Unused medicines among households in internally displacement (IDP) camps in Ethiopia: an explanatory sequential mixed-methods study

The prevalence of unused medicines in households is a significant yet often overlooked public health issue. Among internally displaced persons (IDPs), unique vulnerabilities and access to free or subsidized medications through humanitarian aid may lead to stockpiling or improper medication use, suggesting an even greater burden of unused medicines in these communities. Therefore, this study aims to assess the prevalence and determinants of unused medicines among households of IDPs in IDP camps. An explanatory sequential mixed-methods study design was conducted in internally displacement (IDP) camps located in North Shewa, Ethiopia from April to June 2024 among adults (≥ 18 years) managing unused medications in selected households. Households were selected via systematic random sampling for the quantitative survey, and a purposive sample from these participants was interviewed qualitatively. Quantitative data were collected using an interviewer-administered structured questionnaires and analyzed with SPSS version 25, including descriptive statistics and logistic regression. Qualitative data were collected through in-depth interviews and analyzed thematically using OpenCode software version 4.2. A total of 411 participants were interviewed, yielding a response rate of 97.2%. Among the surveyed households, 69.1% reported storing unused medications at home. The most commonly retained medications were antibiotics (49.6%), antipyretics (23.4%), and analgesics (19.7%). The primary reason cited for storing unused medications was discontinuation upon feeling better (28.7%). Key determinants positively associated with storing unused medications included a lack of information on proper disposal methods (adjusted odds ratio [AOR] = 2.36, 95% CI: 1.425-3.892) and the presence of chronic diseases (AOR = 2.25, 95% CI: 1.192-4.237). Conversely, factors negatively associated with having unused medications included avoiding self-medication specifically with non-steroidal anti-inflammatory drugs (NSAIDs) (AOR = 0.37, 95% CI: 0.225-0.604), attaining a secondary school education (AOR = 0.27, 95% CI: 0.112-0.667), and obtaining a college education or higher (AOR = 0.263, 95% CI: 0.110-0.630). The qualitative study revealed that unused medicines were prevalent in IDP households due to non-adherence, fear of side effects, alternative treatments, community sharing, and limited disposal options. The study reveals a high prevalence of unused medications in households within IDP camps, largely driven by early treatment discontinuation after symptom relief. Limited awareness of proper disposal methods and the presence of chronic diseases were key contributing factors, while higher education and avoiding self-medication particularly with NSAIDs were protective. These findings highlight the need for targeted educational interventions to improve adherence and promote safe disposal practices, especially among individuals with lower education levels and chronic conditions.