Self-medication (SM) refers to treating diseases without consulting a health professional. It is a significant global health challenge. It is beneficial when utilized correctly [1,2].   Children are a crucial target population that requires adequate medical care. Due to their underdeveloped immune systems, they are more susceptible to diseases such as fever, cough, diarrhea, and other self-limited medical disorders. Furthermore, the probability of a child dying before the age of five remains significant [3].   SM for children is an important source of concern across the world owing to their more vulnerable nature to drugs [2]. They rely on their parents to administer medicine. There may be significant differences in medication metabolism and excretion between children and adults. The pharmacokinetic properties of the medication vary with gender and age [4].   In both affluent and developing nations, most parents prefer to treat their children's common illnesses, such as coughs, colds, diarrhea, and fever, without consulting a professional [5]. Parents' SM for their children is associated with hazards such as incorrect diagnosis, prolonged usage, and improper dosing regimen [6]. Appropriate care of pediatric illnesses and promotion of suitable and safe drug administration for children are extremely vital to minimize childhood mortality and morbidity [7].   The prevalence of SM practices varies worldwide. In Jordan, the prevalence of SM among households was 53.1% [8] In the Middle East varies from 35.4% to 83% [9], Turkey 63.5% [10], Ethiopia 39% [11], Spain 22% [12], Palestine, 41.2% [13]In Saudi Arabia, research conducted in the Qassim region indicated that 67.8% of survey participants used self-medication for their children at least once a year [14].   There are various reasons for SM. Some of the key reasons are limited or no access to medical care, saving time, previous experiences, minor illnesses, emergencies, low cost, recommendations by friends, and a sufficient awareness of medications [15]. Additionally, SM can be influenced by cultural, economic, and social factors [16]. Research carried out in Turkey found that the most prevalent grounds for SM behaviors were low-educated and unemployed mothers [10].   To our knowledge, no evidence exists on the prevalence of SM practice among parents for their children in the northern border region, Saudi Arabia. As a result, collecting data on SM in this region is critical for planning future management. Hence, the current study aimed to document the prevalence of SM practice of parents for their children, and to examine the determinants of such behavior.

Study Setting and Design An observational cross-sectional study design was undertaken among the parents at Arar City, the capital of northern Saudi Arabia, over the period from May 1, 2024, to December 31, 2024.   Sample Size The sample size was calculated by using the following formula. N = Z2 (p)(1-p)/d2. Where N = sample size, Z is the statistic corresponding to the confidence level (1.96), p = the expected prevalence of SM practice (67.5%) from the previous study [17], and d = precision (0.05). The expected sample size was 337. A total of 337 questionnaires were collected, with 9 eliminated due to incomplete answers, resulting in 328 participants, and a response rate of 97.3%.   Sampling Tool A well-structured questionnaire, constructed after reviewing the relevant literature, was utilized (17-20). It was initially written in English, then translated into Arabic, and back-translated into English by a multilingual expert. The questionnaire's content validity was reviewed and confirmed by a panel of pediatricians and family medicine professionals at the College of Medicine, Northern Border University. A pilot study with a convenient sample of twenty participants was employed for the clarity, relevance, and simplicity of the questions, and the item's text and layout were slightly modified as a result of the feedback. The findings of the pilot were not included in the results. The tool was composed of three parts:   The 1st section focused on the respondents' sociodemographic characteristics (age, sex, marital status, education, occupation, and number of children) The 2nd part contained questions related to the pattern of SM practices The final part asked questions concerning the rationale for SM   Sampling Method After receiving ethical approval, we conducted a web-based survey through social media platforms (WhatsApp and Snapchat) to enroll participants. We discussed the research objectives and obtained consent for participation at the beginning of the questionnaire. Data privacy and confidentiality were maintained throughout the study procedure.   Statistical Analysis The data were collected, processed, and analyzed using IBM SPSS Statistics (Version 26). Quantitative data were presented as frequencies and percentages, and numerical data were provided as means and standard deviations. For categorical data, either the Chi-squared test (χ2) or Fisher's exact test was utilized. 5% was used as the statistical level of significance.   Inclusion and Exclusion Criteria The research only included parents over the age of 18 years old, who had at least one child and were willing to participate. Parents without children or unwilling to participate were omitted.   Ethical Clearance The research was accepted and approved by the local bioethical committee at Northern Border University (HAP-09-A-043) with no. (50-24-H) dated 7/5/2024.

