IntroductionThe World Health Organization reported that one third of global population was tobacco smoker. In countries with a high tuberculosis burden, a big proportion was attributed to tobacco smoking. In the general population of Rwanda, the prevalence of tobacco smoking was higher among males (14%) compared to females (3%). We conducted a second analysis to assess factor associated with tobacco smoking among patient with TB attending Health Facilities.MethodologyA retrospective case-control study in Centres of Diagnosis and Treatment of tuberculosis (CDT). Cases were patients with bacteriological TB confirmation; controls were persons with signs and symptoms without TB confirmation. Proportions and logistic regression were used in data analysis.ResultsThe total number of tobacco smokers was 680. Among tobacco smokers, 88.1% tobacco smokers were males, 94.3% tobacco smokers had at least 25 years old and 64.6% were living in union. By education, 84.9% tobacco smokers were illiterate or attained primary school. Almost all tobacco smokers (97.0%) ever drunk alcohol while 67.9% used illicit drugs and 25.3% had low BMI (≤ 18.5) with increased proportion among cases (29.1%). A proportion of 38.3% in tobacco smokers had history of imprisonment. In multivariable logistic regression data analysis, males compared to females (aOR = 3.49[95%CI:1.76–6.94]), ever drunk alcohol compared to never drank alcohol (aOR = 6.39[95%CI:2.67–15.31]) and ever used illicit drugs compared to never used illicit drugs (aOR = 9.89[95%CI:3.87–25.25]) were associated with high odds of tobacco smoking. In addition, illiterate people or people who attained only primary school education level compared to people having primary education level and above (aOR = 0.39[95%CI:0.23–0.69]) were associated with low odds of tobacco smoking.ConclusionTobacco smoking is common in pulmonary TB patients. Males were more likely using tobacco smoking compared to females. Alcohol drinkers and illicit drug users were associated to tobacco smoking. A campaign on tobacco cessation, focusing on males, should be conducted in the general population starting by people on TB treatment.