Research Article

Prevalence and Use Pattern of Non-Steroidal Anti-Inflammatory Drugs (NSAIDS) Among Students of Niger Delta University, Amassoma, Bayelsa State

*Peter A Owonaro, Silver Peace Kpasizibe, Owonaro Daughter EA

Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy, Niger Delta University, Nigeria

Submission: May 25, 2024; Published: June 07, 2024

*Corresponding author: Peter A Owonaro, Department of Clinical Pharmacy & Pharmacy Practice, Nigeria Glob J

How to cite this article: Peter A Owonaro, Silver Peace Kpasizibe, Owonaro Daughter EA. Prevalence and Use Pattern of Non-Steroidal Anti-Inflammatory Drugs (NSAIDS) Among Students of Niger Delta University, Amassoma, Bayelsa State. Glob J Pharmaceu Sci. 2023; 11(4): 555817. DOI: 10.19080/GJPPS.2024.11.555817.

Abstract

Nonsteroidal anti-inflammatory drugs (NSAIDs) are a drug class, well known and approved for use as antipyretic, anti-inflammatory, and analgesic agents. NSAIDs have well-known adverse effects affecting the gastric mucosa, renal system, cardiovascular system, hepatic system, and hematologic system. Preliminary observations have revealed a widespread use of NSAIDs. In a bid to understand the prevalence and use pattern of NSAIDs, a quantitative cross-sectional survey was used to assess the prevalence and use pattern of 250 random students of different faculties in the university. An in-house questionnaire was developed and used to collect data, which was then analyzed by IBM SPSS version 27 and Microsoft Excel (version 2013), for descriptive statistics where mean, frequencies, p-values, and chi-squared tests were obtained respectively. The study reported the participation of more single (89.6%) female (66%) students mostly within the age range of 18 to 30 (97.6%).

Inferential statistics revealed that there is no significant association between gender and NSAID use. The study also reported that most of the respondents were residents off campus (84%) and were of the Ijaw ethnic affiliation (48.8%). The study reported that the respondents did not experience any side effects or adverse reactions from taking NSAIDs (66.4%), even when the exact signs of side effects were examined (79.20%). The study reported that the conditions that warranted the use of NSAIDs in the study environment were joint pain (74%), chest pain (68.4%), and leg pain (58.8%) followed by back pain (57.2%). The study also reported that in the event of side effects, most of the respondents never visit medical personnel or seek medical help (77.60%). Most of the NSAIDs were reported to be sometimes or always gotten from Street Medicine Vendors (30.6%), Herbal Clinic / Practitioner (30.4%), and hospitals (30%). The study reported that most of the respondents have used NSAIDs without a prescription/ recommendation from a doctor or pharmacist (62%), and do believe there should be more education about the proper use of NSAIDs (62%). They also think that it is important for healthcare providers to discuss the appropriate use of NSAIDs with their patients (62%). The respondents revealed that never usually finished the full course as prescribed NSAIDs (44.4%), but on average have confessed to having consumed NSAIDs more than three times in a year (39.2%). The most commonly used NSAIDs were reported to be Ibuprofen (77.2%), Cythotec (66.4%), Piroxicam (58.4%), Celebrex (58.4%), and Indomethacin (58.4%). These drugs were said to be mostly never taken (49.36%), and not effective (47.84%).

The study reported that respondents spend an average of ₦2000 - ₦5000 per month on NSAIDs (39.2%), take more than one NSAID at a go (51.2%) which are always easily available for use (65.6%), and may moderately affect the health of the respondents if they are not available for use (37.2%). There was a significant difference between female and male patterns of NSAID use (Χ2 = 84.02, df = 6. P≤0.0001). A similar trend was noted with ibuprofen, celecoxib, and diclofenac. The effectiveness of campus-based interventions aimed at reducing NSAID misuses, such as awareness campaigns, counseling, and services, should be evaluated and implemented; Healthcare providers should prioritize patient education and awareness of NSAIDs-related side effects; prescribing guidelines and patient education programs should be developed and implemented to promote appropriate use of NSAIDs; regulatory agencies should consider implementing stricter guidelines for use and marketing of NSAIDs.

