Computational Analysis of Knowledge, Risk Perception, and Disposal Practice of Unused and Expired Medication among Generation Z in Three sub-Saharan African Countries
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Abstract Background : Knowledge, risk perception, and disposal practices (KPP) of unused and expired medicines (UEMs) among Generation Z (young adults) remain an under-researched field. This study aims to investigate these to provide interventions backed up by solid evidence. Methods : A cross-sectional study was conducted with young adults across three major sub-Saharan African countries: Ethiopia, Nigeria, and Tanzania, receiving a structured questionnaire distributed on Google Forms. Computational statistics was carried out to explore sociodemographic characteristics and their association with KPP using SPSS version 24.0, while p-values < 0.05 were considered statistically significant. Results : A total of 684 respondents (575 young adults, Mean age = 22±2.93 years) completed the survey. KPP scores were 75.65%, 28.69%, and 59.30%, respectively. Knowledge was highest in Nigeria (76.33%), followed by Ethiopia (75.00%), and Tanzania (68.75%). Risk perception was fair, while disposal practice was poor in all countries, but poorest in Tanzania (25%). Knowledge was associated with risk perception and disposal practice (p = 0.01 and 0.03, respectively), but risk perception was not associated with disposal practice (p = 0.329). Residency was a predictor of risk perception; participants in tertiary institutions were four times [Odds Ratio (OR = 4.09; 95% CI, 2.11-7.92)] more knowledgeable than their secondary school counterparts. Conclusion : Having demonstrated high knowledge of what UEMs are, there still exists a disposal practice and risk perception gap in Generation Z. Addressing the predictors is crucial to effectively preventing the future health threat of pharmaceutical waste in these countries.
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Ibirogba, Ebsitu H. Abate, Muganyizi Bisheko, Abdullahi Salhudeen, and 7 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7328819/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 31 Mar, 2026 Read the published version in Discover Public Health → Version 1 posted 12 You are reading this latest preprint version Abstract Background : Knowledge, risk perception, and disposal practices (KPP) of unused and expired medicines (UEMs) among Generation Z (young adults) remain an under-researched field. This study aims to investigate these to provide interventions backed up by solid evidence. Methods : A cross-sectional study was conducted with young adults across three major sub-Saharan African countries: Ethiopia, Nigeria, and Tanzania, receiving a structured questionnaire distributed on Google Forms. Computational statistics was carried out to explore sociodemographic characteristics and their association with KPP using SPSS version 24.0, while p-values < 0.05 were considered statistically significant. Results : A total of 684 respondents (575 young adults, Mean age = 22±2.93 years) completed the survey. KPP scores were 75.65%, 28.69%, and 59.30%, respectively. Knowledge was highest in Nigeria (76.33%), followed by Ethiopia (75.00%), and Tanzania (68.75%). Risk perception was fair, while disposal practice was poor in all countries, but poorest in Tanzania (25%). Knowledge was associated with risk perception and disposal practice (p = 0.01 and 0.03, respectively), but risk perception was not associated with disposal practice (p = 0.329). Residency was a predictor of risk perception; participants in tertiary institutions were four times [Odds Ratio (OR = 4.09; 95% CI, 2.11-7.92)] more knowledgeable than their secondary school counterparts. Conclusion : Having demonstrated high knowledge of what UEMs are, there still exists a disposal practice and risk perception gap in Generation Z. Addressing the predictors is crucial to effectively preventing the future health threat of pharmaceutical waste in these countries. Computational Analysis Pharmaceutical Waste Knowledge Risk Perception Disposal Practices Statistics Figures Figure 1 1.0 Introduction Every year, the production of pharmaceutical products increases (Rogowska and Zimmermann, 2022 ; Akintola & Ayankunle, 2023 ). However, consumption has been very low, increasing the volumes of expired and unused medications. This differential, together with poor disposal practices, has increased the environmental load of toxins (Ayele and Mamu, 2018 ). Leakage of dangerous chemicals and compounds into the environment has resulted in the pollution of water sources, death of wildlife and humans (Kümmerer, 2009 ; Paut Kusturica et al.,2017; Rogowska and Zimmermann., 2022), posing a threat to public and global health (Ayeleru et al., 2023 ) At the root of the accumulation of unused and expired medicines are factors like the discontinuation of medicine due to side effects, lack of attention, dosage adjustment, drugs nearing the expiration date, use as a reserve, and death of the patient. (Makki et al.,2019; Rogowska and Zimmermann., 2022). According to WHO reports, improper prescription, dispensing, and selling account for about 50% of medicines (Ofori-Asenso et al.,2016). To achieve SDG goals, especially SDG 3 (Good health and well-being), and 6 (Clean water and sanitation), creating awareness, positive attitude, and appropriate practice toward drug disposal is key. Developed countries like Australia and Canada have adopted initiatives like the National Return and Disposal of Unwanted Medicines Project, while the United Kingdom and Sweden implemented the drug take-back program (Persson et al.,2009; Tong et al.,2011). In contrast, developing countries have no guidelines for drug disposal at the household level except for the drug disposal units, including health centers and community pharmacies. In sub-Saharan countries like Ethiopia, Nigeria, and Tanzania, there is no policy supporting the creation of awareness and disposal mechanisms at the community level. The World Health Organization (WHO) has recommended protocols such as flushing of liquid pharmaceuticals into sewers in small quantities over time, opening uncontrolled non-engineered dumps and engineered landfills after immobilization by inertization or encapsulation, and returning the drugs to the pharmacy or manufacturer (Okoro and Peter, 2020 ). Unfortunately, this law does not consider disposal at the household level (Marwa et al., 2021 ). While some studies may have assessed the knowledge, practice, and attitude of drug disposal in Ethiopia, Nigeria, and Tanzania in different demographics, evidence assessing the knowledge, practice, and attitude of proper disposal of unused and expired drugs among young adults, including Generation Z (including age range from 14–28) remains elusive. This study, therefore, investigates the level of knowledge, prevalent disposal practices, and perception towards drug disposal while also shedding light on the strategy adopted by all three countries under study. The implication of this extends to the development of research-informed interventions that are bespoke towards young adults, and also an input for the assessment of progress on Sustainable Development Goals. 2.0 Methods 2.1 Study Area Three major sub-Saharan African countries, Nigeria, Ethiopia, and Tanzania, were studied (see Figure 1). Study Design and Sample Size This study is a descriptive cross-sectional study and was carried out from January to March 2024. Sample size was calculated with OpenEpi version 3.0 (Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA), to be 684, with a margin of error of 5%, a confidence level of 99%. Sampling Technique Convenient sampling was used. A structured self-administered questionnaire was distributed to young adults across the three major sub-Saharan African countries: Ethiopia, Nigeria, and Tanzania via online platforms on Google Forms. The forms automatically leads participants who will not consent to submit. Inclusion and Exclusion Criteria Participants older than the Gen Z age range (14-28 years) were excluded from the study. Validity and Reliability of Data Collection Instrument The questionnaire used in this study was modified from Gidey et al., (2020) and was prepared in English language. Section 1 has information on socio-demographic characteristics. Knowledge of Unused and expired Medicines was tested in section 2, while section 3 investigates the risk perception of unused/expired medicines. In section 4, we asked questions about the disposal practices of respondents on unused/expired medicines Statistical Analysis Sorting and coding were done before analysis using the Statistical Package for the Social Sciences (SPSS) version 24. This was followed by descriptive statistics, including frequency and percentage (see Table 1). Knowledge, Practice, Perception (KPP) scores were tested against sociodemographic factors using inferential statistics such as Chi-square tests and logistic regression. p < 0.05 was considered statistically significant (see Table 2-6). 