Pharmaceuticals in two Brazilian villages: lay practices and perceptions

Family use and understanding of modern medicines was studied in two villages in rural Bahia, Brazil. It emerged that pharmaceuticals figure in the treatment of most reported health problems. Nursing infants above all are treated with drugs frequently and intensively. The three most commonly used medicine-groups are antibiotics, analgesics and vitamins. The majority of these medications are 'prescribed' by a pharmacy attendant or the patient himself. Roughly half of the applied medications appear on neither the WHO list nor the Brazilian national list of 'essential drugs'. In almost one third of the cases studied 'dangerous' substances were used. If we consider the medications in use from a strictly biomedical viewpoint, it must be said that between half and two thirds of them ought to be regarded as irrational. A lot of money, moreover, is being spent on modern medicines. In one of the two villages, each week every family spent, on the average, a full day's wages to obtain a wide range of medications. The attitude of the families studied towards modern pharmaceuticals was highly positive. In general, people held the view that medicines should be used in the event of any sickness or discomfort. Possible hazards accruing from the use of modern medicines were scarcely acknowledged, if at all. Furthermore the notion obtained that many drugs should be used at the same time in cases of severe illness, or whenever a quick recovery was desired. A remarkably vigorous interest in diseases and their treatment was observed. Perhaps in this keen interest was a potential solution to problems of over-medication and the irrational use of pharmaceuticals in the Third World. The paper closes with a plea for providing more information about pharmaceuticals to consumers.