Teni et al.

BMC Public Health (2017) 17:238

DOI 10.1186/s12889-017-4152-8

RESEARCH ARTICLE Open Access

A household survey of medicine storage

practices in Gondar town, northwestern
Ethiopia
Fitsum Sebsibe Teni1*, Abdrrahman Shemsu Surur2, Assefa Belay3, Dawit Wondimsigegn4,
Dessalegn Asmelashe Gelayee3, Zewdneh Shewamene3, Befikadu Legesse5 and Eshetie Melese Birru3

Abstract
Background: Household surveys are crucial to get accurate information on how medicines are acquired, and used by
consumers, as they provide the best evidence in the area. The objective of this study was to document household
medicine storage practices in Gondar town, northwestern Ethiopia.
Methods: A cross-sectional household survey was conducted from April 5 to May 6, 2015. In the study, 809 households
were surveyed from four sub-cities in the town selected through multistage sampling with 771 included in the final
analysis. Data on the extent of storage, storage conditions, sources of medicines and their current status among others
were collected through structured interviews and observations. The data were entered in to Epidata version 3.1, exported
to and analyzed using Statistical Packages for Social Sciences (SPSS) version 21.
Results: Of the 771 households in the study, 44.2% stored medicines. Presence of family members with chronic illness(es)
and higher levels of household incomes predicted higher likelihood of medicine storage. In the households which
allowed observation of stored medicines (n = 299), a mean of 1.85 [SD = 1.09] medicines per household were found. By
category, anti-infectives for systemic use (23.9%), medicines for alimentary tract and metabolism (19.2%) and those for
cardiovascular system (17.7%) ranked top. Among individual medicines stored, diclofenac (10.7%), paracetamol (9.9%) and
amoxicillin (8.0%) were on top of the list. Dispensaries (97.8%) and physicians (83.5%) were almost exclusive sources of
medicines and advices/orders for medicines respectively. Nearly two-thirds of the medicines found were on use and a
vast majority (76.5%) were stored in chests of drawers. Proportion of expired medicines was very low (3.14%).
Conclusions: The use of physicians’ and pharmacists’ advice to get medicines; use of dispensaries as principal sources,
large proportion of medicines being in use and very low proportion of expiry showed good practices. However, storage
places of medicines were not purpose built. Encouraging good practices through continued medicine use education and
advocating appropriate medicine storage in medicine cabinets is required to improve storage conditions and consequent
use of medicines.

Background individual consumers constitute a major proportion of the

Medicines found in households are commonly sourced spending, mostly for self-medication and rarely on pre-
from health institution dispensaries through prescriptions scriptions. Getting a good understanding of the individual
or from pharmacies with or without prescriptions. These consumer choices and decisions is crucial for intervention
medicines could be in use for current illnesses or in ensuring efficient resource use. This is important as out
remaining from past use [1]. Expenditure on medicines of pocket spending by individuals is an important compo-
takes up from nearly a third to two-fifth of health care nent of expenditures on medicine [2, 3].
spending in developing countries. Purchases made by While indicators of access to medicines are most com-
monly taken from health facilities and medicine retail
* Correspondence: [email protected] outlets, there is little information from consumers. Al-
1
Department of Pharmaceutics and Social Pharmacy, School of Pharmacy,
College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
though data obtained through indicators measured at
Full list of author information is available at the end of the article health institution levels are vital, household surveys are
© The Author(s). 2017 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0
International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and
reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to
the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver
(http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Teni et al. BMC Public Health (2017) 17:238 Page 2 of 9