Keywords: NSAID; Analgesic; Students; Niger Delta; Pain reliever and Bayelsa State

Abbreviations: NSAIDs: Nonsteroidal Anti-Inflammatory Drugs; COX: Cyclooxygenase; PMAQ: Pain Medication Attitude, Questionnaire; SPSS: Statistical Package for the Social Sciences

Introduction

Nonsteroidal anti-inflammatory drugs (NSAIDs) are a drug class, well known and approved for use as antipyretic, anti- inflammatory, and analgesic agents [1]. These effects make NSAIDs useful for treating muscle pain, dysmenorrhea, arthritic conditions, pyrexia, gout, and migraines, and used as opioidsparing agents in certain acute trauma cases [2-4]. NSAIDs are typically divided into groups based on their chemical structure and selectivity: acetylated salicylates (aspirin), non-acetylated salicylates (diflunisal, salsalate), propionic acids (naproxen, ibuprofen, acetic acids (diclofenac, indomethacin), enolic acids (meloxicam, piroxicam) anthranilic acids (meclofenamate, mefenamic acid), naphthylalanine (nabumetone), and selective COX-2 inhibitors (celecoxib, etoricoxib). Topical NSAIDs (diclofenac gel) are also available for use in acute tenosynovitis, ankle sprains, and soft tissue injuries [5].

The main mechanism of action of NSAIDs is the inhibition of the enzyme cyclooxygenase (COX). Cyclooxygenase is required to convert arachidonic acid into thromboxanes, prostaglandins, and prostacyclins [6]. The therapeutic effects of NSAIDs are attributed to the lack of these eicosanoids. Specifically, thromboxanes play a role in platelet adhesion, prostaglandins cause vasodilation, increase the temperature set-point in the hypothalamus, and play a role in anti-nociception. There are two cyclooxygenase isoenzymes, COX-1 and COX-2. COX-1 gets constitutively expressed in the body, and it plays a role in maintaining gastrointestinal mucosa lining, kidney function, and platelet aggregation. COX-2 is not constitutively expressed in the body; instead, it is inducibly expressed during an inflammatory response. Most of the NSAIDs are nonselective and inhibit both COX-1 and COX-2. However, COX- 2 selective NSAIDs (ex. celecoxib) only target COX-2 and therefore have a different side effect profile. Importantly, because COX-1 is the prime mediator for ensuring gastric mucosal integrity and COX-2 is mainly involved in inflammation, COX-2 selective NSAIDs should provide anti-inflammatory relief without compromising the gastric mucosa [7].

The Main Objective of the Study

This project work is aimed to assess the prevalence and pattern of use of some common NSAIDs (Celecoxib, Indomethacin, Ibuprofen, Piroxicam, Diclofenac sodium+Misoprostol), among students of Niger Delta University, Amassoma, Bayelsa State.

Methods

Study Population: Students of Niger University, Amassoma, Bayelsa State. The student community is made up of 13 Faculties, with an estimated total number of 20,000 students (Table 1).

Study Setting: The study was conducted at the Niger Delta University, Wilberforce Island, Amassoma, Bayelsa State. The University campus and environs are home to thousands of students from all parts of the country, with diverse socioeconomic, cultural, and health statuses.

Study Design: This was a cross-sectional observational study.

Research Instrument: A validated self-report questionnaire which was made available physically and online, was employed for gathering relevant information, which included patients‟ demographics, the knowledge of NSAID use and side effects, the most common NSAIDs used by the respondents, the common medical conditions for which NSAIDs are used, the manner/ context surrounding their use and the availability, affordability and the source of NSAIDs procurement. This followed a written informed consent from the participants.

Inclusion criteria

a. All students of either gender.

b. Age > 18 years.

