Disposal of medicines and impact on water resources

Pharmaceuticals, used for prevention, diagnosis and treatment of medical conditions, play a crucial role in healthcare delivery. Although prescribers, dispensers and users of pharmaceuticals envisage certain outcomes, pharmaceuticals end up having unintended effects both in the consumer and in the environment if the pharmaceuticals end up in the environment. One very significant way in which pharmaceuticals enter the environment is by disposal of unused, unwanted or expired medicines. A case study of the Disposal of Unused Medicines Project was undertaken and the information gathered was analysed to assess the effectiveness of disposal methods in place, discuss identified disposal patterns and estimate the extent to which medicines are disposed indiscriminately and in unregulated circumstances

Development and Bioavailability/Bioequivalence of a Fixed-Dose Combination Antiretroviral Reconstitutable Suspension Intended for Pediatrics

This dissertation was designed to develop and assess bioavailability/ bioequivalence of age-appropriate fixed-dose combination granules of lamivudine/zidovudine/nevirapine as reconstitutable suspension for pediatrics for use in pediatric patients. The granules were developed via roller compaction process to improve granule flow characteristics, minimize segregation of the multi-component active pharmaceutical ingredients, and avoid introducing moisture into the formulation and thereby improve the stability of the product. Optimization of the roller compaction process for the roll pressure and the ratio of the horizontal feed screw speed to the roll speed showed that these parameters had minimal effect on granule quality. Subsequently, a replicated 32 factorial design was utilized to optimize the levels of the suspending agent (Avicel RC 591) and the anticaking agent (Aerosil 200). Modeling of the formulation viscosity through multiple regression analysis showed that the viscosity was a quadratic function of the concentration of Avicel RC 591. An assessment of the stability of the granules for reconstitution under International Conference on Harmonization stability conditions at 40 oC/75 %RH and 30 oC/65 %RH indicated the granule formulation to be stable with an estimated shelf-life of not less than 6 months. Similarly, the evaluation of the chemical stability of the reconstituted suspension at 30 oC/65 %RH showed the suspension to be stable for several weeks. A clinical batch of the granules for reconstitution manufactured under Good Manufacturing Practices was tested for bioavailability and bioequivalence in a clinical study. A randomized single dose two-way complete crossover design in 24 healthy adult cohorts was performed, and the plasma samples from the subjects were analyzed by HPLC with UV detection. Non-compartmental pharmacokinetic analysis was performed to obtain the Cmax, AUCo-t, and AUCo-inf utilizing WinNonlin software. Analysis of variance of the formulation, period, sequence, and subject effects established the absence of any significant effects due to these parameters. Application of the two one-sided statistical tests using the Anderson-Hauck method showed that the 90 % confidence interval for the ratio of test/reference for various pharmacokinetic parameters was within 82.6 - 124.5 % bioequivalence limits for all the three drugs. This confirms that the fixed-dose combination granule for reconstitution was bioequivalent to the simultaneously administered single-entity reference products

Drug disposal flow diagrams and sustainable water quality

Pharmaceuticals and Personal Care Products (PPCPs) are present in water sources in various parts of the world. Strategies have been implemented to control their presence in water sources. Strategies, both potential and existing, must be ascertained to be able to tackle the challenge effectively. This paper examines the feasibility of drug disposal flow diagrams (DDFDs) to control the presence of PPCPs in water sources. Surveys and key informant interviews were conducted in 3 regions in Ghana to assess how community pharmacies, consumers and other participants in the pharmaceutical value chain dispose of unused medicines. The information so gathered was put together in a flow diagram. From the results, DDFDs can be used to control PPCPs in water sources: since 57% of PPCPs disposed of in the areas where they are generated and 29% are discharged untreated into receiving waters, focus on these areas will yield the best outcomes

Emerging Security Challenges to Africa: the Case of Haphazard Disposal of Pharmaceuticals in Ghana

