After a long period of decline, tuberculosis (TB) incidence and mortality in the Tamale Metropolis rose dramatically in the 1990s and peaked in 2000s. During the same period, the proportion of notified TB patient's, cured by therapy; precipitously fell from 90% in 1990 to an estimated 72% in 2011. Despite the introduction and gradual uptake over the past decade of the DOTS strategy, treatment success rates have remained consistently low; even though case notifications have declined. WHO attributes these high failure rates to drug resistance, high rates of default and death among patients receiving DOTS.We conducted a retrospective cohort study of newly detected smear - and/ culture-positive. TB patients aged over 17 who were notified under DOTS and began TB treatment during the period from 1 January 2009 to 31 December 2010. We excluded patients who were admitted to psychiatric hospitals, were in prison, died within one month of beginning therapy or did not live within Tamale city limits. Individuals and programmatic risk factors as well as outcomes were assessed by reviewing patients' charts and TB treatment records: through a TB database set up by the NTP (National TB Programme). We assessed risk factors for non-adherence, defaultand the development of MDR during therapy. In an earlier study; we reported the causes of death of patients undergoing DOTS treatment in Tamale Hospital, from January 2001 to December, 2004.

We observed a 9.6% death rate during TB treatment-due, not only to TB but also comorbidity conditions such as alcoholism and cardiovascular disease. We also found that both alcoholism and late presentationcontributed substantially to mortality. Based on our findings, we proposed several specific interventions that may improve treatment outcomes and reduce the acquisition of drug resistance in patients undergoing TB therapy in this setting as follows:

1. Intensive education and training of staff is necessary to improve compliance and adherence to Direct Observatory Treatment (DOTS);
2. Mass education is obligatory to attract TB patients to come to the hospital for screening and early intervention;
3. TB management in the hospital will have to be patient centered treatment; as requested by the World Health Organization in their millennium goals, at Almata in 1978.
4. Enablers' package will have to be improved to reduce defaulting and absconding;
5. All this will lead to reduction of acquisition of multiple drug resistance, morbidity and mortality.