ASSESSMENT OF DISPOSAL PRACTICES OF PHARMACEUTICAL WASTE AMONG HOUSEHOLDS WITHIN NAKURU TOWN, NAKURU COUNTY, KENYA

ABSTRACT
Pharmaceuticals are critical in maintaining the health of people and improving the quality of life for millions of Kenyans, but not all pharmaceuticals dispensed are consumed. They become waste when they are no longer usable for intended purpose or are being discarded for other reasons such as contamination and expiration. Improperly disposed pharmaceuticals end up in garbage collection centres and water purification systems which are not sufficiently equipped to manage this form of waste. There is growing public concern over presence of active pharmaceutical ingredients in water and the environment. This pharmaceutical waste also includes antimicrobials which interfere with water treatment process since most depend on biodegradation. Pharmaceuticals have immense effects on non-target organisms, such as medicine resistance in humans, increases in morbidity and mortality of the population due to unintentional poisoning. The main objective of this study was to assess the disposal practices of pharmaceutical waste among households in Nakuru Town. This was achieved through conducting a social survey. Data was then processed and analysed using descriptive and inferential statistics. Out of 384 households who participated in the study, 35.8% and 14.4% of the respondents indicated that antibiotics and pain killers were the most commonly disposed of pharmaceuticals respectively. In this study the most commonly used method of disposal was flushing in the toilet. Seventy eight percent (78.4%) of the respondents had no knowledge of pharmaceutical waste handling and management, whereas 71.6% were aware of the risks associated with storing unwanted pharmaceuticals in the house. Eighty percent (80%) have never received any information on how to dispose unwanted pharmaceuticals. Fifty five percent (55%) of the respondents were willing to participate in take-back programs as the most feasible and safe disposal strategy that can be used to manage pharmaceutical waste. However, over 80/% of them expressed their scepticism on implementation of the mail-back programs since it is expensive and neither practical nor feasible under the prevailing economic conditions and governance structure. In conclusion, there are a lot of unwanted pharmaceuticals among households and the public has no knowledge on how to manage them hence they end up using unsafe methods which can pollute the environment. Sensitization of the public on the dangers of poor disposal of pharmaceuticals and provision of collection points for proper disposal are recommended.

CHAPTER ONE
INTRODUCTION
Background information
Pharmaceutical is a drug that is used to diagnose, cure, treat or prevent diseases. It becomes a pharmaceutical waste when it is no longer usable for intended purpose, or is being discarded for other reasons e.g. contamination, already dispensed and expiration. The term waste according to Environmental Management and Co-ordination Act 2015 is ‘any matter whether liquid, solid, gaseous which is discharged, emitted or deposited in the environment in such volume, composition or manner likely to cause an alteration of the environment’ (GOK, 1999). This waste can be hazardous waste, non-hazardous waste or controlled substance (Hoboy, 2011) It is a drug that will never be used that includes all expired pharmaceuticals, all unsealed syrups or eye drops irrespective of its status whether expired or not, all cold chain damaged pharmaceuticals that should have been stored in cold chain but was not hence it has been damaged, all bulk or loose tablets and capsules also includes all unsealed tubes of creams and ointment whether expired or not (WHO, 1999). This can be in healthcare setting or in the home. This waste includes partial vials (safety caps removed), un-dispensed, pre- filled syringes, partial syringes, discontinued medicines, un-administered medicines, prescription medicines or physician treatment samples (Hoboy, 2011).

Pharmaceuticals are critical in maintaining the health of people and improving the quality of life for millions of Kenyans, but not all pharmaceuticals dispensed are consumed. Most of them frequently become waste for a variety of reasons such as: the patient’s medical conditions resolving before completion of a dose, the patient may experience intolerable effects and the prescriber may stop the usage or change it. They also become waste when a patient refuses to take the pharmaceutical as prescribed, the pharmaceutical is not effective and the prescriber stops it or change it and the pharmaceutical may expire before the dose is completed. At times the patient may die and leave the pharmaceutical which becomes waste (Bain 2010a).

Unwanted pharmaceuticals are managed in a variety of ways, such us keeping them at home, dumping them in the trash, rinsing them in the sink, flushing them down the toilet and others take them back to the pharmacy for proper disposal (Dharmender et al, 2013). Pharmaceutical waste can also emanate from donations during conflicts and natural disasters as a sign of humanitarian assistance as they sometimes arrive near or past expiry date. Others may be unrecognizable if labelled in foreign language or may have been given in unwanted large quantities ending up as waste (WHO, 1999).

