\documentclass[11pt,twoside]{article}\makeatletter

\IfFileExists{xcolor.sty}%
  {\RequirePackage{xcolor}}%
  {\RequirePackage{color}}
\usepackage{colortbl}
\usepackage{wrapfig}
\usepackage{ifxetex}
\ifxetex
  \usepackage{fontspec}
  \usepackage{xunicode}
  \catcode`⃥=\active \def⃥{\textbackslash}
  \catcode`❴=\active \def❴{\{}
  \catcode`❵=\active \def❵{\}}
  \def\textJapanese{\fontspec{Noto Sans CJK JP}}
  \def\textChinese{\fontspec{Noto Sans CJK SC}}
  \def\textKorean{\fontspec{Noto Sans CJK KR}}
  \setmonofont{DejaVu Sans Mono}
  
\else
  \IfFileExists{utf8x.def}%
   {\usepackage[utf8x]{inputenc}
      \PrerenderUnicode{–}
    }%
   {\usepackage[utf8]{inputenc}}
  \usepackage[english]{babel}
  \usepackage[T1]{fontenc}
  \usepackage{float}
  \usepackage[]{ucs}
  \uc@dclc{8421}{default}{\textbackslash }
  \uc@dclc{10100}{default}{\{}
  \uc@dclc{10101}{default}{\}}
  \uc@dclc{8491}{default}{\AA{}}
  \uc@dclc{8239}{default}{\,}
  \uc@dclc{20154}{default}{ }
  \uc@dclc{10148}{default}{>}
  \def\textschwa{\rotatebox{-90}{e}}
  \def\textJapanese{}
  \def\textChinese{}
  \IfFileExists{tipa.sty}{\usepackage{tipa}}{}
\fi
\def\exampleFont{\ttfamily\small}
\DeclareTextSymbol{\textpi}{OML}{25}
\usepackage{relsize}
\RequirePackage{array}
\def\@testpach{\@chclass
 \ifnum \@lastchclass=6 \@ne \@chnum \@ne \else
  \ifnum \@lastchclass=7 5 \else
   \ifnum \@lastchclass=8 \tw@ \else
    \ifnum \@lastchclass=9 \thr@@
   \else \z@
   \ifnum \@lastchclass = 10 \else
   \edef\@nextchar{\expandafter\string\@nextchar}%
   \@chnum
   \if \@nextchar c\z@ \else
    \if \@nextchar l\@ne \else
     \if \@nextchar r\tw@ \else
   \z@ \@chclass
   \if\@nextchar |\@ne \else
    \if \@nextchar !6 \else
     \if \@nextchar @7 \else
      \if \@nextchar (8 \else
       \if \@nextchar )9 \else
  10
  \@chnum
  \if \@nextchar m\thr@@\else
   \if \@nextchar p4 \else
    \if \@nextchar b5 \else
   \z@ \@chclass \z@ \@preamerr \z@ \fi \fi \fi \fi
   \fi \fi  \fi  \fi  \fi  \fi  \fi \fi \fi \fi \fi \fi}
\gdef\arraybackslash{\let\\=\@arraycr}
\def\@textsubscript#1{{\m@th\ensuremath{_{\mbox{\fontsize\sf@size\z@#1}}}}}
\def\Panel#1#2#3#4{\multicolumn{#3}{){\columncolor{#2}}#4}{#1}}
\def\abbr{}
\def\corr{}
\def\expan{}
\def\gap{}
\def\orig{}
\def\reg{}
\def\ref{}
\def\sic{}
\def\persName{}\def\name{}
\def\placeName{}
\def\orgName{}
\def\textcal#1{{\fontspec{Lucida Calligraphy}#1}}
\def\textgothic#1{{\fontspec{Lucida Blackletter}#1}}
\def\textlarge#1{{\large #1}}
\def\textoverbar#1{\ensuremath{\overline{#1}}}
\def\textquoted#1{‘#1’}
\def\textsmall#1{{\small #1}}
\def\textsubscript#1{\@textsubscript{\selectfont#1}}
\def\textxi{\ensuremath{\xi}}
\def\titlem{\itshape}
\newenvironment{biblfree}{}{\ifvmode\par\fi }
\newenvironment{bibl}{}{}
\newenvironment{byline}{\vskip6pt\itshape\fontsize{16pt}{18pt}\selectfont}{\par }
\newenvironment{citbibl}{}{\ifvmode\par\fi }
\newenvironment{docAuthor}{\ifvmode\vskip4pt\fontsize{16pt}{18pt}\selectfont\fi\itshape}{\ifvmode\par\fi }
\newenvironment{docDate}{}{\ifvmode\par\fi }
\newenvironment{docImprint}{\vskip 6pt}{\ifvmode\par\fi }
\newenvironment{docTitle}{\vskip6pt\bfseries\fontsize{22pt}{25pt}\selectfont}{\par }
\newenvironment{msHead}{\vskip 6pt}{\par}
\newenvironment{msItem}{\vskip 6pt}{\par}
\newenvironment{rubric}{}{}
\newenvironment{titlePart}{}{\par }

\newcolumntype{L}[1]{){\raggedright\arraybackslash}p{#1}}
\newcolumntype{C}[1]{){\centering\arraybackslash}p{#1}}
\newcolumntype{R}[1]{){\raggedleft\arraybackslash}p{#1}}
\newcolumntype{P}[1]{){\arraybackslash}p{#1}}
\newcolumntype{B}[1]{){\arraybackslash}b{#1}}
\newcolumntype{M}[1]{){\arraybackslash}m{#1}}
\definecolor{label}{gray}{0.75}
\def\unusedattribute#1{\sout{\textcolor{label}{#1}}}
\DeclareRobustCommand*{\xref}{\hyper@normalise\xref@}
\def\xref@#1#2{\hyper@linkurl{#2}{#1}}
\begingroup
\catcode`\_=\active
\gdef_#1{\ensuremath{\sb{\mathrm{#1}}}}
\endgroup
\mathcode`\_=\string"8000
\catcode`\_=12\relax

\usepackage[a4paper,twoside,lmargin=1in,rmargin=1in,tmargin=1in,bmargin=1in,marginparwidth=0.75in]{geometry}
\usepackage{framed}

\definecolor{shadecolor}{gray}{0.95}
\usepackage{longtable}
\usepackage[normalem]{ulem}
\usepackage{fancyvrb}
\usepackage{fancyhdr}
\usepackage{graphicx}
\usepackage{marginnote}

\renewcommand{\@cite}[1]{#1}


\renewcommand*{\marginfont}{\itshape\footnotesize}

\def\Gin@extensions{.pdf,.png,.jpg,.mps,.tif}

  \pagestyle{fancy}

\usepackage[pdftitle={Prevalence, Pattern and Impact of Self Medication of Anti-Infective Agents during COVID-19 Outbreak in Dhaka City},
 pdfauthor={}]{hyperref}
\hyperbaseurl{}

	 \paperwidth210mm
	 \paperheight297mm
              
\def\@pnumwidth{1.55em}
\def\@tocrmarg {2.55em}
\def\@dotsep{4.5}
\setcounter{tocdepth}{3}
\clubpenalty=8000
\emergencystretch 3em
\hbadness=4000
\hyphenpenalty=400
\pretolerance=750
\tolerance=2000
\vbadness=4000
\widowpenalty=10000

