Association between biomass cooking fuels and prevalence of tuberculosis among households: a cross-sectional study from 2019 - 2021 in India

Background: Indoor air pollution (IAP) is the major contributor (26%) to TB, in addition to other socioeconomic and environmental factors. It occurs in most developing countries like India, where people rely on the combustion of biomass-based solid fuels (low combustion efficiency and high pollution emissions) due to the prevailing socio-economic conditions. However, this cause-and-effect relationship between TB and IAP has not been studied much. The current study tries to bridge the gap and analyze the cause-effect relationship to come up with concrete remedies for its minimization and help secure the holy grail of TB-free India.

Methods: The current analysis was done on the fifth round of the National Family Health Survey (NFHS-5), 2019-21 database in India. A total of six sets of questionnaires were used to evaluate the prevalence of TB among households. The questionnaire "Does any member of your household suffer from tuberculosis?" was utilized, which helped identify the TB-affected individuals among household members. Binary logistic regression was performed to analyze the household environment and TB association.

Results: The use of biomass-based solid fuel for cooking and other household environmental factors are measured by adjusted odds ratio (aOR: 1.171; 95% confidence interval (CI): 1.107-1.238; P-value < 0.001), daily household smoking inside the house (aOR: 1.501; 95% CI: 1.407-1.601; P < 0.001), semi pucca house type (aOR: 1.886; 95% CI: 1.717-2.073; P < 0.001), and using tobacco (aOR: 1.144, 95% CI: 1.078-1.214; P < 0.001) were significantly associated with the prevalence of TB among household members.

Conclusions: The study reaffirms the polluted household environment owing to the usage of solid biomass-based cooking fuel in the household, in addition to the other multiple risk factors such as house type, rooms available in the house, use of tobacco, etc., which are strongly associated with TB. A combined effort of governmental and non-governmental organizations is required to spread awareness about the ill effects of using biomass-based cooking fuels.