Diagnostic technique	Efficacy in Rural/Urban	Advantage	Limitation	Reference	WHO/CDC recommendation
Light Microscopy of sputum smear	Rural/Urban	Low cost, easy accessible traditional method.	Low sensitivity. Not suitable for drug resistant strains	[3] [61] .	Discontinued by WHO.
Fluorescence microscopy	Rural/Urban	One of the traditional method.	High setting and cost. Not much difference in sensitivity from light microscopy	[62] [63] [64] [65] .	Discontinued by WHO.
LED fluorescence microscopy	Rural/Urban	Higher sensitivity compared to traditional microscopy. Useful in peripheral area for detection.	The low sensitivity HIV-positive individuals particularly those with low CD4 T cell counts. Not suitable for drug resistant test.	[66] [67] [68] .	WHO has recommended use of LED microscopy which can generate both light and fluorescence wavelength instead of conventional light or fluorescence microscopes [55] .
Culture and Drug susceptibility test	Urban lab settings with biosafety level 3 lab (BSL3) requirements	More sensitive than microscopy. Drug resistance can be confirmed.	Time taking, expensive, Lab setting and expertise needed. Risk of cross contamination and biohazard.	[3] [69] [70] .	Commercial liquid culture medium and rapid speciation strip recommended by WHO [23] [71] .
Immunological technique-(ELISA /RDTs)	Quick serodiagnostc tests in rural and urban settings	Quick commercial tests, ease to use.	Low sensitivity, False positive results	[5] [72] .	Recommended to discontinue commercial serodiagnostic tests by WHO [18] .
DNA based test-LPA	Commercial kits available for rural and urban setting with biosafety level 2 lab (BSL2) requirement	High sensitivity test. Less sample requirement. Drug resistance can be detected and correlated to gene mutation.	Mainly recommended for MDR-TB but not for XDR-TB.	[27] [28] [29] [73] .	The use of commercial line probe assays is recommended by WHO in MDR-TB endemic area as well as combination with cultivation for DST [71] .
DNA based test-RTPCR	Fast commercial Xpert method and GenXpert instruments for rural and urban area	rtPCR based technique Xpert MTB/RIF can detect and identify drug resistance directly from sputum. Highly sensitive, cost effective, less time taking, drug resistance detection, lower biosafety requirements.	Only detects Rifampicin resistance	[31] [74] [75] .	WHO has endorsed the Xpert technology in 2010 [19] [32] .
DNA based test-Microarray technique	Urban laboratory settings	Highly sensitive and advanced method for in depth genomic studies of positive samples. Simultaneously detect all gene mutations.	Requires advanced lab settings.	[33] [34] .	Not recommended for routine diagnostics.