|Year : 2020 | Volume
| Issue : 2 | Page : 114-121
In-homes' medicines storage, use, and beliefs: Saudi study
Ahmed Salah Eldalo1, Mirghani A Yousif2, Abrar A Alotaibi3, Afnan A Alghamdi3, Wejdan S Alzaidi3
1 Department of Clinical Pharmacy, College of Medicine and Health Sciences, University of Palestine, Gaza, Palestine
2 Department of Clinical Pharmacy, Faculty of Pharmacy, University of Gezira, Wad Madani, Sudan
3 Department of Clinical Pharmacy, College of Pharmacy, Taif University, Taif, Saudi Arabia
|Date of Submission||09-Oct-2019|
|Date of Decision||27-Jun-2020|
|Date of Acceptance||22-Jul-2020|
|Date of Web Publication||19-Aug-2020|
Ahmed Salah Eldalo
Department of Clinical Pharmacy, College of Medicine and Health Sciences, University of Palestine, Gaza, Palestine
Source of Support: None, Conflict of Interest: None
Background: In-home medication storage and use in Saudi Arabia seem to be common by consuming medicines that liberally dispensed in community pharmacies as well as freely taken without medical advice at homes level. Objective: The prime objective of this study was to investigate the prevalence of stored medicines especially antibiotics, the storage status of medicines in home and community general perception on medicines' storage and use at the level of Saudi homes. Methodology: A study was carried out in different areas in a Western Region, Saudi Arabia, using a pretested questionnaire on one thousands of randomly selected participants. Data were computed and analyzed using (IBM SPSS) Program (version 22). The association between variables was tested; P ≤ 0.05 was taken as a statistically significant cut measure. Results: The response rate was (97.6%). Females were dominant (82.8%). Almost (99.7%) of the investigated families had at least one drug product stored at homes, (66.1%) of the stored medicines were kept for future use and (19.7%) of participants used to take the medicines without any consultation. Penicillin and cephalosporin were the most commonly store antibiotics. The study revealed poor compliance (49.7%), half of the participants (50.5%) admitted they used to recommend medicines' use for treatment of the same symptoms to others, (16.1%) used to buy medicines that were suggested by friends and (33.46%) of participants stored antibiotics without prescription. Conclusion: In Saudi Arabia, there is still a great need to emphasize on rational use of drugs to safeguard population health and to avoid economic losses by relying on using medicines on professional advice.
Keywords: Antibiotics, in-home storage, medicines, Saudi Arabia
|How to cite this article:|
Eldalo AS, Yousif MA, Alotaibi AA, Alghamdi AA, Alzaidi WS. In-homes' medicines storage, use, and beliefs: Saudi study. Saudi J Health Sci 2020;9:114-21
| Introduction|| |
Self-medication is a global concern, widely spread in all countries. In Saudi Arabia, this pattern of use seems to be a common by consuming medicines that liberally dispensed in community pharmacies as well as freely taken without medical consultation at in-homes' stored levels. The remaining medicines usually stored in-home. In-home medication' storage means where the medicines located at home, such as in drug cabinets, bed rooms, refrigerators, and others. Appropriate in-home medications' storage include instruction of optimal methods of storing drugs aiming to increase community awareness about the information of safe storage conditions. Appropriate household storage and use of medications are essential for minimizing drug wastage and unnecessary risk, maintain the stability, insure the safety, optimum efficacy of drug products, and prevent accidental injury. People may utilize any class and dose of in-home medications for treating themselves, without consultation which may lead to adverse drug reactions or drug toxicity. In addition, the use of such medicines that had been kept beyond their expiry.
Some locations at home are not suitable for medicines' storage, for example, keeping drugs in bathrooms expose them to moisture and heat that accelerate their degradation, expiration, and loss of potency and efficacy of drug. One of the drawbacks of in-home medicines' storage is the fact that families and friends tend to share or exchange medicines without complete information about safe storage, storage condition, and other relevant information.
