title: Assessing medication packaging and labelling appropriateness in Sri Lanka.
abstract: BACKGROUND
  There is substantial evidence of poor dispensing practices with inadequate packaging and labelling of medicines, and limited advice on their usage in low and middle-income countries (LMICs). We examined the labelling and packaging of medicines identified during a survey of 1322 households in six regions of Sri Lanka between 2010 and 2013 conducted using the World Health Organization (WHO) methodology for household surveys. We compared medicines obtained from public and private sources and asked interviewees if they understood how to take the medicines.
  
  
  METHODS
  Packaging was considered adequate when the primary package was an envelope or closable container holding only one medicine. Adequate labels were legible and included medicine name, dose and expiration date. Interviewers assessed whether respondents knew how to take the medicines.
  
  
  RESULTS
  Of 1322 households, 1253 households (94.8%) had at least one medicine; 84% were classified as western medicines and 16% traditional medicines. Of 5756 western medicines identified, 82.1% were adequately packaged, 43.3% adequately labelled and 41.4% both adequately packaged and labelled. Participants stated that they understood the label and knew how to take 96% of the medicines. Private medicine sources had more adequately packaged medicines than public sources (87.7% vs 73.5%; OR 2.58, 95% CI 2.23, 2.99) and more adequately labelled medicines (52.2% vs 27.4%; OR 2.90, 95% CI 2.57, 3.26).
  
  
  CONCLUSIONS
  Inadequate packaging and labelling of medicines remain a concern in Sri Lanka. Commitment to Good Pharmacy Practices, investments in staff education and training and adequate dispensing resources (containers and labels), particularly in the public sector, are needed to address sub-optimal dispensing practices. Ageing populations with more chronic diseases requiring polypharmacy and complex medicine regimens increase the need for appropriately packaged and labelled medicines.
authors.affiliation: Department of Medicine, The Maitland Hospital Clinical School, 550-560 High Street, Maitland, 2320 NSW Australia.
authors.forename: N
authors.initials: N
authors.lastname: Athuraliya
authors.affiliation: Department of Clinical Pharmacology, School of Medicine and Public Health, The University of Newcastle, Newcastle, Australia.
authors.forename: E J
authors.initials: EJ
authors.lastname: Walkom
authors.affiliation: Medical Education Unit, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.
authors.forename: S
authors.initials: S
authors.lastname: Dharmaratne
authors.affiliation: Department of Clinical Pharmacology, School of Medicine and Public Health, The University of Newcastle, Newcastle, Australia.
authors.forename: J
authors.initials: J
authors.lastname: Robertson
keywords: Dispensing; Labelling; Low-middle income countries; Medicines; Packaging; Pharmacy practice