crucial to get accurate information on how medicines number of medicines retail outlets in Gondar town 2014,
are acquired and used by consumers. Such studies are unpublished), (Amhara Regional Health Bureau. Health
important as they are the best sources of evidence in the Management Information System (HMIS) Implementa-
area [1, 4]. tion at private facilities: advocacy 2013, unpublished).
The extent, source and storage conditions of medi-
cines kept at household level provide crucial information Sampling
on access and medicine use. Globally studies on house- The number of households included in the study was
hold use and storage of medicines have been conducted determined using a single population proportion for-
in different countries. In many of the studies significant mula; assuming the proportion (p) of households with at
proportions of households stored medicines in some least one medicine at the time of data collection to be
cases with all of them keeping medicines [5–18]. In the 50%, for maximum possible sample. The margin of error
same and other studies, considerable levels of unused (δ) was taken to be 5% and the z1 − ∝ at 95% confidence
and expired medicines kept at households were reported interval (CI) was set at 1.96. Based on this the
[19–25]. These medicines were stored at home report- sample size was calculated using the formula:
edly due to patient deaths, recovery from disease, expiry h 2
i
N ¼ ðz1−∝ Þ δp
2
ð1−pÞ
[31]. After taking in to account a
as well as changes in medicine [26].
In Ethiopia, so far, few studies were conducted at house- contingency of 5% and a design effect of 2, the final sam-
hold level to document use and storage practice of medi- ple size was calculated to be 809 households.
cines. The findings showed the proportion of households A multistage sampling procedure was followed in sam-
which stored medicines ranged from one-fifth to more pling the households. In the first stage four sub-cities
than one-half in different parts of the country [27–29]. which accounted for one-third of the sub-cities in the
Apart from these, medicine storage practices at household town were selected by simple random sampling. Then
level remain unstudied. Evidence on extent and condition the calculated number of households was equally divided
of storage of medicines is crucial to inform actions toward into the four kebeles. In the second stage, from the se-
ensuring rational use. So, the objective of this study was to lected sub-cities households were sampled by random
document household medicine storage practices among selection from the list of households.
households in Gondar town in northwestern Ethiopia. It
involved comprehensive assessment of the extent of stor- Data collection instrument, process and management
age, source, types, duration, use status as well as expiry An instrument composed of a structured interviewer-
status of the stored medicines. administered questionnaire and a structured observation
checklist was used for data collection. It was developed
Methods by adapting tools used in previous studies and guidelines
Study area and design [2, 12]. The adaptation involved including parts/ques-
In this study, a household survey on medicine storage tions of the instruments which were relevant to answer
practice among residents of Gondar Town in northwest- the objectives of this study. It was first prepared in Eng-
ern Ethiopia, was conducted. The town is located about lish and translated in to Amharic, a language spoken in
750 km away from the capital Addis Ababa, and was the study area, and then back translated into English to
home to 224,000 population in 2014/15 according to make sure it retained the intended meaning. The data
Central Statistical Agency of Ethiopia (CSA) [30]. The collection tool is provided as a supplementary file to this
administrative division of the town includes a total of 24 manuscript [Additional file 1].
‘kebeles’ (the smallest administrative division), among The instrument contained questions on the socio-
which 12 in the urban areas are classified as sub-cities. demographic profile of the respondents and their house-
The other 11 ‘kebeles’ and one special ‘kebele’ make up holds, the overall health situation in the household, and
the rural areas of the town. The present study was specifics of medicines stored. These included current use
undertaken in the urban areas of the town (Gondar status of the medicine(s), illnesses the medicine(s) were
Town Administration. Administrative classification of acquired for, prescription status and source. The struc-
kebeles in Gondar town. 2014, unpublished). tured obsevation focused on the name, packaging, storage
The town has various public and privately owned conditions and others. The instrument was pretested on
health institutions. The public ones include a specialized 50 respondents prior to the actual data collection, which
referral university hospital and a number of health cen- were excluded from the final analysis, and pertinent modi-
ters. There are also nearly 50 clinics and one hospital in fications were instituted based on the finding.
the private sector. More than 50 medicine retail outlets Data were collected from April 5 to May 6, 2015 by
are also found concentrated in the urban areas of the four data collectors, with a diploma level of qualification
town (Gondar Town Health Bureau. Report on the in pharmacy, after a thorough one day training. The
Teni et al. BMC Public Health (2017) 17:238 Page 3 of 9