\renewcommand\section{\@startsection {section}{1}{\z@}%
     {-1.75ex \@plus -0.5ex \@minus -.2ex}%
     {0.5ex \@plus .2ex}%
     {\reset@font\Large\bfseries}}
\renewcommand\subsection{\@startsection{subsection}{2}{\z@}%
     {-1.75ex\@plus -0.5ex \@minus- .2ex}%
     {0.5ex \@plus .2ex}%
     {\reset@font\Large}}
\renewcommand\subsubsection{\@startsection{subsubsection}{3}{\z@}%
     {-1.5ex\@plus -0.35ex \@minus -.2ex}%
     {0.5ex \@plus .2ex}%
     {\reset@font\large}}
\renewcommand\paragraph{\@startsection{paragraph}{4}{\z@}%
     {-1ex \@plus-0.35ex \@minus -0.2ex}%
     {0.5ex \@plus .2ex}%
     {\reset@font\normalsize}}
\renewcommand\subparagraph{\@startsection{subparagraph}{5}{\parindent}%
     {1.5ex \@plus1ex \@minus .2ex}%
     {-1em}%
     {\reset@font\normalsize\bfseries}}


\def\l@section#1#2{\addpenalty{\@secpenalty} \addvspace{1.0em plus 1pt}
 \@tempdima 1.5em \begingroup
 \parindent \z@ \rightskip \@pnumwidth 
 \parfillskip -\@pnumwidth 
 \bfseries \leavevmode #1\hfil \hbox to\@pnumwidth{\hss #2}\par
 \endgroup}
\def\l@subsection{\@dottedtocline{2}{1.5em}{2.3em}}
\def\l@subsubsection{\@dottedtocline{3}{3.8em}{3.2em}}
\def\l@paragraph{\@dottedtocline{4}{7.0em}{4.1em}}
\def\l@subparagraph{\@dottedtocline{5}{10em}{5em}}
\@ifundefined{c@section}{\newcounter{section}}{}
\@ifundefined{c@chapter}{\newcounter{chapter}}{}
\newif\if@mainmatter 
\@mainmattertrue
\def\chaptername{Chapter}
\def\frontmatter{%
  \pagenumbering{roman}
  \def\thechapter{\@roman\c@chapter}
  \def\theHchapter{\roman{chapter}}
  \def\thesection{\@roman\c@section}
  \def\theHsection{\roman{section}}
  \def\@chapapp{}%
}
\def\mainmatter{%
  \cleardoublepage
  \def\thechapter{\@arabic\c@chapter}
  \setcounter{chapter}{0}
  \setcounter{section}{0}
  \pagenumbering{arabic}
  \setcounter{secnumdepth}{6}
  \def\@chapapp{\chaptername}%
  \def\theHchapter{\arabic{chapter}}
  \def\thesection{\@arabic\c@section}
  \def\theHsection{\arabic{section}}
}
\def\backmatter{%
  \cleardoublepage
  \setcounter{chapter}{0}
  \setcounter{section}{0}
  \setcounter{secnumdepth}{2}
  \def\@chapapp{\appendixname}%
  \def\thechapter{\@Alph\c@chapter}
  \def\theHchapter{\Alph{chapter}}
  \appendix
}
\newenvironment{bibitemlist}[1]{%
   \list{\@biblabel{\@arabic\c@enumiv}}%
       {\settowidth\labelwidth{\@biblabel{#1}}%
        \leftmargin\labelwidth
        \advance\leftmargin\labelsep
        \@openbib@code
        \usecounter{enumiv}%
        \let\p@enumiv\@empty
        \renewcommand\theenumiv{\@arabic\c@enumiv}%
	}%
  \sloppy
  \clubpenalty4000
  \@clubpenalty \clubpenalty
  \widowpenalty4000%
  \sfcode`\.\@m}%
  {\def\@noitemerr
    {\@latex@warning{Empty `bibitemlist' environment}}%
    \endlist}

\def\tableofcontents{\section*{\contentsname}\@starttoc{toc}}
\parskip0pt
\parindent1em
\def\Panel#1#2#3#4{\multicolumn{#3}{){\columncolor{#2}}#4}{#1}}
\newenvironment{reflist}{%
  \begin{raggedright}\begin{list}{}
  {%
   \setlength{\topsep}{0pt}%
   \setlength{\rightmargin}{0.25in}%
   \setlength{\itemsep}{0pt}%
   \setlength{\itemindent}{0pt}%
   \setlength{\parskip}{0pt}%
   \setlength{\parsep}{2pt}%
   \def\makelabel##1{\itshape ##1}}%
  }
  {\end{list}\end{raggedright}}
\newenvironment{sansreflist}{%
  \begin{raggedright}\begin{list}{}
  {%
   \setlength{\topsep}{0pt}%
   \setlength{\rightmargin}{0.25in}%
   \setlength{\itemindent}{0pt}%
   \setlength{\parskip}{0pt}%
   \setlength{\itemsep}{0pt}%
   \setlength{\parsep}{2pt}%
   \def\makelabel##1{\upshape ##1}}%
  }
  {\end{list}\end{raggedright}}
\newenvironment{specHead}[2]%
 {\vspace{20pt}\hrule\vspace{10pt}%
  \phantomsection\label{#1}\markright{#2}%

  \pdfbookmark[2]{#2}{#1}%
  \hspace{-0.75in}{\bfseries\fontsize{16pt}{18pt}\selectfont#2}%
  }{}
      \def\TheFullDate{2020 2020-01-15 (revised: 2 Year 2020 15 January 2020)}
\def\TheID{10.34257/GJMRBVOL20IS7PG1\makeatother }
\def\TheDate{2020 2020-01-15}
\title{Prevalence, Pattern and Impact of Self Medication of Anti-Infective Agents during COVID-19 Outbreak in Dhaka City}
\author{}\makeatletter 
\makeatletter
\newcommand*{\cleartoleftpage}{%
  \clearpage
    \if@twoside
    \ifodd\c@page
      \hbox{}\newpage
      \if@twocolumn
        \hbox{}\newpage
      \fi
    \fi
  \fi
}
\makeatother
\makeatletter
\thispagestyle{empty}
\markright{\@title}\markboth{\@title}{\@author}
\renewcommand\small{\@setfontsize\small{9pt}{11pt}\abovedisplayskip 8.5\p@ plus3\p@ minus4\p@
\belowdisplayskip \abovedisplayskip
\abovedisplayshortskip \z@ plus2\p@
\belowdisplayshortskip 4\p@ plus2\p@ minus2\p@
\def\@listi{\leftmargin\leftmargini
               \topsep 2\p@ plus1\p@ minus1\p@
               \parsep 2\p@ plus\p@ minus\p@
               \itemsep 1pt}
}
\makeatother
\fvset{frame=single,numberblanklines=false,xleftmargin=5mm,xrightmargin=5mm}
\fancyhf{} 
\setlength{\headheight}{14pt}
\fancyhead[LE]{\bfseries\leftmark} 
\fancyhead[RO]{\bfseries\rightmark} 
\fancyfoot[RO]{}
\fancyfoot[CO]{\thepage}
\fancyfoot[LO]{\TheID}
\fancyfoot[LE]{}
\fancyfoot[CE]{\thepage}
\fancyfoot[RE]{\TheID}
\hypersetup{citebordercolor=0.75 0.75 0.75,linkbordercolor=0.75 0.75 0.75,urlbordercolor=0.75 0.75 0.75,bookmarksnumbered=true}
\fancypagestyle{plain}{\fancyhead{}\renewcommand{\headrulewidth}{0pt}}

