INDONESIA LINKS MEDICINAL SYRUPS TO CHILD DEATHS: Who’s to blame?

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MEDICINAL SYRUPS
Illustration (AGUNG WAHYUDI/IO)

Jakarta, IO – Indonesia is currently facing a growing public health crisis. As of October 21, the Health Ministry have recorded 241 cases of atypical progressive acute kidney injury (AKI), also known as acute renal failure (ARF), among children – most of who were aged under five – in 22 provinces. Tragically, 133 (55 percent) of them have died. 

AKI is a syndrome characterized by a sudden and rapid kidney failure in regulating the composition of body fluids and electrolytes, as well as the production of metabolic waste products. The cases in Indonesia have several things in common. First, it affects children aged between 0-18 years. Second, they all had fever or other symptoms of infection in the last 14 days. Third, they were diagnosed with acute kidney infection of unknown cause (either at pre-renal, renal, or post-renal stage) by the attending physician (DPJP). Fourth, there had not been diagnosed with any previous kidney disorder or chronic kidney disease. Fifth, there were signs of hyper-inflammation and hyper-coagulation. 

AKI is considered a low prevalence disease; there are usually only one or two cases per month. However, there were sudden spike in cases among children since August. Hospitals were reporting cases of “mysterious kidney illness,” sparking fear among the people, especially parents of young children. 

Cases of AKI from around the world 

It turns out that AKI is not a “new illness”. It has been detected as far back as in 1937 in the US. Prior to Indonesia, the most recent cases were reported in the West African nation of Gambia. In July, dozens of children there suddenly fell ill with unexplained kidney damage. The government of Gambia launched an investigation following the deaths of 28 children in September (this figure has since risen to 70 in October). India and Bangladesh also witnessed similar incidents more than two decades ago. 

On October 6, World Health Organization (WHO) Director-General Tedros Adhanom Ghebreyesus announced that the deaths of young children in Gambia were likely caused by AKI, possibly linked to tainted cough syrups made in India. Laboratory analysis found that the amount of ethylene glycol (EG) and diethylene glycol (DEG) – an organic compound mainly used in the production of polyester fibers and as antifreeze formulations – exceeded a safe limit, making them toxic and harmful to kidneys. 

In a joint investigation with the Indian drug regulator, WHO concluded that the pharmaceutical company that produces the contaminated cough syrups – New Delhi-based Maiden Pharmaceuticals Ltd. – exported its products to several countries in Asia, Africa and Latin America. However, the Indonesian Food and Drug Monitoring Agency (BPOM) confirmed that the India-made cough syrups were not on sale in Indonesia.