Self-medication Practices During the Covid-19 Pandemic in a Latin American Country: A Cross-sectional Survey Study

Abstract

The COVID-19 pandemic has led many people to turn to self-medication as an accessible and convenient method of managing their health. Thus, this study sought to describe the self-medication practices (SMP) and their risk factors among the Peruvian population during the COVID-19 outbreak. A cross-sectional study was conducted from January to March, 2021, in 3 cities of Peru (Lima, Ica, and Chincha). An e-survey was distributed virtually to these populations. The association among the SMP and other variables was explored using the Chi-square test and then analyzed by the Poisson regression model (step-wise). The degree of association was represented by a prevalence ratio (PR) with its respective 95% confidence interval (95% CI). A total of 2207 participants (38.86 ± 15.1 yo) were included. 70.1% (n = 1547) were women and 70.0% (n = 1544) were from Lima. The frequency of SMP among all participants was 35.93%. In the self-medicated population, the most used drugs without a prescription were ivermectin (drops, 72.01%, n = 571), paracetamol (41.24%, n = 327), and azithromycin (25.81%, n = 284). The main factors associated with SMP were living in Chincha (P < .001; PR:1.44; 95% CI: 1.26-1.65), being divorced or widowed (P = .002; PR: 1.37; 95% CI: 1.27-1.93), being an informal employee (P < .001; PR:1.45; 95% CI: 1.23-1.71), and having symptoms of SARS-CoV-2 infection with no confirmed diagnosis (P < .001; PR: 2.17; 95% CI: 1.88-2.50). Our results showed that more than a third of all our participants self-medicated themselves. The SMP was associated mainly with residing in Chincha, not having any marital status, being informally employed, and having the presence of symptoms related to COVID-19 without diagnosis.

• What do we already know about this topic

• With the COVID-19 outbreak, self-medication has become an escalating problem in the public health sector

• How does your research contribute to the field?

• With the current study, we hope to promote awareness of the risks of self-medication and the need for public health education and communication efforts to disseminate accurate information regarding COVID-19 prevention measures and healthcare-seeking behavior.

• What are your research’s implications toward theory, practice, or policy?

• People living in high-mortality regions were more likely to practice self-medication. Therefore, regional governments play a critical role in preventing the spread of misinformation regarding the treatment and prevention of future epidemiological outbreaks. In addition, Government regulations that restrict the sale of drugs to people with valid prescriptions should be improved.

Introduction

Self-medication is defined as the use of drugs to treat self-recognized symptoms or ailments without consulting a physician. ¹ This practice leads to an increase in the risk of adverse drug reaction (ADR), incorrect manner of administration, incorrect dosage, drug interaction, and failure of the treatment.^2,3 This situation worsened when COVID-19 began, especially in developing countries where the economy and healthcare services were not prepared for the Coronavirus arrival.^4,5

In March 2020, the Peruvian government adopted restrictive measures such as lockdowns and social distancing. ⁶ This limited access to healthcare services and severely impacted the informal economic sector, where remote work was not feasible. ⁷ Additionally, misinformation, ⁸ the presence of COVID-19-related symptoms, ⁹ and comorbidities that increased vulnerability to the disease ¹⁰ may have encouraged self-medication practices among the Peruvian population. Some of these cities had the highest mortality rates in the country.

Three Peruvian cities were seriously affected by COVID-19: Lima, the capital city, and Ica and Chincha, cities located in southern Peru. These cities had one of the highest mortality rates during the first years of COVID-19, ¹¹ in particular, the city of Chincha which reported a cumulative rate of 43.5 deaths per 10 000 population. ¹² Studies related to self-medication practices during the COVID-19 pandemic focused on these 3 Peruvian cities, have not been reported in scientific literature. Thus, the objective of this study was to describe the self-medication practices and their associated factors among the population of 3 cities (Lima, Ica, and Chincha) of Peru during the COVID-19 pandemic.

