CHAPTER ONE

1.0 Introduction

This chapter includes different historical aspects related to home based first aid care, starting from the background of the study, followed with the problem statement, objectives research questions the justification of the study, the significance and the scope of the study.

1.1 Background of study

Pharmaceuticals play a critical role in modern health care, significantly improving quality of life and reducing disease burden globally. However, alongside their therapeutic benefits, pharmaceuticals also present a pressing challenge in terms of waste management—particularly the expired or unused medications that accumulate in pharmacies, households, and health facilities. Expired medicines are products that have passed their designated shelf life and can no longer be used safely or effectively for therapeutic purposes. Proper disposal of these medicines is essential to mitigate environmental contamination, prevent accidental poisoning, curb antimicrobial resistance, and uphold community health (Khatri et al., 2025; Akande-Sholabi et al., 2025).

Pharmaceutical waste includes a broad spectrum of products, ranging from expired or unused prescriptions to residual drug stock. Because many medications contain biologically active compounds capable of persisting in the environment, there is a strong global impetus to ensure appropriate waste management systems are in place to reduce harm to ecosystems and human populations (Hiew & Low, 2024; Ionescu, 2024). Inappropriate disposal—such as burning, flushing into drains, or discarding in regular garbage—can lead to contamination of soil, water bodies, and potable water systems. Investigations in several countries have shown pharmaceutical residues in waterways, which can affect aquatic life and potentially interfere with human health through bioaccumulation and extended ecosystem exposure (Environmental impact of pharmaceuticals and personal care products, 2025; Khatri et al., 2025).

Community pharmacies serve as an accessible point of care and are often the public’s primary interface with medicines. Because of their central role in medication distribution and patient counselling, community pharmacy personnel—including pharmacy technicians—are strategically positioned to influence safe disposal behaviours (Hiew & Low, 2024). Pharmacy technicians, who work under the supervision of pharmacists, are frequently responsible for day-to-day operations, including inventory management, storage, and disposal of expired medications in community settings. Yet, despite this responsibility, evidence suggests that service providers often face significant gaps in knowledge and practice concerning safe disposal of expired medications, which contributes to unsafe disposal habits (Akande-Sholabi et al., 2025; Abiola et al., 2020).

Knowledge about safe disposal entails understanding international and national guidelines, the environmental and health risks of improper disposal, and approved disposal mechanisms. Practice refers to the actual operational behaviour of pharmacy staff, including how they handle, store, segregate, and dispose of expired drugs. Challenges may include inadequate training, weak enforcement of policies and guidelines, limited disposal infrastructure (such as take-back programs), cost barriers, and logistical complexities associated with proper waste segregation and destruction (Akande-Sholabi et al., 2025; Abiola et al., 2020).

International organizations such as the World Health Organization have long emphasized the need for safe pharmaceutical waste management. The WHO’s Safe Management of Pharmaceutical Waste from Health Care Facilities: Global Best Practices underscores that pharmaceuticals discarded without proper treatment pose hazards to public health and environment, and therefore systematic disposal procedures are necessary in all health care settings (WHO, 2025). These guidelines recommend segregation, secure collection, and high-temperature incineration or other environmentally sound destruction techniques to render drugs inert before final disposal (WHO, 2025). In addition, the U.S. Food and Drug Administration (FDA) advocates for community drug take-back programs as the most effective method for disposing unused or expired medicines, discouraging household dumping or flushing unless absolutely necessary (FDA, 2024).

Systematic reviews have identified widespread gaps in knowledge, attitudes, and practices regarding pharmaceutical waste disposal among healthcare professionals globally. Many practitioners do not receive adequate education during training, and they often believe that disposal guidance is outside their core responsibilities—leading to inconsistent patient counselling and public education on the subject (Hiew & Low, 2024). This gap reflects a broader deficiency in curricula and continuous professional development related to pharmaceutical waste management.

In the context of community pharmacy, pharmacists and technicians play a dual role: they must ensure medicines are safe to be dispensed and that expired or unused medicines are appropriately managed. Community pharmacies are considered viable collection points where patients can return expired medications, and staff can educate the public about safe disposal practices (Khatri et al., 2025). In some high-income countries, legislation supports this role through formal take-back programs and designated disposal sites; however, in many low- and middle-income settings, such infrastructure is limited or absent (Ionescu, 2024).

Studies show that community pharmacists often recognize the importance of safe disposal but may not consistently practice it due to systemic challenges. A cross-sectional study of community pharmacists in Palestine found that 48.5% cited lack of education, and 66% cited weak law enforcement as major barriers to safe disposal, with nearly all participants supporting enhanced training and educational materials to improve practices (Akande-Sholabi et al., 2025). Similarly, a study in Nigeria revealed that while some pharmacies complied partially with disposal guidelines, over half did not comply at all, and knowledge about how regulatory agencies destroy drugs was limited (Abiola et al., 2020).

