Non-prescribed drug use and its associated factors among pregnant women in Southwest Ethiopia  – Nature.com 21:14 

Scientific Reports volume 15, Article number: 22851 (2025) Cite this article

Abstract

Non-prescribed drug utilization is the act of using medication to treat self-diagnosed problems without consulting a healthcare provider. Pregnant women are among the most vulnerable population groups for self-medication to treat pregnancy-related problems. The use of non-prescribed drugs, however, has numerous detrimental effects on both the growing fetus and the mother. Besides, community-based information regarding the pattern of non-prescribed drug use is limited in Ethiopia. Hence, this study aims to investigate non-prescribed drug use and its associated factors among pregnant women in Jimma town, southwest Ethiopia, in 2023. A community-based cross-sectional study was conducted among 358 pregnant mothers in the peri-urban kebeles of Jimma town, southwest Ethiopia. A systematic random sampling technique (every K = 3 households) was used to select the final study participants. Data were collected using an interviewer-administered structured questionnaire, entered into EpiData version 7.2.2 software, and exported to SPSS version 25 for further analysis. Both bivariable and multivariable logistic regression models were fitted to identify the factors influencing non-prescribed drug utilization status. The level of significance of the association was determined at a P-value < 0.05 with a 95% CI. A total of 358 (99.4%) pregnant women participated in the study. The mean age of the participants was 25.06 years (Standard Deviation ± 4.25). Overall, the prevalence of non-prescribed drug use among pregnant women was 37.7% (95% CI: 32.8–41.7%). The most common reasons for using non-prescribed drugs were the easy availability of these drugs in pharmacies and drug stores, followed by their relatively low cost. Enrollment in health insurance (AOR = 0.21, 95% CI: 0.03–0.76), being primigravida (AOR = 3.05, 95% CI: 1.03–5.08), and experiencing pregnancy-related complications (AOR = 2.34, 95% CI: 1.99–2.76) were found to be significant factors influencing the utilization of non-prescribed drugs among pregnant mothers. In the current study, non-prescribed drug use among pregnant mothers was high. Health insurance enrollment status, gravidity, and the presence of any pregnancy-related complications were identified as significant predictors of non-prescribed drug use among pregnant mothers. Hence, stakeholders should invest their efforts in increasing community enrollment in health insurance programs and place special emphasis on high-risk groups prone to non-prescribed drug use.

Introduction

Non-prescribed drug use or self-medication is defined as the act of utilizing medications by patients to treat self-diagnosed health and health-related problems without getting advice from a healthcare provider. Pregnant women are among the most vulnerable groups for using non-prescribed drugs to prevent and/or treat pregnancy-related issues such as abortion, mood disorders, and anemia. Globally, 22-44% of pregnant women are reported to use non-prescribed drugs. Despite the fact that non-prescribed drug use is increasing worldwide, its burden is particularly high in low and middle-income countries due to poor medical services and a lack of professional control of pharmaceutical products, which is estimated to be greater than 31.5%. In Ethiopia, the extent of non-prescribed drug use is high and varies significantly across regions and communities, influenced by different cultural practices and perspectives1. For instance, its burden ranges from 7.8% in the Tigray region2, 45.2% in Nekmte town3 to 69.4% in Harar town4. Though recent evidences were limited, a prior meta-analysis study also revealed that more than 30% of the pregnant mothers in Ethiopia practice self –medication5.

The high prevalence of non-prescribed drug utilization among pregnant women can seriously affect the health of both the mother and fetus, potentially causing detrimental adverse effects such as congenital birth defects, miscarriage, and allergic diseases. It has been reported that at least 10% of birth defects result from the exposure of pregnant women to drugs, with the risk being particularly heightened during the first trimester of pregnancy6. Additionally, the increased practice of self-medication exacerbates the occurrence of drug interactions and adverse events. Pregnant women’s might frequently utilize non-prescribed drug due to numerous religious and cultural values and beliefs such as for the purpose of treating their psychological distress and other pregnancy -related complications7,8. In most developing countries like Ethiopia, in addition to the cultural perspectives, other several factors including poor access to health facility, socioeconomic status, age, gender, education level, occupation, lack of awareness of their side effects and interactions, time, perception of the risk of self-medication, previous medication use, gestational age, and experience of pregnancy-related complications affects the Non-prescribed drug utilization status of pregnant mothers1,8,9,10,11,12.

