Background

Self-medication, defined by the World Health Organization (WHO) as the use of medicines by individuals to treat self-recognized conditions or symptoms, it remains a widespread global health concern. This practice carries substantial health risks, including incorrect self-diagnosis, delayed treatment, drug interactions, and the emergence of antimicrobial resistance1.

Non-steroidal anti-inflammatory drugs (NSAIDs) are among the most commonly self-medicated drugs globally due to their accessibility and perceived effectiveness. However, unsupervised use of NSAIDs is associated with severe health risks, such as gastrointestinal bleeding, cardiovascular complications, and kidney damage even at recommended doses2,3,4. These complications place a significant financial burden on Ethiopia’s already strained healthcare system, contributing to costly hospitalizations and increased out of pocket expenses.

A study conducted in Gondar revealed that adverse drug reactions significantly increased medical expenses and clinical complications5. Self-medication with NSAIDs poses serious risks, particularly during pregnancy and respiratory illnesses. In pregnancy, NSAIDs may cause embryo-fetal toxicity and neonatal complications6, while in respiratory infections, they can mask symptoms, delaying proper diagnosis and treatment, which can result in severe complications like pleural empyema7. Recognizing these risks, WHO has emphasized the importance of regulating the unsupervised use of NSAIDs to mitigate adverse public health impacts8. Despite these risks, self-medication with NSAIDs remains widespread globally, driven by easy over the counter access perceived immediate relief and limited public knowledge of the associated harms9,10,11,12. Studies in Kosovo and India have shown high rate of unsupervised NSAIDs use, especially among women and youth, with many unaware of potential complications like gastrointestinal and renal damage13,14.Contributing factors for self-medication with NSADs include aggressive pharmaceutical marketing, online misinformation, peer recommendations, and economic constraints, all of which promote the unsafe perception that NSAIDs are harmless for routine use15,16,17. In sub-Saharan Africa, and particularly in Ethiopia weak regulatory enforecement and healthcare access gaps exacerbate the issue. A national systematic review reported that the prevalence of self-medication in Ethiopia is 44%, with analgesics including NSAIDs being among the most commonly misused drugs18,19.

In Gondar City, previous studies have indicated a high prevalence of self-medication in other drugs, but data specific to NSAID use remains limited20,21. Therefore, this study aims to assess the prevalence and associated factors ofNSAIDs self-medication in Gondar City, Ethiopia. This study is essential to inform public health strategies that balance access with safety, raise awareness, and promote rational drug use.

Methods

Study design, setting and period

A cross-sectional study design was employed from July 30 to August 30, 2023, among the public in Gondar, North West Ethiopia. A cross-sectional design was chosen due to its suitability in estimating the prevalence and associated factors of NSAID self-medication within a defined population at a single point in time. Gondar is located 738 km from the capital city of Ethiopia, Addis Ababa. It is located at 12°36′ north latitude and 37°28′ east longitude, with an elevation of 2,133 m above sea level. The city serves as the region’s economic and cultural center, with six sub-cities and 22 Kebeles. Currently, it has a total population of 413,00022.

Source and study population

All residents living in Gondar City were used as the source population. The study population was residents who were present at the time of data collection from July 30 to August 30, 2023. Residents of Gondar city who were under 18 years of age, severely ill or individuals who have impaired cognitive function/unable to speak/, and living less than six months were excluded.

Sample size calculation and sampling technique

The sample size (n) was calculated using a single population proportion formula by using a previous study in Gondar, Ethiopia (50.2% of the household in Gondar practiced self-medication)20 95% confidence interval, and margin of error (d) = 5%, multiplied by two for design effect and adding non response rate of 10%.

$$\:n=\frac{{\left({z}_{\frac{a}{2}}\right)}^{2}\times\:p\times\:\left(1-p\right)}{{d}^{2}}=\frac{{\left(1.96\right)}^{2}\times\:0.502\times\:\left(1-0.502\right)}{{\left(0.05\right)}^{2}}\:+10\%=\:423*2=846$$

The final sample size was 846. Nine kebeles were selected from 22 Kebeles in Gondar city using lottery method to ensure randomization (Fig. 1). This approach was employed to prevent any potential selection bias, offering each kebele an equal chance of being chosen, which increases the representativeness of the sample. The use of the lottery method aligns with random sampling principles and helps to achieve a more generalized and representative sample of the city’s population.

Fig. 1
figure 1

Schematic presentation of the sampling procedure for selecting study participants to assess self-medication practices with NSAIDs in Gondar City, Ethiopia, 2023 (n = 786).