Such findings highlight the knowledge-practice gap—where awareness of disposal principles does not necessarily translate into proper implementation (Akande-Sholabi et al., 2025). This gap may be more pronounced among pharmacy technicians whose training and responsibilities often emphasize dispensing and operations rather than environmental and waste management competencies.

In Sub-Saharan Africa, studies demonstrate widespread issues in pharmaceutical waste management, particularly in community settings. Improper disposal practices—such as throwing medicines into ordinary waste, flushing into sewer systems, or storing expired stock indefinitely—are common, increasing the risk of environmental contamination and accidental ingestion by children or animals (Akande-Sholabi et al., 2025; Abiola et al., 2020). A regional review in East African countries noted that despite existing regulations in some jurisdictions, disposal practices remain suboptimal due to weak enforcement, lack of public awareness, and limited disposal infrastructure (Research in East Africa, 2025).

Research specific to Nigeria, a country with comparable socio-economic and healthcare system characteristics to Cameroon, reveals that community pharmacies often gravitate toward non-standard disposal methods. Only a small fraction of pharmacies fully comply with national guidelines, and common methods such as sending expired drugs to regulatory authorities or waste collectors are inconsistently practised (Abiola et al., 2020). This indicates systemic challenges that likely echo across neighbouring Cameroon, where safe disposal practices are similarly under-researched and under-implemented.

While much research has explored the disposal practices of pharmacists and the public, community pharmacy technicians are an often overlooked yet critical cadre in pharmaceutical service delivery. Technicians are frequently responsible for inventory control, identifying expired stock, and executing disposal processes within the pharmacy. Their knowledge and practice may significantly influence how expired medicines are handled on the ground. However, little empirical research specifically investigates the disposal attitudes, competencies, and challenges faced by pharmacy technicians in Cameroon or similar contexts.

1.2 Statement of problem

Expired and unused medications can pose serious risks when not disposed of safely. Research shows that such medicines often end up in household waste, burned, flushed into drains, or stored indefinitely in homes and pharmacies, leading to contamination of soil and water, environmental pollution, and potential health hazards (Household Disposal of Pharmaceuticals in Low-Income Settings, 2025; Diriba et al., 2023). Improper disposal also increases the risk of accidental poisoning and can contribute to the spread of antimicrobial resistance if antibiotics enter the environment (OECD, 2022).

Community pharmacies are central to medicine distribution and are expected to manage expired stock responsibly. However, studies in similar settings have found inconsistent compliance with disposal guidelines. For example, only a minority of community pharmacies adhere to national standards for medicine disposal, and many pharmacy workers have limited knowledge or do not consistently provide correct disposal advice (Nigeria study; Hiew & Low, 2024; pharmacists surveys, Trinidad and West Indies, 2022). These gaps reflect broader deficiencies in training, practice, and regulation.

In Cameroon, pharmaceutical waste disposal systems are weak. Assessments report that disposal of expired medicines is often conducted in ad-hoc ways, with no standardized facilities or clear procedures, increasing the risk of environmental contamination and public health problems (Assessment of Pharmaceutical Management System in Cameroon, 2024). There is limited evidence on how well community pharmacy technicians—who are frequently responsible for inventory and disposal practices—understand and implement safe disposal procedures in Limbe. Without factual data on their knowledge, practices, and the challenges they face, it is difficult for health authorities to design and enforce effective interventions to protect both public health and the environment.

1.3 Research Objectives

1.3.1 Main Research Objective

The main objective of this study is to assess the knowledge, practice, and challenges faced by community pharmacy technicians regarding the safe disposal of expired medications in Limbe.

1.3.2 Specific Objectives

The specific objectives of the study are to:

1. Assess the level of knowledge of community pharmacy technicians on the safe disposal of expired medications in Limbe.
2. Examine the disposal practices of community pharmacy technicians concerning expired medications in Limbe.
3. Identify the common methods used by community pharmacy technicians to dispose of expired medications in Limbe.
4. Determine the challenges faced by community pharmacy technicians in the safe disposal of expired medications in Limbe.

1.4 Specific Research Questions

1. What is the level of knowledge of community pharmacy technicians on the safe disposal of expired medications in Limbe?
2. How do community pharmacy technicians in Limbe practice the disposal of expired medications?
3. What methods are commonly used by community pharmacy technicians to dispose of expired medications in Limbe?
4. What challenges do community pharmacy technicians face in the safe disposal of expired medications in Limbe?