Implementation of Medicine Take-back Concept at Community Level in Nepal: a Feasibility Study

Abstract

Background: Medications are not always completely consumed as purchased from pharmacy due to lack of awareness, forgetfulness. So, most households may have leftover, unwanted, unused and expired (UUE) medicines. They may lead to health hazards and environment pollution. The present study was aimed to analyze feasibility of implementation of medicine take-back in select communities of Nepal.Methods: Exploratory study was conducted among adults (total 400) in Kathmandu, Lalitpur, Kaski, Kanchanpur and Kailali districts from July 2017 to January 2018. Study sites and participants were selected by simple random sampling and respondents were interviewed about their awareness about medicine disposal techniques, possible hazards and their willingness to support take-back program using semi-structured questionnaire. Multinomial logistic regression analysis was applied to explore the relationship of various take-back related outcomes with the predictors. The p-value less than 0.05 was statistically significant at 95% confidence level. Results: The multinomial logistic regression analysis showed that there was significant relationship of health hazards (rashes and diarrhea) among the farmers, engineers, nurse and lawyers (p value <0.01 in each). Land pollution and effect on health of children was significantly related with the inappropriate disposal of medicines such as site of disposal (p value <0.01), river (p value 0.02), garbage (p value 0.04), and dumping site (p value 0.01). The analysis of the willingness to follow take-back program with the techniques of support showed significant relationship with the establishment of collection center and participation on seminar (p value <0.01). Conclusions: Most participants kept UUE medicines in home, disposed with household rubbish and flushed down the sink. They were interested to support take-back, if implemented in their community but the main constraint was the budget. Hence, take-back concept could be initiated and implemented on government funding or other external sources.