Background: We planned to raise public awareness and decentralize directly observed tuberculosis treatment at village level using volunteer community members in order to reduce prolonged delays in seeking care and improve compliance to tuberculosis treatment. We do not know the magnitude of tuberculosis knowledge gap and preferred modality of tuberculosis treatment supervision among the public in Tigray. Objectives: To assess knowledge of pulmonary tuberculosis and to determine level of acceptance regarding village-based tuberculosis treatment using volunteers among the general public. Method: A cross sectional survey was conducted among 838 adults (=15 years) in 8 districts of Tigray region. Respondents selected from 70 villages using a multistage cluster sampling technique were interviewed using a pre-tested questionnaire in July 2002. Result: The mean and median knowledge score of respondents about pulmonary tuberculosis (PTB) was 5.24 and 6.67 (maximum score of 10) respectively. Female respondents (Adjusted Odds Ratio (AOR)=1.86; 95% Confidence interval (CI)=1.39-2.47), illiterates (AOR=1.64; 95% CI=1.1-2.47) and rural residents (AOR=1.95; 95% CI=1.37- 2.76) were more likely to have a low level of knowledge score. Among respondents who had prior knowledge of PTB (n=717), 599 (83.5%) accepted the idea of tuberculosis (TB) treatment by volunteer community members. Illiterates, rural residents, married and respondents with large family size were more likely to support supervised TB-treatment using volunteers. Respondents' preferred treatment supervisors were: volunteer community health workers (60%), public health staff (16.5%) and family members (12.7%). Conclusion: There is a wide knowledge gap among the public regarding PTB. The idea of organizing directly observed TB treatment using volunteers appears to be accepted.