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This article discusses the effects of diethylene glycol poisoning on the kidneys and the mechanisms behind it.

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The World Health Organization has issued a medical product alert relating to four contaminated cough syrups that have caused acute kidney injuries and are linked to the deaths of 66 children in the Republic of the Gambia.

In a press briefing on 5 October WHO's director general, Tedros Adhanom Ghebreyesus, said, "The four medicines are cough and cold syrups produced by Maiden Pharmaceuticals Limited, in India. WHO is conducting further investigation with the company and regulatory authorities in India."

The syrups are Promethazine Oral Solution, Kofexmalin Baby Cough Syrup, Makoff Baby cough syrup, and Magrip N Cold syrup. Maiden Pharmaceuticals is based in Sonipet, in the northern Indian state of Haryana. WHO's laboratory analysis of the samples of each of the four products found "unacceptable amounts of diethylene glycol and ethylene glycol as contaminants," its report said.

In 1938 the United States passed stringent legislation in response to a public health crisis that occurred ...

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WHO investigates cough syrups after deaths of 66 children in Gambia

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The World Health Organization has issued a medical product alert relating to four contaminated cough syrups that have caused acute kidney injuries and are linked to the deaths of 66 children in the Republic of the Gambia.

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This article discusses the interference of the Indian government.

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Indian government cracks down on 18 drug companies for poor quality manufacturing

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The Indian government has cancelled the licences of 18 pharmaceutical companies as part of a crackdown on poor quality manufacturing, it has been reported.1 The action on 29 March came after an inspection of 76 drug firms across 20 Indian states. The government is also understood to have given noti…

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This article is about the inconsistency within the Indian pharmacy manufacturing system. These are the same companies responsible for the glycol poisoning.

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A global health warning over cough medicine and the deaths of children in the Gambia shone an unwanted spotlight on India's problematic drug regulation. Neha Bhatt reports

In October 2022, the deaths of 70 Gambian children aged between 5 months and 4 years old were linked to cough syrups containing the solvents diethylene glycol or ethylene glycol. The deaths led the World Health Organization to publish a global alert about four cough syrups made in India by Maiden Pharmaceuticals, a company that has, since 2005, been flagged several times1 2 by state regulators and India's central drug regulator for failing safety tests, as well as being blacklisted by Vietnam.

India's drug regulatory authority, the Central Drugs Standard Control Organisation, refuted WHO's charge, claiming its investigation has revealed the cough syrups to be of "standard quality." Though Gambian authorities later backtracked,3 "The incident has brought international exposure to the shambles our regulations are in," said Malini Aisola, co-convener of the All India Drug Action Network, a campaigning group for affordable healthcare. It was also an uncanny echo of a tragedy that had happened in India three years ago: between December 2019 and January 2020, 11 children aged from 2 months to 6 years died of renal failure in the northern city of Jammu after taking cough syrup that was contaminated with diethylene glycol, a commonly used solvent. Three years on, the pharmaceutical company responsible for manufacturing the syrup, Digital Vision, is yet to be penalised.4

Such regulatory lapses are not uncommon in India, but as Indian pharma has grown into an industry worth around $50bn, with over 3000 companies spread across the country, its regulatory system has failed to keep up-and that has far reaching implications. In December 2022, Uzbekistan's health ministry said that 18 children died after ...

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Inconsistent drug regulation spells danger for India's global pharma ambitions

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A global health warning over cough medicine and the deaths of children in the Gambia shone an unwanted spotlight on India's problematic drug regulation. Neha Bhatt reports In October 2022, the deaths of 70 Gambian children aged between 5 months and 4 years old were linked to cough syrups containing the solvents diethylene glycol or ethylene glycol.

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Journalist from India discusses the deaths:

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Journalist from India discusses the deaths:

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Labanya Maitra discusses where else the cough syrup could've ended up in the world.

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4 Indian cough syrups, 66 deaths in the Gambia

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This article from the BBC researches the brands and companies responsible.

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"Subsequent inspections, tests and studies by Government of India's notified bodies and technical team have shown that WHO's presumptuous statement was untrue and incorrect," said Kanchan Gupta, adding that the health body had "[jumped] the gun without valid scientific reasons".

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Maiden Pharmaceuticals: Gambia panel says India firm culpable for cough syrup deaths

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A Gambia parliamentary panel says the Indian firm linked to cough syrups deaths should be prosecuted.