3.0 Results and Discussion This study reveals a significant finding: A considerable proportion of Generation Z individuals in each country (ranging from 71.88% to 76.57%) reported awareness regarding medication waste, mirroring similar observations noted in a prior study, albeit conducted within the broader community of eastern Harar, Ethiopia (Ayele & Mamu, 2018). Another notable trend among this demographic was a high percentage (ranging from 81.25% to 90.18%) demonstrating the practice of checking expiration dates, and a robust understanding (ranging from 83.53% to 96.80%) of the adverse effects associated with improper disposal of unused medications (refer Table 2). In contrast, studies focusing on the adult population have revealed a tendency to retain expired drugs at home for potential future use, irrespective of expiration dates (Kumar et al., 2013; Dayom et al., 2014; Kusturica et al., 2016; Kahsay et al., 2020; Althagafi et al., 2022). This generational difference might be attributed to increasing knowledge about the side effects of expired drugs to consumers as well as to the environment. Moreover, an overwhelming consensus among four out of every five responding young adults (79.82%), favored the crucial need for guidance on proper drug disposal methods. This opinion was shared across Ethiopia (90.18%), Nigeria (77.26%), and Tanzania (78.13%). Additionally, approximately two-thirds of these individuals recommended prescribing medications in controlled quantities and for the required duration to ensure patient compliance. Again, we saw this suggestion being echoed across respondents from Ethiopia (63.39%), Nigeria (63.34%), and Tanzania (65.63%). Furthermore, a staggering 90% of this demographic proposed enhancing awareness about proper disposal methods through over-the-counter education at pharmacy stores, while 67% suggested utilizing mass media channels for dissemination. Other suggestions included dose dispensing and facilitating medication returns to pharmacies (see Table 2). All of these agree with previous studies conducted in Adigrat and Harar, Ethiopia where 72% and 68.6 % (respectively) of respondents advocated for guidance provision (Ayele, and Mamu; 2018; Kahsay et al, 2020) but different from a study carried out in Karachi city which showed only 33% suggests giving guidance Labu et al.,2013). This disparity might be due to population-based levels of awareness resulting from the varying efforts of health workers and stakeholders in disseminating information on the proper mechanism of drug disposal and its advantages. About half of the respondents (ranging from 50% to 62%) discard unused and expired medicines in household garbage, a reduced portion (ranging from 16% to 28%) admitted to disposing them in toilets or sinks. These practices were further underscored by two-thirds of the respondents exhibiting poor drug disposal practices (Ethiopia: 64%, Nigeria: 73%, Tanzania: 75%), an observation shared with findings from adult-based studies conducted in different regions (Ofori-Asenso et al.,2016). In Lagos State Nigeria for example, evidence showed that 19.3% of respondents disposed expired medications by flushing them down the sink while majority (62.4%) threw them away in household trash (Adedeji-Adenola et al., 2022). Similarly, in Malaysia, a study found that 63.6% of participants disposed medications in toilets and water sinks (Ong et al., 2020). Conversely, in Adigrat, Ethiopia, Kahsay et al, showed that 75.2% of respondents disposed unused and expired drugs in household trash, while only 15% chose to flush them down the toilet (Kahsay et al., 2020). This variation could either result from a limited understanding of appropriate drug disposal methods or due to availability of trashcans in these communities. Additionally, adults may choose to flush medications down the toilet as a precautionary measure to safeguard children and prevent environmental contamination. These behaviors, however, were not specific to young adults. Regarding perception, around half of the participants alluded to the inherent health risk of unsafe drug disposal at home, particularly for children. The lack of adequate information on safe disposal was also confirmed by over 80% of this demographic. Respondents (42%) also suggested that the creation of awareness by doctors and other health officers over the counter would be a step in the right direction towards bringing a good perception of proper drug disposal. Moreover, 75% of participants recommended the implementation of take-back programs in the community (refer Table 3). This is consistent with population-based studies done in India, Nigeria, and Mizan-Aman; Southwest Ethiopia (Swaroop et al., 2015; Adedeji-Adenola et al., 2022; Feyissa and Siraj, 2022). Additionally, participants' residency, educational status, and knowledge are significantly associated with the perception status, as reflected in logistic regression analysis (see Table 7). Accordingly, participants with tertiary education had 4.09 (OR= 4.09; 95% CI, 2.11-7.92, p<0.001) better perception than those with secondary level education while urban residents had 1.47 times better perception (OR = 1.47; 95% CI, 0.98-2.19, p=0.06) than the rural resident respondents (see Table 7) This might be an indicator of the gap of awareness at different educational levels and groups of society. It therefore becomes pertinent that developing strategies and policies that encourage the dissemination of the information regarding disposal of unused and expired drugs would be helpful to have a well-rounded change. In comparative terms, knowledge scores were significantly high across the three countries, averaging 75.65%. Notably, young adults from Nigeria demonstrated the highest knowledge levels at 76.33%, followed by Ethiopia at 75.00% and Tanzania at 68.75%. Despite this, risk perception provided more varied results. While the mean risk perception score across the three countries stood at 59.30%, Nigeria ranked the highest at 60.09%, followed closely by Ethiopia at 59.82%, with Tanzania trailing at 46.88%. However, regarding good disposal practices, scores were low in all three countries, with a cumulative average score of only 28.69%. Ethiopia demonstrated comparatively better practices at 35.71%, followed by Nigeria at 27.15%, and Tanzania at 25.00%. Consequently, there is a critical need to prioritize interventions aimed at improving both the perception and practice of pharmaceutical product disposal within these regions. Table 1: Socio-demographic Characteristics of Participants (N=684) Variables Total (N) Ethiopia Nigeria Tanzania Age 14-28 575 (84.10) 112 (90.30) 431 (82.90) 32 (80.00) >28 109 (15.90) 12 (9.70) 89(7.10) 8 (20.00) Generation Zs (14-28 years: N = 575) 112 (90.30) 431 (82.90) 32 (80.00) Gender Female 337(58.6) 84 (75.0) 239 (55.5) 14 (43.8) Male 234(40.7) 27 (24.1) 189 (43.9) 18 (56.2) Prefer not to say 4(0.7) 1 (0.9) 3 (0.6) 0 (0.00) Marital Status Single 546(94.93) 109 (97.32) 413 (95.2) 24 (75) Married 28(4.87) 3 (2.68) 18(4.18) 7(21.87) Divorced 1(0.2) 0 (0.00) 0 (0.00) 1 (3.13) Residency Urban 439(76.34) 101 (90.18) 313 (72.62) 25 (78.12) Rural 136(23.66) 11 (9.82) 118 (27.38) 7 (21.88) Education Status Tertiary (University and College) 536 (93.22) 111 (99.11) 396 (91.88) 29(90.62) Secondary 39(6.78) 1 (0.89) 35 (8.12) 3 (9.38) Employment Status Unemployed 430(77.78) 106 (94.64) 299 (69.37) 25 (78.12) Employed 145(25.22) 6 (5.36) 132 (30.63) 7 (21.88) Media Exposure Frequently 383(66.61) 61 (54.46) 306 (70.99) 16 (50.00) Rarely 138(24.00) 29 (25.99) 97 (22.52) 12 (37.5) No Exposure 54(9.39) 22 (19.65) 28 (6.49) 4 (12.5) Type of Water Status Improved Water Source 522 (90.78) 100 (89.29) 393 (91.18) 29 (90.63) Unimproved Water Source 53 (9.22) 12 (10.71) 38(8.82) 3 (9.37) Sanitation Type Status Unimproved Sanitation 442 (76.87) 74(66.07) 347 (80.51) 21 (65.62) Improved Sanitation 133 (23.13) 38 (33.93) 84 (19.49) 11 (34.38) Table 3: Participants’ responses to Perception items (*An asterisk indicates a correct answer). Perception questions Strongly* agree Agree* Neutral Disagree Strongly disagree Unused medicines present potential risks at home? 207 (36.00) 245(46.61) 70(12.17) 34 (5.91) 19 (3.3) There is a lack of adequate information on safe disposal of unused medicine 237 (41.22) 253 (44.00) 38 (6.61) 14 (2.4) 33 (5.74) Children are more vulnerable to the risks associated with unused and expired household medicines 255 (44.35) 238 (41.39) 36 (6.26) 9 (1.56) 37 (6.43) Doctors and healthcare professionals do provide advice on safe disposal of unused and expired household medicines 82 (14.26) 161 (28.00) 115 (20.00) 142 (24.69) 75 (13.04) Take-back programs for unused and expired medicines should be mandatory 140 (24.34) 293 (50.96) 88 (15.30) 20 (3.48) 34 (5.91) Outreach and awareness programs about how to dispose of unused or expired medicines should be initiated 271 (47.13) 235 (40.87) 33 (5.74) 9 (1.56) 27 (4.69) Table 4: Chi-Square Analysis for Socio-demographic factors and Knowledge Status Variables Knowledge Status p-values Good Knowledge n (%) Poor Knowledge n (%) Gender Female 249 (73.9) 88 (26.1) 0.497 Male 183 (78.2) 51 (21.8) Residence Type Rural 100 (73.5) 36 (26.5) 0.29 Urban 335 (76.3) 104 (23.7) Marital Status Single 410 (75.1) 136 (24.9) 0.376 Married 24 (85.7) 4 (14.3) Educational Status Tertiary 417 (77.8) 119 (22.2) <0.001* Secondary 18 (46.2) 21 (53.8) Table 5: Chi-Square Analysis for Socio-demographic factors and Disposal Practices Variables Disposal Practices p-values Good Practice n (%) Poor Practice n (%) Gender Female 93 (27.6) 244 (72.4) 0.765 Male 71 (30.3) 163 (69.7) Residence Type Rural 39 (28.7) 97 (71.3) 0.544 Urban 126 (28.7) 313 (71.3) Marital Status Single 160 (29.3) 386 (70.7) 0.376 Married 5 (17.9) 23 (82.1) Educational Status Tertiary 157 (29.3) 379 (70.7) 0.162 Secondary 8 (20.5) 31 (79.5) Table 6: Chi-Square Analysis for Socio-demographic factors and Risk Perception Variables Perception Status p-values Good Perception n (%) Poor Perception n (%) Gender Female 197 (58.5) 140 (41.5) 0.306 Male 143 (61.1) 91 (38.9) Residence Type Rural 90 (66.2) 46 (33.8) 0.038* Urban 251 (57.2) 188 (42.8) Marital Status Single 325 (59.5) 221 (40.5) 0.467 Married 16 (57.1) 12 (42.9) Educational Status Tertiary 318 (59.3) 218 (40.7) 0.546 Secondary 23 (59.0) 16 (41.0) Table 7: Logistic Regression Model for Knowledge and Perception Status Variables Adjusted Odds Ratio 95% C.I. p-value Lower Upper Education Status X Knowledge Status Tertiary 4.09 2.109 7.923 <0.001 Secondary REF 1 Residency X Perception Status Urban 1.47 0.98 2.19 0.06 Rural REF 1 4.0 Limitations, Conclusions and Recommendations While the study provides valuable insights into the knowledge, risk perception, and disposal practices of Generation Z regarding unused and expired medication in Sub-Saharan Africa, the