Background: The highest proportion of under-five mortality occurs in the neonatal period with a global estimation of 4 million infants dying annually in the first four weeks of life and the main causes of deaths are 36% neonatal infection, 27% die due to prematurity and 23% birth asphyxia. The neonatal mortality rate in Tanzania is 19/1000 live births with prematurity contributing significantly to this the high neonatal mortality rate. Prematurity results in metabolic derangements such as hypothermia, hypoglycaemia, hyperglycaemia, intracranial hemorrhage and prolonged hospital stay. Objectives Broad Objective: To determine prevalence of prematurity and associated risk factors for mortality during neonatal period among preterm babies born in Moshi Municipality from September 2016 to March 2017. Specific objectives: 1. To determine prevalence of prematurity among babies born in Moshi Municipality from September 2016 to March 2017. 2. To determine the mortality during neonatal period among preterm babies born in Moshi municipality from September 2016 to March 2017. 3. To identify risk factors for mortality during neonatal period among preterm babies born in Moshi municipality from September 2016 to March 2017. Methodology: This will be a nested case control study in a cohort study which will be done at KCMC, Mawenzi and Saint Joseph Hospital in obstetric, labour ward, neonatal unit and POPNF which will be done from September 2016 to May 2017.An estimation of 3184 newborn will be recruited . All live births will be recruited after obtaining informed parental consent. xi Their gestation age will be assessed right after birth using Finnstrom method and all premature babies with GA less than37 weeks will then be followed up to 28 days of life. Risk factors for preterm mortality such as temperature instabilities, hypoglycemia, hyperglycemia, transportation, late ignition of breast feeding, laboratory findings(blood cultures, glucose levels, bilirubin levels, FBP, Glucose)respiratory rate greater than 60 breaths per min, lower chest wall in drawing and reduced activity will be assesed. Maternal factors will be measures. Neonatal data will be recorded in a questionnaire that will also be used to collect maternal data The study outcome which is Death will be measured within 28 days of life in day 1,7 and 28 day. Data will be analyzed using SPSS version 20. For univariate analysis, t-tests will be used for differences in means between groups: chi-squared and odds ratios will be used for categorical variables. P value <0.05 will be considered statistically significant. Ethical clearance: Ethical clearance will be obtained from the Kilimanjaro Christian Medical University College ethical committee and signed consent will be obtained from the parents/guardian prior recruitment to the study. Significance: We expect the findings from this study will help to plan for preventive programme of risk factors for deaths in premature babies and related complications so as to aid proper growth and cognitive functions in children.