# Household Disposal of Unused and Expired Medications: A Cross‐Sectional Study on Awareness, Attitude, and Practice in Boma Health Zone, Democratic Republic of Congo, 2024

## TL;DR

This study examines how households in Boma, DRC, dispose of unused and expired medications, revealing poor awareness and unsafe practices despite some willingness to adopt safer methods.

## Contribution

The study provides the first empirical data on UEM disposal practices in the DRC and highlights the need for targeted interventions.

## Key findings

- Over half of households stored unused medications, mostly due to symptom resolution.
- Only 12.8% of households had received prior information on safe disposal, and 94% were unaware of take-back systems.
- Unsafe disposal methods like burning and household waste disposal were common, with only 4.4% returning expired medicines to pharmacies.

## Abstract

The accumulation of unused and expired medications (UEM) in households represents a growing public health and environmental concern, particularly in low‐resource settings such as the Democratic Republic of Congo (DRC), where safe disposal infrastructure is limited and regulatory frameworks are weak. In the Boma Health Zone, previous environmental studies have documented pollution of the Kalamu River by solid and liquid waste, including pharmaceuticals, altering its physico‐chemical and bacteriological properties. However, no systems for safe medication disposal are available to the public, and empirical data on household UEM disposal practices in the DRC are virtually nonexistent, highlighting the critical need for this research.

This study assessed the knowledge, attitude, and practice (KAP) regarding UEM disposal among households in the Boma Health Zone, DRC.

A community‐based cross‐sectional survey was conducted in April 2024 among 384 households, selected using a four‐stage random sampling technique. Data were collected through face‐to‐face interviews using a structured questionnaire adapted from validated KAP surveys and administered via the Open Data Kit (ODK) app. Reliability was assessed using Cronbach’s alpha (α = 0.78). Descriptive statistics and cross‐tabulations were performed using STATA version 14. Missing data were checked at entry via built‐in ODK validations, and incomplete questionnaires were excluded from analysis.

More than half of households (53.4%, n = 205) stored UEM, primarily due to symptom resolution (70.6%, n = 271). Awareness of safe disposal was poor: only 12.8% (n = 49) had received prior information, and 94.0% (n = 361) were unaware of take‐back systems. Overall, 72.9% (n = 276) had low awareness scores. Attitudes were more favorable, with 53.4% (n = 205) displaying a positive attitude and a majority (53.5%, n = 207) supporting mandatory take‐back programs. However, unsafe practices dominated: the most common methods for disposing of expired medications were burning (41.7%, n = 160) and disposal in household waste (32.8%, n = 126). Only 4.4% (n = 17) returned expired medicines to a pharmacy, resulting in 98.7% (n = 379) being classified as having poor disposal practices.

Critical gaps in awareness and practice regarding UEM disposal persist in Boma, despite a willingness to engage in safer practices. Urgent, multilevel interventions are needed, including community awareness campaigns, the establishment of accessible take‐back programs, and the development of a national pharmaceutical waste management policy.