A household survey of medicine storage practices in Gondar town, northwestern Ethiopia

Disposal practices of unwanted household medications in China: a cross-sectional study

OBJECTIVES

This study aimed to understand disposal practices of unwanted medications in Chinese households and examine associations between influencing factors and these disposal practices.

DESIGN

A nationwide cross-sectional study conducted between 11 October and 26 October 2018.

SETTING

Municipalities directly under the central government and provincial capitals across 30 provinces and autonomous regions.

PARTICIPANTS

A total of 6293 households participated in the study.

PRIMARY AND SECONDARY OUTCOME MEASURES

A self-designed questionnaire was used to survey disposing methods of unwanted medications, which were categorised into three groups: household waste disposal, recycling and use or give unwanted medications to others.

RESULTS

2771 (44%) households reported they have unwanted medications. The majority (89%) disposed of unwanted medications in the bin, sink or toilet. Having a family member of 65 years old and above (OR: 5.45; 95% CI: 3.20 to 9.26), having a family member of medical professions (OR: 1.45; 95% CI: 1.15 to 1.83), receiving information on proper disposal (OR: 6.03; 95% CI: 4.54 to 8.00) and having a high level of perception of risk to the environment (OR: 1.56; 95% CI: 1.05 to 2.30) were associated with recycling. Additionally, a household having more than 10 medications stored (OR: 1.73; 95% CI: 1.29 to 2.34) was more likely to dispose of unwanted medications in the bin or sink/toilet. Women were less likely to use unwanted medications or give them to others (OR: 0.59; 95% CI: 0.38 to 0.90). A higher perception of health risks was associated with increased recycling, particularly among middle-aged and older adults (OR: 1.60; 95% CI: 1.04 to 2.47) and decreased likelihood of using unwanted medications or giving them to others (OR: 0.36; 95% CI: 0.20 to 0.67).

CONCLUSIONS

There is an urgent need to establish a standardised management system for rational disposal of unwanted medications in China. This system should aim to promote and educate the public on rational stocking and use of medications, as well as appropriate disposal practices.

Household storage and disposal of unused and expired medicines in Dessie, Ethiopia: a cross-sectional study

Introduction

Households frequently store unwanted, unused, or expired medicines in their homes indefinitely or discard them through general municipal waste bins, sinks, or flush them into their toilets. Disposing unused or expired medicines through these unauthorized channels can affect the environment and lives of individuals. This study assessed the household storage and disposal practices of unused and expired medicines in the Dessie City Administration in northeast Ethiopia.

Methods

A community-based cross-sectional study was conducted using a semi-structured interview. The data were collected during November 1-30, 2019. A Multistage sampling technique was employed to recruit participants. The data were analyzed using SPSS version 23.

Results

The study found that 62.4% of households stored unused or expired medicines, with analgesics, antibiotics, and cold and flu drugs being the most commonly used. The primary reasons for storing these medicines included future use, discontinuation of medication, and sharing with others, if needed. Most people preferred to dispose of these medicines by trashing them in household garbage, while some disposed of them in their original form and a few diluted them with water before disposal. Multivariate logistic regression analysis identified key factors associated with medicine storage: housewives and government employees were less likely to store unused medicines compared to students and daily workers, and obtaining medicines from private dispensaries was linked to reduced storage. Additionally, households that received advice from physicians were less inclined to store unused medicines.

Conclusion

This revealed the widespread storage of unused medicines, primarily analgesics and antibiotics. Improper disposal practices are common and emphasize the need for public education. Employment status, source of medicines, and healthcare advice influenced storage behaviors. Healthcare providers play a vital role in improving medication management and reducing waste.

Extent and causes of unused medications among patients in rural Ethiopia: a prospective multicenter cohort study

BACKGROUND

Medication waste poses health, economic, and environmental challenges. However, the extent among patients living in rural areas is underexplored. This study assessed the proportion of prescribed medications remaining unused by patients living in rural areas of Ethiopia, and identify the causes thereof and disposal practices.

METHODS

A prospective multicenter cohort study was conducted in 5 rural health centers in Ethiopia. Patients (≥ 18 years), who received a prescription for acute or chronic medication for pick up from the outpatient pharmacy were included. After 3 months, participants received a house visit by a health employee during which a questionnaire was verbally administered to assess the quantity of unused medication, reason thereof, and disposal practices used. Data were analyzed using descriptive statistics and multivariate logistic regression to identify factors associated with presence of unused medications.

