Alcohol consumption poses serious threat to human
health and is responsible for causing more than 200 diseases. Alcohol
consumption results in 3.3 million deaths per year worldwide. Of all deaths
worldwide, 5.9% are due to alcohol use, a figure higher than deaths from human
immunodeficiency virus infection (2.8%) and tuberculosis (1.7%). According to
World Health Organization (WHO), it is among main four modifiable risk factors for
no communicable diseases. In Bangladesh, the consumption of alcohol is strictly
prohibited both as a social function and as a religious rite by most of the
religions. Yet, the problem of alcoholism is becoming a threat to the nation’s
welfare. Information obtained from law enforcement authorities, treatment
providers and other sources indicate that problems of alcohol abuse have become
quite common in Bangladesh.
Social Background:
Cultural and religious
determinants have great impact on alcohol consumption among different classes of
Bangladeshis. Considerable proportion of indigenous population of Bangladesh consume
alcohol for social recreation, ritual and religious purposes. Alcohol
consumption in some working classes like workers in morgue, boot makers and tea
factory laborers is reported to be higher. Nonetheless, it has been reported
that among people with higher income, alcoholic drinking is also popular and is
considered as a sign of “modernity” or “westernized life style”.
Alcohol and government policies in Bangladesh:
According to the “Intoxicant Control Act” of Bangladesh (1990), alcohol means spirit or liquor of whatever kind (wine, beer), or any liquid containing more than 0.5% alcohol. Specific license is required for establishing a distillery or brewery, possession, storage and consumption of alcohol. Consumption of alcohol is illegal unless for: a) Muslim citizens who receive a permission for alcohol use on a health ground from either a civil surgeon or an associate professor of medicine, b) sewage cleaners, morgue workers, coolie (day laborer) in a tea estate, boot makers and indigenous people residing in Chittagong Hill Tracts or CHT c) international tourists and businessmen who consume alcohol in a licensed bar, and d) non-Muslim citizens (with permit). This act has some loopholes as; the act does not specify the health conditions for which a Muslim may be allowed to use alcohol and the decision rests on the authorized physician. Furthermore, because of multiethnic background of Bangladesh and to avoid interfering with old traditions and local culture, use of alcoholic beverages was announced as permissible for indigenous people after an amendment to this act in 2001. Therefore, there is partial ban on alcohol use. It is interesting that only the Muslim citizens are punishable under this act and others are not. There is no minimum age limit for drinking alcohol.
Types of liquor available:
Different types of beverages with varying alcohol content, available in different parts of Bangladesh. It can segmented in two ways as industrially produced name as ; Country liquor, Foreign liquor, Toddy, Beer and Spirit. All brands of Carew and company contain 42.8% ethanol. Homemade brews or Local alcoholic beverages called cholai, tari,Pochani, Ekchuani, Dochuani and Bangla Mad consumed by the lower socioeconomic classes.
Prevalence of alcohol use in Bangladesh:
WHO and Food and Agricultural Organization reports in 2004, 2011 and 2014 have shown an increasing trend in alcohol per capita consumption (APC) in Bangladesh. Binge drinking or heavy episodic drinking has been reported in 20.2% of Bangladeshi drinkers and the majority of them were found to be within 25-44 age group. According to 2014 WHO report; alcohol dependence in Bangladesh was estimated to be 0.7% in general population. However, in certain professions or population are prevalence’s such as vehicle drivers, sex workers, substance abusers with, street (homeless) children (11-18 years old) and university students. There are roughly 4.6 million drug abusers in Bangladesh. Therefore, about 510,600 alcohol abusers likely exist among drug addicts. But alcohol use prevalence in Bangladesh is approximately 24 times higher than estimated legal consumers. Alcohol consumer is generally higher male than female. Regarding the age of alcohol consumers in Bangladesh the majority are within 25 to 44 years of age.
Toxic alcohol ingestion:
According to epidemiologic studies on poisonings in Bangladesh, total of 635 deaths due to alcohol overdose and toxic alcohol ingestion have been reported since 1990s. Illegal homemade beverages came to attention after mass poisoning outbreaks of methanol happened in different parts of the country. Nineteen incidents of methanol mass poisoning were reported during 1998 to 2014 in Bangladesh. During the same period 273 deaths were reported from methanol toxicity. The other highly toxic alcohol, diethylene glycol, was responsible for 363 deaths during the period of 1990 to 1995 and the year 2009.
Alcohol-related morbidities:
Critical organ damages due to chronic toxicity of alcohol drinking such as chronic liver disease (CLD) and hepatocellular carcinoma have been observed in different extents in Bangladesh. Long-term effects on liver was studied among indigenous people of CHT with history of consumption of more than 60 g alcohol in each sitting over 10 years. Alcohol abuse is also instigate physical injuries from accident or violence.
Discussion:
Estimated prevalence of alcohol consumers in general population of Bangladesh is low (1.9%). The results were also consistent with low prevalence of alcohol use in countries with Muslim majority. However, we found that the alcohol consumption in Bangladesh is on the rise. Increase in domestic production, increased number of permits issued for drinking and massive amount of seizures of illegal liquor suggest that actual amount of alcohol use may be much higher than the official reports. This is probably due to the fact that many consumers purchase alcoholic drinks from illegal vendors and are still unaccounted for. Higher prevalence of alcohol use among the university students, truck drivers, sex workers, substance abusers, homeless children, indigenous people, and in families with positive history for alcohol drinking, implies the need to formulate cost effective prevention programs for specific society groups and clusters. Targeted intervention among high-risk population to encourage them to consume alcohol within a safe limit or to quit drinking will be an effective measure.
