Introduction: Chemical pesticide is commonly used among vegetable family farmers in Sabah. There is no system to monitor adverse health effects. This study is to determine the blood cholinesterase activity and associated factors among vegetable family farmers. Methods: A cross sectional study has involved 163 farmers aged 18-60 years old. Validated questionnaire was used to assess the associated factors. Lovibond AF267 Cholinesterase Kit was used to determine the blood cholinesterase activity. Chi square test was used to determine the association between blood cholinesterase activity and socio demographic factors and work practices. Results: Approximately 23.3% of study sample had low blood cholinesterase activity. There were significant associations between low blood cholinesterase activity with older age group (p