RESULTS

In total, 178 patients participated. Up to 136 out of 601 (22.6%) dispensed medications ended up unused, mainly antibiotics and analgesics, with an average economic value of $0.37. Of 178 patients, 72 (40.4%) ended up with unused medication, and 15 (8.4%) did not use 80% or more of the prescribed quantity. Early discontinuation of therapy was the main reason (61.8%) for patients' ending with unused medication. Patients reported to primarily dispose of unused medication either through the toilet (43.6%), household garbage (22.7%), burning (13.6%), or returning it to the pharmacy (2.7%). Medications dispensed to be administered with two or more-unit doses at a time were more likely to remain unused (adjusted OR 1.6 [1.0-3.4]) compared to medications dispensed to be administered one-unit dose.

CONCLUSION

A substantial amount of prescribed medications remains unused by patients in rural areas, frequently not properly disposed. Interventions are needed to ensure medications are not wasted and reduce the unwanted consequences.

The magnitude and associated factors of unused medications storage practice among households in Jimma city, southwest of Ethiopia: Community-based cross-sectional study

Background

Medicines are kept unused at home for many therapeutic reasons. Conversely, unused medication and subsequent wastage can be attributed to several primary factors such as medication change, death, and non-adherence. This study aimed to assess the magnitude and associated factors of unused medication storage practice among households in Jimma City, southwest Ethiopia.

Methods

A community-based cross-sectional study design was conducted among households (n = 397) in Jimma Town from July to August 2021. The data were collected using the pre-tested and interviewer-administered questionnaire. SPSS version 21.0 was used for data analysis. The multivariate logistic regression was used to determine the factors associated with the storage of unused medicine at a 5% level of significance.

Results

Out of 397 households that responded, (n = 90, 23%) of households were found to have unused medicine at home. This study showed that the majority of households dispose of unused drugs by burning them (32.2%) and burying them in the ground (29%). Antibiotics were the most (6.3%) unused medicines stored while the anti-diabetics (1.3%) were the least unused drugs stored among households. The presence of family members working in the health sector (AOR: 0.402, 95%, CI: 0.202, 0.800) and family size in households (AOR: 2.325, 95%, CI: 1.045, 5.174) were significantly associated with the magnitude of unused medicine storage.

Conclusion

The magnitude and improper disposal of unused medicines storage among households were significant in the study area. Therefore, it is important to educate the community and encourage health professionals to understand their role in problems and solutions.

Home drug utilization, storage practice and associated factors among people living in Bahir Dar city, Ethiopia

Background

Medicines are maintained at home for several reasons. However, irrational household storage of medicines is a universal public health problem, causing significant harm to health and the healthcare system.

Objective

This study aimed to assess home drug use and storage practices among the residents of Bahir Dar. Town, Ethiopia.

Method

A cross-sectional household study was conducted in three sub-cities of the town of Bahir Dar from July to October 2022. Multistage stratified sampling was used to select the households included in the study. Data on the prevalence of home drug storage, storage place, and self-medication practice, among others, were collected using a semi-structured questionnaire and analyzed using Statistical Package for Social Science version 20.

Results

More than half (57.9%) of the respondents stored medicines at home, mostly in drawers (35%). In this study, the widespread use of self-medication (44.6%) and drug-sharing practices (25%) were observed. Most of the leftover medicines (67.3%) were disposed of in the trash. Education status (AOR=3.8, 95% CI: 1.6-9.1), occupation (AOR=2.9, 95% CI: 1.2-7.2), income (AOR=1.73, 95% CI: 1.01-3.0), and the presence of chronic disease (AOR=3.2, 95% CI: 1.7-5.9) showed a significant association with home drug storage.

Conclusion

Many study participants stored medications at home and bought them from pharmacies without consulting physicians. Disposing of medications into waste and practice of medication sharing were found to be high in the current study, suggesting that there is a lack of home drug utilization and storage practices by the general public.

Prevalence and determinants of household medicine storage in Vietnam: A community-based cross-sectional study

Objectives

The COVID-19 pandemic has significantly impacted individual health, potentially increasing the demand for home medicine storage. However, inappropriate household medicine storage can lead to drug waste and unnecessary hazards. This study aimed to explore the prevalence of and identify the factors that predict medicine storage in Vietnamese households.

Methods

A community-based cross-sectional study was conducted with 800 households in Danang, Vietnam. A multi-stage sampling method was applied in this study. The data collection tool was modified from previous studies and consisted of three sections: household head characteristics, household characteristics, and medicine storage practice. Bivariable and multivariable binary logistic regression analyses were used to identify the factors influencing medicine storage at a p-value of less than 0.05.

