Abstract: Objective The aim of this study was to understand the TB epidemic features and transmission situation through investigations of clinical records and case follow-up, in order to provide reliable references for the sustainable control policy development.Methods We retrospectively investigated the clinical records of 2931 TB cases in 2008 and 2009 registered in seven high-epidemic counties of Ningxia, and their demographic and clinical information were collected. We also followed-up the 965 cases of TB patients still under active TB treatment in 2010, collected their demographic and clinical information, as well as clinical and laboratory results. All the collected data were input into SPSS for the further analysis. The transmission risks were estimated according to delay days of TB confirmative diagnosis after symptom onset. The Chi-square test was used to compare the different rates between groups. 95% confidential limits at P<0.05 were set as the significant cutoff.Results Data analysis showed that in 2008 the male patients accounted for 58.01% (851/1467), and female accounted for 41.99% (616/1467); and in 2009 the male patients accounted for 59.02% (864/1464), and female accounted for 40.98% (600/1464); in 2010 followed up patients, male accounted for 54.61% (527/965) and female for 45.39% (438/965). The proportion of Muslim patients had a large change, in 2008, the Muslim patients accounted 1/5 of Han patients (Muslim 205 cases, Han 1262), and none in Haiyuan, Pengyang, Xiji county; in 2009 the number of Muslim patient to Han patients was close to 1∶1 (Muslim 744 cases, Han 720 cases); in 2010 followed-up patients, the number of Muslim patients was significantly higher than Han patients (Muslim 618 cases, Han 347 cases). Among the cases, average age was (46±21) years in 2008, (45±21) years in 2009; (46±17) years in 2010;The highest incidence was found in farmers [84.73 (1243/1467) in 2008; 62.50 (915/1464) in 2009; 93.06 (898/965) in 2010] and followed by students [7.43 (109/1467) in 2008; 5.40 (79/1464) in 2009; 3.21 (31/965) in 2010]; The delay of TB diagnosis was common among cases. 43.22% (319/738) cases were confirmed as TB in one month later since symptom onset, about 85% (633/738) cases were delayed up to three months. Theoretically, the diagnosis delay of 738 cases of pulmo-nary tuberculosis patients within 1 year could increase the number of patients to 2.9 times.Conclusion We should strengthen the TB knowledge health promotion in Southern Ningxia.