nowadays , the indiscriminate use of drugs , self - medication is among the greatest health , social and economic issues of different societies , includes iran ( 1 ) . self - medication is a behavior in which the individual attempts to solve his / her health problem without professional opinion or help ( 2 ) . the irrational and self - driven use of drugs can lead to various side effects ( 3 , 4 ) . among the most significant of these are microbial resistances , non - response to treatment , and toxications . moreover , self - medication disrupts the drug market , wastes costs and increases per capita drug financing in the society ( 57 ) . the prevalence of self - medication varies from 12% to 90% in iran ( 812 ) . moreover , each iranian uses 339 drugs annually , a figure that exceeds the global standard . analgesics , eye drops , and antibiotics hold the greatest share in self - medicated drugs ( 10 , 13 , 14 ) . according to a report released by the ministry of health s  adverse drug reactions  ( adr ) center 10000 adverse drug reactions have been registered in the past 10 years , among which 30% belonged to injectable drugs ( 15 ) . the following factors affect the prevalence rate of self - medication among people : costly physician fees , transportation issues , insurance problems , easy access to drugs , feeling of well - being , not taking the disease seriously , previous prescription of the drug , unawareness , cultural and socio - economic issues , etc . taking into account the high prevalence of self - medication in iran and its adverse effects health officials and stakeholder organizations need to consider seriously reducing and preventing this phenomenon . to do this , they need accurate and valid information on the prevalence and etiology of self - treatment in the society . hence , this study , which is a systematic review & meta - analysis , was conducted to provide health system managers , officials , and policy makers with useful and applicable data . this systematic review and meta - analysis study was conducted in 2015 , using the approach adopted in the book  a systematic review to support evidence - based medicine ( 21 )  . moreover , it was performed according to the  preferred reporting items for systematic reviews and meta - analyses  ( prisma ) statement ( 22 , 23 ) . the inclusion criteria for the study were cross - sectional community - based studies on the prevalence and causes of self - medication , studies conducted in iran , articles published in persian and english in iran , articles published from 2000 to 2015 . exclusion criteria included studies conducted in healthcare centers , conference presentations , case reports , interventional and qualitative studies . required data were collected by searching the following keywords : medication , self - medication , over - the - counter , non - prescription , prevalence , epidemiology , etiology , occurrence and iran . the following databases were used : google scholar , pubmed , scopus , magiran , scientific information database ( sid ) and iranmedex . the reference lists of the selected articles were also checked . in the final stage of the literature review in the first phase of the review process , an extraction table was designed that included the following items : first author s name , year of publication , city , sample and sample size , self - medication prevalence percent ( in both males and females ) , drug group , determinant factors , cause of self - medication and type of request for the drug . the validity of the data extraction table was confirmed by experts . a pilot study ( with5 articles ) two authors ( m.m and n.m ) who had sufficient experience and knowledge were responsible for independently extracting the data . in the first phase of article selection , articles with non - relevant titles were excluded . in the second phase , the abstracts and full texts of articles were reviewed to include those articles that matched the inclusion criteria . reference management ( end - note x5-thomson reuters , philadelphia , pa 19130 , usa ) software was used to organize and assess the titles and abstracts , as well as to identify duplicate studies . two reviewers ( m.m and n.m ) evaluated the articles based on the  strengthening the reporting of observational studies in epidemiology cases in which a consensus had not been reached between these two reviewers were referred to a third author ( a.a.s ) . to estimate the overall self - medication prevalence , computer software cma 2 ( comprehensive meta - analysis ) ( englewood , nj , usa ) was used . the size of each square shows the sample size and the lines on each side of the square show the confidence interval . self - medication prevalence was calculated based on the random effect model , with 95%confidence interval . in this study , out of 1256 articles , finally 25 articles completely related to the study objects were included ( 1 , 2739 , 9 , 4046 , 12 , 47 ) ( fig . bibliographical searches and inclusion process in 25 articles , which reviewed , 15222 individuals had gone under study . the highest and lowest prevalence were observed in kerman province among students , and among teachers in babol , respectively . among the most important determinant factors of self - medication were age , sex , education , financial status , place of residence , marital status and type of university ( medical vs. non - medical ) . the overall prevalence of self - medication in community setting of iran is shown in fig . 