Prevalence and Practice of Unused and Expired Medicine-A Community-Based Study among Saudi Adults in Riyadh, Saudi Arabia

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.

Unused, expired pharmaceuticals and their disposal practices among the general public in Burdur-Türkiye: a cross-sectional study

BACKGROUND

Unused pharmaceuticals are currently a public health problem. This study aimed to identify unused pharmaceuticals, research practices about the disposal methods, classify the medicines according to Anatomical Therapeutic Chemical codes (ATC) and, to determine the number of unused medicines.

METHODS

The study was designed as a cross-sectional study. Data were collected between April and August 2023 in Burdur-Türkiye by non-probability sampling technique (convenience method). Pharmaceuticals were classified according to ATC. Statistical Package for Social Science SPSS (V.24) package program was used for data analysis.

RESULTS

A total of 1120 people, 1005 in the first sample group and 115 in the second sample group, participated in the study. Findings of first sample group: A total of 4097 boxes of unused pharmaceuticals (4.7 ± 4.3 boxes/per capita) were detected. It was found that pharmaceuticals were stored in areas such as kitchens (59.1%) and refrigerators (38.6%), the reason for keeping them was reuse (41%), and the disposal practice was household garbage (81%). Paracetamol (648 boxes), Other cold preparation (303 boxes), Dexketoprofen (239 boxes), Diclofenac (218 boxes), Amoxicillin and beta-lactamase inhibitor (190 boxes) were found to be the most frequently unused pharmaceuticals. Using the unused medicines at home without consulting a physician was 94.1% (self-medication). Findings of second sample group: Of the 6189 dosage forms in 265 boxes pharmaceutical, 3132(50.6%) dosage forms were used and 3057(49.4%) were found to be unused.

CONCLUSION

There is a significant amount and number of unused medicines in households, and self-medication is common. Medicines are not properly disposed of and some of them expire. Public information is needed. A "drug take-back system" for unused medicines can be useful in solving this problem.

Work experience, profession type, and perception of medication waste disposal among healthcare workers: A study in the Eastern Province, Saudi Arabia

Background

Improper disposal of medication waste is a global concern. Several published articles reported perceptions and barriers of the community or pharmacists towards proper medications waste disposal, but least are discussing the overall health workers' perception, particularly those in the Eastern Province in Saudi Arabia.

Aim and objectives

The current research aimed to identify the healthcare worker's perception, explore limitations and barriers, and proposed solutions towards proper medication waste disposal. The second aim is to investigate difference in the response among healthcare worker based on their profession type and years of work experience.

Method

This cross-sectional, descriptive study is based on an internet-based survey questionnaire. Questionnaires were adapted from previous study and were validated before distribution to participants. Respondents were classified based on their healthcare profession and based on the year of their work experience. Descriptive statistics analysis was carried out to assess difference in perception among respondents based on their profession or years of work experience. The Statistical Package for the Social Sciences (SPSS, version 26) package was used for conducting statistical analysis.

Results

321 participants responded to the online survey. 60 % of the respondents were from clinical practice settings and 26 % had work experience between 0-2 years. 77 % of them had encountered medication waste issues, whereas 129 respondents reported that these issues raised from the workplace and 92 respondents reported that they raised personal source. Interestingly, respondents with limited work experience reported the lower perception and knowledge toward mediation waste compared to those with more work experience. 31 % agreed that logistic issues (availability of collection bins) and 28 % reported that the unavailable policies/guidelines that govern this proper medication waste disposal are barriers which limit proper practice. 211 participants strongly agreed on that policies from governmental bodies are very important to limit this issue, whereas training and the availability of logistics were the most recommended solutions from respondents to increase healthcare awareness towards proper medication waste disposal.

Conclusion

Proper perception about medication waste disposal is still an ongoing issue among healthcare workers, particularly those who recently joined their work. Training and enforcing policies and guidelines by governmental bodies could be one approach to ensure proper medication waste disposal.

