Household antimicrobial self-medication: a systematic review and meta-analysis of the burden, risk factors and outcomes in developing countries
Open accessAbstract
BACKGROUND: Antimicrobial self-medication is common in most low and middle income countries (LMICs). However there has been no systematic review on non-prescription antimicrobial use in these settings. This review thus intended to establish the burden, risk factors and effects of antimicrobial self-medication in Low and Middle Income Countries. METHODS: In 2012, we registered a systematic review protocol in PROSPERO (CRD42012002508). We searched PubMed, Medline, Scopus, and Embase databases using the following terms; "self-medication", "non-prescription", 'self-treatment', "antimicrobial", "antimalarial", "antibiotic", "antibacterial" "2002-2012" and combining them using Boolean operators. We performed independent and duplicate screening and abstraction of study administrative data, prevalence, determinants, type of antimicrobial agent, source, disease conditions, inappropriate use, drug adverse events and clinical outcomes of antibiotic self-medication where possible. We performed a Random Effects Meta-analysis. RESULTS: A total of thirty four (34) studies involving 31,340 participants were included in the review. The overall prevalence of antimicrobial self-medication was 38.8 % (95 % CI: 29.5-48.1). Most studies assessed non-prescription use of antibacterial (17/34: 50 %) and antimalarial (5/34: 14.7 %) agents. The common disease symptoms managed were, respiratory (50 %), fever (47 %) and gastrointestinal (45 %). The major sources of antimicrobials included, pharmacies (65.5 %), leftover drugs (50 %) and drug shops (37.5 %). Twelve (12) studies reported inappropriate drug use; not completing dose (6/12) and sharing of medicines (4/12). The main determinants of antimicrobial self-medication include, level of education, age, gender, past successful use, severity of illness and income. Reported negative outcomes of antimicrobial self-medication included, allergies (2/34: 5.9 %), lack of cure (4/34: 11.8 %) and causing death (2/34: 5.9 %). The commonly reported positive outcome was recovery from illness (4/34: 11.8 %). CONCLUSION: The prevalence of antimicrobial self-medication is high and varies in different communities as well as by social determinants of health and is frequently associated with inappropriate drug use.
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In a systematic review and meta-analysis by Ocan et al. in Nigeria in 2015, over 60% of respondents discontinued antibiotics once symptoms improved.
“In a systematic review and meta-analysis conducted by Ocan et al. in Nigeria in 2015, over 60% of respondents discontinued antibiotics once symptoms improved [9].”
From Understanding Antimicrobial Self-Medication Practices in the Andaman and Nicobar Islands in India (2025) · cites this paper as [9]
Table 1 in Results > Characteristics of included studies (page not provided) reports that 28.3% stopped taking drugs when symptoms resolved in the Nigerian study, not over 60%. Ocan et al. reviewed studies across low- and middle-income countries; the review was not conducted solely in Nigeria. (LLM, conf=0.88)
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measuredAmong the different channels from which patients in LMICs can access antibiotics, community drug retail outlets are a predominant source of antibiotics for the wider population.
“Among the different channels from which patients in LMICs can access antibiotics, CDROs have been identified to be a predominant source of antibiotics for the wider population [19–22].”
From No prescription? No problem: drivers of non-prescribed sale of antibiotics among community drug retail outlets in low and middle income countries: a systematic review of qualitative studies (2021) · cites this paper as [20]
The Results section, “Source of medicines, information and benefits of antibiotic self-medication” (page not provided), identifies pharmacies and drug shops as sources of antimicrobials used in self-medication; pharmacies appeared in 21 of 34 studies. This supports retail outlets as an important source, but the review concerns self-medication and reports the proportion of studies identifying each source, not whether these outlets predominate for antibiotics across the wider LMIC population. (LLM, conf=0.86)
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“In a systematic review and meta-analysis conducted by Ocan et al. in Nigeria in 2015, over 60% of respondents discontinued antibiotics once symptoms improved [9].”
- Authors
- Ocan, M., Obuku, E. A., Bwanga, F., Akena, D., Richard, S., Ogwal-Okeng, J., & Obua, C.
- Affiliations
- Makerere University (UG)
- London School of Hygiene & Tropical Medicine (GB)
- Corresponding author
- Ocan, Moses
- Venue
- BMC Public Health
- Published
- 2015-08-01
- Volume
- 15
- Issue
- 1
- Pages
- 742-742
- ISSN
- 1471-2458 (ISSN-L)
- PMC
- PMC4522083
- OpenAlex
- W1942976844
- Cited by
- 504
- References
- 62
- Citations by year
- 2026: 50 · 2025: 53 · 2024: 47 · 2023: 62 · 2022: 55 · 2021: 91 · 2020: 48 · 2019: 39 · 2018: 34 · 2017: 19 · 2016: 5 · 2015: 1
- FWCI
- 1.71
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- BMC Public Health (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, other-oa)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Funders
- International Development Research Centre
- National Institutes of Health
- Fogarty International Center (R24TW008886)
- Topics
- Life Sciences › Immunology and Microbiology › Applied Microbiology and Biotechnology › Antibiotic Use and Resistance
- Physical Sciences › Environmental Science › Pollution › Pharmaceutical and Antibiotic Environmental Impacts
- Health Sciences › Medicine › Geriatrics and Gerontology › Pharmaceutical Practices and Patient Outcomes
- Keywords
- non-prescription drug use, antibiotic misuse, antimalarial drugs, inappropriate medication use, risk factors, prevalence, drug adverse events, low- and middle-income countries, leftover medication, drug shops, antiseptics, antimicrobial resistance
- MeSH terms
- Anti-Infective Agents, Anti-Bacterial Agents, Attitude to Health, Bacterial Infections, Developing Countries, Nonprescription Drugs, Humans, Risk Factors, Self Care, Self Medication, Health Behavior, Prevalence
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