Introduction

In December 2019, the first occurrence of a previously unknown coronavirus infection was discovered in Wuhan, China1. Due to its similarities to SARS-CoV, the novel virus was designated SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2), and the illness induced by the virus is Coronavirus Disease 2019 (COVID-19)2. The World Health Organization (WHO) declared the recent coronavirus (COVID-19) outbreak a global pandemic on March 11, 2020. The coronavirus COVID-19 has affected 220 countries and territories and has been confirmed in over 202,430,584 million people worldwide as of January 9, 2021, with over 4,290,728 million fatalities3. The COVID-19 outbreak has triggered a state of emergency in most parts of the world, leaving people with the notion that self-help, self-care, and self-medication are their only alternatives4. The World Health Organization (WHO) defines personal care as "What people do for themselves to establish and maintain health, prevent and deal with illness"5. Hygiene, diet, lifestyle, environmental factors, socioeconomic considerations, and self-medication are all aspects of self-care6. Self-medication is regarded as the use of drugs to treat self-examined illnesses or ailments, or the intermittent or continuous use of a prescription drug to treat incurable or recurring disorders or symptoms7. Self-medication is defined by the World Health Organization (WHO) as "the selection and use of medicines by individuals (or a member of the individual’s family) to treat self-recognized or self-diagnosed conditions or symptoms”8. The prevalence of self-medication has been found to be influenced by age, educational status, family attitudes, medicine manufacturer advertising, enforcement of regulations governing the dispensing and sale of drugs, prior experiences with the symptoms or disease, the significance attributed to the disease, home-stocked prescription drugs, and respondents' financial situations9. COVID-19 is spread via droplets, aerosols, fomites, contact routes, and fecal inhalation10. The rapid spread of the disease prompted country lockdowns across the globe, prohibiting international travel and, in some cases, restricting trade11. This may have hampered the supply of medications in healthcare institutions and slowed mobility, preventing individuals from seeking medical help. Delayed access to healthcare centers, sociocultural beliefs, the relatively high cost of hospital treatment, previous experience of treatment for the same symptoms, easy availability of drugs, poor regulatory practice, and the urgency of feeling relieved, along with advice from friends and the media, are all common reasons for self-medication12. Self-medication is common for a variety of reasons, including delayed access to healthcare centers, sociocultural beliefs, the comparatively high cost of hospital treatment, previous treatments for almost the same symptoms, accessibility of drugs, poor regulatory practice, and the urgency of feeling relieved, as well as recommendations from friends and the media8. Fear of Covid-19 has been discovered to be one of the most significant factors associated with the adoption of behavioral preventive measures, as well as the use of prophylactic drugs and herbal products13. People use masks, avoid crowds, reduce smoking, and practice handwashing as behavioral preventive measures14. We can define this type of preventive measure as self-care. Many studies have revealed that vitamin and mineral supplements, fexo, ordain, zinc, chloroquine, ivermectin, azithromycin, paracetamol, and vitamin D are most commonly used for preventive measures and to manage symptoms related to COVID-197. Additionally, herbal foods or items such as tea, ginger, black seed, cinnamon, garlic, lemon, black pepper, honey, clove, cardamom, bay leaf, and tulsi are used as preventive measures against COVID-1915, 16. Antiviral medications such as ribavirin, remdesivir, lopinavir/ritonavir, antibiotics including azithromycin and doxycycline, and anti-parasite treatments like ivermectin have been recommended for COVID-19 management10, 17. There is substantial evidence to suggest that people self-medicate with antibiotics like azithromycin (AZM), a macrolide that is commonly used to combat community-acquired pneumonia and sexually transmitted diseases. Antimalarials notably chloroquine (CQ) and hydroxychloroquine (HCQ), which are known to be effective in the prevention and management of COVID-19, are also frequently used for self-medication18. As a result of its abuse and misuse during the COVID-19 period, hydroxychloroquine is now in limited supply. Ivermectin is one of the medications that is misused or abused for COVID-19 self-medication19, 20. Vitamins and minerals are crucial immunostimulants and antioxidants that aid in the repair of damaged cells as well as the stimulation of healing21, 22. They are used as therapeutic agents in many diseases and disorders23. One of the most commonly self-medicated vitamins is vitamin C or ascorbic acid24. Vitamin C boosts the immune system and assists the body in fighting off foreign invaders25. Furthermore, due to its ability to improve innate and adaptive immunity during a viral infection, self-medication with additional minerals such as zinc (Zn) is being used in the prevention and treatment of COVID-19 symptoms26. In Bangladesh, Pakistan, and India, some spices including garlic, cinnamon, turmeric, ginger, black pepper, and honey have all been observed to be used as COVID-19 home remedies15, 24. There is no reliable evidence that herbal products can cure or prevent COVID-19. But they may help boost a person's immunity and keep COVID-19 symptoms at bay27, 28. When a person consumes any substance to treat an ailment without consultation with a physician, it is defined as self-medication, which can be detrimental to health because of inappropriate consumption. The present study aims to estimate the extent of self-medication among Bangladeshi people in the current COVID-19 scenario, as well as the factors that influence it.