Methods

Study Design and Population

We conducted a cross-sectional study from January 18th to March 18th, 2021, in 3 cities in Peru (Lima, Ica, and Chincha). This timeframe coincided with the second wave of the COVID-19 pandemic in Peru, which was characterized by the highest number of cases and deaths from this disease in this population. ¹³ The reporting of this study conforms to STROBE guidelines. ¹⁴

Selection of Participants

The inclusion criteria were participants over 18 years old, who agreed to sign the informed consent, and who lived in Lima, Chincha, and Ica. Participants who did not properly complete the e-survey were excluded. Participant selection was made using nonrandom sampling for convenience.

Outcomes and Instruments

The questionnaire was designed based on a review from scientific literature, evaluating potential variables that could influence the self-medication in the Peruvian population during the COVID-19 pandemic. The questionnaire was reviewed and discussed by a committee of experts where the variables and the questions were defined. Once the variables were defined, a pilot study was carried out with 266 participants (Lima = 196, Ica = 37, and Chincha = 33) that allowed calibrating the questions of the online survey. After that, the final version of the e-survey was established.

The online survey consisted of 22 questions strategically divided into 7 sections (Table S1). In the first section, the information on the socioeconomic status of the participants was collected (age, sex, city of residence, level of education, marital status, and type of employment and salary according to the minimum wage in Peru at the moment of the e- survey’s application: S/.930.00, which is equivalent to $232.5 American dollars (exchange rate: PEN 4.0 = USD 1.0).

In the second section, information about self-medication practices during the COVID-19 pandemic (if the participant took any medication without a prescription, what medication was used, why did the participant decide to self-medicate, if the participant gave the drug without a doctor’s supervision to a relative or someone dependent on them, and where did the participant get these drugs).

In the next section, the information related to the diagnosis of COVID-19 was obtained (diagnosis of COVID-19, if they got symptoms related to COVID-19, did the participants go to hospitals and were they attended by a physician?).

The fourth section addressed the perception of the quality of healthcare services during the COVID-19 pandemic in Peru (if the participant trusted the care in health centers and the participant perceived that healthcare services were accessible). The fifth section asked about the participants’ comorbidities (if they had any comorbidity that generates vulnerability to COVID-19). In the sixth section, data was collected on exposition to information on treatments or drugs against COVID-19. The final section was the COVID-19 exposure (perception of the level of risk of contagion to COVID-19 in work environments, access to handwashing and to other preventive measures in order to reduce exposition to COVID-19).

Data Collection

The questionnaire was designed with the Google Forms tool. The e-survey was advertised on Facebook for the target population and distributed by WhatsApp among the research team’s contacts. Most of the participants were recruited through Facebook in our research. Each potential participant was free to respond or not. The e-survey was shared and announced in Spanish (official language in Peru). Finally, only the principal investigator (PI) had access to the database of the online survey. This questionnaire was applied following the Checklist for Reporting Results of Internet E-Surveys’ (CHERRIES) recommendations. ¹⁵

Statistical Analysis

The statistical analysis was carried out in 3 stages. The first stage included tabulations of the participants’ general characteristics. Quantitative variables were described in means and standard deviation, and for qualitative variables, frequency and percentage were used. In the second stage, we described the self-medication practices during the COVID-19 pandemic. The final stage explored the association between self-medication and the other variables using the Chi-square test. Then, only the variables that presented a P < .05 in the bivariate analysis (age, sex, city, education level, marital status, type of employment, salary, diagnosis, and symptoms related to COVID-19, trust in healthcare services, accessibility to hospitals, comorbidities, obesity, exposition to information on therapies and drugs to treat COVID-19, work environment risk of contagion) were considered for the Poisson regression model (step-wise). ¹⁶ We verified that the excluded non-significant variables did not make an important contribution to the multivariate analysis in the presence of the other variables according to the recommendations of Bursac et al. ¹⁷ The degree of association was represented by a prevalence ratio (PR) with its respective 95% confidence interval (95% CI). Values of P < .05 were considered as significant. Data analysis was performed using IBM SPSS Statistics for Window (version 24.0, RRID:SCR_016479).

Ethical Considerations

This research was approved by the Institutional Research Ethics Committee of the San Juan Bautista Private University (Registry No. 190-2020-CIEI-UPSJB, December 2020). The questionnaire included a previous section that provided information about the objective of the study, the anonymity of the responses, the confidentiality of data processing, the risks and benefits of participation, and the informed consent form. All participants in this study gave their informed consent to participate.

