ASSESSMENT OF PHARMACEUTICAL WASTE MANAGEMENT PRACTICES IN PHARMACIES AND MEDICINE STORES: EVIDENCE FROM BAMENDA HEALTH DISTRICT, CAMEROON

CHAPTER ONE

INTRODUCTION

1.1 Background of the study

Pharmaceuticals play a crucial role in a healthcare system, necessitating a consistent supply of appropriate stocks (Pharmacy and Poisons Board, 2018). The rapid expansion of the pharmaceutical business in recent decades has resulted in an increased number of medications available on the market. However, this rise has also brought about major environmental and public health risks when these drugs are not disposed of correctly (Bruno et al., 2017). Pharmaceutical waste management is a crucial aspect of pharmaceutical industries (Jaseem et al., 2017). "The individuals or entities that have the most significant impact on a product, typically the manufacturers, should be involved in responsibly managing the product when it reaches the end of its lifespan." (Lubick, 2018). Antibiotics are widely prescribed pharmacological drugs worldwide. During the manufacturing process, antibiotics have the potential to permeate or be released into the environment. However, a substantial quantity can also enter the environment due to improper disposal methods (such as pouring them down sinks or toilets, or throwing them in household garbage) and through natural human excretion (National Collaborating Centre for Infectious Diseases, 2021).

Pharmaceutical waste can arise from several activities and areas inside healthcare facilities, including pharmacies, distribution centres, and hospitals. Typically, it may consist of expired medications, patients' unused personal medications, waste materials containing excessive drugs (such as syringes, IV bags, tubing, vials, etc.), waste materials containing residues of chemotherapy drugs, open containers of unusable drugs, containers that held highly hazardous waste drugs, discarded drugs, and contaminated garments, absorbents, and spill cleanup materials. Pharmaceutical waste is categorised into three distinct groups: Hazardous waste, Non-hazardous waste, and Chemo waste (Jaseem et al., 2017; WHO, 2018). The primary pharmaceuticals employed in the battle against Covid-19 encompass a range of items such as test kits, surgical masks, gloves, scrubs, hospital gowns, headgears, thermometers, swab sticks, hand sanitisers, disinfectants, face shields, drugs, syringes, intravenous bags, protective suits, tubing, and vials (Ejeromedoghene, 2021). Several of these medications are single-use and must be discarded following their initial administration to a patient. 

There are currently about 3,000 active pharmaceutical compounds being used globally in prescription medicines, over-the-counter therapeutic treatments, and veterinary drugs. Their active components consist of a diverse range of artificial compounds manufactured by pharmaceutical corporations worldwide, including both industrialised and developing nations, at a rate of 100,000 tonnes annually (WHO 2017). Swab sticks have been used to test over 23 million people worldwide for the new virus. The information provided by the Centre for Disease Control and Prevention in 2020 presents a concerning perspective on the quantity of medications that would have been utilised and subsequently discarded during the process of testing additional individuals. A total of 713 distinct active compounds underwent environmental studies, which included 142 transformation products. Out of these, 631 active substances, along with 127 transformation products, were found at concentrations exceeding the detection limit. Furthermore, a total of 16 active chemicals were detected in surface, ground, and drinking waters across all global regions (Beek et al., 2017).  

Diclofenac, a painkiller, was the most prevalent medication detected in the environment, with a presence in around 50 countries. Carbamazepine, ibuprofen, sulfamethoxazole, and naproxen were discovered in a minimum of 45 nations. In addition to antiepileptics, painkillers, and antibiotics, hormones and antilipemics were found in all regions of the United Nations. The presence of antibiotics and other antimicrobial agents in the environment can contribute to the development of Antimicrobial Resistance (AMR). AMR refers to the ongoing evolutionary changes in viruses, bacteria, fungi, and other pathogens that make them resistant to naturally occurring and synthetic antibiotics, antivirals, and antifungals (WHO, 2017 by National Collaborating Centre for Infectious Diseases 2021). According to the United Nations Environment, the increasing antimicrobial resistance (AMR) caused by the release of pharmaceuticals and certain chemicals into the environment is currently one of the most alarming health risks. According to the WHO Expert Committee on Specifications for Pharmaceutical Preparations Fifty-fourth report in 2020, AMR is responsible for around 700,000 fatalities annually worldwide. It is projected that by 2030, AMR will result in a gross domestic product (GDP) loss of up to US$ 3.4 trillion. The deleterious impacts of pharmaceuticals in the environment encompass the dissemination of antimicrobial resistance (AMR) and threats to species survival, as well as disruptions to reproduction and heightened incidence of cancer in humans (Freitas & Radis-Baptista, 2021).