training focused on the data collection instruments and Table 1 Socio-demographic characteristics of respondents and
the appropriate approaches required in interacting with their households, Gondar Town, 2015
and securing consent of respondents. Variable Frequency (%)
Respondents approached in the study were adults Sex Male 183 (23.7)
available in the selected households during data collec- Female 588 (76.3)
tion. Whenever more than one willing adults were
Age (years) 18–29 315 (40.9)
found, priority was given to the one deemed more in-
30–39 177 (23.0)
formed on the health related issues of the household. In
case of unavailability of eligible respondents a second 40–49 127 (16.5)
visit was made. If this failed, the household next to it 50–59 68 (8.8)
was included in the survey instead. 60+ 84 (10.9)
Religion Orthodox Christianity 565 (73.3)
Data entry, analysis and interpretation
Islam 159 (20.6)
The collected data was coded and entered using Epidata
Protestantism 31 (4.0)
version 3.1 (Epidata Association, Odense, Denmark). It
a
was then exported to and analyzed by using Statistical Others 16 (2.1)
Packages for Social Sciences (SPSS) version 21 (IBM Ethnicity Amhara 696 (90.3)
Corp. IBM SPSS Statistics for Windows, Armonk, NY: Tigre 47 (6.1)
IBM Corp. Released 2012). Data on medicines recorded Othersb 28 (3.6)
from the observation in the households were categorized
Educational status Can’t read or write 162 (21.0)
using the World Health Organization (WHO) Anatom-
Can read and write 87 (11.3)
ical Therapeutic Chemical (ATC) classification system
level one [32]. Descriptive analyses were performed by Primary education 98 (12.7)
frequency and mean, with results presented in tables Secondary education 249 (32.3)
and bar charts. In the analysis of the association between College/university education 175 (22.7)
socio-demographic as well as other related variables and Highest education level Reading and writing 26 (3.4)
medication storage practices, independent samples T in family
Primary education 94 (12.2)
tests, one way analysis of variance (one way ANOVA)
Secondary education 234 (30.4)
and binary logistic regression tests were undertaken. A
p-value cut off point of 0.05 at 95% CI was used to College/university education 417 (54.1)
determine statistical significance of association. Occupation Not working/unemployed 36 (4.7)
Housewife 311 (40.3)
Results Student 49 (6.4)
Socio-demographic profile of respondents and their
Retiree 30 (3.9)
households
Government employee 106 (13.7)
From the 809 households in the study, surveys of the 771
were deemed complete and included in the final analysis Private company employee 95 (12.3)
making the response rate 95.3%. Of the participants of the Merchant 141 (18.3)
study who represented their respective households, up- Farmer 3 (0.4)
wards of three quarters (76.3%) and two-fifths (40.9%) Family’s monthly income Up to 50 164 (21.3)
were female and those in the age group of 18 to 29 years, (USD)
51 to 100 137 (17.8)
respectively. Nearly three-fourths (73.3%) followed Ortho-
101 to 150 110 (14.3)
dox Christianity and almost all (90.3) were Amhara in
their ethnic identity (Table 1). 151 to 200 76 (9.9)
Nearly a third (32.3%) and more than a fifth (22.7%) of 200 to 250 80 (10.4)
the respondents were at secondary and college/univer- >250 56 (7.3)
sity education level, respectively. In the overwhelming Not disclosed 148 (19.2)
majority (84.5%) of the households, the highest level of a
Judaism, Catholicism
education reported was secondary or higher education b
Qimant, Oromo
level. Housewives accounted for the largest proportion
(40.3%) of respondents as to occupational status. In
terms of income, more than one-fifth (21.3%) of the 100 USD (17.8%). Nearly a fifth of the households
households reported monthly earnings of 50 United (19.2%) did not disclose their monthly earnings
States Dollars (USD) followed by those earning 51 to (Table 1).
Teni et al. BMC Public Health (2017) 17:238 Page 4 of 9

Number of medicines stored in the households Table 2 Statistical (independent T) tests assessing difference in
Of the total 771 households included in the analysis, 341 the mean number of medicines stored by household situations,
(44.2%) had kept medicines at home during data collec- Gondar town, 2015 (n = 299)
tion. However, 42 (12.3%) of these households were un- Variable Number of medicines stored
able or unwilling to show the medicines. In the 299 Mean (SD) p-value
households where it was possible to observe medicines Member with chronic
stored, an average of 1.85 [SD = 1.09] medicines per illness
household were found. These were constituted by 93 dif- Yes 2.15 (1.294) <.001*
ferent medicines. Looking at the number of medicines No 1.62 (0.842)
stored, about half (46.5%) of the households stored one Presence of a health
medicine (Fig. 1). professional in the
Based on independent samples T test, a statistically household
significant higher mean number of medicines were Yes 1.84 (0.943) 0.929
stored in households where family members with No 1.85 (1.119)
chronic illnesses (p-value < 0.01) lived. However, pres- *p value < 0.05
ence of a health professional in the household, did not
show such a difference (Table 2).
Monthly income of a family and highest education The medicines observed in the households were report-
levels attained in households did not show a statistically edly acquired for managing different health problems/ill-
significant difference in the number of medicines kept at nesses. These included 39 different illnesses/conditions
home (Table 3). reported by the households with a total frequency of 452.
Of the ten most frequently reported illnesses or conditions
for which medicines were taken and kept in the house-
Types and purposes of medicines stored holds, headache (16.4%), hypertension (13.9%) and diabetes
On the basis of ATC classification, anti infectives for sys- mellitus (10.8%) ranked in the first three (Table 5).
temic use ranked first accounting for nearly a quarter
(23.9%) of the medicines kept at home. These were Storage place, current status and sources of medicines
followed by medicines for alimentary tract and metabol- Of the total 553 medicines stored, more than three quar-
ism (19.2%) and those for cardiovascular system (17.7%) ters (80.8%) were of solid dosage forms. More than half
(Fig. 2). (53.3%) of the medicines were on use by the persons for
Diclofenac, paracetamol and amoxicillin accounted for which they were originally acquired; while about a sixth
the most frequently stored individual medicines with (16.1%) of them were kept with no purpose in the
proportions of 10.7%, 9.9% and 8.0% in that order. Only households (Table 6).
eight among the 93 different medicines kept in the The vast majority (83.5%) of the medicines observed
households made up half (50.5%) of the total 553 medi- were reported to be acquired through physician prescrip-
cines found (Table 4). tions; while nearly a tenth (9.2%) were gained through

