Tuberculosis (TB) is a leading killer from a single infectious agent globally. In 2019, Malaysia’s TB incidence rate was 92 per 100,000 population, and the TB mortality rate was estimated at 4 cases per 100,000 population per year. However, the state of Sabah had a higher burden of TB with a notification rate of 128 per 100,000 population and a TB case fatality rate of 8% compared to the national figure. This study aims to provide a comprehensive report on TB deaths epidemiology and its associated factors at a sub-national level. This nested case-control study used Sabah State Health Department TB surveillance data from the Malaysia national case-based TB registry (MyTB) between 2014 and 2018. Cases were defined as all-cause TB deaths that occurred before anti-TB treatment completion from the time of TB diagnosis. Controls were randomly selected from TB patients who completed anti-TB treatment. The TB mortality rate had increased significantly from 9.0/100,000 population in 2014 to 11.4/100,000 population in 2018. The majority of TB deaths occurred in the first two months of treatment. TB-related deaths were primarily due to advanced disease or disseminated TB, whereas non-TB-related deaths were primarily due to existing comorbidities. Many important independent risk factors for TB deaths were identified which are useful to address the increasing TB mortality rate.

Introduction Sabah is a high tuberculosis (TB) burden area with incidence rate of 120 – 138 per 100,000 population. Until now, TB is still unable to control due to high loss to follow up rates. Loss to follow up TB treatment can cause to increase notification rate, prolonged infection, recurrent TB infections, increase multiple drug-resistance, and increase morbidity and mortality rates. To know the factors that contribute towards loss to follow up will better understand the epidemiology of treatment outcome and guide for appropriate strategies planning to improve the situation. Previous study by Liew et al. indicated that, incidence rate for loss to follow up in 2012 in Malaysia was 10.5%.