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The A stratified sampling technique was applied based on kebele population size to ensure proportional representation.

Within each kebele, systematic random sampling was used to select households, with every Kth households included after randomly selecting a starting point.

Data collection instrument and data collection procedure

Data were collected through interview using a structured questionnaire which was adapted from different studies23,24,25,26. The questionnaire included socio demographic characteristics (sex, age, marital status, educational level, occupation, living condition, monthly income, chronic illness, number of families), a single item with yes or no answer was used to assess self-medication practice among the households. The question was whether the participants had self-medicated practice with NSAIDs in the preceding 6 months (Have you self-medicated with NSAIDs in the previous 6 months?). The six-month recall period was selected to provide a balanced time frame long enough to capture potential seasonal variations in NSAID use while minimizing recall bias compared to longer recall periods. To improve recall accuracy, data collectors used visual cues, such as packaging, tablet color, and common brand names to help respondents identify medications they had used.

Three trained pharmacists were recruited as data collectors. They conducted face-to-face interviews with the head of each household using smartphone equipped with the Kobo Toolbox application. If the head of the household was unavailable, up to two follow up visits were made, households that remained unreachable after these attempts were replaced using systematic random sampling, ensuring consistency in respondent selection and minimizing bias. The questionnaire was originally prepared in English and then translated into the local language (Amharic) and back-translated to the English language accuracy and clarity.

Data quality control

The questionnaire was pre-tested on 21 individuals from a non-sampled kebele (Kebele 18) to assess clarity, relevance, and cultural appropriateness. Based on the pre-test results, minor modifications were made to socio-demographic items to improve comprehension and linguistic alignment with local terminology. Content validity was evaluated through expert review, and reliability was supported by training data collectors and close supervision during the data collection process. The data was checked from the beginning of the data collection to the end of the analysis. There was active involvement of the principal investigators in the data collection process to ensure the quality of the data.

Variables of the Study

Dependent variable: Self-medication practice of NSAIDs.

Independent variables: Socio-demographic characteristics such as gender, age, residence, number of families, marital status, educational level, and occupation, and average monthly income. Information related to self-medication status such as receiving information about safe way of disposing of unwanted pharmaceuticals, source of information, place of the medication, time taken to the source of drugs, current health insurance user, checking of expiry date at the time of purchasing were included.

Measuring techniques

Those study participants who had used NASIDS in the previous 6 months were considered having self-medication practice of NSAIDS. The kinds of NASIDS were identified based on the recall of the participants, the packaging and the color of the medication identified by the data collectors.

Statistical analysis

The collected data were exported to excel and translated to the English language then exported to SPSS Version 26 for computing, recording, and statistical analysis. Categorical variables were expressed as percentages. For continuous variables, normality was assessed using the Shapiro-Wilk test. Normally distributed data were presented as mean with standard deviation (SD), while non-normally distributed data were presented as median with interquartile range (IQR). Logistic regression was used to explain the relationship between self-medication and the independent variables. Independent variables with a p-value of < 0.25 were selected for multivariable logistic regression. A variable with a p-value of ≤ 0.05 with 95% CI were treated as a significant factor for self-medication.

Operational definitions

Self-medication with NSAIDs was operationally defined as the use of NSAIDs without a prescription or consultation with a healthcare professional for the treatment of self-recognized conditions such as pain, fever, or inflammation within the past six months.

Non-Steroidal Anti-Inflammatory Drugs: A class of drugs used to reduce pain, decrease fever, and, in higher doses, decrease inflammation. In this study, examples include diclofenac, ibuprofen, aspirin, meloxicam, indomethacin, and piroxicam.

Results

Socio-demographic characteristics

In this study, 786 individuals were participated giving a response rate of 92.91%, of which 432 (55.0%) were male. The mean age was 35.7 years old. About 45.4% participants were followed college and/or above, 13.5% had primary education while, 13.1% can’t read and write. About 49.4% of participants were living in rental house. With regard to occupation, most of the study participants (42.6%) were employee while 14.4% of them were housewife (Table 1).