The presence of pharmaceutical waste in the environment is a widely acknowledged global issue (Costel et al., 2021). The issue of medication disposal is currently a cause for concern and is receiving increasing attention from healthcare professionals and consumers (Kadam et al., 2017).The deliberate focus on addressing Covid-19 cases would result in the development of various trash, which could pose an additional health hazard if not well managed and disposed of (Alrawi et al., 2021; Ejeromedoghene, 2021).Pharmaceutical waste disposal is a crucial aspect of the supply chain, but both poor and high-income nations face challenges in establishing an economical, efficient, and safe disposal system (Kamba et al., 2017).The primary objective is to establish a method for safely disposing of pharmaceutical waste that is both environmentally friendly and conducive to public health, while also remaining cost-effective and efficient (Costel et al., 2021).Pharmaceutical waste management and disposal methods encompass incineration, secure landfilling, waste immobilization-encapsulation, waste immobilization-inertization, and sewage disposal (Jaseem et al., 2017). Pharmaceuticals are often eliminated through burning at temperatures exceeding 1200 °C (Nyagah et al., 2020). Pharmaceuticals that are disposed of by being flushed into septic systems may present a greater danger to waterways compared to those that are disposed of through municipal systems (Lubick, 2010). The disposal techniques for medications in underdeveloped nations are predominantly inadequate and hazardous (Oladimeji-Salami et al., 2017), since numerous low and middle income countries lack proper mechanisms for pharmaceutical disposal (Bataduwaarachchi & Chamari, Iosue, 2020).Therefore, it is crucial for developing nations to possess sufficient technologies for the proper disposal of their pharmaceutical wastes in order to eliminate potential dangers (Jason et al., 2018).

The regulations governing the management of healthcare wastes in Cameroon are under the purview of laws that safeguard public health and the environment, overseen by the Ministry of Public Health (Manga et al., 2019). Diaby et al. (2020) found that the numerous statutory instruments and rules pertaining to waste management are frequently either insufficient or not effectively enforced. The absence of enforcement in this context indicates a deficiency in the provision of supported guidelines and regulations, such as technical specifications and specific protocols for waste disposal. Cameroon, like to other African nations, possesses a deficient healthcare infrastructure (Ojong, 2020). Despite the allocation of funding by the Ministry of Public Health in Cameroon, medical waste management has not been given sufficient attention. The order with reference number 003/MINEPDED, issued on 15th October 2012, established regulations for the management of medical and pharmaceutical waste. Article 3 of this directive explicitly states that medical and pharmaceutical waste must be categorised based on their specific features and nature (Mbacham, 2022). There is a scarcity of literature regarding the handling of pharmaceutical waste in Cameroon. The pharmaceutical disposal practices in Cameroon have been shown to be inadequate and hazardous. This study aims to investigate and outline the methods of managing pharmaceutical waste carried out by pharmacies and medicine stores in the Bamenda Health District of the North West Region of Cameroon.

1.2 Statement of the problem

Pharmaceutical waste, comprising of outdated, unused, or contaminated drugs, poses a substantial public health and environmental problem if not handled appropriately (Son, 2018). Improper disposal of pharmaceutical waste can result in the pollution of water supplies, soil, and ecosystems. Additionally, it can contribute to the emergence of antibiotic resistance, which poses dangers to both human health and the environment (Majid et al., 2019).