Recently researchers found pharmaceuticals such as antibiotics, hormones and controlled substances in almost all environmental media. There is enough evidence that pharmaceuticals harm aquatic life and humans. Humans also feed on aquatic organisms that live in water contaminated with the antibiotics and hormones. They also use the same water even for drinking.

Evidence from rodent and fish study suggest that some endocrine-disrupting compounds, including those found in prescribed synthetic hormones, may contribute to tumour formation in humans (WHO, 1999).Anti-neoplastic or cytotoxic drugs must be handled carefully as they have the ability to kill or stop the growth of living cells and can have extremely serious effects, such as interfering with reproductive processes in various life forms (Atul et al, (2016). Exposure of pharmaceuticals to non-target organisms has been linked to increase in infertility, genital defects and cancers and neurological disorders in children which have been exposed to them especially exposure to hormones (Obonyo &, Mutai , 2014).

There exist safe methods of disposal of pharmaceuticals among households which are already practised by other countries. This includes the take back programmes which provide safe and environmental friendly options for consumers. Other examples are mail back programmes where the consumers send their unused drugs to the central location through the postal service. This is operational in various countries such as United States. Another take back program is the use of drop off models where permanent collection sites exist or a one day event where consumers take their unwanted pharmaceuticals and they are later disposed in a recommended way (Siler & Brown , 2009).

Disposal of pharmaceutical waste among households is a global challenge especially in developing countries like Kenya. This study assessed the disposal practices of pharmaceutical waste, identifying and describing the commonly disposed pharmaceutical waste, assessing the current disposal methods, assessing the factors influencing pharmaceutical waste disposal and assessing the factors that influence disposal of pharmaceutical wastes. The study also sought to document feasible safe disposal strategies that can be used to manage pharmaceutical waste among households.

Statement of problem
In the last few decades studies in other countries have shown presence of pharmaceuticals in drinking water. This is evident in a 2002 study from the U.S Geological survey. Studies carried out in Kenya have shown that improperly disposed of pharmaceuticals end up in garbage sites and waste water treatment systems which are not sufficiently equipped to manage this form of waste (Wagema, 2016). Pharmaceuticals have immense effects on non- target organisms such us aquatic life and in humans. Improper disposal of pharmaceuticals might be the cause of dysfunction of sewage treatment facilities since they have been shown to be toxic to beneficial bacteria especially the antibiotics. There is inadequate information on handling of pharmaceutical waste at household level. Further, knowledge on environmentally-friendly and sustainable disposal methods for pharmaceuticals is lacking. Several studies conducted in other countries have demonstrated that improperly disposed pharmaceuticals can cause adverse effects on human such as medicine resistant, accidental poisoning of children and pets. This can also happen in the study area if the pharmaceutical waste is not properly disposed. Nakuru was dubbed the cleanest town in East Africa though this has changed due to rapid urbanisation and high population growth (Kanani, 2014). Waste in Nakuru is not segregated and medical wastes have ended up at the dumpsite- both from households and health facilities (Kahenda & Wagema, 2016). This has brought about rising cases of medical waste which have been carelessly disposed in the Nakuru Gioto dumpsite. From the academic trips made to the dumpsite it was clearly shown that there were medical waste haphazardly disposed there. Therefore there is need to assess the disposal practices of pharmaceutical waste among households in the study area.

Broad objective
To assess the disposal practices of pharmaceutical waste among households in Nakuru town, Nakuru County

Specific objectives
1. To determine and characterize the commonly disposed pharmaceutical waste among households in Nakuru town.

2. To assess the current pharmaceutical waste disposal practices among households in Nakuru town.

3. To assess factors that influence pharmaceutical waste disposal among household in the study area.

4. To document feasible safe disposal strategies that can be used to manage pharmaceutical waste among households in Nakuru town.

Research Questions
1. What are the common types of pharmaceutical wastes disposed among households in Nakuru town?

2. How are pharmaceutical wastes currently disposed among households in Nakuru town?

3. Which factors influence pharmaceutical waste disposal among households in the study area?

4. What are the feasible safe disposal strategies that can be used to manage pharmaceutical waste among households in Nakuru town?