Results

Among 800 households surveyed, 71.6% stored medicine. Analgesics-antipyretics were the most common type of medicine stored (80.8%). 90.1% of households obtained their medicines from private pharmacies, 68.1% of households stored medicine for future use and 58.8% had a home medicine cabinet. 9.4% of households did not store medicine in the appropriate packaging and 19.4% of households did not check the expiry date of their medicine. Educational level (AOR = 2.74; 95% CI = 1.84-4.06), income (AOR = 11.38; 95% CI = 1.46-88.79), presence of chronic illnesses (AOR = 12.44; 95% CI = 7.20-21.21), presence of children (AOR = 2.36; 95% CI = 1.56-3.58), presence of healthcare professionals (AOR = 2.14; 95% CI = 1.28-3.56) were predictors of the medicine storage.

Conclusions

The current study found a high prevalence of household medication storage and some inappropriate storage behaviors. Therefore, attention should be given to develop effective interventions and policies to promote safe and appropriate storage practices.

Health literacy, knowledge, household disposal, and misuse practices of antibiotics among UAE residents: a nationwide cross-sectional study

BACKGROUND

The study aimed to evaluate health literacy, knowledge, household disposal, and misuse practices of antibiotics among the United Arab Emirates (UAE) residents.

RESEARCH DESIGN AND METHODS

An observational cross-sectional study was conducted between May 1st and August 31st, 2022. The study encompassed a sample of 1074 participants.

RESULTS

Participants involved in a medical field (OR: 1.98, 95% CI: 1.45-2.69, p < 0.001) were more likely to have adequate health literacy. Most participants rarely (n = 315; 29.33%) or sometimes (n = 292; 27.19%) sought help from a doctor or pharmacist with reading the instructions and leaflets of antibiotics. A bachelor`s degree was associated with a reduced odds ratio of self-medication with antibiotics (OR: 0.46, 95% CI: 0.29-0.75, p = 0.002). Only 10.61% of unneeded antibiotics were returned to the pharmacy, 79.42% were disposed of at home and 10% were disposed of using other disposal practices.

CONCLUSIONS

Higher levels of adequate health literacy were observed in those involved in the medical field and those with higher educational levels. The prevalence of self-medication with antibiotics among the UAE population was low. These findings highlight the importance of improving health literacy, promoting responsible antibiotic use, and encouraging proper disposal practices among the population.

Assessment of home storage of antimicrobials and its predictors in Mecha demographic surveillance and field research center: a cross-sectional study

BACKGROUND

Home storage of antimicrobials is a worldwide practice. Irrational storage and inappropriate use of antimicrobials should get special attention in low-income countries due to limited information, knowledge, and perceptions. This study was conducted to survey home storage of antimicrobials and assess its predictors in Mecha Demographic Surveillance and Field Research Center (MDSFRC), Amhara region, Ethiopia.

METHODS

A cross-sectional survey was conducted on 868 households. Predeveloped structured questionnaire was used to collect data on sociodemographics, knowledge on antimicrobials and perception about home stored antimicrobials. Data was analyzed using SPSS version 20.0 to execute descriptive statistics, and run binary and multivariable binary logistic regression. P-value < 0.05 was considered significant at 95% confidence level.

RESULTS

The total number of households included in this study were 865. Female respondents represent 62.6%. The mean age (±) of respondents was 36.2 (± 13.93) years. The mean family size (±) of the household was 5.1 (± 2.5). Nearly one-fifth (21.2%) of the households stored antimicrobials at home with a condition similar to any household material. Most commonly stored antimicrobials were: Amoxicillin (30.3%), Cotrimoxazole (13.5%), Metronidazole (12.0%), and Ampicillin (9.6%). The most common immediate source of home stored antimicrobials was discontinuation of therapy (70.7%) either from symptomatic improvement (48.1%) or missing doses (22.6%). Predictors of home storage of antimicrobials with corresponding p-value were: age (0.002), family size (0.001), education status (< 0.001), home distance from the nearby healthcare institution (0.004), counseling while obtaining antimicrobials (< 0.001), knowledge level on antimicrobials (< 0.001), and perception of home stored antimicrobials as a wisdom (0.001).

