Investigation of the household storage of medicines and disposal practices in Parklands sub-county in Nairobi,Kenya

Introduction

The escalating incidence and prevalence of diseases globally have led to an increase in the consumption of drugs (Bashaar et al., 2017). In Kenya, essential medicines constitute a significant portion of medical supplies, with an estimated 30% comprising prescription drugs (Angi’enda and Bukachi, 2016). Moreover, the Business Monitor International (BMI) report indicates that prescription medicines constitute about 68.7% of the total healthcare market share (Angi’enda and Bukachi, 2016). This surge in medicine consumption has resulted in a notable rise in the accumulation of unused medicines at home, presenting various challenges (Angi’enda and Bukachi, 2016). The reasons for medications remaining unused are diverse, including patients changing or discontinuing medications, experiencing side effects, poor medication adherence, packaging challenges faced by geriatric patients, and the repeated purchase of medicines without checking existing stock at home (Raja et al., 2018).

Contributing to the issue of unused medicines are irrational practices in medicine use by both healthcare professionals and consumers. Over-the-counter purchases, medicine expiry, aggressive marketing by pharmaceutical companies, and unfortunate incidents like death also contribute to the stockpiling of unused medicines (Angi’enda and Bukachi, 2016). An emphasis on the rational use of medicines is crucial to ensure patients receive the correct medications at the right time and adhere to proper consumption practices. The reuse of unused medicines for self-medication, especially antibiotics and other prescription drugs, has been reported. This practice is deemed unsafe and should ideally be supervised by a medical professional (Raja et al., 2018; Gitawati, 2014). Additionally, the use of stored unused medicines poses an increased risk of potential drug-related problems, including adverse reactions and errors in medication, and can be considered a waste of resources (Kheir et al., 2011).

While drug therapy is integral to treating and preventing diseases, it generates harmful medical waste and poses health-related risks (Bashaar et al., 2017).

Improper disposal of unused medicines can lead to environmental contamination, posing hazards to public health. The World Health Organization (WHO) reports that a majority of medicines are prescribed wrongly, leading to avoidable storage and environmental threats during improper disposal (Bashaar et al., 2017).

Accidental use of unused or expired medications can result in serious complications, including adverse drug reactions that could be harmful or fatal (Amster, 2016; Bashaar et al., 2017). Several studies have reported the presence of trace amounts of medications in groundwater, surface water bodies, and drinking water due to improper disposal (Kotchen et al., 2009; Vollmer, 2010). Although many developed countries monitor the presence of pharmaceutical wastes in waste and open water and have proper disposal practices for expired and unused medication by households (Glassmeyer et al., 2009), these disposal practices are lacking in many developing countries (Bellan et al., 2012; Marwa et al., 2021).

To address these issues, there is a need for education and guidelines on the proper handling of unused/expired drugs. Consequences such as accidental consumption, resale, or misuse during sorting can occur due to improper disposal, necessitating specific drug disposal mechanisms supported by legislative regulations and policies. Responsibility to minimize risks associated with unused or expired medications should extend beyond the point of sale to the disposal phase (Angi’enda and Bukachi, 2016). Understanding the public's perception regarding the storage and disposal of unused/expired medicines is crucial. Currently, there is a lack of statistical evidence on the amount of unused drugs in homes in Kenya (Angi’enda and Bukachi, 2016).

Previous studies reveal varied practices for the disposal of unused medicine, often due to a lack of awareness. Common practices in Kenya include throwing medicines in dustbins or flushing them in toilets as reported in the literature (Angi’enda and Bukachi, 2016), a practice that has been recommended by a review of pharmaceutical wastes done by El-Khateeb, especially if connected to a sanitary sewer and a collecting site is not accessible (El-Khateeb, 2022). In another study, the respondents were not certain about what to do with the drugs, hence keeping them at home while some shared them with their friends and family members (Bashaar et al., 2017).

There is also a lack of programs promoting the safe disposal of unused/expired drugs in Kenya. Patients are not adequately guided on proper disposal by healthcare professionals, revealing a knowledge gap (Angi’enda and Bukachi, 2016). As patients are not correctly guided on the disposal of unused/expired medicines by doctors, pharmacists, or any other healthcare professional, thus there is a gap in the knowledge imparted to the public. The absence of national policies exacerbates the issue, emphasizing the need for strategies to encourage safe and appropriate medicine disposal.

