Background: Tuberculosis (TB) remains a major global health concern, especially in low and middle-income countries where poverty, HIV co-infection, and weak health systems increase vulnerability. Despite being preventable and treatable, TB continues to cause high morbidity and mortality. The main aim of this study was to determine the prevalence and factors associated with tuberculosis among patients at the Regional Hospital Limbe from 2020 to 2024. Methods: A retrospective, cross-sectional hospital-based study was conducted through the review of TB patient records admitted between January 1st 2020, and December 31st 2024. Data was collected for a period of eight months, from November 2024 to June 2025. Data analysis was performed using the Statistical Package for Social Sciences version 20. Significance was set p <0.05 at a 95% confidence interval. Results: The overall prevalence of TB at the health facility was 3.5%. The prevalence of tuberculosis at the health facility was particularly higher among internally displaced persons (11%) and prisoners (2.3%). Pre-treatment co-morbidities included HIV (18.6%) and diabetes (12.1%), while co-morbidities during treatment included arthritis (3.1%) and diabetes (2.1%). Treatment outcomes showed a mortality rate of 3.1%, treatment failure of 17.3%, and relapse rate of 18.3%. Conclusion: Tuberculosis remains a public health challenge among vulnerable populations in Limbe, with internally displaced persons, prisoners, and patients with chronic illnesses being disproportionately affected. Targeted interventions should be prioritized for internally displaced persons and prisoners, alongside strengthened monitoring of co-morbidities to improve treatment outcomes.