Several studies conducted around the world about self-medication and in-home uses and storage of medicines. A study conducted in Taif, Saudi Arabia, revealed that (80.6%) self-medicated medicines were antibiotics. In Sudan, more than half (55%) of the families repeated using of incomplete stored medicines and about (60%) share medicines among them. A study conducted in the United Arab Emirate (UAE) found that families stored (16-20) medicines at households and the percentage of medicines storage in bedroom and kitchen were 39% and 42%, respectively. In Palestine, 43.4% of medicines were used to be kept in unsafe places that being easily accessible to children. Another UAE study revealed an increased repeated pattern of self-medication. In Iraq, antibiotics were irrationally promoted and used in upper respiratory infections and diarrhea.
Physicians and pharmacists play a major role in counseling and educating the patients about medication use to encourage more rational use and proper storage of medicines. Therefore, all academic institutions should focus their attention on educating the future health-care professionals to be prepared for effective patients' communications and consultations' skills.
This study was initiated by the hypothesis that there is possible liberal misuse of the stored medicines at homes in Saudi community. Authors attributed this pattern of use to the national wide provision of easy accessible health services and free distribution of medicines. This was accompanied with the shortage of knowledge in medicine' use. The prime objective of this study was to determine the prevalence of stored medicines especially antibiotics at homes, the storage status, and community general perceptions on medicines' storage and use at the level of Saudi homes.
| Materials and Methods|| |
Study area and population
This study was conducted in the western part of the Kingdom of Saudi Arabia (Jeddah, Makkah, and Taif). The population of this study was randomly selected from the assigned area.
A cross-sectional study based on self-administered pretested survey was carried out over 1 year from April 2016 to April 2017.
Inclusion and exclusion criteria
Only participants who gave consent to complete the survey were included. Illiterate participants and those who were not able to complete or refused to complete the questionnaire were excluded.
Sampling method and sample size
A proportionate, random sampling method was used to generate suitable sample size. The current study was carried out on 1000 families to investigate the prevalence of stored medicines especially antibiotics, alongside with the storage status and community general perception on medicines' storage and use at Saudi homes levels.
An inclusive questionnaire was used to elicit the general opinions of the use and storage of medicines in home on different assigned variables and to best address the study's objectives. The questionnaire consisted of four parts with 35 questions. The first part constituted of eight questions on demographic information (gender, number of family members, place of residence, academic status, and employment). The second part, 13 questions related to a health state and the patterns of stored medicines and its uses (family members suffering from chronic diseases, source of information about medication, and suggesting medicines to others). The third part composed of seven questions about home storage/disposal and use of medicine. The fourth part constituted of six questions on antibiotics usage and the last part of questions contain a table filled with the names of the of stored medicines, their dosage form, places of the stored medicines in the homes, the reasons of medicines' storage, and their expiration dates. Questions included closed-ended (yes/no, single choice, and multiple choice), and open-ended questions. The questionnaire was pretested on suitable number of homes (20 homes) to ensure validity. The pilot outcomes results were not included in the study results.
The present study was approved by the Medical Ethical Committee at the College of Pharmacy, Taif University. Verbal consent was obtained from each participant before his/her participation in the study.
Data were computed and analyzed using IBM SPSS, version 22, Armonk, NY: IBM Corp. Means, frequencies and percentages were determined. The association between variables was tested by Chi-square. The level of P ≤ 0.05 was considered as a cut-off point for significance.
| Results|| |
A total of 1000 participants were randomly selected representing the head of family. The response rate was 951 (95.1%). Females were dominant 784 (82.8%), the mean number per family was seven (7.00 ± 2.794). Most of the participants 608 (65.0%) had a university degree, 500 (53.9%) were employees while only 159 (17.1%) were belonged to medical field professional. A total of 264 (28.0%) of family had a member in the medical field [Table 1].
