A SYSTEMATIC REVIEW OF DETERMINANTS OF SELF-MEDICATION AND ANTIBIOTIC MISUSE IN LOW- AND MIDDLE-INCOME COUNTRIES
DOI:
https://doi.org/10.66811/eijrihs.vol1.no3.52Keywords:
antibiotic self-medication, antibiotic misuse, antimicrobial resistance, low- and middle-income countries, healthcare accessAbstract
Self-medication with antibiotics remains a major public health concern, particularly in low- and middle-income countries (LMICs), where it contributes to inappropriate antibiotic use and the growing burden of antimicrobial resistance. This systematic review examined the prevalence and determinants of antibiotic self-medication in LMICs by synthesising evidence from studies published between 2015 and 2025. The review was reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2020) guidance. PubMed and Google Scholar were searched using combinations of terms relating to antibiotic self-medication, misuse, determinants, predictors, developing countries and sub-Saharan Africa. Of 50 records identified, 45 remained after duplicate removal, 27 full-text articles were assessed and 20 studies met the eligibility criteria for narrative synthesis. The evidence showed that antibiotic self-medication is common but highly variable across settings, with particularly high estimates reported in several sub-Saharan African populations. The major determinants clustered around behavioural, sociodemographic and health-system factors. Behavioural influences included previous successful antibiotic use, perceiving an illness as minor, confidence in personal knowledge, advice from relatives or peers and the reuse of leftover medicines. Sociodemographic influences included education, income, age, residence and health-insurance status, although their effects were not uniform across settings. Health-system drivers included treatment costs, distance to facilities, long waiting times, poor experiences with health workers, easy access to antibiotics from drug outlets and weak enforcement of prescription regulations. The review concludes that antibiotic self-medication in LMICs is produced by an interaction between individual decision-making and structural barriers to appropriate care. Stronger regulation of antibiotic sales, improved access to affordable and responsive healthcare, community-centred antimicrobial-resistance education and better antibiotic stewardship are required to reduce the practice.
Downloads
References
Adoko, D. D., & Nakaziba, R. (2025). Antibiotic self-medication in Otuke District, Northern Uganda: Prevalence and associated factors. PLOS ONE, 20(8), e0329290. https://doi.org/10.1371/journal.pone.0329290
Ahmed, I., King, R., Akter, S., Akter, R., & Aggarwal, V. R. (2023). Determinants of antibiotic self-medication: A systematic review and meta-analysis. Research in Social and Administrative Pharmacy, 19(7), 1007–1017. https://doi.org/10.1016/j.sapharm.2023.03.009
Andersen, R. M. (1995). Revisiting the behavioral model and access to medical care: Does it matter? Journal of Health and Social Behavior, 36(1), 1–10. https://doi.org/10.2307/2137284
Antimicrobial Resistance Collaborators. (2022). Global burden of bacterial antimicrobial resistance in 2019: A systematic analysis. The Lancet, 399(10325), 629–655. https://doi.org/10.1016/S0140-6736(21)02724-0
Ayenew, W., Tessema, T. A., Anagaw, Y. K., Siraj, E. A., Zewdie, S., Simegn, W., Limenh, L. W., Tafere, C., & Yayehrad, A. T. (2024). Prevalence and predictors of self-medication with antibiotics in Ethiopia: A systematic review and meta-analysis. Antimicrobial Resistance & Infection Control, 13, Article 61. https://doi.org/10.1186/s13756-024-01417-1
Gashaw, T., Yadeta, T. A., Weldegebreal, F., Demissie, L., Jambo, A., & Assefa, N. (2025). The global prevalence of antibiotic self-medication among the adult population: Systematic review and meta-analysis. Systematic Reviews, 14, Article 49. https://doi.org/10.1186/s13643-025-02783-6
Gebregziabher, N. K., Netsereab, T. B., Franchesko, B. T., Ghebreamlak, H. H., & Yihdego, N. M. (2024). Prevalence of self-medication practices with antibiotics and associated factors among students in five colleges in Eritrea: A cross-sectional study. Antimicrobial Resistance & Infection Control, 13, Article 106. https://doi.org/10.1186/s13756-024-01466-6
Green, D. L., Keenan, K., Fredricks, K. J., Huque, S. I., Mushi, M. F., Kansiime, C., Asiimwe, B., Kiiru, J., Mshana, S. E., Neema, S., Mwanga, J. R., Kesby, M., Lynch, A. G., Worthington, H., Olamijuwon, E., Abed Al Ahad, M., Aduda, A., Njeru, J. M., Mmbaga, B. T., . . . Holden, M. T. G. (2023). The role of multidimensional poverty in antibiotic misuse: A mixed-methods study of self-medication and non-adherence in Kenya, Tanzania, and Uganda. The Lancet Global Health, 11(1), e59–e68. https://doi.org/10.1016/S2214-109X(22)00423-5
Horumpende, P. G., Said, S. H., Mazuguni, F. S., Antony, M. L., Kumburu, H. H., Sonda, T. B., Mwanziva, C. E., Mshana, S. E., Mmbaga, B. T., Kajeguka, D. C., & Chilongola, J. O. (2018). Prevalence, determinants and knowledge of antibacterial self-medication: A cross sectional study in North-eastern Tanzania. PLOS ONE, 13(10), e0206623. https://doi.org/10.1371/journal.pone.0206623
