Background: Tuber culosis remains a major heal- th problem affecting about a third of the world population despite a number of preventive and control measures taken in the past few decades. Eighty-five percent of all tuberculosis cases are concentrated in Asia and Africa due to lack of education and health care infrastructure. Objec- tive: To determine factors affecting low tuber- culosis case detection in the Sissala East dis- trict in the Upper West Region of Ghana. Meth- ods: This was a descriptive study where semi- structured questionnaire was administered to 61 respondents; six focus group discussions and 20 in-depth interviews were conducted to gen- erate both qualitative and quantitative data for analysis. Results: Tuberculosis, known locally as Kesibine was identified as a major problem in the district. The two most frequently reported TB related distresses were coughing (96.7%) and chest pains (95.0%). However, these distresses were reported more after probing for them. The most frequently spontaneously reported dis- tress was reduced income (60.7%) for patients. The most prominent cause reported was sexual pollution (72.2%). Suspected tuberculosis pa- tients are stigmatized and are denied sex by their partners as shown in the following narra- tive; I will not eat or have sex with her or eat any leftover from her plate (male local h ealer, In-dep- th interview). Case detection and treatment is hampered by lack of communication between sub-district facilities and the district hospital to aid laboratory diagnosis. Conclusion: There is therefore the need for vigorous health education to inform the people about the biomedical causes of TB and the availability of appropriate treatment for the disease at health facilities. However, the education should not aim at chang- ing the “wrong beliefs” but focus on making people aware of the biomedical causes and see TB as treatable infection, which could be con- trolled.