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This article from Reuters highlights that no one has been punished or held accountable for the cough syrup deaths.

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Toxic cough syrup made and sold in India may have been the start of a recent global wave of contamination. Some of the drugmakers could not prove they even tested their products. Bereaved parents are still waiting for justice.

In December 2019, Jafar Din's two-month-old son Irfan was coughing and feverish. Din left their single-room home in the Himalayan mountains and traveled 10 km (6 miles) to the nearest pharmacy, where he bought a bottle of medicine, COLDBEST-PC.

He returned and gave the child a dose.

Hours later, Irfan started vomiting. He stopped passing urine. He was admitted to hospital in Jammu city. A week later, he died.

Irfan was one of at least 16 children whom authorities in India's northern region of Jammu and Kashmir found had been poisoned. Twelve died after their kidneys and other organs failed, a police charge sheet showed; four others were left with severe disabilities.

Investigations by police and state drug inspectors pointed to medicines made by one manufacturer, Digital Vision Pharma. The family-owned business is based in the neighboring state of Himachal Pradesh, a center for India's pharmaceutical industry and one of Asia's biggest drug manufacturing hubs.

Government analyses of the syrups made by Digital Vision that the children took - as well as samples taken from the company's factory and its distributor in early 2020 - found they contained a 34% concentration of the toxin diethylene glycol (DEG), according to the charge sheet for an ongoing criminal case against Digital Vision's owners and an investigative report by Jammu and Kashmir's drugs regulator, both seen by Reuters.

That concentration is far above safe levels for DEG, an industrial solvent used in car brake fluid. The World Health Organization (WHO) says the safe limit, based on internationally accepted standards, is no more than 0.10%.

Digital says there was no DEG in its syrup and its medicines are not to blame. The company has provided no evidence to support this.

"We will challenge any case against us."

The WHO told Reuters the Jammu deaths may have been the start of a wave of poisonings, by medicines made in India by three other companies, that have been linked to the deaths of 141 children in Gambia, Uzbekistan and Cameroon over the last year. They are part of one of the largest episodes of such contamination on record.

In all three cases, the syrups were found to contain high levels of DEG and a related chemical, ethylene glycol (EG). The WHO says at least 15 countries may have had tainted syrups on sale, made by various different companies.

The rash of poisonings has led to criminal probes, lawsuits and a surge in regulatory scrutiny in India and abroad. Indian regulators have conducted a wave of inspections this year that found possible violations in nearly nine in 10 of some 160 factories targeted.

Still, despite intense lobbying on behalf of the families of the children in Jammu, no one has yet been found guilty in a court of law for the cough syrup deaths.

A Reuters examination of court records and regulatory filings - as well as interviews with two company executives and two regulators - show that the drugmakers linked to the child deaths in India, Uzbekistan and Gambia either did not test their products for known toxins, or could not prove to investigators that they did so - as required by Indian law.

India's health ministry, the office of the prime minister and the federal drugs regulator, the Central Drugs Standard Control Organisation (CDSCO), did not respond to requests for comment for this article.

The three drugmakers - Digital Vision, Marion Biotech and Maiden Pharmaceuticals - implicated in the cases in India, Uzbekistan and Gambia said they had purchased pharmaceutical quality chemical ingredients. But Reuters found these claims were denied or called into question by the chemicals suppliers themselves in all three cases.

Reuters' reporting also showed how two of the companies had already come under scrutiny for lax manufacturing practices.

The news agency found that Digital Vision and its unit Orison Pharmaceuticals had received at least 16 warnings from the drug regulators of Maharashtra and Gujarat states about substandard heartburn, antibiotic, anti-fungal and other medicines before the Jammu deaths.

And senior executives at the company linked to cough syrup deaths in Gambia - Maiden Pharmaceuticals - were on bail on charges of illegally storing substandard medicines when the African poisonings occurred.

Seven Indian pharmaceutical executives and regulators told Reuters it is common practice among some manufacturers there to substitute cheaper, commercial-grade ingredients when making cough syrups. They declined to identify any companies.

Police in Jammu and Kashmir in December charged Digital Vision's founder, Parshottam Goyal, and his sons Manic and Konic with crimes including culpable homicide not amounting to murder - comparable to manslaughter - in connection with the poisonings, according to the charge sheet submitted to a court in Ramnagar town.

The charges carry a possible sentence of up to life in jail. The Goyals deny any wrongdoing.

