Aknowledge and Perceptions of Post Graduate Students on Disposal of Unused Medicines

Introduction

Human consumption of medication continues to increase over the years with continued discovery of new drugs to treat various conditions. This can also be attributed to increased information available readily on various internet platforms hence continued self-medication and also seeking of health services especially with the continued uptake of health insurance. All these factors it goes without saying that most students will have unused medicines in their possession at a given point. Some of the reasons why people have unused medicines include; over prescription of medicines, oversupply of required amount, change in treatment plan, adverse drug reaction or side effects of a drug, expiry date reaches, non-adherence to therapy, clinical symptoms resolves (person feels better), medical label instructions are not clear and sometimes someone is just unsure as to why they should take the medication.

A study which was conducted in Ethiopia revealed that 89. 1% ( Tekele etal,2014)of medications purchased were never consumed hence remained unused. Article 42 of the constitution of Kenya provides that all citizens are entitled to a clean and healthy environment. Unused medicines pose a risk to humans as well as the environment especially if not properly disposed. Disposing unused medicines into water ways can lead to toxicity to animals in or using the water (Bound and Voulvoulis 2005) into sewer systems antibiotics may work against the disinfectants thus neutralizing their activity this could lead to hazard to water borne diseases due to untreated waste. Unused medicines kept for long may expire and hence become either toxic or have a lower dose of required drug, this could lead to adverse drug reactions or even resistance to certain disease conditions. Most countries including Kenya lack proper guidelines and policy to implement safe disposal of unused medicine (tong etal 2011)This studys’ finding can be used to inform policy on matters safe disposal of unused medicines. It is also important in terms of promoting proper use of medicines to enhance compliance to treatment. This study was targeted at university students. This very diverse and educated target group that could inform the general gaps in the population and also represent a diverse number of households. A similar study (Angienda& Bukachi 2016) which was conducted in Nairobi Kenya recommends a similar study in an institution to evaluate any differences that would arise.

Objectives

General objective

To determine the knowledge and perceptions of university students on disposal of unused medicines and the different practices of disposalSpecific objectives1. To determine knowledge of disposal practices of unused medicines of students2. To find out their perceptions on disposal practices. 3. To find out the different practices among the students.

Methodology

Study Design

This was a qualitative study. It a descriptive cross sectional study that has both qualitative and quantitative data was collected. A structured questionnaire was used that had both closed and open ended questions to bring out the narrative from the respondents. Study populationA sample size of 42 respondents was used for this particular study. These were all university of Nairobi post graduate students. This was mostly dictated by time and logistical constraints. Number was used since the major aim of study was just to understand people’s perceptions rather than getting a representative sample. Convenience sampling method was used according to availability and willingness to participate in the study. Data collection methodsA questionnaire (Appendix a)with both closed ended and open ended questions was administered as a Google form document. This was shared via various social media platforms especially whatssup application and emails. A few instances involved face to face administration and filling of the Google document. It contained five sections. A brief introduction and purpose of study was in section one. Section two contained some demographics of participants and section three to five captured the specific objectives of this study. Data process and analysisData was processed after disabling receiving responses from the Google form. Summaries for categorical data were obtained while open ended questions were further analysed using qualitative methods. Qualitative analysis was analysed by use of grounded theory from the open ended questions to better understand and interpret the results. Emerging concepts and themes were summarised to answer the different study objectives. Categorical variables are represented in pie charts, tables and bar graphs. Ethical considerationsConfidentiality and informed consent from the respondents was important as well as maintaining anonymity. A brief introduction on the Google form document was necessary since it introduced the researcher and explained the purpose of the study together with study objectives. Hence once a respondent went ahead to fill the questionnaire it was assumed that consent was obtained.

Results and Discussions

Participants’ characteristics42 postgraduate students currently studying at the University of Nairobi were studied. Table 1 below shows the different characteristics of respondents. The different categorical variables were represented in percentages and graphs.

