<p>Institution based unmatched case-control study design Was employed. The study was conducted from July, 2023 to August, 2023. The study population were adult pulmonary Tuberculosis patients registered under directly observed Treatments service for follow up at public health institutions in Gefersa Guje sub city of guje health center, Burayau and Malka Nono sub city of Sheger city during the study period. A total of 83 cases and 164 controls were selected for the study using&nbsp; systematic random sampling method; every second Tuberclusis patient visiting the facilities at TB departments. Data was collected by using structured questioners interviewer administered and entered in to Epi data version 3.1 and then exported to SPSS version 23 for analysis. Bivariable and multivariable logistic regressions was used to identify factors associated with outcome variable. The strength of association between independent variables and dependent variable was measured using adjusted odds ratio and 95% confidence interval. P-values below 0.05 was used as a cut of point to declare significance in the multivariable logistic regression model.&nbsp;</p>