Prevalence and determinants of unused medicines among households in Ethiopia: A systematic review and meta-analysis

Abstract

Background

Unused medicines present significant public health, environmental risks and economic challenges. Understanding their prevalence and determinants is crucial for designing appropriate interventions. This systematic review and meta-analysis aimed to estimate the pooled prevalence and determinants of unused medicines among households in Ethiopia.

Method

A comprehensive search was conducted across major databases, including Scopus, Science Direct, Embase, PubMed/MEDLINE, Google Scholar, and Research Gate, to identify relevant studies published up to January 10, 2025. Eligible studies reporting the prevalence and determinants of unused medicines in Ethiopian households were included. Data were extracted via a Microsoft Excel spreadsheet and analyzed using STATA version 11.0, applying a random-effects model to estimate the pooled prevalence and account for heterogeneity. Subgroup and sensitivity analyses were performed to explore variations across studies.

Result

A total of 12 studies involving 6123 households were included. The pooled prevalence of unused medicines was estimated at 44.34 % (95 % CI: 32.83, 55.84), with substantial heterogeneity among studies (I² = 99.0 %, p value =0.000). Subgroup analyses revealed higher prevalence rates in urban households at 47.8 % compared to rural households at 26.89 % and regional disparities. Antibiotics were the most frequently unused class of medications, accounting for 31.49 % of all unused medicines in households, followed by analgesics at 26.14 %, while antacids constituted 8.7 %. The primary reasons for the accumulation of unused medicines included self-discontinuation upon symptom relief at 34.21 %, while anticipation of future use constitute 20.47 %. Factors such as self-medication with NSAIDs, acquisition of medications without prescriptions, and higher household income were significantly associated with the prevalence of unused medicines among households in Ethiopia.

Conclusion

This systematic review and meta-analysis revealed that unused medicines among households in Ethiopian was prevalent, with significant regional variations. Antibiotics were the most commonly unused medications, followed by analgesics, while cardiovascular medicines and dietary supplements were the least reported. The primary reasons for the accumulation of unused medicines included self-discontinuation upon symptom relief, and anticipation of future use. Key determinants such as self-medication with NSAIDs, acquisition of medications without prescriptions, and higher household income were significantly associated with the prevalence of unused medicines. These findings underscore the need for context specific interventions to address the high prevalence of unused medicines in Ethiopia, particularly in urban settings and regions with higher rates.