Self-medication and associated factors: A cross-sectional study among undergraduate students at the University of Juba, South Sudan

Abstract

Introduction: Self-medication (SM), the use of unauthorized medicines for self-diagnosed disorders or symptoms, is a global problem in healthcare delivery. Although SM can provide quick relief for minor ailments, it also poses significant risks, including misdiagnosis, adverse reactions, and antimicrobial resistance. There is currently scant evidence on SM in South Sudan. Therefore, this study aimed to assess its prevalence, use, and associated factors among undergraduate students at the University of Juba.

Method: A cross-sectional descriptive study was conducted at the University of Juba. A three-stage sampling technique was used to select 384 students. Data were collected through a researcher-administered structured questionnaire. Using IBM SPSS 23.0, descriptive statistics were obtained, and chi-squared tests and multivariate logistic regression analysis were performed to identify significantly associated factors.

Results: Of 324 respondents, the modal age group was 23-27 years (206 participants); males were the dominant group (63%). 275 were single, and 299 (78%) were Christians. The prevalence of SM in the last six months was 75.6%. Analgesics, antibiotics, and antimalarial medications were the most used therapeutic groups. Logistic regression analysis showed quality of sleep (aOR 0.22, 95% CI 0.08-0.64, p-value 0.005) and source of medication information (aOR 0.15, 95% CI 0.05-0.50, p-value 0.002) as significantly associated predictors in this study.

Conclusion: Self-medication is highly prevalent among undergraduate students at the University of Juba. It is associated with peer influence, sleep quality, and the source of medication information. The study recommends strengthening regulations on rational medication use and increasing awareness among the students at the university.

Keywords: self-medication, students, University of Juba, South Sudan

Introduction

Self-medication (SM) is ‘the use of medicines to treat self-diagnosed disorders or symptoms, or the intermittent or continued use of prescribed drugs for chronic or recurrent diseases or symptoms’.^[1] Patients make the decision when they believe the severity of their symptoms warrants drug therapy, but not to the extent of justifying a physician’s consultation.^[2] According to the World Health Organization (WHO), SM serves a purpose, such as the convenience of obtaining appropriate medications for conditions that do not require consultation, but such medications should be prescribed by law only if proven to be fit for the purpose.^[1] The problem is therefore inappropriate use of prescription-only medicines, which seems to be widespread.

Globally, several studies report varying levels of SM. For instance, in a Jordanian study, prevalence was as high as 98.4% while it was 92.4% in Iraq, 87.1% in Yemen, 81.3 in Serbia, 78% in Sri Lanka, 66.4%, and 54.3% in Portugal.^[2–7] In these settings, SM is influenced by age, educational level, and family attitudes, advertising of drugs by manufacturers, lack of legislation regulating dispensing and sale of drugs, previous experiences with the symptoms or disease, and significance attributed to the disease. 

In the African Continent, a systematic review involving 19 countries reported SM prevalence ranging from 12.1% to 93.9%.^[8] There is marked heterogeneity across African countries and settings, as the practice is reportedly highest (96.9%) among medical students at Sudan International University, with lower findings in other countries, including 69.4% in Nigeria, 62.9% among university students in Egypt, 61.1% among medical students at the Copperbelt University in Zambia.^[9–11] From these studies, SM is attributed to shortages of drugs at health facilities, long waiting time, long distance from health facilities, inability to pay for health care charges and the freedom to choose the preferred drugs, lack of medical professionals, poor quality of healthcare facilities, unregulated distribution of medicines and patients’ misconception about physicians, mildness of disease, familiarity with the drug and illness.

The WHO guidelines for the regulatory assessment of medicinal products for use in SM associate SM with many problems, ranging from incorrect self-diagnosis to excessively prolonged use, risk of dependence and abuse, as well as storage of medicines in incorrect conditions or beyond the recommended shelf life.^[1] This makes the practice a major public health problem. Despite several studies conducted in other settings, there is inadequate evidence on SM in South Sudan, and none has been conducted among university students. Therefore, this study aimed to assess the prevalence, commonly used medicines, and associated risk factors of SM among undergraduate students at the University of Juba.

Method

The study was conducted at the University of Juba, South Sudan’s premier university, located in Juba, the country’s administrative and economic hub. Since 1975, the university has grown and currently hosts 40,000 students across 22 Schools, 3 Institutes, and 4 specialized centres, of which 4,000 are postgraduate students. This study targeted the undergraduate students, estimated at more than 36,000.^[12]

A cross-sectional design was adopted. Primary quantitative data were collected from a convenience sample of students using a pretested structured questionnaire. Cochran’s formula was used to estimate the sample size; it assumed a confidence level of 95% and a prevalence of 50%, resulting in a sample of 384. The sampling procedure was as follows: First, the university’s natural clusters, i.e., colleges/institutes/centres, were identified. Second, the clusters were randomly selected by assigning each college a unique identifier (e.g., College 1, College 2, etc.), and students were selected via a lottery. Next, all selected students in the selected clusters were interviewed based on their presence and willingness to participate. Three teams, each consisting of two data collectors, were dispatched to the selected clusters. To participate in this study, one had to be a University of Juba student aged 18 years and above, and willing to participate.

