Expired Medicines: Assessment of the Magnitude and Contributing Factors in the Public Pharmaceutical Supply Chains of Western Ethiopia

Abstract

Background: Unknown magnitude of expired medication in the public pharmaceutical supply chain is a serious problem that potentially leads to big loss of useable medicines, antibiotic resistance, environmental concerns, economical implications, administrative burdens and related problems but there is lack of study that explores magnitude of expired medicines. Therefore, the aim of this study is to assess the magnitude of expired medicines and contributing factors in the public pharmaceutical supply chain of western Ethiopia. Methods and Materials Both quantitative and qualitative, cross sectional study was conducted at public pharmaceutical supply chain of western Ethiopia (n=60) from July 1 to August 30 2021. The sample size of the study calculated by including 70% of EPSA, 30% of hospital and 15% of health centers from western Ethiopian public pharmaceutical supply chains. Stratified procedures and probability sampling techniques were used to select hospitals and health centers that served in EPSA's western cluster. Purposive sampling was utilized in the qualitative part to pick interviewers. The data was collected using observational checklists for the quantitative aspect and an interview guide for the qualitative aspect. A pre-test was done on 16% of the sample size to check the validity and accuracy of the research instrument. Microsoft Excel and the statistical package for social science (SPSS) version 23 (Amsterdam, Netherland), were used to examine the quantitative data, then qualitative data was analyzed using a thematic analysis approach. Binary logistic regression has been used to explore the relationship between dependent and independent variables, while multivariate logistic regression used to investigate m ajor contributing factors at a 5% (P 0.05) level of significance. The data was presented in a textual and diagrammatic format utilizing pie charts and tables. Results: The study has shown that, a total of 162 different expired medicine that estimated to cost more than twenty million birr (= 20,538,198.93 ETB) in monetary value, and the percentage of expired medicine was 5% during the previous two fiscal years (2012 up to 2013). The largest percentage (20%) of expired drugs was tetanus antitoxin (TAT), equine 1,500 IU/ml in 1ml ampoule. Furthermore, 239,801 unit packets containing various classes of medications and dosage forms was observed in western Ethiopia's public pharmaceutical supply chain. v This study also revealed the most expensive class of expired medicines were liquid dosage form, which cost 11,614,266.11 ETB (57 %), and vaccines, which cost 5,729,098.86 ETB (28 %). The majority of the public pharmaceutical supply chain 45 (75 %) contained more than two percent expired medications. This study analyzed the size of expired drug by supply chain level, with EPSA (n=2), hospitals (n=8), and health centers (n=50) accounting for 95%, 3%, and 2% of total expired cost, respectively. Furthermore, no scheduled for procurement (COR: 4.333, 95% CI: 1.13, 16.612), poor store management (COR: 10.706, 95% CI: 2148, 53.348), an outdated essential drug list (COR: 3, 95% CI: 4.23, 36.47), and poor accountability of store manager (COR: 4, 95% CI: 1.164, 13.74) were significantly associated with the magnitude of expired medicine. Multivariate logistic regression is used to explore major contributing factors to the magnitude of expired medicine, as poor store management (AOR: 9.718, 95 % CI: 1.474, 64.082). The interviewers mentioned contributing factors to the magnitude of expired medicine as delivery of short shelf life, poor turnover, poor forecasting during procurement, and poor quantification during selection. Furthermore, avoid delivering short half-life products and implement inventory management as possible intervention mechanisms to reduce the extent of expired medicine. Conclusion and Recommendation: The study found a large amount of expired medicine in western Ethiopia's public pharmaceutical supply chain. Several causes contribute to this problem, including unplanned procurement, an outdated essential medicine list, and poor store manager accountability, with poor store management being the most significant contributor. The presence of expired medicine due to short shelf life delivery, poor turnover, poor forecasting during procurement, and poor quantification during selection are also revealed from the qualitative part of the study. To improve the situation, all pharmaceutical supply chains must implement robust inventory management, an updated essential drug list, and a use schedule during procurement to reduce the high magnitude of expired medicine.