According to WHO, self-Medication is defined as “the selection and use of medicines by individuals to treat self-recognized illnesses or symptoms”. It involves obtaining medications without a prescription, taking medicines on the advice of pharmacists, relative or friends without consulting medical professional, sharing medicines with family members /friends or consuming leftover medicines stored at home [1]. Self-medication can help treat minor ailments that do not require medical consultation and hence reduce the pressure on medical services particularly in the deprived countries with inadequate health care resources. In a number of developing countries, many drugs are dispensed Over The Counter (OTC) without medical direction [2].

Use of medication without medical guidance is inappropriate because using insufficient dosages or incorrect or unnecessary drugs increases wastage of resources, resistance of pathogens, drug dependence and causes serious health hazards such as adverse reaction and prolonged suffering [3]. Antimicrobial resistance is a current problem worldwide particularly in developing countries where antibiotics are often available without a prescription [4].

The prevalence of self- medication practices is alarmingly high in health-care students, despite knowing the consequences and potential risks. The reasons for self-medication practice among health care professionals are easy availability of drugs, professional exposure to drugs and knowledge of treatment of the diseases. Another reason for non-prescription drugs amongst youth is the exposure to media and advertisements.

Survey of self-medication among student population is important because this population represents a segment of highly-educated members of the society that have better access to healthcare-related information. Of particular significance is research on self-medication among the population of medical students, because they are the future generation that will have the right to prescribe drugs and to work on healthcare education. Additionally, their attitudes towards pharmacotherapy could affect the way they will prescribe medication in the future [5]. Therefore, the purpose of our study was to access the self-medication practices among Health care professional students in a tertiary care hospital.

A cross-sectional observational survey was carried out among medical, pharmacy and nursing students of a tertiary care hospital, Pune for a period of three months with sample size of 318. A convenience sample of 318 participants was recruited from the students enrolled in medical, pharmacy and nursing courses with a confidence interval of 95% and margin of error of 5.5%. In order to have equal distribution, 106 medical students, 106 pharmacy students and 106 nursing students were included in the study. The study protocol was approved by the college research committee. The objectives were explained to the students involved in the study and their verbal consent was obtained. All the participants ensured confidentiality. The data were collected through self -administered pretested questionnaire prepared in English. The study questionnaire was opted from similar study conducted previously by Zafar SN et al. [6]. The self-administered questionnaire was validated by research committee and faculty of Clinical Pharmacy Department, Bharati Hospital & Research Centre, Pune. Data collection sheet consists of two sections; the first section was about demographic information and characteristics (like age, gender, level of education, college and year of study, etc.), while, the second section had questions like number of drugs used in the last three months, practicing self- medication yes or no, presence or absence of medical indication, with and without prescription, adverse effect, sources of information. Pilot study was carried out in 36 students. During the pilot study, the participants were responded to all questions without confusions. Reliability scale evaluation was performed and good Cronbach's alpha (α = 0.78) score was achieved. Descriptive data analysis was conducted and reported as frequencies and percentage to identify the demographic of patients, classes of drugs used for self- medication and reasons for self-medication.

Out of 318 health science students, 88.0% were practicing self-medication whereas, 12.0% denied for taking medications on their own. Out of 318 participants, 52.5% were female. It was also found that, 84.0% of the students participated were less than 25 years, and 16.0% were more than 25 years. Other than Allopathic medicines, students were also using homeopathic (7.0%) and ayurvedic drugs (9.0%) for self- medication (Table 1).

Figure (1) shows the reason for self-medication which showed that majority of students (67.0%) were taking self-medication because they were aware of the symptoms and their treatment and 65.0% were practicing self-medication because of minor ailments.

Fig. (1). Distribution of subjects according to reason for self-medication.

Table 2 lists the illnesses for which the students used self-medication. Common illness for self-medication was fever with chills (62.5%), followed by headache (40.0%), cough and common cold (35.0%).

