Use and misuse of aspirin in rural Ethiopia

OBJECTIVES: To investigate ability to distinguish simple analgesics, to document misconceptions about aspirin use, and to identify strategies to diminish potentially harmful aspirin use in Ethiopia.

DESIGN: Qualitative study (eight focus group discussions) used to inform cross-sectional survey.

SETTING: Butajira, a small town in southern Ethiopia, and surrounding rural areas.

PARTICIPANTS: Purposively selected informants for focus groups; random sample of urban and rural residents for cross-sectional survey.

MAIN OUTCOME MEASURES: Ability to distinguish aspirin from paracetamol; proportion using aspirin; proportion aware of common risks of aspirin.

RESULTS: Questionnaires were completed by 204 of the 250 residents sampled (82% response). Three-quarters of survey participants knew the difference between aspirin and paracetamol. Aspirin was used by 7.3% of respondents, and was mainly taken for headache and fever. In focus group discussions there was a suggestion that aspirin was considered particularly useful for children. There was very low awareness of the risks of using aspirin in children (2.5% unprompted, 18.6% prompted) or in people with asthma (1% unprompted, 5.9% prompted). Aspirin is cheap and widely available in urban and rural areas.

CONCLUSION: Awareness of the risks of aspirin use by children and in asthma is extremely low in this rural Ethiopian setting. Medications are purchased with minimal packaging by a population with low literacy. Drug dispensers and vendors must be trained to convey simple verbal warnings about aspirin use.