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

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

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

Peer reviewe

Scoping of pharmacists’ health leadership training needs for effective antimicrobial stewardship in Africa

Abstract Background Antimicrobial resistance (AMR) is a global public health concern currently mitigated by antimicrobial stewardship (AMS). Pharmacists are strategically placed to lead AMS actions that contribute to responsible use of antimicrobials; however, this is undermined by an acknowledged health leadership skills deficit. Learning from the UK’s Chief Pharmaceutical Officer's Global Health (ChPOGH) Fellowship programme, the Commonwealth Pharmacists Association (CPA) is focused to develop a health leadership training program for pharmacists in eight sub-Saharan African countries. This study thus explores need-based leadership training needs for pharmacists to provide effective AMS and inform the CPA’s development of a focused leadership training programme, the ‘Commonwealth Partnerships in AMS, Health Leadership Programme’ (CwPAMS/LP). Methods A mixed methods approach was undertaken. Quantitative data were collected via a survey across 8 sub-Saharan African countries and descriptively analysed. Qualitative data were collected through 5 virtual focus group discussions, held between February and July 2021, involving stakeholder pharmacists from different sectors in the 8 countries and were analysed thematically. Data were triangulated to determine priority areas for the training programme. Results The quantitative phase produced 484 survey responses. Focus groups had 40 participants from the 8 countries. Data analysis revealed a clear need for a health leadership programme, with 61% of respondents finding previous leadership training programmes highly beneficial or beneficial. A proportion of survey participants (37%) and the focus groups highlighted poor access to leadership training opportunities in their countries. Clinical pharmacy (34%) and health leadership (31%) were ranked as the two highest priority areas for further training of pharmacists. Within these priority areas, strategic thinking (65%), clinical knowledge (57%), coaching and mentoring (51%), and project management (58%) were selected as the most important. Conclusions The study highlights the training needs of pharmacists and priority focus areas for health leadership to advance AMS within the African context. Context-specific identification of priority areas supports a needs-based approach to programme development, maximising African pharmacists’ contribution to AMS for improved and sustainable patient outcomes. This study recommends incorporating conflict management, behaviour change techniques, and advocacy, amongst others, as areas of focus to train pharmacist leaders to contribute to AMS effectively

Scoping Review of National Antimicrobial Stewardship Activities in Eight African Countries and Adaptable Recommendations

Antimicrobial resistance (AMR) is a global health problem threatening safe, effective healthcare delivery in all countries and settings. The ability of microorganisms to become resistant to the effects of antimicrobials is an inevitable evolutionary process. The misuse and overuse of antimicrobial agents have increased the importance of a global focus on antimicrobial stewardship (AMS). This review provides insight into the current AMS landscape and identifies contemporary actors and initiatives related to AMS projects in eight African countries (Ghana, Kenya, Malawi, Nigeria, Sierra Leone, Tanzania, Uganda, and Zambia), which form a network of countries participating in the Commonwealth Partnerships for Antimicrobial Stewardship (CwPAMS) programme. We focus on common themes across the eight countries, including the current status of AMR, infection prevention and control, AMR implementation strategies, AMS, antimicrobial surveillance, antimicrobial use, antimicrobial consumption surveillance, a one health approach, digital health, pre-service and in-service AMR and AMS training, access to and supply of medicines, and the impact of COVID-19. Recommendations suitable for adaptation are presented, including the development of a national AMS strategy and incorporation of AMS in pharmacists’ and other healthcare professionals’ curricula for pre-service and in-service training

Scoping Review of National Antimicrobial Stewardship Activities in Eight African Countries and Adaptable Recommendations

Antimicrobial resistance (AMR) is a global health problem threatening safe, effective healthcare delivery in all countries and settings. The ability of microorganisms to become resistant to the effects of antimicrobials is an inevitable evolutionary process. The misuse and overuse of antimicrobial agents have increased the importance of a global focus on antimicrobial stewardship (AMS). This review provides insight into the current AMS landscape and identifies contemporary actors and initiatives related to AMS projects in eight African countries (Ghana, Kenya, Malawi, Nigeria, Sierra Leone, Tanzania, Uganda, and Zambia), which form a network of countries participating in the Commonwealth Partnerships for Antimicrobial Stewardship (CwPAMS) programme. We focus on common themes across the eight countries, including the current status of AMR, infection prevention and control, AMR implementation strategies, AMS, antimicrobial surveillance, antimicrobial use, antimicrobial consumption surveillance, a one health approach, digital health, pre-service and in-service AMR and AMS training, access to and supply of medicines, and the impact of COVID-19. Recommendations suitable for adaptation are presented, including the development of a national AMS strategy and incorporation of AMS in pharmacists’ and other healthcare professionals’ curricula for pre-service and in-service training