1. Introduction
Self-medication is the most important health issue in developing countries like India. Even though there is abundant healthcare available, self-medication is still chosen by patients. The prevalence of self-medication practices is influenced by various circumstances, including the person’s educational background and the lack of access to expert doctors while traveling. Self-medication does indeed have a strong tradition and long before the development of the specialized profession of doctors, human beings had already been treating themselves. It is believed to be a rapid, convenient, and instant source of relief for a person. Unfortunately, it can lead to unfavourable outcomes such as adverse drug responses, drug misuse, and antimicrobial resistance. Self-medication which is not regulated can cause problems not only for the persons but also for the communities. Researchers have discovered that its incidence in India varies significantly, ranging from 31% in 1997 to 53.57% in 2020 [1]. Although the fishermen’s community receives free health care, they prefer self-medication since it saves their time and dignity. There has never been a community-based study on the factors that cause self-medication practices and adverse drug reactions among fishermen, and the present study is the first of its type. 

Objectives
The followings are the present study’s objectives: 
● To estimate the prevalence of self-medication practices among the fisherman population in the urban area of Puducherry
● To determine the factors influencing the self-medication practices among the fisherman population in the urban area of Puducherry

2. Methods
Participants, study setting and sample size
A cross-sectional study was performed in the Urban field practice areas of Aarupadai Veedu Medical College and Hospital in Puducherry from July 2021 to December 2021. The sample size was estimated to be 370 using the 4pq/d2 formula where P shows a prevalence of 71% and precision of 5% obtained from a previous study by Balamurugan et al. [2] substituting the formula. After considering an anticipated 10% non-response rate, finally, the sample size was considered 370. Our urban training health center maintains a house list of the fisherman population. Three villages inhabited by a fisherman population were selected through simple random sampling covering a population of about 6204. 

Inclusion criteria
The inclusion criteria were fishermen with an age limit above 18 years (both men and women) residing in our study area and their willingness to participate in this study.

Exclusion criteria
The participants with communication problems, severe illness, immobilized patients, psychiatric or mentally challenged patients, and those not consenting to participate in this study. ​
A semi-structured questionnaire was used to collect data on sociodemographic characteristics such as age, gender, education, occupation, income, and self-medication patterns such as frequency, sources, reasons, side effects, and storage. Institutional Ethical Committee approval was obtained. The questionnaire was incorporated into a google form. After obtaining the informed consent, data was gathered through interviews with the senior members of the households who were present at the time of the visit, following the standard COVID precautions. The data was entered into SPSS software, version 28, and the analysis was carried out using proportions and the chi-square test. Statistical significance was considered P<0.05.

3. Results
The results showed that most of the participants (77.8%) were in the age group of 30-60 years. In total, 57% were male and 43% were female. The prevalence of self-medication was 67%. Among those who were practicing self-medication, 49.39% were male and 50.6% were female. The prevalence was found to be more among men than women. The majority of respondents were graduate or postgraduate (35.4%) followed by high school certificates (32.7%). The lowest number of participants were professionals or middle school certificates (2.7%). The prevalence of self-medication was found more among the graduate or postgraduates (37.6%). Most of the respondents were in the socio-economic status of Class III (39.5%) (modified BG Prasad classification, 2021) followed by class IV (20.3%) with the lowest number of participants in class I (9.5%). The prevalence of self-medication was found more among class III (42.5%). Most of the respondents were unemployed (42.7%) followed by skilled workers (22.2%). The prevalence of self-medication was found more among the unemployed fishermen (47.7%). The majority of study participants preferred government hospitals for their health ailments followed by private hospitals and clinics, but their relationship with self-medication practice was not statistically significant (P=0.994) (Table 1).

The relationship between sociodemographic factors and self-medication practices was statistically significant (P<0.05).
Table 2 shows that allopathic drugs were the most common mode of self-medication (84.6%).