The government of Ethiopia gives substantial emphasis on prioritizing the health and well-being of mothers and neonates13. Although non-prescribed drug use is difficult to eliminate, intervention can be made to minimize the burden of this malpractice. This requires extensive knowledge on the level and risk factors contributing to the increased prevalence of non-prescribed drug utilization among pregnant mothers in a certain geographical areas. In this regard, though there are several studies that asses the level of self-medication practice among pregnant women in Ethiopia, most of them were institution based which will not represent the general population. Hence, this study is aimed to investigate the use utilization status and associated factors associate of non-prescribed drug among pregnant women in peri-urban kebeles of Jimma town, south west Ethiopia.

Methods and materials

Study area, period and design

This study was conducted among pregnant women in the peri-urban kebeles of Jimma town, south-west Ethiopia, from January 20 to March 1, 2023. Jimma town is located 352 km south-west of Addis Abeba, the capital city of Ethiopia14. In the town, there are about 17 kebele’s, of which 5 are peri-urban areas (Jireen, Qofe, Haro gibe, Bore, and Ifa bula). There are about 4,686 households in these peri-urban kebeles. A community based cross sectional study was employed to assess the use and factors associated with non-prescribed drug among pregnant women in peri-urban kebeles of Jimma town, south west Ethiopia, 2023.

Source and study population

The source population was all pregnant women who have been residing in the study area for at least six months. Whereas, all pregnant women are in peri-urban kebeles of Jimma town and presented in the data collection period were the study populations. Pregnant mothers who were not mentally competent to provide adequate information were excluded from the study.

Sample size determination and sampling technique

The sample size for this study was determined using EPINFO version 7.2.3.1 software through a single population proportion formula. Considering parameters like 80% power, 95% confidence level, 5% marginal error, 69.4% prevalence of non-prescribed drug use among pregnant women in Harar town, and 10% non-response rate, a final sample size of 360 pregnant mothers were included in this study. Study participants were selected using systematic random sampling techniques. Initially, the total number of pregnant women and household numbers were obtained from health extension workers in each keble. The total calculated sample size (n = 360) was proportionally allocated to each kebele. Finally, systematic sampling techniques (every k = 3 interval) were used to select the final eligible study participants. In the case of more than one pregnant woman per household, only one pregnant woman was selected randomly to reduce selection bias (Fig. 1).

figure 1
Fig. 1

Study variable

The main exposure variable for this study was the presence or absence of Non-prescribed drug use (yes/no). Whereas, variables socio-demographic variables (age, income, educational level), pregnancy and health related factors ( history of abortion, gravidity, number of living children, previous pregnancy related problems ), health service delivery-related factors (distance from health facility, and health insurance enrollment ) and behavior related factors (perceived status of the disease, previous experiences of non-prescribed drug use).

Operational definitions

Non-prescribed drug is the use of non-prescription medications to treat self-diagnosed disorders or symptoms, without consulting a physician and without any health professional supervision. Pregnancy related complications were defined as those problems that are specifically linked to the pregnant state as well as conditions that commonly occur incidentally in women who are pregnant which includes pregnancy related hypertension, premature rupture of membranes, pre-term labor or birth, antepartum hemorrhage, headache, vaginal discharge, abdominal cramp15,16. The income status of the participants were categorized as low (≤ 1,025), lower middle (1,026 − 3,995) ,upper middle(3,996 − 12,375 ) and upper (> 12,375) based on the 2018 international monetary fund (IMF) income level scale for Ethiopia17. Gravidity was defined as the sum of all pregnancies, including all live births and pregnancies that terminated at < 6 months or did not result in a live birth18. The occupational status of the study participants was categorized as government-employed, self-employed (merchants and business owners), and non-employed.

