The uncontrolled practice of self-medication results in serious health hazards [41]. Its prevalence is high in Arab countries [42]. Many factors influence SM, including socioeconomic status, access to health care facilities, and the emergency of the condition, as previously reported [43]. The COVID-19 pandemic emphasized these factors and added fear of the infection, lockdown policies, and increased internet searches about self-medication [21]. As follows, the public became more liable to misinformation and misuse of medicines [44, 45]. This paper aimed to assess the prevalence, influencing factors of self-medication, the commonly used drugs, and the sources of information about SM among Arab countries during the COVID-19 pandemic. This study reported that self-medication practice was highly prevalent among respondents. The most commonly used drugs were analgesics, antipyretics, and vitamins. The common associated risk factors were experience with similar health conditions and the urgency of the problem. Pharmacist consultation was the most frequent source of information for self-medication. Predictors of self-medication practice were older age, having chronic diseases, and having monthly income or medical insurance that does not cover the treatment costs. It is considered the first one of its kind that included such a large sample size across the Arab region during the COVID-19 pandemic.

We found that 62.7% of the participants self-medicated during the COVID-19 pandemic; the prevalence rate ranged from 40.4% in Palestine to 72.1% in Egypt. These results differ from the findings of an earlier systematic review across the Middle East before the pandemic revealing prevalence rates ranging from 35.4% in Saudi Arabia to 83% in Iran [39]. Additionally, similar studies conducted in different countries around the world showed significant health hazards of SM [7, 46,47,48,49,50,51,52,53,54]. This study detected an increase in the consumption rate of SM during the pandemic in 19.6% of the self-medicated participants (SMPs), no change in 63.7%, and a decrease in 16.3%.

The data clarified a significant association of SM with chronic disease. Other studies revealed similar findings [55, 56]. The reason may be due to the effective use of medicines in previous similar conditions [57]. Experience with similar conditions was the most frequent reason for SM (74.6%) among SMPs. The stable character of chronic disease may also contribute to SM practice rather than visiting a physician [55]. Approximately 41.6% of SMPs reported that their reason for SM was fear of infection from health care units. This could be explained by the possibility that a lack of information regarding the COVID-19 disease may have evoked people’s worries and fears of catching it [8, 58, 59]. More than one-third (38.2%) of participants who consumed medicines thought that SM practice would protect them from COVID-19. Other causes of SM in the present study were urgency of the condition (47.2%), prior commitments and lack of time (33%), cost of the consultation (23.9%), and transport unavailability (10%). These reasons were consistent with those of previous studies [50, 54, 58].

The usage of certain drugs is consistent with COVID-19 symptoms; fever relief (65.1%), vitamins (57.1%), and antitussives (47.6%) were the most common drugs during the COVID-19 surge after painkillers (86%). These results were similar to those of previous studies [44, 46, 54]. Surprisingly, the reported SM practice not only included over-the-counter drugs but also prescribed drugs, specifically antibiotics (43.3%). This raises concerns as drug-resistant deaths are of considerable numbers, not to mention the economic burden in treating these cases [60].

In this study, the most frequent sources of information were pharmacist consultation (66.7%), academic knowledge (50.1%), and prior prescriptions for them (50.1). Previous studies agreed with our results [50, 61,62,63,64]. Hence, pharmacists play a key role in directing the population to appropriate SM [65]. However, some pharmacists seek profits, and their practice leads to inappropriate SM [66]. Strict policies and regulations should be applied to avoid these unethical behaviors.

The present data showed a significant increase in SM practice with increasing age, as reported earlier in Jordan, China, Nigeria, and Peru [7, 67,68,69,70,71]. This finding can be explained by the fact that elderly individuals tend to take care of their health to avoid aging-related diseases [69]. Some studies disagreed with these results and showed that SM practice was more common in younger individuals [72, 73]. Similar to Albawani, S. M. et al., we found that SM was not significantly associated with gender (male/female) or residence (urban/rural) [62]. However, these findings were in contrast with earlier studies [74,75,76,77,78,79,80].

Regarding the univariate logistic regression, we detected low odds of SM practice with preuniversity (p = 0.005), university (p = 0.003), and a high level of education (p = 0.008). This may be due to the raised awareness among educated participants about the threats of inappropriate use of drugs; most of the participants were related to the medical field (42.1%) [77]. Amuzie, C. I. et al. showed a significant association between SM frequency and those who did not attain university education compared to those who did [69].

Government employees and freelancers were more prone to self-medication than other occupations. This may be due to the idea of visiting a doctor being time-consuming [74]. The current data showed that time commitments were the reason for SM for 33% of the self-medicated participants. Having no medical insurance was another reason reported by 69.79% of respondents. This might explain why they tended to self-medicate. In contrast, a study conducted in Ethiopia reported lower self-medication practices among governmental employees [72]. The authors observed low odds of SM among the nonworking and retired groups. The cause may be the low income to purchase medications [67]. Our results indicated that SM is significantly associated with having monthly income and medical insurance but did not cover the treatment cost. This was inconsistent with the findings of Shafie, Mensur et al., who showed high SM practices among the high-income group [56].

The findings of this study inform Arab healthcare policymakers about the status of self-medication in the Arab region. Hence, this may encourage the development of policies and regulations to control the inappropriate use of medications. Additionally, since pharmacists play an important role in informing people about SM, we recommend developing educational curricula for pharmacists that focus on the ethics of drug supply, holding frequent seminars to discuss these challenges, and posting professional ethics charts in pharmacies. Furthermore, health ministries should conduct frequent public awareness campaigns to educate the public about the negative impacts of medication misuse, to provide reliable sources of information about medications and to give advice on the appropriate use of nonprescribed medications.

The main strength of this study is the large sample size across ten countries with different sociodemographic data. The general population is another strength instead of previous studies that included specific populations: medical students, undergraduates, or elderly individuals. Hence, this wider scope helped in exploring the pattern of SM across a diverse variety of populations. Regarding the limitations, we did not add 10% to the sample size to cover the decrease in response. Additionally, selection bias was a possibility because only those with access to internet-connected smart devices could respond to the questionnaire. However, the authors allowed offline data collection in the countries with ethical approval. The convenience sampling strategy is also one of the limitations. Additionally, the estimated SM practice was from the start of the pandemic, which might lead to recall bias. We recommend further studies to assess awareness about SM and any associated health hazards in the Middle East.