Saudi Journal for Health Sciences - Vol 2, Issue 2, May-Aug 2013 103

INTRODUCTION
Children constitute a large percent of the population in
developing countries.
[1]
Children drug utilization is of great concern globally and
has received a lot of attention. Many studies have been
conducted in this field in the developed and developing
countries, and have all shown various problems ranging
from misuse and abuse of prescribed drugs, and errors of
medications.
[2,3]
Most drugs in children are used outside the
health settings with or without prescription. The family initial
response to many illnesses in their children has been found
to be self-medication.
[4]
Fever is among the chief complaints
of all pediatric consultations in general practice.
[5]
A study
by Crocitti, et al. 2001 indicated that parents still have a
problem to resolve the fever in children. Some parents
believe that fever is one of the diseases which may occur
among their children, rather than to be a sign or symptom
of ailment.
[6]
In many countries, the antipyretic drugs and
other over-the-counter (OTC) medicines are commonly
used among parents to treat their children.
[7]
Using (OTC)
medicines among parents may be affected by their attitudes
towards illnesses. However, some previous studies show
that parents knowledge about fever is still inaccurate. Most
parents are confused about which medicine should be given
to their children to manage the pain and fever associated
with minor ailments.
[8]
The common ailments of children
including headache, fever, flu, diarrhoea and sore throat can
be treated at home. Some minor ailments can be relieved
with (OTC) medications such as paracetamol or with some
other traditional or herbal medicines, without seeking
for physician consultation. When a child complains, the
parents concerns are often influenced by their knowledge
of the ailments and treatment. Parents may get advice
from the media, through family tradition, from friends and
via other sources which affect their responses toward the
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DOI:
10.4103/2278-0521.117914
Sudanese parents knowledge, attitudes
and practice about selfmedication to their
children: Qualitative study
Ahmed S. Eldalo, Tarig M. H. El-Hadiyah
1
, M. A. Yousif
2
Department of Pharmacology and Toxicology, College of Pharmacy, Taif University, KSA,
1
Department of Therapeutics, Faculty of
Pharmacy, National Ribat University, Sudan,
2
Department of Clinical Pharmacy, College of Pharmacy, Taif University, KSA
Address for correspondence:
Dr. Ahmed S. Eldalo,
Department of Pharmacology and
Toxicology, College of Pharmacy, Taif
University, Kingdom of Saudi Arabia.
E-mail: ahmed_dalo@hotmail.com
Aim: This study was designed to test the Sudanese parents knowledge, attitudes and
practice (KAP) toward self medicating their children. Design and Methods: A cross-sectional
study was carried out by using a pretested questionnaire. Non probability convenient sampling
method was used to select the participants. The total sample size was 1000 parents from
different health settings in Khartoum State, Sudan in the period from January to June 2011.
Results: The obtained response rate was 94.9%. The majority of Sudanese parents in this
study 84% used to recommend western medicines to their children. More than one-third of
children had received parental self medication in the month preceding this study. The results
revealed that parents in 95.7% cases, self medicated their children from minor illnesses. The
most frequently used medicines are antibiotics 36.6% followed by paracetamol 31.5%, even
though the most common symptom reported was fever 39.7%. In case of self-treatment failure;
64.0% of responded parents used to consult physicians in public settings, while 8.0% seek
advice from the community pharmacists. The main reasons of parental self medication were
the expensive consultation fees and the long waiting time in the clinics. Conclusion: The
study revealed that parents knowledge was inadequate, and their parental self medication
practice showed to be inappropriate. The study outcomes urge instant move toward educating
parents on risk of liberal use of medicines in children.
Key words: Children, knowledge, parental self-medication, Sudan
Original Article
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Eldalo, et al.: Parent self-medication to children
104 Saudi Journal for Health Sciences - Vol 2, Issue 2, May-Aug 2013
ailments.
[8]
The concept of self-management in healthcare
includes disease prevention, self diagnosis, self-treatment
and appropriate consultation with health care practitioners.
