Household Disposal of Pharmaceuticals in Low-Income Settings: Practices, Health Hazards, and Research Needs

Abstract

Pharmaceuticals are widely used in Africa due to the high burden of human and animal diseases. However, a review of the current practices and pollution risks arising from the disposal of pharmaceuticals in low-income settings in Africa is still lacking. Therefore, the present review examined the literature to address the following questions: (1) what are the key factors driving the accumulation of unused and expired pharmaceuticals?, (2) what are the current disposal practices for unused and expired pharmaceuticals, and wastewater (feces and urine) containing excreted pharmaceuticals?, (3) what are the potential environmental and human health hazards posed by current disposal practices?, and (4) what are the key research needs on the disposal of pharmaceuticals in low-income settings? Evidence shows that, in low-income settings, wastewater comprising predominantly of feces and urine containing excreted pharmaceuticals often end up in on-site sanitation systems such as pit latrines, septic tanks, and the environment in the case of open defecation. Unused and expired pharmaceuticals are disposed of in pit latrines, household solid waste, and/or burned. The pollution risks of current disposal practices are poorly understood, but pharmaceutical pollution of groundwater sources, including those used for drinking water supply, may occur via strong hydrological connectivity between pit latrines and groundwater systems. Potential high-risk pollution and human exposure hotspots are discussed. However, compared to other environmental compartments, the occurrence, dissemination, fate, and human health risks of pharmaceuticals in the pit latrine-groundwater continuum are still understudied. Future research directions are discussed to address these gaps using the Source-Pathway-Receptor-Impact-Mitigation (SPRIM) continuum as an organizing framework.