Hussain, M. A., Mohamed, A. O., Abdelkarim, O. A., Yousef, B. A., Babikir, A. A., Mirghani, M. M., Mohamed, E. A., Osman, W., Mothana, R. A., & Elhag, R. (2023). Prevalence and predictors of antibiotic self-medication in Sudan: A descriptive cross-sectional study. Antibiotics, 12(3), Article 612. https://doi.org/10.3390/antibiotics12030612
Joanna Briggs Institute. (2024). Critical appraisal tools. https://jbi.global/critical-appraisal-tools
Kapatsa, T., Lubanga, A. F., Bwanali, A. N., Harawa, G., Mudenda, S., Chipewa, P. C., Kamayani, M., Makole, T. J., Ali, A. Y., Mohamed, A. A., Youn, K. T., Kim, L., Daniel, W. D., Kim, M., Chehab, T. E., & Nyirenda, T. (2025). Behavioral and socio-economic determinants of antimicrobial resistance in sub-Saharan Africa: A systematic review. Infection and Drug Resistance, 18, 855–873. https://doi.org/10.2147/IDR.S503730
Khaddaj, R., Salameh, P., Al-Hajje, A., Bou Dib, J., Yeretezian, J., Cherfane, M., Kotb, R., Nakhoul, D., Awad, R., & Iskandar, K. (2025). Social determinants of self-medication with leftover antibiotics in Lebanese households: A cross-sectional study. PLOS ONE, 20(9), e0333377. https://doi.org/10.1371/journal.pone.0333377
Limwado, G. D., Aron, M. B., Mpinga, K., Phiri, H., Chibvunde, S., Banda, C., Ndarama, E., Walyaro, C., & Connolly, E. (2024). Prevalence of antibiotic self-medication and knowledge of antimicrobial resistance among community members in Neno District rural Malawi: A cross-sectional study. IJID Regions, 13, 100444. https://doi.org/10.1016/j.ijregi.2024.100444
Mabilika, R. J., Mpolya, E., & Shirima, G. (2022). Prevalence and predictors of self-medication with antibiotics in selected urban and rural districts of the Dodoma region, Central Tanzania: A cross-sectional study. Antimicrobial Resistance & Infection Control, 11, Article 86. https://doi.org/10.1186/s13756-022-01124-9
Makeri, D., Dilli, P. P., Pius, T., Tijani, N. A., Opeyemi, A. A., Lawan, K. A., Jakheng, S. P. E., Muhwezi, R., Shabohurira, A., Usman, I. M., & Agwu, E. (2025). The nature of self-medication in Uganda: A systematic review and meta-analysis. BMC Public Health, 25, Article 197. https://doi.org/10.1186/s12889-025-21380-9
Nakato, G., Adongo, P. R., Iramiot, J. S., & Epuitai, J. (2023). Practices and drivers of self-medication with antibiotics among undergraduate medical students in Eastern Uganda: A cross-sectional study. PLOS ONE, 18(12), e0293685. https://doi.org/10.1371/journal.pone.0293685
Ocan, M., Obuku, E. A., Bwanga, F., Akena, D., Richard, S., Ogwal-Okeng, J., & Obua, C. (2015). Household antimicrobial self-medication: A systematic review and meta-analysis of the burden, risk factors and outcomes in developing countries. BMC Public Health, 15, Article 742. https://doi.org/10.1186/s12889-015-2109-3
Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., Shamseer, L., Tetzlaff, J. M., Akl, E. A., Brennan, S. E., Chou, R., Glanville, J., Grimshaw, J. M., Hróbjartsson, A., Lalu, M. M., Li, T., Loder, E. W., Mayo-Wilson, E., McDonald, S., . . . Moher, D. (2021). The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ, 372, n71. https://doi.org/10.1136/bmj.n71
Popoola, O. O., Adepitan, D. S., Adeyemi, A. S., Oladeru, O. F., & Yusuff, S. I. (2024). A national survey of the antibiotic use, self-medication practices, and knowledge of antibiotic resistance among graduates of tertiary institutions in Nigeria. Scientific African, 23, e01978. https://doi.org/10.1016/j.sciaf.2023.e01978
Rosenstock, I. M. (1974). Historical origins of the Health Belief Model. Health Education Monographs, 2(4), 328–335. https://doi.org/10.1177/109019817400200403
Shea, B. J., Reeves, B. C., Wells, G., Thuku, M., Hamel, C., Moran, J., Moher, D., Tugwell, P., Welch, V., Kristjansson, E., & Henry, D. A. (2017). AMSTAR 2: A critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both. BMJ, 358, j4008. https://doi.org/10.1136/bmj.j4008
Simegn, W., & Moges, G. (2022). Antibiotics self-medication practice and associated factors among residents in Dessie City, Northeast Ethiopia: Community-based cross-sectional study. Patient Preference and Adherence, 16, 2159–2170. https://doi.org/10.2147/PPA.S370925
Torres, N. F., Chibi, B., Middleton, L. E., Solomon, V. P., & Mashamba-Thompson, T. P. (2019). Evidence of factors influencing self-medication with antibiotics in low- and middle-income countries: A systematic scoping review. Public Health, 168, 92–101. https://doi.org/10.1016/j.puhe.2018.11.018
Torres, N. F., Solomon, V. P., & Middleton, L. E. (2023). “Antibiotics heal all diseases”; the factors influencing the pratices of self-medication with antibiotics in Maputo City, Mozambique. Journal of Public Health, 31(1), 73–84. https://doi.org/10.1007/s10389-020-01416-7
World Health Organization. (2000). Guidelines for the regulatory assessment of medicinal products for use in self-medication. https://apps.who.int/iris/handle/10665/66154
World Health Organization. (2023). Antimicrobial resistance. https://www.who.int/news-room/fact-sheets/detail/antimicrobial-resistance
Yeika, E. V., Ingelbeen, B., Kemah, B.-L., Wirsiy, F. S., Fomengia, J. N., & van der Sande, M. A. B. (2021). Comparative assessment of the prevalence, practices and factors associated with self-medication with antibiotics in Africa. Tropical Medicine & International Health, 26(8), 862–881. https://doi.org/10.1111/tmi.13600