CONCLUSION

Substantial proportion of households stored antimicrobials in a condition that may exert selection pressure. To reduce home storage of antimicrobials and its consequences, stakeholders should give due attention to predictors variables related to sociodemographics, level of knowledge on antimicrobials, perception of home storage as a wisdom, and counseling service.

Public knowledge of antibiotics, self-medication, and household disposal practices in Jordan

BACKGROUND

This study aimed to assess public understanding of antibiotics, self-medication, and drug disposal practices.

METHODS

A cross-sectional self-administered online survey was undertaken in Jordan.

RESULTS

The study was completed by 1,105 participants. When asked about their knowledge of antibiotics, rational antibiotic use, and disposal practices, 16% percent believed they should discontinue antibiotics once they felt better, and 12% agreed to take the same antibiotics prescribed to others for the same illness. Self-medication with antibiotics was practiced by 44% of the participants. Prior experience, healthcare costs, and pharmacy location were all major determinants of self-medication. Only 6.4% of unneeded antibiotics were returned to the pharmacy, 60% were kept at home, and 26.6% were disposed of at home. Almost half of those who kept the antibiotics said they would use them again, and one-third said they would give them to friends and family. Respondents who had used antibiotics within the previous 6 months (p = 0.052) and relied on medication leaflets (p = 0.031) and physician recommendations (p = 0.001) were less likely to self-medicate with antibiotics.

CONCLUSIONS

The study highlighted areas of inappropriate use of antibiotics, self-medication and the improper antibiotic disposal that can inform antimicrobial stewardship.

Prevalence and Determinants of Household Medication Storage During the COVID-19 Outbreak in Southwest Ethiopia

Background

Most households worldwide keep medicines on hand for various reasons, including emergency use, treatment of acute and chronic diseases, and anticipated future use. Being infected or fear of getting COVID-19 in the current pandemic could increase the storage of drugs at home. Thus, this study aimed to assess the prevalence of household storage of medicines and associated factors in southwest Ethiopia during the COVID-19 outbreak.

Methods

A cross-sectional household survey was conducted from February 1 to May 30, 2022. Data on the extent of storage, storage conditions, their current status, disposal methods, among others, were collected through structured interviews and observations. The data were entered into EPI info, exported, and analyzed using Statistical Packages for Social Sciences (SPSS). Bivariate followed by multivariate logistic regression was used to identify associated factors. P-value <0.05 was used as a cut-off point to decide statistical significance.

Results

The magnitude of household medication storage was 48% (95% CI). Analgesics (28.7%) and antibacterial (21.1%) agents were the most predominant class of drugs stored in the households. The most significant proportion of the home-stored medications (34.7%) was reserved for future use, and 31.8% were for treating current medical conditions. The majority of the respondents (84.1%) had never heard/learned about the safe disposal ways of drugs. The presence of children aged less than 5 years in a household [AOR = 1.90 (1.19, 3.05)] and the existence of chronically sick patients in a household [AOR = 4.3 (2.25, 8.45)] were factors significantly associated with household medication storage.

Conclusion

The current study revealed a high prevalence of home medication storage; thus, to lessen or eliminate the negative consequences of storing medications at home, it is necessary to review the medication utilization chain and offer community-based training on proper medication storage and disposal techniques, including establishing take-back programs.

Factors Influencing Public Willingness to Reuse the Unused Stored Medications in Jordan: A Cross-Sectional Study

The reissuing, redispensing, redistributing, or even recycling of the returned unused stored medicines is referred to as medicine reuse. A few studies have examined people's willingness to reuse unused stored medicines. This study aims primarily to explore the public's willingness to reuse unused stored medicines in the future and the factors affecting their decisions, and to assess the pharmacological types and formulations of the unused stored medicines by the public. A cross-sectional study was conducted using a convenient sampling technique over three weeks (February-March 2022) among Jordanian populations. Data were collected from 681 participants who agreed to fill out a questionnaire, which was distributed online. Participants showed a positive perception of reusing any of the unused stored medicines in the future; of those, 79.6% (n = 400) believed that reusing "unused medicines" has economic benefits and 50% (n = 251) believe there are environmental benefits. Moreover, more than half of the participants believed that reusing "unused medicines" is safe (n = 256, 51%), but provided that a pharmacist or a doctor evaluates their quality or that the unused medicines are stored well. Results from this study show that the public positively endorses the idea of reusing unused stored medicines if the quality and safety are assured. However, future studies are needed to evaluate the Jordanian healthcare professionals' perceptions towards medicine reuse and pharmaceutical companies' willingness to be a part or facilitator of medicine reuse.