Within the context of childrens ailments, the responsibility
will usually be on the children parents.
[9]
The aim of this study was to test the Sudanese parents
knowledge, attitudes and practice (KAP) towards self
medicating their children, to identify the most commonly
used drugs and the reasons of parental self medications in
Khartoum State, Sudan.
MATERIALS AND METHODS
A cross-sectional study was designed and the data
collection was carried out in several governmental and
private hospitals in Khartoum State, Sudan. The study was
approved by National Ribat University Ethical Committee.
Non probability convenient random sampling method was
used to select the respondents. The target population was
included parents from different areas regardless of their
occupation, age, social status and education. The total
distributed sample size was 1000 parents in the period
from January to June 2011. A questionnaire was designed
to elicit the knowledge, attitude and pattern of practice of
the parents towards self-medicating their children and to
best addressing the study objectives. Data collection was
carried out through structured interviews. A pilot study
was carried out in a similar area for validity testing of the
contents and the results were not included in the original
study. Verbal consents were obtained from the parents
who were agreed to participate in the survey. Parents were
requested to complete the questionnaire on the spot. The
questionnaire consisted of three parts: The first part was
designed to obtain demographic characteristics such as
gender, age, occupation, education and number of children.
The second part was investigated the parents knowledge,
and the pattern of self-medication practice. Questions
were used to examine the type of medications given to
treat the children, most frequent medicines used and the
most favorite sources of health information. In the third
part five point Likert scale ranging from strongly agree to
strongly disagree was used to determine the attitude and
the reasons of parental self medication. The collected data
was computed by using SPSS (version 16), then analyzed
descriptively and Chi-square test was used for categorical
variables associations.
RESULTS
The study showed a very good cooperation of parents, with
a total of 949 parents (94.9%) responding. Two thirds of those
parents were females 629 (66.3%). The majority of population
going through the interviews was less than 40 years old
666 (70.2%), and they were dominantly non-healthcare
workers 789 (83.1%). Regarding parents education level;
349 (36.8%) were university graduates. The obtained results
revealed that most of the Sudanese families bearing large
number of children, the families were having five and more
children were dominant 267 (28.1%), as shown in Table 1.
Although Sudan is a developing country; the majority of
Sudanese parents in this study 797 (84%) used to recommend
western medicines, while only 152 (16%) of them preferred
to self medicate their children by traditional medicines.
There were no significant difference between healthcare
worker and non-healthcare workers (P = 0.535) whereas
the graduated participants showed a significant difference,
P value was (P < 0.001). The majority of interviewed parents
obtained their medicines from private retail pharmacies
528 (55.6%), while only 273 (28.8%) of them had their
medicines from public hospitals and just a few of them got
their medications from friends or private clinics. Most of
the participants reported that their children did not have
any drug related allergy 687 (72.4%). The study showed
that more than one-third of the children 365 (38.5%) had
received parental self medication in the last month, while
271 (28.6%) of them did the same in the last year. The results
revealed that the majority of parents used to self medicate
their children from minor illnesses 908 (95.7%), and only
5 (0.05%) of them reported doing the same in case of more
serious ailments. Table 2 shows, the most common diseases
that parent self medicated their children from and the most
frequent medicines they tend to use. The most frequent
medicines used were the antibiotics 347 (36.6%) followed
by paracetamol 289 (31.5), although the most common
self-treated symptom was fever 377 (39.7%).
