The Department of Drug Administration said it has alerted drug inspectors to step up surveillance to prevent the import and sales of cough syrups manufactured by an Indian pharmaceutical company after scores of children in Gambia died of kidney failure after consuming the syrups.

The move by the department follows a global alert by the World Health Organisation about four cough syrups that could have links to the deaths of the children in July, August, and September, in the West African country.

“We have alerted our drug inspectors to step up surveillance to prevent import and sales of the cough syrups manufactured by Maiden Pharmaceutical Limited (Haryana India),” said Santosh KC, spokesperson at the department. “The products are not registered with the DDA.”

The UN health agency identified four medicines —Promethazine Oral Solution, Kofexmalin Baby Cough Syrup, Makoff Baby Cough Syrup, and Magrip N Cold Syrup as substandard products manufactured by the Indian company which could be responsible for the deaths. The WHO said that the company had failed to guarantee the safety of the products.

The Indian government is also investigating the situation, according to media reports.

“Laboratory analysis of samples of each of the four products confirms that they contain unacceptable amounts of diethylene glycol and ethylene glycol as contaminants,” reads the WHO alert published on its website. “To date, these four products have been identified in the Gambia, but may have been distributed, through informal markets, to other countries or regions.”

Diethylene glycol and ethylene glycol are used as antifreeze, brake fluids, and other industrial applications, but also as a cheaper alternative in some pharmaceutical products to glycerine, a solvent or thickening agent in many cough syrups, according to a Reuters report.

Nepal and India share hundreds of kilometers of porous borders, through which thousands of people cross over to each other’s territories every day. Small traders smuggled various goods including medicines into Nepal taking undue advantage of the porous border.

The WHO requests increased surveillance and diligence within the supply chains of countries and regions likely to be affected by these products. Increased surveillance of the informal/unregulated market is also advised.

Health experts in Nepal criticize the lackadaisical approach of authorities concerned to the risks.

“The Ministry of Health and Population has not felt it necessary to issue a notice about the risk even after five days of the global alert by the UN health agency,” said Dr Baburam Marasini, former director of the Epidemiology and Disease Control Division.

“We have a very bad tendency to buy over-the-counter drugs without knowing their side effects.”

Multiple doctors the Post talked to agreed that medicines are not needed in most cases of cough and cold and that not all cough medicines serve the same purpose.

“We have a tendency to buy medicines over the counter by showing old prescriptions or empty medicine bottles,” said Dr Ganesh Rai, president of Nepal Pediatric Society. “Medicines are not required in most of the cases of cough, and coughs are also caused by allergy, asthma, bronchitis, etc.”

Doctors say some cough syrups are made to loosen the mucus so it will help clear the throat and chest, and some cough syrups are meant to suppress mucus.

“We should not forget that medicines made for one purpose don't work for another purpose,” said Dr Ram Hari Chapagain of the Kanti Children’s Hospital. “And every cough medicine has its side effects.”

Medicine does not work if the cough is caused by a virus and some cough syrups also contain paracetamol, which is not needed if children do not have a fever.

“Home remedies—hot water, ginger, honey, lemon, and taking steam—help to heal cough in many instances,” said Rai, who is also the former director at the Kanti Children’s Hospital.