Disposal Practices of Unused and Expired Medicines Among the General Public and Pharmacies: A Mixed-Method Study in the Odisha State of Eastern India

Introduction Unused and expired medicines are potentially toxic substances that should be managed effectively to avoid possible environmental hazards. The absence of well-defined protocols in India regarding the proper disposal of unused, unwanted, and expired medications raises concerns about the potential for accidental poisoning and environmental threats. Consequently, this research was conducted to evaluate the disposal practices of medications within both urban slum households and pharmacies. Methods This questionnaire-based, mixed-method study was conducted among 385 general public residing in urban slums and 10 registered pharmacies in Bhubaneswar city, India, from September 2020 to August 2021. A semi-structured questionnaire was framed to collect data from the households and the pharmacies; key informant interview was carried out among expert members regarding the disposal of expired medicines. Results Results found that 82.1% (316/385) of the study population threw unused drugs in dustbins, whereas only 2.6% (10/385) returned the medicines to the pharmacy. The most common reason for leftover medicine was the stoppage of drugs on symptomatic relief (53.2%, 205/385), followed by changes in prescription by doctors (18%, 69/385). Out of 10 pharmacies, seven pharmacies disposed of expired drugs in general dustbins. Conclusion Our findings indicate that a majority of the participants tend to dispose of medicines in an unsafe manner. Conversely, the responsible disposal of medications is significantly influenced by patient education. Hence, healthcare professionals are better positioned to impart knowledge to the public, fostering awareness about the proper storage and safe disposal of unused, unwanted, and expired medicines.

Assessment of knowledge and disposal practices of unused and expired household medicines in a community in Liberia

Background

Expansion of pharmaceutical industries and improved availability of pharmaceuticals across the world have contributed to an increase in drug usage and accumulation in homes. Improper disposal of expired and unused medications has several consequences such as environmental pollution, and childhood poisoning.

Objectives

The aim of the study was to assess the knowledge on disposal as well as disposal practices of unused and expired household medicines in the Parker Corner Road Community in Brewerville, Liberia.

Methods

This study was a cross-sectional survey conducted among 162 residents of Parker Corner Road Community using face-to-face interviews. Outcomes measured were knowledge of disposal as well as disposal practices of unused and expired household medicines. The data collected were analysed using descriptive statistics.

Results

Majority of respondents (55.6%) were female and 23.5% had university education. 71% of the respondents reported that they had not received any information on safe disposal practices while 64.2% admitted that they often did not read and follow disposal instructions. The most popular disposal practices were disposal of the drugs along with household waste (61.1%) and flushing them down the toilets or sinks (25.3%). Majority of the respondents (82.1%) were aware of the health effects arising from improper disposal of unused and expired medicines while 64.2% usually read medicine disposal instruction on the package. Only about 3% of them knew of expired medication take-back system and 33.3% knew nothing about medication expiration date.

Conclusion

The study revealed insufficient knowledge as well as inappropriate disposal practices of unused and expired medicines among residents of Parker Corner Road Community in Brewerville. There is need to organize a public enlightenment programme on safe, appropriate use, as well as disposal of unused and expired medicines.

Knowledge of Cardiovascular Disease Risk Factors and Its Primary Prevention Practices Among the Saudi Public - A Questionnaire-Based Cross-Sectional Study

Background and Objectives

In response to the aging population and rapid rise of chronic diseases, it is important to understand the knowledge about primary prevention. We aim to explore Saudi adults' knowledge of cardiovascular disease (CVD) risk factors and its primary prevention practices among the Saudi public.

Methods

This is a cross-sectional community-based study, conducted among people living in Saudi Arabia to assess the knowledge of CVD risk factors using a total of 24-item questionnaires divided into two sections using the Likert scale, true /False/I do not know. The data were analyzed using the statistical software SPSS v. 26.0 (SPSS Inc., Chicago, IL, USA).

Results

In this study, the 81.8% of participants (n=296) agreed that high blood pressure was a risk factor for CVD, while more than two-thirds (68.8%; n=249) believed that diabetes was a risk factor for CVD. Furthermore, about the same proportion of respondents ((79.8%; n=289) and (78.7%; n=285)) agreed that physical inactivity and smoking were risk factors for CVD. In addition, the vast majority of them (n=324; 89.5%) believed that regular exercise aids in the prevention of CVD. In contrast, 74.9% (n=271) of individuals agreed that quitting smoking helps prevent CVD. This study indicated that 55.8% (n=202) of respondents had strong knowledge of CVD, while 44.2% (n=160) had inadequate awareness of CVD risk factors and prevention methods. In terms of the association between socio-demographic factors and overall participants' knowledge of CVD risk factors and preventative measures, we discovered that age (p=0.000), gender (p=0.011), educational status (p=0.000), and the presence of chronic disease (p=0.000) were all significantly associated with CVD knowledge score levels.