Methods

Ethical Considerations

The research was conducted in accordance with the general principles (section 12) of the Helsinki WMA Declaration. This survey-based dissertation work is also supported by the Department of Public Health and Informatics at Jahangirnagar University. No hazardous agents were used by the human participants involved in this research, and samples were not collected from them.

Variable	Frequency	Percentage
Gender
Male	289	58.5%
Female	205	41.5%
Age
15-24	232	47.0%
25-34	169	34.2%
35-44	60	12.1%
45-54	20	4.0%
55+	13	2.6%
Education Level
High School	52	10.5%
College	105	21.3%
Honors	232	47.0%
Master's or More	105	21.3%
Family Member
<4	208	42.1
5-6	221	44.7
7+	65	13.2
Occupation
Student	293	59.3
Govt. Job Holder	43	8.7
Private Job Holder	41	8.3
Business	34	6.9
Unemployed	38	7.7
Housewife	45	9.1
Monthly Income
<10000	108	21.9
10000-20000	62	12.6
20000-30000	106	21.5
30000-40000	112	22.7
40000-50000	54	10.9
50000+	52	10.5
Having Chronic Disease
No	422	85.4%
Yes	72	14.6%

Variable	Behavioral Preventive practice		Kruskal Wallis/Mann Whitney value	P-value
	Mean	SD
Gender			2.03	0.153
Male	3.36	1.03
Female	3.57	0.70
Age			7.03	0.130
15-24	3.47	0.89
25-34	3.50	0.91
35-44	3.17	1.08
45-54	3.09	0.76
55+	3.62	0.51
Education Level			9.83	0.02
High School	3.08	1.25
College	3.33	0.997
Honors	3.53	0.79
Master's or More	3.57	0.82
Family Member			2.50	0.286
<4	3.480	0.90
5-6	3.479	0.84
7+	3.23	1.14
Occupation			15.13	0.010
Student	3.49	0.87
Govt. Job Holder	3.65	0.53
Private Job Holder	3.24	1.07
Business	2.82	1.31
Unemployed	3.53	0.98
Housewife	3.53	0.66
Monthly Income			3.44	0.633
<10000	3.50	0.83
10000-20000	3.60	1.017
20000-30000	3.44	1.024
30000-40000	3.47	0.90
40000-50000	3.40	0.81
50000+	3.50	0.85
Residence			3.75	0.04
Rural	3.30	1.09
Urban	3.55	0.74
Having Chronic Disease			.329	0.568
No	3.47	.908
Yes	3.31	.929
Terrified about Covid-19			33.34	<0.001
Never	2.66	1.396
Sometimes	3.49	0.85
Always	3.65	0.62
Covid-19 related symptom			3.72	0.054
Yes	3.37	.90
No	3.48	.92