The main source of information for self-medication was pharmacists (55.8%). The most common reason for self-medication was the easy availability of medicines in medical stores (63.1%) followed by saving time (25.5%). The most common conditions for self-medication practices were cough, cold, flu, and headache (31.9%) followed by myalgia (21.05%), fever (13.3%), and sore throat (1.6%). The majority of the population (82.5%) took self-medication only when there were similar complaints as in the past, while 6.8% indulged in regular self-medication practice. Only 17% of the respondents knew the dose and duration, 4.04% of the participants knew about the knowledge of side effects of self-medication practice, 42.9% checked the expiry date of the drug before usage and only 2.8% knew about the various drugs interactions they were using as self-medication, while 33.1% of the respondents did not know at all. About 12.1% of the study participants reported various side effects due to self-medication practice. Respondent’s knowledge of the above parameters was triggered by asking direct questions or indirectly enquiring about drug use in sub-therapeutic dosages for an inadequate period, overuse of drugs, use of drugs with the potential to aggravate the existing pathology or concomitant drug use with potential interactions. 

4. Discussion
We found that about 67% of the participants followed self-medication practices which is very high despite the various healthcare facilities and access to healthcare facilities compared to the study done by Selvaraj et al. [3] who showed the prevalence of self-medication for 11.9% in Puducherry’s urban field practice. Our study found that women have a greater prevalence rate than men, which is similar to the previous study done in Puducherry by Priyan [4]. Our study reported a high prevalence of self-medication among graduate or postgraduates and unemployed people which is similar to a previous study by Priyan et al. [4]. Various studies have indicated that the respondent’s education and occupation are the most important factors influencing their self-medication behaviour. This study showed a higher prevalence rate in the lower middle socioeconomic class. This could be due to high OPD consultation fees. In our study, the most common type of self-medication was allopathic medications (84.6%). 
Similar findings were found in a study conducted among the elderly in Amravati by Jawarkar et al. [5] where allopathic medications were used among 95% of the participants. These variations in the prevalence of self-medication from our study to other studies might be due to differences in methodology, socioeconomic, and demographic characteristics among regions, despite the consistent patterns of drug use and factors influencing self-medication. The most important source of information in our study was pharmacists who identified about 55.8%. Similarly, the study by Jawarkar et al. [5], Varadarajan et al. [6], and Taklikar et al. [7] reported this information source for 89%, 58%, and 59% respectively and stated that every consumer who approaches a pharmacy purchases medications without a prescription. Whereas, in a study conducted in a rural area by Kumar et al. [8] friends, family, and neighbours composed 32% of sources of information regarding self-medication practices. Self-medication was chosen mostly due to the nature of mild sickness, cost savings, as well as a lack of time. 
Over the last two decades, the pharmacists’ position has evolved and they are no longer merely providers of medicines or discoveries of pharmaceutical drugs. They are now a part of a healthcare team, whether in clinics, local pharmacies, laboratories, industrial, or educational establishments. The most common reason for self-medication in our study was the easy availability of medication in medical stores (63.1%), followed by time savings (25.5%) with financial constraints as the least reason (6.4%). Similar to a study by Jawarkar et al. [5], easy access to drugs from medical pharmacies was the most common reason for self-medication (45.75%), and also the study by Varadarajan et al. [6] that indicated financial limitations as the most common factor for self-medication (40.8%). In this study, the most common condition of self-medication was coughing, cold, flu, and headache accounting for 31.9 % followed by myalgia for 21.05%, and sore throat for 1.6%. Similar to studies by Taklikar et al. [7], Jawarkar et al. [5], Varadarajan et al. [6] , Kumar et al. [8], the most common conditions of self-medication were coughing, common cold, myalgia, and fever. In our study, 12.01% of side effects of self-medication were observed, which is lower than the 21.13% found in a study conducted in Pune by Keche et al. [9]. Patients’ selections on allopathic medicine and supplementary pharmaceuticals used for self-medication are essential to know because easily accessible drugs are risks to the people. Self-medication has become a scary thing due to the availability of potentially dangerous medications for the majority of people uninformed of the dangers of taking painkillers and other medications at the same time. As a result, all healthcare professionals must step up their efforts to educate and counsel people on how to use medications safely and appropriately.