Table 1 Socio demographic characteristics of study participants among the public in Gondar city, 2023(n = 786).
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Reported Self-medication practice status

Almost seven out of ten individuals reported self-medicating with NSAIDs. Diclofenac (21.3%) was the most commonly used NSAIDs followed by Ibuprofen (20.8%) for majorly the symptoms of headache (38.0%) and menstrual pain (21.3%). Most information regarding these drugs is obtained from retail/community pharmacies (62.8%), while only a small percentage (3.1%) relies on physician advice. About 11.2% of respondents experienced side effect. The most common reported side effect was gastric discomfort (42%). Reasons for self-medication varied, with lack of time (30.9%) and the ease of acquiring medication from pharmacies (19.7%) among the top motivators. About 46.8% of individuals checked the expiry dates when purchasing drugs and the time taken to acquire these medications ranged from under 15 min (17.7%) to more than an hour (19.6%). About 54.6% study participants use some form of health insurance to secure their health (Tables 2 and 3; Fig. 2).

Table 2 NSAIDs self-medication practice, symptomsand adverse effects among the public in Gondar city, Northwest ethiopia, 2023 (n = 786).
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Table 3 Common NSAIDs used, source of medication, Resean for use and access to healthcare among the public in Gondar city, Northwest ethiopia, 2023 (n = 786).
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Fig. 2
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Prevalence of self-medication practice with NSAIDS among the public in Gondar city, Ethiopia, 2023(N = 786).

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Associated factors to self-medication among the public in Gondar City

In the current study, age, educational status, receiving information on good disposal practice, and current health insurance user were candidate variables for the final model and entered into multivariable logistic regression. In the final model, educational status and current health insurance user were statistically significant variables. After adjusting for covariates, individuals who had completed secondary education were considerably less likely to engage in self-medication with NSAIDs compared to those without any formal education (AOR = 0.362, p < 0.001). Those with tertiary education also showed a decreased likelihood of self-medicating, although this was only marginally significant (AOR = 0.688, p = 0.052). Additionally, having current health insurance substantially reduced the chances of self-medicating with NSAIDs (AOR = 0.449, p < 0.001). Conversely, primary education and previous knowledge regarding medicine disposal did not have significant predictive value. (Table 4).

Table 4 Associated factors for NSAIDs self-medication among the public in Gondar city, Northwest ethiopia, 2023 (n = 786).
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Discussion

This study revealed that self-medication with NSAIDs is highly prevalent in Gondar City, Northeast Ethiopia, with 69.2% of participants reported such practice. The most commonly used NSAIDs were diclofenac (21.3%) and ibuprofen (20.8%) primarily for symptoms of headache (38.0%) and menstrual pain (21.3%). Community pharmacies were the main source of information (62.8%) and a very low proportion of respondents (3.1%) consulted physicians. Educational status and health insurance coverage were significantly associated with self-medication practice.

The high prevalence of self-medication in this study is comparable to findings from some regions of Ethiopia but varies across global settings. The prevalence was lower than findings from Jimma, and urban areas in India andKuwait27,28,29 but higher than studies conducted among Mekelle and Pakistan university students30,31. These variation can be attributed to differences in healthcare access, regulatory policies and cultural norms. India’s relatively lenient prescription policies contribute to higher self-medication rates, whereas Kuwait, despite having stricter regulations, still reports high rates due to socio-cultural factors and medication affordability28,29. Unlike studies focusing on university students who may self-medicate based on perceived knowledge of drug safety, this study targeted the general population, potentially with limited awareness of NSAIDs risks. This difference in population characterstics explains some of the higher prevalence observed. In addition, our findings regarding commonly used NSAIDs align with prior studies in Portuguese30 and Jazan University31 showing diclofenac and ibuprofen as leading choices. While Saudi Arabian study showed paracetamol and Ibuprofen as more common32, these variation reflects regional drug availability, local prescribing habits and consumer preferences.

In our study, communities reliance on retail/community pharmacies (62.8%) for information on NSAIDs. In our study, 62.8% of participants relied on retail or community pharmacies for information on NSAIDs. This findings shows the critical role of pharmacies and community drug retail outlets in shaping NSAIDs use behavior. The reliance on pharmacies for both procurement and drug information reflects the trust the public places in pharmacy professionals. Similar trends have been observed in studies from Northwest Ethiopia and Thailand33,34. However in the absence of structured counselling and regulation, this reliance may inadvertently promote inappropriate use. Pharmacy professionals thus represent an important intervention point for addressing NSAIDs misuse through education, risk communication, and guideline based counselling. Moreover, the low percentage (3.1%) of respondents seek advice from physicians suggests systematic barriers such as affordability, long waiting times at healthcare facilities, financial constraints, and cultural perceptions that NSAIDs are relatively safe for minor ailments and therefore do not require medical consultation. These finding are consistent with studies from LMICs that report similar access constraints influencing self-care practices35,36,37. Improving accessthrough community clinics and telemedicine, enhancing health literacy, and integrating pharmacists as key advisors could encourage safer medication practices38.Our study found that 11.2% of participants exprienced side effects from NSAIDs use gastric discomfort (42%) being the most common. This is in line with research from Nigeria39 Uganda40 and Pakistan41 where gastrointestinal irritation was also prevalent among NSAIDs self-users. These consistent findings suggest that gastrointestinal complications are a common global concern associated with unsupervised NSAID use and reinforce the need for patient education on risks, correct dosing, and storage practices.”