Table 1: Socio-demographic characteristics of the sample
(N=949)
Socio-demographic characteristics Frequency (%)
Gender
Male 320 (33.7)
Female 629 (66.3)
Age
Less than 40 years 666 (70.2)
40 years and above 283 (29.8)
Occupation
Healthcare 160 (16.9)
Non-healthcare 789 (83.1)
Education
Postgraduate 72 (7.6)
Graduate 277 (29.2)
Tertiary school 280 (29.5)
Primary school 320 (33.7)
Children number
One 161 (17.0)
Two 196 (20.7)
Three 191 (20.1)
Four 134 (14.1)
Five and more 267 (28.1)
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Eldalo, et al.: Parent self-medication to children
Saudi Journal for Health Sciences - Vol 2, Issue 2, May-Aug 2013 105
In case of self-treatment failure most of the parents in the
present study tend to consult physicians in public settings
604 (64.0%), while 78 (8.0%) of them seek advice from
the community pharmacists, as shown in Figure 1. The
significant difference were found between the healthcare and
non-healthcare workers (P < 0.001). The healthcare worker
usually went to the pharmacists or to private clinics, while non
healthcare usually went to the public hospitals, but sometime
went to their relatives, also significant difference found between
graduated and non graduated participants (P < 0.001). Some
of non graduated participants seek advice from friends, but
none of the graduated did. Figure 2 illustrated the main sources
from which parents retrieved health information. Doctors
were the first favorite source for 769 (81.0%) of parents, while
pharmacists were the second choice for 737 (77.7%) of them
and relatives were the third favorite option for 407 (42.9%)
of the parents. Table 3 shows the reasons of parental self
medication, the most common reasons were the expensive
consultation fees and long waiting time in the clinics. Large
portion of parents disagreed that healthcare workers attitudes
were bad, or that information relayed to them was insufficient.
Another important finding was 488 (51.4%) of parents were
convinced that they can diagnose their childrens illnesses by
the symptoms.
DISCUSSION
This study investigated the knowledge, attitudes and
practice of parental self-medication to their children in
Sudan, and identified the main ailments and the most
used types of medications. The majority of the participants
were younger which reflect the actual status of the Sudan
population distribution.
[10]
The results showed that 84%
of the parents preferred the western medicines compared
78
8%
244
26%
604
64%
11
1%
12
1%
Consult community
pharmacist
Go to private clinic
Go to hospital
continue self medication
Seek advice from friends
and /or relatives
Figure 1: Participants attitude toward self-treatment failure P = 0.001
with parents education and occupation
0
100
200
300
400
500
600
700
800
First favorite
Second favorite
Third favorite
R
e
l
a
t
v
e
s
F
r
i
e
n
d
s
M
a
g
a
z
i
n
e
s

n
t
e
r
n
e
t
P
h
a
r
m
a
c
i
s
t
D
o
c
t
o
r
S
o
u
r
c
e
Figure 2: Parents favorite sources of health information P = 0.011
with the parents occupation
Table 2: The most common diseases and frequent
medicines used by parental self medication (N=949)
Most common
diseases
Frequency
(%)
Most frequent
used medicines
Frequency
(%)
Fever 377 (39.7) Antibiotics 347 (36.6)
Cough 212 (22.3) Paracetamol 289 (31.5)
Flu 149 (15.7) Cough syrup 73 (7.7)
Diarrhea 108 (11.4) Metronidazole 57 (6.0)
Rashes 43 (4.5) Anti diarrhea 29 (3.1)
Vomiting 34 (3.6) Anti malaria 25 (2.6)
Malaria 15 (1.6) Vitamins 14 (1.5)
Others 11 (1.2) Aspirin 12 (1.3)
Mefnamic Acid 11 (1.2)
Traditional drugs 82 (8.6)
Table 3: Reasons for parental self medication to their children (N=949)
Reason of self medication Strongly
agree*F/%
Agree
F/%
Neutral
F/%
Disagree
F/%
Strongly
disagree F/%
Waiting time in the clinic is too long 230 (24.2) 238 (25.1) 157 (16.5) 200 (21.1) 124 (13.1)
Consultation fees are too expensive 240 (25.3) 248 (26.1) 143 (15.1) 219 (23.1) 99 (10.4)
Nearest clinic is too far away 111 (11.7) 176 (18.5) 138 (14.5) 353 (37.2) 171 (18.0)
Bad attitudes of healthcare workers 90 (9.5) 124 (13.1) 151 (15.9) 391 (41.2) 193 (20.3)
Lack of suffcient health information relayed by the medical 95 (10.0) 137 (14.4) 169 (17.8) 363 (38.3) 185 (19.5)
I am expert enough to treat my children 61 (6.4) 145 (15.3) 224 (23.6) 305 (32.1) 214 (22.6)
Are you aware of side effects of medications 115 (12.1) 251 (26.4) 135 (14.2) 282 (29.7) 166 (17.5)
Can know illness of my children from symptoms 111 (11.7) 377 (39.7) 150 (15.8) 225 (23.7) 86 (9.1)
*F=Frequency, %= Percentage
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Eldalo, et al.: Parent self-medication to children
106 Saudi Journal for Health Sciences - Vol 2, Issue 2, May-Aug 2013
to the traditional ones. This is probably because most of
the respondents were well educated and they think that
modern medicines are more efficient and more reliable
than traditional ones. The results agree with the Malaysian
study which, showed that most of the parents prefer modern
medicine to treat their children,
[11]
but differs from a Nigeria
one which showed 34% of the mothers had used herbal
medicines for their children.