Prevalence of SM in the last six months was the variable of interest and the dependent variable in the regression analysis. Variables recorded that could potentially affect SM included demographic factors (Age, Sex, Marital status, Residence, Religion and Year of study), social factors (peer influence, family influence, cultural beliefs, stress and social supports), economic factors (income status, employment and willingness to pay), educational factors (academic pressure, exam anxiety and workload coping mechanisms e.g. use of stimulants or relaxants), previous healthcare experiences (satisfaction with previous medical service, past adverse drug reactions and trust in medical practitioners), health system factors (distance to nearest health facility, health insurance status, cost of medical consultation, frequency of common illness and chronic disease) and medication specific factors (types of medication and frequency and dosage of medication).

Epidata Manager 4.6.0.6 and IBM SPSS 23.0 were used for quality-assured data entry and analysis, respectively. Descriptive statistics, chi-squared tests, and regression analyses were performed. At a 95% confidence limit, p-values less than or equal to 0.05 were considered significant. 

Mindful of quality assurance, we followed the approved protocol, trained enumerators in ethical data collection, and pretested the questionnaire with 10 students who did not participate in the final sample. In addition, quality checks were carried out daily, and corrective actions were taken before the next session. Ethically, this study was expected to cause minimal or no harm to the respondents since it did not involve any invasive procedures. Nevertheless, all ethical principles of autonomy, beneficence, non-maleficence, and justice were followed diligently. Institutional ethical clearance was obtained from the School of Medicine, University of Juba (Ref. SM/17/24), then from the University of Juba Administration, and informed consent was obtained from each participant prior to data collection. 

Results

Table 1 shows the relation of general characteristics of the respondents and self-medication. Of the 384 initial sample, only 84.4% (324) responded. Out of this, the modal age group (63.6%) was 23-27 years, with males being dominant (63%), and 84.9% were single. The majority (92.3%) were Christians, and only 5.2% (17) reported having a long-term illness. Around 76% (210) of single students said they practised SM, while Computing and Applied and Industrial Science have the highest proportion. 

Table 1. Relation of general characteristics of the respondents to self-medication

Analgesics (53.4%) were the main medications used for SM, followed by antimalarial medicines, with the least used being cough syrups (3.1%). Most respondents (63.6%) admitted peer influence on their decision about SM (Table 2).

Table 2. Relation of health status-related factors to self-medication

Out of 248 respondents reporting satisfaction with previous medical services, 76.2% self-medicated in the last six months preceding the study. Similarly, 75.1% of those who did not experience adverse reactions practised SM (Table 3).

Table 3. Relation of other health status factors of the respondents to self-medication

Overall, 75.6% (245) of respondents reported SM, with more than 80% of females reporting SM. Of SM users, 94.3% (231) did not have long term conditions, 96.7% (237) were non-smokers, and 92.7% (227) did not drink alcohol (Tables 1 and 2).

Factors that were significant at bivariate analysis (peer influence, sources of medication information, type of medication and self-rating of the quality of sleep) were subjected to logistic regression analysis (Table 4). Students who had good quality of sleep were significantly less likely to SM (aOR 0.22, 95% CI 0.08-0.64, p-value 0.005), as were those who got information from members of their class, rather than from a pharmacy (aOR 0.15, 95% CI 0.05-0.50, p-value 0.002). There were no other significant associations.

Discussion

This study assessed the level and associated factors of SM among the University of Juba undergraduate students, as well as the commonly used medicines. Seventy-five percent of respondents admitted engaging in SM, and this was associated with the source of information and the quality of sleep. These findings are lower than the prevalence reported by studies conducted in Sri Lanka (78%), Iraq (92.4%), Jordan (98.4%), Serbia (81.3%), and Sudan, where SM was practiced by almost the entire sample (96.9%).^[2,3,5,7,9] They are, however, higher compared to findings from studies conducted in African countries such as Nigeria (69.4%) and Egypt (62.9%).^[10] Given the estimated Global and sub-Saharan Africa antibiotic SM of 43% and 55.2%, respectively, our findings warrant particular attention, as antibiotics are among the most affected medicines in this study.^[13] In consonance with our findings, studies conducted in Ethiopia and Jordan reported analgesics at the top of the list along with antibiotics, while in India, allopathic remedies featured, a manifestation of regional preferences of medication use.^[2,14,15] 

Our study found a significant association between SM and the source of medication information and sleep quality, but no relationship with factors such as academic pressure, financial constraints, ease of access to medications, prior experience with similar illnesses, and family influence. These findings are not consistent with those from Zambia, which identified economic and social factors as key determinants of SM.^[11] A similar study among students in Uganda reported the reasons for SM as minor illness, time-saving, old prescriptions, and high consultation fees.^[16] There is a need to further investigate the specific role of peers and the effects of the high levels of SM at the university. 

