Introduction: Poor compliance with https://www.omicsonline.org/trauma-treatment.php (default) is thus a major impediment to effective tuberculosis (TB) chemotherapy worldwide even though free medication may be available, many patients may not be successfully treated. This study was designed to identify risk factors associated with treatment failure during TB treatment within the National Tuberculosis and Leprosy Control Programme [NTBLCP programme] in rural primary health care centres in Nigeria. Methods: This study is a retrospective, cohort study. The information was collected from the facility record using a data collection form. A cohort of all TB patients attending clinic for treatment from 1st April 2004 to 30th June 2007 was used. A total sample of 938 patients was reviewed. Result: The overall treatment failure rate among the TB patients was 5.0% and [15.4%] of the entire negative outcome. In all, 749 [79.9%] of cases completed treatment and were cured, 135 (14.4%) defaulted, 47[5.0%] had treatment failure and 27 (2.9%) of cases were transferred out. Predictors of treatment failure were Relapse after previous treatment [RR=2.41, C.I=1.21-4.81] and far distance of domicile from PHC centre [RR=6.9, C.I=2.15-22.18]. There was no statistically significant difference in treatment failure between HIV positive and HIV negative TB patients [RR=2.65, C.I=0.63-11.09], cases transferred in [RR=2.24, C.I=0.35-14.55] and age (children RR=1.48, C.I=0.78- 2.42]). Conclusion: The previous treatment failure category presented with lower risk of current failure and better favourable outcome than cases of relapse suggesting that most of these failure might have been due to logistic failure rather than multi-drug resistance strain. This study indicates that National TB control programmes should pay a closer attention to stricter monitoring of patients that are transferred-in or relapse and are coming from far distances from PHC in order to prevent multi-drug resistant tuberculosis in rural African populations.