[12]
The self-medication tendency
among Sudanese community was clearly shown by the fact
that 55.6% of the investigated population obtained their
childrens therapy directly from retail pharmacies. This might
be due to financial reasons as well as the liberal over-counter
dispensing of medicines in the community pharmacies. The
study revealed that 95.7% of parents tend to liberally self
medicate their children for minor illnesses which could be
considered as an irrational attitude. This is in agreement
with Escourrou et al. study which decided that parents
self-medicate their children in France study mostly for mild
pathologies.
[13]
More than one-third 38.5% of the children
in this study had received parental-self medication in the
last month, while 28.6% of them received it in the last year.
This attitude was common in many countries, for example a
study conducted in China showed about 51% of children had
received parental self-medication on six or more occasions
during a year period and 32.8% on four to five occasions.
[14]

The most frequent medicines used were the antibiotics 36.6%,
paracetamol 31.0% and cough syrups 7.7%, although the most
common symptoms reported were fever 39.7%, cough 22.3%
and flu15.7%. The empiric treatment of fever with antibiotics
without further microbiological investigations had been
considered as a major component of irrational drug use
among communities of the developing countries in general
and Sudan in specific.
[15]
Common cold and sore throat are
usually viral pathological conditions that will induce bacterial
resistance and decrease the efficiency of antibiotics,
[16]

overuse of antibiotics has been described worldwide in both
community and hospital settings particularly in developing
countries.
[17,18]
In previous similar studies; the main groups
of self-prescribed drugs were: Analgesics/antipyretics and
the main ailment was respiratory tract infection.
[11,19-21]
Since
medical consultations in public hospitals are less expensive
than private ones; most of the present study participants
64.0% used to go to public hospitals in case of self-medication
failure. This findings in agreement with Malaysian study by
Dawood et. al. which reported; most of the parents prefer to
bring their children to consult a doctor in public hospitals.
[11]

The reasons of parental-self medication obtained in this
study were in line with the reasons reported in a study of
antibiotics use among Chinese children carried out by Tong
et.al., showing that payment of the medical fees is important
reason of self-medication.
[14]
CONCLUSION
The parental liberal self-medication practice in Sudan
should be considered as alarming problem. Parents
knowledge on the diseases and treatments seems to
be inadequate, and their self-medication practice was
inappropriate. The most commonly used medicines were
antibiotics and antipyretics, while the most frequently
treated symptom was fever. The main reasons for parental
self-medication were expensive consultation fees and long
waiting time in clinics. Therefore it is necessary to expose
Sudanese parents to a national program in rational use of
medicines in children.
ACKNOWLEDGMENT
The authors highly appreciated the hard work of data collection that
was carried out by the undergraduate final students, batch number
six, National Ribat University.
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How to cite this article: Eldalo AS, El-Hadiyah TM, Yousif MA. Sudanese
parents knowledge, attitudes and practice about self-medication to their
children: Qualitative study. Saudi J Health Sci 2013;2:103-7.
Source of Support: Nil, Confict of Interest: None declared.
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