study's scope is limited to three specific countries, and factors such as cultural differences, socioeconomic disparities, and healthcare infrastructure variations within and across other Sub-Saharan African nations may influence differently. Another limitation is the reliance on self-reported data which allows for social desirability bias especially among this demographic. Future research should consider incorporating medication tracking devices or environmental assessments, as well as expanding the sample size and geographical coverage. The findings of this study underpin risk perception and disposal practices of UEMS as a pressing sub-Saharan health issue, specifically among Gen Zs. These can be addressed by incentivizing proper disposal practices starting from secondary school levels and extending to rural residents. Take-back programs should also be initiated in the studied region. These are crucial to controlling and effectively preventing the future health threat of pharmaceutical waste in these countries. Initiatives should be implemented to increase public awareness about proper disposal methods, with a focus on educational campaigns in pharmacy stores and utilizing mass media channels for awareness dissemination. Efforts should then be made to encourage the adoption of dose dispensing practices and facilitate medication returns to pharmacies, thereby promoting safe medication management and disposal practices throughout the community. Abbreviations UEMs – unused and expired medicines KPP - Knowledge, risk perception, and disposal practices SDG – Sustainable development goals WHO – World Health Organization CDC - Centers for Disease Control and Prevention OR – Odds Ratio CI – Confidence Interval Declarations Ethics Approval: The study received approval number NHREC/OYOSHRIEC/10/11/22 from the Ministry of Health, Department of Planning, Research, and Statistics Division, Oyo State, Nigeria. Consent to Participate : Written informed consent was obtained from all subjects and/or their legal guardian(s) to take part in the study. Respondents who did not consent were prompted to submit and were automatically excluded from the study. Consent to Publish : Participants and/or their legal guardian(s) were informed that their digital identifiers were not collected in the form, while disseminating and publishing results publicly to policymakers. Please refer to the data link shared at (https://forms.gle/bK7w2nWapeji2Yqs7) Availability of Data and Materials: The datasets used and/or analyzed during the current study available from the corresponding author on reasonable request Clinical trial number : not applicable Conflict of Interest : None Funding : This study was self-funded. Authorship Damilola A. Ibirogba and Ebsitu Abate conceived and designed the study, acquired the data, analyzed the data, and drafted the article; Abdullahi Abdulraheem Salahudeen, Ibrahim Sulaiman Egyegini, Olukogbe Oluwagbemisola Oyin, and Oluwatobi Esther Adelaja acquired the data and drafted the article; Damilola A. Ibirogba, Muganyizi Jonas Bisheko, and Oyepeju Folashade Abioye revised the drafts and assisted with graphical designs, and Abdisa Tufa Bedada, Chibuzor Success Udoji & Ayooluwa Tomiwa Akintola further revised the drafts. All authors approved the final submitted version. Acknowledgments We would love to acknowledge the Ministry of Health, Department of Planning, Research, and Statistics Division, Oyo State, Nigeria, for giving us approval for the study and all our participants for providing their consent for the study. All methods were carried out following relevant guidelines and regulations. References Akintola AT, Ayankunle AY. Improving pharmaceuticals removal at wastewater treatment plants using biochar: A review. Waste Biomass Valoriz. 2023;14(8):2433–58. Ayele Y, Mamu M. Assessment of knowledge, attitude and practice towards disposal of unused and expired pharmaceuticals among community in Harar city, Eastern Ethiopia. J Pharm Policy Pract. 2018;11:1–7. 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Household survey on rational use of medicines in India. Int J Pharm Ther. 2013;4(1):59–69. Enato D, Mantim E, N. and, Dangiwa D. Expired and leftover medicines in the home: potentials for accidental drug poisoning in children. Int J Pharm Ther. 2014;5(4):283–8. Kusturica MP, Tomas A, Tomic Z, Bukumiric D, Corac A, Horvat O, Sabo A. Analysis of expired medications in Serbian households. Slovenian J Public Health. 2016;55(3):195–201. Althagafi A, Alshibani M, Alshehri S, Noor A, Baglagel A, Almeleebia T. Assessment of knowledge and awareness of safe disposal of unused or expired medication in Saudi Arabia: A cross-sectional study. Saudi Pharm J. 2022;30(11):1672–8. Kahsay H, Ahmedin M, Kebede B, Gebrezihar K, Araya H, Tesfay D. 2020. Assessment of knowledge, attitude, and disposal practice of unused and expired pharmaceuticals in community of Adigrat City, Northern Ethiopia. Journal of environmental and public health , 2020 . Adedeji-Adenola H, Adesina A, Obon M, Onedo T, Okafor GU, Longe M, Oyawole M. (2022). Knowledge, perception, and practice of pharmaceutical waste disposal among the public in Lagos State, Nigeria. The Pan African medical journal, 42, 106. https://doi.org/10.11604/pamj.2022.42.106.34529 Table Table 2 is available in the Supplementary Files section. Additional Declarations No competing interests reported. Supplementary Files GraphicalAbstractDPH.png Table2.docx Cite Share Download PDF Status: Published Journal Publication published 31 Mar, 2026 Read the published version in Discover Public Health → Version 1 posted Editorial decision: Revision requested 05 Nov, 2025 Reviews received at journal 05 Nov, 2025 Reviews received at journal 15 Oct, 2025 Reviewers agreed at journal 09 Oct, 2025 Reviews received at journal 08 Oct, 2025 Reviewers agreed at journal 28 Sep, 2025 Reviewers agreed at journal 15 Sep, 2025 Reviewers invited by journal 15 Sep, 2025 Editor assigned by journal 15 Sep, 2025 Editor invited by journal 29 Aug, 2025 Submission checks completed at journal 26 Aug, 2025 First submitted to journal 26 Aug, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Abate","email":"","orcid":"","institution":"Addis Ababa University","correspondingAuthor":false,"prefix":"","firstName":"Ebsitu","middleName":"H.","lastName":"Abate","suffix":""},{"id":516271433,"identity":"29a791fd-7c3d-49d7-a8cc-7c60b44ea723","order_by":2,"name":"Muganyizi Bisheko","email":"","orcid":"","institution":"Amrita School for Sustainable Futures (ASF), Amrita Vishwa Vidyapeetham University","correspondingAuthor":false,"prefix":"","firstName":"Muganyizi","middleName":"","lastName":"Bisheko","suffix":""},{"id":516271434,"identity":"7f1d2c29-44bf-4db4-9a0d-abc13da19b21","order_by":3,"name":"Abdullahi Salhudeen","email":"","orcid":"","institution":"Usmanu Danfodiyo University","correspondingAuthor":false,"prefix":"","firstName":"Abdullahi","middleName":"","lastName":"Salhudeen","suffix":""},{"id":516271435,"identity":"e5d2e247-8bc1-41e5-aab7-7186548beac3","order_by":4,"name":"Ibrahim Egyegini","email":"","orcid":"","institution":"Bauchi State University","correspondingAuthor":false,"prefix":"","firstName":"Ibrahim","middleName":"","lastName":"Egyegini","suffix":""},{"id":516271436,"identity":"63068c63-1e34-4a20-9908-098aca0e5c09","order_by":5,"name":"Oluwagbemisola Olukogbe","email":"","orcid":"","institution":"University of Ibadan","correspondingAuthor":false,"prefix":"","firstName":"Oluwagbemisola","middleName":"","lastName":"Olukogbe","suffix":""},{"id":516271437,"identity":"58576893-f006-43f8-bc82-3b2d9d4fb9d8","order_by":6,"name":"Oluwatobi Esther Adelaja","email":"","orcid":"","institution":"Lagos State University Teaching Hospital","correspondingAuthor":false,"prefix":"","firstName":"Oluwatobi","middleName":"Esther","lastName":"Adelaja","suffix":""},{"id":516271438,"identity":"19b8f7ee-3e2c-4152-b4ab-e2431a055a6c","order_by":7,"name":"Chibuzor Udoji","email":"","orcid":"","institution":"Redeemer Health Center","correspondingAuthor":false,"prefix":"","firstName":"Chibuzor","middleName":"","lastName":"Udoji","suffix":""},{"id":516271439,"identity":"72c6e15c-fede-4ea0-a025-b436f7366af4","order_by":8,"name":"Oyepeju Folashade Abioye","email":"","orcid":"","institution":"AHN Allegheny General","correspondingAuthor":false,"prefix":"","firstName":"Oyepeju","middleName":"Folashade","lastName":"Abioye","suffix":""},{"id":516271440,"identity":"38e204cf-72c0-4ef1-b446-e0a7f9f7b363","order_by":9,"name":"Abdisa Tufa Bedada","email":"","orcid":"","institution":"Addis Ababa University","correspondingAuthor":false,"prefix":"","firstName":"Abdisa","middleName":"Tufa","lastName":"Bedada","suffix":""},{"id":516271441,"identity":"8ed3818c-4e89-4be0-9a93-2158d9d99ef4","order_by":10,"name":"Ayooluwa T. 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08:03:04","extension":"html","order_by":14,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":124851,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7328819/v1/0fdee5363d8bd92deaaa3b7d.html"},{"id":91960450,"identity":"d2ef4876-3ddb-4872-bee9-47b9bac1f3f3","added_by":"auto","created_at":"2025-09-23 07:47:04","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":53257,"visible":true,"origin":"","legend":"\u003cp\u003eThe three major sub-Saharan African countries, Nigeria, Ethiopia, and Tanzania, under study\u003c/p\u003e","description":"","filename":"Figure1DPH.png","url":"https://assets-eu.researchsquare.com/files/rs-7328819/v1/6d5b04cbfd8494b28eeac555.png"},{"id":106344352,"identity":"f72d609e-7e94-4c0c-a04e-7eb10fc024b9","added_by":"auto","created_at":"2026-04-07 16:13:44","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1143095,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7328819/v1/09b5ea0b-8db0-446b-a07b-a2250a06666b.pdf"},{"id":91960449,"identity":"cd6c2d06-ff19-417d-b265-83a864094467","added_by":"auto","created_at":"2025-09-23 07:47:04","extension":"png","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":65045,"visible":true,"origin":"","legend":"","description":"","filename":"GraphicalAbstractDPH.png","url":"https://assets-eu.researchsquare.com/files/rs-7328819/v1/976c801a9e2a65678ef7b87e.png"},{"id":91962441,"identity":"c7640079-f4d7-4c62-a3fe-b162dbf59509","added_by":"auto","created_at":"2025-09-23 07:55:04","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":23407,"visible":true,"origin":"","legend":"","description":"","filename":"Table2.docx","url":"https://assets-eu.researchsquare.com/files/rs-7328819/v1/138616958321f5b0a27f607d.