Original Research
Pharmaceutical Public Health

Consumer Perception of the Health Care Services in Yemen and Its Impact on Self-Medication Practice

Background and Context

Self-medication — the use of medicines by individuals to treat self-recognised symptoms without professional medical consultation — is a global public health phenomenon with particularly pronounced implications in low- and middle-income countries. While appropriate self-medication with over-the-counter products can be a useful component of primary healthcare, problematic self-medication involves the use of prescription-only medications without medical oversight, incorrect dosing, inappropriate drug selection, and failure to recognise warning symptoms requiring professional attention.

Yemen presents a uniquely challenging context for pharmaceutical public health. Even prior to the armed conflict that escalated in 2015, Yemen’s healthcare system faced severe structural deficiencies, including an acute shortage of qualified physicians (particularly in rural areas), limited health insurance coverage, high out-of-pocket healthcare costs, and a regulatory environment that inadequately controlled medication distribution. Community pharmacies in Yemen have functioned not merely as dispensing outlets but as de facto primary care points, with pharmacy staff frequently assuming roles that extend well beyond their professional scope — including diagnosis and prescription of medications including antibiotics and other controlled substances.

The profession of pharmacist in Yemen has, as the study authors note, become less trusted and reliable in the perception of many consumers. Concerns about medication quality are well-founded: counterfeit and substandard medicines have been documented entering the Yemeni market without adequate quality control. This erosion of trust, combined with the high cost of physician consultations relative to average household income, creates powerful economic and social incentives favouring self-medication over formal healthcare utilisation.

Study Design and Methods

This descriptive cross-sectional study recruited 400 consumers attending 10 community pharmacies in Sana’a City, Yemen’s capital. A self-administered questionnaire containing both open-ended and closed-ended questions was developed, validated, and distributed to eligible participants. The questionnaire assessed sociodemographic characteristics, healthcare utilisation patterns, perceptions of healthcare service quality, attitudes toward medications and pharmacists, self-medication practices including types of medications used, and reasons for choosing self-medication over professional consultation.

Data analysis employed chi-square tests to examine bivariate associations between sociodemographic and behavioural variables and self-medication practice. Multiple logistic regression was then used to identify independent predictors of self-medication while controlling for potential confounding variables. The dependent variable was self-medication practice (yes/no) within the preceding six months.

Principal Results

The prevalence of self-medication was strikingly high at 90.7%, with females reporting slightly higher rates (94.1%) than males (88.3%). This prevalence is among the highest reported in the Middle East and North Africa region, though direct comparisons should account for methodological differences between studies. A subsequent study among health science students in Sana’a City found a similarly high 90% prevalence of self-medication, and another investigation reported that 85% of patients at Ibb city hospitals had practised self-medication in the three months preceding the survey.

The multivariate analysis produced several notable findings. Paradoxically, khat chewers and smokers were less likely to engage in self-medication. This counterintuitive result may reflect the social networks and healthcare-seeking behaviours associated with khat use — khat chewing sessions are communal social gatherings where health information is shared and advice sought, potentially encouraging formal healthcare utilisation. Additionally, regular smokers and khat users may have more frequent contact with healthcare providers for smoking- and khat-related health concerns.

Consumers living near medical services were approximately three times more likely to self-medicate. This finding may initially seem paradoxical but likely reflects the fact that “medical services” in Sana’a often primarily means community pharmacies rather than physician-staffed clinics. Greater proximity to pharmacies increases convenience of purchasing medications without prescription, effectively lowering the barrier to self-medication.

Perhaps most importantly, consumers who did not believe that self-medication could lead to death were 2.6 times more likely to self-medicate. This finding underscores the critical role of risk perception in health behaviour and suggests that educational interventions highlighting the genuine dangers of inappropriate self-medication — including drug interactions, adverse effects, antimicrobial resistance, and masking of serious conditions — could have meaningful impact on behaviour.

Self-Medication With Antibiotics: A Special Concern

Complementary research from the same setting found that antibiotic use during self-medication was 87.1% among Sana’a City consumers, with common cold, cough, diarrhoea, and fever being the most frequently treated conditions. Only 49.5% of respondents were aware of bacterial resistance as a consequence of antibiotic misuse. The high cost of physician consultation was cited as the primary driver of antibiotic self-medication. These findings have significant implications for antimicrobial resistance — a global health priority identified by the World Health Organization as one of the greatest threats to modern medicine.

Implications for Health System Strengthening

This study provides evidence that the high prevalence of self-medication in Yemen is driven by systemic healthcare access barriers rather than simple consumer preference. Addressing the problem requires multi-level interventions encompassing regulatory reform to strengthen medication dispensing controls, expanded health insurance coverage to reduce out-of-pocket barriers to physician consultation, investment in pharmacist education and continuing professional development, public awareness campaigns about medication safety, and quality assurance systems to combat counterfeit and substandard medicines in the supply chain.

For the international public health community, the findings offer important lessons about the relationship between healthcare system fragility and pharmaceutical consumption patterns — lessons that have become even more relevant as Yemen’s conflict has further devastated the country’s health infrastructure.

Limitations

The study was conducted in Sana’a City and may not represent self-medication patterns in rural Yemen, where healthcare access is even more constrained. The convenience sampling approach limits generalisability. Self-reported data on medication use may be subject to recall bias and social desirability bias. The cross-sectional design precludes causal inference about the direction of associations. The study did not assess clinical outcomes of self-medication, such as adverse drug reactions, treatment failures, or contribution to antimicrobial resistance. Additionally, the study was conducted before the intensification of Yemen’s civil conflict, and current self-medication patterns may differ substantially from those documented here.

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