Household pharmaceutical waste in South Africa: A Scoping Review of disposal practices, drivers, challenges, and potential solutions.

Mr. Tiisetso Aubrey  Chuene; Mr. Banele Nkosingiphile  Siboza; Ms. Lehlogonolo Prudence  Chuene

doi:10.51168/sjhrafrica.v6i12.2171

Authors

Mr. Tiisetso Aubrey Chuene Department of Student Health and Wellness Centre, University of Limpopo, Private Bag X1106, Sovenga, 0727, South Africa.
Mr. Banele Nkosingiphile Siboza Department of Student Health and Wellness Centre, University of Limpopo, Private Bag X1106, Sovenga, 0727, South Africa.
Ms. Lehlogonolo Prudence Chuene Department of Geography and Environmental Studies, University of Limpopo, Private Bag X1106, Sovenga, 0727, South Africa.

DOI:

https://doi.org/10.51168/sjhrafrica.v6i12.2171

Keywords:

Household pharmaceutical waste, disposal practices, unused medicine, expired medicine, Challenges, South Africa

Abstract

Background

Improper disposal of household pharmaceutical waste (HPW) poses significant health and environmental risks. In South Africa, many households retain unused and expired medicines, with unsafe disposal practices driven by limited awareness, over-prescribing, and easy access to medicines, particularly in rural communities. This review synthesises current evidence on disposal practices, drivers, challenges, and risks to inform policy development and support interventions for safer HPW management.

Methods

Following the Arksey and O’Malley scoping review framework and PRISMA guidelines, English peer-reviewed studies published between 2014 and 2024 were identified through PubMed, Google Scholar, ScienceDirect, and Sabinet. Studies addressing HPW generation, disposal, or management were included, while those published before 2014, not in English, or without full text were excluded. Data were extracted, charted, and synthesised thematically.

Results

Households frequently retained unused or expired medicines due to non-adherence, over-prescribing, large pack sizes, self-medication, and stockpiling. Unsafe disposal practices, such as discarding in household waste or flushing, were common. Structural and systemic factors, including limited public awareness, inadequate take-back systems, insufficient healthcare guidance, and weak regulatory enforcement, contributed to unsafe practices. The management of HPW is constrained by a combination of systemic, infrastructural, and behavioural factors. Together, these challenges impede the adoption of safe and sustainable disposal practices.

Conclusion

The HPW is influenced by multifaceted behavioural, structural, and systemic factors. Addressing these challenges requires coordinated interventions, including public education, improved regulatory frameworks, accessible take-back programs, and integration of disposal counselling into routine healthcare practice. These measures are critical to reduce risks, prevent environmental contamination, and promote sustainable HPW management.

Recommendations

Future efforts to manage HPW should prioritise the expansion of accessible take-back programs and the integration of disposal counselling into healthcare services. Continuous research and environmental monitoring should be conducted to inform interventions and support sustainable household waste management.

Author Biographies

Mr. Banele Nkosingiphile Siboza, Department of Student Health and Wellness Centre, University of Limpopo, Private Bag X1106, Sovenga, 0727, South Africa.

is a postgraduate student (Master of Public Administration and Management) in the Department of Public Administration at the University of Limpopo and serves as a Student Assistant at the Student Affairs Division in the University of Limpopo.

Ms. Lehlogonolo Prudence Chuene, Department of Geography and Environmental Studies, University of Limpopo, Private Bag X1106, Sovenga, 0727, South Africa.

is a registered Environmental Assessment Practitioner with EAPASA. She holds a Master of Science in Geography and Environmental Science from the University of Limpopo. With over a decade of experience in the environmental field, she has been involved in diverse projects spanning mining, renewable energy, infrastructure development, and waste management facilities. Through her professional work, she champions responsible environmental stewardship, with a particular focus on regulatory compliance and waste reduction.