\date{}
\usepackage{authblk}

\providecommand{\keywords}[1]
{
\footnotesize
  \textbf{\textit{Index terms---}} #1
}

\usepackage{graphicx,xcolor}
\definecolor{GJBlue}{HTML}{273B81}
\definecolor{GJLightBlue}{HTML}{0A9DD9}
\definecolor{GJMediumGrey}{HTML}{6D6E70}
\definecolor{GJLightGrey}{HTML}{929497} 

\renewenvironment{abstract}{%
   \setlength{\parindent}{0pt}\raggedright
   \textcolor{GJMediumGrey}{\rule{\textwidth}{2pt}}
   \vskip16pt
   \textcolor{GJBlue}{\large\bfseries\abstractname\space}
}{%   
   \vskip8pt
   \textcolor{GJMediumGrey}{\rule{\textwidth}{2pt}}
   \vskip16pt
}

\usepackage[absolute,overlay]{textpos}

\makeatother 
      \usepackage{lineno}
      \linenumbers
      
\begin{document}

             \author[1]{Dr. Morshed  Nasir}

             \author[2]{Dr. Mahmudul  Mannan}

             \author[3]{Dr. ASM Salauddin  Chowdhury}

             \author[4]{Dr. Tahmina  Zahan}

             \author[5]{Dr. Rawshan Ara  Perveen}

             \affil[1]{  Holy Family Red Crescent Medical College}

\renewcommand\Authands{ and }

\date{\small \em Received: 13 December 2019 Accepted: 31 December 2019 Published: 15 January 2020}

\maketitle


\begin{abstract}
        


Background: The outbreak of coronavirus disease-2019 is putting a massive strain on the vulnerable healthcare systems in low and middle-income countries like Bangladesh. Inequitable access to healthcare is further widened by the socio-economic gap and sense of insecurity during this pandemic. Self-medication is a common practice in Bangladesh as it provides a low-cost alternative for people, which involves inappropriate and injudicious use of medicines to treat self-recognized symptoms by the people. During the outbreak of COVID-19 in Dhaka city, the tendency of taking medicines by own decision was increased alarmingly due to unusual distress, caused by high self-awareness of their health and buying capacity of medication.Objectives: To observe the prevalence, pattern, sources, and impact of self-medication practice among the respondents with high socio-economic standings and education.Setting: Citizens living in Dhaka city, Bangladesh, during the COVID-19 outbreak from April 2020 to May 2020. Method: Cross-sectional online survey conducted on 626 citizens without having a background of medical knowledge or related to any healthcare services (doctors, nurses, pharmacists, medical students) by structured questionnaires during the COVID-19 outbreak.Outcome measures: Frequency of self-medication, commonly used antimicrobial agents, symptoms causing self-medication, sources of inspiration, relation with COVID-19 test results, economic burden involved in self-medication during the outbreak.

\end{abstract}


\keywords{}

\begin{textblock*}{18cm}(1cm,1cm) % {block width} (coords) 
\textcolor{GJBlue}{\LARGE Global Journals \LaTeX\ JournalKaleidoscope\texttrademark}
\end{textblock*}

\begin{textblock*}{18cm}(1.4cm,1.5cm) % {block width} (coords) 
\textcolor{GJBlue}{\footnotesize \\ Artificial Intelligence formulated this projection for compatibility purposes from the original article published at Global Journals. However, this technology is currently in beta. \emph{Therefore, kindly ignore odd layouts, missed formulae, text, tables, or figures.}}
\end{textblock*}


