By: Sainabou Sambou
The chief medical director at the counrty’s main refferal hospital, Edward Francis Small Teaching Hospital (EFSTH), Dr. Mustapha Bittaye, Director told the High Court in Banjul on Wednesday that the deadly Acute Kidney Injury (AKI) outbreak in children in 2022 was attributable to medicines contaminated with diethylene glycol (DEG) and ethylene glycol (EG), as a key document detailing plaintiff data was formally admitted into evidence.
Justice Ebrima Jaiteh presided over the session in a case where families of deceased children are suing parties allegedly responsible for importing and distributing the toxic medicines. The court admitted, without objection, a comprehensive document containing biographical and medical information on all plaintiffs for the period from June to December 2022. Marked as Exhibit AS4, the document was prepared using data from the epidemiology and disease control units and will be shared with both plaintiffs and defense teams.
Dr. Bittaye testified as a key witness for the plaintiffs. He explained the classification system used in outbreak investigations: suspected, probable, and confirmed cases. A suspected case involves children aged eight or younger showing symptoms like fever, vomiting, diarrhea, cough, and reduced urine output, particularly with a history of consuming syrups. Probable cases are those who died without laboratory confirmation, while confirmed cases meet strict criteria of kidney failure symptoms or lab results.
Dr. Bittaye clarified that the term “confirmed” in Exhibit AS4 refers only to meeting the outbreak case definition for surveillance purposes, not to a final medical diagnosis of the cause of death. He identified several entries in the document as children of the plaintiffs, including Banna Jatta (listed as case number 75), the child of the first plaintiff, and entries linked to multiple other plaintiffs across both suits. Some handwritten notes at the bottom of the list, he noted, were added by him in preparation for court and were not part of the original record.
The witness also referenced Exhibit AS3, the report of the Causality Assessment Committee established by the Ministry of Health. The committee, comprising Gambian and international experts and chaired by a Senegalese specialist, reviewed 56 AKI cases in children. Thirteen cases lacked sufficient data for assessment, and ten more were set aside, leaving 46 for detailed review.
According to Dr. Bittaye, 22 cases were confirmed to have been exposed to DEG- and EG-contaminated medicines, with no other cause identified. Four cases had possible alternative diagnoses, but DEG/EG poisoning could not be ruled out. For 34 cases with unclear exposure histories, the committee concluded that contamination could not be excluded, especially given the epidemiologic context and lack of other explanations. Two children in this group had autopsy findings suggestive of DEG-EG poisoning.
“Based on the detailed review of 56 cases of AKI in children in The Gambia, DEG-EG poisoning could be confirmed as a cause of AKI and death in 22 children,” Dr. Bittaye told the court. He added that for the remaining cases, “DEG-EG poisoning also needs to be considered as a likely cause… given the epidemiologic context, the absence of other identified causes… and the fact that two children in this group have autopsy findings suggestive of DEG-EG poisoning.”
“In summary,” he stated, “the Causality Assessment Committee certified that the outbreak of AKI in children in The Gambia is attributable to medicines contaminated with DEG-EG.
Dr. Bittaye further revealed that 38 medicines were laboratory-tested in Ghana, France, and Switzerland, with four found to be contaminated. While the initial focus was on paracetamol syrups, testing identified contamination in four different medicines. He noted that official reports deliberately used “attributable” rather than “direct cause” due to scientific caution, as individual causation is difficult to prove in every case without exhaustive evidence.
The expert agreed that both the Causality Assessment Committee report (Exhibit AS3) and the Commission of Inquiry report (Exhibit P3115) concluded the outbreak was attributable to contaminated medicines imported by Atlantic Pharmacy from a pharmaceutical company.
The case was adjourned to Thursday at 10:00 a.m. for continuation of proceedings.
