Disposal of antimicrobials in primary health care in the districts and islands of the Amazon metropolis

Abstract

Introduction: Primary Health Care, as the gateway to the Brazilian Unified Health System, plays a crucial role in health promotion and the rational use of medicines. Among the challenges faced at this level of care is the improper use and disposal of antimicrobials, a practice that jeopardizes both public health and the environment by promoting microbial  resistance  and contamination of bodies of water. The lack of standardized procedures and the limited training of health teams  aggravate  this scenario, especially in the outskirts and riverside  regions. Taking  this into  consideration, in  this study, we investigated the practices related to the use and disposal of antimicrobials in Health Centers in the districts and islands of the municipality of Belém (state of Pará, Brazil), considering the principles of the Brazilian Unified Health System and the guidelines of the National Solid Waste Policy. Objective: To investigate the improper use and disposal of antimicrobials in Primary Health Care, highlighting their environmental and public health implications. Methods: This is a descriptive and exploratory study, analyzing the perception of health professionals about the use and disposal  of antimicrobials in the Health Centers of the districts and islands of Belém, in 2024. Pharmacists or those in charge of the Health Centers answered structured questionnaires, assessing awareness and knowledge of appropriate disposal methods. Results: According to the data, there is a heterogeneous scenario regarding the management and disposal of pharmaceuticals in the health units investigated. We identified structural weaknesses in the disposal process and gaps in professionals’ awareness. There is no unified Standard Operating Procedure for all Health Centers. While 66.6% of the units follow guidelines established by the Municipal Department of Health, 7.4% adopt their own procedures, 11.1% have no formal regulations, 3.8% state there is a unified Standard Operating Procedure for the whole district, and 1% of those interviewed were unable to answer. In addition, guidance to users on proper disposal was insufficient, favoring inappropriate practices. Conclusions: We verified weaknesses in the disposal of antimicrobials related to the lack of standardization, insufficient training of professionals, and lack of knowledge among the population. Therefore, stricter regulations, the implementation of a unified Standard Operating Procedure, periodic training, and educational campaigns are essential to promote public and environmental health and the rational use of this drug class. All the data are described in the manuscript and are available upon request.