Introduction Tuberculosis (TB) is a major public concern. Sputum smear conversion after starting TB treatment is under-studied. The objective of this study was to determine sputum smear conversion among TB patients after two months of treatment. Materials and Methods Data was retrieved from the TBIS System, a national reporting system by the Disease Control Division, Ministry of Health Malaysia. Descriptive and multivariable analysis were performed using Stata version 13. Results Sociodemographic characteristics and factors associated with among TB patients.Logistic regression analysis of negative sputum status at 2 months post treatment with different variables. Discussion and Conclusion The mean age of the patient was 43.95 ± 17.14. Out of 52,776 positive TB sputum smears, 92.6% (n=48,875) converted to negative after two months treatment. Patients who remained positive after two months treatment with no sputum conversion was significantly associated with male (aOR: 1.217, 95% CL: 1.119, 1.323), non-Malaysian (aOR: 1.249, 95% CL: 1.122, 1.389), smoking (aOR: 1.117, 95% CL: 1.035, 1.206) and history of diabetes (aOR: 1.157, 95% CL: 1.068, 1.253). Findings from this study shown delay in sputum smear conversion was associated with several factor as gender, citizenship status, smoking habit and diabetes status. Monitoring response to patient’s treatment should be monitored closely for factors cause to treatment failure.