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Abstract:Background: Pulmonary tuberculosis (PTB) remains a major public health concern globally andcontinues to cause substantial morbidity and mortality, particularly in resource-limited settings.Early detection among presumptive TB cases is critical for timely treatment initiation andreducing transmission.Methods: A hospital-based cross-sectional study was conducted from April to August 2025 atAkim Oda Government Hospital. A total of 234 participants aged 10–40 years with symptomssuggestive of PTB (especially cough ≥2 weeks) were recruited using a purposive samplingtechnique. Sputum samples were collected and analyzed using Ziehl–Neelsen smear microscopyand GeneXpert MTB/RIF assay for detection of Mycobacterium tuberculosis. A structuredquestionnaire was administered to obtain socio-demographic characteristics and risk factorinformation. Data were analyzed using SPSS version 26, and associations between PTB statusand selected variables were tested using Chi-square, with statistical significance set at p < 0.05.Results: Out of the 234 participants, 50 tested positive, giving an overall PTB prevalence of21.4% (50/234). GeneXpert detected PTB in 26.6% (24/90) of tested samples, while smearmicroscopy detected PTB in 18.1% (26/144). PTB positivity was significantly associated withage group (p = 0.001) and gender (p = 0.019), with the highest burden observed amongparticipants aged 30–40 years and among males. Sputum appearance was significantlyassociated with PTB detection by both GeneXpert (p = 0.014) and microscopy (p = 0.020), withmucopurulent samples yielding the highest positivity. Among the risk factors assessed (smoking,alcoholism, family history, overcrowding, and malnutrition), none showed significantassociation with PTB positivity (p > 0.05); however, TB awareness demonstrated a borderlineassociation (p = 0.067).Conclusion: Pulmonary tuberculosis prevalence among presumptive TB patients at Akim OdaGovernment Hospital was high (21.4%). GeneXpert MTB/RIF demonstrated a higher detectionyield than smear microscopy. Age, gender, and sputum quality were significant predictors ofPTB positivity, emphasizing the need for strengthened facility-based screening, improvedsputum collection practices, and expanded access to rapid molecular diagnostics.