Conclusion

Saudi adults have adequate knowledge of CVD risk factors and prevention interventions, but more effort is needed to raise continuous awareness to reduce the prevalence of CVD.

Antibiotic resistance in low- and middle-income countries: current practices and its global implications

INTRODUCTION

Antibiotic consumption rates are high in both high and low-income countries, but addressing antibiotic practices in low- and middle-income countries (LMICs) is crucial to combatting antibiotic resistance (AR).

AREA COVERED

This editorial examines the current landscape of antibiotic practices in LMICs, investigate the factors driving such trends including lack of resource equity and shared global responsibility, and explore (AR) global implications, with particular emphasis placed on swift measures to combat its spread.

EXPERT OPINION

LMICs face three key obstacles that exacerbate AR: inadequate WASH services, climate factors, and misuse of antibiotics. A lack of sanitation and clean water promotes infections, while poor hygiene exacerbates resistant pathogen spread. Global strategies should go beyond simply educating LMICs about antibiotic misuse; they must also understand its repercussions, such as prolonged illnesses and drug-resistant bacteria like MRSA. Addressing this challenge requires multifaceted strategies, including improving WASH services, acknowledging climate impacts, and tightening regulations. Prioritizing WASH requires significant funding, community participation, technology solutions, and partnerships with NGOs. Utilizing social media influencers can boost AR awareness. Antibiotic regulation reforms, manufacturing quality, and seeking antibiotic alternatives are vital. Antimicrobial Stewardship Programs and AI's potential in managing resistant infections are notable.

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.

Assessment of knowledge, attitude, and practice regarding the disposal of expired and unused medications among the Lebanese population

BACKGROUND

Medication waste is a public health problem affecting developed and developing countries. In Lebanon, a developing country in the Middle East, efforts are being deployed in hospitals but not in the community.

OBJECTIVE

This study aimed to validate a questionnaire to explore the knowledge, attitude, and practice (KAP) towards the disposal of unused and expired medicines among the Lebanese population and then identify the factors associated with these variables comparatively between the general population and healthcare professionals.

METHODS

A cross-sectional study was conducted among the general Lebanese population in May-June 2022 using a standardized questionnaire. The validity and reliability of the KAP scales were assessed, then a thorough statistical analysis was done to explore the factors associated with these scales.

RESULTS

The KAP scales generated by this study were valid and reliable. Using these scales, 24.5%, 22.6%, and 21% of participants demonstrated proper knowledge, attitude, and practice, respectively. Higher knowledge scores were significantly associated with female gender (Beta = 0.97), a high monthly income (Beta = 1.68), a secondary (Beta = 6.11) or university (Beta = 6.80) education level, and postgraduate education (Beta = 7.13). However, older age (Beta = - 0.06) and a low monthly income (Beta = - 3.06) were significantly associated with lower knowledge scores. A higher knowledge score (Beta = 0.06) was significantly associated with a more positive attitude regarding unused or expired medication disposal. Being a healthcare professional (Beta = 0.72) was significantly associated with a higher practice score, while being a female (Beta = - 0.32) and living in a rural area (Beta = - 0.37) were significantly associated with lower practice scores.

CONCLUSION

This study validated KAP scales regarding medication waste in Lebanon and showed low KAP scores in the majority of respondents. Factors associated with higher KAP scores in various aspects of medication disposal, including gender, age, education level, and profession (healthcare professionals), suggest the need to consider those when implementing targeted corrective measures. Although further studies are required to confirm our findings, this study could be the ground for a medication waste management national strategy in Lebanon.