Results

Sociodemographic Characteristics of the Participants

A total of 2283 participants were enrolled. According to the selection criteria, 2207 participants were included in the study. The selection process of participants was described in Figure 1.

Figure 1.

Recruitment and selection process from 3 Peruvian’s cities during the COVID-19 pandemic.

The average age of the participants was 38.86 ± 15.1 years old (range: 18-83 years). Also, 70.1% (n = 1547) were women, 70.0% (n = 1544) were from Lima and, 50.1% (n = 1105) were single. The rest of the basal characteristics are detailed in the Table 1.

Table 1.

Socioeconomic Status of Participants in the 3 Cities of Peru During the COVID-19 Pandemic.

Characteristics	n	%
Age
Average ± SD	38.8 ± 15.1
<60 years	1948	88.3
≥60 years	258	11.7
Sex
Male	660	29.9
Female	1547	70.1
City
Lima	1544	70.0
Ica	363	16.4
Chincha	300	13.6
Education level
University	1616	73.2
Technician	336	15.2
Completed schooling	212	9.6
Incomplete schooling	43	1.9
Marital status
Single	1105	50.1
Cohabiting	736	33.3
Married	213	9.7
Divorced	40	1.8
Widowed	113	5.1
Type of employment
Formal	1246	57.3
Informal	203	9.2
Unemployed	316	14.3
Other	424	19.2
Salary, according to minimum wage a
More to $ 930	418	18.9
More to $ 232.5 until $ 930	699	31.7
Less or equal to $ 232.5	1090	49.4

Note. ^aMinimum wage in Peru was s/. 930.00 and it was converted to its equivalent in American Dollars: $ 232.5 (exchange rate: 4.00).

SD = standard deviation.

Self-medication Practices During COVID-19

A total of 793 (35.93%) participants have used a drug without medical advice during the COVID-19 pandemic. The frequency of self-medication was similar in the population of Lima (33.81%, n = 522), Ica (34.4%, n = 125), and Chincha (48.67%, n = 146).

Among the population who self-medicated, the 5 most used drugs without a prescription were ivermectin (drops presentation, 72.01%, n = 571), paracetamol (41.24%, n = 327), azithromycin (25.81%, n = 284), Vitamin C (26.61%, n=211), and dexamethasone (14.0%, n = 111). The complete drug list used without a prescription is described in Table S2. The participants’ self-medication practices are described in detail in Figure 2.

Figure 2.

Self-medication practices among inhabitants from 3 Peruvian’s cities during the COVID-19 pandemic.

COVID-19 Diagnosis, Perception About Healthcare Services During the Pandemic, and Other Variables

19.4% (n = 428) of the total participants were diagnosed positive for COVID-19. Other participants reported having had symptoms related to COVID-19, but with negative diagnosis (5.6%, n = 124) or not having taken the diagnostic test (9.3%, n = 206). Curiously, from the participants who reported symptoms (n = 758), only 59.0% (n = 447) were attended by a doctor and 29.9% (n = 227) went to a health center.

Regarding the perception of health centers during the COVID-19 pandemic, it was found that 73.1% (n = 1613) of the participants trusted health care centers in Peru. On the other hand, 83.1% (n = 1834) stated that healthcare services were not accessible during the COVID-19 pandemic.

Some participants, around 42.5% (n = 939), answered they had at least one comorbidity, with the most frequent being obesity (14.1%, n = 310) and asthma (9.4%, n = 208). Furthermore, most of the participants (90.0%, n = 1985) replied they always/almost always had been exposed to information about therapies or drugs to treat COVID-19.

In addition, it was found that 42.0% (n = 926) of all participants mentioned they had a low risk of contagion COVID-19 in their work environments. Finally, 2162 (98.0%) and 2183 (98.9%) participants reported they had had access to handwashing and to other preventive measures (masks, facial protector, others) to reduce the exposition to COVID, respectively. All these variables are described in the Table 2.

Table 2.

COVID-19 Diagnosis, Perception About Healthcare Services During Pandemic, and Other Variables.

