Context: Tuberculosis (TB) is a major public health challenge, especially in resource-limited settings. The burden of the disease is particularly larger in developing countries due to factors like poverty, undernutrition, and even HIV, which propagate its spread and complicates its control. West Africa, with its high levels of poverty, hunger, overcrowding, and infectious diseases like HIV, is not left out in the tuberculosis epidemic. Our study aimed to review the burden of TB and the challenges hindering its eradication in West Africa. Evidence Acquisition: This review assesses available evidence on issues relating to the burden of tuberculosis and the challenges facing its eradication in West Africa. Search for relevant medical literature in biomedical databases such as PubMed, Google Scholars, and OVID was conducted with the appropriate key terms without date restriction. Fifty-seven articles were found in a search through the database; 33 data sources, including reports, were selected and reviewed in order to contribute data to this study. Results: From the study, the incidence of tuberculosis is high in West Africa, especially considering the high rate of factors, which propagate its spread. TB/HIV co-infection is also an issue in this region, as evidenced by the high burdens in Nigeria, Ghana, Liberia, and Guinea Bissau. In fact, Nigeria still holds the position of the country with the highest TB burden in West Africa and also account for about 4% of the TB incidence globally. However, the burden only represents an estimate due to paucity of data attributed to ineffective surveillance method. The rate at which the incidence of tuberculosis is declining is slow due to various challenges facing its eradication such as poverty, endemic of the causative agents, drug resistant tuberculosis, and inefficient diagnostic methods, among others. Conclusions: There is now increasing evidence to support that TB prevalence in West Africa is on a continual projection in which the futuristic outcome is worrisome, considering the challenges the region continually faces. The challenges need to be addressed by selecting the most appropriate strategy for the region, and efforts should be made to improve the surveillance system. Leveraging on the public-private partnership and cost-effectiveness evaluation should also be encouraged.