Background:Tuberculosis (TB) is a major disease of public health importance and continues to cause significant morbidity and mortality in populations around the world. It is the leading cause of morbidity, the third cause of hospital admissions, and the second cause of death in Ethiopia. Due to that, there is limited research about the survival status and risk of TB patient mortality in the study area. Therefore, this study aimed to identify the time when most deaths occurred and investigate associated factors during TB treatment to reduce the burden of TB deaths in the health facilities found in the study districts. Objectives: To assess the survival status and risk of tuberculosis patient mortality, Malga Woreda, Sidama Region, Ethiopia, in 2023 G.C. Methods:A facility-based retrospective cohort study design was used. A systematic random sampling technique was used to select 415 samples of known treatment outcome study subjects from the district. Coded data were entered into EpiData version 3.1, and Statistical Package for Social Sciences (SPSS) version 25 was used for analysis. KaplanMeier (KM) methods using log rank, Breslow, and Tarone-W were used to compare survival curves. A Cox proportional hazard model was used, and P ≤ 0.05 set statistically significant predictors. Result: -A total of 415 samples were used for the analysis, of which 24 (5.8%) died during the treatment. The overall mortality rate was 10.8 per 1000 person-months of observation. A majority of TB deaths 13 (54.17%) occurred during the intensive phase, and the median time of death was two months into the treatment. Male sex (AHR = 0.066, 95% CI = [0.011, 0.39], P = 0.003), baseline body weight (AHR = 6.20, 95% CI = [1.24, 31.12], P = 0.027), and total household contact (AHR = 0.049, 95% CI = [0.004, 0.61], P = 0.019) were independent predictors of death during TB treatment. Conclusion: - Most deaths occurred in the first two months of TB treatment. Male sex, household members > 5, and weight ≤ 35 kg increased mortality during TB treatment. Therefore, a healthcare worker providinga special follow-up of TB patients during the intensive phase, who had many contact numbers, as well as nutritional supplementation for underweight patients, may be important to consider as interventions to reduce deaths during TB treatment.