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

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

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

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

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

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

Characteristic Home Medication Storage Practice Status P Value PositiveNegative Age (Yrs.) 34 (IQR: 25-44) 34 (IQR: ) 0.33 Gender (%) 0.14 Males Males Females Females Employment Status (%) 0.33 Employed Employed Unemployed Unemployed Illness in the Family (%) < With chronic illness With chronic illness Without chronic illness Without chronic illness Educational Attainment 0.05 Vocational (%) Vocational (%) College (%) College (%) Results

Why do you store medicines at home? - “Intended for future use, in case of emergency” - “Left over from previous prescription” - “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” - “Still effective” Why do you throw expired medications in the garbage? - “Don’t know any other method of disposal” - “Don’t know any other method of disposal”

Conclusion Prevalence of household drug storage was high at 81%Prevalence of household drug storage was high at 81% Most commonly stored drugs were symptom relievers, vitamins, antibiotics and antihypertensive medicationsMost 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 attainmentPractice 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 communityDrug storage patterns and disposal increase risk of harm to family members and community

Patient education regarding indications and potential adverse effects of prescribed drugsPatient education regarding indications and potential adverse effects of prescribed drugs Caution patients against medication-sharing: symptoms may be similar for many diseases of varying etiologyCaution 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 dispensingRestrict 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 homeWarn against potential for toxicity in children due to improper storage of medications at home Monitor drug advertisements in mediaMonitor drug advertisements in media Implement community drug-disposal programImplement community drug-disposal program Implications & Recommendations