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Computational Analysis of Knowledge, Risk Perception, and Disposal Practice of Unused and Expired Medication among Generation Z in Three sub-Saharan African Countries","fulltext":[{"header":"1.0 Introduction","content":"\u003cp\u003eEvery year, the production of pharmaceutical products increases (Rogowska and Zimmermann, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Akintola \u0026amp; Ayankunle, \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). However, consumption has been very low, increasing the volumes of expired and unused medications. This differential, together with poor disposal practices, has increased the environmental load of toxins (Ayele and Mamu, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). Leakage of dangerous chemicals and compounds into the environment has resulted in the pollution of water sources, death of wildlife and humans (K\u0026uuml;mmerer, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2009\u003c/span\u003e; Paut Kusturica et al.,2017; Rogowska and Zimmermann., 2022), posing a threat to public and global health (Ayeleru et al., \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2023\u003c/span\u003e) At the root of the accumulation of unused and expired medicines are factors like the discontinuation of medicine due to side effects, lack of attention, dosage adjustment, drugs nearing the expiration date, use as a reserve, and death of the patient. (Makki et al.,2019; Rogowska and Zimmermann., 2022). According to WHO reports, improper prescription, dispensing, and selling account for about 50% of medicines (Ofori-Asenso et al.,2016). To achieve SDG goals, especially SDG 3 (Good health and well-being), and 6 (Clean water and sanitation), creating awareness, positive attitude, and appropriate practice toward drug disposal is key. Developed countries like Australia and Canada have adopted initiatives like the National Return and Disposal of Unwanted Medicines Project, while the United Kingdom and Sweden implemented the drug take-back program (Persson et al.,2009; Tong et al.,2011). In contrast, developing countries have no guidelines for drug disposal at the household level except for the drug disposal units, including health centers and community pharmacies. In sub-Saharan countries like Ethiopia, Nigeria, and Tanzania, there is no policy supporting the creation of awareness and disposal mechanisms at the community level.\u003c/p\u003e\u003cp\u003eThe World Health Organization (WHO) has recommended protocols such as flushing of liquid pharmaceuticals into sewers in small quantities over time, opening uncontrolled non-engineered dumps and engineered landfills after immobilization by inertization or encapsulation, and returning the drugs to the pharmacy or manufacturer (Okoro and Peter, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). Unfortunately, this law does not consider disposal at the household level (Marwa et al., \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2021\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eWhile some studies may have assessed the knowledge, practice, and attitude of drug disposal in Ethiopia, Nigeria, and Tanzania in different demographics, evidence assessing the knowledge, practice, and attitude of proper disposal of unused and expired drugs among young adults, including Generation Z (including age range from 14\u0026ndash;28) remains elusive. This study, therefore, investigates the level of knowledge, prevalent disposal practices, and perception towards drug disposal while also shedding light on the strategy adopted by all three countries under study. The implication of this extends to the development of research-informed interventions that are bespoke towards young adults, and also an input for the assessment of progress on Sustainable Development Goals.\u003c/p\u003e"},{"header":"2.0 Methods","content":"\u003cp\u003e\u003cstrong\u003e2.1 Study Area\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThree major sub-Saharan African countries, Nigeria, Ethiopia, and Tanzania, were studied (see \u0026nbsp;Figure 1).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy Design and\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eSample Size\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study is a descriptive cross-sectional study and was carried out from January to March 2024. Sample size was calculated with OpenEpi version 3.0 (Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA), to be 684, with a margin of error of 5%, a confidence level of 99%.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSampling Technique\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConvenient sampling was used. A structured self-administered questionnaire was distributed to young adults across the three major sub-Saharan African countries: Ethiopia, Nigeria, and Tanzania via online platforms on Google Forms. \u0026nbsp; The forms automatically leads participants who will not consent to submit.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInclusion and Exclusion Criteria\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParticipants older than the Gen Z age range (14-28 years) were excluded from the study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eValidity and Reliability of Data Collection Instrument\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe questionnaire used in this study was modified from Gidey et al., (2020) and was prepared in English language. Section 1 has information on socio-demographic characteristics. Knowledge of Unused and expired Medicines was tested in section 2, while section 3 investigates the risk perception of unused/expired medicines. In section 4, we asked questions about the disposal practices of respondents on unused/expired medicines\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSorting and coding were done before analysis using the Statistical Package for the Social Sciences (SPSS) version 24. This was followed by descriptive statistics, including frequency and percentage (see Table 1). Knowledge, Practice, Perception (KPP) scores were tested against sociodemographic factors using inferential statistics such as Chi-square tests and logistic regression. p \u0026lt; 0.05 was considered statistically significant (see Table 2-6).\u003c/p\u003e"},{"header":"3.0 Results and Discussion","content":"\u003cp\u003eThis study reveals a significant finding: A considerable proportion of Generation Z individuals in each country (ranging from 71.88% to 76.57%) reported awareness regarding medication waste, mirroring similar observations noted in a prior study, albeit conducted within the broader community of eastern Harar, Ethiopia (Ayele \u0026amp; Mamu, 2018). Another notable trend among this demographic was a high percentage (ranging from 81.25% to 90.18%) demonstrating the practice of checking expiration dates, and a robust understanding (ranging from 83.53% to 96.80%) of the adverse effects associated with improper disposal of unused medications (refer Table 2). In contrast, studies focusing on the adult population have revealed a tendency to retain expired drugs at home for potential future use, irrespective of expiration dates (Kumar et al., 2013; Dayom et al., 2014; Kusturica et al., 2016; Kahsay et al., 2020; Althagafi et al., 2022). This generational difference might be attributed to increasing knowledge about the side effects of expired drugs to consumers as well as to the environment.\u003c/p\u003e\n\u003cp\u003eMoreover, an overwhelming consensus among four out of every five responding young adults (79.82%), favored the crucial need for guidance on proper drug disposal methods. This opinion was shared across Ethiopia (90.18%), Nigeria (77.26%), and Tanzania (78.13%).\u0026nbsp;Additionally, approximately two-thirds of these individuals recommended prescribing medications in controlled quantities and for the required duration to ensure patient compliance. Again, we saw this suggestion being echoed across respondents from Ethiopia (63.39%), Nigeria (63.34%), and Tanzania (65.63%).\u0026nbsp;Furthermore, a staggering 90% of this demographic proposed enhancing awareness about proper disposal methods through over-the-counter education at pharmacy stores, while 67% suggested utilizing mass media channels for dissemination. Other suggestions included dose dispensing and facilitating medication returns to pharmacies (see Table 2). All of these agree with previous studies conducted in Adigrat and Harar, Ethiopia where 72% and 68.6 % (respectively) of respondents advocated for guidance provision (Ayele, and Mamu; 2018; Kahsay et al, 2020) but different from a study carried out in Karachi city which showed only 33% suggests giving guidance Labu et al.,2013).\u0026nbsp;This disparity might be due to population-based levels of awareness resulting from the varying efforts of health workers and stakeholders in disseminating information on the proper mechanism of drug disposal and its advantages.