Subsequent advancement in healthcare systems has led to a considerable rise in medication accessibility (1). Medicines are a crucial component of medical care but can cause detrimental effects if wrongly taken and maintained by the consumers. Many consumers are unaware of proper disposal methods for unused medicines (2). Children and pets are at risk of poisoning by unused medicines left insecurely in a home rather than being properly disposed of after use. It is due to the inherent characteristics of pharmaceutical substances that they may inadvertently impact animals and microorganisms within the surrounding ecosystem (3). Drugs may negatively affect wildlife, with estrogens feminizing male fish of many species, raising the risk of ecotoxicological effects (4, 5).

The microorganisms, upon transmission to humans, may already possess resistance to the existing antibiotics due to inadequate disposal, thereby contributing to heightened morbidity and mortality rates, as well as imposing an economic burden on the healthcare system (4, 6). Reducing the risk of releasing unused medicinal products into the environment is highly desirable as the management of pharmaceutical waste in the environment is both challenging and potentially costly, in addition to the harm it poses to public health (7). However, in most African countries, few programs or systems are advocating safe disposal habits of unused medicines (8).

Lack of knowledge about proper disposal systems in low-income settings, coupled with local attitudes, means that pharmaceuticals are often disposed of in an unsafe manner. Programs or systems encouraging the safe disposal of unused medications in African countries remain scarce. For instance, Ethiopia currently lacks a national policy for effectively controlling the safe disposal of unused medicines. However, Ghana has taken steps to implement a program aimed at minimizing the accumulation of unused medications (9). Kenya is considered a benchmark for pharmaceutical waste disposal, with comprehensive guidelines and procedures in place (10). In contrast, Ethiopia faces challenges in pharmaceutical waste management, including a lack of proper practices, limited disposal facilities, inadequate administrative and regulatory systems, and unclear guidelines. Medical waste is often burned at healthcare facilities despite issues with low-quality incinerators and open burning. Furthermore, the safe disposal of pharmaceutical waste is not enforced at the household level in Ethiopia (11). Exploring drug take-back systems and encouraging the participation of consumers in appropriate disposal methods are considered favorable avenues to prevent unused medications from ending up in landfills and wastewater (12). Assessing the extent to which possess the necessary measures to manage pharmaceutical waste effectively is crucial for revamping the wellbeing of individuals and populations (13).

Users’ understanding of pharmaceutical waste and their disposal behavior was assessed in studies conducted around the world. Studies conducted in Africa regarding public awareness of the disposal of unused medicines found that 31.77% (14) and 52.4% (15) “strongly agreed” that unused medicines pose a risk or could lead to negative consequences. While 89.02% of respondents (14) said it was a lack of sufficient information that caused the negative consequences, 38.8% of respondents (15) also believed it was. In Gondar city, studies have revealed that self-medication practices and easy access to prescription medicines have increased significantly in recent years (16, 17). Consequently, medicines may go unused or become outdated and expired and are disposed of indiscriminately. Understanding appropriate medicine disposal and attitudes needs to be developed within communities (18, 19). This study aimed to assess and report the level of knowledge, attitudes, and awareness regarding the proper disposal of unused medicines in Gondar city, northwest Ethiopia.

It has been documented in the literature that users are unclear about who offers medication disposal programs and how to properly dispose of unused medications (2). The consumer’s attitude toward medication disposal and their knowledge of the facts about it are essential components of implementation strategies to properly manage pharmaceutical waste (23). Based on this study, only 23.8% of the participants stated that they had received information on the proper disposal of unused medications. This is lower than a similar study, which declared that only 28.3% had never received any information on how to dispose of unused or unwanted medications (24). In the study with participants who received information, pharmacy (36.9%) was most often mentioned as the source of drug disposal information.

A significant finding from our study is that 369 participants (46.9%) showed a lack of awareness regarding the harmful effects of disposing of unused medicine in regular waste. In contrast, countries such as Sweden, where pharmaceutical companies and the government work together to conduct awareness campaigns, have achieved a much higher level of awareness (2). The lack of awareness observed could be partly attributed to the absence of a well-established drug-take-back system in Ethiopia, including the specific study area. Implementing such a program would likely contribute to raising awareness regarding the proper disposal of unused medications (25).

The findings of this study bear witness to another study where 79.8% of respondents thought pharmacists were the best source of information on drug disposal (24). Despite the pharmacy being the best place to educate the community while dispensing (26), the most reported place by respondents, only 42.6% of respondents had good knowledge of how to properly dispose. This might be because pharmacists do not consider proper disposal information a crucial component of counseling, so people are not informed of the proper disposal of unused medications. It may be linked to pharmacists not considering proper disposal information as a vital component of counseling; hence, respondents are not informed by the pharmacist on what to do with unused medications, indicating poor knowledge about proper disposal methods (27).

Based on our data, 42.6% of participants had good knowledge of how to dispose of unused medicines. Compared to a similar study conducted in Adigrat city (20), which gave a score of 50.14, 70.1% in Malaysia (28), 71.6% in Indonesia (29), and 76% in Makerere (30), the value observed in this study was lower. Nevertheless, it was higher in contrast to the findings of research carried out in Lebanon (24), which reported a mere 24.5% level of knowledge. Possibly, the discrepancy in knowledge levels might be attributed to the absence of awareness campaigns promoting proper medicine disposal as beneficial to health and the environment. Furthermore, a lack of convenient and easily accessible locations to return unused medications may also contribute to the lack of knowledge in this area (25).