2 . the overall prevalence of self - medication in community setting of iran the overall prevalence of self - medication in community setting of iran based on the random effect model was determined to be 53% ( 95% ci , lowest = 42% , highest = 67% ) . 95% ci for the prevalence was drawn for each study in the horizontal line format ( q = 363.8 df = 24 , p < 0 . the prevalence of self - medication among students in community setting of iran is shown in fig . the prevalence of self - medication among students in community setting of iran based on the random effect model was determined to be 67% ( 95% ci , lowest = 55% , highest = 81% ) . 95% ci for the prevalence was drawn for each study in the horizontal line format ( q = 63.9 df = 12 p < 0 . the prevalence of self - medication among household in community setting of iran is shown in fig . the prevalence of self - medication among students in community setting of iran the prevalence of self - medication among household in community setting of iran the prevalence of self - medication among household in community setting of iran based on the random effect model was determined to be 36% ( 95% ci , lowest = 17% , highest = 77% ) . 95% ci for the prevalence was drawn for each study in the horizontal line format ( q = 150.8 df = 4 p < 0 . the prevalence of self - medication among elderly people in community setting of iran is shown in fig . the prevalence of self - medication among elderly people in community setting of iran the prevalence of self - medication among elderly people in community setting of iran based on the fixed effect model was determined to be 68% ( 95% ci , lowest = 54% , highest = 84% ) . 95% ci for the prevalence was drawn for each study in the horizontal line format ( q = 6.2 df = 3 p < 0 . 09 i= 52.2 ) . to evaluate the publication bias , funnel plot was applied ( fig . funnel plot of standard error by event rate the most common causes of self - medication are shown in fig . the most important self - medication determinant factors were : mild symptoms of disease , self - diagnosis of disease symptoms , previous use of medication , and ease of access to non - prescribed medication . the most common causes of self - medication in community setting of iran the most common groups of diseases , which patients self - medicated , are shown in fig . the most common self - medicated groups of diseases in community setting of iran as seen in fig . 8 , the most important groups of diseases in which patients self - medicated were respiratory diseases , common cold and headache . the most common groups of medication , which patients self - medicated , are shown in fig . . 9 , the most important groups of medication that were self - prescribed were analgesics , antibiotics , and cold medications . the most important determinant factors of self - medication were mild symptoms of disease , self - diagnosis of disease symptoms , previous use of medication , and ease of access to non - prescribed medication . the most important groups of diseases in which patients self - medicated were respiratory diseases , common cold and headache . the most important groups of medication that were self - prescribed were analgesics , antibiotics , and cold medications . based on our results , this percentage exceeds that of other studies performed elsewhere : brazil ( 2010 ) 29.9% ( 48 ) , china ( 2011 ) 32.9% ( 49 ) , portugal ( 2014 ) 18.9% ( 50 ) , germany ( 2004 ) 13.8% ( 51 ) , india ( 2014 ) 11.9% ( 4 ) , and nigeria ( 2011 ) 19.2% ( 52 ) . most other studies too have reported lower prevalence of self - medication than the one in iran ( 5357 ) . the side effects of drugs are becoming more and more evident and people are getting more used to self - medication as the years pass by . hence , medical universities and stake - holder organizations should try to reduce the rate of self - medication through proper planning , and prevent its harmful outcomes through the following measures : directing physicians toward the employment of non - medication treatment techniques , universal health insurance , reduction of treatment expenditures , creation of facilities for simple and inexpensive access to physicians , appropriate notification through mass media - television & radio - news agencies- publications and medical universities , raising public awareness of self - medication , limiting the sales of drugs without prescriptions , supervising pharmacies performance and other similar measures . the prevalence of self - medication was higher among students ( 67% ) than its mean public rate . this figure has been reported at a lower level in most studies conducted in other countries ( 5862 ) . however , some studies have reported the self - medication prevalences at rates higher than ours ( 2 , 6367 ) . it seems that self - medication is more prevalent among students than it is among the public . perhaps , their higher level of information  as compared to that of the public- can be one of the reasons behind this phenomenon . these individuals have access to greater information and self - medicate based on their incomplete data , an act that can be followed by detrimental effects . this phenomenon is probably higher among medical students than it is among students of other disciplines , reason being , the nature of their curricula and their high information in the fields of drugs and diseases . in any case , appropriate planning and intervention need to be carried out in this field ; culture building among students and increasing their awareness on the effects of self - medication can prove beneficial . self - medication was also higher among the elderly ( 68% ) than