Types of pharmaceuticals in homesteads in Eswatini: knowledge level of dangers of storage and disposal, and description of practices among home-dwellers in urban and rural settings

The dramatic increase in chemical production and trade during the past three decades has raised both public and official concern about the potential risks posed by hazardous chemicals pesticides and medicines. With increased threat from HIV infection, many householders find themselves needing to access and keep a complex and diverse variety of pharmaceuticals. A cross-sectional, explorative and qualitative survey was carried out among 329 households involving in-depth interviews and observation to investigate types of pharmaceuticals found in rural, peri-urban and urban areas in Eswatini, the level of knowledge of householders and disposal practices of unused and expired pharmaceuticals. Eswatini does not have any laws that regulate the management of household pharmaceuticals. The results of the survey suggested that a majority of homesteads (85%) stored unused, often expired and left-over pharmaceuticals mainly for future use. The level of knowledge of risks associated with presence of pharmaceuticals was found to be very low among householders and that no programmes were initiated by the local health authority or the municipal councils to enhance the knowledge levels. Eighty-two different types of pharmaceuticals were identified including analgesics (38%), antibiotics (27%), supplements (21%) and others (14%). In urban areas, respondents reported that they disposed waste pharmaceuticals into the normal bins which are collected and disposed into landfills and dump sites while peri-urban and rural areas reported that they burn their pharmaceuticals in backyards. The findings in this study suggest the need for further research to determine availability of the variety of pharmaceuticals in surface, ground and drinking water around the country. Guidelines for management and safe disposal of pharmaceuticals need to be urgently developed and programmes to educate householders should be initiated in Eswatini.