Drug utilisation and self-medication in rural communities in Vietnam

Abstract

Reportedly 40–60% of people in Vietnam depend on self-medication. To assess the current situation of self-medication practices as compared with medication given by health professionals in rural areas in Vietnam, we conducted a cross sectional survey at household level. A total of 505 women with at least one child younger than 5 years of age were interviewed in their homes about their drug utilisation practices and attitudes toward medication, by using structured questionnaires. Of the 505 households, 138 stocked drugs for anticipated illness in the future. A total of 96 different antibiotics (in terms of generic type) were kept at 76 households. These antibiotics were kept mainly for coughs and diarrhoea. The self-medication group was twice as likely to use antibiotics than the other group. In addition, self-medication practice was increased when a mother kept medicines in the house.

This study revealed that mistaken beliefs about medicines and undesirable attitudes toward medication were prevalent. Mothers used antibiotics as if such drugs were panaceas. In this context, there was insufficient public health education, no control over pharmaceutical promotion, and no efficient drug policy and regulation. More attention should be given to consumers and patients as the ultimate users of drugs so that they can access accurate information, assess the reliability of information and ask necessary questions.

Introduction

The introduction of a market economy, Doi Moi, has led to many changes in the Vietnamese healthcare system since 1986. As a result, many private pharmacies have emerged. Total pharmaceutical sales increased from US$285 million in 1995 to US$414 million in 1996. The rapid and powerful development of the pharmaceutical industry resulted in introducing a wide variety of pharmaceuticals to Vietnam (Vietnamese MOH, 1996b; Witter, 1996). In 1994, per capita drug consumption averaged US$ 3.20—a six fold increase during the 1986–1990 period and increased further in 1996 to US$ 4.20, about 78% of this amount coming from users’ pockets (Vietnamese MOH, 1996b).

Accompanying such increased use of pharmaceuticals are the problems of self-medication, particularly the overuse of antibiotics, which leads to widespread bacterial resistance to antibiotics (Johanson, Diwan, Huong, & Ahlberg, 1996; UNICEF, 1994; Van Duong, Binns, & Le, 1977; Chuc & Tomso, 1995). A survey of antibiotic use in children with respiratory infections in Vietnam in 1991 revealed 85% of the children were treated with antibiotics. 58% received inappropriate medication; the wrong drugs and/or insufficient doses. In 71% of cases, the antibiotics were given by the patient’s family (Thu, 1997). According to a national survey conducted in 1994 by the Vietnam Advisory Committee for Antibiotic Use, bacterial strains resistant against antibiotics expanded nation-wide. The result was more serious than estimated by the Committee prior to the survey, e.g., 87% and 55% of Staphylococcus aureus were resistant to Chloramphenicol and Erythromycin, respectively. Approximately 90% of Shigella flexneri were resistant to Chloramphenicol, Ampicillin, and Tetracycline. Although Norfloxacin has been recently introduced into Vietnam, 3% of Shigella flexneri has already become resistant to the drug (Vietnamese MOH, 1994). To cope with the problems created by self-medication practices, particularly the overuse of antibiotics and some other dangerous drugs, Regulation 488/BYT-QD was promulgated on March 4 1995 to restrict prescription drug sales at private pharmacies and other private drug outlets. In reality, however, lack of enforcement is still a problem and currently people can buy almost all types of drugs over the counter without prescription (Johanson et al., 1996; UNICEF, 1994; Van Duong et al., 1977; Chuc et al., 1995; Vietnamese MOH, 1997b). Such easy access to drugs is observed mainly in urban areas. In rural areas, on the other hand, the sub-median income population still does not have good access to essential drugs. However, with the country’s remarkable economic development, the rural areas seem to be following the same path as the urban areas. It seems that pharmaceutical industries are expanding the market to include rural areas.

The purpose of this study was: (1) to assess current situation of self-medication practices as compared with medication given by health professionals; and (2) to identify factors associated with antibiotic use as well as other drugs through self-medication practices in Vietnam.