References

Ngqwala, N. P., & Muchesa, P. (2020). Occurrence of pharmaceuticals in aquatic environments: A review and potential impacts in South Africa. South African Journal of Science, 116(7-8), 1-7. https://doi.org/10.17159/sajs.2020/5730

Rogowska, J., & Zimmermann, A. (2022). Household pharmaceutical waste disposal as a global problem review. International Journal of Environmental Research and Public Health, 19(23), 15798. https://doi.org/10.3390/ijerph192315798 PMid:36497873 PMCid:PMC9737308

Yimer, A., Moges, G., & Kahissay, M. H. (2024). Household storage and disposal of unused and expired medicines in Dessie, Ethiopia: a cross-sectional study. Frontiers in Public Health, 12, 1422304. https://doi.org/10.3389/fpubh.2024.1422304 PMid:39512718 PMCid:PMC11540675

Jafarzadeh, A., Mahboub-Ahari, A., Najafi, M., Yousefi, M., & Dalal, K. (2021). Medicine storage, wastage, and associated determinants among urban households: a systematic review and meta-analysis of household surveys. BMC Public Health, 21(1), 1127. https://doi.org/10.1186/s12889-021-11100-4 PMid:34118923 PMCid:PMC8196539

Kampamba, M., Nyirenda, M., Hatwiko, H., Kampamba, D., & Hikaambo, C. N. (2020). Assessment of household knowledge, attitude, and practices on disposal methods of expired and unused medicines among residents of Lusaka City, Zambia. African Journal of Pharmacy and Pharmacology, 14(7), 221-228. https://doi.org/10.5897/AJPP2020.5165

Makki, M., Hassali, M. A., Awaisu, A., & Hashmi, F. (2019). The prevalence of unused medications in homes. Pharmacy, 7(2), 61. https://doi.org/10.3390/pharmacy7020061 PMid:31200530 PMCid:PMC6631141

Ayele, Y., & Mamu, M. (2018). Assessment of knowledge, attitude, and practice towards disposal of unused and expired pharmaceuticals among the community in Harar city, Eastern Ethiopia. Journal of Pharmaceutical Policy and Practice, 11(1), 27. https://doi.org/10.1186/s40545-018-0155-9 PMid:30459955 PMCid:PMC6236888

Kusturica, M. P., Tomas, A., & Sabo, A. (2016). Disposal of unused drugs: knowledge and behaviour among people around the world. Reviews of Environmental Contamination and Toxicology, 240, 71-104. https://doi.org/10.1007/398_2016_3 PMid:27115675

Mahlaba, K. J., Helberg, E. A., Godman, B., Kurdi, A., & Meyer, J. C. (2022). Patients' knowledge and practice on disposal of medicines kept in households in South Africa: findings and implications. Journal of Research in Pharmacy Practice, 11(1), 13-18. https://doi.org/10.4103/jrpp.jrpp_85_21 PMid:36277964 PMCid:PMC9585805

Toe, J., Orok, E., & Erah, P. (2023). Assessment of knowledge and disposal practices of unused and expired household medicines in a community in Liberia. Exploratory Research in Clinical and Social Pharmacy, 12, 100369. https://doi.org/10.1016/j.rcsop.2023.100369 PMid:38058360 PMCid:PMC10696106

Michael, I., Ogbonna, B., Sunday, N., Anetoh, M., & Matthew, O. (2019). Assessment of disposal practices of expired and unused medications among community pharmacies in Anambra State, southeast Nigeria: a mixed study design. Journal of Pharmaceutical Policy and Practice, 12(1), 12. https://doi.org/10.1186/s40545-019-0174-1 PMid:31016021 PMCid:PMC6469121

Munzhelele, E. P., Mudzielwana, R., Ayinde, W. B., & Gitari, W. M. (2024). Pharmaceutical contaminants in wastewater and receiving water bodies of South Africa: A review of sources, pathways, occurrence, effects, and geographical distribution. Water, 16(6), 796. https://doi.org/10.3390/w16060796

Inarmal, N., & Moodley, B. (2024). Removal efficiencies and environmental risk assessment of selected pharmaceuticals and metabolites at a wastewater treatment plant in Pietermaritzburg, South Africa. Environmental Monitoring and Assessment, 197(1), 102. https://doi.org/10.1007/s10661-024-13515-z

PMid:39724437 PMCid:PMC11671546

Nibamureke, U. M. C., & Barnhoorn, I. E. J. (2025). Screening of Pharmaceuticals in Surface Waters from Vhembe District, Limpopo Province, South Africa. Water, 17(3), 379. https://doi.org/10.3390/w17030379

https://doi.org/10.3390/w17030379

Ojemaye, C. Y., & Petrik, L. (2022). Pharmaceuticals and personal care products in the marine environment around False Bay, Cape Town, South Africa: occurrence and risk‐assessment study. Environmental Toxicology and Chemistry, 41(3), 614-634. https://doi.org/10.1002/etc.5053 PMid:33783837