Data collection techniques and tools

A pretested interviewer administered standard questionnaire was developed after thoroughly reviewing the findings of prior related literatures. The questionnaire was initially prepared in English and translated to Afan Oromo and Amharic, then back to English to ensure consistency between the original and translated questionnaires. To ensure data quality, a pre-test was conducted on 5% (18) of the households at Ginjo Kebele of Jimma town, south west Ethiopia. Data were collected by five trained BSc Midwifery professionals. Additionally, one-day training was given for data collectors and supervisors about the objective of the study, how to obtain consent from participants, and how to ensure the confidentiality of the patient information. The collected data was checked for completeness every day before the following day of data collection by supervisors and the principal investigator, and corrective measures were taken according to the findings during supervision.

Data processing and analysis

The data was entered using Epi-data version 7.2.2.2 statistical software and analyzed using SPSS version 25 statistical package. Descriptive statistics such as frequencies with percentage, mean with standard deviation were used to describe the study population sociodemographic and other characteristics. Logistic regression model was used to fit the data to identify factors associated with non-prescribed drug use. Variables with a P-value of < 0.25 in the simple binary logistic regression model were fitted to the multivariable binary logistic regression model, and finally, the level of significance was declared at a p-value of < 0.05. The backward likelihood ratio elimination method was used to identify factors which are significantly associated with the non-prescribed drug –use pattern. The overall goodness of the model with the fitted data was evaluated using the “Hosmer and Lomeshow” goodness of fit test. Finally, the result of this study was presented in texts, graphs and tables.

Ethical considerations

An ethical approval letter was obtained from the Institutional Review Board (IRB) of Bahirdar University with a protocol number of BDU 651/2022, and then a supportive letter was written to Jimma Town Health Administration and each kebele administration. Verbal informed consent was obtained from the mothers after explaining the purpose and benefit of the study. Confidentiality was assured to all informants, and their anonymity was guaranteed as no name or identification of the parent or study participant pregnant women was collected during the interview. Furthermore, all methods were carried out in accordance with relevant guidelines and regulations.

Result

Result of Socio-demographic characteristics

From 360 samples, 358 (99.4%) pregnant women were participated in the study .The Mean age of the study participants were 25.06 years with the standard deviation of ± 4.25 years. Only 59 (16.5%) of the study participants were unable to read and write. Regarding the occupational status of the mother, majority (98.6%) of the study participants were housewife (Table 1) .Table 1 Socio-demographic characteristics of pregnant women in Jimma town peri-urban kebeles, southwest Ethiopia, 2023 (N = 358).

Full size table

Maternal and obstetric history of the respondents

During the current pregnancy, 302 (84.36%) of the respondents attended Antenatal care (ANC) visits. About 117 (32.7%) pregnant women experienced health problems during pregnancy. Constipation was the most common complaint that the pregnant women’s experienced during pregnancy, accounting for 61 (45.2%) (Table 2).Table 2 Obstetric history of pregnant women in peri-urban kebeles of Jimma town, Southwest Ethiopia, 2023.

Full size table

Magnitude of non-prescribed drug use

In the current study, the magnitude of non-prescribed drug use during pregnancy found to be 37.7% (95% CI: 33.4–42.0) (Fig. 2). The most common reason for using Non-prescribed drug was the easy availability of these non-prescribed drugs in pharmacies and drug, which account about 116 (85.92%) (Fig. 3).