5. Conclusion
Self-medication practice was prevalent among 67% of urban fishermen in Puducherry. Majority of the people use self-medication for acute illness, in case of seeking emergency hospital services. The awareness of health hazards, drug resistance in prolonged self-medication practice, and regulation of pharmacies limit self-medication.

Limitations
Our study was conducted on a fishermen population in the urban area of Puducherry. Our findings, however, are not generalizable to other states in India and other countries due to differences in socioeconomics, health-seeking behaviours, and pharmacy sales procedures. 

Recommendations
Puducherry’s governing agencies are required to classify medications regularly according to their safety to implement stricter rules. Consumers should have access to information about each drug and be informed of the risks associated with self-medication practices. Self-medication must be addressed by the Ministry of Health and Family Welfare to make the expenses of a private doctor’s consultation affordable and acceptable to the public. To achieve universal health coverage, efforts should be taken to expand health insurance services. 

Ethical Considerations
Compliance with ethical guidelines
The research was started after obtaining Institute Ethics Committee clearance (Code: AV/IEC/2021/015) and written informed consent was obtained before collecting information from the participants. The privacy and confidentiality of our study participants were secured (Research Code: RR-015). 

Funding
This research did not receive any grant from funding agencies in the public, commercial, or non-profit sectors.

Authors' contributions
All authors equally contributed to preparing this article.

Conflict of interest
The authors declare no conflict of interest. 

Acknowledgments
We would like to thank the participants of the study and co-authors, my colleagues, my assistant professor, department of community medicine, and Aarupadai Veedu Medical College and Hospital for their keen interest, encouragement, and collective comments during the study period. I also extend my thanks to the healthcare workers for their complete cooperation. 


Reference

1. Rashid M, Chhabra M, Kashyap A, Undela K, Gudi SK. Prevalence and predictors of self-medication practices in India: A systematic literature review and meta-analysis. Curr Clin Pharmacol. 2020; 15(2):90-101. [DOI:10.2174/1574884714666191122103953] [PMID] [PMCID]
2. Balamurugan E, Ganesh K. Prevalence and pattern of self medication use in coastal regions of South India. Br J Med Pract. 2011; 4(3):a428. ^[Link]
3. Selvaraj K, Kumar SG, Ramalingam A. Prevalence of self-medication practices and its associated factors in Urban Puducherry, India. Perspect Clin Res. 2014; 5(1):32-6. [DOI:10.4103/2229-3485.124569] [PMID] [PMCID]
4. Shanmuga Priyan M, Maharani B, Lourdu Jafrin A, Chavada VK, Sivagnanam G, Student M, et al. Self-medication practices among residents of Puducherry: A cross sectional questionnaire-based survey. Indian J Pharm Pharmacol. 2017; 4(4):168-71. ^{[10.18231/2393-9087.2017.0036]}
5. Jawarkar AK, Wasnik VR, K A. Self-medication practices amongst elderly population in an urban health center of Amravati District of Maharashtra, India. J Indian Acad Geriatr. 2017; 13(3):118-23. [DOI:10.35262/jiag.v13i3.118-123]
6. Varadarajan V, Paul CM, Swapna S, Preethi S, Kumar K, Dharshini DPU. A cross sectional study on the prevalence of self-medication in a Chennai based population, Tamil Nadu, India. Int J Community Med Public Health. 2017; 4(2):418. [DOI:10.18203/2394-6040.ijcmph20170265]
7. Taklikar CS, Dobe M. A cross sectional study on self-medication practices among a selected rural community of Hooghly district, West Bengal. Int J Community Med Public Health. 2019; 6(3):1052. [DOI:10.18203/2394-6040.ijcmph20190583]
8. Kumar CA, Revannasiddaiah N. Assessment of self-medication patterns in a rural area of south India: A questionnaire-based study. Int J Community Med Public Health. 2017; 5(1):354. [DOI:10.18203/2394-6040.ijcmph20175812]
9. Keche Y, Yegnanarayan R, Bhoyar S, Agrawal R, Chavan R, Mahendrakar P. Self-medication pattern in rural areas in Pune, India. Int J Med Public Health. 2012; 2(4):7-11. [DOI:10.5530/ijmedph.2.4.2]