"We will challenge any case against us," Goyal told Reuters ahead of the next hearing in the case, due on Sept. 15. Asked about the toxin and the children's deaths, he said someone may have "planted something" or that medicines may have been misused. "Who knows what was fed to whom," he said.

Konic Goyal declined to comment; Reuters could not contact his brother, Manic. Police investigators did not respond to requests for comment about the case.

A court in Himachal upheld Digital's appeal in August 2020 against the suspension of its manufacturing license by the state drugs regulator five months earlier, noting that only one batch of its COLDBEST syrup had been found to contain toxins - the consignment that was sold in Jammu.

The court barred Digital Vision from making drugs containing certain ingredients and the case concluded without a definitive ruling on who was to blame for the Jammu deaths.

Asked by Reuters about the impact of the legal cases, Goyal said Digital Vision's business had "stabilized" and "expanded." Digital has tripled its capacity to produce other medicines, he said, and another company he owns that makes medicines, including antibiotics and eye drops, started exporting them last year.

Poli Devi, whose 11-month-old daughter Janvi died on Dec. 29, 2019, after consuming contaminated cough syrup, holds a photo of her at their house near Ramnagar. REUTERS/Anushree Fadnavis

"Starting point"

The risks posed by DEG and EG are well known. The toxins have killed nearly 1,000 children worldwide over the last 80 years, according to Kalle Hoppu, a Finnish poisons and pediatric medicines expert, who worked with Gambia's government to investigate the deaths of children there.

Cough and cold syrups are made with propylene glycol (PG), a colorless, viscous liquid that does not react with other substances, making it an ideal solvent for syrupy medicines. It is generally sold in two grades: pharmaceutical and industrial.

Industrial grade PG - widely used in liquid detergents, antifreeze, paints or coatings - is always cheaper than the pharmaceutical version. This is partly because it is not intended for human consumption, and may contain more DEG or EG.

Prices for pharmaceutical grade PG in India jumped several times in recent years due to supply chain disruptions, according to ChemAnalyst, a Mumbai-based chemicals market tracker.

A DEG concentration of 34% - the level identified in Digital Vision's cough syrup - would likely make children sick very quickly if they took several doses, putting them at risk of death - particularly if they had poor access to doctors, said British consultant nephrologist Dr. Graham Lipkin.

Initial symptoms include nausea and vomiting. Without treatment, patients may experience acute kidney injury. Then other organs can become inflamed, start to bleed and fail, he said.

The WHO said it learnt of the 2019 poisonings in Jammu and Kashmir only after it began to help Gambia investigate its deaths last year. The U.N. health agency has linked the deaths of at least 70 children in the West African country to cough syrups made by Maiden Pharmaceuticals.

Maiden, whose factory is in the northern state of Haryana, denies any wrongdoing. It did not respond to requests for comment for this story.

Rutendo Kuwana, the WHO's team lead for incidents with substandard and falsified medicines, said such poisonings tend to cluster together. The agency suspects the contamination occurred when someone switched in cheaper, toxic ingredients somewhere along the pharmaceutical supply chain.

"It is likely that (Jammu) is your starting point" for the global wave, Kuwana told Reuters. Further testing and paperwork are required to be sure, he said.

"Just add it in"

Reuters' examination of the children's deaths in Jammu shows the difficulties of tracing chemicals within India's $42 billion-a-year pharmaceutical industry.

Digital told Reuters it produced the suspected batch of COLDBEST in September 2019 using pharmaceutical-grade PG from a supplier, Thakur Enterprises, based in Haryana state.

Thakur confirmed it sold PG to Digital, but said it only supplies industrial grade chemicals.

"All my bills say, in red letters, that all my products are for industrial use only," said Vibhor Chitkara, who runs Thakur. Neither he nor Digital Vision's Goyal would provide any documentation to Reuters to support their assertions.

Chitkara said he had bought the PG from another company, Manali Petrochemicals, which is India's sole PG manufacturer and sells both pharma and industrial grades, according to a spokesperson.

But Manali told Reuters it had not done business with either Thakur or Digital, and called such a claim "entirely incorrect and misleading." Thakur declined to provide proof of having done business with Manali.

In the case of Marion Biotech, whose cough syrups have been blamed by authorities in Uzbekistan for the wave of poisonings there, Reuters reported in June that its PG supplier Maya Chemtech did not have a license to sell pharmaceutical-grade materials and dealt only in industrial-grade chemicals.