[Table 2] shows that, a total of 304 (32.0%) participants had family members suffering from chronic diseases, 109 families (16.7%) have members suffering from hypertension, 199 (20.9%) diabetes and 61 (6.4%) thyroid disorders. Six hundred and fifty-five (69.0%) of respondents used to obtain information about medications from physicians, while 417 (43.9%) from pharmacists and 335 (35.3%) from medications packet inserts as source of information. The liberal use of medicines based on a prior use of relatives or friends was a common practice among the Saudi community. The current study revealed that half of the participants 475 (50.5%) admitted they used to recommend medicines' use for the treatment of the same symptoms to others, and 152 (16.1%) used to buy medicines that were suggested by friends. The present study had shown a poor adherence to physician's instructions; only 470 (49.7%) of respondents used to follow the given instructions. Approximately, quarter of participants 238 (25.2%) used to stop taking medications based on personal judgment of better feeling. One of the main drawbacks of using in-home stored medicines without medical consultation is the potential possibility of repeated use of expired medicines. Fortunately, the majority of the respondents 591 (62.5%) used to check the expiry date prior to self-medication by stored medicines. Although 501 (53.9%) of the participants used to consult physicians before using in home-stored medicines, while 183 (19.7%) used to take the medicines without any consultation.
Home storage/disposal of medicines
The in-home storage places have shown a remarkable impact on the stability of the stored medicines and hence on their efficacy. The majority of the participants used to rationally store their medicines at homes 509 (54.4%). While 225 (24.1%) tend to use irrational patterns of storing their medicines in kitchens, toilets, and others [Table 3]. The majority of the stored medicines 606 (66.1%) were kept for future use while the rest 311 (33.9%) of stored medicines were for the current use.
The knowledge of medicine's labels is very important for identification to prevent medicines mix up. In the current study, the majority of respondents 791 (84.0%) used to keep labeled stored medicines in their original packets. Approximately, half of the stored medicines 470 (49.7%) were kept with clear use instruction while 384 (40.6%) were with partly instructed information [Table 3]. Approximately one-third of respondents 296 (31.4%) used to get rid of the remaining used medicines. Proper disposal of medicines is an essential part of safe environment measure. Special type of incineration should be adopted for medical materials disposal in general. Unfortunately, the majority of respondents 703 (74.3%) used to dump the remaining of used medicine in the homes recycle bins [Table 3].
The current study revealed that, the total amount of in-home stored medicines were found to be 7362 with a mean (9.8 ± 11.79), about 939 (99.7%) of the investigated families had at least one medicine stored at homes. Most of the stored medicines were antihypertensive, hypoglycemic, and thyroid agents 1317 (17.88%), 1258 (17.08%), and 846 (11.49%), respectively, while vitamins and minerals were the least stored ones [Figure 1].
In-home stored antibiotics
Self-medication with leftover antibiotics is widespread in countries where drugs are sold without prescriptions, and this misuse of antibiotics could be a significant cause of antibiotic resistance. The present study had shown that 824 (11.19%) of stored medicines were antibiotics. The results also showed that 276 (33.46%) of them were self-prescribed. Hence, only 278 (33.73%) of antibiotics were for the current use, while approximately half of them 375 (45.50%) were leftovers and 171 (20.75%) were kept to be used on need. The beta lactam antibiotics were dominant 365 (44.33%). Penicillins 220 (26.72%) were the most commonly encountered antimicrobials followed by metronidazole 167 (20.32%), cephalosporins 145 (17.61%), macrolides 110 (13.36%), and tetracycline 74 (9.02%). Many other antibiotics were also stored by Saudi families, but with lower rate such as aminoglycoside 67 (8.21%), quinolones 24 (2.95%) and antifungal 14 (1.81%) [Figure 2].
Participants in the current study reported the reasons that drove them to buy antibiotics without prescription were to treat sore throat 538 (63.2%), common cold 475 (55.8%), dental infections 360 (42.3%), fever 310 (36.4%), gastrointestinal tract infections 79 (9.3%), dermatitis 63 (7.4%), and urinary tract infection 43 (5.1%) [Figure 3].