Female students were 18/42 representing 42. 86% of study sample while the male were 24/42 representing 57. 14% of the sample. This was a generally gender balanced group as much as selection was based on willingness to answer the questionnaire. Age variable was distributed as illustrated in the pie chart below. Over 90% of respondents were between 20-39 years while only 7% were above 40years.

Knowledge on Storage and Disposal of Unused Medicines

The study findings had 36/42 (86%)patients who have unused medicines. This represents the majority of respondents, similar results are reported (Supriya etal 2017),(Vellinga etal 2014) and (Braund etal 2009) among other similar studies. . 16/42 respondents denied having any expired medicines with them while 15/42 admitted to having stored expired medicines, the remaining 11 were unsure as to whether they did or did not have any expired medicines. Almost all (35/36) patients gave their place and storage reasons of unused medicine.

Storage Areas for Unused Medicines

Majority of the participants 24 (69%) reported that they stored the medicine in cabinets/cupboards. Some of the details are as shown: “On the shelves away from Children” Male, 30-39 years“In the Kitchen Cabinet” Female, 30-39 yearsA quarter of the patients reported storage of unused medicines in open and easily accessible places 9 (26%). Some of the participant responses are as shown: “On top of my fridge” Female, 30-39 years“In a small bag” Female, 30-39 years Reasons for storing unused medicine. More than half of the participants reported that they store unused drugs for future use 20 (57%). Examples of the participant’s,“You never know when sickness strikes” Male, 40 + years“Just for emergency purposes” Female, 20-29 yearsSome of the participants 4 (11%) stored the unused medicines because they did not know how to dispose them. “Unsure how to dispose them due to risk involved such as kids taking and using them up” Female, 30-39 years.

In a similar study in Ireland 57% of respondents reported that they store unused medicine ‘in case I need it later’, 20% didn’t want to waste,17% did not know how to dispose them while 5% wanted to give to other people. (Vellinga etal 2014)The study found that 38/42 participants were willing to learn on how to dispose unused medicine. 59. 5%(25) would prefer to get this information through media(i. e tv, radio), 45. 2%(19) would prefer from pharmacies,19%( 8) hospitals, 23. 8%(10) from the community while remaining2. 4% from the internet. Perception of disposal practices22 %( 9) and 36% (15) of respondents strongly agree and agree respectively that unused medicines are a health hazard, while 38 %( 16) are neutral meaning they neither agree nor disagree. 2 %( 1) disagree while the other 2 %( 1) strongly disagree. . Availability of information on disposal of unused medicines90 %( 38) of respondents agreed or strongly agreed in equal measures that there is lack of information on proper methods of disposing unused medicines. 7% (3) were neutral while 3% (1) strongly disagreed. “Setting up proper disposal centres”, Male, 20-29

Policy

“Have safe disposal method put in place by the Government”, Male, 40 +Major theme that came out was that promoting awareness was the right step towards achieving safe disposal practices. 78. 57% of the respondents thought so. Sensitization, enlightening and educating students. 4. 77% proposed the setting up of disposal centres inorder to enhance proper disposal while the other 9. 52 % had different approaches like enhancing adherence to minimize unused medicines.

Conclusion

From the finding of this survey there is a clear gap in terms of awareness on safe disposal of medication among students. Disposal in the dustbin is the most commonly used method of disposal which is relatively safe as compared to flushing down the sink or burying in the shamba as seen in the study, which is very unsafe for the environment. There is also a gap in policy since the guidelines for disposal is available but has not been fully implemented or been given the seriousness it deserves. Last year during world pharmacist day a massive campaign was held to advocate for safe disposal of expired drugs by the Pharmaceutical Society of Kenya alongside Pharmacy and Poisons Board. Such initiatives would go a long way is bridging this information gap and are highly recommended. Measures through different stakeholders should be put in place to facilitate these recommendations.