Global medication waste management practices: challenges and opportunities in developing countries

Medication waste is synonymous with pharmaceutical waste, unused or expired medicines. Improper disposal of medication waste leads to serious personal and environmental health hazards. There were no established medication waste management programmes in most of the developing countries including Asia. Presence of unique socioeconomic problems in these counties makes the establishment of successful medication waste management programme a challenge. We reviewed the literature pertaining to the disposal of medication waste in different countries in order to understand the current status. We found that the medication waste disposal via normal sewage systems was the main method practiced in most of the countries and that the situation was much worse in developing countries. Return of unused medicines to pharmacies, which is considered to be the best method, was successfully practiced in some developed countries with established systems. Lack of proper mechanism to handle medication waste seems to be the main reason behind substandard medication waste management in developing countries. We propose a simple model for the disposal of medication waste taking into consideration the unique challenges and infra-structure issues in developing countries. International level policy and funding support, national level policy and unbiased financial allocations, institutional level comprehensive programmes according to the local requirements and most importantly the public support will make medication waste management programme a success. Furthermore, developing countries should join the on-going international forum on medication waste management. This short communication will be an eye opener for the academic key opinion leaders in developing countries to initiate medical waste management programmes in their countries

Medication waste disposal practices among patients attending selected out patient departments in a tertiary care institution: a cross sectional survey

Background: Medication waste has major implications on human and animal health, environmental safety and the health economy. Low and middle income countries have paid less attention to proper medication waste disposal at household and community level. This is the first baseline assessment on medication waste disposal practices among the general public in Sri Lanka.Methods: This was a descriptive, cross-sectional survey, conducted via face to face interviews using a structured questionnaire among selected outpatient clinics at the National Hospital of Sri Lanka. A non-probability sampling technique was used to achieve a representative sample from each clinic. The data collectors were trained prior to administering the questionnaire. Data was presented as descriptive statistics using percentages. Chi-square test was used to find associations.Results: From the total number of participants (n=200) majority were females 135 (67.5%). Majority of the participants (78%) stated that they have unused medicines at home. Among them, tablet form was the commonest (78%) followed by topical preparations (49%). Commonest reason for having unused medicines at home were self-discontinuation as illness resolved (57.5%). There was a significant difference between the knowledge and practices when disposing tablet form (<0.001), syrups (0.002), topical preparations (0.04) and sharps (<0.001). Majority (23%) discarded sharp to rubbish bins. Rubbish bin was the commonest mode of disposal for all dosage forms as well as devices.Conclusions: In this sample majority had unused medicines at home which was compatible with the pattern seen in other countries and need proper attention

Obstetric outcomes and effects on babies born to women treated for epilepsy during pregnancy in a resource limited setting: a comparative cohort study

Abstract Background Management of epilepsy during pregnancy in a resource-limited setting (RLS) is challenging. This study aimed to assess obstetric outcomes and effects on babies of women with epilepsy (WWE) exposed to Anti-epileptic drugs (AEDs) compared to non-exposed controls in a RLS. Methods Pregnant WWE were recruited from antenatal and neurology clinics of a tertiary care hospitals in Sri Lanka. Patients were reviewed in each trimester and post-partum. Medication adherence, adverse effects, seizure control and carbamazepine blood levels were monitored. Post-partum, measurements for anthropometric and dysmorphic features of the babies and congenital abnormalities were recorded. Age and sex matched babies not exposed to AED recruited as controls were also examined. Results Ninety-six pregnant WWE were recruited (mean period of gestation 22.9 weeks). Mean age was 28 years and 48(50%) were primigravidae. Fifty percent (48) were on monotherapy, while 23.8, 15.9 and 4.1% were on two, three and four AEDs respectively. AEDs in first trimester (TM1) were carbamazepine (71%), valproate (25.8%) clobazam (29.5%), lamotrigine (7%) topiramate (5%) and others (3.4%). Sodium valproate use reduced significantly from T1 to T2(p < 0.05). Sub-therapeutic carbamazepine levels correlated positively (r = 0.547) with poor medication adherence (p = 0.009) and negatively (r = 0.306) with adverse effects (p = 0.002). Seventy-six WWE completed follow-up reporting w 75 (98.6%) live births and one T1 miscarriage (1.3%). Three (4.3%) were preterm. Majority (73.33%) were normal vaginal deliveries. Cesarean sections were not increased in WWE. Fifty-nine (61.45%) babies were examined. For those examined during infancy, 53 age and sex matched controls were recruited and examined.. Congenital abnormalities occurred in 5 (9.43%) babies of WWE [atrio-ventricular septal defect (2), renal hypoplasia (1), cryptorchidism (1), microcephaly (1)] compared to 2 (3.77%) in controls (2 microcephaly; p = 0.24). Fetal exposure to AEDs increased a risk of low birth weight (RR 2.8; p = 0.049). Anthropometric parameters of AED exposed babies were lower at birth but not statistically significant between the two groups (weight p = 0.263, length p = 0.363, occipito-frontal circumference (OFC) p = 0.307). However, weight (p = 0.009), length (p = 0.016) and OFC (p = 0.002) were significantly lower compared to controls at an average of 3.52 months. Conclusion Most pregnancies are unplanned in the RLS studied, and AEDs were altered during pregnancy. Congenital anomalies occurred at rates comparable to previous reports. Fetal exposure to AED had growth retardation in infancy compared to non-exposed babies