Indonesia has seen dozens of child deaths in recent days attributed by authorities to harmful substances found in cough syrups.  

According to Health Ministry data, 255 children were diagnosed with acute kidney injury (AKI) as of October 24 and 143 children lost their lives due to the illness.

The cases have prompted the government to launch an investigation and slap a ban on all syrup and liquid medicine prescriptions and sales, before lifting the prohibition on some types of medicinal syrups after deeming them safe for consumption.

Health Minister Budi Gunadi Sadikin said during a press conference last week that they found traces of harmful substances in children being treated for AKI.

"Seven out of 11 children had that harmful substance: ethylene glycol, diethylene glycol and ethylene glycol butyl ether," he said, adding: "It is confirmed that (AKI) was caused by (those) substances."

Most AKI cases reported in the Southeast Asian nation this year involved children under five years old. Before the recent rise, authorities typically recorded two to five cases of AKI a month.

More cases in coming days?

Masdalina Pane, senior researcher at the National Institute of Health Research and Development (NIHRD) in Indonesia, said she expects the number of reported AKI cases to increase in the coming days as the federal government receives more comprehensive reports from provincial authorities.

"Don't be alarmed if the numbers continue to increase," she said. But Pane also stressed that the cases will drop in two to four weeks as authorities found an antidote to the illness and more people become aware of the problem.

On October 21, the country's Food and Drug Monitoring Agency (BPOM) withdrew five brands of cough and fever syrups from pharmacies, saying that the amount of ethylene glycol and diethylene glycol in these medicines exceeded what's considered a safe level.

Experts say ingesting these chemicals above the safety threshold can lead to acute kidney failure and death.

Penny Lukito, the head of the BPOM, told reporters earlier this week that the agency had identified two drug manufacturers whose medicinal syrups breached the tolerable levels for the two chemical compounds.

Parents worry about their children's health

The scandal surrounding the medicines has left many parents of young children deeply distressed.

Before the AKI cases emerged, 35-year-old Meirissa Ramadhani had been regularly using one of the now-banned syrups whenever her children were suffering from cough.

"I am worried. I did not know it contained hazardous substances. What can I do?" she said, adding that she was left with no other option but to keep a close eye on her children's health and hope all will be well.

Elvya Dea, mother of an 18-month-old toddler, said she became furious after knowing that such medicines were allowed to be sold on the market, both with and without a prescription.

She noted that she had immediately stopped using any non-urgent syrup medication for her child after the news broke out. Dea demanded accountability from the BPOM for the health crisis.

The Indonesian Ombudsman, Robert Na Endi Jaweng, this week also put the onus on the agency as well as the Health Ministry over the AKI deaths. Furthermore, he called on the government to provide valid and accurate data on the cases.

Need for a thorough investigation

Dicky Budiman, an epidemiologist at Griffith University in Australia, raised similar concerns. 

"There might have been an error, or weakness, and even poor drug quality control, because how come these drugs continue to get approval even though there have been cases reported since early 2022," Budiman told DW.

President Joko Widodo has also ordered officials to conduct a thorough investigation and stressed its importance to ascertain all the facts.

Authorities, meanwhile, have recommended using the drug fomepizole to treat those suffering from AKI due to ethylene glycol poisoning. The health minister said patients' health improved after being treated with the antidote. 

Indonesia has so far imported 10 vials of fomepizole from Singapore and 16 vials from Australia. It will also procure 200 vials from Japan and the United States, said a spokesperson for the Health Ministry.

Similar cases in The Gambia

Indonesia is not the only country currently confronting this problem.

The World Health Organization said this month that it found an "unacceptable amount" of diethylene glycol and ethylene glycol in four Indian-made cough syrups that were linked to the deaths of nearly 70 children in The Gambia due to AKI.

The agency warned that the products were "contaminated" and triggered symptoms including "abdominal pain, vomiting, diarrhea, inability to pass urine, headache, altered mental state, and acute kidney injury which may lead to death."

Edited by: Srinivas Mazumdaru