The recent deaths of dozens of children from acute kidney problems in the Gambia and Indonesia have caused alarm worldwide. They can be caused by toxic substances in the syrup.
The first deaths were reported in Gambia last month, prompting authorities to launch an investigation. Indonesia alone this month announced a ban on all liquid medicines and syrups after dozens of children were reported to die there, also from acute kidney injury.
There is no confirmed link between the cases in the two countries, but investigations are still underway.
Here’s what to know about what happened.
Gambia
In September, the Gambia government launched an investigation into the deaths of 28 children from acute kidney problems after they took a paracetamol syrup to treat a fever.
At the beginning of October, the World Health Organization (WHO) said death in Gambia may be related to four contaminated cough and cold syrups made by Maiden Pharmaceuticals, an Indian drug manufacturer. It said an investigation was underway, along with Indian regulators and the New Delhi-based company.
The WHO said in a health product alert on October 5 that excessive levels of diethylene glycol and ethylene glycol were found in four products manufactured by Maiden Pharmaceuticals and sold in The Gambia: Promethazine Oral Solution , Kofexmalin Baby Cough Syrup, Makoff Baby Cough Syrup and Magrip N Cold Syrup.
The agency warns that their use can lead to serious injury or death, especially in children,
Diethylene glycol and ethylene glycol are toxic alcoholic chemicals used in industrial applications such as the manufacture of paints, printing inks or brake fluid. Their effects include altered mental status, stomach cramps, nausea, vomiting, and diarrhea. They can harm the kidneys, liver and central nervous system.
The Gambia government on Friday ordered a recall of all cough and cold syrups circulating in the country, expanding the scope of previous recalls to medicines containing paracetamol or promethazine syrup.
Last week, police in the Gambia said in a preliminary investigation report that the number of child deaths had increase to at least 69.
The report also said deaths from acute kidney injury were linked to four Indian-made cough syrups mentioned in the WHO warning, according to news agencies. It does not directly name Maiden Pharmaceuticals but includes the four liquid products of the company in question.
Indian health authorities, who have also conducted their own internal probe, suspend all production at Maiden Pharmaceuticals in mid-October after a defect was discovered at its manufacturing facility in Haryana state.
The state’s drug regulator said tainted products sold in the Gambia were made at the factory in Harayana in December, according to Indian media. report.
“Due to the severity of the violations observed during the investigation and its potential risk to the quality, safety and effectiveness of the manufactured drug, all manufacturing operations of the company is being stopped immediately,” said the federal order and state drug regulators.
Al Jazeera contacted Maiden Pharmaceuticals but had not received a response at the time of publication.
Maiden Pharmaceuticals director Naresh Goyal told the Economic Times of India that “the deaths were caused by the paracetamol syrup and not our cough syrup”.
Prashant Reddy, a lawyer and writer who studies drug regulations in India, said the country’s drug regulation laws are inadequate and outdated.
“In total, India has 38 regulatory bodies with limited authority, limited to their states, and a lot of bad guys have slipped through the cracks,” he told Al Jazeera.
Reddy added that longtime government efforts to strengthen the system in order to create a more unified regulator have been unsuccessful.
“It is important to understand that the Indian pharmaceutical industry is a very strong entity in the country,” he said. “Many of them are completely against a more unified system because they know that this will increase the quality and effectiveness of regulations and perhaps the cost of producing drugs.”
southern Ocean
Indonesian health authorities first announced an investigation into the deaths of about 20 children from acute kidney injury in early October.
Together with WHO officials, the authorities formed an expert group to investigate death cases.
Because the death toll was first reported increased to 99 And after that to 133the country has moved to impose a ban on the sale and prescription of all syrup-based drugs.
Health Minister Budi Gunadi Sadikin on Thursday said the death toll was among a total of 241 cases of kidney failure in 22 provinces, adding that most of the patients were children under the age of five.
Budi added that some of the syrups containing paracetamol in Indonesia also include ethylene glycol and diethylene glycol, the same ingredients that have been linked to child deaths in the Gambia.
Indonesia’s Food and Drug Administration on Thursday announced that five domestically produced drugs, out of 26 tested, contained excessive levels of ethylene glycol. It said it had ordered manufacturers to withdraw them from circulation and destroy them.
According to the agency, Maiden Pharmaceuticals products are not available locally.
In its warning, WHO said the four products identified in the Gambia “may have been distributed, through informal markets, to other countries or regions”.
Other cases
In the winter of 2019 and 2020, at least 14 dead children after drinking adulterated cough syrup prescribed to them by local doctors in Indian Kashmir and Jammu region. Twelve of the deaths occurred in Jammu.
Coldbest PC cough syrup made by Himachal Pradesh-based Digital Vision Company contains diethylene glycol, according to Media reports cited by the authorities.
Jammu and Kashmir police have yet to prosecute the company and a court case against it is still pending.
In Nigeria, 84 children died in various parts of the country between late 2008 and early 2009 after drinking teething syrup contaminated with diethylene glycol.
The government at the time said there had been 111 reported cases of children falling ill after drinking a syrup called My Pikin.