The study of the Disposal of Unused/Unwanted Medicines Project examines ways in which medicines are disposed of in Ghana and assesses how disposal methods can impact water resources. The study showed a number of challenges: gaps in the legislative framework for the disposal of medicines; environmentally-unfriendly methods of disposal of medicines; and large quantities of medicines potentially disposed of indiscriminately with major impact on the environment. It recommends a review of the legal framework to ensure the proper disposal of all unused medicines; policies to mop up excess medicines with members of the public; review of prescribing and dispensing practices to reduce excess medicines; and further research into the types of pharmaceuticals that are present and persist in the environment, their effects and how they affect quality of life

Finance for long-term sustainability of small towns piped water services: the case of Ghana

Financing of small towns piped water services is critical to ensure the long term sustainability of the services provided. Tariff determination details have been outlined in the national guidelines for small towns water delivery. However, a study on a number of the systems in Ghana indicates strong emphasis on funds generation mainly through the sale of water without corresponding attention to efficient and effective management of the funds for long-term sustainability. Some small towns piped water services barely break even and struggle to reach their design life. There is then a sharp decline in service level due to their inability to expand/upgrade their capacity to meet growing demand for from increasing populations. The authors have explored the evolution of post-project financing and have identified a serious gap in keeping a capital maintenance/replacement fund. Refocusing on efficient financial management and transparent governance systems for judicious utilisation of the funds is recommended

Development of results-based financing framework for sanitation delivery

Access to sanitation in Ghana is one of the lowest in the West Africa sub-region with coverage of about 15%. Several projects to increase access to sanitation have achieved little success. Community-Led Total Sanitation (CLTS) was introduced in Ghana and it was expected to bring about a big change. Coverage however remains off track, and a major change is required if the country is to achieve the MDG target of 56% for sanitation by 2015. The Results-Based Financing (RBF) refers to public funds being used to pay for services ONLY when pre-specified results are achieved. A stakeholders meeting was held to discuss the merits and strategies for implementing RBF for CLTS in Ghana. The framework developed in Ghana has five stages and payments will be made only when the pre-defined outputs/outcomes are completed and verified by a third party. It is expected that with effective facilitation and monitoring of the process, there will be a rapid increase in access to sanitation in Ghana

Facilities management plan: tool for effective operation and maintenance of school WASH facilities

A School Health Education Programme (SHEP) Policy and Strategy Framework was developed for Ghana in 2010 and launched in 2014. Safe water and sanitation are key components of the policy. A National Strategy for WASH in Schools has been developed under this component. To ensure the sustainability of school WASH facilities a comprehensive Facilities and Management Plan (FMP) was developed. The inability of existing schools to properly operate and manage their WASH facilities was found to be one of the main challenges leading to the breakdown of facilities provided. The FMP focuses on the necessary actions, and the people responsible to make sure the actions are taken to ensure the sustainability of what is provided. It also provides a costing framework which will enable school authorities and the managers of schools to provide the appropriate resource when required for the well-being of school children in Ghana

Finding hidden knowledge in WASH: effective methods for exploring the needs of perimenopausal women in Ghana

As increased urbanisation brings the challenges of providing sustainable and equitable WASH provision for all, a globally ageing population will bring more women in low income countries passing through the perimenopause, the transition to menopause , with various hidden WASH needs. A lack of knowledge upon these needs also means that effective methods to work with perimenopausal women are not well established. Drawing on field experiences from Accra and Kumasi in Ghana, this paper reflects upon the methodological lessons learned in researching the WASH needs of perimenopausal women in two low income communities. An effective methodology to explore perimenopausal women’s WASH needs encourages participation and engagement with the topic through use of appropriate tools , and effective community mobilisation. A collaboration of different people in a team, group reflection and adaptation of tools which consider practical aspects and local cultural values are needed to understand such needs

Tackling antimicrobial resistance : developing and implementing antimicrobial stewardship interventions in four African commonwealth countries through a health partnership model

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