A Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Master of Science in Health Systems Management (MHSM) of Mzumbe University.Involuntary tobacco smoking exposure at home had been reported to be associated with health effects and decreasing children academic performance in school, but no similar study conducted in Tanzania. This study aimed at determining human health effects and academic performance of primary school children exposed to tobacco smoking at home. The study Used case control study, a total of 120 respondents were recruited in this study, where exposed group were 60 and other 60 were compared group, all respondents came from class five, six and seven at Kikundi primary school in Morogoro. In order to determine the association of exposure the outcome variables for health effects were asthma, wheezing, breathing, antisocial behavior, attention deficit disorders, ears problem, nose (sense of smell), throat problems and respiratory disease like nasal passages. Pupil’s class participation, class position, average score, and general academic performance were considered as outcome variables for academic performance, whereas smoking tobacco at home by Parents/guardians or any family members were considered as risk factors. Questionnaires were used to acquire information. The study determined strong association between involuntary tobacco smoking at home, health effects and pupils poor/decrease in academic performance at school. Heart diseases 2.5%, anti-social 5.8%, nose fail sense 7.5%, asthma 11.7%, respiratory problem 14.2%, ear diseases 16.7%, wheezing 23.3%, deficit disorders 23.3% and throat diseases 33.3. The Pearson Chi- Square and fisher’s exact test shows 0.000, 0.017, 0.000, 0.036 and 0.014. The study found the strong association for wheezing, anti-social, throat diseases, nose sensing problem and ear problem respectively. For academic general performance 0.038, average first term (0.015, 0.043 & 0.050) and end term report (0.000-0.003). Therefore there is no self point/position of exposing children on involuntary tobacco smoking, even a single cigarette is harmful to children’s health and academic performance.