\begin{textblock*}{10cm}(1.05cm,3cm)
{{\textit{CrossRef DOI of original article:}} \underline{10.34257/GJMRBVOL20IS7PG1}}
\end{textblock*}\let\tabcellsep& 	 	 		 
\section[{Introduction}]{Introduction}\par
ccording to the World Health Organization (WHO), self-medication is explained as "the selection and use of medicines by individuals (or a member of the individual's family) to treat self-recognized or selfdiagnosed conditions or symptoms. Reasons commonly adducted for indulgence in self-medication include delayed access to healthcare centers, socio-cultural belief, relatively high cost of hospital treatment, previous experience of treatment of same symptoms, easy availability of drugs, poor regulatory practice, the urgency of feeling relieved, advice from friends and media. The of self-medication is prevalent in most parts of Bangladesh, regardless of socio-economic status and level of education. While this is indisputable, the incidence of self-medication is may be higher in the low or middle-income countries without consulting with qualified health professionals \hyperref[b0]{1} . Although the WHO stressed that rational self-medication practice helps in the prevention and treatment of some minor pathological conditions at affordable cost \hyperref[b1]{2} , otherwise it may cause wastage of resources, resistance to pathogens, and serious health hazards with adverse drug reactions and prolonged morbidity \hyperref[b2]{3} . In a developing country like Bangladesh, the practice of selfmedication may provide an alternative for people as lowcost to avoid the high cost of clinical services, and many drugs dispensed over the counter (OTC) without prescription \hyperref[b3]{4} . But it is gone beyond the OTC drugs and sometimes prescription-only drugs like antimicrobials, sedatives, hypnotics and strong NSAIDs also reported to be dispensed without prescription in few cases.\par
Moreover, the ratio between doctor and patient in Bangladesh is currently as low that places the country at second position from the bottom, among the South Asian countries, according to the WHO \hyperref[b4]{5} . Besides, some individuals practice out of ignorance, poverty, and generalized hypes.\par
Dhaka, being the capital and the major economic-hub of the country; it lags in the ratio between healthcare workers compared to other neighboring countries, thus hampering proper and timely healthcare. So, practice of self-medication is almost inevitable as the country has only six doctors, nurses, and midwives for every 10,000 populations, according to the report of health bulletin published yearly by the Health Ministry 6 . Some studies on the general tendency and pattern of self-medication practice of prescription-only drugs among students, and people with or without medical knowledge showed an alarming scenario in Dhaka city \hyperref[b5]{7} .\par
The outbreak of coronavirus disease-2019 is putting a massive strain on vulnerable healthcare systems in low and middle-income countries like Bangladesh. Inequitable access to healthcare is further widened by the socio-economic gap and sense of insecurity during this pandemic since the beginning of 2020 \hyperref[b6]{8} . Besides, the population of higher socioeconomic standing is more potential to have access to better health information, medications and affordability that may lead to self-medication practice in mass. Similarly, people with higher education are reported to have much distress, probably due to high selfawareness and access to mass information network \hyperref[b7]{9} .\par
The combat against COVID-19 is continuing in Bangladesh, with the highest incidence rate in Dhaka city. The available data by WHO revealed that the highest AR was observed to continue in the Dhaka (2321.7/1,000,000) and was highest (9422.1/1,000,000) from April to June 2020 10 . As there is no approved cure for the COVID-19 or a vaccine against SARS-CoV-2, the aim of treatment is focused to manage and reduce symptoms until clinical recovery. Most people (around 80\%) are an asymptomatic or mild infections that can be treated at home.\par
As stated in the National Guideline on Case Management of COVID-19 in Bangladesh, there is no precise, effective treatment for COVID-19; the mainstay of management is early diagnosis and supportive care of symptoms and optimum support for organ function in severe illness. No drug is yet recommended as chemoprophylaxis as there is no quality evidence of efficacy and safety in COVID 19. Though Patients should be managed in hospital settings; however, proper home care may also be advised with mild illness unless rapid deterioration or inability to avail hospital if necessary \hyperref[b8]{11} . But lack of rapid response, scarcity of hospital beds, absence of private practice, inadequate capacity of testing (RT-PCR), the spread of un-authenticated treatment protocols are putting the citizens in the dilemma of choosing medical advice. Lot of prescription-only drugs like antimicrobials (azithromycin, doxycycline), anti-parasitic (ivermectin), anti-malarial (hydroxychloroquine) are reported to become a shortage in the dispensary and peripheral supply chain throughout the city. Moreover, the risk of a wide range of side effects (Table-I) are also of great concern for undocumented self-medication. Because of commonly occurring symptoms of soreness or pain in throat, dry cough, fever, body ache, breathlessness, people started to take medicines without being diagnosed or tested for COVID-19. Besides the risk of misuse or overuse of these drugs may lead to immediate or delayed complications including adverse drug reactions (hypersensitivity, anaphylaxis), drug interactions, malfunction or destruction of vital organs such as the liver, kidney; the practice of self-medication gives a deceitful sense of security, and masking the correct diagnosis. Many countries are using different drugs, but they are not using those as the guidelines and should only be used under the supervision of physicians on a case-by-case basis, not as a general recommendation 12 .\par
Given this high prevalence of self-medication of prescription-only drugs in Bangladesh and its associated adverse socio-economic impact on individuals, and the healthcare service system, supply chain at large. This study is therefore done to evaluate the awareness, pattern and attitude towards selfmedication of anti-infective agents among the high socio-economic and educated citizens in Dhaka during the outbreak of the COVID-19 without testing, diagnosis and prescription.\par
Ethics Approval: None of the authors has any conflict including employment, consultancies, stock ownership, honoraria, paid expert testimony, patent applications/ registrations for this study. 
\section[{II.}]{II.} 
\section[{Methodology}]{Methodology}\par
Using and relying on the authors' network with people living in Dhaka city, the capital of Bangladesh; this online survey adopted a descriptive nonexperimental research design to investigate the awareness and practice of self-medication conducted from April to June 2020, the period during the nationwide lockdown and to surge of number of positive COVID-19 cases. Because it was not feasible to do a community-based sampling survey during this outbreak period, we decided to collect data online by convenience sampling. A structured questionnaire was circulated to complete via clicking the link, connected to Google form. The questionnaire contained a brief introduction on the background, objective, procedure, voluntary nature of participation, declaration of anonymity and confidentiality, and notes for filling in the online questionnaire.\par
