Background: Ethiopia ranked 101h from the 22 high tuberculosis burden countries and 4th in Africa, with an estimated 44,398 TB cases. The incidence and prevalence rate of tuberculosis is 200 and 21 O per 100,000 populations .. respectively. Multi drug resistant tuberculosis is also another headache. Estimated 40% Multi drug resistant tuberculosis cases were detected and notified in 2014. Case detection by sputum smear microscopy is one of the five key components of the directly observed treatment (DOTS) strategies among symptomatic patients self reporting to health facilities. Objective: The aim of this study was to determine sputum smear positivity rate and associated factors among pulmonary tuberculosis suspected patients visiting DOTs providing private and government health facilities in Bahir Dar vi ., Town. Methodology: A cross sectional study was conducted among 283 TB suspected patients attending 4 private & 7 government health facilities providing DOTs service from December 01/12/15 to January 30/01/16, in Bahir Dar town, North West Ethiopia. A pretested and structured interviewer administered questionnaire & WHO standard observational checklist were used to collect data. Data were collected through Interviewing, slide rechecking and processing left over samples. Bi-variable and multivariable logistic regression analyses were performed to see an association between the dependent and independent variables. The strength of association was described by using odds ratio at 95% Cl. Intervention was made for sputum smear positive PTB suspects. Results: A total of 283 pulmonary Tuberculosis (PTB) suspected individuals were interviewed. The overall sputum smear positivity was15.2%. Age (16- 24) yrs [AOR 5.83, Cl (1.31-25.99)], Cdl.Jgh >2 week [AOR 7.1, 95% Cl (2.058-24.77)], sputum >4ml [AOR 4.1, 95% Cl (1.379-12.686], Purulent sputum [AOR 6.481, 95% Cl (1.93-21.68)], HIV/AIDS [AOR 15.74, 95% Cl(2.852-86.93)], Sputum deeply coughed from the lung [AOR 8.76, 95% Cl (1.983-38.72)], Quality of smear staining [AOR 4.0, 95% Cl (1.132-14.547)] and microscopic observation of 51-100 fields/HPF [AOR 24.1, 95% Cl (5.97- 97.43)] were variables showed significant association with sputum smear positivity. Conclusions: The overall sputum smear positivity was15.2%. Age, duration of cough, volume of sputum, gross appearance of sputum, quality of smear staining, number of microscopic fields/HPF and sources of sputum sample are factors for sputum smear positivity. Improving TB suspects screening, AFB smearing, microscopic reading, sputum sample collection procedures and following TB laboratory standards are important to improve smear positivit rat