Research has demonstrated that Active Pharmaceutical Ingredients (APIs) pollute the environment, posing threats to biodiversity, ecosystem services, and public health. These risks include the emergence and dissemination of antimicrobial resistance, disruption of hormone function, heightened chances of poisonings and the inadvertent consumption of expired or counterfeit medication, as well as the promotion of illicit sales on the black market (Gupta et al., 2019; Iosue, 2020; Khobragade, 2019; Jaseem et al., 2017). Pharmaceutical residues can enter the human body through the ingestion of drinking water and food (Ojong, 2020).

In addition, improper disposal of drugs can facilitate the accessibility of pharmaceuticals that are no longer necessary to potential abusers (Atang, 2022). In light of the escalating opioid epidemic nationwide, it is crucial to ensure that medications are not readily accessible to individuals who may misuse them (Mandiba, 2020). As to the Substance Abuse and Mental Health Services Administration (SAMHSA) situated in Rockville, Maryland, a significant number of adolescents hold the misconception that prescription medicines are comparatively safer or less detrimental than other types of drugs. However, a fact that many people fail to recognise is that the most rapidly expanding issue with drugs is not cocaine, heroin, or methamphetamines, but rather prescription medicines (Sanjay et al., 2021). Having a solid understanding of prescription disposal can assist individuals in effectively managing their medications, reducing the likelihood of misuse or abuse of expired drugs (Atang, 2022).

Pharmacies and medicine stores in the Bamenda Health District of Cameroon have a vital function in the distribution and disposal of pharmaceutical items. Nevertheless, the efficacy of pharmaceutical waste management measures at these establishments is frequently ambiguous. Insufficient detailed data exists regarding the handling, storage, and disposal of pharmaceutical waste, as well as the compliance of current processes with regulatory standards and best practices. Inadequate handling of pharmaceutical waste at pharmacies and medicine stores poses significant public health problems, such as unintentional poisoning, environmental pollution, and the potential for misuse of expired or tainted drugs. In addition, there is a lack of awareness and compliance with appropriate disposal methods, which worsens the problem. The objective of this study is to evaluate the methods used for managing pharmaceutical waste in pharmacies and medicine stores located in the Bamenda Health District.

Objectives of the study

The primary objective of this study is to critically assess pharmaceutical waste management practices in pharmacies and medicine stores: evidence from Bamenda health district, Cameroon. Specific objectives of this study are to:

To evaluate Current Pharmaceutical Waste Management Practices in pharmacies and medicine stores in Bamenda Health District

To determine the level of knowledge among pharmacy staff and medicine store operators regarding pharmaceutical waste management regulations, guidelines, and best practices.

To identify the challenges faced by pharmacies and medicine stores in implementing effective pharmaceutical waste management practices in Bamenda Health District

To provide recommendations for enhancing pharmaceutical waste management practices in Bamenda Health District.

1.4 Research Questions

The following research questions which are in line with the objectives of this study will be answered in this study:

What are the current pharmaceutical waste management practices in pharmacies and medicine stores in Bamenda Health District?

What is the level of knowledge among pharmacy staff and medicine store operators regarding pharmaceutical waste management regulations, guidelines, and best practices?

What are the challenges faced by pharmacies and medicine stores in implementing effective pharmaceutical waste management practices in Bamenda Health District?

What are the recommendations for enhancing pharmaceutical waste management practices in Bamenda Health District?

1.5 Research Hypotheses

To determine the effectiveness of this study, the following research null hypotheses will be formulated to guide the study and it will be tested at 0.05% levels of significance.:

Ho: There are no significant practices related to the management of pharmaceutical waste in pharmacies and medicine stores in Bamenda Health District.

Ha: There are significant practices related to the management of pharmaceutical waste in pharmacies and medicine stores in Bamenda Health District.

1.6 Significance of the study

The importance of this study resides in its capacity to increase public health and environmental security, guarantee adherence to regulations, improve healthcare procedures, and contribute to a more comprehensive comprehension of pharmaceutical waste management. The study intends to facilitate the creation of efficient strategies and policies that benefit both the local population and the environment by considering these elements.

