Use and misuse of aspirin in rural Ethiopia

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.

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

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

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

Ability to distinguish aspirin from paracetamol; proportion using aspirin; proportion aware of common risks of aspirin.

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.

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.