Marion did not respond to requests for comment for this story.

Maiden, meanwhile, told Indian authorities that its PG was made by South Korea's SKC. But SKC told Reuters it never supplied PG to either Maiden or its stated chemicals supplier, Delhi-based Goel Pharma Chem, the agency reported in May.

Digital Vision told the High Court of Himachal Pradesh in August 2020 - when it was appealing to reopen its factory there - that it had requested tests of its syrup for DEG and EG at a laboratory in New Delhi. But it provided no proof.

The laboratory, Shree Sai Test House, did not respond to Reuters inquiries.

Indian regulations require drug manufacturers to test each batch of raw materials and products for strength, quality and purity. They explicitly require tests for DEG and EG. Violations carry fines or jail sentences up to life if a product is found to cause grievous harm or death. However, there is no nationwide record of punishments for selling or failing to test toxic medicines.

The Himachal High Court ruled in August 2020 that Digital had not proven it bought the PG from a licensed dealer, nor tested it for DEG.

The court nevertheless allowed Digital to resume production of medicines - as long as these do not contain PG.

Though Goyal insisted that his ingredients met pharmaceutical-grade standards - known as pharmacopeia - he said others' may not.

"Many pharma companies buy non-pharmacopeia PG," he told Reuters, without providing evidence. "Many people don't even test PG. They think, 'It's in a big drum, just add it in.'"

Rattan Chand holds a picture of his son Amit, 4, who died on Jan. 2, 2020, due to kidney injury after consuming contaminated cough syrup. REUTERS/Anushree Fadnavis

"Nobody's responsibility"

Consumer advocates and lawmakers have lobbied India's government for more than two decades for improved oversight of its pharmaceuticals industry, one of the world's largest.

They say supervision remains ineffective partly due to a patchwork of understaffed regulators with no overarching authority, and an array of vague production standards.

There are 37 local-level regulators across India as well as the federal body, CDSCO. Different states often have jurisdiction over different companies in the supply chain.

Although CDSCO is responsible for laying down standards and coordinating state drug control organizations, its role is curtailed by India's constitution, which allows individual states to have their own laws on drugs.

"So, everybody's responsibility becomes nobody's responsibility," said Kundan Lal Sharma, a former senior Indian health ministry official.

In the Jammu and Kashmir poisonings, the local government said the onus of investigating the products was on the state where Digital Vision's operations are based - Himachal Pradesh.

But Himachal says finding out how the cough syrups were contaminated is mainly the responsibility of yet another state, Haryana, because that's where the PG supplier, Thakur Enterprises, is based.

Haryana's drug regulator did not respond to requests for comment.

A Jammu and Kashmir court ruled in March 2021 that the regional government's Drugs and Food Control Department should be held accountable because it could have kept the syrups off shelves if it had tested them vigilantly.

The government appealed but India's highest court upheld the ruling, saying last November that drugs officers had been found "negligent."

The Supreme Court ordered Jammu and Kashmir to pay the families of the 12 dead children 300,000 rupees ($3,668) each in compensation. But again, it did not rule on who was responsible or order help for those left disabled.

Jammu and Kashmir has paid the compensation. Its drugs controller, Lotika Khajuria, told Reuters that before the deaths it did not inspect medicines or medicine-makers thoroughly, but it will open a new laboratory in September to double its annual testing capacity to 10,000 samples.

"We're hoping that we will do some justice to the kids," she said. "Small and medium-scale industries, they never used to test."

Govind Ram shows a picture of his daughter Surbhi Sharma, who died at age 3 on Dec. 31, 2019, after consuming contaminated cough syrup. REUTERS/Anushree Fadnavis

"We never tested"

Marion Biotech, based in the Indian state of Uttar Pradesh, produced cough syrups that the health ministry in Uzbekistan linked to the deaths of 65 children there last year.

The syrups shipped to Uzbekistan last year by Marion were made with a toxic industrial-grade ingredient, rather than the legitimate pharmaceutical version, Reuters reported in June.

Tests by an Indian government laboratory in January found 22 samples of Marion-made syrups were " adulterated and spurious," the country's drug controller said in March.

The company's then-head of operations, Tuhin Bhattacharya, told Reuters it had exported cough syrups for more than a decade without testing the PG for impurities like DEG or EG.

"No exporter in India used to test for DEG and EG," he said. "No one does it."

Reuters reported in April that government inspectors had found that Maiden Pharmaceuticals also did not test the PG before use.