Education level of the family health care supervisor is the most powerful reason to deal wisely with medication in homes. When duration of use of the medicines was correlated with education level; illiterate people 6 (35.3%) and intermediately educated 35 (47.9%) respondents had the highest rate of poor compliance and used to stop taking medications based on personal judgment of better feeling, while university educated respondents had the lowest rate, (P = 0. 032) [Table 4]. There was a significant relationship between education level and checking the expiry date, (P = 0. 001). University educated respondents who were always checking the expiry date were 407 (67.3%) while illiterate persons who always checking the expiry date only 6 (35.3%). On the other hand, illiterates showed the highest rate of keeping medicines at cars 3 (17.6%), while university degree respondents were having the lowest rate 71 (11.8%).
|Table 4: Education level of the family health-care supervisor versus health situation|
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[Table 5] presents the relationship between levels of education for families health care supervisors and storage patterns. When correlating the level of education to places of medicine's storage in the homes, the study revealed that the highest rate of storage places were in special boxes for university graduated 351 (58.5%), followed by illiterate respondents 6 (46.2%) and intermediate graduated 32 (43.8%), (P = 0.020). There was no statistically significant association when education level was compared with situation of storage medicines (P = 0.574). When level of education was correlated to knowledge of family health-care supervisor about the use of stored medicines, participants with university degree had the best knowledge about stored medicines' uses 391 (64.5%), followed by illiterate respondents 6 (35.3%) and intermediately educated ones 25 (33.8%), (P < 0.001). As for the relationship between the level of education and the reason of medicines storage, there was no significant difference [Table 6].
|Table 5: Education level of the family health-care supervisor versus storage|
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|Table 6: Family health-care supervisor working in medical field and families of members working in medical field versus antibiotics use|
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| Discussion|| |
The current study revealed female dominance (82.8%) this was in contrast with the Iranian study which reported that male were dominance (53.8%). Authors were attributed this difference to the fact that the principle investigators were females, and due to some logistical and cultural reasons that dictated this type of participants. Inclusion of large number of females is one of the study limitations. With regard to level of education the current study showed less rate of illiterate participants (1.8%) when compared with Palestinian study (57.6%). The authors attributed this difference to the fact that most of the participants in the Saudi study were from urban areas (86.9%). On the other hand, participants in Palestinian study nearly half of them were from rural population who lived in village or suburbs (54.2%).
The total number of home-stored medicines was 7362 items, with a mean of (9.8) per home. This number was higher than Sudanese study (4.4), and lower than the Palestinian one (13.3). This discrepancy between countries may be due to some variations such as chronic disease prevalence; such as diabetes mellitus, hypertension, and impact of the health sector on community education about medication and irrational use. No significant difference was found when comparing the respondents who did not keep medicines at home in the current study (1.3%) with that of the Emirati one (0.7%). This may be due to the same culture, attitude, and medicines use regulation.
The findings showed that (6.4%) of the respondents were sharing medicines with relatives while in Sudanese study reported (59.3%) exchanged of medicines among others. This may be due to difference in societal values or purchasing capacities measures. In addition, the habit of buying suggested medicines by relatives, and friends was reported by (16.1%) of the respondents, while those who recommended medicines to other were reported as (50.5%) and therefore the problem of irrational use of medicines warrant more efforts to educate public and health professionals to avoid the complication of wrong utilization of medicines.
The results revealed that (80.3%) of participants used medicines according to physicians' and pharmacists' consultations which was approximately similar to that reported by Palestinian study (75%).
The obtained results can be used to estimate the compliance with medicines. In the current study, only (49.7%) used medicines according to physician's or pharmacist's consultation which is lower than the rate reported in Sudanese study which showed (71.2%) compliance with regimen. The present study reported that (62.5%) of participants used to check expiry date before the use of the stored medicines. This may be due to the fact that the majority of participants (65.0%) were university graduates.
In this study, (54.4%) rationally stored medicines in special boxes; in the Sudanese study was estimated the appropriateness of the storage condition of medication and report suitable storage conditions was (51.2%).