figure 2
Fig. 2
figure 3
Fig. 3

Factors associated with the use of non-prescribed drug during pregnancy

In the final multivariable logistic regression model, at 5% of the level of significance, the following variables, namely being enrolled in health insurance, history of health problems during the current pregnancy, and gravidity were found to be significant predictors of non-prescribed drug use during pregnancy. In this aspect, the odd of non-prescribed drug use was found to be 79% times less likely among pregnant women’s who were enrolled in health insurance compared with their counterparts (AOR = 0.21, 95% CI: 0.03–0.76). Primigravida mothers 3.05 times more likely to practice non-prescribed drugs compared with their counterparts (AOR = 3.05, 95% CI: 1.03–5.08). Furthermore, this study also showed that the odd of utilizing non-prescribed drug in pregnant women’s who experienced any pregnancy – related problems was 2.34 times higher than their counterparts (AOR = 2. 34, 95%CI:1.99–2.76) (Table 3).Table 3 Bivariable and multivariable logistic regression analysis of factors associated with utilization of non-prescribed among pregnant women in Jimma town peri-urban kebeles, Southwest Ethiopia, 2023 (n = 358).

Full size table

Discussion

This research tried to assess non-prescribed drug use and its associated factors among pregnant women in Jimma town, peri-urban Kebeles, south-west Ethiopia. Despite the potential harmful effect of self-mediation during pregnancy, 135 or 37.7% (95%CI: 32.8–41.7%) of pregnant women used non-prescribed drugs during their pregnancy. This finding is in line with the study conducted at Jimma University medical centre, in Ayder comprehensive specialized hospital, in Iran, and in the United Arab Emirates14,19,20,21. Moreover, this figure is higher than the findings of the study conducted in Addis Ababa, in Goba Town located in southeast Ethiopia, South Africa, Brazil and in developed nations like Portugal and Netherlands12,22,23,24,25,26. These variations could be attributed to the differ.

rences in population demographic, the regulations and policies on the use of over-the-counter drugs and variations on the access of health services. In line to this, in certain African countries including Ethiopia, it’s possible to obtain all medications without needing a prescription from a healthcare provider27. On the contrary, the findings of this study were lower than the results of studies done in Harari town in Ethiopia, Ghana, and Tanzania4,28,29. This discrepancy could be due to the study settings and period. Overall, the finding further indicates the existence of systemic challenges related to healthcare access, education, cultural practices, and regulation. It underscores the need for public health interventions to improve maternal healthcare services, strengthen pharmaceutical regulations, and raise awareness about the risks of using non-prescribed medications during pregnancy.

In the present study, the most commonly reported reasons for using non-prescribed drugs during pregnancy were ease of access to medicines, feeling that disease is minor, low cost, and prolonged waiting time. In agreement with our study, similar findings were reported from previous studies conducted in Addis Ababa and the Democratic Republic of the Congo23,28. The possible explanation might be the lack of attention and priorities of health policymakers and other stakeholders on the burden of self-medication risks23. Therefore, necessary measures should be taken to strengthen the regulatory system and enforce regulations so as to reduce the practice of non-prescribed drugs during pregnancy.

This study showed that pregnant women who were enrolled in health insurance were 79% less likely to use non-prescribed drugs than women without health insurance (AOR 0.24, 95% CI: 0.03–0.76). This is supported by the results of the study conducted in Ayder Comprehensive Hospital, Tigray region and in Iran21,30. The possible explanation for the observed association might be due to the fact that being enrolled to health insurance would increase healthcare utilization of individuals31, thereby reducing the necessity for utilization of non-prescribed drugs. This result might indicate a need for public insurance coverage for all people in the community.

In this research, pregnant women who had experienced pregnancy-related problems were 2.34 times more likely to use non-prescribed drug use compared with their counterparts. This finding is supported by literatures conducted in southeast Ethiopia, Jordan, Indonesia, western Nepa and a systematic review and meta-analysis report of 13 studies12,32,33,34,35. The possible explanation for the observed association might be that pregnancy-related complications are both physically and emotionally overwhelming36, mothers might seek self-medication in order to alleviate their symptoms promptly. This suggests the need for incorporating counselling and mental health support into antenatal care services to help women manage the stress and anxiety associated with complications.

