By Awa Sowe
Acute Kidney Injury (AKI) is an abrupt decrease in kidney which includes both injury (structural damage) and impairment (loss of function). It is a syndrome that rarely has a sole and distinct path physiology. Many patients with AKI have a mixed etiology where the presence of sepsis, ischemia and nephrotoxicity often co-exist and complicate recognition and treatment.
On 1 August 2022, the Epidemic and Disease Control Unit of the Ministry of Health in The Gambia reported an unusual event detected at the Edward Francis Small Teaching Hospital in Banjul, the main tertiary hospital in the country. A total of 75 cases of Acute Kidney Injury (AKI) of unknown etiology with 50 deaths ( CFR 66.7%) have been reported by the World Health Organistion (WHO).
The median age is 17 years old and ranges from five to 46 months. The index case was traced to 4 July 2022 . Patients presented with symptoms such as inability to urinate (100% of cases), fever (100% of cases), vomiting (91%), and diarrhea (55%).
All children with the symptoms had an acute onset of symptoms, and clinical progression was rapid.
Stool samples from children with similar clinical symptoms to AKI cases (fever, vomiting and diarrhea) were negative for rotavirus and Vibrio cholerae. However, 38 (61%) out of 62 stool samples (from children with similar clinical presentation as AKI cases) tested positive for Escherichia Coli (E. coli.).
Two samples were positive for Shiga toxin- producing E. coli (O157). Whole-genome sequencing of E. coli to identify lineage was also done and is awaiting interpretation.
Water quality assessment tests conducted in household of children with AKI revealed the presence of E. coli, but were negative for heavy metals including mercury and lead. Additionally, increased nitrite levels mainly in boreholes and one major national water source (Fajara) were also reported. The 2018 Multiple Indicator Cluster Surveys also revealed the presence of E. coli in all the water points tested.
As of 29 th September, 2022 a cumulative reporting revealed at least 78 cases since July, including 66 deaths (CFR 85%). Cases were reported from six out of the country seven health regions, with 86% of cases reported from three health regions (Western Region 1 and 2 and Upper River Region).
About 72% of the cases were under the age of two years. Cases were reported from six out of the country’s seven health regions, with 87% of cases reported from three health regions (Western Region 1 and 2 and Upper River Region).
The World Health Organization issued an alert on four medicines made by Delhi-based Maiden Pharmaceuticals. At least 66 children have died in Gambia from acute kidney injury since July. World Health Organization (WHO) said that the deaths of 66 children from kidney injuries may be linked to four cough and cold syrups made by an Indian drug manufacturer
WHO Director-General Tedros Adhanom Ghebreyesus said the UN’s health agency was conducting investigations along with Indian regulators and India’s Maiden Pharmaceuticals.
The WHO issued a medical product alert asking regulators to remove four products made by the Maiden Pharmaceuticals manufacturer from the market.
According to the alert, the drugs have only been identified in Gambia but may have been distributed in other countries through informal markets.
“In addition, the manufacturer may have used the same contaminated material in other products and distributed them locally or exported,” the WHO warned. “Global exposure is therefore possible.”
The four products identified by the alert were: Promethazine Oral Solution, Kofexmalin Baby Cough Syrup, Makoff Baby Cough Syrup and Magrip N Cold Syrup.
The UN agency said its lab analysis confirmed the presence of “unacceptable” amounts of diethylene glycol and ethylene glycol.
The press realease said that the two substances are toxic to humans and can cause acute kidney injury. According to WHO up to date, the stated manufacturer has not provided guarantees to WHO on the safety and quality of these products.
The Gambia Government in its effort to investigate and tackle this meance through The Ministry of Health in collaboration with the Medicines Control Agency and The Gambia Red Cross Society recently commenced the Medicines Recall of Paracetamol syrups, Promethazine syrups, and Cough syrups.
Speaking to Mr Lamin Sambou , Risk Communication Officer, Ministry of Health said that the exercise is conducted as prior laboratory confirmation tests, confirmed that paracetamol syrup, Promethazine syrups, and Cough syrups were suspected to either cause or aggravate the AKI amongst children
He added that, these medicines were quarantined nationwide including both importers and retailers. He went on to explained that the exercise is also conducted to account for the syrups in the households
According to Mr Sambou , the recall is also held to ensure that the last bottle of these syrups are recalled and disposed most especially the four types of syrups bottles that are found containing the unacceptable amounts of industrial chemicals.
The public is cooperating and the exercise is progressing smoothly. He went on to explained that some of the households are volunteer to take the medicines to the nearest health centre or collection point.
“Some households called 1025 requesting for teams to collect the medicines from home” . he noted
In conclusion Sambou said that once the exercise is completed the medicines will be destroy he further call on individuals, religious leaders, and families to continue the discussions and encourage households to continue cooperating with the collecting teams.
