Author(s):
Saraswathi Simansalam, Kelly Ang, Sam Aaseer Thamby, Nina Varghese
Email(s):
saraswathi@aimst.edu.my
DOI:
10.52711/2454-2652.2026.00021 
Address:
Saraswathi Simansalam*, Kelly Ang, Sam Aaseer Thamby, Nina Varghese
Faculty of Pharmacy, AIMST University, Semeling, Kedah Darulaman, Malaysia.
*Corresponding Author
Published In:
Volume - 14,
Issue - 2,
Year - 2026
ABSTRACT:
Globally, inappropriate disposal of used and expired medications (UEM) presents significant health and environmental risks. In Malaysia, such practices continue despite the implementation of the Medication Return Program (MRP) in 2010. This research assessed adults’ knowledge, attitudes, and practices (KAP) regarding UEM disposal in Johor Bahru, Malaysia. It also examined the association between their knowledge and actual disposal methods by dosage form. An online survey was conducted using a pre-validated 40-item questionnaire to gauge the knowledge, attitudes, and practices (KAP) related to disposal of unused and expired medication (UEM) disposal among adults aged 20 to 60 years. A total of 386 respondents completed the survey (mean age: 38.47±11.88 years). Over half were female (n = 204) and held a bachelor’s degree (n = 221). About one-third were married (n = 134), and 45.9% worked in the private sector. Only 15.8% of respondents achieved a knowledge score of 80% or higher regarding UEM disposal. Demographic information was significantly linked to knowledge scores (p<0.01). Despite over 80% showing positive attitudes, 75% (n = 295) still discarded tablets and capsules in household garbage. Knowledge was significantly linked to disposal practices, except for disposal via household garbage. This study reveals a gap in proper UEM disposal in Johor Bahru, highlighting the need for improved public awareness. Incentive-based return programs at pharmacies, clinics, and hospitals could increase participation. Mobile MRP services and continuous awareness campaigns are recommended. Healthcare professionals should educate patients and offer disposal reminders during consultations to promote safer UEM practices.
Cite this article:
Saraswathi Simansalam, Kelly Ang, Sam Aaseer Thamby, Nina Varghese. Knowledge, Attitude and Practice of Unused and Expired Medicines Disposal among Community-dwelling adults in Johor Bahru District. International Journal of Advances in Nursing Management.2026;14(2):99-6. doi: 10.52711/2454-2652.2026.00021
Cite(Electronic):
Saraswathi Simansalam, Kelly Ang, Sam Aaseer Thamby, Nina Varghese. Knowledge, Attitude and Practice of Unused and Expired Medicines Disposal among Community-dwelling adults in Johor Bahru District. International Journal of Advances in Nursing Management.2026;14(2):99-6. doi: 10.52711/2454-2652.2026.00021 Available on: https://www.ijanm.com/AbstractView.aspx?PID=2026-14-2-7
REFERENCES:
1. Krychkovska A, Zayarnyuk N, Venhryn N, Khomenko O, Monka N, Lubenets V. Comparative analysis of reverse distribution of medicines and medical products in the world and in Ukraine. Res J Pharm Technol. 2024 Jul 1; 17(7): 3284-96.
2. Chacko S. A Statistical Study on the need for an Educational Module to Improve the Knowledge of Infection Control and Bundle Careamong the Healthcare Workers. Int J Adv Nurs Manag. 2024 Jun 4;12(2):69-73.
3. Rogowska J, Zimmermann A. Household pharmaceutical waste disposal as a global problem—a review. Int J Environ Res Public Health. 2022 Nov 27; 19(23):15798.
4. Isam MW, Shehhi KA, Gacem SA. Assessment of the consumers’ attitude towards leftover and expired medications at homes. Res J Pharm Technol. 2019; 12(11): 5182-8.
5. Ghozali MT, Astuti YM. Conformity assessment of pharmaceutical storage on the rural public health centre of West Kalimantan, Indonesia. Res J Pharm Technol. 2023; 16(9): 4155-60.
6. Al-Naggar RA, Alareefi A. Patients’ opinion and practice toward unused medication disposal in Malaysia: a qualitative study. Thai J Pharm Sci. 2010;34(3):117-23.