Authorities in Uttar Pradesh canceled Marion's license in March and arrested Bhattacharya and two of its chemists. They were released on bail a few days later.

Ashok Kumar and Veena Kumari show a picture of their son Anirudh. "He was a naughty boy, he spoke clearly from an early age. We miss him a lot," said his mother. REUTERS/Anushree Fadnavis

A court barred police from arresting Marion's owners, Jaya Jain and Sachin Jain, saying police should not have investigated the matter without first bringing it to court. But it allowed drug officials to continue their enquiries.

Drug inspectors from the federal regulator CDSCO are pursuing their investigation into Marion, according to two sources with knowledge of the matter, who declined to be named as they were not authorized to talk to the media.

A lawyer for Marion's owners declined to comment, and the owners themselves could not be reached.

Bhattacharya said the standards Marion followed were set by the British Pharmacopeia, or drug standards guidelines, as requested by authorities in Uzbekistan and approved by drug regulators such as CDSCO. Uzbek authorities did not reply to requests for comment.

Bhattacharya said British standards do not explicitly call for propylene glycol to be tested for DEG or EG. "If something has happened, it's because of the regulation," he said. "It is not the fault of our technicians."

A spokesperson for Britain's Medicines and Healthcare Regulatory Products Agency, which oversees the standard, said that was "not a fair statement." She cited wider British and international manufacturing guidelines requiring tests that should uncover any toxins and spark further inquiry. However, she added that the agency is working with global regulators to make its requirements more explicit.

"Would have killed 100 kids"

Digital's Goyal told Reuters COLDBEST-PC could not have killed the children in Jammu, because the deaths were concentrated in one region, while his companies supplied 5,575 bottles to eight regions in total.

"Had something been wrong with our product, kids would have died elsewhere too," said Goyal, 60.

"I am not saying that all those who consumed the medicine would have died, but had it been toxic, it would have killed at least 100 kids."

Half a dozen experts interviewed by Reuters said Goyal's argument was not convincing. Several variables could explain the pattern of deaths, they said: For example, any single batch may have used different barrels of the same ingredient. And smaller patients are more vulnerable to DEG poisoning.

"The toxicity depends on the dose and the size of the child," said Hoppu, the poisons and pediatric medicines expert. "The more doses a child gets, the more likely they are to get kidney damage."

The seven other regions recalled COLDBEST in February 2020. Federal authorities found toxins in samples sold in four states, according to court and government documents. In Haryana, a sample had 35.87% DEG - the highest of all.

One of the states, Tamil Nadu, told Reuters no deaths had been linked to the syrup but said it was seeking legal action against the company and its owners for selling adulterated drugs.

The others did not respond. Reuters could not determine how many medicines had been sold outside Jammu or if anyone was harmed.

Parents Murfan Bibi and Jafar Din hold their baby and son Mohammed Ashrat in their home in Jammu region. Irfan, their firstborn, died after consuming contaminated cough syrup. REUTERS/Anushree Fadnavis

"Absence of testing"

Amid mounting international outcry, Prime Minister Narendra Modi's government doubled down on testing requirements in June, introducing a new rule that all cough syrups for export must be checked in government laboratories. Health Minister Mansukh Mandaviya said more than 900 cough syrup samples have since been cleared.

Mandaviya told parliament in August that authorities had inspected 162 drug factories since the overseas cough syrup deaths and found possible violations in 143 of them - nearly nine in 10.

The health ministry said in August the inspections of drug factories found an " absence of testing of incoming raw materials." It gave all companies up to a year to fix that shortcoming and comply with international manufacturing standards set by the WHO. The ministry said fewer than a quarter of India's 8,500 small drug factories currently meet these.

But India did not increase testing requirements for the domestic market.

Industry executives have complained about the cost of extra tests for exports and asked the government to cover this, according to communications viewed by Reuters.

"I demand strict action against them."

In June, a national association of small businesses close to Modi's Bharatiya Janata Party (BJP), called Laghu Udyog Bharati, wrote to the health ministry that inspecting drug factories whose products had been found substandard was a "death sentence" for small companies.

The group later retracted the letter, which the president of its pharmaceutical wing, Rajesh Gupta, told Reuters was inadvertently issued by an official on "emotional grounds." He declined to identify the official.

"We are not against the government on quality inspections," Gupta said. "It is the regulator's right to inspect but it should be done in a friendly way and not in the manner of a raid, which creates fear."

