Why WHO Has Warned About 4 Indian Cough Syrups After Death of 66 Kids in Gambia

The WHO issued alerts against four cough syrups manufactured by an Indian company after 66 kids died in the Gambia.

The World Health Organization (WHO) on Wednesday, 5 October, issued a warning alert against four cough and cold syrups, manufactured by an Indian company after 66 kids died in the Gambia over the last few months.

The Haryana-based company – Maiden Pharmaceuticals – has been “potentially linked” to the deaths of the children who had developed acute kidney injuries, the WHO said.

The cough syrups – Promethazine Oral Solution, Kofexmalin Baby Cough Syrup, Makoff Baby Cough Syrup, and Magrip N Cold Syrup – were found to have diethylene glycol and ethylene glycol, both of which are harmful to children and adults.

The Gambian government has been investigating the deaths since July after children, who were younger than five years of age, started developing acute kidney injuries.

The WHO is now conducting its own investigation “with the company and regulatory authorities in India,” reported Reuters.

What Has the WHO Said?

“Please DO NOT use them," said the WHO in a statement. People are urged to seek immediate medical consultation from a licensed healthcare provider if they or someone they know has used these items or had any negative side effects.

“It is important to detect and remove these substandard products from circulation to prevent harm to patients," the WHO added.

WHO Director General Tedros Adhanom Ghebreyesus said that while the "contaminated products” were detected only in the Gambia, there’s no clarity if they were distributed to other countries as well.

What Are the Risks?

According to the WHO, the syrups were found to have diethylene glycol and ethylene glycol, which are poisonous and can be fatal

These components can cause:

• Abdominal pain

• Vomiting

• Diarrhoea

• Headache

• Severe renal injury

"To date, the stated manufacturer has not provided guarantees to WHO on the safety and quality of these products."

WHO Statement

Neither India’s Central Drugs Standard Control Organisation nor the health ministry has commented on this so far. All four syrups are available in the market in India.

When The Investigation Began

In September, Gambia had already suspended the sale and import of all paracetamol syrups, since the autopsies that had followed the children’s death had “suggested the possibility of paracetamol,” according to the country’s Health Services Director Mustapha Bittaye.

By August, 28 children had died.

Bittaye had told reporters that the children fell ill 3-5 days after they had taken a paracetamol syrup “sold locally.”

The symptoms were an inability to pass urine, fever, and vomiting which eventually caused kidney failures in the children. However, till then, it wasn’t clear which syrup had caused it.

Earlier in September, Gambian authorities started to collect paracetamol and promethazine syrups from households. Preliminary investigations pointed fingers at them for the deaths, said Abubacarr Jagne, the nephrologist leading the health ministry’s investigation.

While the Gambia had banned all paracetamol syrups on 9 September, the WHO had stated that there was no evidence that the syrup had caused the deaths. The WHO was leaning towards E. coli bacterial infections as a possible cause, along with the severe flooding that had rocked the whole country in July, including the capital of Banjul. During this time, Gambia was also struggling with measles and malaria as health emergencies.

"It is quite unusual because it is confined to only one age group. Normally you see different age groups affected. That is why we are trying to investigate everything."

Sharmila Lareef-Jah, WHO’s disease prevention specialist in the Gambia, told Reuters

Counterfeit Medicines A Problem in the Gambia

With over 40 percent of its population being under the poverty line, the Gambia is known to face the issue of counterfeit medicines – since they are cheaper, and can be bought without a prescription.

Citing the United Nations Office on Drug and Crime, Quartz had reported back in September that African countries accounted for 40 percent of the counterfeit drugs globally and that “about a third of medicines sold in some parts of Africa are fake."