\u003c/p\u003e\n\u003cp\u003eAbout half of the respondents (ranging from 50% to 62%) discard unused and expired medicines in household garbage,\u0026nbsp;a reduced portion (ranging from 16% to 28%) admitted to disposing them in toilets or sinks. These practices were further underscored by two-thirds of the respondents exhibiting poor drug disposal practices (Ethiopia: 64%, Nigeria: 73%, Tanzania: 75%), an observation shared with findings from adult-based studies conducted in different regions (Ofori-Asenso et al.,2016). In Lagos State Nigeria for example, evidence showed that 19.3% of respondents disposed expired medications by flushing them down the sink while majority (62.4%) threw them away in household trash (Adedeji-Adenola et al., 2022). Similarly, in Malaysia, a study found that 63.6% of participants disposed medications in toilets and water sinks (Ong et al., 2020). Conversely, in Adigrat, Ethiopia, Kahsay et al, showed that 75.2% of respondents disposed unused and expired drugs in household trash, while only 15% chose to flush them down the toilet (Kahsay et al., 2020). This variation could either result from a limited understanding of appropriate drug disposal methods or due to availability of trashcans in these communities. Additionally, adults may choose to flush medications down the toilet as a precautionary measure to safeguard children and prevent environmental contamination. These behaviors, however, were not specific to young adults.\u003c/p\u003e\n\u003cp\u003eRegarding perception, around half of the participants alluded to the inherent health risk of unsafe drug disposal at home, particularly for children. The lack of adequate information on safe disposal was also confirmed by over 80% of this demographic. Respondents (42%) also suggested that the creation of awareness by doctors and other health officers over the counter would be a step in the right direction towards bringing a good perception of proper drug disposal. Moreover, 75% of participants recommended the implementation of take-back programs in the community (refer Table 3). This is consistent with population-based studies done in India, Nigeria, and Mizan-Aman; Southwest Ethiopia (Swaroop et al., 2015;\u0026nbsp;Adedeji-Adenola\u0026nbsp;et al., 2022; Feyissa and Siraj, 2022). Additionally, participants' residency, educational status, and knowledge are significantly associated with the perception status, as reflected in logistic regression analysis (see Table 7). Accordingly, participants with tertiary education had 4.09 (OR= 4.09; 95% CI, 2.11-7.92, p\u0026lt;0.001) better perception than those with secondary level education while urban residents had 1.47 times better perception (OR = 1.47; 95% CI, 0.98-2.19, p=0.06) than the rural resident respondents (see Table 7) This might be an indicator of the gap of awareness at different educational levels and groups of society. It therefore becomes pertinent that developing strategies and policies that encourage the dissemination of the information regarding disposal of unused and expired drugs would be helpful to have a well-rounded change.\u003c/p\u003e\n\u003cp\u003eIn comparative terms, knowledge scores were significantly high across the three countries, averaging 75.65%. Notably, young adults from Nigeria demonstrated the highest knowledge levels at 76.33%, followed by Ethiopia at 75.00% and Tanzania at 68.75%. Despite this, risk perception provided more varied results. While the mean risk perception score across the three countries stood at 59.30%, Nigeria ranked the highest at 60.09%, followed closely by Ethiopia at 59.82%, with Tanzania trailing at 46.88%. However, regarding good disposal practices, scores were low in all three countries, with a cumulative average score of only 28.69%. Ethiopia demonstrated comparatively better practices at 35.71%, followed by Nigeria at 27.15%, and Tanzania at 25.00%.\u0026nbsp;Consequently, there is a critical need to prioritize interventions aimed at improving both the perception and practice of pharmaceutical product disposal within these regions.\u003c/p\u003e\n\u003cp\u003eTable 1: Socio-demographic Characteristics of Participants (N=684)\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"509\"\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal (N)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEthiopia\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNigeria\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTanzania\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003e14-28\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e575 (84.10)\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e112 (90.30)\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e431 (82.90)\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e32 (80.00)\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003e\u0026gt;28\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e109 (15.90)\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e12 (9.70)\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e89(7.10)\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e8 (20.00)\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"5\" style=\"width: 509px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGeneration Zs (14-28 years: N = 575)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e112 (90.30)\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e431 (82.90)\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e32 (80.00)\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e337(58.6)\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e84 (75.0)\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e239 (55.5)\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e14 (43.8)\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e234(40.7)\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e27 (24.1)\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e189 (43.9)\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e18 (56.2)\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003ePrefer not to say\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e4(0.7)\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e1 (0.9)\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e3 (0.6)\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e0 (0.00)\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarital Status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e546(94.93)\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e109 (97.32)\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e413 (95.2)\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e24 (75)\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e28(4.87)\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e3 (2.68)\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e18(4.18)\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e7(21.87)\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003eDivorced\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e1(0.2)\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e0 (0.00)\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e0 (0.00)\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e1 (3.13)\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eResidency\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003eUrban\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e439(76.34)\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e101 (90.18)\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e313 (72.62)\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e25 (78.12)\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003eRural\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e136(23.66)\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e11 (9.82)\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e118 (27.38)\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e7 (21.88)\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducation Status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003eTertiary (University and College)\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e536 (93.22)\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e111 (99.11)\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e396 (91.88)\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e29(90.62)\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003eSecondary\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e39(6.78)\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e1 (0.89)\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e35 (8.12)\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e3 (9.38)\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEmployment Status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003eUnemployed\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e430(77.78)\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e106 (94.64)\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e299 (69.37)\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e25 (78.12)\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003eEmployed\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e145(25.22)\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e6 (5.36)\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e132 (30.63)\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e7 (21.88)\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMedia Exposure\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003eFrequently\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e383(66.61)\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e61 (54.46)\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e306 (70.99)\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e16 (50.00)\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003eRarely\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e138(24.00)\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e29 (25.99)\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e97 (22.52)\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e12 (37.5)\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003eNo Exposure\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e54(9.39)\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e22 (19.65)\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e28 (6.49)\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e4 (12.5)\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eType of Water Status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003eImproved Water Source\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e522 (90.78)\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e100 (89.29)\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e393 (91.18)\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e29 (90.63)\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003eUnimproved Water Source\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e53 (9.22)\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e12 (10.71)\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e38(8.82)\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e3 (9.37)\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSanitation Type Status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003eUnimproved Sanitation\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e442 (76.87)\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e74(66.07)\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e347 (80.51)\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e21 (65.62)\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd style=\"width: 201px;\"\u003e\n \u003cp\u003eImproved Sanitation\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e133 (23.13)\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e38 (33.93)\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e84 (19.49)\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e11 (34.38)\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\n\u003cp\u003eTable 3: Participants’ responses to Perception items (*An asterisk indicates a correct answer).\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"690\"\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd style=\"width: 252px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePerception questions\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eStrongly* agree\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAgree*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNeutral\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDisagree\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eStrongly disagree\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd style=\"width: 252px;\"\u003e\n \u003cp\u003eUnused medicines present potential risks at home?\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e207 (36.00)\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003e245(46.61)\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e70(12.17)\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e34 (5.91)\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e19 (3.3)\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd style=\"width: 252px;\"\u003e\n \u003cp\u003eThere is a lack of adequate information on safe disposal of unused medicine\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e237 (41.22)\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003e253 (44.00)\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e38 (6.61)\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e14 (2.4)\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e33 (5.74)\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd style=\"width: 252px;\"\u003e\n \u003cp\u003eChildren are more vulnerable to the risks associated with unused and expired household medicines\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e255 (44.35)\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003e238 (41.39)\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e36 (6.26)\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e9 (1.56)\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e37 (6.43)\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd style=\"width: 252px;\"\u003e\n \u003cp\u003eDoctors and healthcare professionals do provide advice on safe disposal of unused and expired household medicines\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e82 (14.26)\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003e161 (28.00)\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e115 (20.00)\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e142 (24.69)\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e75 (13.04)\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd style=\"width: 252px;\"\u003e\n \u003cp\u003eTake-back programs for unused and expired medicines should be mandatory\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e140 (24.34)\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003e293 (50.96)\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e88 (15.30)\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e20 (3.48)\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e34 (5.91)\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd style=\"width: 252px;\"\u003e\n \u003cp\u003eOutreach and awareness programs about how to dispose of unused or expired medicines should be initiated\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e271 (47.13)\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003e235 (40.87)\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e33 (5.74)\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e9 (1.56)\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e27 (4.69)\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\n\u003cp\u003eTable 4: Chi-Square Analysis for Socio-demographic factors and Knowledge Status\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"624\"\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\u003ctd colspan=\"2\" valign=\"top\" style=\"width: 391px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eKnowledge Status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-values\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003eGood Knowledge n (%)\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003ePoor Knowledge n (%)\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003e249 (73.9)\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e88 (26.1)\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e0.497\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003e183 (78.2)\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e51 (21.8)\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eResidence Type\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003eRural\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003e100 (73.5)\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e36 (26.5)\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e0.29\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003eUrban\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003e335 (76.3)\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e104 (23.7)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarital Status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003e410 (75.1)\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e136 (24.9)\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e0.376\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003e24 (85.7)\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e4 (14.3)\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003eEducational Status\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003eTertiary\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003e417 (77.8)\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e119 (22.2)\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003eSecondary\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003e18 (46.2)\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e21 (53.8)\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\n\u003cp\u003eTable 5: Chi-Square Analysis for Socio-demographic factors and Disposal Practices\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"624\"\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\u003ctd colspan=\"2\" valign=\"top\" style=\"width: 391px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDisposal Practices\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-values\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003eGood Practice n (%)\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003ePoor Practice n (%)\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003e93 (27.6)\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e244 (72.4)\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e0.765\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003e71 (30.3)\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e163 (69.7)\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eResidence Type\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003eRural\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003e39 (28.7)\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e97 (71.3)\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e0.544\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003eUrban\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003e126 (28.7)\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e313 (71.3)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarital Status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003e160 (29.3)\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e386 (70.7)\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e0.376\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003e5 (17.9)\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e23 (82.1)\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducational Status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003eTertiary\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003e157 (29.3)\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e379 (70.7)\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e0.162\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003eSecondary\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003e8 (20.5)\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e31 (79.5)\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\n\u003cp\u003eTable 6: Chi-Square Analysis for Socio-demographic factors and Risk Perception\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"624\"\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\u003ctd colspan=\"2\" valign=\"top\" style=\"width: 391px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePerception Status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-values\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003eGood Perception n (%)\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003ePoor Perception n (%)\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003e197 (58.5)\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e140 (41.5)\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e0.306\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003e143 (61.1)\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e91 (38.9)\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eResidence Type\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003eRural\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003e90 (66.2)\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e46 (33.8)\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.038*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003eUrban\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003e251 (57.2)\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e188 (42.8)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarital Status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003e325 (59.5)\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e221 (40.5)\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e0.467\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003e16 (57.1)\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e12 (42.9)\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducational Status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003eTertiary\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003e318 (59.3)\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e218 (40.7)\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e0.546\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003eSecondary\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 199px;\"\u003e\n \u003cp\u003e23 (59.0)\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e16 (41.0)\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\n\u003cp\u003eTable 7: Logistic Regression Model for Knowledge and Perception Status\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"624\"\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd valign=\"top\" style=\"width: 230px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAdjusted Odds Ratio\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\u003ctd colspan=\"2\" style=\"width: 160px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e95% C.I.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd valign=\"top\" style=\"width: 230px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003eLower\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003eUpper\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd valign=\"top\" style=\"width: 230px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducation Status X Knowledge Status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd valign=\"top\" style=\"width: 230px;\"\u003e\n \u003cp\u003eTertiary\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e4.09\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e2.109\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e7.923\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd valign=\"top\" style=\"width: 230px;\"\u003e\n \u003cp\u003eSecondary \u003csup\u003eREF\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd valign=\"top\" style=\"width: 230px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eResidency X Perception Status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd valign=\"top\" style=\"width: 230px;\"\u003e\n \u003cp\u003eUrban \u003csup\u003e\u0026nbsp;\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e1.47\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e0.98\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e2.19\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e0.06\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd valign=\"top\" style=\"width: 230px;\"\u003e\n \u003cp\u003eRural \u003csup\u003eREF\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\n\n\n"},{"header":"4.0 Limitations, Conclusions and Recommendations","content":"\u003cp\u003eWhile the study provides valuable insights into the knowledge, risk perception, and disposal practices of Generation Z regarding unused and expired medication in Sub-Saharan Africa, the study's scope is limited to three specific countries, and factors such as cultural differences, socioeconomic disparities, and healthcare infrastructure variations within and across other Sub-Saharan African nations may influence differently. Another limitation is the reliance on self-reported data which allows for social desirability bias especially among this demographic. Future research should consider incorporating medication tracking devices or environmental assessments, as well as expanding the sample size and geographical coverage.\u0026nbsp;\u003c/p\u003e\u003cp\u003eThe findings of this study underpin risk perception and disposal practices of UEMS as a pressing sub-Saharan health issue, specifically among Gen Zs. These can be addressed by incentivizing proper disposal practices starting from secondary school levels and extending to rural residents. Take-back programs should also be initiated in the studied region. These are crucial to controlling and effectively preventing the future health threat of pharmaceutical waste in these countries. Initiatives should be implemented to increase public awareness about proper disposal methods, with a focus on educational campaigns in pharmacy stores and utilizing mass media channels for awareness dissemination. Efforts should then be made to encourage the adoption of dose dispensing practices and facilitate medication returns to pharmacies, thereby promoting safe medication management and disposal practices throughout the community.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eUEMs \u0026ndash; unused and expired medicines\u003c/p\u003e\n\u003cp\u003eKPP - Knowledge, risk perception, and disposal practices\u003c/p\u003e\n\u003cp\u003eSDG \u0026ndash; Sustainable development goals\u003c/p\u003e\n\u003cp\u003eWHO \u0026ndash; World Health Organization\u003c/p\u003e\n\u003cp\u003eCDC - Centers for Disease Control and Prevention\u003c/p\u003e\n\u003cp\u003eOR \u0026ndash; Odds Ratio\u003c/p\u003e\n\u003cp\u003eCI \u0026ndash; Confidence Interval\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cem\u003eEthics Approval:\u0026nbsp;\u003c/em\u003eThe study received approval number NHREC/OYOSHRIEC/10/11/22 from the Ministry of Health, Department of Planning, Research, and Statistics Division, Oyo State, Nigeria.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eConsent to Participate\u003c/em\u003e: Written informed consent was obtained from all subjects and/or their legal guardian(s) to take part in the study. Respondents who did not consent were prompted to submit and were automatically excluded from the study.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eConsent to Publish\u003c/em\u003e\u003cstrong\u003e:\u0026nbsp;\u003c/strong\u003eParticipants and/or their legal guardian(s) were informed that their digital identifiers were not collected in the form, while disseminating and publishing results publicly to policymakers. Please refer to the data link shared at (https://forms.gle/bK7w2nWapeji2Yqs7)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of Data and Materials:\u0026nbsp;\u003c/strong\u003eThe datasets used and/or analyzed during the current study available from the corresponding author on reasonable request\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number\u003c/strong\u003e: not applicable\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConflict of Interest\u003c/strong\u003e: None\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e: This study was self-funded.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthorship\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDamilola A. Ibirogba and Ebsitu Abate conceived and designed the study, acquired the data, analyzed the data, and drafted the article; Abdullahi Abdulraheem Salahudeen, Ibrahim Sulaiman Egyegini, Olukogbe Oluwagbemisola Oyin, and Oluwatobi Esther Adelaja acquired the data and drafted the article; Damilola A. Ibirogba, Muganyizi Jonas Bisheko, \u0026nbsp;and Oyepeju Folashade Abioye revised the drafts and assisted with graphical designs, and Abdisa Tufa Bedada, Chibuzor Success Udoji \u0026amp; Ayooluwa Tomiwa Akintola further revised the drafts. All authors approved the final submitted version.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would love to acknowledge the Ministry of Health, Department of Planning, Research, and Statistics Division, Oyo State, Nigeria, for giving us approval for the study and all our participants for providing their consent for the study. All methods were carried out following relevant guidelines and regulations.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAkintola AT, Ayankunle AY. Improving pharmaceuticals removal at wastewater treatment plants using biochar: A review. Waste Biomass Valoriz. 2023;14(8):2433\u0026ndash;58.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAyele Y, Mamu M. Assessment of knowledge, attitude and practice towards disposal of unused and expired pharmaceuticals among community in Harar city, Eastern Ethiopia. J Pharm Policy Pract. 