The online questionnaire was developed and validated through the face and content validity techniques, by giving the draft questionnaire to a few of the citizens with inclusion criteria at Dhaka city, to assess whether the response looks meaningful, well designed and a good measure of the construct to an innocent bystander. The response was used to refine and modify the questionnaire further.\par
The content validity was done by giving the resultant questionnaire to three independent scholars from the fields of Public Health, Pharmacology, and Social Statistics to assess its appropriateness, clarity, coverage, and relevance to the study.\par
The reliability of the validated questionnaire was ascertained by test-retest method. The questionnaire was administered twice at two weeks' interval on ten respondents from Dhaka city who practiced selfmedication during the COVID-19 outbreak. The responses were compared and the reliability coefficient determined (r=0.83). The incorporated draft questionnaire was recast for ambiguity and repetitive questions were struck off.\par
The cross sectional populations were included with the inclusion criteria as, the adult citizens living in Dhaka city, aged 25 years or more, with the education level of graduation or above, non-medical professionals, having email address, and agreed to participate voluntarily. Respondents having involvement or knowledge on medical background (medical graduates, medical practitioners, nurses, medical researchers, pharmacists) were excluded from finding out the public perceptions, and their responses to take medications without prescription during the COVID-19 outbreak. The frequencies of the response were recorded in the datasheet, and observed according to demographic characteristics, sources of information, clinical symptoms, the status of COVID-19 test results, and cost involvement. The market prices of commonly used medicines as self-medication during the outbreak were calculated to reveal the economic burden caused by COVID-19 driven self-medication practice. 
\section[{III.}]{III.} 
\section[{Results}]{Results}\par
Total of 639 participants completed the online survey questionnaire and submitted it with e-mail verification. After excluding 13 respondents, of whom 10 were doctors by profession and three were below the minimum age limit (25 years), the final sample consisted of 626 were valid participants. Among the final sample, 316 (50.47\%) respondents were from the age group of 45-54 years, 346 (55.27\%) were women, 312 (49.84\%) held a bachelor's degree, and 230 (36.74\%) engaged in non-civil services. Other demographic characteristics are shown in Table-II. The most frequently used prescription-only drug among the respondents were ivermectin (77.15\%), azithromycin (54.15\%), montelukast (43.13\%), calcium supplements (41.37\%), doxycycline (40.25\%), and hydroxychloroquine (20.44\%) respectively. The frequency of taking the prescription-only drugs among the respondents who were not even diagnosed by the rRT-PCR positive results, was reported higher with ivermectin (76.68\%) and azithromycin (50.0\%) as shown in Table-III. 
\section[{Figure-2: Distribution of respondents taken medication according to symptoms}]{Figure-2: Distribution of respondents taken medication according to symptoms}\par
Among the respondents, only 179 (28.59\%) took medication with doctors' advic and remaining 447 (71.40\%) respondents took the drugs, as "selfmedication" by the other sources like friends/family, pharmacy/dispensary and media/internet as shown in Fig-  {\ref 1}.\par
A total of 105 (16.77\%) respondents took medications without having any symptoms, and the remaining 521 respondents, common symptoms for which the respondents took medications were fever (37.61\%), throat pain (28.79\%), dry-cough (14.20\%), loss of smell (9.21\%), loss of taste (3.45\%), body ache (4.99\%), and rarely diarrhea (1.72\%) respectively as shown in Fig-  {\ref 2}. The market price of the anti-infective agents was higher than the retail price as shown in Fig-  {\ref 3}. Azithromycin raised almost 37\%, hydroxychlorquine 18\%, doxycycline 12\% and ivermectin 7\%, respectively.\par
IV. 
\section[{Discussion}]{Discussion}\par
To the best of our knowledge, this is the first online survey in Dhaka city evaluating the pattern and frequency of self-medication practice of prescriptiononly drugs in the COVID-19 outbreak (April to June 2020) in Bangladesh. As the survey population was welleducated adults from different working status, the respondents' participation was expected to represent the sincerest and accurate scenario of the defined survey population.\par
An almost equal proportion of males and females participated in the study and most of them (50.47\%) belonged to the age group of 45-54 years. The highest number of respondents (49.84\%) were graduates (Bachelor's degree), and the lowest with doctoral degrees (4.15\%). Only 2.06\% respondents were from civil service and the rest were from non-civil service (36.74\%), self-employed, or business (29.39\%) living in Dhaka city at the time of the COVID-19 pandemic.\par
Among 626 survey population in Dhaka city who had taken medication for COVID-19, only 132 (21.08\%) were documented as positive and 78 (12.45\%) as negative by RT-PCR test. The rest of 416 (66.45\%) had never done the test, but almost 355 (85.33\%) had taken medication without doing any test for the COVID-19. This finding could be due to having additional distress due to high self-awareness of their health, as reported by Roberts T. et al. among people with higher educational status \hyperref[b7]{9} . Having self-medication without detecting COVID-19 among a large number of respondents could also be due to feeling of insecurity influenced by the availability of local medical resources, efficiency of the public health system, and prevention and control measures taken in pandemic situation \hyperref[b13]{17} .\par
The rate of self-medication of antimicrobial agents like azithromycin (54.15\%), doxycycline (40.25\%) was found much higher during the outbreak of COVID-19 comparing to 21\% and 25\% for azithromycin and doxycycline before the pandemic as reported by Chowdhury N et al \hyperref[b9]{13} . Azithromycin was the fifth-highest percentage of people with self-medication throughout the previous years, whereas it became the most common antibiotic during the present pandemic. On the other hand, ivermectin being the anti-parasitic agent, was self-medicated by 77.15\% of the respondents. This might be due to the nationwide broadcast of an experience by a team of Bangladeshi physicians, and Bangladesh Medical College Hospital (BMCH) claimed as "outstanding results" in 60 patients with COVID-19 patients all of whom recovered in a combination with ivermectin and doxycycline 12 . This attempt was made on the outcome of an in-vitro study reported as a single treatment by ivermectin is capable of \textasciitilde 5000-fold reduction of viral load at 48 hours in cell culture \hyperref[b10]{14} . Selfmedication of this drug was found highest (483/626) among the respondents irrespective of test results by RT-PCR. Though the drugs like chloroquine, hydroxychloroquine and azithromycin, was recommended in the treatment protocol of the Covid-19 patients in Bangladesh, according to the "National Guidelines on Clinical Management of Coronavirus Disease-2019" published in the health directorate's website \hyperref[b8]{11} ; hydroxychloroquine was used much less (20.44\%) than any other antimicrobials without prescription. This could be due to mass publicity and sharing of news in national and international news and social media as the drug can cause hazardous abnormalities in cardiac rhythm in the COVID-19 patients, and should be limited only in clinical trials or hospitals with adequate facilities to monitor any cardiac complications, warned by FDA in a safety communication briefing globally 12 . The overall the prevalence and dominance of self-medication of antimicrobials in low and middle-income countries were reported around 39\% in previous studies before the COVID-19 pandemic \hyperref[b11]{15,}\hyperref[b12]{16} but was outrageously higher (88.33\%) in Dhaka city during the pandemic.\par