in the other community groups . similar to the proportion observed in other groups in iran , the prevalence of self - medication was higher among the iranian elderly than among the elderly in other societies ( 6870 ) . the prevalence of self - medication among the elderly in the world is 38% ( 71 ) . the high rate in iran may be attributed to the low level of awareness among the elderly . a study showed an inverse relationship between self - medication and level of awareness among the elderly ( 37 ) . hence , health officials should raise awareness among this group . upon entering the aging phase , treatment costs and medication use rise . moreover , chronic diseases that predominantly affect the elderly cause pain & disability and reduce their quality of life , hence , raising their need for medication ( 72 ) . in this respect , focus needs to be laid on the cognitive and physiologic changes that take place during aging and that pre - dispose the elderly toward medication use ( 73 ) . therefore , it is essential to teach the correct use of drugs to the elderly and advise abstinence of self - medication through models that identify and strengthen factors affecting behavior . one of the models that can prove effective for this goal is the  extended parallel process model ( eppm ) . based on the eppm , if individuals believe that they are highly at risk of a disease or exposed to a health risk , they will be more stimulated to confront that threat . in fact , fear of a threat causes individuals to adopt certain behaviors to confront that health threat . if the threat assessment is realized , and the efficacy of the solutions is assessed , the possibility of attitude change , behavioral intention and behavior will increase ( 74 ) . mild symptoms of disease , self - diagnosis of disease symptoms , previous use of medication , and ease of access to non - prescribed medication were among the most important determinant factors of self - medication . these factors have been repeatedly reported in earlier studies ( 30 , 53 , 65 , 7582 ) . moreover , the most significant groups of diseases that are self - medicated i.e. respiratory diseases , common cold and headache , are similar to the findings of other studies too ( 4 , 79 , 8396 ) . likewise , the most significantly self - medicated drugs in iran were similar to those self - medicated elsewhere ( 76 , 92 , 95 , 97103 ) . prioritizing these factors while planning for self - medication reduction can yield greater results . limitations : one of the main limitations of this study was our lack of access to certain databases . furthermore , certain details had not been reported in the published articles , so they could not be extracted . laying the results of current study show a relatively higher prevalence of self - medication among the iranian population in community setting as compared to other countries in the world . moreover , it was relatively high in special groups ( students , elderly and households ) . the most important reason behind self - medication was the appearance of mild symptoms of disease . the most significant group of diseases that were self - medicated was respiratory diseases , and the most important groups of drugs self - medicated were analgesics and antibiotics . the detrimental effects of self - medication from the health , social and economic perspectives warrant the need for appropriate planning and policy - making to reduce it . raising public awareness , culture - building , control & supervision of physicians and pharmacies performance can have beneficial effects in this regard . ethical issues ( including plagiarism , informed consent , misconduct , data fabrication and/or falsification , double publication and/or submission , redundancy , etc . ) have been completely observed by the authors .
background : nowadays self - medication is one of the most common public health issues in many countries , as well as in iran . according to need to epidemiological information about self - medication , the aim of this study was to systematic review and meta - analysis of prevalence and cause of self - medication in community setting of iran.methods:required data were collected searching following key words : medication , self - medication , over - the - counter , non - prescription , prevalence , epidemiology , etiology , occurrence and iran in google scholar , pubmed , scopus , magiran , sid and iranmedex ( from 2000 to 2015 ) . to estimate the overall self - medication prevalence , computer software cma : 2 applied . in order to report the results , forest plot was employed.results:out of 1256 articles 
 , 25 articles entered to study . 
 the overall prevalence of self - medication based on the random effect model was estimated to be 53% ( 95% ci , lowest= 42% , highest=67% ) . 
 the prevalence of self - medication in students was 67% ( 95% ci , lowest=55% , highest=81% ) , in the household 36% ( 95% ci , lowest=17% , highest= 77% ) and in the elderly people 68% ( 95% ci , lowest=54% , highest=84% ) . 
 the most important cause of self - medication was mild symptoms of disease . 
 the most important group of disease in which patients self - medicated was respiratory diseases and the most important group of medication was analgesics.conclusion:the results show a relatively higher prevalence of self - medication among the iranian community setting as compared to other countries . raising public awareness , 
 culture building and control of physicians and pharmacies performance can have beneficial effects in reduce of prevalence of self - medication .