In the present study, (24.1%) of respondents were stored medicines in the kitchen and that may expose medicines to high humidity and temperatures and (0.4%) of respondents were stored medicines in the bathroom. This pattern of storage is not advisable due to high humidity and temperatures that accelerate medication' destruction. The current study showed that (12.6%) of participants used to keep medicines in the car that may expose medicines to instability earlier than the expiry date because of the sensitivity of most medicines to sunlight and heat. Out of the investigated respondents, 66.1% stored medicines for future use. This higher rate of storage may lead to easily accessibility to medicines even when not needed. Various methods of medicines disposal pattern were observed in the current study, most of the participants (74.3%) used to throw medicines as it is in the waste similar to that reported from Emirates (84.0%).
Hypertension, diabetes, and thyroid gland disorders were the most common diseases observed in this study. The stored medicines were forming the same occurrence pattern of diseases prevalence; this was shown by the fact that, most of stored medications were antihypertensive, hypoglycemic and thyroid agents (17.88%), (17.08%), and (11.49%), respectively. Regarding percentage and types of stored drug, this was found dissimilar to that reported from the Palestinian study which showed that most stored medications were from alimentary tract medications (18.53%), musculoskeletal (14.2%), and respiratory categories (13.6%).
The self-medication with antibiotics in this study was mainly to treat sore throat (63.2%) and common cold (55.8%), this was similar to that reported from Kuwait, common cold (54.5%) and sore throat (41.2%).
From all classes of antimicrobials that were used for self-medication; penicillins were the most commonly used (26.72%) followed by metronidazole (20.32%), cephalosporins (17.61%), macrolides (13.36%), and tetracycline (9.02%). Compared to Iraqi study, penicillins (24%) were the most commonly encountered antimicrobial drugs followed by cephalosporins (17%), co-trimoxazole (14%), erythromycins (10%), and aminoglycosides (8%). Also in Europe, penicillins were the most commonly used antibiotics, representing percentage of (54%). Self-medication with leftover antibiotics is widespread in countries where drugs are sold without prescriptions, and this misuse of antibiotics could be a significant cause of antibiotic resistance. In Makkah Province, Saudi study was conducted to measure community pharmacists' practices toward dispensing antibiotics without prescription, this study found that more than two-thirds (70.5%) of the pharmacists were not aware with illegality of such practice.
The present study had shown (11.19%) of stored medicines were antibiotics. The results also showed that (33.46%) of them were self-prescribed. Only (33.73%) of antibiotics were for current use, while approximately half of them (45.50%) were leftovers and (20.75%) were kept for future use. In the current study, the findings regarding antibiotics' storage reasons were similar to that reported from Iraq, 26.96% of antibiotics were for the current use, while half of them (50.57%) were leftovers and (22.45%) were kept for future use. Education level of the family health care supervisor considered as the most powerful reason to deal wisely with medications. This was confirmed by the obtained results in the current study. There was a significant relationship between education level and checking the expiry date, (P = 0. 001). University educated respondents who always checking the expiry date were (67.3%) while illiterate persons who always checking the expiry date only (35.3%). On the other hand, illiterates showed the highest rate of keeping medicines in the car (17.6%), intermediate educated participants (15.3%) and university degree were the lowest rate (11.8%). Researchers admitted the remarkable influence of the education on the rational use and storage of medicines at homes. Thus, public education efforts were recommended.
| Conclusion|| |
In Saudi Arabia, there is still a great need to emphasize on rational usage of drugs to safeguard community their health and to avoid economic losses by relying on using medicines on professional advice. The results of this study confirmed that in-homes use of self-medication antibiotics was prevalent among the studied population. Educational and managerial interventions are required to reduce the frequency of antibiotics misuse. The educational interventions for health personnel (e.g., flow charts, newsletters, bulletins, etc.,) and patients (e.g., educational programs in the form of pictures, videos, brochures, and lectures) are very important and should be considered a priority. Managerial interventions could include updating and developing strict policies and legislations to prohibit the supply of drugs without prescription.
The authors highly appreciated and fully thank all the families who accepted to participate in this study.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 2], [Figure 1], [Figure 3]
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]