7. Azad AK. Disposal practice for unused medications among the students of the International Islamic University Malaysia. J Appl Pharm Sci. 2012; 2(7): 101-6.
8. Lim MT. Disposal practices of unused and unwanted medications among patients in a tertiary hospital. Educ Med J. 2016; 8(3): 49-59.
9. Bhandari K, Yadav R, Pradhan S, Singh R, Kushwaha NK. Knowledge regarding biomedical waste management among nursing staffs of teaching hospital at Birgunj, Parsa, Nepal. Int J Adv Nurs Manag. 2024 Mar 16; 12(1): 1-6.
10. Stella M. Overcoming Challenges in Nursing Administration and Management. Int J Adv Nurs Manag. 2023 Mar 20; 11(1): 1-3.
11. Jarvis CI, Seed SM, Silva M, Sullivan KM. Educational campaign for proper medication disposal. Journal of the American Pharmacists Association. 2009 Jan 1; 49(1): 65-8.
12. Anthony P, Dada SA. Community and leadership strategies for advancing responsible medication use and healthcare equity access. International Journal of Multidisciplinary Research and Growth Evaluation. 2022 Nov; 3(6): 748-67.
13. Kim JM, Suarez-Cuervo C, Berger Z, Lee J, Gayleard J, Rosenberg C, Nagy N, Weeks K, Dy S. Evaluation of patient and family engagement strategies to improve medication safety. The Patient-Patient-Centered Outcomes Research. 2018 Apr; 11(2): 193-206.
14. Yang SL, Tan SL, Goh QL, Liau SY. Utilization of Ministry of Health medication return programme, knowledge and disposal practice of unused medication in Malaysia. J Pharm Pract Community Med. 2018 Feb; 4(1): 7-11.
15. Gupta R, Gupta BM, Gupta A. A study on awareness regarding disposal of unused medicines among consumers at a tertiary care teaching hospital of North India. Int J Adv Med. 2019 Jan;6(1):91.
16. Taksande V, Shrivastvas D, Sebastian T. A care bundle approach: quality nursing care. Int J Adv Nurs Manag. 2020 Sep; 8(3). https://doi.org/10.5958/2454-2652.2020.00056.6
17. Kaur A, Kaur P. A study to assess the effectiveness of self-instructional module on biomedical waste management among the staff nurses of the selected hospitals of Ludhiana, Punjab. Int. J. Adv. Nurs. Manag. 2018 Mar 31; 6(1): 62.
18. Punjot P, Thomas CV, Suseel S. NurCON 2018-Nursing is Healthcare–The Road to Achieve Excellence. Int. J. Adv. Nurs. Manag. 2019 Jul;7(3):294-7.
19. Ariffin M, Zakili TS. Household pharmaceutical waste disposal in Selangor, Malaysia—policy, public perception, and current practices. Environ Manage. 2019 Oct; 64(4): 509-19.
20. Kadir NF, Suhaimi NS, Balakrishnan M, Zaidi WN, Fai SC. Assessment on knowledge, attitude and practice of patients in Hospital Tapah regarding disposal of unused and expired medicines. Malays J Pharm Sci. 2021; 19(1): 1-18.
21. Kavuluru VK. Knowledge and attitude of nurses on patient safety: A systematic review. Int J Adv Nurs Manage. 2022 May 6; 10(2): 156-60.
22. 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 Nov 1;30(11): 1672-8.
23. James JM. E-learning in nursing education. Int J Adv Nurs Manag. 2022 Aug 4; 10(3): 295-300.
24. Wang LS, Aziz Z, Chik Z. Disposal practice and factors associated with unused medicines in Malaysia: a cross-sectional study. BMC Public Health. 2021 Sep 16; 21(1): 1695.
25. Ling JY, Ng PY, Shamsuddin AS, Zulkifli A, Lee KE. Medication disposal patterns and practices with awareness of environmental contamination caused by pharmaceuticals among the general public in Malaysia. Asian Pac J Cancer Prev. 2024; 25(8): 2723.
26. Sim SM, Lai PS, Tan KM, Lee HG, Sulaiman CZ. Development and validation of the return and disposal of unused medications questionnaire (ReDiUM) in Malaysia. Asia Pac J Public Health. 2018 Nov; 30(8): 737-49.