To address these gaps, our study aimed to investigate the disposal of medical products in Parklands sub-county in Nairobi. This research aims to generate awareness among the public, pharmaceutical companies, and policymakers, ultimately contributing to strategies that minimize the potential risks associated with the unsafe disposal of unused medicines.

Methodology

Sample size determination and sampling techniques

A systematic sampling method was used which involved selecting households at regular intervals. The sample size was selected by using a sample size determination formula given below (Kibuacha, 2016):

n = ( Z s c o r e ) 2 S D ( 1 − S D ) ( M E ) 2

Where,

n is the sample size

Z_score is a value corresponding to the specified confidence level (CL)

SD is the standard deviation

ME is the margin of error

From the statistical tables, the Z-score values corresponding to the specified CL are obtained. Assuming an 80% CL with a Z-score of 1.28 and a ±5% margin of error with a standard deviation (SD) of 0.5, the sample size will be as follows:

n = ( 1.28 ) 2 × 0.5 ( 1 − 0.5 ) ( 0.5 ) 2 = 164

Results

Socio-demographic characteristics of the respondents

All approached individuals agreed to participate, giving a 100% response rate. The socio-demographic characteristics of the respondents are presented in Table 1. A total of 164 people participated in this study and among them 76 (46.3%) were male and 88 (53.60%) were females. Fifty-four of the participants (33%) were between the ages of 31 and 40 years. About half of the respondents were married 87 (53%) and the rest were single 77(47%). In terms of education, 106 (64.6%) of the participants passed senior high school, 53 (32.3%) graduated from university, and 5 (3%) had not reached the senior high school level.

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Table 1.

Socio-demographic characteristics of Respondents in Parklands sub-county, in Nairobi.

Variables	Categories	Frequency (%)
Gender	Male	76 (46.3)
	Female	88 (53.6)
Age (in years)	20 and below	27 (17)
	21–30	40 (24)
	31–40	54 (33)
	40 and above	43 (26)
Marital status	Single	77 (47)
	Married	87 (53)
Education status	Less than senior high school	5 (3)
	Passed senior high school	106 (65)
	Graduated from University	53 (32.3)

n = 164.

Storage of medicines at home

All households reported that they kept medicines at home and Figure 1 shows the places where the medicines were stored at home. The results indicated that the most common place of storage was the bedroom with 41 participants. Forty-five (45) participants reported that they stored their medicines in both the kitchen and the bedroom, while 32 participants reported that they stored their medicines in the bedroom and the bathroom, and 25 participants reported that they stored their medicines either in the bathroom, in the kitchen, or in the bedroom.

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Figure 1.

Area of storage of medicines among households.

The study sought to determine if the respondents had received information regarding the storage of the medicines at home. Eighty-two (82) (50%) of the respondents reported that they had received information regarding the storage of medicines from the chemist/pharmacy they purchased them from, 61 (37%) said they received information from doctors, while 15 (9%) and 6 (4%) said they received information from friends and relatives, and books/journals respectively as shown in Figure 2.

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Figure 2.

Receiving important information about the storage of medication at home.

Of the medicines kept at home, 148 (91%) of the respondents reported that they had unused/unwanted or expired medicines at home, while 15 (9%) of the respondents said they did not have unused/unwanted or expired medicines at home. The significant justification for keeping the unused medicines or terminated prescriptions at home was the improvement of symptoms and feeling better 77 (48%) as shown in Figure 3. Twenty-five (25%) reported that they had kept the unused medicines at home because the doctor had to change the medication, while 18% stopped using the medication because they felt it was not helping and 9% stopped using the medication due to side effects.

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Figure 3.

Reasons for unused medication at home.

