A cross-sectional study was conducted among 735 new adult tuberculosis (TB) cases registered between January to December 2015 in 10 woredas, equivalent to districts, of southwestern Ethiopia. TB patients waited too long time to initiate anti-TB treatment, reflecting longer periods of morbidity and disease transmission. The delays are attributed to patient, disease and health system related factors. Hence, improving community awareness, and involving informal providers, health extension workers and TB treatment supporters can reduce the patient delay. Similarly, cough screening and improving diagnostic efficiencies of healthcare facilities should be in place to reduce provider delays.