Padayachee, N., Rothberg, A., Butkow, N., & Truter, I. (2020). Over-the-counter medicine utilization by beneficiaries under medical schemes in South Africa. Drug, Healthcare and Patient Safety, 61-69. https://doi.org/10.2147/DHPS.S236139 PMid:32425615 PMCid: PMC7187947

Hiew, S. Y., & Low, B. Y. (2024). A systematic review of the knowledge, attitude, and practice of healthcare professionals and healthcare professional students towards household pharmaceutical waste disposal. Exploratory Research in Clinical and Social Pharmacy, 17, 100556. https://doi.org/10.1016/j.rcsop.2024.100556

PMid:39877296 PMCid:PMC11773479

Magagula, B. K., Rampedi, I. T., & Yessoufou, K. (2022). Household pharmaceutical waste management practices in the Johannesburg Area, South Africa. International Journal of Environmental Research and Public Health, 19(12), 7484. https://doi.org/10.3390/ijerph19127484 PMid:35742731 PMCid:PMC9223455

Padayachee, N., Rothberg, A. D., Truter, I., & Butkow, N. (2019). Utilization of over-the-counter analgesics in two private medical insurance schemes in South Africa. Drug, healthcare, and patient safety, 37-45. https://doi.org/10.2147/DHPS.S194347 PMid:31410069 PMCid:PMC6645681

Akunne, O. O., Valoyi, V., Wehmeyer, A., Johnson, Y., & Coetzee, R. (2023). Implications of the South African National Drug Policy on prescribing patterns: a case study of the Limpopo province. Journal of Pharmaceutical Policy and Practice, 16(1), 111. https://doi.org/10.1186/s40545-023-00622-4 PMid:37784167 PMCid:PMC10544492

Mitkidis, K., Obolevich, V., Chrysochou, P., & Mitkidis, P. (2021). Harmonisation of pharmaceutical take-back systems in the EU. European Journal of Health Law, 28(5), 445-471. https://doi.org/10.1163/15718093-bja10051 PMid:34610578

Ariffin, M., & Zakili, T. S. T. (2019). Household pharmaceutical waste disposal in Selangor, Malaysia-policy, public perception, and current practices. Environmental Management, 64(4), 509-519. https://doi.org/10.1007/s00267-019-01199-y PMid:31399770

Dias-Ferreira, C., Valente, S., & Vaz, J. (2016). Practices of pharmaceutical waste generation and discarding in households across Portugal. Waste Management & Research, 34(10), 1006-1013. https://doi.org/10.1177/0734242X16639388 PMid:27026517

Tricco, A. C., Lillie, E., Zarin, W., O'brien, K., Colquhoun, H., Kastner, M., ... & Straus, S. E. (2016). A scoping review on the conduct and reporting of scoping reviews. BMC Medical Research Methodology, 16(1), 15. https://doi.org/10.1186/s12874-016-0116-4 PMid:26857112 PMCid:PMC4746911

Arksey, H., & O'malley, L. (2005). Scoping studies: towards a methodological framework. International Journal of Social Research Methodology, 8(1), 19-32. https://doi.org/10.1080/1364557032000119616

Marwa, K. J., Mcharo, G., Mwita, S., Katabalo, D., Ruganuza, D., & Kapesa, A. (2021). Disposal practices of expired and unused medications among households in Mwanza, Tanzania. PloS one, 16(2), e0246418. https://doi.org/10.1371/journal.pone.0246418 PMid:33539402 PMCid:PMC7861449

Yimenu, D. K., Teni, F. S., & Ebrahim, A. J. (2020). Prevalence and predictors of storage of unused medicines among households in Northwestern Ethiopia. Journal of Environmental and Public Health, 2020(1), 8703208. https://doi.org/10.1155/2020/8703208 PMid:32300369 PMCid:PMC7136802

Alfian, S. D., Adhinagoro, B., Winardi, D. O., Angela, F., Griselda, M., Gathera, V. A., & Abdulah, R. (2024). Pharmacist-led interventions in addressing improper disposal practices of unused and expired household medication: A systematic review. Heliyon, 10(18). https://doi.org/10.1016/j.heliyon.2024.e37764