Variable	Taken preventive medicine against Covid-19			Taken herbal products as preventive measures against Covid-19
	Adjusted Odds ratios	95% Confidence interval	P- value	Adjusted Odds ratios	95% Confidence interval	P- value
Gender
Male	Ref
Female	1.59	0.90-2.79	.108	0.37	0.18-0.75	0.006
Age
15-24	Ref
25-34	2.542	0.44-14.66	.296	.450	0.06-3.27	0.430
35-44	2.509	0.47-13.55	.285	.994	0.15-6.70	0.995
45-54	1.642	0.31-8.77	.562	1.470	0.20-10.69	0.703
55+	1.136	0.17-7.82	.897	.581	0.07-5.19	0.627
Education Level
High School	Ref
College	.470	0.17-1.28	.139	.223	0.07-0.73	0.013
Honors	.408	0.18-0.94	.036	.433	0.15-1.24	0.118
Master's or More	.455	0.22-0.94	.034	.390	0.15-1.02	0.054
Family Member
<4	Ref
5-6	.58	0.25-1.31	.187	.955	0.39-2.31	0.918
7+	.79	0.35-1.80	.580	.908	0.38-2.19	0.830
Occupation
Student	Ref
Govt. Job Holder	1.86	0.63-5.45	.259	2.758	0.77-9.93	0.121
Private Job Holder	1.68	0.44-6.37	.449	4.892	0.81-29.41	0.083
Business	1.25	0.34-4.52	.738	1.424	0.31-6.46	0.647
Unemployed	1.18	0.33-4.27	.797	1.401	0.33-5.99	0.650
Housewife	.907	0.24-3.43	.886	.664	0.15-2.89	0.586
Monthly Income
<10000	Ref
10000-20000	1.35	0.53-3.43	.530	.651	0.22-1.97	0.448
20000-30000	1.22	0.44-3.39	.700	.800	0.25-2.60	0.711
30000-40000	1.50	0.60-3.75	.385	.766	0.25-2.32	0.637
40000-50000	3.17	0.22-8.27	.018	1.457	0.44-4.74	0.532
50000+	1.10	0.39-3.06	.853	2.616	0.56-12.26	0.222
Residence
Rural	Ref
Urban	.48	0.28-0.80	.005	0.83	0.46-1.49	0.531
Having Chronic Disease
No	Ref
Yes	.72	0.31-1.67	.446	1.14	0.42-3.14	0.795
Terrified about Covid-19
Never	Ref
Sometimes	0.31	0.15-0.63	.001	0.41	0.19-0.88	0.022
Always	0.64	0.39-1.06	.081	0.68	0.38-1.23	0.210

Results

Discussion

During the COVID-19 pandemic, self-medication and self-care have become conventional practices, given the rising acceptance of home-based administration for mild and asymptomatic cases. The main findings of the study show that out of 494 participants, 58.5% were male and 47% were in the age group of 15-24. Students made up 59.3% of the participants, with 47% having at least an honors degree and 57.6% living in urban areas. 85.4% reported having no chronic diseases. We found that behavioral preventative strategies—such as washing hands (72.9%), staying at home except for essential requirements (86.8%), avoiding crowded places (89.7%), and wearing masks (95.3%)—were widely used. This was consistent with findings from many previous studies in Nigeria, Saudi Arabia, and Bangladesh30, 1, 31. Education level, occupation, residence, and being terrified about COVID-19 were significantly different from behavioral preventive practices (p<0.05), similar to a previous study in Bangladesh32. 67.8% of participants reported that they had no COVID-19-related symptoms. In our study, most participants were non-smokers (78.3%). Smoking has been linked to an increased incidence of respiratory tract infections among smokers33, and also to the progression of COVID-1934. However, many people reported an increase in smoking, which may be related to the pandemic and the heightened stress, worry, and boredom caused by the lockdown. This research shows that smoking increased by more than 1.4%, which is lower than in the previous study in Bangladesh32.

