Household disposal of unused and expired medications in Bahir Dar City, Northwest Ethiopia: Knowledge, attitudes, practices, and factors associated with good disposal practices

Introduction Proper household management of unused and expired medications reduces environmental and public health risks. The aim of this study was to assess household knowledge, attitudes, and disposal practices of unused and expired medications, and identifies factors associated with good disposal practices among households in Bahir Dar City, Northwest Ethiopia. Methods A community-based cross-sectional study was conducted from October 1, 2025, to October 30, 2025. A total of 417 participants were selected using simple random sampling. Data were collected through face-to-face interviews using a pretested, structured questionnaire. Data were entered into Microsoft Excel and analyzed using SPSS version 26. Variables with p-values <0.05 in multivariable logistic regression analysis were considered statistically significant. Results Among 415 participants, 32.2% had good knowledge, 56.4% had a positive attitude, and 43.4% demonstrated good storage and disposal practices. The majority (89.4%) stored unused and expired medications at home, mainly due to improvement in medical condition (53.4%), intolerable side effects (17.5%), and medication change (14.3%). Analgesics (55.0%) and antibiotics (32.1%) were the most commonly stored medications. Although 75.7% reported disposing of unused and expired medications, poor practices were common. Unused medications were often kept until expiry (53.3%), discarded in household garbage (23.3%), or flushed into toilet or sink (15.4%). Expired medications were mainly discarded in household garbage (70.4%), whereas only 9.2% were returned to pharmacies or health facilities. Good disposal practices were significantly associated with age >35 years (AOR=7.14, 95% CI: 1.29-39.67), health insurance (AOR= 2.97, 95% CI: 1.03-8.55), college or higher education (AOR=2.14, 95% Cl: 1.02- 9.20), good knowledge (AOR = 3.41, 95% CI: 1.44-21.49), and positive attitude (AOR = 4.65, 95% CI: 1.29-16.76). Conclusion Households in Bahir Dar City had a positive attitude; however, their knowledge and disposal practices were poor. Strengthening public awareness and implementing medication take-back systems are recommended to promote good disposal practices and reduce public health and environmental risks.