He also said the deadline for small factories to meet WHO manufacturing standards would lead to the closure of nearly half of them, because they are already heavily indebted. The health ministry did not respond to a request for comment. The WHO declined to comment.

Digital Vision's Goyal said his company's sales have now returned to levels seen before 2020, to up to 400 million rupees annually, and he is ramping up exports.

A Goyal-owned company called Vellinton Healthcare is registering to sell drugs in eight countries including Ghana, Ethiopia and Afghanistan. It has exported to countries including Turkmenistan since last year, he said.

"Our vision is mainly export now. There is barely any money in the domestic market," Goyal said. "Competition is fierce and unhealthy. Quality is not maintained."

In Jammu, Reuters spoke to the families of six of the dead children. Din took a reporter to the hilly graveyard strewn with boulders where Irfan, his firstborn, is buried. Like the parents of the other five, he said he wants the manufacturers punished.

"I demand strict action against them," said the 27-year-old father. "It's been too long already."

Firms linked to deaths received prior warnings

The deaths of 12 children in northern India between December 2019 and January 2020, police allege, were caused by adulterated cough syrup made by drugmaker Digital Vision. It was not the first time the company's medicines have come under scrutiny.

Indian drugs regulators found quality shortfalls in drugs made by Digital and its unit Orison Pharmaceuticals at least 22 times between 2012 and July this year, according to a Reuters review of records from five states and India's federal drugs regulator CDSCO.

The medicines either did not contain the claimed volume of ingredients or failed to dissolve quickly enough for absorption by the body, according to the records.

Digital Vision founder Parshottam Goyal downplayed the shortfalls. "Drug samples of every company fail on some criteria every now and then: small mismatches in the quantity of medicines and things like that," he told Reuters, when asked about the regulators' warnings.

Tests by government laboratories in 2020 found that a batch of Digital Vision's COLDBEST-PC cough syrup taken by the children in the northern region of Jammu and Kashmir contained high levels of toxic chemicals. The company has denied this and said its syrup was not to blame for the wave of poisonings, without providing proof.

Maiden Pharmaceuticals - whose cough syrups have been linked to deaths of at least 70 children in Gambia last year - had also been alerted by regulators to quality shortfalls in some of its drugs.

Regulators found at least 10 medicines produced in India by Maiden were "not of standard quality," according to records shared by India's Department of Pharmaceuticals with parliament in March. The eastern state of Bihar in 2011 banned the company for five years for selling substandard medicines there.

India's health ministry and the CDSCO did not respond to requests for comment.

Maiden, which has denied its cough syrup was responsible for the deaths in Gambia, did not respond to requests for comment for this story.

When Maiden produced the syrups exported to Gambia in late 2021, its founder, Naresh Kumar Goyal, and Technical Director Mahender Kumar Sharma were already on bail since March 2018 in a separate case on charges of illegally storing substandard medicines, according to documents from a court in Haryana state.

Goyal did not respond to requests for comment; Sharma could not be reached.

The court documents show that inspectors visited Maiden's factory in 2014 after Vietnam had banned the company the previous year for allegedly selling another heartburn drug there that did not meet specifications.

Maiden's lawyers told the court in Haryana its own testing had shown the drugs discovered by the Indian inspectors fell short and it had not intended to sell them.

But the court in February this year found "substandard quality medicines were kept for the purpose of its sale to derive undue gain" and that "such types of sub-standard quality drugs were also exported" to Vietnam.

It sentenced Goyal and Sharma to two and half years in jail. They pleaded not guilty, appealed in a higher court, and have been on bail again since March while their petition is heard.

Contamination cases

Since last October, the WHO and other health agencies have found cough and cold syrups made by several Indian companies were contaminated. A dozen children killed by toxic syrups in India preceded these findings: The WHO said that may have been the start of a wave of deaths.

* Promethazine Oral Solution

* Kofexmalin Baby Cough Syrup

* Makoff Baby Cough Syrup

* Magrip N Cold Syrup

Contamination flagged where; by whom

British Pharmacopeia (BP)

DEG 1%-21.3%, ethylene glycol (EG) 0.3%-5.9% according to tests for WHO

At least 70 dead in Gambia

Company view; action taken

Death by the Dose
By Krishna N. Das and Jennifer Rigby

Additional reporting by Saurabh Sharma and Shivam Patel in New Delhi

Video: Ilan Rubens and Lucy Fielder

Photo editing: Edgar Su

Art direction: John Emerson

Edited by Sara Ledwith, Michele Gershberg and Daniel Flynn

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Cough syrup killed scores of children. Why no one has been held

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Indian parents whose children died after taking toxic syrups want justice. Some of the drugmakers haven't shown they even tested their products.