Effective management of pharmaceutical waste is crucial in order to minimise the health hazards associated with exposure to expired, unused, or dangerous pharmaceuticals. Implementing efficient waste management strategies can effectively mitigate the risks of drug usage, unintentional poisoning, and negative health consequences within the community. Implementing proper disposal protocols minimises the likelihood of environmental pollution and potential danger to both patients and the general population. The study highlights the significance of appropriate waste disposal among pharmacy workers, medicine shop proprietors, and the community by examining pharmaceutical waste management practices. The acquired knowledge can assist pharmacies and pharmaceutical stores in Bamenda Health District in enhancing their waste management methods, resulting in enhanced healthcare service delivery as a whole.

In addition, the appropriate disposal and management of pharmaceutical waste effectively avoid the pollution of land, water, and air. This work has the potential to reduce the environmental harm caused by medications, hence aiding in the protection of local ecosystems. The study advocates for the identification and promotion of efficient waste management strategies in order to enhance environmental sustainability and minimise the ecological impact of healthcare activities.

Moreover, the study will aid in evaluating the extent to which present methods conform to local, national, and international standards pertaining to the management of pharmaceutical waste. Ensuring adherence to regulations is crucial for preventing legal complications and upholding the operational integrity of pharmacies and medication stores. The study's findings can be used to shape the creation or modification of policies and recommendations that effectively tackle the requirements and difficulties in managing pharmaceutical waste.

In addition, the study will determine deficiencies in knowledge and training among pharmacy workers and medicine store proprietors. This information is vital for the development of focused training programs aimed at improving their comprehension and use of optimal waste management techniques. The study establishes a foundation for enhancing the efficiency of waste management by documenting existing practices and difficulties, so enabling improvements in operational procedures, resource distribution, and infrastructure.

Furthermore, this study will provide useful data to the current corpus of research on the management of pharmaceutical waste, specifically in the context of pharmacies and medicine stores in Cameroon. The findings can provide valuable insights for future research endeavors and aid in addressing rising concerns pertaining to the management of pharmaceutical waste in comparable contexts.

1.7 Scope of the study

Broadly, this study focus is to critically assess pharmaceutical waste management practices in pharmacies and medicine stores in Cameroon. Specifically, this study seeks to evaluate Current Pharmaceutical Waste Management Practices in pharmacies and medicine stores in Cameroon and determine the level of knowledge among pharmacy staff and medicine store operators regarding pharmaceutical waste management regulations, guidelines, and best practices in Cameroon. 

Further, this study will focus on identifying the challenges faced by pharmacies and medicine stores in implementing effective pharmaceutical waste management practices in Cameroon and it also seeks to provide recommendations for enhancing pharmaceutical waste management practices in Cameroon.

 The study is carried out in Bamenda Health Daistrict, Cameroon. 

1.8 Limitations of the study

During the examination, the researchers observed numerous minor limitations, which are typical in any human attempt. The primary constraint was the paucity of comprehensive literature on the subject, stemming from the dearth of data on assessment of pharmaceutical waste management practices in pharmacies and medicine stores: evidence from Bamenda health district, Cameroon. Consequently, a substantial investment of time and effort was required to ascertain the suitable materials, books, or information and collect data. 

Moreover, this study is limited by its limited sample size and restricted geographic coverage, concentrating exclusively on Bamenda Health Daistrict, Cameroon. Hence, the ability to generalise the results of this study to a wider scope is limited, emphasising the necessity for more research. 

Furthermore, the researcher's shortcomings were predominantly attributed to financial restraints, as they are a student who lacks the necessary financial resources to support themselves. The excessively high transportation fees at the study site presented a difficulty in fulfilling the financial responsibilities associated with transportation costs.

In addition, the researcher encountered a time limitation as a result of the necessity to do this research while concurrently meeting the responsibilities of attending lectures and engaging in other educational endeavors.

1.9 Definition of terms

Pharmaceutical waste: Pharmaceutical waste is defined as an expired or unused/leftover medication that can be classified as non-hazardous or hazardous, depending on its chemical properties. Such a determination also depends on its potential to risk human health or the environment.

Waste management: Waste management refers to the process of managing, treating, and disposing of waste in a safe and environmentally responsible manner. The goal of waste treatment is to reduce the harm caused by waste to human health and the environment.