title: Household antimicrobial self-medication: a systematic review and meta-analysis of the burden, risk factors and outcomes in developing countries.
abstract: 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 %).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Pharmacology & Therapeutics, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda. mss_ocan@yahoo.co.uk.
authors.forename: Moses
authors.initials: M
authors.lastname: Ocan
authors.affiliation: Africa Centre for Systematic Reviews and Knowledge Translation, College of Health Sciences, Makerere University, P. O. Box 7072, Kampala, Uganda. ekwaro@gmail.com.|Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK. ekwaro@gmail.com.
authors.forename: Ekwaro A
authors.initials: EA
authors.lastname: Obuku
authors.affiliation: Department of Microbiology, College of Health Sciences, Makerere University, P.O Box 7072, Kampala, Uganda. fxb18@case.edu.
authors.forename: Freddie
authors.initials: F
authors.lastname: Bwanga
authors.affiliation: Department of Psychiatry, College of Health Sciences, Makerere University, P.O Box 7072, Kampala, Uganda. akenadickens@yahoo.co.uk.
authors.forename: Dickens
authors.initials: D
authors.lastname: Akena
authors.affiliation: Infectious Disease Institute, College of Health Sciences, Makerere University, P.O Box 22418, Kampala, Uganda. ssenorichard@gmail.com.
authors.forename: Sennono
authors.initials: S
authors.lastname: Richard
authors.affiliation: Department of Pharmacology & Therapeutics, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda. jogwal.okeng@gmail.com.
authors.forename: Jasper
authors.initials: J
authors.lastname: Ogwal-Okeng
authors.affiliation: Department of Pharmacology & Therapeutics, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda. cobua1953@gmail.com.
authors.forename: Celestino
authors.initials: C
authors.lastname: Obua
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000009:adverse effects; D000890:Anti-Infective Agents / Q000008:administration & dosage; D001294:Attitude to Health; D001424:Bacterial Infections / Q000188:drug therapy*; D003906:Developing Countries; D015438:Health Behavior; D006801:Humans; D004366:Nonprescription Drugs / Q000008:administration & dosage* / Q000009:adverse effects; D015995:Prevalence; D012307:Risk Factors; D012648:Self Care / Q000706:statistics & numerical data; D012651:Self Medication / Q000009:adverse effects / Q000706:statistics & numerical data*
chemical_list: D000900:Anti-Bacterial Agents; D000890:Anti-Infective Agents; D004366:Nonprescription Drugs