A variety of cough syrup suspected by Cameroonian authorities of killing a dozen children in the central African country in recent months bears markings indicating it was made in India.

Photographs of a box of Naturcold medication show a manufacturing license number matching that of Riemann Labs Pvt. Ltd., based in Indore in the Indian state of Madhya Pradesh. The photos, provided by Eko Eko Filbert, a regional health official in Cameroon, don’t show a manufacturer’s name.

The drugs in the photo “look like ours,” said a director at Riemann, Navin Bhatia, in a phone interview. He said Riemann follows strict quality controls and couldn’t have made tainted medicine, and that counterfeiting is common.

The revelation raises the prospect of a third mass death event linked to exported Indian cough syrups in less than a year. Medicines from two other Indian companies killed more than 60 children in Gambia and about 20 in Uzbekistan last year. In those cases, the syrup medications were found to have been contaminated with two toxic chemicals, ethylene glycol and diethylene glycol. Two more Indian companies are suspected of making similarly tainted syrups found in Liberia and in the Marshall Islands, although no injuries have been reported in those cases.

“Based on your questions, we have sent a team to investigate and we are waiting for the reports,” an official at the Madhya Pradesh Food and Drugs Administration told Bloomberg.

The Cameroonian authorities are still investigating the cause of the outbreak and plan to test the Naturcold samples connected to the deaths, Filbert said in a text message on June 5. The death toll stood at 12 children as of that date, he said. Filbert said the medicine was not authorized to be imported into Cameroon and was probably smuggled into the country. He said authorities don’t have information about the drugs’ origin. According to the product label visible in the photos, the bottle of cough syrup was made in March 2022. It bears the name and logo of Fraken International, a marketing company with a UK address. Attempts to reach people at that address by email and LinkedIn messages were unsuccessful.

Bhatia said that Riemann last produced a batch of Naturcold under contract for Fraken in early 2022 and provided it to an exporter who reported sending it to Cameroon. Riemann is one of several Indian companies that have made the product, he said.

Propylene glycol and glycerin are key raw materials for syrups. Riemann buys these chemicals only in sealed containers from name-brand manufacturers, and then hires a third-party lab to test them prior to use, Bhatia said.

“We pay extra attention to quality,” he said. “Everything is done to ensure safety.”

Duplicacy, a term for when a drug is disguised to look like another company’s product, is common in some parts of Africa, Bhatia said.

“They look like ours, but we cannot be sure. There is so much duplicacy there. Based on the quality of our product, it is doubtful,” he said. “I am 110% sure that my product is not contaminated — what we sent from here.”

–With assistance from Pius Lukong.