Objectives: To examine the relation between use of biomass cooking fuels (wood or dung) and prevalence of active tuberculosis in India.

Methods: The analysis is based on 260,162 persons age 20 and over in India's 1992–1993 National Family Health Survey. Logistic regression is used to estimate the effects of biomass fuel use on prevalence of active tuberculosis, as reported by household heads, after controlling for a number of potentially confounding variables.

Results: Persons living in households that primarily use biomass for cooking fuel have substantially higher prevalence of active tuberculosis than persons living in households that use cleaner fuels (odds ratio [OR] = 3.56; 95% confidence interval [Cl] = 2.82-4.50). This effect is reduced somewhat when availability of a separate kitchen, house type, indoor crowding, age, gender, urban or rural residence, education, religion, caste or tribe, and geographic region are statistically controlled (OR = 2.58; 95% Cl = 1.98-3.37). Fuel type also has a large effect when the analysis is done separately for men (OR = 2.46; 95% Cl = 1.79-3.39) and women (OR = 2.74; 95% Cl = 1.86-4.05) and separately for urban areas (OR = 2.29; 95% Cl = 1.61-3.23) and rural areas (OR = 2.65; 95% Cl = 1.74-4.03). The analysis also indicates that, among persons age 20 years and over, 51% of the prevalence of active tuberculosis is attributable to cooking smoke.

Conclusions: Results strongly suggest that use of biomass fuels for cooking substantially increases the risk of tuberculosis in India.