PMid:39315146 PMCid:PMC11417203

Rusić, D., Bozic, J., Bukic, J., Seselja Perisin, A., Leskur, D., Modun, D., & Tomic, S. (2019). Evaluation of the accordance of the antibiotics package size with the recommended treatment duration of guidelines for sore throat and urinary tract infections. Antimicrobial Resistance & Infection Control, 8(1), 30. https://doi.org/10.1186/s13756-019-0495-5 PMid:30792852 PMCid:PMC6371554

Chong, K. M., Rajiah, K., Chong, D., & Maharajan, M. K. (2022). Management of medicines wastage, returned medicines, and safe disposal in Malaysian community pharmacies: A qualitative study. Frontiers in Medicine, 9, 884482. https://doi.org/10.3389/fmed.2022.884482 PMid:35665362 PMCid:PMC9161356

Makeri, D., Dilli, P. P., Pius, T., Tijani, N. A., Opeyemi, A. A., Lawan, K. A., ... & Agwu, E. (2025). The nature of self-medication in Uganda: a systematic review and meta-analysis. BMC Public Health, 25(1), 197. https://doi.org/10.1186/s12889-025-21380-9 PMid:39825271 PMCid:PMC11740451

Kawuma, R., Chimukuche, R. S., Francis, S. C., Seeley, J., & Weiss, H. A. (2021). Knowledge, use (misuse), and perceptions of over-the-counter analgesics in sub-Saharan Africa: a scoping review. Global health action, 14(1), 1955476. https://doi.org/10.1080/16549716.2021.1955476 PMid:34420494 PMCid:PMC8386732

Ocan, M., Bwanga, F., Bbosa, G. S., Bagenda, D., Waako, P., Ogwal-Okeng, J., & Obua, C. (2014). Patterns and predictors of self-medication in northern Uganda. PloS one, 9(3), e92323. https://doi.org/10.1371/journal.pone.0092323 PMid:24658124 PMCid:PMC3962384

Maharaj, P., Baijnath, S., & Naidoo, P. (2020). Knowledge and practices of HIV infected patients regarding medicine disposal among patients attending public ARV clinics in KwaZulu-Natal, South Africa. BMC Public Health, 20(1), 884. https://doi.org/10.1186/s12889-020-09018-4 PMid:32513139 PMCid:PMC7282097

Matlakala, N. Z. (2024). Medical Waste Management: Study of Household Practices and Potential Harm in the Developing Countries, such as South Africa. Dissertation in Environmental Management. Silenus University.

Mashiane, M. M. (2017). Disposal practices for unwanted medicines from households in Johannesburg. Dissertation (Pharmacy Administration and Policy Administration). University of the Western Cape

Wang, L. S., Aziz, Z., Wang, E. S., & Chik, Z. (2024). Unused medicine take-back programmes: a systematic review. Journal of Pharmaceutical Policy and Practice, 17(1), 2395535. https://doi.org/10.1080/20523211.2024.2395535 PMid:39257836 PMCid:PMC11385643

Tegegne, A. A., Genet, G., Workie Limenh, L., Yohannes, L., Mohammed Seid, A., Alemayehu, T. T., ... & Simegn, W. (2024). Public awareness, knowledge, and attitude regarding proper disposal of unused medicines and associated factors in Gondar city, northwest Ethiopia. Frontiers in Public Health, 12, 1372739. https://doi.org/10.3389/fpubh.2024.1372739 PMid:38932773 PMCid:PMC11204293

Kampamba, M., Chawangwana, M., Mwanza, B., Hikaambo, C. M., Chabalenge, B., Chimombe, T., & Mwangana, D. S. (2025). Assessment of pharmacists' perspectives on state-run drug take-back programs and disposal practices for unused and expired medications in Zambian community pharmacies. Discover Public Health, 22(1), 522. https://doi.org/10.1186/s12982-025-00941-8

Mogajane, B. Z., Chelule, P., & Hoque, M. (2024). Knowledge and Practices on the Storage and Disposal of Expired Medicines Among Patients at a Public Hospital in South Africa. Gender and Behaviour, 22(2), 22615-22623.