Exclusion criteria

a. Adolescents (students who are less than 18).

b. Pregnant students.

c. Students who are unwilling to partake.

d. Allergic/ hypersensitive patients.

e. Participants involved in the pilot study.

Data Collection Tool: Self-report questionnaire or in-house questionnaire was used.

Measures

A semi-structured self-report questionnaire was designed based on the objectives of the study. The questionnaire, which was written in English, contained both “open” and “closed” -ended questions and was divided into four sections. The first section elicited responses on participants’ socio-demographics. The demographic features to be investigated were: gender, marital status, age, faculty, level, residence, and ethnicity of participants. The second section contained questions on the prevalence of NSAIDs, while the third section asked questions on the pattern of NSAID use, reflecting the most common NSAIDs used by the respondents, the common medical conditions for which NSAIDs are used, and the manner of use of NSAIDs by the participants. The fourth section requested information on the availability, affordability, and source of NSAIDs procurement. This study instrument was adapted from the short-form Pain Medication Attitude, Questionnaire (PMAQ-14) and the research tool used in the work of Owonaro et al, 2017. The PMAQ-14 tool was designed to assess prevalence, pattern, knowledge, attitude, reported side effects, misuse, and services provided towards NSAIDs prescribing and dispensing among the users. Self-report questionnaires will be designed, pre-tested, and administered after validation.

Pilot Study

A pilot study was carried out with ten (10) NSAID users and the results will be entered into the Statistical Package for the Social Sciences (SPSS) to check if the questions will elicit the right responses and could be understood. The respondents who took part in the pilot study were excluded from the actual study, to avoid any bias. Amendments were made where ambiguity was observed. Furthermore, during the pilot study, the researcher was available to give more explanations to the respondents. An average of 10 to 15 minutes was required to fill out each questionnaire.

Ethical Consideration

Ethical approval was sought from the management of Niger Delta University, Wilberforce Island, Amassoma, Bayelsa State. This was after an assurance that the confidentiality of the patients would be strictly maintained.

Sampling Calculation or Power Calculation

A sample size calculator was used to derive sample data from the total number of students in Niger Delta University, Amassoma, Bayelsa State. From the calculated sample size, a Convenience, and Voluntary response sampling technique was used to get respondents for this study from all faculties in the university, based on the population size, number of faculties, and ease of access. This population gave a statistical representation of the prevalence and use pattern of NSAIDs in Niger Delta University, Amassoma, Bayelsa State. Participants who met the inclusion criteria were allowed to fill in the questionnaires.

Sampling Techniques

From the calculated sample size, a Convenience and Voluntary response sampling technique was used to get respondents for this study from all faculties in the university, based on the population size, number of faculties, and ease of access.

Study Procedure

On the day of the study, the researcher met with the students and an introduction was made. Thereafter, the author gave a detailed explanation of what the study entails, and what was to be expected of them. The self-report questionnaires and consent forms were then provided with the study participant information sheet. The study questionnaire was distributed to the participants. On completion of the self-report questionnaire, the study tools were retrieved immediately to prevent the participants from sharing information about the study. Questionnaires were then checked to ensure the appropriate filling was done. Those who completed the questionnaire were thanked for their willingness to participate in the study. The above process lasted for a period of 20 to 35 minutes.

Data Analysis

The data generated was analyzed using Statistical Package for the Social Sciences (SPSS) version 27 and/or Microsoft Excel. The result was presented using descriptive statistics and expressed as simple percentages. Average values were presented in mean and standard deviation.

Results

Demographic characteristics of respondents

The study reported the participation of more single (89.6%) female (66%) students mostly within the age range of 18 to 30 (97.6%). The study also reported that most of the respondents were residents off campus (84%) and were of the Ijaw ethnic affiliation (48.8%). Table 2 below contains information on the above including other demographic details.

Inferential statistics can be conducted as follows, to see if there is a significant association between gender and NSAID use (yes/no).

Null Hypothesis (H0): Gender and NSAID use are independent (no association).

