“A Clear and Present Danger . . . .”

1. Household Drug-Storing Practices Among Community Residents In Paknaan, Mandaue City, Philippines, 2010 “A Clear and Present Danger . . . .”

2. Background • *Global increase in drug consumption • *In 1998, Philippines ranked second to Singapore in terms of per capita drug consumption • *Drug prices are 600% more expensive • Unrestricted drug availability and use: • Inappropriate drug use • Drug resistance • Drug-drug interactions • Waste of resources • Inappropriate disposal of expired medications • * Valera, M. Experiences with Insurance Coverage of Medicines in the Philippines: Philippine Health Insurance Coverage. WHO, 2005.

3. Research Question • What is the epidemiology (prevalence, nature and determinants) of the practice of household drug-storing among the residents in Paknaan, Mandaue City, Philippines? • Household storage refers to the practice of keeping drugs at home

4. Methodology • Study Design: AnalyticalCross Sectional Survey • Study Setting: Paknaan, Mandaue City, Philippines, April-July 2010 • Study Population: Caregivers, household heads or any adult family member of household units • Sampling Procedure: Proportionate sampling • Sample Size: 80% of the total number of households within each zone

5. Methodology • Maneuvers: - house-to-house survey - structured data collection form - questionnaire - focus group discussion – for questionnaire development and validation of responses in filled questionnaire • Data Analysis: - Data were entered with Microsoft Excel Spread sheet and analyzed with SPSS ver. 16.0 - P value < 0.05 defined statistical significance

6. Results • A total of 1,209 household units (80% of total households in community) • Respondent characteristics: • Median age: 34 years (IQR: 26 – 44) • Majority of respondents were females (77.3%) • Educational attainment: 52.9% High School • Only 21.9% were employed • Household medication storage was high (81%) • More prevalent in households with a family member with chronic illness - HPN, arthritis • Medications stored in non-child proof containers

7. Results • Most commonly stored drugs: symptom relief, vitamins, antibiotics, anti-hypertensive agents • Stored expired drugs: 433 (44.2%) • Stored medicines without expiry dates: 306 (31.3%) • Stored unlabelled medications: 126 (12.9%) • High prevalence of OTC drug purchases (86.1%) • Non-compliance from a prescription (29.5%) • Mostly stored in dining room/ kitchen (53.7%) • Most commonly thrown in garbage bin in original formulation (86.5%)

8. Results

9. Why do you store medicines at home? - “Intended for future use, in case of emergency” - “Left over from previous prescription” - “For remedy of common illness” - “To avoid consulting physicians to save money” - “Maintenance medications” Why do you keep in kitchen/ dining room? - “Most doses are taken with meals” Why do you store or give expired medications to others? - “Still effective” Why do you throw expired medications in the garbage? - “Don’t know any other method of disposal”

10. Conclusion • Prevalence of household drug storage was high at 81% • Most commonly stored drugs were symptom relievers, vitamins, antibiotics and antihypertensive medications • Practice of household drug storage was significantly associated with presence of family member with chronic disease and level of educational attainment • Drug storage patterns and disposal increase risk of harm to family members and community

11. Implications & Recommendations • Patient education regarding indications and potential adverse effects of prescribed drugs • Caution patients against medication-sharing: symptoms may be similar for many diseases of varying etiology • Restrict and monitor Over-The-Counter (OTC) antimicrobial drug sales and drug dispensing • Warn against potential for toxicity in children due to improper storage of medications at home • Monitor drug advertisements in media • Implement community drug-disposal program

12. Daghan Salamat