Table 1 shows the demographics of the sample. The survey involved 328 respondents with a mean age of 33.9±11.5, slightly less than half (48.5%) were unemployed and aged between 18-30 years. Almost two-thirds (63.1%) were females, the majority were married (73.2%), and nearly a third had more than three children.   Table 1: Sociodemographic Characteristics of the Surveyed Respondents Items No Percentage Age 18-30 159 48.5 30-50 133 40.5 ≥50 36 11 Sex Male 121 36.9 Female 207 63.1 Marital status Married 240 73.2 Divorced 50 15.2 Widowed 38 11.6 Educational level Intermediate or less 20 6.1 Secondary 78 23.8 University 204 62.2 Post-Graduate 26 7.9 Occupation Unemployed 159 48.5 Governmental 110 33.5 Private 48 14.6 Retired 11 3.4 Number of children One 89 27.1 Two 70 21.3 Three 63 19.2 More than three 106 32.4 Figure 1 demonstrates the overall SM practices among the participating parents. The majority of participants (249,76%) self-medicated their children.     Figure 1: SM Practices among the Respondents Studied   Table 2 depicts the participants' self-medication behaviors. Less than sixty percent (58.2%) utilized SM for mild illnesses, and nearly two-thirds (63.9%) utilized synthetic medication. Over one year, SM practice by the parents for their children showed varying frequencies (20.5% more than 4 times, 8.4% four times, 21.7% three times, 22.9% twice, 21.7% once, and 4.8% never).   Table 2: Pattern of Self-Medication Practices among the Studied Parents Items No no=249 Percentage When did you use self-medication? Mild symptoms 145 58.2 Moderate symptoms 104 41.8 What kind of treatment? Synthetic Medicine 159 63.9 Herbal treatment 90 36.1 How many times have you self-medicated your children in the previous year? One 54 21.7 Two times 57 22.9 Three Times 54 21.7 4 times 21 8.4 More than 4 times 51 20.5 Never 12 4.8 Did you know the correct dosage for children? Yes 220 88.4 No 29 11.6 Did you follow the full course of treatment? Yes 190 76.3 No 59 23.7 Did you know about the adverse effects of the medications used? Yes 155 62.2 No 94 37.8 Did you read the medication’s pamphlet? Yes 149 59.8 No 100 40.2 What did you do if the child’s illness did not improve following self-medication? Go to the hospital 148 59.4 Go to a private clinic 47 18.9 Consult a community pharmacist 19 7.6 Search internet 9 3.6 Seeking advice from friends and/or relatives 19 7.6 Continue self-medication 7 2.8   Most of the participants were aware of the correct medication dose (88.4%), knew the full course of treatment (76.3%), slightly more than sixty percent were aware of the medication side effects (62.2%), and around sixty percent read the medication pamphlets (59.8%), and went to the hospital if there is no improvement (59.4%).   Table 3 highlights the rationales for parental SM of their children. The most commonly stated reason for SM was that the waiting time at the clinic is too long (58.2%), followed by familiarity with child's condition based on the symptoms (53%), having enough knowledge (39%), insufficient health provider (38.2%), too expensive medical care (34.5%), inaccessible clinic (34.5%), and poor attitude of the health care provider (26.9%).   Table 3: Reasons for Self-Medication Practices among Research Participants Items No Percentage The waiting time at the clinic is too long Agree 145 58.2 Disagree 49 19.7 Neutral 55 22.1 Familiarity with the child's condition based on the symptoms Agree 132 53 Disagree 58 23.3 Neutral 59 23.7 I am knowledgeable enough. Agree 97 39 Disagree 102 41 Neutral 50 20.1 Lack of an adequate health care provider Agree 95 38.2 Disagree 102 41 Neutral 52 20.8 Consultation costs are too expensive. Agree 86 34.5 Disagree 138 55.5 Neutral 25 10 The closest clinic is too far away. Agree 86 34.5 Disagree 133 53.5 Neutral 30 12 Poor attitude of healthcare personnel Agree 67 26.9 Disagree 135 54.2 Neutral 47 18.9   Table 4 displayed the association between SM practices and demographic features of the studied respondents. SM practices were significantly higher among females (68.3%) compared to males (31.7%) (p = 0.001), married individuals (79.1%) compared to divorced (16.5%) and widowed (4.4%) (p<0.0001), and those having more than three children compared to those having three or fewer (p<0.0001).   Table 4: The Association of SM Practices and Demographic Characteristics of the Respondents Studied Items SM no (%) No = 249 No SM no (%) No = 79 p-Value Gender Female 170(68.3) 37(46.8) 0.001* Male 79(31.7) 42(53.2) Marital status Married 197(79.1) 43(54.4) <0.0001* Divorced 41(16.5) 9(11.4) Widowed 11(4.4) 27(34.2) Education Intermediate or less 14(5.6) 6(7.6) 0.5* Secondary 61(24.5) 17(21.5) University 152(61) 52(65.8) Post-Graduate 22(8.8) 4(5.1) Occupation Unemployed 116(46.6) 43(54.4) 0.1© Governmental 90(36.1) 20(25.3) Private 33(13.3) 15(19) Retired 10(4) 1(1.3) Number of children One 52(20.8) 37(46.8) Two 50(20.1) 20(25.3) <0.0001* Three 50(20.1) 13(16.5) More than three 97(39) 9(11.4) *Chi-squared test, © Fisher's exact test