Characteristics	n	%
COVID-19 diagnosis
Diagnosis and symptoms related to COVID-19
Neg. Dx + NS	1449	65.7
No Dx + S	206	9.3
Neg. Dx + S	124	5.6
Pos. D + S	428	19.4
When you got the symptoms, did you go to a hospital? a
Yes	227	29.9
No	481	63.5
No response	50	6.6
When you got the symptoms, were you attended by a physician? a
Yes	447	58.9
No	311	41.1
Perception of the healthcare services during
The participant trusted the healthcare services during the COVID-19 pandemic
Yes	1613	73.1
No	594	26.9
Participant considered that hospitals were accessible during the pandemic
Yes	373	16.9
No	1834	83.1
Comorbidities
Presence of comorbidities
Yes	939	42.5
No	1268	57.5
Obesity
Yes	310	14.1
No	1897	85.9
Asthma
Yes	208	9.4
No	1999	90.6
Arterial hypertension
Yes	198	8.9
No	2009	91.1
Diabetes
Yes	103	4.7
No	2104	95.3
Other diseases
Yes	380	17.2
No	1827	82.8
Exposition to information about possible treatments for COVID-19
Frequency to exposition to information about possible treatments for COVID-19
Always	1204	54.6
Almost always	781	35.4
Sometimes	162	7.3
Hardly ever	46	2.1
Never	14	0.6
Exposition to COVID-19
Perception of the level of risk of contagion to COVID-19 in their work environments.	1
No risk	501	22.7
Low risk	926	42.0
High risk	780	35.3
Access to handwashing during COVID-19 pandemic
Yes	2162	98.0
No	45	2.0
Access to other preventive measures to reduce the exposition to COVID-19 (masks, facial protector, others)
Yes	2183	98.9
No	24	1.1

S = presented symptoms related to COVID-19; NS = no presented symptoms related to COVID-19; Neg. Dx = negative diagnosis; No Dx = without diagnosis; Pos. DX = positive diagnosis.

^aThese variables were calculated for the participants who reported having had symptoms related to COVID-19 (n = 758).

Factors Associated With Self-medication for COVID-19

Bivariate analysis was used to explore potential risk factors associated to self-medication practices among participants. All variables with significant association (P < .05) were included in a logistic regression analysis. We found that being female was a protective factor (aPR: 0.88; 95% CI: 0.78-0.99), but residing in Chincha (aPR: 1.50; 95% CI: 1.30-1.71), being married/cohabiting (aPR: 1.28; 95% CI: 1.14-1.45), being divorced/widowed (aPR: 1.57; 95% CI: 1.27-1.93), being an informal employee (aPR: 1.24; 95%; CI: 1.05-1.47), having symptoms related to COVID-19 with no diagnosis (aPR: 2.03; 95% CI: 1.75-2.34), negative diagnosis (aPR: 1.97; 95% CI: 1.63-2.38), and positive diagnosis (aPR: 1.74; 95% CI: 1.52-1.98), not trusting the healthcare services (aPR: 1.23; 95% CI: 1.10-1.37); considering that hospitals were not accessible during COVID-19 pandemic (aPR: 1.31; 95% CI: 1.10-1.55) and never having been exposed to information about therapies and drugs to treat COVID-19 (aPR: 1.72; 95% CI: 1.17-2.55) were risk factors of self-medication among the participants. These analyses were described in detail in Table 3.

Table 3.

Variables Associated With Self-medication Practices in Inhabitants From 3 Cities of Peru During the COVID-19 Pandemic by the Bivariate and Logistic Regression Analysis.

