Background: Tuberculosis is a major public health problem throughout the world. Nearly one third of the world's population is infected with Mycobacterium tuberculosis (MTB) and hence at risk of developing active disease. Tuberculosis is a major cause of morbidity and mortality in Ethiopia, and the country belongs to one of the most affected high burden countries. Objective: To determine the prevalence of smear positive pulmonary tuberculosis (PTB) and some associated risk factors among suspected patients attending Metehara sugar factory hospital, East Showa, Ethiopia. Methodology: A cross-sectional study was conducted from March 25 to May 30/2011 on 113 pulmonary tuberculosis suspected participants. Socio demographic and risk factors data were collected by using questionnaire. Sputum samples from tuberculosis suspects were collected, processed by sodium hypochlorite (bleach) centrifugation sedimentation concentration technique, stained by Ziehl-Neelsen staining and examined by Microscopy. Result: The overall prevalence of smear positive pulmonary tuberculosis was 14.2%. Statistical significant association was observed between age, family size, history of contact with chronic coughers (TB infected patients), smoking habit and alcoholism with pulmonary tuberculosis (P< 0.05). Conclusion:The prevalence of smear positive pulmonary tuberculosis is high in Metehara sugar factory hospital. The magnitude is higher in the economically productive age group. Smoking, alcoholism and contact history with chronic coughers are highly associated with smear positive pulmonary tuberculosis Therefore, intensification of health education, early case finding & treatment are recommended to reduce the spread of the disease.