Tuberculosis (TB) remains a significant public health concern in Nigeria, particularly in coastal regions where social and economic disparities exacerbate transmission risk. A comparative study design was employed to assess the impact of community health workers (CHWs) on TB incidence rates, adherence to treatment protocols, and patient satisfaction levels. Data were collected from 10 randomly selected communities over two years using a combination of self-reported surveys and clinic-based data collection. Significant reductions in TB transmission were observed among CHW-managed areas (p < 0.05), with an average decrease of 23% in new case notifications compared to control regions. Community health worker programmes demonstrated effectiveness in enhancing TB detection and adherence to treatment protocols, contributing to a reduction in TB incidence rates. Continuation and expansion of CHW initiatives are recommended as part of comprehensive TB control strategies. Further research should explore the scalability and sustainability of these interventions across diverse populations. Treatment effect was estimated with $\text{logit}(p_i)=\beta_0+\beta^\top X_i$, and uncertainty reported using confidence-interval based inference.