In the current study, educational status, and current health insurance user were found to be statistically significant factors for self-medication of NSAIDs in the current study. Educational status was a significant predictor of NSAIDs self-medication. Educated individuals may feel more confident in diagnosing and managing minor ailments independently but this can result in misplaced trust and unsafe practices. While higher health literacy can empower responsible use, it can also lead to self-treatment without adequate understanding of adverse effects. This finding is consistent with prior studies in Africa and Ethiopia where the educational level is a significant factor for the practice of self-medication42,43,44 and suggests that awareness campaigns must also target educated populations, reinforcing the importance of professional guidance.

Conversely, individuals with health insurance were less likely to self-medicate with NSAIDs, likely due to improved access to professional care and lower financial barriers. This supports finding from Jordan, where uninsured participants were more likely to seek medical consultation45.

Insurance appears to function as a protective factor, reducing out of pocket expenses and increasing healthcare seeking behavior. However contrasting findings from Hosanna Town, Hadiya Zone46, and other regional studies27 may be due to variability in insurance types (community-based versus government health insurance), the healthcare infrastructure in the regions, and differing awareness of insurance benefit. The high prevalence of NSAID self-medication and reliance on community pharmacies demonstrate the need for regulations. These might include mandatory pharmacist consultations for NSAID purchases, continuous training for pharmacy employees, and more transparent risk labeling. Expanding health insurance coverage may contribute to a further reduction in self-medication by increasing access to official healthcare. Campaigns for public health should also emphasize the potential dangers of NSAIDs and the necessity of consulting a specialist, especially for persistent or repeated pain.

The study might have limitations that should be acknowledged. The sample size and representativeness may limit the generalizability of our findings. Future research should consider larger, multi-site studies across various Ethiopian cities to ensure broader applicability. Given the cross-sectional design of this study, causal inferences between associated factors and NSAID self-medication practices cannot be established. Future longitudinal studies are recommended to examine causal pathways and temporal patterns. Additionally, incorporating mixed-methods approaches could provide deeper insights into the motivations, perceptions, and contextual factors influencing self-medication.

The self-reported nature of NSAID use may introduce recall bias, especially given the six-month recall period. Although measures such as probing with brand names, packaging, and medication color were used to enhance recall, some inaccuracies may still exist.” Although a systematic random sampling method was applied to enhance representativeness, transient or newly relocated residents who did not meet the minimum six-month residency requirement may have been underrepresented, which could introduce selection bias. Another limitation of the current study is that it did not explore the role of pharmacists in mitigating inappropriate NSAID use. Future research should assess pharmacists’ involvement in patient education, medication counseling, and interventions to reduce NSAID misuse in community settings.

Finally, while this study notes that a majority of participants obtained NSAID information from community pharmacies, we did not assess the extent or quality of pharmacists’ counseling. Future studies should explore pharmacists’ adherence to counseling protocols, their knowledge of NSAID safety, and their role in preventing inappropriate NSAID use through structured interventions.

Conclusions

This study revealed a high prevalence of self-medication with NSAIDs in Gondar City, with educational status, and current health insurance usage significantly associated with this practice. These finding suggest that improved health literacy and access to affordable healthcare services may reduce inappropriate NSAIDs use. To address this public health concern, a coordinated set of interventions is recommended, including mandatory pharmacist led consultations before dispensing of over the counter NSAIDs, nationwide public awareness campaigns about the risks of NSAIDs misuse, and strict regulatory enforcement on NSAIDs sales in retail pharmacies. Integrating these strategies can help mitigate misuse and its associated health consequences. Expanding access to health insurance and healthcare services may further discourage self-medication practices. Given the potential for serious NSAIDs related complications such as gastrointestinal bleeding, renal impairment, and cardiovascular events timely and coordinated action by Ethiopian pharmacy regulators, public health authorities and policymakers is essential to promote responsible NSAIDs use and protect public health.