Assessment of antibiotic storage practices, knowledge, and awareness related to antibiotic uses and antibiotic resistance among household members in post-conflict areas of Pakistan: Bi-central study

Background

The storage of antimicrobials at home is frequently in-practice in various developing countries, resulting an irrational use, antibiotic resistance, and toxicities. This condition may worsen more in conflict zones where health facilities are limited. This study aimed to determine the storage and use of leftover antibiotics among households (HHs) along with knowledge and awareness about antibiotics and antibiotic resistance (ABR).

Methods

A descriptive cross-sectional study design was employed. Members of HHs were invited to participate in the survey while using a convenient sampling technique. The data were obtained using a validated questionnaire and analyzed through SPSS.

Results

A total of 96 HHs were randomly selected from two districts (n = 50, n = 46), with most of the participants being men between the ages of 18 and 28 (n = 45, 46.9%) years. The majority of HHs (n = 32, 33.3%) had six to eight total family members, with one to two chronic diseases (n = 63, 65.6%), individual families (n = 60, 62.5%), and with (n = 35, 36.5%) LRTIs (lower respiratory tract infections). The HHs were aware of the word "antibiotic" (n = 59, 61.5%) and gave correct replies to amoxicillin as an antibiotic (n = 42, 43.8%); on the other hand, HHs also thought of paracetamol as an antibiotic (n = 45, 47.9%). They identified the most common brands of antibiotics easily, and a majority of them (n = 69, 71.9%) had never heard of ABR before and had lower levels of awareness. The most stored antibiotic at home (n=38, 39.6%) was azithromycin (J01FA10). In addition, they had multiple needless (1-2, n = 62, 64.6%; 3-4, n = 29, 30.2%) and antibiotics in their houses. Age had a strong association (p = 0.017, H = 12) affected the mean knowledge scores related to antibiotic use. Association of education levels (p = 0.001, H = 52.8) and occupation (p = 0.04, H = 10) with proper antibiotics use were found to be significant. However, family members with more than one chronic illness (p = 0.09, H = 0.8) showed a significant relationship with their awareness of antibiotics.

Conclusion

Participants generally stored various antibiotics of different classes in their homes. Lack of knowledge related to the appropriate usage of antibiotics, use of leftover antibiotics, and awareness related to ABR were unknown to the participants.

The Pattern of Disposal Practices of Unused and Expired Medications Among Healthcare Professionals: A Cross-Sectional Survey in Rajendra Institute of Medical Sciences, Ranchi, Jharkhand

BACKGROUND

Medicines play a crucial role in treating various diseases. Most individuals, in their haste to get through their day, have developed the bad habit of improperly discarding their unwanted or expired prescriptions, which poses a number of risks to human health and contributes to environmental degradation. Disposal procedures of unused and expired pharmaceuticals among health care personnel at tertiary care centers have been the subject of very little research to date. Therefore, the purpose of this study is to examine how medical staff at Rajendra Institute of Medical Sciences in Ranchi, Jharkhand, handle stale or unwanted prescription drugs.

METHODS

The design of the study was cross-sectional analytical conducted among 385 health care professionals. Pretested semi-structured questionnaires prepared in Google Forms (Google LLC, Mountain View, California, United States) have been used for evaluation.

RESULTS

The completely filled questionnaires were analyzed, evaluated, and expressed in the percentage using Microsoft Excel (Microsoft Corporation, Redmond, Washington, United States). The most common method of disposal of unused and expired medications was throwing them in the dustbin.

CONCLUSIONS

In this study, although, all the participants were health care professionals, because of the hectic schedule majority of them used unsafe methods of drug disposal. So, in order to protect our ecosystem, appropriate policy should be made to implement the methods for the safe disposal of unused and expired medications.

In-home medication management by older adults: a modified ethnography study using digital photography walkabouts

BACKGROUND

Medication mismanagement can lead to non-optimal management of chronic diseases and poor health outcomes.

OBJECTIVE

The purpose of this study was to better understand meanings associated with in-home medication management and storage practices of older adults with chronic diseases.

METHODS

A modified ethnographic approach using digital photography walkabouts, observation protocols and field notes were used to document in-home medication organisation and storage locations. Thematic analysis was used to generate themes and sub-themes.