Justification
Pharmaceuticals enter the environment via water, sewage, manure and animal carcases and they disperse through food chain. Pharmaceuticals are designed to alter physiology at low concentrations and can be particularly potent contaminants in high concentrations to non- target organisms. Though there is inadequate evidence on exact harm of pharmaceuticals on human, action should be taken because they already exist in our environment. The Nation’s experience with chemicals such as asbestos and lead which demonstrate that it will be costly in terms of health, human lives and in monetary terms, action should be taken to avoid being overwhelmed in the future with these effects.

This study will make a contribution to the Sustainable Development Goals (SDGs) most notably goal 6 target 6.3 that aims to achieve improved water quality by reducing pollution, eliminating dumping and minimizing release of hazardous chemicals and materials into water sources by 2030. Further, it will contribute to Goal 3 target 3.9 that aims to reduce the number of deaths and illness from hazardous chemicals and air, water and soil pollution and contamination by 2030. The study findings will be useful in the attainment of Kenya’s Vision 2030, the social pillar on the environment which aims at regulating pollution and waste management and seeks to create “a just, cohesive and equitable social development in a clean and secure environment”. Data generated from this study can be beneficial for policy makers and relevant authorities especially those working on environmental and public health management. The findings will form a database that can be utilized in development and improvement of guidelines for disposal of pharmaceutical waste among households in Kenya.

Scope of the study
The scope of this study was confined to Milimani, Free area and Kaptembwo which fall within Nakuru town. A social survey design was used to carry out the study from May to June 2016. Data was collected from households in the selected areas. The demographic factors considered as intervening included age, education, awareness, gender. Age of respondent was between 18 to 65 years. The study focused on the following aspects: commonly disposed pharmaceuticals waste, current pharmaceutical waste disposal practices, factors that influence pharmaceutical waste disposal and feasible safe disposal strategies that can be used to manage pharmaceutical waste among households in Nakuru town.

Limitations and assumptions
· Inability to establish the expiry date for cases where the original packages were missing. This was solved by the researcher’s operationalization of the term expiry date of the pharmaceutical since it was not guaranteed once the drug container was opened and improperly stored.

· The political and security situation remained stable thus allowing administration of household questionnaires and community level interactions to be carried out.

· Prejudice- this may have arisen out of suspicion from respondents on the interviewers and the actual use of information that was being gathered.

· The local community in the study area was to be friendly and was to provide true information on what they were to respond to the questions.

Definition of terms
Characterization- is to describe pharmaceuticals in terms of naming the commonly disposed, its type whether it is syrup, tablets..., the source and finally classification on the basis of pharmacological properties and their pharmacological actions e.g. Antipyretics, Analgesics, Antibiotics...

Diagnosis- it refers to pharmaceuticals which are used to determine cause of an illness or disorder. They include diagnostic radiopharmaceuticals such as Adreview which is used to detect certain kinds of cancer of the adrenal glands.

Expiry- this are pharmaceuticals which are past their drug expiration date which exist in most medication labels, including prescription and over the counter, though their stability is not guaranteed once the original package is opened and storage conditions are not follow

Households - The smallest domestic unit consisting of one or more people who share living accommodation.

Improper disposal – any disposal of pharmaceuticals which is not following the safe disposal guidelines by World Health Organisation (1999) on how to dispose Pharmaceuticals. Improper disposal includes; flushing pharmaceuticals down the toilet and sink, throwing in the thrush, storing of unwanted pharmaceuticals in the house.

Non target organisms - any organism which is unintentionally affected in this case by pharmaceuticals this includes aquatic life like fish, microbes and even humans who are not intended to take those medication.

Pharmaceuticals - these are drugs or substances used to diagnose, cure, treat or prevent diseases for humans and pets.

Pharmaceutical Waste - refers to drugs which are no longer usable for intended purpose and it will never be used whether expired or not for humans and pets.

Social economic status-it is an individual or family’s economic and social position in relation to others based on their income.

Take back programmes- these are initiatives which entails collection of unwanted pharmaceuticals from household to hospitals where they are later disposed of in a safe way which cannot pollute the environment.

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Item Type: Kenyan Material  |  Attribute: 80 pages  |  Chapters: 1-5
Format: MS Word  |  Price: KSh900  |  Delivery: Within 30Mins.
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