Fig. 1 Percentage distribution of households by number of medicines stored (n = 299 households)

Teni et al. BMC Public Health (2017) 17:238 Page 5 of 9

Table 3 Statistical (One-way ANOVA) tests assessing difference Table 4 The most frequently stored medicines in households,
in the mean number of medicines stored by household Gondar town, 2015 (n = 553 medicines)
situations, Gondar town, 2015 (n = 299) Medicine name Frequency (%)
Variable Number of medicines stored Diclofenac 59 (10.7)
Mean (SD) p-value Paracetamol 55 (9.9)
Family’s monthly income (USD) Amoxicillin 44 (8.0)
Up to 50 1.74 (0.953) 0.785 Hydrochlorothiazide 36 (6.5)
51 to 100 1.88 (1.036) Enalapril 25 (4.5)
101 to 150 1.80 (0.808) Metformin 23 (4.2)
151 to 200 1.92 (1.025) Glibenclamide 22 (4.0)
200 to 250 1.76 (0.932) Omeprazole 15 (2.7)
> 250 1.78 (0.751) Insulin 13 (2.4)
Not disclosed 2.11 (1.909) Metronidazole 13 (2.4)
Highest education level in the family Nifedipine 13 (2.4)
Reading and writing 1.60 (1.342) 0.952 Cotrimoxazole 12 (2.2)
Primary education 1.79 (0.918) Ciprofloxacin 10 (1.8)
Secondary education 1.85 (0.969) Doxycycline 8 (1.4)
College/university education 1.86 (1.152) Tetracycline 8 (1.4)

request by individuals taking the medicines or by family = 23 days). Among the total number of medicines, 541
members. As to sources of medicines, government run had their expiry dates recorded on their packaging. Of
health institution dispensaries (health centers and the hos- these, 17 (3.14%) were expired.
pital) (45.4%) and private medicine retail outlets (pharma-
cies and drug stores) (41.2%) were reported to be principal Predictors of medicine storage in the households
sources. The most commonly cited reasons for acquiring Binary logistic regression tests showed that households
medicines from the preferred sources included distance with a family member having chronic illness were nearly
from the source, mentioned by nearly half of the respon- 15 times (Adjusted OR (AOR) = 14.824, 95% CI = 9.072-
dents (43.4%). Chest of drawers in living rooms and bed 24.222) more likely to keep medicines in their house-
rooms were spots of storage of medicines in more than holds compared to those with no such members after
three quarters (76.5%) of the households (Table 6). controlling for other variables. Higher income levels
The medicines found were kept from one to as long as were also associated with increased likelihood of keeping
730 days with a median of 15 days (Inter-quartile range medicines in the households with statistical significance

Fig. 2 Percentage distribution of medicines at level one ATC classes stored in households, Gondar town, 2015 (n = 553 medicines); Legend: A = Alimentary
tract and metabolism, B = Blood and blood forming organs, C = Cardiovascular system, D = Dermatologicals, G = Genitourinary system and sex hormones,
H = Systemic hormonal preparations excluding sex hormones and insulins, J = Antiinfectives for systemic use, M = Musculo-skeletal system, N = Nervous
system, P = Antiparasitic products, insecticides and repellents R = Respiratory system S = Sensory organs V = Various
Teni et al. BMC Public Health (2017) 17:238 Page 6 of 9

Table 5 The ten most frequently reported illnesses/conditions Table 6 Features of medicines stored in households, Gondar
for which medicines were kept in the households, Gondar town, 2015 (n = 553)
Town, 2015 (n = 452 illnesses/conditions) Variable Frequency (%)
Reported illness/condition Frequency (%) Dosage forms Solid 447 (80.8)
Headache 74 (16.4) Semisolid 14 (2.5)
Hypertension 63 (13.9) Liquid 92 (16.6)
Diabetes mellitus 49 (10.8) Current status On use by the person originally 295 (53.3)
Unspecified 29 (6.4) of medicine intended for
Fever 26 (5.8) On use by another person 30 (5.4)
Eye problem 18 (4.0) Kept for future use 139 (25.1)
Tonsilitis 16 (3.5) Kept with no purpose 89 (16.1)
Peptic ulcer disease 15 (3.3) Storage place Drawer 423 (76.5)