SM is using drugs to treat illnesses without contacting a medical professional. Improper SM practices are a growing public health concern [8]. The study aimed to investigate the patterns and determinants influencing parents' SM practices of their children.   In terms of the prevalence of SM practice among the investigated parents, the majority practiced SM (76%), approximately two-thirds used synthetic medication(63.9%), more than half (58.2%) used SM in mild illnesses, around thirty percent practiced SM four or more times per year, the vast majority (88.4%) were aware of the correct dosage, (76.3%) followed the full course of treatment, 62.2% were aware of the drug side effects, 59.8% read the medication pamphlets, and 59.4% sought advice from the hospital if there was no improvement.   This study affirms earlier studies that SM among parents is quite widespread in Saudi Arabia, Such as in AL-Qassim region, 86.1% of the parents used SM practices, 35% practiced four or more times per year, 86% for mild conditions, and 59.3% sought hospital medical advice if there was no improvement [19]. Eldalo et al. in their study across different parts of Saudi Arabia revealed that 86.7% utilized SM, with 95% treating mild illnesses [20].   In Jordan, a qualitative study found that practically all participant parents self-medicated their children largely for minor diseases [21]. In the same country, Al Sheha et al. observed a 54% prevalence of SM among households [8].   In Egypt, many studies have been conducted regarding SM practices, including those by Ghazawy et al., who reported a73%prevalence [22], Farahat et al. (72%) [23], Ali et al. (57%) [24], and Abd Elsamad et al., who observed that almost all participating mothers utilized SM for their children, and more than half (54.2%) knew the adverse effects of the drug used [25].   In Pakistan, Khalil et al. discovered that 90% of parents used SM for their children, primarily for minor ailments including fever, cough, and vomiting, and 94.9% of them visit a physician if their medical condition is not resolved [26] In Latin America, the observed prevalence was 77.4% [27], in Kenya, it was 76.9% [28], in Romania, a comparable web-based survey demonstrated that the prevalence of SM was 70%, mostly for mild conditions like fever, cough, and vomiting, and 51% were aware of the likelihood of bad consequences of the medications they used [29].   A survey done in Italy found that 69.2% of respondents' parents had used SM for their children without a prescription from their physician at least once in their lifetime [5]. in India, a hospital-based survey found that 64% of parents self-medicated their children [30]. Furthermore, El Sheshtawy et al. in Egypt reported that in the case of no improvement, 50% of the participants contacted a community pharmacist, whereas only 8.3% visited a physician [31].   Variations in reported prevalence can be attributed to the differences in population characteristics between studies, the definitions used, the recall period looked at, the region chosen, the methodology used, the role of local culture, and the expected role of health practitioners [32].   Concerning the rationale for parental SM of their children, the most stated reason was too long waiting time at the clinic (58.2%), followed by awareness of my child's condition based on the symptoms (53%), having enough knowledge (39%), insufficient health provider (38.2%), too expensive medical care (34.5%), inaccessible clinic (34.5%), and poor attitude of the health care provider (26.9%).   According to the results of a similar survey in Saudi Arabia, the most commonly indicated reason for SM was long waiting time (78.8%), followed by familiarity with the child's condition (64.2%), cost of treatment (53.5%), insufficient health care provider (38.8%), adverse attitude of the health care provider (33.3%), and inaccessible health facility (32.3%) [20].   Similar research done in Egypt demonstrated that 37.5% of participants thought the illness was simple and easy to treat; they were continually concerned about the high cost of medical care for their children, and 26.7% used SM based on their experience [25].   A qualitative study conducted in Jordan showed that the reasons given most often for SM by parents were the following: they believe the illness is simple and can be treated, based on previous experience, governmental hospitals are usually congested, physicians do not give each child enough attention, and there is a long waiting time at the clinic [21].   In Romania, 74% of parents used SM because they were familiar with their children's symptoms, 62.1% owing to time restrictions, and 59.7% due to limited access to health-care facilities [29].   According to qualitative research conducted in Pakistan, the most commonly cited reasons for SM were lack of trust in health care personnel (90%), financial issues (67%), time constraints (42%), awareness of the child's symptoms (37%), and poor communication practices of the health care providers (25%) [33] Furthermore, Gohar et al., in the same country, revealed that more than two-thirds of participants' parents employed SM for their children (77.2%), and almost one-third reasoned from their experience (35%) [34].   Study Limitation The current study has some limitations. First, some age groups and social factors were underrepresented in the sample due to their lack of internet access and non-use of social media, which may have limited its generalizability. Second, the questionnaire was self-administered; therefore, bias in recall might have occurred due to the research design. Finally, the descriptive study design used failed to detect the cause-and-effect relationship.

The significantly high prevalence of parental SM practice for their children in Northern Saudi Arabia should be regarded as a worrying issue. Because most parents have an inadequate understanding of diagnosis and illness, this may lead to treatment misuse and subsequent complications. The current study highlights the need for comprehensive programs and further research to enhance rational medication use.