Introduction: Micronutrients are commonly referred to as "vitamins and minerals." Micronutrients deficiency also known as a hidden hunger is common in people living in developing country. Significant proportion of tuberculosis patient experienced micronutrient deficiency. Low micronutrient deficiency increases the severity of tuberculosis infection and accelerates the resistance pattern of mycobacterium tuberculosis.

Objective: The objectives of this study were to estimate the micronutrients deficiency levels of tuberculosis patients at the start and end of intensive phase, and the predictors of major micronutrient deficiencies in tuberculosis patients.

Methods and materials: A prospective cohort study design was implemented targeting tuberculosis patients during the intensive phase.  The sample size was calculated using epi-info software version 7 with the assumption of 95 % CI, 80% power, extra pulmonary to pulmonary tuberculosis patient’s ratio of 1:1, odds ratio of 1.5 and 10 non response rate. Finally 448 pulmonary tuberculosis patients and 448 extra pulmonary tuberculosis patients was estimated. Both pulmonary and extra pulmonary tuberculosis patients were selected using systematic sampling technique. Descriptive statistics were used to estimate the micronutrient levels. General linear model was used to predict the determinants of micronutrient level.

Results: A total of 881 tuberculosis patients were included giving for the response rate of 98%. At the start of DOTS (directly observed treatment strategy), 64% of tuberculosis patients had a serum iron level less than 60µg/dl, 41.9% of tuberculosis patients had serum zinc level less than 52 µg/dl, 29.7 % of tuberculosis patients had serum selenium level less than 70 ng/dl, 40.5 % of tuberculosis patients had serum vitamin d level less than 20ng/ml, and 60.4 % of tuberculosis patients had urine iodine level of less than 60.4 µg/dl. At the end of DOTS (directly observed treatment strategy), 16.7 % of tuberculosis patients had a serum iron level less than 60µg/dl, <1% of tuberculosis patients had serum zinc level less than 52 µg/dl, <1 % of tuberculosis patients had serum selenium level less than 70 ng/dl, 20.4 % of tuberculosis patients had serum vitamin d level less than 20ng/ml, and 53 % of tuberculosis patients had urine iodine level of less than 60.4 µg/dl. serum iron level was affected by HIV infection, hookworm infection, and site of tuberculosis infection:, serum vitamin d level was affected by HIV infection:  and alcohol dependency affected the serum zinc level of tuberculosis patients during the course of tuberculosis treatments.

Conclusion: Anti tuberculosis drugs were effective in normalizing the serum zinc and selenium level, but the serum level of iron, vitamin d and iodine were not normalized by the anti tuberculosis drugs.

Keywords: micronutrient, tuberculosis patients, DOTS, Ethiopia