Asthma 13 (2.9) Refrigerator 29 (5.2)

Pain 13 (2.9) Table 30 (5.4)

Bag/purse 22 (4.0)
Pockets on cloth 11 (2.0)
in specific income categories compared to households
a
earning up to 50 USD per month (Table 7). Others 38 (6.9)
Source of advice Self-initiated 51 (9.2)
Discussion for medicine
Pharmacist 40 (7.2)
Nearly half of the total households in this study stored Physician 462 (83.5)
medicines which was much lower compared to studies in
Source of medicines Government health institution 251 (45.4)
countries like Indonesia, Iran, Iraq, Oman, Greece and dispensary
USA where 82 to 100% of households did so [9–12, 18, 33].
Private medicine retail outlets 228 (41.2)
This could be attributed to the difference in the economic
Aid organization pharmacy 62 (11.2)
development level between Ethiopia and the compared
b
countries. This in turn could be translated in to difference Others 12 (2.2)
in access to medicines, health insurance schemes as well as Reason for choosing Short distance/proximity 240 (43.4)
difference in the trend of self medication practice. However, source
Quality of services 35 (6.3)
the finding from the current study was higher compared to Urgency to medicines 45 (8.1)
studies from northern Uganda as well as Addis Ababa and
Had follow up at source 82 (14.8)
Tigray in Ethiopia; and was comparable to another study in
Availability of medicines 15 (2.7)
southwestern Ethiopia [8, 27–29].
In terms of likelihood of storing medicines, households Fairness of price 76 (13.7)
with members having chronic illnesses(es) were more Othersc 59 (10.7)
likely to keep medicines compared to those without such a
by window, under mattress, hung in plastic bags
b
individuals. Higher monthly income was also associated private clinic, sent from abroad
c
free of fee services, relationships, agreement with employers
to higher likelihood of medicine storage. Similar findings
have been reported by other studies also [8, 25]. time could be a reason for this. Other variables like, pres-
The mean number of medicines found per household, ence of health professionals, highest education level in the
in the current survey, was much lower compared to household, monthly income of the households did not dif-
findings from Asia and Europe, where medicines ranging fer in a statistically significant manner with the mean
from five to 31 were found stored at home [9, 11, 12, 17, number of medicines stored.
33]. The difference here could similarly be explained by The ATC Level One categories of medicines were con-
the above mentioned differences between Ethiopia and stituted by anti-infectives for systemic use, medicines
the compared countries. Studies from two towns in used for the alimentary tract and metabolism as well as
Ethiopia, however, reported similar number of medicines those used for the cardiovascular system as the top
per household to the present finding [28, 29]. three. Studies in Uganda, Iraq, Oman and Greece re-
Households where member with chronic illness(s) lived ported similar findings [8, 11, 12, 33]. Findings consist-
had higher mean number of medicines compared to those ent with the present study were also found by other
with no members with such conditions, in a statistically studies in Ethiopia [27–29]. Diclofenac, paracetamol and
significant manner. The nature of the diseases which re- amoxicillin ranked top among medicines found, with
quire a number of medicines over an extended period of similar findings reported in other studies [8, 10, 28].
Teni et al. BMC Public Health (2017) 17:238 Page 7 of 9

Table 7 Binary logistic regression test for predictors of presence of medicines in households, Gondar town, 2015 (n = 771)
Variable Medicines in household OR (95% CI) AOR (95% CI)
Yes (%) No (%)
Highest level of education in
the family
Reading and writing 6 (23.1) 20 (76.9) 1 1
Primary education 22 (23.4) 72 (76.6) 1.019 [0.364-2.852] 1.120 [0.343-3.662]
Secondary education 98 (41.9) 136 (58.1) 2.402 [0.930-6.202] 2.582 [0.858-7.771]
*
College/university education 215 (51.6) 202 (48.4) 3.548 [1.397-9.013] 2.542 [0.833-7.756]
Presence of a health professional
in household
Yes 57 (52.8) 51 (47.2) 1.492 [0.992-2.243] 0.853 [0.513-1.418]
No 284 (42.8) 379 (57.2) 1 1
Persons with chronic illness
in household
Yes 150 (86.7) 23 (13.3) 13.897 [8.674-22.266]* 14.824 [9.072-24.222]*
No 191 (31.9) 407 (68.1) 1 1
Household monthly income (USD)
Up to 50 54 (32.9) 110 (67.1) 1 1
*
51–100 63 (46.0) 74 (54.0) 1.734 [1.086-2.769] 1.402 [0.814-2.414]
101–150 59 (53.6) 51 (46.4) 2.357 [1.434-3.872] * 1.813 [1.002-3.278]*
151–200 43 (56.6) 33 (43.4) 2.654 [1.519-4.639] * 2.203 [1.130-4.296]*
*
201–250 45 (56.3) 35 (43.8) 2.619 [1.513-4.534] 1.933 [0.971-3.848]
*
> 250 32 (57.1) 24 (42.9) 2.716 [1.459-5.056] 2.518 [1.215-5.221]*
Not disclosed 45 (30.4) 103 (69.6) 0.890 [0.552-1.436] 0.748 [0.431-1.299]
*
p value < 0.05