Table 3 indicates the types of medications (drugs) used in self-medication practice among the respondents. The most common class of drugs used was found to be analgesics (81.2%), anti-pyretic (67.6%) and anti-inflammatory (41.0%).

Figure (2) represents the distribution of self-medication among health care students in which most number of students who were on self- medication was medical students (34.2%), followed by pharmacy and nursing (33.0%) students.

Fig. (2). Demographic distribution of Self-medication among health care students.

Table 4 indicates the sources of drug information from which the most common was Reading books for medical students(30.0%) and for pharmacy and nursing students, the sources were family, friends and previous medical expertise (23.0%) and (27.0%) Advertisement and Internet were also the sources of information for the students.

Out of 318 participants, 12% participants denied taking medications on their own. 78.6% mentioned the fear of adverse effect as the main reason while, 36 .7% did not take self-medication because of the fear of wrong diagnosis and 13.1% mentioned other reasons (Table 5).

30.0% of health care students practicing self-medication in our study were not aware of the adverse effect of the drugs which they were using (Table 6).

In our study, we observed that 88.0% of the students were practicing self-medication, which is similar to a study conducted in Karachi [6], Malaysia [7] and Serbia [8], where self-medication was reported to be 76.0%, 77.6%, & 79.9% respectively. The incidence of self-medication practice reported by James H et al. [9] in Bahrain was 44.0% whereas, a study conducted in Karnataka [10] revealed 53.0% of students practicing self- medications. The high prevalence of self-medication in India is due to easy accessibility to OTC medicines without prescriptions. A study conducted by Banerjee et al. in west Bengalw [11] showed that female students were found using self-medication more than males, which when compared to our study, showed similar results. The percentage of self-medication among female students in our study was 52.5%. The illnesses for which students were practicing self-medication were fever & chills (62.5%) followed by pain, headache, cough and common cold. Our results are similar to the study conducted by Abay SN et al. inEthiopia [12]. The drugs which were frequently used for self- medication in our study were Analgesics (81.2%) followed by Anti-pyretics(67.6%) and Anti- inflammatory (41.0%); these were the drugs which were used in high frequency; moreover, a study in karachi⁶ also showed similar results. OTC medicines are safe and useful for treating minor ailments. Despite the significant benefits of self-medication, there are some inherent risks as well. High prevalence of self-medication with antibiotics results in human pathogens resistance. In our study, 35.0% students were taking antibiotics without prescription. Many studies in developing countries showed the use of antibiotics to be high, as these drugs are easily available without prescription [6, 13]. A reason for self- medication reported in our study was that they knew how to treat minor ailments. These findings resemble with another study by Sharif et al. (only last name of author must be mentioned) conducted in Sharjah [14]. Another study in Oman showed reasons like previous expertise and minor ailment. Even after studying about the drugs and its usage pattern in detail, 30.0% of health care students in our study were not aware of the adverse effect of the drugs which they were using.

Also, our study found that 2.0% of the students experienced adverse reaction, whereas, in another study conducted by Badiger et al. (only last name of author must be mentioned) in Mangalore, the percentage was 5.0% [15], for which they visited physician or discontinued the drugs. The sources of information in our study were reading books, Internet and family- friends, which when compared to a study by Pragna Patel et al. [16] in Gujarat showed similar results. In our study, we also found that 60.5%of the students who were practicing self- medication suggested to their friends and family.

In our study, we found that the use of self-medication among the health care students was high. The drugs which were greatly used among the students were analgesics, antipyretics and anti-inflammatory for the conditions such as fever and chills, headache and common cold. It is important for the health care students to understand the negativity of self-medication, and they must accept to enter the role of patient. Because of self-medication, lots of resources are also being wasted due to high usage of antibiotics that leads to resistance to pathogens, side effects and harm to the society. Educating the students and creating awareness among them may decrease the chance of adverse effect, therefore, health authorities should work together for the better quality of life.