Alternative Hypothesis (H1): Gender and NSAID use are not independent (association exists).:

χ2 = 3.84 , df = 1, p = 0.78 and χ2 = 0.42, df = 1, P = 3.84, we fail to reject the null hypothesis (H0).

Thus, we conclude that there is no significant association between gender and NSAID use pattern

Prevalence of Non-Steroidal Anti-inflammatory Drugs

The study reported that about 70% of the respondents have consumed NSAIDs but most of them profess not to have taken NSAIDs in the past year (30.8%). They also profess to have a good knowledge of NSAIDs (27.2%) including its regimen patterns (50.57%) and that they have not experienced any side effects or adverse reactions from taking NSAIDs (66.4%), even when the exact signs of side effects were examined (79.20%). This information is contained in table 3-5 below.

The study also reported that in the event of side effects, most of the respondents never visit medical personnel or seek medical help (77.60%). Most of the NSAIDs were reported to be sometimes or always gotten from Street Medicine Vendors (30.6%), Herbal Clinic / Practitioner (30.4%), and hospitals (30%). This is contained in Table 6 & Table 7 below.

Use Pattern of NSAIDs

The study reported that most of the respondents have used NSAIDs without a prescription/ recommendation from a doctor or pharmacist (62%), and do believe there should be more education about the proper use of NSAIDs (62%). They also think that it is important for healthcare providers to discuss the appropriate use of NSAIDs with their patients (62%). The respondents revealed that never usually finish the full course as prescribed NSAIDs (44.4%), but on average have confessed to having consumed NSAIDs more than three times in a year (39.2%). This is shown in table 8 below.

The most commonly used NSAIDs were reported to be Ibuprofen (77.2%), Cythotec (66.4%), Piroxicam (58.4%), Celebrex (58.4%), and Indomethacin (58.4%). These drugs were said to be mostly never taken (49.36%), and not effective (47.84%). This is contained in table 10 below. The NSAIDs reported in this study were reported to be sometimes taken as prescribed by the health care provider (65.6%), as recommended by the chemist (79.6%), as recommended by family/friend (65.2%), and as stated on the package label (53.2%). This is contained in table 11 below. Other drugs mostly taken alongside NSAIDs, according to the study, are antimalarials (46.8%), and antibiotics (71.2%). This is contained in Table 12 below.

Availability of NSAIDs

The study reported that respondents spend an average of N2000 - N5000 per month on NSAIDs (39.2%), taken more than one NSAID at a go (51.2%) which are always easily available for use (65.6%) and may moderately affect the health of the respondents if they are not available for use (37.2%).

Discussion of Key Findings

The study found a high prevalence of NSAID Use with about 70% of respondents reporting using NSAIDs, with 30.8% using them in the past year. This is a concerning finding, as it indicates a high prevalence of NSAID use among students. This is consistent with previous studies that have reported high rates of NSAID use among young adults (Owonaro et al., 2017) [8].

Despite high usage, many respondents lacked knowledge about NSAIDs, including their regimen patterns, side effects, and interactions. Only 27.2% of respondents reported having good knowledge of NSAIDs, and 50.57% reported average knowledge. This lack of knowledge is a concern, as it can lead to inappropriate use and adverse effects. A study by Abdulla et al. [9] found that only 22% of respondents had good knowledge of NSAIDs, while 45% had average knowledge. Similarly, Gnjidic et al. (2014) reported that only 30% of respondents had good knowledge of NSAIDs; also, most respondents (62%) used NSAIDs without a prescription or recommendation from a doctor or pharmacist, and 44.4% never finished the full course as prescribed. This is a worrying finding, as it indicates a high prevalence of inappropriate NSAID use. Using NSAIDs without a prescription or medical supervision can lead to adverse effects, drug interactions, and other health problems. A study by Meara & Simon (2013) found that 60% of respondents used NSAIDs without a prescription, while 40% never finished the full course as prescribed.

