الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
Abstract
Medications, when used correctly, can have very positive and beneficial effects for patients, such as managing health conditions and curing illness. However, unintended exposure to small or trace amounts of drugs that are not medically necessary can have a detrimental, long-term effect on plants, animals, and humans. Many of the prescriptions will go unused for various reasons such as improved patient condition, the inability to tolerate adverse effects of the drug, changes in dosage or medication regimen, death, or medication expiration. Often, the unwanted or expired medications are just stored at home indefinitely or disposed of via the sink, flushed down the toilet, or tossed in the garbage The storage and the disposal of unwanted or expired medications in this way poses hazardous effects on human health as well as on the ecosystem.
Since the community pharmacists have the greatest interaction with consumers regarding prescription and over-the-counter medications, thus the KAP of the community pharmacists towards the management of pharmaceutical waste need to be raised using educational program because the current practices are not optimal.
The present study aimed at assessing the role of community pharmacists in household pharmaceutical waste management in Alexandria Governorate.
The target population was Adult population of Alexandria Governorate and community pharmacists.The adult population included 400 participants selected randomly. The one group pre-test and post-test design included 330 community pharmacists (East and Middle districts)in the pretest phase from which 50 participants were chosen for the implementation of the educational intervention program.
A pre designed structured interviewing questionnaire for the selected sample of the population in Alexandria Governorate was made to gain information about the type of leftover drugs, the reasons why there are leftover drugs at home, when and how do people get rid of them.
Another pre designed structured interviewing questionnaire for community pharmacists to assess their KAP. An intervention program was designed according to the results of initial assessment of the community pharmacists‘ knowledge, attitude, and practice regarding the management of household pharmaceutical waste in the two selected districts (East and Middle).Assessment of knowledge, attitude and practice of intervention participants was redone in the post-test phase using the same questionnaire of the pre-test phase immediately and three months later .
The present study revealed the following results: I-The public’s opinion concerning the management of leftover drugs in Alexandria Governorate. The results show that analgesics are the most common drugs stored at home(46%) then come the vitamins(23%) and the antibiotics(14%) respectively.
Summary
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The public‘s opinion regarding the cause of keeping drugs stored at home showed that (78%)stop taking the medications when they feel better. The opinion of the participants regarding the suitable time of disposal of unused/expired drugs showed that 85.5% get rid of the medications when they check the drug cupboard and discover they are expired. The opinion of the participants regarding the method of disposal of unused or expired drugs showed that the majority of the people throw the medication in the garbage or in the toilet; only 10% get rid of the unused medications in an appropriate way.
II-Educational Intervention Program Results Study results showed poor knowledge regarding health care waste management before the implementation of the educational program; after which there was a significant improvement. Statistical significant difference between pre and post –test (from 27% to 99%), (P<0.001). Regarding the attitude, the overall results indicated a significant improvement in the attitude among participants concerning the household pharmaceutical waste after applying educational intervention program and providing sufficient education and training as effective tools to improve the behavior of the participants. Statistical significant difference between pre and post –test (from 52% to 99%), (P<0.001). Concerning pre and post-test assessment results of the community pharmacists, study results showed significant improvement in their practice. There was statistically significant difference between pre and post –test of the community pharmacists (from 40% to 99%),(P<0.001).
In conclusion, the overall results indicated a significant improvement in the KAP of the participants after the implementation of the intervention educational environmental program which reflects the importance and the success of the educational intervention and the necessity of further programs.
RECOMMENDATIONS Raising the health care providers‘ awareness like between the community pharmacists, in the undergraduate curriculum in the faculty of pharmacy and in the pharmaceutical companies. Also between other health care providers like: physicians,nurses and dentists. Public campaigns to raise the public awareness concerning the management of leftover drugs. Policies and guidelines from the Ministry of Health and Population and the Ministry of Environment on the management of household pharmaceutical waste. Government should establish pharmaceutical collection programs to reduce the quantity of unused and unwanted medicines entering the environment and reduce the amount of drugs available for diversion, theft, or accidental poisoning. Ecopharmacovigilence whose role is to design drugs from the start to be less harmful to the environment. Sewage treatment improvement to reduce the amount of drugs that reach rivers and lakes