2018;11:1\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAyeleru OO, Fewster-Young N, Gbashi S, Akintola AT, Ramatsa IM, Olubambi PA. A statistical analysis of recycling attitudes and behaviours towards municipal solid waste management: A case study of the University of Johannesburg, South Africa. Clean Waste Syst. 2023;4:100077.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGidey MT, Birhanu AH, Tsadik AG, Welie AG, Assefa BT. 2020. Knowledge, attitude, and practice of unused and expired medication disposal among patients visiting Ayder Comprehensive Specialized Hospital. \u003cem\u003eBioMed research international\u003c/em\u003e, \u003cem\u003e2020\u003c/em\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eK\u0026uuml;mmerer K. The presence of pharmaceuticals in the environment due to human use\u0026ndash;present knowledge and future challenges. J Environ Manage. 2009;90(8):2354\u0026ndash;66.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMakki M, Hassali MA, Awaisu A, Hashmi F. 2019. The prevalence of unused medications in homes. \u003cem\u003ePharmacy\u003c/em\u003e, \u003cem\u003e7\u003c/em\u003e(2), p.61.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMarwa KJ, Mcharo G, Mwita S, Katabalo D, Ruganuza D, Kapesa A. Disposal practices of expired and unused medications among households in Mwanza, Tanzania. PLoS ONE. 2021;16(2):e0246418.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eOfori-Asenso R, Brhlikova P, Pollock AM. Prescribing indicators at primary health care centers within the WHO African region: a systematic analysis (1995\u0026ndash;2015). BMC Public Health. 2016;16:1\u0026ndash;14.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eOkoro RN, Peter E. 2020. Household medicines disposal practices in Maiduguri, North-Eastern Nigeria. Int J Health Life Sci, \u003cem\u003e6\u003c/em\u003e(1).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePaut Kusturica M, Tomas A, Sabo A. Disposal of unused drugs: Knowledge and behavior among people around the world. Reviews Environ Contam Toxicol Volume. 2017;240:71\u0026ndash;104.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePersson M, Sabelstr\u0026ouml;m E, Gunnarsson B. Handling of unused prescription drugs\u0026mdash;knowledge, behaviour and attitude among Swedish people. Environ Int. 2009;35(5):771\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRogowska J, Zimmermann A. 2022. Household Pharmaceutical Waste Disposal as a Global Problem\u0026mdash;A Review. \u003cem\u003eInternational Journal of Environmental Research and Public Health\u003c/em\u003e, \u003cem\u003e19\u003c/em\u003e(23), p.15798.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTong AY, Peake BM, Braund R. Disposal practices for unused medications around the world. Environ Int. 2011;37(1):292\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eT\u0026ouml;rőcsik M, Szűcs K, Kehl D. How generations think: research on generation z. Acta universitatis Sapientiae communicatio. 2014;1(1):23\u0026ndash;45.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFeyissa D, Siraj J. Knowledge, Attitude and Disposal Practices of Unused and Expired Medications Among the General Public in Mizan-Aman, Southwest Ethiopia. Health Sci. 2022;11:1\u0026ndash;13.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSwaroop HS, Charaborty A, Virupakshaiah A. Knowledge, attitude and practice of medical professionals towards the safe disposal of unused medications in South India. World J Pharm Pharm Sci. 2015;4(5):1423\u0026ndash;30.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eOng SC, Ooi GS, Shafie AA, Hassali MA. 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Int J Pharm Ther. 2014;5(4):283\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKusturica MP, Tomas A, Tomic Z, Bukumiric D, Corac A, Horvat O, Sabo A. Analysis of expired medications in Serbian households. Slovenian J Public Health. 2016;55(3):195\u0026ndash;201.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAlthagafi A, Alshibani M, Alshehri S, Noor A, Baglagel A, Almeleebia T. Assessment of knowledge and awareness of safe disposal of unused or expired medication in Saudi Arabia: A cross-sectional study. Saudi Pharm J. 2022;30(11):1672\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKahsay H, Ahmedin M, Kebede B, Gebrezihar K, Araya H, Tesfay D. 2020. Assessment of knowledge, attitude, and disposal practice of unused and expired pharmaceuticals in community of Adigrat City, Northern Ethiopia. \u003cem\u003eJournal of environmental and public health\u003c/em\u003e, \u003cem\u003e2020\u003c/em\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAdedeji-Adenola H, Adesina A, Obon M, Onedo T, Okafor GU, Longe M, Oyawole M. (2022). Knowledge, perception, and practice of pharmaceutical waste disposal among the public in Lagos State, Nigeria. The Pan African medical journal, 42, 106. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.11604/pamj.2022.42.106.34529\u003c/span\u003e\u003cspan address=\"10.11604/pamj.2022.42.106.34529\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Table","content":"\u003cp\u003eTable 2 is available in the Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"discover-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Discover Public Health](https://link.springer.com/journal/12982)","snPcode":"12982","submissionUrl":"https://submission.springernature.com/new-submission/12982/3","title":"Discover Public Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Computational Analysis, Pharmaceutical Waste, Knowledge, Risk Perception, Disposal Practices, Statistics","lastPublishedDoi":"10.21203/rs.3.rs-7328819/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7328819/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e: Knowledge, risk perception, and disposal practices (KPP) of unused and expired medicines (UEMs) among Generation Z (young adults) remain an under-researched field. This study aims to investigate these to provide interventions backed up by solid evidence.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e: A cross-sectional study was conducted with young adults across three major sub-Saharan African countries: Ethiopia, Nigeria, and Tanzania, receiving a structured questionnaire distributed on Google Forms. Computational statistics was carried out to explore sociodemographic characteristics and their association with KPP using SPSS version 24.0, while p-values \u0026lt; 0.05 were considered statistically significant.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e: A total of 684 respondents (575 young adults, Mean age = 22±2.93 years) completed the survey. KPP scores were 75.65%, 28.69%, and 59.30%, respectively. Knowledge was highest in Nigeria (76.33%), followed by Ethiopia (75.00%), and Tanzania (68.75%). Risk perception was fair, while disposal practice was poor in all countries, but poorest in Tanzania (25%). Knowledge was associated with risk perception and disposal practice (p = 0.01 and 0.03, respectively), but risk perception was not associated with disposal practice (p = 0.329). Residency was a predictor of risk perception; participants in tertiary institutions were four times [Odds Ratio (OR = 4.09; 95% CI, 2.11-7.92)] more knowledgeable than their secondary school counterparts.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e: Having demonstrated high knowledge of what UEMs are, there still exists a disposal practice and risk perception gap in Generation Z. Addressing the predictors is crucial to effectively preventing the future health threat of pharmaceutical waste in these countries.\u003c/p\u003e","manuscriptTitle":"Computational Analysis of Knowledge, Risk Perception, and Disposal Practice of Unused and Expired Medication among Generation Z in Three sub-Saharan African Countries","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-23 07:46:59","doi":"10.21203/rs.3.rs-7328819/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-11-05T06:32:34+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-05T06:30:41+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-15T09:35:03+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"335115883829081473246808585795126973873","date":"2025-10-09T11:53:48+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-08T16:12:36+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"33826743433786037242620992933414462803","date":"2025-09-28T17:32:24+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"206104086176866845039076033495611218716","date":"2025-09-15T07:53:19+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-09-15T05:10:32+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-09-15T05:06:54+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-08-29T16:51:52+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-08-27T00:33:15+00:00","index":"","fulltext":""},{"type":"submitted","content":"Discover Public Health","date":"2025-08-27T00:30:30+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"discover-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Discover Public Health](https://link.springer.com/journal/12982)","snPcode":"12982","submissionUrl":"https://submission.springernature.com/new-submission/12982/3","title":"Discover Public Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"7c199188-1b8f-47cc-8d36-e87761ad00f8","owner":[],"postedDate":"September 23rd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-04-07T16:07:32+00:00","versionOfRecord":{"articleIdentity":"rs-7328819","link":"https://doi.org/10.1186/s12982-026-01554-5","journal":{"identity":"discover-public-health","isVorOnly":false,"title":"Discover Public Health"},"publishedOn":"2026-03-31 15:59:58","publishedOnDateReadable":"March 31st, 2026"},"versionCreatedAt":"2025-09-23 07:46:59","video":"","vorDoi":"10.1186/s12982-026-01554-5","vorDoiUrl":"https://doi.org/10.1186/s12982-026-01554-5","workflowStages":[]},"version":"v1","identity":"rs-7328819","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7328819","identity":"rs-7328819","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}
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