Saudi Arabian Plants: A Powerful Weapon against a Plethora of Diseases

The kingdom of Saudi Arabia (SA) ranks fifth in Asia in terms of area. It features broad biodiversity, including interesting flora, and was the historical origin of Islam. It is endowed with a large variety of plants, including many herbs, shrubs, and trees. Many of these plants have a long history of use in traditional medicine. The aim of this review is to evaluate the present knowledge on the plants growing in SA regarding their pharmacological and biological activities and the identification of their bioactive compounds to determine which plants could be of interest for further studies. A systematic summary of the plants' history, distribution, various pharmacological activities, bioactive compounds, and clinical trials are presented in this paper to facilitate future exploration of their therapeutic potential. The literature was obtained from several scientific search engines, including Sci-Finder, PubMed, Web of Science, Google Scholar, Scopus, MDPI, Wiley publications, and Springer Link. Plant names and their synonyms were validated by 'The Plant List' on 1 October 2021. SA is home to approximately 2247 plant species, including native and introduced plants that belong to 142 families and 837 genera. It shares the flora of three continents, with many unique features due to its extreme climate and geographical and geological conditions. As plants remain the leading supplier of new therapeutic agents to treat various ailments, Saudi Arabian plants may play a significant role in the fight against cancer, inflammation, and antibiotic-resistant bacteria. To date, 102 active compounds have been identified in plants from different sites in SA. Plants from the western and southwestern regions have been evaluated for various biological activities, including antioxidant, anti-cancer, antimicrobial, antimalarial, anti-inflammatory, anti-glycation, and cytotoxic activities. The aerial parts of the plants, especially the leaves, have yielded most of the bioactive compounds. Most bioactivity tests involve in vitro assessments for the inhibition of the growth of tumour cell lines, and several compounds with in vitro antitumour activity have been reported. More in-depth studies to evaluate the mode of action of the compounds are necessary to pave the way for clinical trials. Ecological and taxonomical studies are needed to evaluate the flora of SA, and a plan for the conservation of wild plants should be implemented, including the management of the protection of endemic plants.

Disposal of leftover and expired medicines by community pharmacies and their clients in Ghana

Improper and unsafe disposal of expired and unwanted medicines could cause harm to both people and the environment and therefore it is of public health importance. The objective of the study was to determine the methods employed by community pharmacist and their clients in the disposal of unwanted and expired medicines. Furthermore, the role of the pharmacists in the assessment of clients left over medicines was also explored. A cross sectional study design was employed with a sample of 120 pharmacy staff and 200 clients. Semi structured questionnaires were developed and administered to the two groups. Ethical approval was obtained. Data collected were analyzed using the Statistical Package for Social Sciences (SPSS v.24). Two hundred and eighty medicines were assessed from 131 respondents (65.5%) who brought their unused or left-over medicines to the pharmacy. These included analgesics 102(36.4%), antibiotics 50 (17.9%) and antacids 22 (7.9%). Disposal of expired and left-over medicines cited by respondents were the general-purpose bin 58(77.0%) and down the sink 11(14.3%). The majority 99(82.9%) of community pharmacies also disposed of solid dosage forms through the general-purpose bin. In addition, 90(75%) community pharmacies disposed of liquid waste in general purpose bin. Lack of enforcement of legislation was cited by community pharmacy staff as a barrier to the proper disposal of pharmaceutical waste. The predominant method of disposal of expired/unwanted medicines by community pharmacies and their clients was via the general-purpose bin. Implementation of interventions such as take back programmes that will enhance proper disposal of expired and left over medicines should be initiated.

An Intelligent System for Proper Management and Disposal of Unused and Expired Medications

For years, several countries have been concerned about how to dispose of unused pharmaceuticals that can endanger human health and the environment. Moreover, some people are in desperate need of medical attention and medications, but they lack the financial resources to obtain them. In Saudi Arabia, there are no take-back medicine programs, and there is no published research on how medications properly are disposed. The aim of this research is to use the power of artificial intelligence to assist in the proper management and disposal of expired and unused medications and to develop a prototype device for collecting medication by automatically classifying medications for proper disposal and donation. In this research, artificial intelligence technologies such as web-based expert systems, image recognition and classification algorithms, chatbots, and the internet of things are used to assist in a take-back medications program. In conclusion, the prototype design of a web-based expert system and the device reduced improper disposal risks by providing significant advice on the safe disposal of unwanted pharmaceuticals. By using an organized method of collecting expired medications, the benefits were made possible.