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It's been difficult to find an exact account of health organizations helping specifically with the cough syrup deaths. The only organization holding Maiden Pharmaceuticals accountable is the Indian Government. However, CARE India works with children and women and I'm assuming they have aided in informing Indian families about what can be done to prevent more deaths.

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Building community and healthcare facilities' resilience and response towards the prevention, timely identification, and medical attention during the COVID-19 pandemic.

CARE India has been extensively working across India to contain and control the spread of COVID-19 cases and to manage and expedite the response towards it. We are supplementing multiple state governments in their fight against Covid by deploying personnel with expertise and mobilising and streamlining the requisite resources- medicine, consumables, lifesaving critical equipment and lab testing provisioning.

Enhancing Critical Care and emergency handling abilities

Setting up Model secondary care hospitals

Strengthening District Hospitals

Equipment availability and upkeep

Infrastructure enhancement

HR Augmentation

Mentoring Support

Supplementing Lab setup

Supporting governments setting up DCHCs

Social mobilization - hiring and placing social mobilizers at the block and sub-block mobilizers

Organizing Communication events

Enhancement of Vaccination Points- Mega Vaccination camps and Mobile Vaccination Vans

Additional vaccinator support (wherever required)

Providing innovative ICT solutions to streamline processes

Establishing models for Community Surveillance

Post COVID psychological and physiological care of the COVID affected patients and families

Caring for the COVID orphans, semi-orphans and widows

Address learning -loss in children and students; and

Rebuild livelihoods of those impacted by Covid

Our activities

To safeguard our frontline workers, we helped procure/supply PPE (personal protective equipment) including N95 masks, 3 PLY masks, surgical gloves, surgical caps, hand sanitisers, disposable bed sheets, floor disinfectants to hospitals and other frontline workers.

We have been providing customised relief kits to local areas consisting of essentials and staples to provide appropriate nutrition and immediate food relief to those impacted by the pandemic.

Scaling COVID vaccinations - Addressing hesitancy, mobilisation involving the community front-line workers and ensuring that the maximum numbers of people get vaccinated through delivery and demand side interventions.

Strengthening the healthcare facilities and making them ready for any future surges - Through human resource, equipment, infrastructure, technical and administrative support.

Building community resilience and response - Prevention, timely identification, and action including post-COVID psychological and physiological care of the COVID affected patients and families, caring for the COVID orphans, semi-orphans, and widows and re-building livelihoods impacted by COVID.

Increased size of metal used for Plain Cement Concrete (PCC) and Reinforced Cement Concrete (RCC) works.

Caring for the COVID orphans, semi-orphans, and widows.

Addressing learning -loss in children and students.

Rebuilding livelihoods of those impacted by Covid.

Impact

Setting up at least 14 make-shift hospitals with 2,035 beds and supporting multiple other hospitals with the supply of oxygen related and lifesaving equipment like bipap machines, concentrators, PSA plants, scryogenic liquid medical oxygen tanks, and PPE kits among others.

Around 4 lakh people have been vaccinated in Patna through Mega Vaccination Camps alone. Similar camps running and coming up in multiple other cities across India. These centres target up to 2,000 vaccinations per day in Patna through two state of the art facilities open 24/7 with public amenities.

Recently launched Suraksha Vahinis (travellers) carry a Nukkad Natak troop who performs in front of the target population breaking the myths and misinformation around COVID vaccination, address the vaccine hesitancy and subsequently the vaccinators and data verifiers accompanying the vehicle vaccinate the people.

Around 10 lakh people have been vaccinated through Mobile Vans alone. Similar vans running and coming up in multiple other states across India, which address the inaccessibility of vaccines through doorstep delivery and increased coverage.

Enhanced vaccination possible through both demand and delivery side interventions.

Demand side interventions include- addressal of vaccine hesitancy through research and field exposure and subsequent addressal based on the causes through a team of specialists involving social behaviour change communication experts, doctors, and public health experts.

Deploying Health Volunteers to boost the morale of the community through door-to-door and community level interaction and mobilisation.

