Self-Medication: A Public Health Threat in Hiding in South Sudan

By Dr Thomas Akuith Ngong, Juba, South Sudan

Tuesday, 13 May 2025 (PW) — South Sudan is a nation near-drowned by a multitude of national public health threats including infectious disease outbreaks, natural disasters, emergence of noncommunicable diseases, and self-medication.  As things stand, self-medication is variably conspicuous as a public health concern in South Sudan. As a rule, the users see it as their public health right, and the national public health regulators view it as atrivial public health issue. As such, it is a “public health threat in hiding.” In other words, it is not yet popularly recognised as a public health threat.

Fatally, self-medication claimed 96, 000 lives globally between the years 2020 and 2021. This is a big death toll in just two calendar years. However, no documented epidemiological data about the prevalence and mortality rates of self-medication in both rural and urban South Sudan. This is because no scientifically valid study has ever been conducted to determine such epidemiologic statistics. Nonetheless, my educated guess is that the figures for our country could be staggering. 

To set things off, I will shed some light on the overview, contributing factors, deleterious health consequences, and some preventive strategies for self-medication. As long it is understood as a leading public health issue, its eradication is not a big deal. This is because it does not require an advanced weaponry. Above and beyond, it does not even require heavily trained healthcare personnel to wage its war. 

By definition, self-medication is the use of medicines to treat self-diagnosed diseases or symptoms.  To elaborate it further, it is obtaining and consuming drugs without a physician’s medical advice, either for diagnosis, prescription or surveillance of treatment. It is re-submitting the old prescriptions to purchase medicines in drugstores, sharing medicines with relatives or members of one’s social circles, or using the stored-at-home leftover medicines. In a lay terminology, it is called “do-it-yourself medication (DIY medication).”

The user may lack an informed understanding that our matter in question is unsafe health-wise. Medicines have to be used with a lot of wisdom and care. This is due to the fact that modern medicines become hazardous when used unsuitably. Most importantly, the best state of health is always medication-free. This is the top health secret I can share with you and your much-loved family. Instead of allowing oneself to fall sick and end up practicing DIY medication, it is remarkably medically advisable to invest in good nutrition, exercise, healthy lifestyles, and good sleep. This investment can be achieved by consulting and seeking evidence-based professional advice from medical doctors and dieticians. 

For an experienced medical doctor, not every illness necessitates the use of a medication. For instance, common cold which healthcare workers often call an upper respiratory tract infectiondoes not need a pharmacological treatment. This is because it is self-limited since it is commonly caused by viruses or allergies. It is a non-bacterial infection. Hence, its treatment does not require an antibiotic use. Circumstantially, administration of an antibiotic precipitates medical complications, prolongs the illness, and leads to the emergence of bacterial resistance in this case.

In my many professional encounters with patients and acquaintances, antibiotics are the most commonly self-medicated drug group. Those topping the list include amoxicillin, amoxicillin clavulonate, azithromycin, cefixime, benzyl penicillin, and ciprofloxacin. The users invariablyattribute any symptomology they experience to a bacterial infection. Judiciously, such antibiotics are meant for severe bacterial infections diagnosed by a medical doctor. They are not for self-assumed diseases by the laypeople. 

Self-medication occurs owing to awful lots of reasons. These reasons are diverse and context-dependent. Unequivocally, self-medication is a common practice in our societal setups regardless of personal traits. Therefore, it is a moment to lend me your ears to go through them individually. I promise that I will present them in a sweetly unambiguous manner. The listing is extensive, but I will narrow it down into five crucial reasons to minimise waste of your time. So let us dive into them in an ordinal listing as below;

First, lack of control on sale of drugs without prescription. Undeniably, when a person feels sick, he/she may decide to go to a pharmacy or drugstore, and ask for a drug that he/she assumes to relieve his/her symptom (s). A drug seller or on rare occasion, an inexperienced pharmacy technician would not hesitate to give him/her a drug of his/her order. Remember, a pharmacy technician is a dispenser and a doctor is a prescriberand the reverse is not always true. A doctor exactly knows the first-line drug for a patient’s medical condition based on his/her medical training, experience, and skills. To be clear, prescription medications are not in any way dispensed without a doctor’s prescription note in health conscious societies.