Considering the sources or advice for medication, only 179 (28.59\%) respondents followed or consulted with doctors and rest by media or internet (27.15\%), pharmacy or dispensary (24.44\%), and friends or family (19.8\%). This finding was very much similar to the previous studies that reported the high prevalence of self-medication (including antimicrobials) since people could obtain any drugs from the pharmacies without prescription even in the distant areas of the country \hyperref[b14]{18} . Moreover, during a pandemic, people struggle to cope with constant news of the spread and effects of COVID-19 on news-media, social-media, internet without having adequate forms of social support and access to doctors as a result of lockdowns and self-isolation \hyperref[b6]{8,}\hyperref[b15]{19} . Most of the respondents (37.61\%) took antibiotics as selfmedication for fever during Covid-19 outbreak, followed by throat pain (28.79\%), dry cough (14.20\%), whereas almost 16.77\% respondents had no symptoms whatsoever. Having inappropriate antimicrobials, and supplementary medications (zinc, calcium, Vitamin-D) without prescription is associated with the risk of drug interactions, masking symptoms of underlying diseases, and most importantly, the development of antimicrobial resistance \hyperref[b16]{20,}\hyperref[b17]{21} .\par
Prices of essential COVID-19 medicines have increased 4\% globally since February 2020, as reported by Gustav Ando in Life Science Research and Analysis. Although there is no specific treatment for Covid-19, the drug administration in Bangladesh started working in advance to increase the production of some supportive medicines \hyperref[b18]{22} . Despite the availability of essential drugs, the increase demand in major cities for self-medication of azithromycin raised almost 37\%, hydroxychlorquine 18\%, doxycycline 12\%, and ivermectin 7\% respectively. The total amount of buying those medicines in response to COVID-19 situation had an unnecessary financial burden on the people in Dhaka. Overall economic hardship in low and middle-income countries have to cope with the added expenditure that could be avoided by strict regulatory surveillance on self-medication and dispensing without prescription.\par
Although there is no approved specific medication to prevent or treat COVID-19, this online survey among the educated adults with high socioeconomic standings revealed that a high prevalence of self-medication of prescription-only drugs was persistent during the outbreak in Dhaka city. Unsolicited news of spread, effects and remedies in media channels, internet, mental stress of lockdown, and isolation, insecurity, and panic about the scarcity of drug and healthcare support might has triggered up the practice self-medication. Psychological distress levels were also influenced by availability of local medical resources, prevention and control measures \hyperref[b19]{23} . There is sufficient evidence of increasing resistance to antibiotics in Bangladesh resulting from irrational and misuse of antibiotics, where sales of antibiotics are not restricted at any level \hyperref[b20]{24} . Unopposed access to buy antibiotics and its injudicious use might provoke a long-term burden of drug-resistant strains with problems of under and overdosage, treatment failure and severe adverse effects on vital organs. It also results in delays in care seeking, which results in paradoxical economic loss due to delayed diagnosis, and irrational treatment \hyperref[b21]{25} . Bangladesh is already in the burden of a lower ratio of healthcare workers and a supply support system, with a high rate of community-transmission of COVID-19 and requires effective and efficient enforcement of regulation against free display and sales of drugs without prescription and individuals duly authorized.\par
V. 
\section[{Conclusion}]{Conclusion}\par
The pattern of medication, including selfmedication, is an important health indicator, which reflects the degree of supply utilization, and regulatory enforcement of healthcare services within a community. Immediate acceleration of health education campaigns, strict legislations on dispensing drugs and increasing the quality, and access to healthcare are the important interventions that might change the people's healthseeking behavior \hyperref[b22]{26} . The pandemic situation of COVID-19 is likely to sustain for years and it will have a huge socioeconomic and psycho-social impact on people's lifestyle and behavior, as predicted by the WHO, and epidemiologists from different regions. Therefore, a vast nationwide survey and surveillance should be done on self-medication of the mass population to protect them from the potential risks, overuse shortage and irrational financial burden during the COVID-19 outbreak. \begin{figure}[htbp]
\noindent\textbf{-} \par 
\begin{longtable}{P{0.03426877470355731\textwidth}P{0.4058498023715415\textwidth}P{0.0013438735177865612\textwidth}P{0.01209486166007905\textwidth}P{0.0026877470355731225\textwidth}P{0.005375494071146245\textwidth}P{0.3883794466403162\textwidth}}
Ivermectin\tabcellsep \multicolumn{5}{l}{tiredness, loss of energy, stomach pain, loss}\tabcellsep Bronchospasm, hepatotoxicity, seizure\\
\tabcellsep \multicolumn{5}{l}{of appetite, nausea, vomiting, diarrhea,}\\
\tabcellsep \multicolumn{5}{l}{dizziness, sleepiness or drowsiness,}\\
\tabcellsep \multicolumn{5}{l}{itchiness, trouble breathing, swelling of}\\
\tabcellsep \multicolumn{4}{l}{throat or tongue, skin rash}\tabcellsep \\
\tabcellsep \tabcellsep \tabcellsep \multicolumn{2}{l}{Mild / common}\tabcellsep \tabcellsep Severe / rare\\
Azithromycin\tabcellsep \multicolumn{5}{l}{Diarrhea, nausea, abdominal pain, vomiting,}\tabcellsep Prolong QT interval, Arrhythmia, Hepatic\\
\tabcellsep headache\tabcellsep \tabcellsep \tabcellsep \tabcellsep \tabcellsep dysfunction, Myasthania\\
Doxycycline\tabcellsep \multicolumn{5}{l}{loss of appetite, nausea, vomiting, diarrhea,}\tabcellsep headache, blurry vision, double vision, vision\\
\tabcellsep \multicolumn{5}{l}{rash, sensitivity to the sun, hives, discoloring}\tabcellsep loss, Irritation of esophagus, Anemia,\\
\tabcellsep \multicolumn{5}{l}{of teeth, bloody diarrhea, stomach cramping}\tabcellsep Pancreatitis. pain in upper abdomen, fever,\\
\tabcellsep \multicolumn{5}{l}{and pain, fever, dehydration, weight loss}\tabcellsep skin reactions, blisters, peeling skin, small\\
\tabcellsep \tabcellsep \tabcellsep \tabcellsep \tabcellsep \tabcellsep purple spots\\
Hydroxychloroquine\tabcellsep \multicolumn{5}{l}{nausea, vomiting, stomach pain or cramps,}\tabcellsep Bone marrow depression, anemia, aplastic\\
\tabcellsep \multicolumn{5}{l}{loss of appetite, weight loss, diarrhea,}\tabcellsep anemia, agranulocytosis, leukopenia, and\\
\tabcellsep \multicolumn{5}{l}{dizziness, spinning sensation, headache,}\tabcellsep thrombocytopenia. Hemolysis reported in\\
\tabcellsep ringing\tabcellsep in\tabcellsep ears,\tabcellsep mood\tabcellsep changes,\tabcellsep individuals with glucose-6-phosphate\\
\tabcellsep \multicolumn{5}{l}{nervousness, irritability, skin rash, itching, or}\tabcellsep dehydrogenase deficiency, Cardiomyopathy,\\
\tabcellsep hair loss.\tabcellsep \tabcellsep \tabcellsep \tabcellsep \tabcellsep cardiac failure, prolongs the QT interval,\\
\tabcellsep \tabcellsep \tabcellsep \tabcellsep \tabcellsep \tabcellsep Ventricular arrhythmias, torsade de pointes\end{longtable} \par
 