Most of the medicines were of solid dosage forms (80%) Virtually all of the medicines found stored in the sur-
as also reported in other studies [8, 29]. veyed households were acquired from pharmacies be
Nearly two-thirds of the medicines kept at home were be- they of public, private or aid organizations ownership.
ing used/taken. This was higher compared to findings in This is an encouraging practice which can help minimize
Uganda (48%), Indonesia and Iraq (31% each), [8, 9, 11]. the risk to patients due to buying medicines of question-
This showed a good practice in relation to household medi- able quality from informal/illegal sources. Similar prac-
cines use in the town as it helps reduce wastage of useful tices were reported by other studies [8, 9, 12].
medicines and risks from unused medicines. Of medicines with recorded expiry date, 3.14% were
Chest of drawers found in living rooms as well as bed- found to be expired which was comparable to a finding
rooms were reported as principal storages in three-quarters by another study in Tigray region of Ethiopia [29]. How-
of the households. However, medicine cabinets dedicated for ever, much higher proportions of expired medicines
medicine storage were not found. Similarly drawers were the were recorded by studies in different countries in the
major storage spots as reported by another study in Ethiopia Middle East [11, 12, 24, 25]. The very low proportion of
[21]. However in Iran and Oman refrigerators were reported expired medicines could be associated to the fact that
as major storage places while a study in New Zealand re- the median duration of storage of medicines was only
ported kitchens as major storage rooms [10, 12, 16]. 15 days which shows medicines were not kept for very
Almost all of the medicines assessed were advised to be long time in most of the households.
acquired by physicians (83.5%) through prescriptions
which was similar to a finding in Oman [12]. This could Limitations
indicate a lower level of self-medication practice among The present study did not include the rural parts of
the households. The finding was very much higher com- Gondar Town. The findings are not representative of the
pared to a study in Iraq which reported only about a third pattern of household medicine storage practice in those
of the medicines were prescribed by physicians [11]. areas.
Teni et al. BMC Public Health (2017) 17:238 Page 8 of 9