Gwenzi, W., Simbanegavi, T. T., & Rzymski, P. (2023). Household disposal of pharmaceuticals in low-income settings: Practices, health hazards, and research needs. Water, 15(3), 476. https://doi.org/10.3390/w15030476

Barbara, M. A., Olivia, M., Agyemang, I., & Ackah, D. (2025). Disposal of Unused Medicines in a Rural Ghanaian Household and Its Effect on the Environment. Dama Academic Scholarly Journal of Researchers, 10(2), 40-51. https://doi.org/10.4314/dasjr.v10i2.5

Amoabeng, I. A., Otoo, B. A., Darko, G., & Borquaye, L. S. (2022). Disposal of Unused and Expired Medicines within the Sunyani Municipality of Ghana: A Cross‐Sectional Survey. Journal of environmental and public health, 2022(1), 6113346. https://doi.org/10.1155/2022/6113346 PMid:35664422 PMCid:PMC9162851

Kenya Law. (2022). The Pharmacy and Poisons (Pharmaceutical Waste Management) Rules, Legal Notice No. 99 of 2022. https://new.kenyalaw.org/akn/ke/act/ln/2022/99/eng@2022-12-31

OECD. (2022). Management of pharmaceutical household waste: Limiting environmental impacts of unused or expired medicine. OECD Publishing. https://www.oecd.org/en/publications/management-of-pharmaceutical-household-waste_3854026c-en.html https://doi.org/10.1787/3854026c-en

Wheeler, A. J., Spinks, J., Bettington, E., & Kelly, F. (2017). Evaluation of the National Return of unwanted medicines (RUM) program in Australia: a study protocol. Journal of Pharmaceutical Policy and Practice, 10(1), 38. https://doi.org/10.1186/s40545-017-0126-6 PMid:29234498 PMCid:PMC5719897

Olagunju, O. J., Ben, E., Olagunju, O., Majolagbe, O. G., Osanyinlusi, O. O., Adewoye, T., ... & Dawha, S. D. (2025). Poorly Regulated Antibiotic Use in Nigeria: A Critical Public Health Concern and Its Impact on Medical Practice. Cureus, 17(6). https://doi.org/10.7759/cureus.85212

Alnsour, M., & Moqbel, S. (2023). Enhancing environmental sustainability through a household pharmaceuticals take-back program in Jordan. Environmental Monitoring and Assessment, 195(12), 1424. https://doi.org/10.1007/s10661-023-12050-7 PMid:37934353

Mostafanejad, R., Ghassab-Abdollahi, N., Derakhshani, N., & Rezapour, R. (2025). Medication waste and disposal behaviors among Iranian households: A Cross-sectional study. Scientific Reports, 15(1), 15714. https://doi.org/10.1038/s41598-025-00376-w PMid:40325066 PMCid:PMC12053692

Kampamba, M., Kalambwa, Z., Chabalenge, B., Zulu, J., Mudenda, S., Chimombe, T., ... & Ngula, M. I. (2024). Patients' knowledge, attitude, and practices on disposal methods of expired and unused medicines: Implications for creation of drug take-back program. Pharmacology & Pharmacy, 15(4), 113-128. https://doi.org/10.4236/pp.2024.154008

Nurolaini, K., Sultana, S. M., & Wai See, W. (2016). Medication Wastage and its Disposal Amongst Patients at Suri Seri Begawan Hospital in Brunei Darussalam. Medicine & Health (Universiti Kebangsaan Malaysia), 11(2). https://doi.org/10.17576/MH.2016.1102.04

Kristina, S. A., & Wulandari, G. P. (2020). Understanding burden of medicine disposal: a systematic review. International Journal of Pharmaceutical Research, 12(3), 673-684. https://doi.org/10.31838/ijpr/2020.12.03.102

Okonkwo Ihebe, M. O. (2019). Disposal of unused medicines from households in Cape Town. Dissertation: Master's in pharmacy. University of the Western Cape.

Yang, Z., Liu, Z., Zhu, Q., Chen, W., Xue, Q., Zhang, Y., ... & Jiang, B. (2025). Disposal practices of unwanted household medications in China: a cross-sectional study. BMJ open, 15(5), e088086. https://doi.org/10.1136/bmjopen-2024-088086 PMid:40374227 PMCid:PMC12083272