\caption{\label{tab_0}Table - I: List of possible side effects of anti-infective agents used in self-medication during COVID-19}\end{figure}
 \begin{figure}[htbp]
\noindent\textbf{-} \par 
\begin{longtable}{P{0.20067324955116697\textwidth}P{0.05264811490125673\textwidth}P{0.2693447037701975\textwidth}P{0.008393177737881508\textwidth}P{0.018312387791741474\textwidth}P{0.08087971274685817\textwidth}P{0.027468581687612206\textwidth}P{0.021364452423698384\textwidth}P{0.019838420107719926\textwidth}P{0.11292639138240573\textwidth}P{0.016786355475763015\textwidth}P{0.021364452423698384\textwidth}}
\tabcellsep \tabcellsep Variables\tabcellsep \tabcellsep \tabcellsep \multicolumn{2}{l}{Frequency}\tabcellsep \tabcellsep \tabcellsep \multicolumn{2}{l}{Percentage (\%)}\\
\tabcellsep \tabcellsep \tabcellsep \tabcellsep \tabcellsep \multicolumn{2}{l}{Gender:}\tabcellsep \tabcellsep \tabcellsep \tabcellsep \\
\tabcellsep \tabcellsep Male\tabcellsep \tabcellsep \tabcellsep \multicolumn{2}{l}{282}\tabcellsep \tabcellsep \tabcellsep 45.04\%\tabcellsep \\
\tabcellsep \tabcellsep Female\tabcellsep \tabcellsep \tabcellsep \multicolumn{2}{l}{346}\tabcellsep \tabcellsep \tabcellsep 55.27\%\tabcellsep \\
\tabcellsep \tabcellsep \tabcellsep \tabcellsep \tabcellsep \multicolumn{2}{l}{Age:}\tabcellsep \tabcellsep \tabcellsep \tabcellsep \\
\tabcellsep \tabcellsep 25-34\tabcellsep \tabcellsep \tabcellsep \tabcellsep 96\tabcellsep \tabcellsep \tabcellsep 15.33\%\tabcellsep \\
\tabcellsep \tabcellsep 35-44\tabcellsep \tabcellsep \tabcellsep \multicolumn{2}{l}{156}\tabcellsep \tabcellsep \tabcellsep 24.92\%\tabcellsep \\
\tabcellsep \tabcellsep 45-54\tabcellsep \tabcellsep \tabcellsep \multicolumn{2}{l}{316}\tabcellsep \tabcellsep \tabcellsep 50.47\%\tabcellsep \\
\tabcellsep \tabcellsep 55 +\tabcellsep \tabcellsep \tabcellsep \tabcellsep 58\tabcellsep \tabcellsep \tabcellsep 9.26\%\tabcellsep \\
\tabcellsep \tabcellsep \tabcellsep \tabcellsep \tabcellsep \multicolumn{3}{l}{Education level:}\tabcellsep \tabcellsep \tabcellsep \\
\tabcellsep \tabcellsep \multicolumn{2}{l}{Undergraduate}\tabcellsep \tabcellsep \multicolumn{2}{l}{110}\tabcellsep \tabcellsep \tabcellsep 17.57\%\tabcellsep \\
\tabcellsep \tabcellsep \multicolumn{2}{l}{Bachelor degree}\tabcellsep \tabcellsep \multicolumn{2}{l}{312}\tabcellsep \tabcellsep \tabcellsep 49.84\%\tabcellsep \\
\tabcellsep \tabcellsep \multicolumn{2}{l}{Master degree}\tabcellsep \tabcellsep \multicolumn{2}{l}{178}\tabcellsep \tabcellsep \tabcellsep 28.43\%\tabcellsep \\
\tabcellsep \tabcellsep \multicolumn{2}{l}{Doctoral and advanced}\tabcellsep \tabcellsep \tabcellsep 26\tabcellsep \tabcellsep \tabcellsep 4.15\%\tabcellsep \\
\tabcellsep \tabcellsep \tabcellsep \tabcellsep \tabcellsep \multicolumn{2}{l}{Work status:}\tabcellsep \tabcellsep \tabcellsep \tabcellsep \\
\tabcellsep \tabcellsep Students\tabcellsep \tabcellsep \tabcellsep \tabcellsep 84\tabcellsep \tabcellsep \tabcellsep \multicolumn{2}{l}{13.41\%}\\
\tabcellsep \tabcellsep \multicolumn{2}{l}{Civil service}\tabcellsep \tabcellsep \tabcellsep 13\tabcellsep \tabcellsep \tabcellsep 2.06\%\tabcellsep \\
\tabcellsep \tabcellsep \multicolumn{2}{l}{Non-civil service}\tabcellsep \tabcellsep \multicolumn{2}{l}{230}\tabcellsep \tabcellsep \tabcellsep 36.74\%\tabcellsep \\
\tabcellsep \tabcellsep \multicolumn{2}{l}{Self-employed / business}\tabcellsep \tabcellsep \multicolumn{2}{l}{184}\tabcellsep \tabcellsep \tabcellsep 29.39\%\tabcellsep \\
\tabcellsep \tabcellsep Retired\tabcellsep \tabcellsep \tabcellsep \tabcellsep 38\tabcellsep \tabcellsep \tabcellsep 6.07\%\tabcellsep \\
\tabcellsep \tabcellsep \multicolumn{2}{l}{Unemployed}\tabcellsep \tabcellsep \tabcellsep 77\tabcellsep \tabcellsep \tabcellsep 12.30\tabcellsep \\
\tabcellsep \tabcellsep \multicolumn{8}{l}{Table-III: Frequency distribution of respondents by use of anti-infective agents}\tabcellsep \\
\tabcellsep \tabcellsep \tabcellsep \tabcellsep \multicolumn{2}{l}{Azithromycin}\tabcellsep \multicolumn{2}{l}{Doxycycline}\tabcellsep \multicolumn{2}{l}{Hydroxychloroquin}\tabcellsep \multicolumn{2}{l}{Ivermectin}\\
\tabcellsep \tabcellsep \multicolumn{2}{l}{Number of}\tabcellsep \tabcellsep Cost\tabcellsep \tabcellsep Cost\tabcellsep \tabcellsep Cost\tabcellsep \tabcellsep Cost\\
\tabcellsep \tabcellsep \multicolumn{2}{l}{Respondents}\tabcellsep N\tabcellsep involved\tabcellsep N\tabcellsep involved\tabcellsep N\tabcellsep involved\tabcellsep N\tabcellsep involved\\
\tabcellsep \tabcellsep \tabcellsep \tabcellsep \tabcellsep (USD)\tabcellsep \tabcellsep (USD)\tabcellsep \tabcellsep (USD)\tabcellsep \tabcellsep (USD)\\
\tabcellsep RT-\tabcellsep Positive\tabcellsep 132\tabcellsep 111\tabcellsep 490\tabcellsep 93\tabcellsep 227\tabcellsep 84\tabcellsep 420\tabcellsep 109\tabcellsep 160\\
\tabcellsep PCR test\tabcellsep Negative\tabcellsep 78\tabcellsep 20\tabcellsep 102\tabcellsep 31\tabcellsep 76\tabcellsep 0\tabcellsep 0\tabcellsep 55\tabcellsep 81\\
\tabcellsep \tabcellsep Not done\tabcellsep 416\tabcellsep 208\tabcellsep 1046\tabcellsep 128\tabcellsep 313\tabcellsep 44\tabcellsep 215\tabcellsep 319\tabcellsep 469\\
\tabcellsep \tabcellsep Total\tabcellsep 626\tabcellsep 339\tabcellsep 1638\tabcellsep 252\tabcellsep 616\tabcellsep 128\tabcellsep 635\tabcellsep 483\tabcellsep 710\\
?\tabcellsep \multicolumn{6}{l}{Cost involved = Unit price x Daily dosage x Number of days}\tabcellsep \tabcellsep \tabcellsep \tabcellsep \\
\multicolumn{5}{l}{? Total cost converted from local BDT to USD}\tabcellsep \tabcellsep \tabcellsep \tabcellsep \tabcellsep \tabcellsep \\
\tabcellsep \tabcellsep \multicolumn{4}{l}{Out of 626 respondents, only 73 (11.66\%) did}\tabcellsep \tabcellsep \tabcellsep \tabcellsep \tabcellsep \\
\multicolumn{6}{l}{not take any medication during the survey period as 12}\tabcellsep \tabcellsep \tabcellsep \tabcellsep \tabcellsep \\
\multicolumn{6}{l}{(1.91\%) were negative by rRT-PCR test for COVID-19}\tabcellsep \tabcellsep \tabcellsep \tabcellsep \tabcellsep \\
\multicolumn{6}{l}{and 61 (9.74\%) did not test. The remaining 132}\tabcellsep \tabcellsep \tabcellsep \tabcellsep \tabcellsep \\
\multicolumn{6}{l}{respondents (21.08\%) was found positive test results for}\tabcellsep \tabcellsep \tabcellsep \tabcellsep \tabcellsep \\
\multicolumn{3}{l}{COVID-19.}\tabcellsep \tabcellsep \tabcellsep \tabcellsep \tabcellsep \tabcellsep \tabcellsep \tabcellsep \end{longtable} \par
 
