Evidence brief: Storage and disposal practices of unused and expired medications among adult women attending Banadir Hospital, Mogadishu, Somalia: A cross-sectional study

Abstract

Improper storage and disposal of unused and expired medications in households pose significant environmental and public health risks. A cross-sectional study was conducted in November 2025 among 427 consecutively selected women visiting the outpatient pharmacy of Banadir Hospital to assess storage and disposal practices of unused and expired medications. Data were analyzed using descriptive statistics, while associations between socio-demographic characteristics and medication storage and disposal practices were assessed using the chi-square test and interpreted with Cramér’s V. Most respondents reported storing unused medications at home (97%), mainly for emergency situations, while more than one-third also kept expired medications at home (34%). Nearly all participants did not read storage instructions on medication labels (98%), and most did not check expiration dates before purchasing (70%) or using medications (74%). Disposal practices were inappropriate in most cases, with over 90% reporting disposal in household trash. These findings indicate that improper medication storage and disposal practices are highly prevalent in this setting. Public awareness programs and the establishment of a national drug take-back system are needed to reduce environmental contamination, prevent medication misuse, and improve public health safety.

Introduction

Medications play a crucial role in addressing human health problems; however, proper storage and disposal of unused and expired medications are equally important [1].

Proper medication storage practice is defined as storing medications in accordance with the manufacturer’s labeled storage conditions and keeping them out of the sight and reach of children, whereas proper medication disposal practice is defined as the use of drug take-back or return options [1–3].

The combined annual amount of prescription and over-the-counter (OTC) medications exceeds 1,000,000 tons [4]. However, patients might not take all of the medications that have been given to them for a variety of reasons [5]. The primary reasons include symptom relief, dosage changes, forgetfulness, intolerance of side effects, large quantities prescribed by physicians or pharmacists, and medication expiration [6]. Additionally, some patients store their medications at home for future use [7]. Improper disposal of expired and unused medications is common, with many people flushing them down the toilet or sink, throwing them into household trash, or leaving them stored in medicine cabinets [8,9]. These practices are often driven by limited awareness and the absence of local medication disposal programs [10]. Such improper disposal poses significant risks to public health, the environment, and animal life, including accidental ingestion, misuse, and contamination of water sources [11]. Adult women are an important population for assessing the storage and disposal practices of medications, as they usually store and dispose of medications used in their households and are also more likely to obtain them due to reproductive health issues [12,13]. The collapse of the Somali central government in 1991 led to the breakdown of the national health system, including the pharmaceutical sector. However, in 2014, the Somali National Medicines Policy was established to strengthen pharmaceutical governance and regulation [14]. By November 2023, the first edition of the Somali National Pharmacovigilance Guidelines was published by the Interim National Medicine Regulatory Authority [15]. Although the Federal Ministry of Health and its partners are undertaking reforms, there are currently no national guidelines for the storage and disposal of unused and expired medications, and no national drug take-back scheme is in place. To our knowledge, this is the first study conducted in Somalia on this topic and aimed to assess the storage and disposal practices of unused and expired medications among adult women attending Banadir Hospital, Mogadishu, Somalia.