Characteristics	No (n = 1414)		Yes (n = 793)		PR	95% CI	P	aPR	95% CI	P
	n	%	n	%
Age
<60 years	1232	63.2	716	36.8	Ref.			Ref.
≥60 years	181	70.2	77	29.8	0.81	0.67-0.99	.037	0.82	0.67-1.00	.052
Sex
Male	413	62.6	247	37.4	Ref.			Ref.
Female	1001	64.7	546	35.3	0.94	0.84-1.06	.337	0.88	0.78-0.99	.032
City
Lima	1022	66.2	522	33.8	Ref.			Ref.
Chincha	154	51.3	146	48.7	1.44	1.26-1-65	<.001	1.50	1.30-1.71	<.001
Ica	238	65.6	125	34.4	1.02	0.87-1.19	.82	1.09	0.93-1.28	.27
Education level
University	1078	66.7	538	33.3	Ref.			Ref.
Technician	197	58.6	139	41.4	1.24	1.08-1.44	.003	1.01	0.87-1.18	.86
Completed schooling	114	53.8	98	46.2	1.39	1.18-1.63	<.001	1.06	0.90-1.25	.51
Incomplete schooling	25	58.1	18	41.9	1.26	0.88-1.80	.211	1.04	0.75-1.43	.83
Marital status
Single	751	68.0	354	32.0	Ref.			Ref.
Married/Cohabiting	577	60.8	372	39.2	1.22	1.14-1.45	.001	1.28	1.14-1.45	<.001
Divorced/Widowed	86	50.0	86	50.0	1.37	1.27-1.93	.002	1.57	1.27-1.93	<.001
Type of employment
Formal	847	67.0	417	32.9	Ref.			Ref.
Informal	106	52.2	97	47.8	1.45	1.23-1.71	<.001	1.24	1.05-1.47	.013
Unemployed/Other	461	62.3	279	37.7	1.14	1.01-1.29	.031	1.09	0.95-1.26	.216
Salary
More to $ 930	295	70.6	123	29.4	Ref.			Ref.
More to $ 232.5 until $ 930	465	66.5	234	33.5	1.14	0.95-1.36	.164	1.05	0.88-1.26	.605
Less or equal to $ 232.5	654	60.0	436	40.0	1.36	1.15-1.60	<.001	1.17	0.97-1.42	.107
Diagnosis and symptoms related to COVID-19
Neg. Dx + NS	1053	72.7	396	27.3	Ref.			Ref.
No Dx + S	84	40.8	122	59.2	2.17	1.88-2.50	<.001	2.03	1.75-2.34	<.001
Neg. Dx + S	58	46.8	66	53.2	1.95	1.62-3.24	<.001	1.97	1.63-2.38	<.001
Pos. D + S	219	51.2	209	48.8	1.79	1.57-2.03	<.001	1.74	1.52-1.98	<.001
The Participant trusted the healthcare services during the COVID-19 pandemic
Yes	1085	67.3	528	32.7	Ref.			Ref.
No	329	55.4	265	44.6	1.36	1.22-1.53	<.001	1.23	1.10-137	<.001
Participant considered that hospitals were accessible during the pandemic
Yes	271	72.6	102	27.4	Ref.			Ref.
No	1143	62.3	691	37.7	1.38	1.16-1.64	<.001	1.31	1.10-155	.002
Presence of comorbidities
Yes	589	62.7	350	37.3	Ref.			Ref.
No	825	65.1	443	34.9	1.07	0.95-1.19	.257	1.03	0.91-1.17	.606
Obesity
Yes	180	58.1	130	41.9	Ref.			Ref.
No	1234	65.1	663	34.9	1.20	1.04-1.39	.014	1.04	0.89-1.23	.600
Asthma
Yes	130	62.5	78	37.5	Ref.
No	1284	64.2	715	35.8	1.05	0.87-1.26	.616
Arterial hypertension
Yes	121	61.1	77	38.9	Ref.
No	1293	64.4	716	35.7	1.09	0.91-1.31	.353
Frequency to exposition to information about therapies and drugs to treat COVID-19
Always	781	64.9	423	35.1	Ref.			Ref.
Almost always	492	63.0	289	37.0	1.05	0.93-1.19	.395	1,05	0.93-1.17	.424
Sometimes	107	66.1	55	33.9	0.97	0.77-1.21	.769	0.99	0.79-1.24	.946
Hardly ever	29	63.1	17	36.9	1.05	0.72-1.55	.797	0.89	0.61-1.31	.565
Never	5	35.7	9	64.3	1.83	1.23-2.72	.003	1.72	1.17-2.55	.006
Perception of the level of risk of contagion to COVID-19 in their work environments.
No risk	331	66.1	170	33.9	Ref.			Ref.
Low risk	612	66.1	314	33.9	1.00	0.86-1.16	.993	0.99	0.86-1.14	.894
High risk	471	60.4	309	39.6	1.17	1.01-1.36	.043	1.08	0.93-1.25	.295
Access to handwashing during COVID-19 pandemic
Yes	1388	64.2	774	35.8	Ref.			.
No	26	57.8	19	42.2	1.18	0.83-1.67	.351
Access to other preventive measures to reduce the exposition to COVID-19 (masks, facial protector, others)
Yes	1398	64.1	785	35.9	Ref.			.
No	16	66.7	8	33.3	0.93	0.52-1.64	.794