Conclusion

Self-medication is widely practiced among undergraduate students at the University of Juba and involves the free use of analgesics, antibiotics, cold/influenza medications, herbal or traditional medicines, and cough syrups. The practice is significantly associated with peer influence, source of medication information, and sleep quality. The study recommends enforcing standard treatment guidelines and accurately implementing drug use plans to mitigate SM practices. An awareness intervention is also recommended at the University to address peer influence and sleep quality. 

Conflict of interest: None 

Sources of funding: None

References

1. World Health Organization. Guidelines for the regulatory assessment of medicinal products for use in self-medication. World Health Organization. 2000. World Health Organization.[cited 2025 Jul 14]; https://iris.who.int/bitstream/handle/10665/66154/WHO_EDM_QSM_00.1_eng.pdf 
2. Malak MZ, Abu Kamel AM. Self-medication Practices among University Students in Jordan. 2019; https://medic.upm.edu.my/upload/dokumen/2019060311350615_MJMHS_June_2019.pdf   
3. Al-Ameri RJK, Abd Al-Badri HJ, Lafta RK. Prevalence of self-medication among university students in Baghdad: a cross-sectional study from Iraq. East Mediterr Health J Rev Sante Mediterr Orient Al-Majallah Al-Sihhiyah Li-Sharq Al-Mutawassit 2017;23(2):87–93. https://pubmed.ncbi.nlm.nih.gov/28383097/ 
4. Mohanna M. Self-medication with Antibiotic in Children in Sana’a City, Yemen. Oman Med J 2010;25 (1):41–3. https://pmc.ncbi.nlm.nih.gov/articles/PMC3215380/  
5. Tomas Petrović A, Pavlović N, Stilinović N, Lalović N, Paut Kusturica M, Dugandžija T, et al. Self-Medication Perceptions and Practice of Medical and Pharmacy Students in Serbia. Int J Environ Res Public Health 2022;19(3):1193. https://pubmed.ncbi.nlm.nih.gov/35162213/  
6. Alves RF, Precioso J, Becoña E. Knowledge, attitudes and practice of self-medication among university students in Portugal: A cross-sectional study. Nord Alkohol- Nark NAT 2021;38(1):50–65. https://pubmed.ncbi.nlm.nih.gov/35309090/  
7. Subashini N. & Udayanga L. Demographic, socio-economic and other associated risk factors for self-medication behaviour among university students of Sri Lanka: a cross sectional study. BMC Public Health. [cited 2025 Jul 14]; https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-020-08622-8 
8. Yeika EV, Ingelbeen B, Kemah BL, Wirsiy FS, Fomengia JN, van der Sande MAB. Comparative assessment of the prevalence, practices and factors associated with self-medication with antibiotics in Africa. Trop Med Int Health 2021;26(8):862–81. 
9. Abdelmotalab M, Alhaj MMA, Eltaib MZA, Abd Alghafar MSE, Nour ASM, Ali HHM. Knowledge, Attitudes, and Practice of Self-Medication among Medical Students at Sudan International University, Sudan. AL-Kindy College Medical Journal. [cited 2025 Jul 14]; https://jkmc.uobaghdad.edu.iq/index.php/MEDICAL/article/view/873 
10. Olawuyi, A. , Ibrahim, L. and Uti, O. (2019) Self-Medication for Oral Health Problems among Dental Outpatients at a Nigerian Tertiary Hospital. Open Journal of Stomatology, 2019;9, 9-20.[cited 2025 Jul 14]; https://www.scirp.org/journal/paperinformation?paperid=89404  
11. Banda O, Vlahakis PA, Daka V, Matafwali SK. Self-medication among medical students at the Copperbelt University, Zambia: A cross-sectional study. Saudi Pharm J SPJ Off Publ Saudi Pharm Soc 2021;29(11):1233–7. 
12. Overview & Identity – University of Juba. [cited 2025 Jul 14]; Available from: https://uoj.edu.ss/overview-identity/ 
13. Gashaw T, Yadeta TA, Weldegebreal F, Demissie L, Jambo A, Assefa N. The global prevalence of antibiotic self-medication among the adult population: systematic review and meta-analysis. Syst Rev 2025;14(1):49. 
14. Zewdie S, Andargie A, Kassahun H. Self-Medication Practices among Undergraduate University Students in Northeast Ethiopia. Risk Manag Healthc Policy 2020; 13:1375–81. 
15. Juneja K, Chauhan A, Shree T, Roy P, Bardhan M, Ahmad A, et al. Self-medication prevalence and associated factors among adult population in Northern India: A community-based cross-sectional study. SAGE Open Med 2024; 12:20503121241240507.
16. Niwandinda F, Lukyamuzi EJ, Ainebyona C, Ssebunya VN, Murungi G, Atukunda EC. Patterns and Practices of Self-Medication Among Students Enrolled at Mbarara University of Science and Technology in Uganda. Integr Pharm Res Pract 2020; 9:41–8 

More from the February 2026 issue