Tuberculosis (TB), an infectious disease is a major public health challenge costing one human life every 20 seconds globally [1] . There is wide variation in the sensitivity of ZN smear microscopy, ranging from 20% to 80% across various studies [7,9] , whereas, the new molecular based methods have shown promising sensitivity in TB detection. Keeping the above points in view, also no such study was done earlier from this region. The present study was undertaken to determine the accuracy of sputum ZN smear microscopy in diagnosing pulmonary tuberculosis as compared with the sputum GeneXpert MTB/RIF assay as the reference test at our set up. In the present study, a total of 70 patients were included, in which 60(86%) were male and 10(14%) were female. A total of 65(92.9%) patients sputum samples detected MTB DNA by GeneXpert MTB/RIF and 5(7.1%) samples were negative. In these 65 positive patients, 55(85%) were male and 10(15%) were female. Older age group was most affected 24(37%) and children and young adults were least affected as only 6(9%) patients in each age group. Sputum ZN smear microscopy is a highly specific but moderately sensitive test for the diagnosis of pulmonary tuberculosis. This study recommends the sputum GeneXpert MTB/RIF test in preference to sputum ZN smear microscopy for the diagnosis of pulmonary tuberculosis.