Health awareness is one of the most important reasons to avoid different infection such as pulmonary-TB and COVID-19. ¹ The developing countries are the most infected with these types of infections. ^{2 , 3} Pulmonary-TB considered as the most infection caused by Mtb and can cause many dangerous complicated in the lung lead to death in many times. ⁴ Pulmonary-TB is a contagious disease that is a major cause of illness and one of the top causes of mortality around the world and was the biggest cause of mortality from a single infectious agent until the COVID-19 pandemic, ranking ahead of many infections such as acquired immunodeficiency syndrome (AIDS). ^{5 , 6} More than 80% of pulmonary-TB patients can be successfully treated with a six to nine-month drug regimen. Many factors can lead to PTB progress such as smoking, malnutrition, diabetes, poverty and absent of health awareness. ^{7 , 8} In 2020, milestone of about more than 30% reduction in the absolute number of PTB deaths between 2015 and 2020. ⁹ Al-Najaf Governorate is one of the most important holy cities in Iraq, about 180 kilometers south of Baghdad capital of Iraq and its estimated population about 1,500,000 people and it is crowded Governorate as compared with other because of highly percentage of visitors came to it from inside and outside of Iraq over the year. ² This feature may be lead to fast transmit of different pandemic diseases in population such as COVID19 and PTB. ^{10 , 11} According to important features above, the main goal of this study is to detect the prevalence of numbers and percentages of PTB-patients caused by Mtb in AL-Najaf Governorate during one year to find the most important ways to avoid this deadly disease in future.

Al-Najaf is a tourist governorate in Iraq, attracting millions of tourists from within Iraq and abroad annually and inhabited by a high percentage of the population. Therefore, it is necessary to study the most important epidemic diseases that may be dangerously and quickly transmitted in this type of crowded population. ^{17 , 18} In this epidemiological study we divided Al-Najaf Governorate in two sections: north and south ( Table 1), the results demonstrated that north section was higher than south section according to total infection in 2019, this result is may be due to the increase in the population and the large number of rural and crowded areas in north section more than south section. ^{2 , 19} Also, Table 1 proved that there was approximately equal frequency in numbers of male and female infected with PTB; 89 and 85 respectively, while other researchers proved that PTB rates are significantly higher in male than in female. ^{20 – 22} In this study, the equal numbers of male and female infected with PTB may be due to there have their equal involvement in society and public life. ²³ Therefore, man and women are vulnerable to PTB in equal percentage. Male and female have different combinations of risk factors for PTB but the main reason still not fully unclear. ²⁴ Out of five age groups, we documented in Table 2 the age group 14-26 was the highest infected with 52 patients 29.9%. We think this is dangerous indicator in young age groups and the reason may be due to low health awareness, malnutrition and hookah smoking. ^{25 , 26} Martinez et al. (2017) ¹² recommended that focusing PTB preventive efforts on home contacts is extremely beneficial. However, beyond the family, a significant portion of transmission may occur at the communal level. ²⁷ Therefore, we must increasing health awareness among young people and holding seminars to focus on the seriousness of this deadly disease to protecting children at risk for tuberculosis transmission in communities and households should be recommended. Poor health system development, scarcity of medical care and socio-economic factors and have been linked with increased risk of PTB on individual and population levels in developing countries. ^{28 , 29} These factors cannot account for the seasonality of PTB incidence, which has been seen in many parts of the world. According seasonal variation, quarter two recorded 55 cases it is the highest numbers of PTB-patients. Much research recorded a high numbers in infections in the warm seasons. ^{30 , 31} Al-Najaf Governorate has hot climate in most of year with hot shiny sun, therefore, most peoples try avoiding the sun light that lead to decrease in vitamin D that support innate immune responses to Mtb. ^{32 , 33} Skin is the important source for Vitamin D synthesis dependent upon sunlight exposure. The low exposure to sunlight during summer and winter could lead to vitamin D deficiency and subsequent that leads to low innate immune response and may be increase to Mtb infection. ^{34 , 35}

There were low PTB-patients numbers in AL-Najaf Governorate in 2019 but the Youngers were the most susceptible to infected. Infection in north section was higher than south section and there were no high differences between genders. Seasons have no high effect on the number of infections.

All data has been included in this manuscript.

Sputum No.	Gender of patient	Age group/Year
		16-24	25-34	35-44	45-54	55-64
1	Male	X
2	Male	X
3	Male	X
4	Male	X
5	Male		X
6	Male		X
7	Male			X
8	Male			X
9	Male				X
10	Male				X
11	Male				X
12	Male				X
13	Male				X
14	Male				X
15	Male					X
16	Male					X
17	Male					X
18	Male	X
19	Male	X
20	Male	X
21	Male	X
22	Male	X
23	Male	X
24	Male	X
25	Male	X
26	Male		X
27	Male		X
28	Male		X
29	Male		X
30	Male		X
31	Male		X
32	Male		X
33	Male			X
34	Male			X
35	Male			X
36	Male			X
37	Male			X
38	Male				X
39	Male				X
40	Male				X
41	Male				X
42	Male					X
43	Male					X
44	Male					X
45	Male					X
46	Male	X
47	Male	X
48	Male	X
49	Male	X
50	Male	X
51	Male	X
52	Male	X
53	Male		X
54	Male		X
55	Male		X
56	Male			X
56	Male			X
58	Male			X
59	Male				X
60	Male				X
61	Male				X
62	Male				X
63	Male					X
64	Male					X
65	Male					X
66	Male					X
67	Male					X
68	Male					X
69	Male					X
70	Male					X
71	Male	X
72	Male	X
73	Male	X
74	Male	X
75	Male		X
76	Male			X
77	Male			X
78	Male			X
79	Male			X
80	Male			X
81	Male			X
82	Male				X
83	Male				X
84	Male				X
85	Male				X
86	Male				X
87	Male				X
88	Male					X
89	Male					X
90	Female	X
91	Female	X
92	Female	X
93	Female	X
94	Female	X
95	Female	X
96	Female	X
97	Female	X
98	Female	X
99	Female		X
100	Female		X
101	Female		X
102	Female			X
103	Female			X
104	Female			X
105	Female			X
106	Female				X
107	Female					X
108	Female					X
109	Female					X
110	Female					X
111	Female	X
112	Female	X
113	Female	X
114	Female	X
115	Female	X
116	Female	X
117	Female	X
118	Female	X
119	Female	X
120	Female		X
121	Female		X
122	Female		X
123	Female			X
124	Female				X
125	Female				X
126	Female				X
127	Female				X
128	Female					X
129	Female					X
130	Female					X
131	Female					X
132	Female					X
133	Female					X
134	Female					X
135	Female					X
136	Female					X
137	Female					X
138	Female	X
139	Female	X
140	Female	X
141	Female	X
142	Female		X
143	Female		X
144	Female		X
145	Female		X
146	Female		X
147	Female			X
148	Female				X
149	Female				X
150	Female					X
151	Female					X
152	Female					X
153	Female					X
154	Female					X
155	Female					X
156	Female					X
157	Female	X
158	Female	X
159	Female	X
160	Female	X
161	Female	X
162	Female	X
163	Female	X
164	Female		X
165	Female		X
166	Female			X
167	Female				X
168	Female					X
169	Female					X
170	Female					X
171	Female					X
172	Female					X
173	Female					X
174	Female					X

Special thanks to Specialized Center for Chest and Respiratory Disease in AL-Najaf Governorate for all assistance and all information that introduced to researchers to finish this study.