RESULTS

Data from multiple home visits of 10 participants (mean age = 76 years; 80% females) including 30 photographs, 10 observation protocols and field notes were analysed. The average number of medications used was reported to be 11.1 (range: 5-20). Themes and sub-themes include choice of storage location (sub-themes: impact on medication behaviour, visibility of medications and storage with other items), knowledge regarding appropriate medication storage conditions (sub-themes: impact on safety of patient and impact on stability of medications) and systems to manage in-home medication intake.

DISCUSSION

In-home medication management reflects older adults perspectives regarding privacy, medication taking routine, knowledge about safe and effective storage and organisation systems. The lack of knowledge causing inappropriate medication storage not only impacts the stability of medications, but also increases risk of medication errors and safety, ultimately affecting medication intake behaviours.

Impact of Women's Home Environment on Use of the Dapivirine Vaginal Ring for HIV Prevention in Sub-Saharan Africa

The monthly dapivirine vaginal ring has proven efficacious in reducing HIV incidence in two Phase 3 clinical trials. When considering the potential future availability of the ring to the public, key questions remain about the feasibility of integrating the ring as an HIV prevention intervention into women's lives. We conducted qualitative mapping interviews (n = 66) among women enrolled in MTN-025/HOPE, an open-label trial conducted in Malawi, South Africa, Uganda and Zimbabwe, to examine how home environments influenced use of the dapivirine vaginal ring. Most women had secure places to store their rings including wardrobes, suitcases, and bags. The primary concerns for ring storage were potential tampering from children or rodents. Household overcrowding limited the privacy some women had which made removal and insertion of vaginal rings challenging. Despite these challenges, ring storage, insertion, and removal was feasible across social and living contexts.

Medicine storage, wastage, and associated determinants among urban households: a systematic review and meta-analysis of household surveys

Background

Irrational household storage of medicines is a world-wide problem, which triggers medicine wastage as well as its associated harms. This study aimed to include all available evidences from literature to perform a focused examination of the prevalence and factors associated with medicine storage and wastage among urban households. This systematic review and meta-analysis mapped the existing literature on the burden, outcomes, and affective socio-economic factors of medicine storage among urban households. In addition, this study estimated pooled effect sizes for storage and wastage rates.

Methods

Household surveys evaluating modality, size, costs, and affective factors of medicines storage at home were searched in PubMed, EMBASE, OVID, SCOPUS, ProQuest, and Google scholar databases in 2019. Random effect meta-analysis and subgroup analysis were used to pool effect sizes for medicine storage and wastage prevalence among different geographical regions.

Results

From the 2604 initial records, 20 studies were selected for systematic review and 16 articles were selected for meta-analysis. An overall pooled-prevalence of medicine storage and real wastage rate was 77 and 15%, respectively. In this regard, some significant differences were observed between geographical regions. Southwest Asia region had the highest storage and wastage rates. The most common classes of medicines found in households belonged to the Infective agents for systemic (17.4%) and the Nervous system (16.4%). Moreover, income, education, age, the presence of chronic illness, female gender, and insurance coverage were found to be associated with higher home storage. The most commonly used method of disposal was throwing them in the garbage.

Conclusions

Factors beyond medical needs were also found to be associated with medicine storage, which urges effective strategies in the supply and demand side of the medicine consumption chain. The first necessary step to mitigate home storage is establishing an adequate legislation and strict enforcement of regulations on dispensing, prescription, and marketing of medicines. Patient’s pressure on excessive prescription, irrational storage, and use of medicines deserve efficient community-centered programs, in order to increase awareness on these issues. So, hazardous consequences of inappropriate disposal should be mitigated by different take back programs, particularly in low and middle income countries.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-11100-4.

What medicines do households keep in their cabinets? Understanding the possession and use of medicines at home and the role of health insurance in Nigeria

Background

Globally, the possession of medicines stored at home is increasing. However, little is known about the determinants of possessing medicines, their usage according to clinical purpose, which we term ‘correct drug match’, and the role of health insurance.

Methods

This study uses data from a 2013 survey evaluating a health insurance program in Kwara State, Nigeria, which upgraded health facilities and subsidized insurance premiums. The final dataset includes 1,090 households and 4,641 individuals. Multilevel mixed-effects logistic regressions were conducted at both the individual level and at the level of the medicines kept in respondents’ homes to understand the determinants of medicine possession and correct drug match, respectively, and to investigate the effect of health insurance on both.

