Medicine Storage, Wastage and Associated Determinants Among Urban Households: A Systematic Review of Household Surveys

Abstract

Background: Irrational household storage of medicines is a world-wide problem resulting medicine wastage and associated harms, which imposes an additional burden on the health care system. The study has performed a systematic review of household surveys to provide strong evidences and policy implications through a comprehensive and comparative understanding of available global literatures. The review also maps existing literature on the burden, outcomes and affecting socio-economic factors of medicine storage and wastage.Methods: Five electronic databases were searched (from inception to 2019) for surveys that reviewed in-home medicine storage modality, size, cost and main determinants. The methodological quality of included studies was appraised through an adapted checklist developed by past studies.Results: From the initial 2604 records we identified, 22 studies met our inclusion criteria. In 16 studies, medicine storage rates were reported for more than 70%. The maximum rate of potential (not in use medicines) and real (expired or without expiration date medicine) wastage were about 70 and 40 percent, respectively. The most common classes of medicines found in households belonged to the nervous system (18%) and anti-infective for systemic use (15%). Income, education, age, presence of chronic illness, female gender and insurance coverage were among the factors influencing medicine storage. The most commonly used method of disposal was throwing them in the garbage.Conclusions: Factors beyond medical needs determined medicine storage in the studied contexts which urges effective strategies in the supply and demand side of the medicine consumption chain. The first necessary step to mitigate home storage is adequate legislation and strict enforcement of regulations on dispensing, prescription and marketing of medicines. Patient pressure on excessive prescription, irrational storage and use of medicines deserve efficient community centered programs for increasing awareness of these issues. Hazardous consequences of inappropriate disposal should be mitigated by different take back programs, particularly in low and middle income countries.

Prevalence of unused medicines and determinants among the general public in Addis Ababa, Ethiopia

“…Anti-pain (36.7%), anti-microbial (31.8%), gastrointestinal-related medicines (27.1%), chronic case medicines (12.8%), and vitamins & minerals (12.5%) were found to be the major medicines found in the households which is similar to studies which were conducted in developing countries (Uganda, Sudan, Kenya and Ethiopia), anti-microbial and anti-pains were the most common categories of medicines found unused in households [21,25,30]. A systematic review-based study conducted globally also revealed that common classes of medicines left unused and disposed of in African and Asian countries were antimicrobial and analgesic which is in line with this study [5,7].…”

“…In contrast, in developed countries, other classes like those for chronic conditions comprised the major unused medicines. Studies in Great Britain, the Middle East countries and USA showed that among unused medicines in houses of residents, cardiovascular drugs, central nervous system agents and respiratory drugs were the major ones [7,[31][32][33]. The difference might be due to differences in the prevalent disease condition in the area.…”

“…Patient non-adherence, poor patient education, and poor prescribing and dispensing practices are some of the factors associated with the existence of such unused medicines [5,6]. Patients' doubt about the need for medication, damage due to poor storage, fear of adverse effects, and forgetfulness also contribute to medicine accumulation, being leftover, and wastage at individual or household levels [7].…”

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

“…Despite a thorough literature review on the causes of medication waste [ 6 , 14 , 20 , 21 , 22 , 23 ], the financial [ 4 , 6 , 20 , 24 , 25 , 26 , 27 , 28 ] and environmental impact of medication waste [ 7 , 10 , 11 ], medicine disposal practices [ 8 , 9 , 22 , 24 , 28 , 29 , 30 , 31 , 32 , 33 , 34 ], and management strategies of medication waste [ 6 , 14 ], only some studies have reported the type and therapeutic classes and dosage forms of unused or returned medication waste, and none have brought the information together in a focused review [ 6 , 23 , 28 ]. This study aimed to narratively review and report findings from the literature about the different therapeutic classes and the dosage forms of medication waste that are returned by patients to community pharmacies, hospitals, general practitioners’ clinics, or collected through waste campaigns in different countries around the world.…”