Conclusions levels of education/literacy among participants was expected. This was approved
Nearly half of the households stored medicines mostly by the Ethical Review Committee. In the study, the decisions of respondents on
participation and showing data collectors the medicines kept in their households
acquired through physician advise almost entirely from was respected.
dispensaries. Most of medicines kept at home were on Furthermore, the data collection instruments did not have any personal
use and were kept mostly in chests of drawers with no identifiers, instead codes were employed. The data collected in such a
manner were kept strictly confidential and used only for the purpose of the
medicine cabinets in use. A very low proportion of the study. The analysis of the findings from the survey was conducted in
medicines were found to be expired. aggregate.
The good practices should be encouraged through
continued health education at health institutions and Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in
medicine retail outlets. Installing cabinets dedicated for published maps and institutional affiliations.
medicine storage at households should be advocated by
the town’s health bureau to improve storage conditions Author details
1
Department of Pharmaceutics and Social Pharmacy, School of Pharmacy,
of medicines. College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
2
Department of Pharmaceutical Chemistry, School of Pharmacy, College of
Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
Additional file 3
Department of Pharmacology, School of Pharmacy, College of Medicine and
Health Sciences, University of Gondar, Gondar, Ethiopia. 4Department of
Additional file 1: Data collection instrument used in the data collection. Pharmaceutics and Social Pharmacy, School of Pharmacy, College of
(PDF 67 kb) Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
5
Department of Public Health Sciences, Karolinska Institute, Stockholm,
Sweden.
Abbreviations
ANOVA: Analysis of variance; AOR: Adjusted odds ratio; ATC: Anatomical Received: 26 March 2016 Accepted: 1 March 2017
Therapeutic Chemical; CSA: Central Statistical Agency; OR: Odds ratio;
SD: Standard deviation; SPSS: Statistical Packages for Social Sciences;
USD: United States Dollar; WHO: World Health Organization
References
Acknowledgements 1. World Health Organization (WHO) International Working Group for Drug
The authors would like to extend their acknowledgement to the participants Statistics Methodology, WHO Collaborating Centre for Drug Statistics
of the study for their willingness and time. The authors also appreciate the Methodology, WHO Collaborating Centre for Drug Utilization Research and
efforts of Adugna Sitotie, Asemachew Lakie, Eyob Mengesha and Zemene Clinical Pharmacological Services. Introduction to drug utilization research.
Demelash during the data collection. World Health Organization 2003.
2. Hardon A, Hodgkin C, Fresle D. How to investigate the use of medicines by
consumers. World Health Organization/University of Amsterdam/Royal
Funding
Topical Institute. Geneva: World Health Organization; 2004.
The study was funded by the College of Medicine and Health Sciences,
3. de Joncheere K, Rietveld AH, Huttin C. Experiences with generics.
University of Gondar. The funding institution had no role in the design of
International Journal of Risk & Safety in Medicine Prices, affordability and
the study; collection, analysis and interpretation of data and in writing the
cost containment. In: Dukes MNG, Haaijer-Ruskamp FM, de Joncheere CP,
manuscript.
Rietveld AH, editors. Drugs and money. 2nd ed. Amsterdam: Ios Press; 2003.
4. World Health Organization. Manual for the Household Survey to Measure
Availability of data and materials
Access and Use of Medicines. World Health Organization 2008. Geneva.
The datasets generated and/or analyzed during the current study are not Available: http://www.who.int/medicines/areas/coordination/household_
publicly available due requirement of confidentiality up on which the study manual_february_2008.pdf. Accessed 23 Dec 2014.
was approved by the ethical review committee and consent was secured
5. Arhinful DK. WHO level II household survey to measure access to and use of
from participants. However, they are available from the corresponding
medicines in Ghana. WHO medicines survey conducted in Ghana in May/June
author on reasonable request. 2008. Ministry of Health, Ghana. 2011. Available: http://apps.who.int/
medicinedocs/documents/s17742en/s17742en.pdf. Accessed 04 March 2017.
Authors’ contributions 6. Kalyango JN, Hall M, Karamagi C. Home medication management practices
FST: conceived the study, FST, ASS, AB, DW, DAG, ZS, BL and EMB: were and associated factors among patients with selected chronic diseases in a
involved in the development of the proposal, prepared data collection community pharmacy in Uganda. BMC Health Serv Res. 2012;12:323.
instrument, supervised data collection, FST: performed analysis and 7. Tourinho FSV, Bucaretchi F, Stephan C, Cordeiro R. Home medicine chests
interpretation of the data, drafted the manuscript, FST, ASS, AB, DW, DAG, ZS, and their relationship with self-medication in children and adolescents. J
BL and EMB: revised and approved the submission of the manuscript. Pediatr (Rio J). 2008;84(5):416–22.
8. Ocan M, Bbosa GS, Waako P, Ogwal-Okeng J, Obua C. Factors predicting home
Competing interests storage of medicines in Northern Uganda. BMC Public Health. 2014;14:650.
The authors declare that they have no competing interests. 9. Gitawati R. Pattern of household drug storage. Jurnal Kesehatan Masyarakat
Nasional. 2014;9(1):27–31.
Consent for publication 10. Foroutan B, Foroutan R. Household storage of medicines and self-
Not applicable medication practices in south-east Islamic Republic of Iran. East Mediterr
Health J. 2014;20(9):548–53.
Ethics approval and consent to participate 11. Jassim AM. In-home drug storage and self-medication with antimicrobial
The proposal for this study was submitted for review by the Ethical Review drugs in Basrah, Iraq. OMJ. 2010;25:79–87.
Committee of the College of Medicine and Health Sciences at University of 12. Sultanate of Oman Ministry of Health. Household survey on medicine use in
Gondar; and it was provided with an ethical approval by the same. In addition, Oman. Directorate of Rational Use of Medicines Ministry of Health Muscat,
during the data collection at individual households, respondents were asked for Sultanate of Oman 2009. Available: http://apps.who.int/medicinedocs/
their verbal consent to participate in the survey; and to show the medicines kept documents/s17055e/s17055e.pdf. Accessed 12 Mar 2014.
in their households after explanation of the purpose of the study. Verbal consent 13. Enato EFO, Sounyo AA, Einarson TR. Drug storage practices in the developing
was asked because the study did not pose any risk to participants; and different world: a survey of Nigerian households. J Pharm Allied Sci. 2011;8(1):1228–34.
Teni et al. BMC Public Health (2017) 17:238 Page 9 of 9

