Introduction: World health organization (WHO) defines perinatal mortality for developing countries as neonatal deaths of less than seven days of age and fetal deaths after 28 weeks of gestation, which is known as perinatal mortality. Perinatal mortality rate (PMR) is taken as one of the indicators of the health status of a given society. Out of about 6 million perinatal mortalities estimated worldwide, stillbirths account for about 3.3 million, and more than 97% of this occur in low and middle income countries Objectives: To determine the prevalence and the factors contributing to neonate mortality at St. Joseph hospital, Moshi Town, Kilimanjaro from January 2014- March 2016 Methodology: The study design employed in this research was Retrospective analytical design. It was done at St. Joseph Hospital, Moshi, Kilimanjaro. Data was collected by a principal researcher by using data sheet s. Data was presented into tables and figures. Data was entered into Excel package and analyzed using SPSS Version 20. Categorical variables were summarized using frequency and proportions whereas mean and standard deviation or median and interquartile range were used for continuous data. Results: A total of 182 participants were enrolled. The results of this study showed that, there is significant increase of prevalence which is about 60%. Also in the study showed that, there is association of factors contributing to the neonatal death where by Mothers who had no premature rupture of membrane were at 35%less odds of getting neonatal death compared to those who had (OR (95%CI) =0.65(0.007-0.621). The participants who had no ant partum hemorrhage were at 77% less odd getting neonatal death compared to those who had (OR (95%CI) =0.033(0.003- 0.397) also neonates who had no birth asphyxia were 48%less odd of dying compared to those who had (OR (95%CI) =0.52(0.07-0.395. Furthermore the study results of the prevalence of determined contributing was significant in birth asphyxia where by it was found to be 69.8% others like pre mature rupture of membrane was about 8.2%, ant partum hemorrhage was about 3.8%,and preterm was 3.8%. x Conclusion: This study found the prevalence of Neonatal mortality is still higher, this means the prevalence of neonatal mortality significant increasing despite of effort done by government, and birth asphyxia was the leading factor contributing in neonate mortality at St. Joseph hospital. The found Birth asphyxia, premature rupture of membrane and ant partum hemorrhage are the common risks factors contributing to neonatal mortality, however birth asphyxia is leading cause of all neonatal death at St. Joseph Hospital.