27. Ong SC, Ooi GS, Shafie AA, Hassali MA. Knowledge, attitude and disposing practice of unused and expired medicines among the general public in Malaysia. J Pharm Health Serv Res. 2020 Jun; 11(2): 141-8.
28. Khairunniza N, Aliyu MK. Public practice on the unused pharmaceutical waste and the effect on surface water. IOP Conf Ser Earth Environ Sci. 2023 Jun 1; 1205(1): 012003.
29. Azmi Hassali M, Shakeel S. Unused and expired medications disposal practices among the general public in Selangor, Malaysia. Pharmacy (Basel). 2020 Oct 23; 8(4): 196.
30. Lai PS, Tan KM, Lee HG, Wong YY, Wasi NA, Sim SM. Effectiveness of an intervention to increase the knowledge, attitude, and practice regarding the return and disposal of unused medications. Malays Fam Physician. 2021 Feb 1; 16(1): 56.
31. Mazlan A, Mahir HM, Shamsudin MP, Chen XW. Leptospirosis in Perak state for the year 2024: hospitalisation rate and its associated factors. Med J Malaysia. 2025 Nov; 80(6): 771.
32. Kharaba Z, Al-Azzam S, Altawalbeh SM, Alkwarit A, Salmeh NA, Alfoteih Y, et al. Health literacy, knowledge, household disposal, and misuse practices of antibiotics among UAE residents: a nationwide cross-sectional study. Expert Rev Anti Infect Ther. 2024 Mar 3; 22(1-3): 103-13.
33. Arumugam A, Lee KE, Ng PY, Shamsuddin AS, Zulkifli A, Goh TL. Pharmaceuticals as emerging pollutants: implications for water resource management in Malaysia. Emerg Contam. 2025 Jan 9: 100470.
34. Mariappan V, Vellasamy KM, Mohamad NA, Subramaniam S, Vadivelu J. OneHealth approaches contribute towards antimicrobial resistance: Malaysian perspective. Front Microbiol. 2021 Oct 25; 12: 718774.
35. Makki M, Shafie AA, Awaisu A, Hussain R, Al Hail M, ElMotasim WM, et al. Patients’ knowledge, attitude, and practices toward unused medications in Qatar: a cross-sectional survey. Heliyon. 2024 Jun 30; 10(12).
36. Kristina SA. A survey on medicine disposal practice among households in Yogyakarta. Asian J Pharm. 2018 Nov 5; 12(3).
37. Kahsay H, Ahmedin M, Kebede B, Gebrezihar K, Araya H, Tesfay D. Assessment of knowledge, attitude, and disposal practice of unused and expired pharmaceuticals in community of Adigrat City, Northern Ethiopia. J Environ Public Health. 2020; 2020(1): 6725423.
38. Sarvanan SS, Santosh Kumar SK. An Exploratory Study to Assess Staff Nurse Knowledge and Attitude related to Legal Responsibilities in patient care at YCR Hospital, Latur, Maharashtra. Int J Adv Nurs Manag. 2023 Jun 6; 11(2): 120-4.
39. Hajj A, Domiati S, Haddad C, Sacre H, Akl M, Akel M, et al. Assessment of knowledge, attitude, and practice regarding the disposal of expired and unused medications among the Lebanese population. J Pharm Policy Pract. 2022 Dec 31; 15(1): 107.
40. Jha N, Kafle S, Bhandary S, Shankar PR. Assessment of knowledge, attitude, and practice of disposing and storing unused and expired medicines among the communities of Kathmandu, Nepal. PLoS One. 2022 Aug 4; 17(8): e0272635.
41. Al Dweik R, Ajaj R, Hafez W. Public awareness of medication disposal and its impact on environmental and public health: a cross-sectional study in the United Arab Emirates. Inform Med Unlocked. 2024 Jan 1; 50: 101580.
42. Gwenzi W, Simbanegavi TT, Rzymski P. Household disposal of pharmaceuticals in low-income settings: practices, health hazards, and research needs. Water (Basel). 2023 Jan 25; 15(3): 476.