How Bihar’s blanket alcohol ban is impacting its TB program

New Delhi: A blanket ban on alcohol in Bihar has negatively impacted the Revised National Tuberculosis Control Programme (RNTCP) in the state. The connection may sound bizarre but the Union ministry of health and family welfare is perturbed over non-availability of ethyl alcohol, absolute alcohol and spirit required for performing diagnostic tests for tuberculosis.

The ministry officials have written to the principal secretary, Department of Health in Bihar, to solve the problem on a priority basis. “With the alcohol ban imposed in Bihar, there is a severe scarcity of ethyl alcohol which is used to conduct tests for tuberculosis in government and private laboratories. The laboratories and hospitals are facing difficulties in procuring alcohol,” said Dr Jagdish Prasad, director general of health services, Union health ministry.

The diagnosis of tuberculosis at the peripheral levels continues to be performed primarily by smear microscopy.

Smear microscopy is the most common diagnostic test used to detect tuberculosis. It is a microscopic examination of stained sputum or other clinical material smeared on a glass slide. The reagents (substances for analysis) required for smear microscopy (both Ziehl Neelsen and Fluorescent staining) include absolute alcohol.

Spirit is also needed for the lamps used for making smears. Cleaning of the plungers of the Cartridge-Based Nucleic Acid Amplification Test (CBNAAT), as part of monthly maintenance, also requires alcohol. CBNAAT is a diagnostic device for the diagnosis of tuberculosis and rapid detection of resistance to TB medicines.

The intermediate reference laboratories and Culture and Department of Science & Technology (DST) laboratories also require alcohol for performing various procedures. Moreover, freshly prepared 70% alcohol is also required at all levels for surface disinfection; the health ministry informed the state government.

“Prompt diagnosis and appropriate treatment is essential for a successful tuberculosis control programme. Bihar government should abolish ban on the use of alcohol and spirit especially in laboratories and hospitals as this is essential for microscopy test. We have urged the Bihar government to sweep away the ban over alcohol in hospitals and laboratories for uninterrupted diagnostic services under the RNTCP,” said Dr Prasad.

Bihar had last year recorded 64,158 cases of tuberculosis in government hospitals, which is 33% of the total cases in the state. There are 736 microscopic laboratories, apart from 38 special laboratories for detecting TB.

The Nitish Kumar-led Bihar government imposed a total ban on the sale and consumption of alcohol, including India-made foreign liquor (IMFL), on 5 April 2016, declaring Bihar a dry state. Kumar has been emphasising on the positive impacts of the decision.