Note. Minimum wage in Peru was s/. 930.00 and it was converted to its equivalent in American Dollars: $ 232.5 (exchange rate: 4.00).

PR = prevalence rate; aPR = adjusted prevalence rate; CI = confidence interval; Ref = reference; S = presented symptoms related to COVID-19; NS = no presented symptoms related to COVID-19; Neg. Dx = negative diagnosis; No Dx = without diagnosis; Pos. DX = positive diagnosis.

Discussion

In this study, we aimed to describe the self-medication practices and their associated factors in the Peruvian population during the COVID-19 pandemic. We found a high prevalence of self-medication during this period, with the main factors associated with these practices being residence in the Chincha region, marital status (married/cohabiting or divorced/widowed), informal employment, experiencing COVID-19 symptoms without a formal diagnosis, distrust of the healthcare system, and lack of exposure to information about COVID-19 treatments. Self-medication was a widespread practice during the COVID-19 pandemic globally.^5,18 A systematic review by Kazemioula et al, ⁵ reported a self-medication prevalence of 48.6%. In our study, 35.93% of participants engaged in self-medication, a rate similar to another study on the general Peruvian population, which reported 34.4%. ¹⁹ However, this contrasts with findings from studies focusing on hospitalized patients (54.8%) ²⁰ and the student population (14.5%) ²¹ in Peru.

The frequency of self-medication was notably higher among participants from Chincha (48.7%) compared to those from Lima (33.8%) and Ica (34.4%). It can be explained because Chincha showed a critical mortality rate during the COVID-19 pandemic in comparison to other Peruvian subpopulations, ¹² and this situation could encourage in the inhabitants to self-medicate.^22,23 On the other hand, despite our study was conducted during a period with the highest COVID-19 mortality rate, our results suggest that the frequency of self-medication practices did not vary significantly across the different waves of the COVID-19 pandemic in Peru. ¹⁹

One of the strengths of this study was the detailed description of self-medication practices among participants. As expected, the most commonly self-medicated drugs were ivermectin (drops), paracetamol, and azithromycin, similar to other studies.^{19 -21} While paracetamol is an over-the-counter (OTC) medication with relatively safe use, ivermectin (drops) and azithromycin require a medical prescription and should be used under healthcare provider supervision. The majority of participants likely self-medicated due to poor access to quality healthcare services. ²⁴ Indeed, we found that participants who did not trust the healthcare system or perceived hospitals as inaccessible during the pandemic were more likely to self-medicate. Widespread distrust and limited access to healthcare were prevalent globally during the COVID-19 pandemic, ²⁵ factors that significantly contributed to Peru’s high COVID-19 mortality rate. ²⁶ Given this context, it is understandable that study participants who expressed distrust or perceived the Peruvian healthcare system as inaccessible were more likely to engage in self-medication practices.^27,28

In the question “Did you give this drug to a relative or dependent of yours?,” our findings indicate that the most frequent population that received these self-medicated drugs were “other adults.” However, we also observed that vulnerable populations were exposed to self-medication practices. Exposure to medication without a prescription could lead to irreversible adverse effects and serious health complications for these individuals. ²⁹

In response to the question, “Where did you obtain this drug?,” participants indicated that they primarily sourced these medications from pharmacies and drugstores, which were more accessible than other healthcare facilities in Peru. ²⁴ Previous studies have also identified pharmacies and drugstores as major sources of medication during the pandemic.^{30 -32} This trend may be explained by the population’s desire to avoid healthcare facilities, the proximity and convenience of pharmacies, and the affordability of the medications.^33,34

