reasons for noncompliance.[17],[18]

Our study conducted in rural areas of Kamrup district of Assam had certain limitations. Dependence on memory of the parents regarding medication use was one of them. Limited sample size was considered due to the resource constrains that might influence the generalization of the study on other population. Only a few variables were considered in our study. But despite certain limitations, our study conducted in rural areas in a community-based setup revealed valuable information regarding use of medication among young children. Further research in this regard should be done so that the use of drugs among young children become safe and effective.


  Conclusion Top


Our study tried to throw some light on the critical issue of medicine use among young children. The study findings, such as patterns of common diseases among children in rural areas and different medicines used for these conditions, pattern of compliance of those medicines might be helpful for prioritizing the health-care activities, and for better understanding of health problems of infants and young children. High prevalence of traditional therapy, self-medication, and noncompliance indicated the role of health education to parents specially the mothers regarding safe medication use for their children.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
World Health Organization. Children's Health and the Environment: WHO Training Package for the Health Sector. Geneva: World Health Organization; 2008. p. 5-6.  Back to cited text no. 1
    
2.
Bozzoli C, Deaton A, Quintana-Domeque C. Child mortality, income and adult height. Princeton University; NBER Working Paper No. 12966. 2007. p. 4-6.  Back to cited text no. 2
    
3.
Cella M, Knibbe C, Danhof M, Della Pasqua O. What is the right dose for children? Br J Clin Pharmacol 2010;70:597-603.  Back to cited text no. 3
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4.
Kotwani A, Roy Chaudhury R, Holloway K. Antibiotic-prescribing practices of primary care prescribers for acute Diarrhoea in New Delhi, India. Value Health 2012;15(Suppl):S116-9.  Back to cited text no. 4
    
5.
Lusini G, Lapi F, Sara B, Vannacci A, Mugelli A, Kragstrup J, et al. Antibiotic prescribing in pediatric populations: A comparison between Viareggio, Italy and Funen, Denmark. Eur J Public Health 2009;19:434-8.  Back to cited text no. 5
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6.
Di Paolo E, Gehri M, Ouedraogo-Ruchet L, Sibailly G, Lutz N, Pannatier A. Outpatient prescriptions practice and writing quality in a pediatric university hospital. Swiss Med Wkly 2012;142:w13564.  Back to cited text no. 6
    
7.
WHO. Promoting Safety of Medicines for Children. Geneva: World Health Organization; 2007. p. 14-16.  Back to cited text no. 7
    
8.
Office of registrar general and census commissioner. Annual health survey: 2010-11: Fact sheet: Assam. New Delhi: Govt of India; 2011. Available from: http://www.censusindia.gov.in/vital_statistics/AHSBulletins/Factsheets.html. [Last accessed on 2016 Feb 09].   Back to cited text no. 8
    
9.
Borah M, Baruah R, Baruah KK. A cross sectional study on health status of infants in rural areas of Kamrup District of Assam. Indian J Comm Health 2015;1:161-4.  Back to cited text no. 9
    
10.
Sarkar R, Sivarathinaswamy P, Thangaraj B, Sindhu KN, Ajjampur SS, Muliyil J, et al. Burden of childhood diseases and malnutrition in a semi-urban slum in southern India. BMC Public Health 2013;13:87.  Back to cited text no. 10
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11.
Gladstone BP, Das AR, Rehman AM, Jaffar S, Estes MK, Muliyil J, et al. Burden of illness in the first 3 years of life in an Indian slum. J Trop Pediatr 2010;56:221-6.  Back to cited text no. 11
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12.
Zaki A, Abdel-Fattah M, Bassili A, Arafa M, Bedwani R. The use of medication in infants in Alexandria, Egypt. East Mediterr Health J 1999:5;320-7.  Back to cited text no. 12
    
13.
Nazir S, Goel K, Mittal A, Singh J, Goel RK, Rashid A. Parent induced self-medication among under five children: An observational cross sectional study. TAF Prev Med Bull 2015;14: 81-6.  Back to cited text no. 13
    
14.
Hoan le T, Chuc NT, Ottosson E, Allebeck P. Drug use among children under 5 with respiratory illness and/or diarrhoea in a rural district of Vietnam. Pharmacoepidemiol Drug Saf 2009;18:448-53.  Back to cited text no. 14
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15.
Keshari SS, Kesarwani P, Mishra M. Prevalence and Pattern of Self-medication Practices in Rural Area of Barabanki. Ind J Clin Pract 2014;25:636-9.  Back to cited text no. 15
    
16.
Al Balushi KA, Al-Sawafi F, Al-Ghafri F, Al-Zakwani I. Drug utilization pattern in an Omani paediatric population. J Basic Clin Pharma 2013;4:68-72.  Back to cited text no. 16
    
17.
Jin J, Sklar GE, Min Sen Oh V, Chuen Li S. Factors affecting therapeutic compliance: A review from the patient's perspective. Ther Clin Risk Manag 2008;4:269-86.  Back to cited text no. 17
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Dawood OT, Izham M, Ibrahim M, Palaian S. Medication compliance among children. World J Pediatr 2010;6:200-2.  Back to cited text no. 18
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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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