Results

A total of 9,266 medicines were classified with 61.2% correct match according to self-reported use, 11.9% incorrect match and 26.9% indeterminate. Most medicines (73.0%) were obtained from patent proprietary medicine vendors (PPMVs). At 36.6%, analgesics were the most common medicine held at home, while anti-malarial use had the highest correct match at 96.1%. Antihistamines, vitamins and minerals, expectorants, and antibiotics were most likely to have an incorrect match at respectively 35.8%, 33.6%, 31.9%, and 26.6%. Medicines were less likely to have a correct match when found with the uneducated and obtained from public facilities. Enrolment in the insurance program increased correct matches for specific medicines, notably antihypertensives and antibiotics (odds ratio: 25.15 and 3.60, respectively).

Conclusion

Since PPMVs serve as both the most popular and better channel compared to the public sector to obtain medicines, we recommend that policymakers strengthen their focus on these vendors to educate communities on medicine types and their correct use. Health insurance programs that provide affordable access to improved-quality health facilities represent another important avenue for reducing the burden of incorrect drug use. This appears increasingly important in view of the global rise in antimicrobial resistance.

Household Level Drug Utilization and Associated Factors in South Gondar Zone, North Western Ethiopia

Introduction

Methods

Results

Conclusion

Towards Medicines Reuse: A Narrative Review of the Different Therapeutic Classes and Dosage Forms of Medication Waste in Different Countries

BACKGROUND

Medicines reuse, the idea of re-dispensing returned medicines to others following quality control, is yet to be implemented in the UK. This practice is potentially a sustainable way of dealing with returned medicines, which are otherwise classed as medication waste and destroyed. To inch towards medicines reuse, it is important to know more about the different therapeutic classes and dosage forms that make up medication waste. For example, it is helpful to know if medicines being returned are mostly solid-dosage forms and thus have the potential to be reused or are from therapeutic classes that would make medicines reuse cost-effective. Little is known about the therapeutic classes and the dosage forms of wasted medicines. This study aimed to narratively review and report findings from the international literature on the different therapeutic classes and the dosage forms of medicines that are returned by patients to community pharmacies, hospitals, general practitioners' clinics, or collected through waste campaigns. Studies based on surveys without physically returning medicines were also included where relevant.

METHODS

A comprehensive electronic search of databases, including PubMed and Google Scholar, was carried out over one month in 2017 and updated by 5 November 2020, using a combination of carefully created keywords.

RESULTS

Forty-five studies published in English between 2002 and 2020, comprising data from 26 countries were included and reviewed. Oral solid dosage forms (mostly tablets) were the commonly reported dosage form of all wasted medicines in 14 studies out of the 22 studies (64%) that described the dosage form, with percentages ranging from 40.6% to 95.6% of all wasted medicines. Although there was variability among the levels of medication waste reported in different countries, findings from the UK and Ethiopia were relatively consistent; in these, medicines for the cardiovascular system and anti-infective medicines, respectively, were the most common therapeutic classes for medication waste.

CONCLUSION

This narrative review provides insights about the different therapeutic classes and dosage forms of medication waste either returned by patients, collected through waste campaigns, or indicated in survey responses. The findings could help policy makers understand the potential implications of treating most unused medicines as medication waste and whether therefore pursuing a medicines reuse scheme could be environmentally or financially logical. The quality and the safety of these returned medicines using criteria related to the storage conditions (such as heat and humidity), physical shape (such as being sealed, unopened, unused, and in blister packaging), and tampering are other important considerations for a medicines reuse scheme.

Medicines in Western Sahara Refugee Camps in Tindouf: Prescriptions and self-medication mixing in the drawer

Problems with access to medicines, either by shortage or excess can be especially relevant in refugee camps. In the present study, we describe the medicines found in a sample of the Western Sahara refugee households, with special emphasis on antimicrobials and their use. All households of the 2nd district of Mahbes daira, in the Smara wilaya of the Sahrawi Refugee Camps in Tindouf (Algeria) were visited during 10 days in April 2019 in order to know which medicines are kept at home. Seventy-six families were included in the study and 269 medicines were found. Eight (10.5%) did not have any medical product at home and the remaining 68 (89.5%) had a median of 3 drugs, ranging from 1 to 13. The most consumed drugs were analgesics (35.7%) and antimicrobials (15.6%). Most medicines had been prescribed, but in the case of antimicrobials, an incomplete consumption pattern was observed in 42.9% of the cases and, more worrying, one-third of them were used to treat viral or non-infectious diseases. This first drug utilization study in the Saharawi population highlighted the importance, not only to ensure appropriate access to medicines in refugee's camps, but also to watch over their appropriate use.

