Tuberculosis (TB) is a major public health concern not only in developing nations but globally and the World Health Organization (WHO) estimated 10.4 million incident cases of TB and 1.67 million TB deaths in 2017. The study was conducted in Infectious Disease Hospital (IDH), Kano, a reference health facility for infectious disease of public health importance. The aim of the study was to determine the transmission pattern of Mycobacterium tuberculosis complex (MTBC) strains and the role played by Directly Observed Therapy Short course (DOTS) clinic in the control of TB. Of the 945 case-patients enrolled, 625 (66.1%) were males and 320 (33.9%) were females. The mean age of patients in years was 32.8 ± 13.8 SD and the median age was 30 years (range 3-95 years). Incidence of TB among presumptive cases was 15.0%. There was a fairly consistent increase in TB prevalence from 2015 (11.0%), 2016 (11.5%), 2017 (10.0%) and 2018 (36%). Pulmonary TB was diagnosed in 884 (93.5%) while Extra-Pulmonary TB accounted for 6.5%. New cases of TB within the study period were 819 (86.7%) and while 126 (13.3%) were relapse TB cases. Treatment outcome that included patients described as cured or have completed treatment successfully (smear negative) were recorded in 811 (85.8%) cases. DOTS clinic has improved TB detection rate through the years and consequently played a big supervisory role in TB treatment and control strategy in the state.