14. Sharif SI, Abduelkarem AR, Bustami HA, Haddad LI, Khalil DS. Trends of
home drug storage and use in different regions across the northern United
Arab Emirates. Med Princ Pract. 2010;19:355–8. doi:10.1159/000316372.
15. Paniz VMV, Fassa AG, Maia MFS, Domingues MR, Bertoldi AD. Measuring
access to medicines: a review of quantitative methods used in household
surveys. BMC Health Serv Res. 2010;10:146.
16. Hewson C, Shen CC, Strachan C, Norris P. Personal medicines storage in
New Zealand. J Prim Health Care. 2013;5(2):146–50.
17. De Bolle L, Mehuys E, Adriaens E, Remon J, Van Bortel L, Christiaens T.
Home medication cabinets and self-medication: a source of potential health
threats? Ann Pharmacother. 2008;42:572–9.
18. Wieczorkiewicz SM, Kassamali Z, Danziger LH. Behind closed doors: medication
storage and disposal in the home. Ann Pharmacother. 2013;47:482–9.
19. Al-Azzam S, Khader Y, Rawashdeh S, Hijazi S. An assessment of the Extent of
Medication Wastage among Families in Jordan. Jordan J Pharm Sci. 2012;5(1):65–73.
20. Sooksriwong C, Jarupas C, Chinawong D, Supakul S, Ploylermsang C,
Sornlumlertwanich K, et al. Values of leftover drugs in households:
preliminary study in 5 major Thai cities. JAASP. 2013;2:235–42.
21. Law AV, Sakharkar P, Zargarzadeh A, Bilvick BW, Hess K, Hata M, et al. Taking
stock of medication wastage: Unused medications in US households. Res
Soc Adm Pharm. 2015;11:571–8.
22. West LM. Medication wastage: the current situation. J Malta College of
Pharmacy Practice. 2015;21:25–8.
23. Vogler S, Leopold C, Zuidberg C, Habl C. Medicines discarded in household
garbage: analysis of a pharmaceutical waste sample in Vienna. J Pharm
Policy and Pract. 2014;7:6.
24. Abou-Auda HS. An economic assessment of the extent of medication use
and wastage among families in Saudi Arabia and Arabian Gulf countries.
Clin Ther. 2003;25(4):1276–92.
25. Zargarzadeh AH, Tavakoli N, Hassanzadeh A. A survey on the extent of
medication storage and wastage in urban Iranian households. Clin Ther.
2005;27(6):970–8.
26. West LM, Diack L, Cordina M, Stewart D. A systematic review of the
literature on ‘medication wastage’: an exploration of causative factors and
effect of interventions. Int J Clin Pharm. 2014;36:873–81.
27. Amare G, Gedif T, Alemayehu T, Tesfahun B. Pattern of drug use in Addis
Ababa community. East Afr Med J. 1997;74(6):362–7.
28. Sado E, Gedif T. Drug utilization at household level in Nekemte Town and
surrounding rural areas, western Ethiopia: a cross-sectional study. Open
Access Library Journal. 2014;1:1–9. doi:10.4236/oalib.1100651.
29. Wondimu A, Molla F, Demeke B, Eticha T, Assen A, Abrha S, et al. Household
storage of medicines and associated factors in tigray region, northern
Ethiopia. PLoS One. 2015;10(8):e0135650. doi:10.1371/journal.pone.013565.
30. Federal Democratic Republic of Ethiopia Central Statistical Agency. Population
projection of Ethiopia for all regions at Wereda level from 2014–2017. Addis
Ababa. 2013. Available: http://www.csa.gov.et/index.php/ehioinfo-
internal?download=724:population-projection-of-ethiopia-for-all-regions-
atwereda-level-from-2014-2017&start=5. Accessed 04 March 2017.
31. Lwanga SK, Lemeshow S. Sample Size Determination for Health Studies: A
Practical Manual. Geneva: World Health Organization; 1991. p. 1–5.
32. WHO Collaborating Centre for Drug Statistics Methodology. Guidelines for
ATC classification and DDD assignment2015.WHO Collaborating Centre for
Drug Statistics Methodology, Oslo, 2014.
33. Tsiligianni IG, Delgatty C, Alegakis A, Lionis C. A household survey on the
extent of home medication storage: a cross-sectional study from rural Crete,
Greece. Eur J Gen Pract. 2012;18:3–8.

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