Background: Trauma continues to be an enormous public health problem worldwide and it is associated with high morbidity and mortality both in developed and developing countries. Globally, 10% of all trauma admissions result from chest injuries and 25% of trauma-related deaths are attributable to chest injuries. Thoracic trauma is the 3rd leading cause of morbidity and mortality among trauma cases in developing countries. Approximately 85% of chest injuries can be treated with tube thoracostomy. Only 15% of chest injuries require thoracotomy. Pleural drainage with chest tube insertion for thoracic trauma is a common and often life-saving technique. Although considered a simple procedure, the overall complication rates have been reported to be 2 - 30% among all operators. Aim: To determine risk factors and short term complications of tube thoracostomy in thoracic trauma patients at Kilimanjaro Christian Medical Center. Method: A prospective hospital based study conducted at Kilimanjaro Christian Medical Center surgical wards and surgical intensive care units from October 2013 to March 2014. A total of 53 thoracic trauma patients were enrolled in this study. Results: Fifty three chest drains were placed in 53 thoracic trauma patients over the 6 month period. Males were 34 (64.2%) and females 19 (35.8%), the most affected age group being 21 – 40 years. Common indications for tube thoracostomy were haemopneumothorax 28 (52.8%) and haemothorax 15 (28.3%). Seventy five percent of tubes were placed as a result of blunt trauma. Eighty nine percent of chest tubes were inserted in the wards. The overall complication rate of the procedure was 28.3%. Tube thoracostomy complications were significantly associated with duration of chest tubes. There were neither insertional complications nor empyema thoracis. The mortality rate was 9.4%, which was significantly associated with the severity of injury. Conclusion: Complication rate of 28.3% associated with tube thoracostomy is unacceptably high. Tube thoracostomy complications increased with duration of chest tubes. Mortality of 9.4% was associated with severity of injury.