Furthermore, this study also showed that the odd of non-prescribed drug use was 3.05 times more likely among prmigravida women’s than mutigravida women’s. This finding is in agreement with prior studies conducted in Mizan-Tepi University Teaching Hospital, Southwest Ethiopia, in Tanzania and Indonesia37,38,39. The possible explanation for the observed association would primigravida women may have limited knowledge about the potential risks and safety concerns associated with medication use during pregnancy, making them more likely to use self-medication without understanding the potential harm it can cause. Indeed, women’s experiencing pregnancy-related problems for the first time may lack experience and knowledge about these complications. They may feel anxious or uncertain about seeking medical advice, leading them to look for alternative solutions like self-medication.

Limitation of the study

The limitation of this study might be the study being prone to recall bias that may affect the generalizability of this study, because the pregnant women might not remember their past experience on drug utilization. The other possible limitation could be women in early pregnancy might not have the chance yet to use medications consequently affecting the reported results on drugs commonly used during pregnancy.

Conclusion and recommendation

This community-based cross-sectional study revealed that a significant number of pregnant mothers used self-medication during pregnancy. Being enrolled in health insurance, experiencing pregnancy-related complications, and gravidity were found to be factors influencing the utilization of non-prescribed drugs. Therefore, special attention should be given to primigravida women and those experiencing pregnancy-related complications, as they are more likely to use non-prescribed drugs. Additionally, stakeholders need to mobilize the community to participate in health insurance programs and strengthen health education to raise awareness among pregnant women about the potential risks of self-medication and the importance of seeking professional medical advice, particularly during pregnancy.

Data availability

All data that have been used to support the conclusion of this study are available in the manuscript the manuscript.

Abbreviations

ANC:

Ante Natal CareBDU:

Bahir Dar UniversityETB:

Ethiopian BirrHMIS:

Health Management Information SystemJUMC:

Jimma University Medical CentreNGO:

Non-Governmental OrganizationSM:

Self-MedicationWHO:

World Health Organization

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Authors and Affiliations

  1. Department of Clinical Midwifery, School of Health Science, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, EthiopiaFentahun Yene & Simachew Animen
  2. Department of Comprehensive Nursing, College of Health Science, Debre Tabor University, Debre Tabor, EthiopiaBerihun Bantie
  3. Department of Maternal and Child health, Wogeda Primary Hospital, Debre Tabor, EthiopiaTarekegn Yilma
  4. Department of Clinical Midwifery, College of Medicine and Health Sciences, Jimma University, Jimma, EthiopiaIdalamin Zinab

Contributions

All the authors made significant contributions to the improvement of this manuscript. IZ, FY, SM were participated in the synthesizing the research question, formulating research objectives, data extraction, analysis, interpretation and conclusion, of the finding. BB and TY were participated in data extraction, analysis, interpretation and preparing the initial draft of the manuscript. All authors had thoroughly read and approved the manuscript.

Corresponding author

Correspondence to Berihun Bantie.

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Competing interests

The authors declare no competing interests.

Ethical approval and consent to participate

An ethical approval letter was obtained from the Institutional Review Board (IRB) of Bahirdar University with a protocol number of BDU 651/2022, and then a supportive letter was written to Jimma Town Health Administration and each kebele administrations. Verbal informed consent was obtained from the mothers after explaining the purpose and benefit of the study. Confidentiality was assured to all informants, and their anonymity was guaranteed as no name or identification of the parent or study participant pregnant women was collected during the interview. Furthermore, all methods were carried out in accordance with relevant guidelines and regulations.

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Yene, F., Bantie, B., Yilma, T. et al. Non-prescribed drug use and its associated factors among pregnant women in Southwest Ethiopia. Sci Rep 15, 22851 (2025). https://doi.org/10.1038/s41598-024-80247-y

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