Discussion

All households reported that they kept medicines at home with the bedroom being the most common storage area as indicated in Figure 1, which was consistent with other results reported in other countries such as Qatar, where a study showed that most medicines were stored in the bedroom (Foroutan and Foroutan, 2014). The appropriate place for storing medicines at home depends upon the medication; for instance, after the preparation of antibiotic suspensions, they should be kept in a cool area, however, not frozen, while cold remedies for adults ought to be kept at room temperature in a kitchen or room cabinet (Foroutan and Foroutan, 2014). The architecture of every household is different and thus a certain room or area such as the kitchen or bedroom cannot be deemed the correct storage area for everyone. The significant justification for keeping the unused medicines or terminated prescriptions at home was the improvement of symptoms and feeling better 77 (48%) as shown in Figure 3. These discoveries are consistent with those recorded from past investigations in the USA and different nations (Marwa et al., 2021).

Most of the households (91%) reported that of the medicines they had kept at home, some of them were expired or unwanted as shown in Figure 3. This is worrying since having such medications at home might be an indication of noncompliance and can lead to self-medication whereby patients are most likely to not complete the treatment and administer insufficient doses favoring the development of drug resistance (Saha et al., 2022).

The main disposal method practiced by the participants was throwing the medicines in the dustbins (59%) followed by returning them to the pharmacy (27%), 12% kept the medicines, and 2% gave the unused medicines to friends and family as shown in Figure 4. These results were analogous to those reported in the USA, Kuwait, Malaysia, Serbia, and many other parts of the world (Marwa et al., 2021). In this study, sharing of medications with friends was stated by some respondents, similar to results reported in Kuwait (Abahussain et al., 2006) and other parts of Kenya (Angi’enda and Bukachi, 2016). Nevertheless, it was different from a study conducted in Jeddah, where 50% believed that giving leftover medications away to family and friends was the best method of disposal (AlAzmi et al., 2017). Nonetheless, in the current examination, 44 (27%) of the respondents working on returning unused meds to the drug store was similar to an investigation led earlier in Kenya (Angi’enda and Bukachi, 2016). A few respondents returned unused and expired drugs to the drug stores in Kuwait (Abahussain et al., 2006), the USA (Seehusen and Edwards, 2006), Malaysia, and Jeddah (AlAzmi et al., 2017). This could be clarified by the absence of extensive medication removal arrangements and drug stores with reclaim programs in Kenya. It is therefore important to raise awareness through various interventions such as educating the population on the importance of disposing of medications properly instead of sharing with friends and family.

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Figure 4.

Disposal practice adapted to unused medicines at home.

Among all methods for discarding drug waste, the most harmless on the ecosystem way is burning at high temperatures, albeit this is possible only if medications are taken back to the pharmacy where they are purchased from or any nearby pharmacy (Kassahun and Tesfaye, 2020). This practice of returning unwanted and unused medications to the pharmacist was recommended as the best approach to dispose of them in a review by El-Khateeb (El-Khateeb, 2022) since many pharmacists are usually prepared to take unused medications and properly dispose of them. The inappropriate disposal of unused or expired medicines through dust bins as recorded in the current study is harmful to the environment and increases impacts to the environment, antimicrobial resistance, and hinders impacts to the local area's well-being through drinking water (Marwa et al., 2021). Moreover, this practice may increase the pollution of vegetation which may contain medications in trace amounts (Marwa et al., 2021). Studies have shown a relationship between inappropriate disposal of antibiotics and a rise in antimicrobial resistance, in this way, the effect of inappropriate disposal of terminated or unused family prescriptions on the improvement of antimicrobial resistance ought not to be neglected in Kenya and other agricultural nations where self-medicine is normal and in a portion of these nations in Africa many drugs including antibiotics are simply sold over-the-counter without any prescription (Marwa et al., 2021).