Assessment of Knowledge, Attitude, and Disposal Practice of Unused and Expired Pharmaceuticals in Community of Adigrat City, Northern Ethiopia

Background

Medicines have become part of our day-to-day life. Due to different reasons, patients may not use all the medications dispensed to them. The storage of drugs at home promotes self-medication, which results in variety of adverse consequences. Global growth in health-seeking awareness and behavior among people has resulted in increment of medicine consumption over years. However, Ethiopians have little awareness about proper disposal of unused and expired pharmaceuticals. Besides, large quantities remain unused or expired since not all medications given to the consumers are consumed. Hence, this study could serve as an indicator for the country policy makers concerning pharmaceutical waste management.

Objective

To assess knowledge, attitude, and disposal practice of unused and expired pharmaceuticals in the community of Adigrat city, Tigray, Ethiopia, 2019. Methodology. A cross-sectional study was conducted among 359 respondents from the residents of Adigrat city. Semistructured questionnaires, which focused on knowledge, attitudes, and disposal practices for unused and expired medications, were used to collect data from respondents. Epi-data 3.0 suite and the statistical package for social sciences (SPSS) version 20 were used in data entry and analysis.

Results

All of the 359 returned questionnaires were valid for data entry and analysis. Of the 359 respondents, 57.7% were men and the majority (93%) were Orthodox Christians. Almost half of the respondents (50.14%) have good knowledge concerning the disposal of unused and expired pharmaceuticals. Most (82.2%) of the respondents have a positive attitude towards the disposal of unused and expired pharmaceuticals. Around fifty-two (52.4) of the respondents had unused medicines stored at home, with analgesics being the most common (41.5%). Around three-quarters (75.2%) and 63% of the respondents discarded unused and expired medicines in the garbage bins, respectively.

Conclusion

Although the majority of the respondents had a positive attitude towards the disposal of unused and expired medications, almost half of the sample population were unaware of proper disposal practices. Furthermore, less were inclined to practice proper disposal of unused and expired medications in the city. Therefore, we recommend further studies that focus on how the disposal attitude of the population can influence their knowledge and practice of the disposal of unused and expired medications.

Attitudes and Practice Regarding Disposal for Unwanted Medications among Young Adults and Elderly People in China from an Ecopharmacovigilance Perspective

Due to the expensive cost and uncertain effectiveness of environmental management options in eliminating pharmaceutical residues, recently, decreasing the emission of pharmaceutical pollutants from a drug administration perspective has been considered a hot area of research. As a kind of drug administration for the environment, ecopharmacovigilance (EPV) emphasizes the source control of pharmaceutical pollutants. Disposal of unwanted medicines has been considered as the easiest target for source control of pharmaceutical contamination. Here, we focused on public attitudes and practice regarding disposal of unwanted medicines from the EPV perspective among 365 Chinese university young adults and 206 elderly retirement home residents. The results showed that the majority of respondents had positive attitudes, but exhibited inadequate awareness and poor practice. In addition, the young-adult respondents were found to pay more attention to the environmental problems posed by pharmaceutical residues, and be more supportive of the EPV intervention predominantly performed by pharmaceutical industries and pharmacists. Therefore, it is urgent to establish the standard medicine disposal protocols and educate the general public on the best way for medication disposal under the principle of EPV in China, and efforts on environmentally-preferred drug disposal under EPV should target for the specific demographics.

Storage of prescription veterinary medicines on UK dairy farms: a cross-sectional study

Prescription veterinary medicine (PVM) use in the UK is an area of increasing focus for the veterinary profession. While many studies measure antimicrobial use on dairy farms, none report the quantity of antimicrobials stored on farms, nor the ways in which they are stored. The majority of PVM treatments occur in the absence of the prescribing veterinarian, yet there is an identifiable knowledge gap surrounding PVM use and farmer decision making. To provide an evidence base for future work on PVM use, data were collected from 27 dairy farms in England and Wales in Autumn 2016. The number of different PVMs stored on farms ranged from 9 to 35, with antimicrobials being the most common therapeutic group stored. Injectable antimicrobials comprised the greatest weight of active ingredient found, while intramammary antimicrobials were the most frequent unit of medicine stored. Antimicrobials classed by the European Medicines Agency as critically important to human health were present on most farms, and the presence of expired medicines and medicines not licensed for use in dairy cattle was also common. The medicine resources available to farmers are likely to influence their treatment decisions; therefore, evidence of the PVM stored on farms can help inform understanding of medicine use.