Vitamin C, vitamin supplements, paracetamol, zinc, fexofenadine, and chloroquine were used by a large proportion of the participants as preventative medications against COVID-19. Our study shows that Vitamin C was consistently used by participants at 32.8%, which is higher than the previous study in Togo (27%)35. Vitamin C plays a majestic role in boosting our immune systems23. High dosages of vitamin C have been helpful in the treatment of COVID-19 in many trials36.

In our study, education level, occupation, residence, and being terrified about COVID-19 influenced the prevalence of self-medication, similar to several studies in different countries37, 24, 9. Participants with honors and master’s degrees were most likely to take preventive medicine (p=0.03, 95% CI: 0.18-0.94; p=0.22, 95% CI: 0.022-0.94). Urban participants (p=0.005, 95% CI: 0.28-0.80) and those a little bit terrified about COVID-19 (p=0.001, 95% CI: 0.15-0.63) were most likely to take preventive medicine32.

Tea/herbal tea (60.5%), lemon (58.4%), ginger (44.6%), black seed (34.7%), and honey (24.9%) were the most commonly used by participants as preventive measures against COVID-19. Indigenous medicinal treatments are available to help strengthen a person's immunity and alleviate COVID-19 symptoms15. Gender, education level, monthly income, residence, and being terrified about COVID-19 have a significant association with taking herbal products as a preventive measure. Females were more likely to use herbal products (p=0.006, 95% CI: 0.18-0.75). Family/friends/relatives were the main sources of information for 39.4% of participants.

There are several limitations to this study. Firstly, this study employed a cross-sectional design, which makes drawing causal inferences difficult. Secondly, data was collected using self-reporting interviews rather than face-to-face interviews, which are prone to social desirability and declarative memory biases. Thirdly, an online survey with a convenience sample was distributed through the researchers' networks and various social media sites (Facebook, WhatsApp). Fourthly, vulnerable populations such as the elderly, the poor, and the illiterate were not included in this research. Consequently, the survey's scope was limited, and the results are unlikely to be representative of the general population. The exclusion of vulnerable people who may not have internet access means there is a risk of bias; thus, the survey is unlikely to provide an accurate representation of the entire Bangladeshi population. Lastly, some respondents may have selected response options at random to complete the survey quickly, or they may have looked up answers while filling out the forms. These factors were not accounted for in our research, and they could have affected the results.

Conclusions

Self-medication is a common practice in various countries around the world, where individuals use or choose medicines to treat self-identified illnesses, symptoms, or health challenges without consulting a physician. Such practices can lead to health risks, including antimicrobial resistance. In Bangladesh, self-medication is prevalent as it offers a low-cost alternative for people. This often involves the inappropriate and injudicious use of medicines to treat self-recognized symptoms. The World Health Organization (WHO) does not recommend any medicine that can act as a preventive drug for COVID-19. Nevertheless, people in different areas of the world are consuming drugs as self-medication to prevent or alleviate COVID-19 or to boost the immune system against the virus. Self-care measures, such as behavioral preventive practices and restricted use of herbal remedies, may be more beneficial than self-medication with preventative medicines in reducing the occurrence of COVID-19.

Abbreviations

AZM - Azithromycin, BDT - Bangladeshi Taka (currency), CHERRIES - Checklist for Reporting Results of Internet E-Surveys, CI - Confidence Interval, CQ - Chloroquine, COVID-19 - Coronavirus Disease 2019, HCQ - Hydroxychloroquine, OR - Odds Ratio, SARS-CoV-2 - Severe Acute Respiratory Syndrome Coronavirus 2, WHO- World Health Organization, Zn - Zinc

Acknowledgments

The authors express their sincere appreciation to all the participants who participated willingly and voluntarily in this study.

Author’s contributions

All authors read and approved the final manuscript.

Funding

None.

Availability of data and materials

Data and materials used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Ethics approval and consent to participate

The Institutional Research Ethics and Human Involvement Guidelines (Helsinki declaration) were followed in the study. The human subjects that took part in this study did not utilize any hazardous substances, nor were any samples taken from them. Additionally, the Department of Public Health and Informatics at Jahangirnagar University has supported this survey-based research.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.