Self-medication with antibiotics for the treatment of menstrual symptoms in southwest Nigeria: a cross-sectional study

Background: Self-medication with antibiotics is an important factor contributing to the development of bacterial antibiotic resistance. The purpose of this study was to evaluate the prevalence of self-medication with antibiotics for the treatment of menstrual symptoms among university women in Southwest Nigeria. Methods: A cross-sectional survey was administered to female undergraduate and graduate students (n = 706) at four universities in Southwest Nigeria in 2008. The universities were selected by convenience and the study samples within each university were randomly selected cluster samples. The survey was self-administered and included questions pertaining to menstrual symptoms, analgesic and antibiotic use patterns, and demographics. Data were analyzed using descriptive statistics and logistic regression. Results: The response rate was 95.4%. Eighty-six percent (95% CI: 83-88%) of participants experienced menstrual symptoms, and 39% (95% CI: 36-43%) reported using analgesics to treat them. Overall, 24% (95% CI: 21-27%) of participants reported self-medicated use of antibiotics to treat the following menstrual symptoms: cramps, bloating, heavy bleeding, headaches, pimples/acne, moodiness, tender breasts, backache, joint and muscle pain. Factors associated with this usage were: lower levels of education (Odds Ratio (OR): 2.8, 95% CI: 1.1-7.1, p-value: 0.03); nonscience major (OR: 1.58, 95% CI: 1.03-2.50, p-value: 0.04); usage of analgesics (OR: 3.17, 95% CI: 2.07-4.86, p-value: <0.001); and mild to extreme heavy bleeding (OR: 1.64, 95% CI: 1.01-2.67, p-value: 0.05) and pimples/acne (OR: 1.57, 95% CI: 0.98-2.54, p-value: 0.06). Ampicillin, tetracycline, ciprofloxacin and metronidazole were used to treat the most symptoms. Doctors or nurses (6%, 95% CI: 4-7%), friends (6%, 95% CI: 4-7%) and family members (7%, 95% CI: 5-8%) were most likely to recommend the use of antibiotics for menstrual symptoms, while these drugs were most often obtained from local chemists or pharmacists (10.2%, 95% CI: 8-12%). Conclusions: This is the first formal study to report that approximately 1 out of 4 university women surveyed in Southwest Nigeria self-medicate with antibiotics to treat menstrual symptoms. This practice could provide monthly, low-dose exposures to antibiotics among users. Further studies are necessary to evaluate the impacts of selfmedication on student health

Land reforms in Kerala: an aid to ensure sustainable development

In any agrarian society, such as India, there is a strong linkage between land and societal status. Land is the most valuable, imperishable possession from which people derive their economic independence, social status and a modest and permanent means of livelihood. In addition, land also assures land owners an identity and dignity and creates conditions and opportunities for them to realise social equality as stated in the Draft Land Reforms Policy by the Government of India (Department of Land Resources, Ministry of Rural Development, Government of India 2013). As a problem, insecurity of tenure has different meanings, i.e. the likelihood of forced eviction, inequitable land distribution between races and lack of secure jobs for farm workers. This may also refer to discrimination against the disadvantages, such as women and the minority, in favour of the rich and the powerful people. Land governance is about policies, processes and institutions by which land, property and natural resources are managed. Land reform requires the redistribution of wealth and power. Government plays the key role in this process because "it is the only actor with authority [and power] to command compliance" [International Fund for Agricultural Development (IFAD) 2006, p. 2]. International agencies, such as the IFAD, the United Nations Development Programme (UNDP) and the World Bank, explained that rural poverty cannot be eradicated without land reform and believes that poor people in the rural areas must have access to and control over land and other natural resources to eradicate extreme poverty. Governments in different states in India have redistributed land by setting ceilings on how much land could be owned and leased to individuals. Landholdings that were in excess of the ceilings were redistributed to peasants (UNDP 2008). The central theme of this chapter is to revisit the concepts of land governance, land reform, and the relationship between land governance and sustainable development. This chapter also investigates (i) land reform movement in Kerala, India, and (ii) challenges of land reform in this state. The chapter ends with some recommendation and a conclusion