Table 2 shows the perception of the participants on the disposal practices of unused medicines. Hundred and three (63%) of the participants said that the unused medications were harmful mostly because they could lead to accidental poisoning, could pose the risk of potential for abuse, could lead to unwanted side effects, and could cause drug-drug interactions. This could be detrimental to children and pets since they are more prone to accidental medication exposure and toxicity, as unused/left-over or expired medications pose serious health as well as safety risks to them (Kassahun and Tesfaye, 2020). The majority of the respondents (88%) had been unaware of the right methods for disposal of expired medicinal drugs and had never acquired any data on the proper disposal of medicines since they did not receive any information on the correct disposal method of the medicines, wherein most of them made uninformed decisions in disposing of their medicines. This is not sudden considering that the majority of pharmacies do not have steady recommendations to their customers on medicinal drug disposal after finishing treatment or remaining with unused medications (Marwa et al., 2021). The lack of know-how on proper medication disposal strategies among family participants has additionally been recorded in evolved nations, a few examples being the United States (Marwa et al., 2021) that is because of the reality that little data is passed to the general public by FDAs and health care carriers on the disposal of unused or expired tablets (Marwa et al., 2021). Moreover, 129 (79%) of the participants checked the expiry date of the medicines while 103 (21%) of the participants did not check the expiry data of the medicines. These results indicate a communication gap between pharmacists and healthcare professionals and their customers regarding safe medication disposal practices (Angi’enda and Bukachi, 2016; Athern et al., 2016).

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Table 2.

Perception of the participants on the disposal practices of unused medicines.

Variables	Frequency n (%)
	Yes	No
Unused medications on themselves or their loved ones (family, children, relatives)	137 (84)	27 (16)
Are the leftover or unused medications harmful?	103 (63)	61 (37)
Receival of information on the correct disposal of medicines	19 (12)	145 (88)
Were the expiration dates of the medicines checked?	129 (79)	103 (21)

In this study, 81 (49%) of the respondents agreed that improper disposal of medications affects the environment, 78 (48%) said they did not know, and 5 (3%) did not agree that improper disposal of medications affects the environment. The reasons why the respondents were not aware of the proper remedy disposal strategies but knew about the impact of unsuitable medicine disposal could be that the respondents have been related to their very own approach they use in disposing of medicinal drugs and not incorrect medicine disposal.

The current study gives a concise picture of the chance of quality of a lot of unused or expired prescriptions beginning from families in our environment. It is therefore important to raise awareness about the disposal of expired medicines and educate the public on what to do with unused medications (Alshehri and Banjar, 2022). This requires an all-around planned and deliberate public effort program to teach the general population the potential dangers related to ill-advised medication removal practices and how to arrange meds appropriately for the well-being of the public. Cost-benefit analysis in specific international locations has confirmed the need for organizing pharmaceutical disposal software that entails the willingness of manufacturers, pharmacies, vendors, opposite distributors, health facilities/clinics, FDAs, and even patients to make contributions in phrases of cost and different requirements (Marwa et al., 2021). Bringing issues to light through different instructive mediations ought to be considered to improve the disposal practice. By advising on appropriate drug use, drug specialists and other medical care experts can teach patients the significance of accepting their prescriptions as coordinated, prompting an increment in adherence while limiting the requirement for disposal simultaneously. All in all, protected disposal of extra drugs assumes a critical part in lessening the acquaintance of drugs with the environment since it can cause serious harm to people and in this study 87% of the respondents reported that there was a need for a program to collect unused medicines from homes as well as educate them on the proper disposal methods.

Conclusions and future perspectives

In the current study, there was a high practice of keeping drugs at home and most disposal approaches shown by the members were not suggested techniques. What is more, the majority of the respondents did not get counsel from pharmacists and other medical services experts on the most proficient method to discard unused/left-over and expired medications. Inappropriate disposal of unused and terminated prescriptions is a typical practice around Parklands sub-county, Nairobi. There is little mindfulness among family individuals concerning legitimate approaches to dispose of unused/left-over and expired medications. Therefore, there is a requirement for appropriate counseling and correctly informing patients about storage and disposal practices of unused/left-over and expired medications.

Pharmacists should therefore educate their patients when dispensing drugs with proper disposal methods. Seminars can be conducted on methods of drug disposal to make the general public aware of the correct methods of drug disposal that should be followed, and the health risks it poses to the environment as well as the public. Chemists/pharmacies should be willing to accept medicines back from customers even if they are expired since the best way of drug disposal is incinerating them, which can efficiently be done by pharmacies. Drug take-back programs need to be implemented whereby the public can safely drop off their unused medications which can be given as a charity to homes if they can still be used. Pharmacy and Poisons Board guidelines on drug disposal need to be more emphasized by healthcare practitioners to the general public.