This study discovered that approximately 42.9% of the participants exhibit a favorable attitude toward the appropriate disposal of unused pharmaceuticals. Conversely, other studies of a similar nature have reported percentages of 82.2% in Adigrat city (20), 76.7% in Malaysia (28), 68.2% in Indonesia (29), 64.8% in India (31), and 22.6% in Lebanon (24). There is probably a need to enhance the attitude of communities concerning the appropriate and secure disposal of unused medications. In addition, it outlines the importance of raising awareness about the detrimental consequences of improper disposal and providing education about the safe disposal of unused medicines.

Age, education, awareness of how to dispose of unused medicines, and medication use in the past 6 months were significantly associated with good knowledge. A good knowledge score was found among respondents of younger ages. Young adults between the ages of 19–25 years are 6.91 times more likely to have good knowledge about the proper disposal of unused medicines than older adults aged 44 years and older, which is in line with a similar study in Lebanon (24). Despite the older participants using more medicines and having more knowledge about the safe disposal of medications, the younger participants scored higher on knowledge. Older adults may be limited in their ability to watch, read, and understand information and lack familiarity with modern technologies, social networks/internet use (32). However, individuals with educational backgrounds at the secondary school level (with a 1.82-fold increase, p < 0.05) and at the college level and beyond (with a 5.68-fold increase, p < 0.001) exhibited a significantly higher perceived knowledge score compared to those who lack literacy skills. This finding aligns with previous research conducted in Adigrat city (20) and Lebanon (24).

People with higher levels of education may be more intuitive about seeking information and have a better understanding of their surroundings, but those with a lower level of education are more likely to encounter difficulties and may not realize the negative consequences of improperly disposing of medications (18). Participants who received information about the safe disposal of unused medicines were 6.41 times more likely to possess good knowledge than their counterparts. The finding may suggest that the lack of information reaching the general public can have an impact on the optimal approach to unused medicine disposal, influencing individuals’ decisions and promoting the adoption of safe disposal practices (23). Similarly, respondents who had not used medication in the past 6 months were found to have a 1.83 times higher likelihood of possessing good knowledge, which is consistent with a study conducted in Arba Minch (33).

Multivariate logistic regression revealed that good attitudes toward proper disposal of unused medicines were significantly associated with people who did not take any medications in the previous 6 months. Respondents who did not use medication in the past 6 months were 1.61 more likely to possess good attitudes than those who did. Furthermore, individuals who received information about safe disposal of unused pharmaceuticals were 1.86 times more likely to have good attitudes toward proper disposal than their counterparts.

A significant association was found between respondents’ attitudes and their knowledge in the current study. In this study, those with good attitudes were 2.11 times more likely to have good knowledge about the proper disposal of unused medicines, while those with good attitudes were 2.07 times more likely to have a good attitude toward proper disposal of unused medicines, corroborated study conducted in Lebanon (24). This suggests people with positive attitudes are more likely to acquire knowledge, and people with higher levels of knowledge are more likely to have positive attitudes. The idea is that by increasing awareness, the community is more likely to have a positive attitude and knowledge regarding proper disposal, thus helping to protect the environment and public health (34).

It has been determined that the public possesses a relatively low level of knowledge and attitudes concerning the proper disposal of unused medications. The knowledge and attitudes were associated with multiple factors, which encompass age, educational attainment, reception of information regarding the disposal of unwanted pharmaceuticals, and utilization of any medication within the past half-year. This finding implies that targeted corrective interventions should fully consider these aforementioned factors. Consequently, it is recommended that a well-coordinated and methodical public awareness campaign be executed to disseminate information and knowledge concerning the health hazards associated with unused medications, as well as to promote the appropriate disposal thereof.

The data underlying the conclusions in this article will be provided upon request, with inquiries directed to the corresponding author.

The study obtained ethical approval from the Department of Pharmacy, College of Medicine and Health Science, Wollo University (Ref: WU Phar/266/2013). Additionally, an official permission letter was obtained from the Gondar city administration to conduct the study. Before obtaining written or verbal consent, potential participants were informed about the study’s objectives and anticipated benefits. All participants willingly took part in the interviews, and their confidentiality was guaranteed.

AT: Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Project administration, Resources, Software, Supervision, Validation, Visualization, Writing – original draft, Writing – review & editing. GG: Resources, Visualization, Writing – original draft, Writing – review & editing, Data curation, Software. LW: Conceptualization, Data curation, Resources, Visualization, Writing – original draft, Writing – review & editing, Software. LY: Conceptualization, Data curation, Resources, Software, Visualization, Writing – original draft, Writing – review & editing. AM: Data curation, Resources, Software, Visualization, Writing – original draft, Writing – review & editing. TA: Data curation, Resources, Software, Visualization, Writing – original draft, Writing – review & editing. WA: Conceptualization, Data curation, Resources, Software, Visualization, Writing – original draft, Writing – review & editing. WS: Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Project administration, Resources, Software, Supervision, Validation, Visualization, Writing – original draft, Writing – review & editing.