The study found that joint pain, chest pain, leg pain, and back pain were the most common conditions for which NSAIDs were used. This is consistent with previous studies that have reported that NSAIDs are commonly used for musculoskeletal pain and other conditions [2,3]. A study by Dawood [2] found that 70% of respondents used NSAIDs for musculoskeletal pain, while 30% used them for other conditions. Similarly, Shekelle et al. [3] reported that 60% of respondents used NSAIDs for musculoskeletal pain, while 40% used them for other conditions. The study found that Ibuprofen, Cythotec, Piroxicam, Celebrex, and Indomethacin were the most commonly used NSAIDs, with Ibuprofen being the most widely used (77.2%). This is consistent with previous studies that have reported that Ibuprofen is one of the most commonly used NSAIDs (Owonaro et al., 2017). A study by Owonaro et al. (2017) found that 50% of respondents used Ibuprofen, while 30% used diclofenac.

Furthermore, the study found that Street Medicine Vendors (30.6%), Herbal Clinic/Practitioners (30.4%), and hospitals (30%) were the main sources of NSAIDs. This is a concern, as it indicates that many respondents are obtaining NSAIDs from unverified sources, which can lead to counterfeit or adulterated products. A study by Gnjidic et al. (2014) found that 40% of respondents obtained NSAIDs from pharmacies, while 30% obtained them from street vendors. Despite experiencing side effects, most respondents (77.60%) never visited medical personnel or sought medical help. This is a worrying finding, as it indicates that many respondents are not seeking medical attention when they experience side effects, which can lead to worsening of conditions and adverse effects. A study by Meara & Simon (2013) found that 60% of respondents experienced side effects, but only 30% sought medical help. Respondents spent an average of ₦2000-₦5000 per month on NSAIDs, which were always easily available for use (65.6%). This is a concern, as it indicates that many respondents are spending a significant amount of money on NSAIDs, which can lead to financial burdens and other health problems. A study by Farah et al. [8] found that respondents spent an average of $10- $20 per month on NSAIDs.

The study’s findings are consistent with previous studies that have reported a high prevalence of NSAID use among students and young adults (Owonaro et al., 2017) [8]. The study’s findings on limited knowledge of NSAIDs and inappropriate use also support previous studies that have highlighted the need for education and awareness campaigns to promote responsible NSAID use [9] (Gnjidic et al., 2014; Meara & Simon, 2013).

Conclusion

The study reported about 70% consumption of NSAIDs with a good knowledge of its regimen patterns (50.57%), and fewer side effects (79.20%). Respondents claim to have used NSAIDs without a prescription/ recommendation from a doctor or pharmacist (62%) but do believe that there should be more education around the proper use of NSAIDs (62%) and that it is important for healthcare providers to discuss the appropriate use of NSAIDs with their patients (62%). The respondents revealed that never usually finish the full course as prescribed NSAIDs (44.4%), but on average have confessed to having consumed NSAIDs more than three times in a year (39.2%).

The study reported that the conditions that warranted the use of NSAIDs were joint pain (74%), chest pain (68.4%), and leg pain (58.8%) followed by back pain (57.2%), of which the most commonly used NSAIDs were Ibuprofen (77.2%), Cythotec (66.4%), Piroxicam (58.4%), Celebrex (58.4%), and Indomethacin (58.4%). These drugs were said to be mostly not effective (47.84%), though sometimes taken as prescribed by a health care provider (65.6%), as recommended by the chemist (79.6%), as recommended by family/friend (65.2%), and as stated on the package label (53.2%). Other drugs mostly taken alongside NSAIDs, according to the study, are antimalarials (46.8%), and antibiotics (71.2%). The study reported that respondents spend an average of ₦2000 - ₦5000 per month on NSAIDs (39.2%), take more than one NSAID at a go (51.2%) which are always easily available for use (65.6%), and may moderately affect the health of the respondents if they are not available for use (37.2%) [10-17].

Acknowledgment

There was no conflict of interest among the authors. The researchers appreciated the statistician, participants, and researchers for the time.

Conflict of Interest

The Researchers declare that there was no conflict of interest.

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