The overall tilapia production, one of the most important inland aquaculture in Thailand, has remained very low (480 kg/Rai) although there are some good practices available. The objectives of this research were to get the information about current status of tilapia culture, tilapia diseases, the problems relating to climate change and other factors affecting the tilapia production. The second year of this research had been carried out by farm visits to collect the tilapia culture data which were then analyzed to generate the sustainable tilapia farming. This year, data was collected from Chiangmai, Chiangrai, Lamphun, Lampang, Uttaradit, Phitsanulok, Kamphaeng Phet, and Tak. It was found that most fish farmers do not adjust the culture techniques to enhance their productivity. Some set up the aeration; however, the application of them is still not effective. Fish farmers have faced fish death during a culture period, but the sick or moribund fish are not diagnosed. Some chemicals and antibiotics have been used to solve this problem. Some stop feeding until the fish death is over. There is no salt application for stress relief and no water exchange plan for fish culture in earthen ponds. Three major fish bacterial pathogens include Flavobacterium columnare, Streptococcus agalactiae, and Aeromonas hydrophila. Fish death usually occurs during season change from late summer to rainy season; March – July. In cases of fish stress, Trichodina may become pathogenic ectoparasite interfering with feeding and respiration of small fish. The massive deaths of cage cultured tilapia due to an improper reservoir management and the abrupt changes in weather as well as water quality were reported every year. Tilapia farmers' associations have been formally and informally set up in order to get the benefit from seed and commercial feed buying as well as product selling. There are still a room for Good Aquaculture Practices (GAP) including hatchery, nursery, and on-farm culture because most farmers lack of the motivation to improve their farms due to the GAP fish product is not high. To be a sustainable tilapia culture, farmers must apply a market driven, select the suitable sites, release the good quality of bigger fingerlings in the appropriate stocking density depending on the culture system, go on studying the culture techniques and analysis, adapt the culture method to suit to water and climate situation.