\caption{\label{tab_1}Table -}\end{figure}
 		 		\backmatter   			 
\subsection[{Acknowledgement}]{Acknowledgement}\par
We gratefully acknowledge all the respondents for their spontaneous participation in the study. We also extend our gratitude and thanks to Dr. Farhana Selina for data extraction, logistic and software support. Funding: No fund or grants to declare. 			  			 			 			  				\begin{bibitemlist}{1}
\bibitem[Chowdhury et al. ()]{b9}\label{b9} 	 		\textit{},  		 			N Chowdhury 		,  		 			M R Islam 		,  		 			M M Hasan 		.  	 	 		\textit{International Journal of Pharmacy Teaching \& Practices}  		2013. 4  (1)  p. .  	 
\bibitem[Qiu et al. ()]{b19}\label{b19} 	 		‘A nationwide survey of psychological distress among Chinese people in the COVID-19 epidemic: implications and policy recommendations’.  		 			J Qiu 		,  		 			B Shen 		,  		 			M Zhao 		.  	 	 		\textit{General Psychiatry}  		2020. 33 p. e100213.  	 
\bibitem[Okeke et al. ()]{b16}\label{b16} 	 		‘Antimicrobial resistance in developing countries Part II: strategies for containment’.  		 			I N Okeke 		,  		 			K P Klugman 		,  		 			Z A Bhutta 		.  	 	 		\textit{Lancet Infect Dis}  		2005. 5 p. .  	 
\bibitem[Oyediran et al. ()]{b0}\label{b0} 	 		‘Awareness of risk associated with self-medication among patients attending out-patient department of a tertiary hospital in south western Nigeria’.  		 			O Oyediran 		,  		 			E O Ayandrian 		,  		 			M I Olatubi 		.  	 	 		\textit{International Journal of Africa Nursing Science}  		2019. 10 p. .  	 
\bibitem[Hughes et al. ()]{b2}\label{b2} 	 		‘Benefits and risks of self-medication’.  		 			C M Hughes 		,  		 			J C Mcelnay 		,  		 			G F Fleming 		.  	 	 		\textit{Drg Saf}  		2001. 24 p. .  	 
\bibitem[Nasir et al. ()]{b5}\label{b5} 	 		‘Comaparative study on knowledge, attitude and practice of selfmedication among the medical and non-medical undergraduate students in Dhaka city’.  		 			M Nasir 		,  		 			T Zahan 		,  		 			R A Parvin 		.  	 	 		\textit{World Journal of Pharmaceuticals and Life Sciences}  		2017. 3  (4)  p. .  	 
\bibitem[Community-Based Surveillance of Antimicrobial use and Resistance in Resource constrained settings. A report on five pilot projects World Health Organization ()]{b17}\label{b17} 	 		‘Community-Based Surveillance of Antimicrobial use and Resistance in Resource constrained settings. A report on five pilot projects’.  		 \url{http//www.apps.who.int/medicinedocs/documents/s16168e.pdf}  	 	 		\textit{World Health Organization}  		2009.  	 
\bibitem[Covid-19), by Disease Control Division, Directorate General of Health Services Ministry of Health & Family Welfare; Government of the People's Republic of Bangladesh National Guidelines on Clinical Management of Coronavirus Disease ()]{b8}\label{b8} 	 		‘Covid-19), by Disease Control Division, Directorate General of Health Services Ministry of Health \& Family Welfare; Government of the People's Republic of Bangladesh’.  		 \url{https://dghs.gov.bd/index.php/en/home/5343-covid-19-update}  	 	 		\textit{National Guidelines on Clinical Management of Coronavirus Disease}  		2019. Version-4, 30 March, 2020.  	 
\bibitem[Kalyan et al. ()]{b21}\label{b21} 	 		‘Evaluation of self-medication practices among undergraduate dental students of tertiary care teaching dental hospital in south India’.  		 			V S Kalyan 		,  		 			K Sudhakar 		,  		 			P Srinivas 		.  	 	 		\textit{Journal of Education and Ethics in Dentistry}  		2013. 3  (1)  p. .  	 
\bibitem[Hussain et al. ()]{b3}\label{b3} 	 		‘Exploring health seeking behavior, medicine use and selfmedication in rural and urban Pakistan’.  		 			S Hussain 		,  		 			F Malik 		,  		 			A Hameed 		,  		 			H Riaz 		.  	 	 		\textit{Southern Med Rev}  		2008. 3 p. .  	 
\bibitem[Roberts et al. ()]{b7}\label{b7} 	 		‘Factors associated with health service utilizationfor common mental disorders: a systematic review’.  		 			T Roberts 		,  		 			Miguel Esponda 		,  		 			G Krupchanka 		,  		 			D 		.  	 	 		\textit{BMC Psychiatry}  		2018. 18 p. 262.  	 
\bibitem[Li et al. ()]{b15}\label{b15} 	 		‘Fighting against COVID-19: Innovative strategies for clinical pharmacists’.  		 			Huibo Li 		,  		 			Siqian Zheng 		,  		 			Fang Liu 		.  		 \url{https://www.sciencedirect.com/science/article/pii/S1551741120303284}  	 	 		\textit{Res Soc Adm Pharm}  		2020.  	 	 (IN PRESS] Available at) 
\bibitem[Ocan et al. ()]{b11}\label{b11} 	 		‘Household antimicrobial self-medication: a systematic review and meta-analysis of the burden, risk factors and outcomes in developing countries’.  		 			M Ocan 		,  		 			E A Obuku 		,  		 			F Bwanga 		.  	 	 		\textit{BMC Public Health}  		2015. 15 p. 742.  	 
\bibitem[Kretchy et al.]{b6}\label{b6} 	 		‘Medication management and adherence during the COVID-19 pandemic: Perspectives and experiences from lowand middle-income countries’.  		 			I A Kretchy 		,  		 			M Asiedu-Danso 		,  		 			J P Kretchy 		.  		 \url{https://www.sciencedirect.com/science/article/pii/S1551741120303326[INPRESS}  	 	 		\textit{Research in Social and Administrative Pharmacy. Available}  		 	 
\bibitem[ne-supply-prices-managed-well-amid-crisis-1900585 Viewed on (2020)]{b18}\label{b18} 	 		\textit{ne-supply-prices-managed-well-amid-crisis-1900585 Viewed on},  		 \url{https://www.thedailystar.net/frontpage/news/medici}  		2020. 30 July, 2020. 08.  	 	 (DGDA-Medicine supply, prices managed well amid crisis) 
\bibitem[Morgan et al. ()]{b12}\label{b12} 	 		‘Nonprescription antimicrobial use worldwide: A systematic review’.  		 			D J Morgan 		,  		 			I N Okeke 		,  		 			R Laxminarayan 		.  	 	 		\textit{Lancet Infect Dis}  		2011. 11 p. .  	 
\bibitem[Report in Dhaka Tribune (2019)]{b4}\label{b4} 	 		\textit{Report in Dhaka Tribune},  		 \url{https://www.dhakatribune.com/health/2019/07/21/patient-doctors-nurses-ratio-bangladesh-lags-far-behind-its-neighbours}  		July 21. 2019.  	 
\bibitem[Report of the WHO Expert Committee on National Drug Policies ()]{b1}\label{b1} 	 		\textit{Report of the WHO Expert Committee on National Drug Policies},  		 \url{https://apps.who.int/iris/handle/10665/63068?locale-attribute=en\&show=full}  		1995. Geneva.  	 
\bibitem[Biswas et al. ()]{b20}\label{b20} 	 		‘Self-medicated antibiotics in Bangladesh: a cross sectional health survey conducted in the Rajshahi city’.  		 			M Biswas 		,  		 			M N Roy 		,  		 			I N Manik 		.  	 	 		\textit{BMC Public Health}  		2014. 14 p. 847.  	 
\bibitem[Alghanim ()]{b22}\label{b22} 	 		‘Self-medication practice among patients in a public health care system’.  		 			S A Alghanim 		.  	 	 		\textit{Eastern Mediterranean Health Journal}  		2011. 7  (5)  p. .  	 
\bibitem[Islam ()]{b14}\label{b14} 	 		‘Self-medications among higher educated population in Bangladesh: an email-based exploratory study’.  		 			M S Islam 		.  	 	 		\textit{Internet J Health}  		2007. 5  (2) .  	 
\bibitem[Leoncaly et al. ()]{b10}\label{b10} 	 		‘The FDA-approved drug ivermectin inhibits the replication of SARS-CoV-2 in vitro’.  		 			Julian D Leoncaly 		,  		 			Mike G Druce 		,  		 			Catton 		.  	 	 		\textit{Antiviral Research}  		2020. 178 p. 104787.  	 
\bibitem[Wind and Komproe ()]{b13}\label{b13} 	 		‘The mechanism that associate community social capital with postdisaster mental health: a multilevel model’.  		 			T R Wind 		,  		 			I H Komproe 		.  	 	 		\textit{Soc Sci Med}  		2012. 75 p. .  	 
\end{bibitemlist}
 			 		 	 
\end{document}