Second, poor drug regulation. In a well set-up nation where public health is one of the government’s top priorities, drugs are strictly regulated. To make the matter worse, markets of South Sudan are laden with irrational drugs banned in other countriesas well as spurious and time-expired drugs. Besides, in about 75% of retailer pharmacies in our States and Administrative Areas, drugs are sold by lay workers or self-proclaimed on-the-job trained employees. What kind of a drug does a patient expectto receive from drug sellers without basic medical pharmacology? I do not have the answer, but it is upon you to analyse, and make the best out of it. 

Third, disagreement with a doctor’s interpretation of a patient’s own medical condition. Before a patient reputes a doctor’s judgement, he/she is supposed to know that he/she is coming with a medical condition, not an economic or legal condition.Who is supposed to address such a problem? Without explanation, everyone can agree with me that it is a medical doctor. I suggest he/she should see another doctor if an element of mistrust exists between the two.

Forth, avoidance of healthcare bills. This is the commonest reason why a number of patients end up self-medicating. They fear medical bills including consultation and testing. Hence, going to pharmacy straightaway is their shortcut to getting medical treatment. Frankly, what they get there is self-treatment.Avoiding a medical doctor when one is sick is inimical to one’s health.

Fifth and the last, lack of knowledge on the adverse effects of medications. Most of the patients who self-medicate do not completely know the harmful effects of drugs they buy and use. They use drugs haphazardly and end up having another problem on top of the very problem. This is why it is important to seek medical advice and use the recommendations of a medical doctor.

Self-medication results in seriously bad health consequences as numerically discussed in the subsequent paragraphs;

Number one is delay in diagnosis. The more a person wastes time on self-medication, the more the medical problem gets worse and continues to get worse, and the person will show up in hospital with complications beyond the medical doctor’s repair.

Number two is incorrect treatment and dosage. As the real medical problem remains unidentified, the drugs gathered in abundance from the store will not solve it. The doses given will not relieve the problem. They may possibly fail to treat the underlying problem, exacerbate the problem or may insidiously hamper one’s health if administered in high dosages.

Number three is drug toxicities. Certain overdosed drugs incur harmful impact on body’s organs. To be specific, drugs having bad side-effects profile will damage the liver, kidneys or the bone marrow when self-medicated without a doctor’s prior approval. These toxicities will pose a significant ill-health.Besides, chronic drug-induced diseases are many. For example, aplastic anaemia from chronic and irrational administration of chloramphenicol; drug-induced gastritis and peptic ulcerationresulting from aspirin intake; and osteoporosis, resulting from the prolonged use of glucocorticoid drugs.

Number four is antimicrobial resistance. Irrational use of antimicrobials can result in a serious problem of antimicrobial resistance. For example, typhoid fever, which in the earlier days was easily treated with short courses of chloramphenicol, ampicillin, and cotrimoxazole. Currently with the misuse of these antibiotics, typhoid bacillus has developed resistance making such antibiotics ineffective against typhoid fever.

To prevent and eradicate self-medication, I strongly recommend some easy-to-implement strategies. These strategies are both individual-centred and government-led. They include avoidance of self-medication of prescription drugs; implementation of strict government-led pharmaceutical regulations in markets; improvement of pharmacies’ responses to patients demanding drugs without a doctor’s prescription note; and patient education on the rational use of medicines.

As a final point, self-medication is a lethal public health problem in hiding in South Sudan. It is a common practice due to a host of reasons including lack of drug regulation, patient’s avoidance of medical bills, lack of knowledge on adverse effectsof medications, among others. It adversely incurs serious health consequences on the user such as deaths from medication toxicities, antimicrobial resistance, and long-standing drug-induced disorders. It is our collective responsibility to champion absolute prevention of self-medication by changing people’s perception about drugs through health education and increased consultation with medical practitioners when one is sick.

The writer, Dr Thomas Akuith Ngong, is an opinion writer, humanitarian aid worker, and medical doctor with the Bachelor of Medicine and Bachelor of Surgery from the University of Juba. He currently lives in Kuajok, Warrap State. He is contactable on +211 928 897 336 or via thomasakuiz88@gmail.com

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