Increasing Awareness of Proper Disposal of Unused and Expired Medication Using a Knowledge-Based Disposal Management System

Medicines are used daily in Saudi Arabian homes. However, when these medicines are no longer needed, most people dispose of them incorrectly, forgetting the harmful impact of improper disposal. Inadequate awareness and knowledge are major reasons for improper disposal. In this study, we create a broad inclusive knowledge base that includes many types of medications available in Saudi homes and provides guidance on how to dispose of them as a means of raising awareness on correct disposal methods and preventing harmful impacts on both the environment and society. The study primarily aims to understand societal behaviour regarding the disposal of unused and expired medications and develop a prototype of a knowledge-based system that helps raise awareness of correct disposal methods for unused and expired medications. The data in the knowledge base are presented in tables that are easy to understand and comprehend, and the recommendations are also easy to apply and practice in everyday life. The results from the survey show that 66.8% of the 310 participants had unneeded medications in their homes, and only 14.9% knew how to dispose of unusable medications, while only 6.5% knew how to dispose of expired medications. Overall, the research studied Saudi society's behaviour regarding unused and expired medications, and we created a prototype of a knowledge-based system designed to increase awareness of proper disposal and management of unused and expired medications.

Community Pharmacists' Practice, Awareness, and Beliefs about Drug Disposal in Saudi Arabia

The awareness among Saudi people regarding the good and safe practice of drug disposal is fairly low. Community pharmacists’ potential toward drugs disposal directions and practice are not emphasized enough. Therefore, a cross sectional study was conducted in Riyadh, Saudi Arabia, to evaluate the practice, awareness and beliefs of community pharmacists about disposal of unused drugs. Out of 360 subjects who participated in the study, more than 70% returned the unused drugs to the pharmaceutical distributors. Around 80% of the participants confirmed the risk of environmental damage due to the inappropriate disposal of drugs, and 87.5% of them held themselves responsible for preventing such risk. Approximately 85% of surveyed pharmacists believed community pharmacies to be an appropriate location for the collection of unused drugs. There was no significant association between the community pharmacists’ age group and years of practice as community pharmacists with either the awareness of unused medication disposal on environmental hazards, or the beliefs about the appropriate location for collecting unused drugs (p > 0.05). The awareness and proactive accountable responsibility, along with community pharmacists’ belief of appointing pharmacies to collect unused drugs, strongly support the institution of drug take-back programs.

Lack of Awareness of the Impact of Improperly Disposed Of Medications and Associated Factors: A Cross-Sectional Survey in Indonesian Households

Introduction: Disposal of unused medications through environmentally unsafe routes is common in Indonesia. The lack of awareness of the impact of improperly disposed of medications is a significant contributing factor. The objectives of this study were to identify factors associated with lack of awareness of the impact of improperly disposed of unused medications and to assess the associations of awareness with medication disposal practices among the general population in Indonesia.

Patients and methods: An observational cross-sectional survey was conducted using nonprobability sampling in Bandung, Indonesia, from November 2017 to January 2018 among respondents who were older than 18 years, had used any medication in the past, were literate, and had signed an informed consent document. Disposal practices and awareness regarding the impact of improperly disposed of unused medications were collected using an online- and a paper-based pre-validated questionnaire. The paper-based questionnaires were distributed to respondents in public places such as city center, markets, and religious places. Binary logistic regression was performed to assess associations of sociodemographic and other related factors with a lack of awareness. Odds ratios (ORs) with 95% confidence intervals (CIs) are reported.

Results: Of 497 participating respondents, 433 and 64 respondents filled an online- or a paper-based questionnaire, respectively. Most respondents were female, aged between 18 and 30 years, and students/university students. Of 497 respondents, more than half (53.1%) were not aware that improper medication disposal could harm the environment and population health. Most respondents (79.5%) had never received information about proper medication disposal practices. The education level, the number of stored medications at home, and previous education about medication disposal practices were significantly associated with awareness of proper practices. In the multivariate analysis, only those with previous education about medication disposal practices were less likely to report a lack of awareness (OR: 0.043; 95% CI: 0.02–0.09). Respondents with a lack of awareness tended to dispose of their unused medications in the garbage or shared them with friends or relatives.

Conclusion: There is a clear need to increase awareness of the importance of proper medication disposal practices, in particular among the student population of Bandung city, Indonesia. Healthcare providers can play an important role by educating this specific population on the proper disposal of unused medications.