Streamlining the vaccine registration process by deploying data verifiers who verify the vaccinees' documents and fill the details in the portal on their behalf, solving the problem arising due to digital divide.

Leveraging and involving the community influencers and frontline workers to reach out to the communities for better mobilisation and trust.

Delivery side interventions include- Managerial support to the states at various levels in vaccination site planning & preparedness and proper supply chain management of vaccines as per the data analysis done through CARE deployed data analysts, doctors, vaccinators, data verifiers and associated staff to expedite the vaccination process.

Ensuring sufficient delivery points in metro cities, urban centers, rural and tribal areas based on the site analysis through Vaccination Camps and Mobile Vaccination Vans.

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COVID - 19 Second Wave Response Building community and healthcare facilities' resilience and response towards the prevention, timely identification, and medical attention during the COVID-19 pandemic. CARE India has been extensively working across India to contain and control the spread of COVID-19 cases and to manage and expedite the response towards it.

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Similar to my other global health article - this does not directly discuss the cough syrup deaths but it discusses a program that brought health information to Indian families. This connects back to the cough syrup deaths because awareness and prevention are extremely important when preventing tragedies such as these.

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Democratic Republic of Congo, Egypt, Ethiopia, Ghana, Guinea, Haiti, India, Kenya, Madagascar, Malawi, Mali, Mozambique, Myanmar, Namibia, Nigeria, Pakistan, Rwanda, South Africa, Tanzania, Uganda, Zambia,

SUMMARY

The Maternal and Child Survival Program was a global USAID Cooperative Agreement that supports high-impact health interventions with a focus on 24 high-priority countries with the ultimate goal of ending preventable child and maternal deaths within a generation. The Program focused on ensuring that all women, newborns, and children most in need have equitable access to quality health care services to save lives.

The Maternal and Child Survival Program supported programming in maternal, newborn, and child health, immunization, family planning and reproductive health, nutrition, health systems strengthening, water/sanitation/hygiene, malaria, prevention of mother-to-child transmission of HIV, and pediatric HIV care and treatment. The Program tackled these issues through approaches that focused on health systems strengthening, household and community mobilization, gender integration, and eHealth, among others.

With approaches tailored to meet individual country needs, the Program empowered countries to design effective approaches, develop technical skills, apply analytical tools, manage workforce capacity and devote resources to reduce inequities in care, and build sustainable health systems to keep mothers, newborns, and children alive and healthy.

JSI led the Program's work in the areas of child health, immunization, and pediatric HIV. Our staff also contributed technically to MCSP's cross-cutting functions of measurement, monitoring, evaluation, and learning (MMEL), community health, and health systems strengthening, with a focus on the strengthening of routine health information systems and supply chain management. Other partners included Jhpiego, Save the Children, PATH, PSI, Core Group, ICF, Results for Development. The Maternal and Child Survival Program was the follow-on project to MCHIP, USAID's global flagship maternal and child health technical assistance project on which JSI was also a partner.

JSI provided technical assistance through MCSP in nineteen countries and is leading the program in Namibia, Nigeria, and Uganda. MCSP is the follow on project to MCHIP, USAID's global flagship Maternal and Child Health Integrated Program on which JSI was also a partner. MCHIP continues to work in: Bangladesh, Malawi, Mozambique, Pakistan, Republic of South Sudan, Yemen, and Zimbabwe.

View peer-reviewed journal articles on the Maternal and Child Survival Program's groundbreaking work, "Immunisation Training Needs in Malawi" East African Medical Journal, "Engaging Communities With a Simple Tool to Help Increase Immunization Coverage" Global Health: Science and Practice, "Routine Immunization in India: A Perspective" Indian Journal of Community Health , "Monitoring Coverage of Fully Immunized Children" VACCINE, "Assessment of Health Benefits and Cost-Effectiveness of 10-Valent and 13-Valent Pneumococcal Conjugate Vaccination in Kenyan Children" PLoS ONE

Supporting Retail Medicine Vendors as Resources for Child Health

Webinar from Child Health Task Force on Digital Tools for ECD and Child Health

Restoring Health Services in Liberia

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Maternal and Child Survival Program (MCSP) - JSI

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The Maternal and Child Survival Program was a global USAID Cooperative Agreement that supports high-impact health interventions with a focus on 24 high-priority countries with the ultimate goal of ending preventable child and maternal deaths within a generation. The Program focused on ensuring that all women, newborns, and children most in need have equitable access to...