In our study, being female was a protective factor against self-medication practices. This outcome is similar to another study focused on the Peruvian population. ²⁰ In contrast, other studies carried out in Togo, ³⁵ Mexico,^10,36 and Jordan ³⁷ found that this variable was a risk factor for self-medication practices during the COVID-19 pandemic. The difference between results may be due to social factors, such as gender roles, that influence healthcare-seeking behavior. ³⁸

Living in the city of Chincha was another risk factor for self-medication. As previously mentioned, this city was severely impacted by COVID-19, with one of the highest mortality rates in Peru. ¹² This situation may have contributed to widespread panic and confusion, driving self-medication practices among the population. Additionally, we found that marital status and type of employment were also linked to self-medication. Individuals in these groups likely faced a higher risk of exposure to COVID-19. Those with family responsibilities were particularly vulnerable due to household dynamics, caregiving duties, and financial pressures.^39,40 Meanwhile, individuals with informal jobs had limited opportunities to work remotely or comply with lockdown measures, as they needed to secure a daily income.^7,41

As expected, participants with symptoms related with COVID-19 showed a higher risk to self-medication regardless of whether they had had a confirmatory diagnosis or not. Some drugs could be useful to treat some symptoms, such as paracetamol for fever; however, the consumption of other drugs such as ivermectin or hydroxychloroquine without medical supervision, or substances without health registration, for example, chlorine dioxide, could also have negative impacts on the participants because the false sense of safety could delay the decision to go to a health center to receive adequate treatment. Other studies have also reported the significant association between symptoms related to COVID-19 and self-medication.^9,19,42 One of the strengths of this study was the detailed description of self-medication practices among participants. As anticipated, the most commonly self-medicated drugs were ivermectin (drops), paracetamol, and azithromycin, consistent with findings from other studies.^{19 -21} While paracetamol is an over-the-counter (OTC) medication with relatively safe usage, ivermectin (drops) and azithromycin require medical prescriptions and should be used under the supervision of healthcare professionals. It is likely that many participants self-medicated due to limited access to quality healthcare services. ²⁴ Indeed, we found that participants who distrusted the healthcare system or perceived hospitals as inaccessible during the pandemic were more inclined to self-medicate. Globally, distrust and restricted access to healthcare were prevalent during the COVID-19 pandemic, ²⁵ contributing significantly to Peru’s high COVID-19 mortality rate. ²⁶ Given this context, it is understandable that participants who expressed distrust or found the Peruvian healthcare system inaccessible were more prone to self-medication practices.^27,28

Finally, we found that participants who reported never having heard about therapies or drugs to treat COVID-19 had a higher risk of self-medication compared to those who were regularly exposed to this type of information. However, this association should be interpreted with caution, as the relationship may be bidirectional—self-medication might reduce the likelihood of seeking or receiving information about available treatments. Furthermore, the number of participants who reported never hearing about therapies or drugs for COVID-19 was relatively small, which may limit the generalizability of this finding.

Limitations

A limitation of this study was the potential for selection bias due to social distancing measures, as only individuals with internet access could respond to the questionnaire. Since participation was open, it was not possible to calculate the total number of people contacted, so only the number of respondents was reported. Additionally, the use of convenience sampling limits the generalizability of the findings to the broader Peruvian population, and no formal sample size calculation was performed. Lastly, the online survey did not have a mechanism to detect duplicate responses, and the study design does not allow for the determination of causal relationships.

Conclusions

In conclusion, our results showed that more than a third of all our participants self-medicated. The most consumed drugs were ivermectin (in drops), azithromycin and paracetamol. The practice of self-medication was associated with residing in Chincha, being single, being informally employed, having symptoms related to COVID-19; as well as distrust and perception about the inaccessible health system during the COVID-19 pandemic in Peru. Likewise, this study highlights the need to enhance public health education, improve access to the healthcare system, and strengthen the training of healthcare professionals to mitigate self-medication practices, especially during catastrophic events like the COVID-19 pandemic.