BACKGROUND: Stillbirth (SB) remains a major public health problem in developing countries particularly in Sub- Saharan Africa (SSA) where an estimated 880,000 stillborns occur yearly .It accounts to over 50% of perinatal mortality rate globally, yet stillbirth remains to be invisible on the global policy agenda. Despite of decline in under five mortality in Tanzania, the stillbirth rate is still high (25.9 per 1000 births) and it contributes significantly to perinatal mortality. There is scant information regarding the frequency of SB and associated maternal – fetal risk factors in Tanzania. This information is important to help planning and design appropriate interventions to reduce the burden of SB and improve new born survival. This study aims at determining the associated maternal and fetal factors in northern Tanzania. METHODOLOGY: A retrospective cohort study was conducted using maternally linked data from Kilimanjaro Christian Medical Centre Medical Birth Registry (KCMC MBR) from 2000 to 2014. This study was conducted at KCMC located in Moshi (about 4.7 km from Moshi town) Kilimanjaro region in the northern Tanzania. KCMC is the teaching as well as a referral hospital. It serves over 11 million people in northern Tanzania. The hospital is a huge complex, with an average delivery rate of 4000 births per year. A total of 47681 women who gave birth to singleton at KCMC hospital from 2000 to 2014 were analyzed. Women with multiple gestations and those with missing record on stillbirth were excluded. Data analysis was performed using SPSS. Descriptive statistics was summarized using proportions and frequency for categorical variables while mean and standard deviation were used summarized for continuous variables. Chi-square was used to compare difference in proportions between groups. The Odds ratio with 95% confidence interval (CI) for maternal and fetal factors associated with stillbirth was estimated in multivariable logistic regression models. A p value of less than 5% was considered to be statistically significant. Results: A total of 47,681birth were analyzed, of these 1665 (3.5%) were SB. 623(1.3%) were fresh stillbirth and 586(1.2%) were macerated stillbirths. Multivariate logistic regression showed that Maternal age ≥35yrs (AOR 1.34, 95% CI: 1.14-1.56), obesity (AOR 1.74, 95% CI: 1.51- 2.02),alcohol use during pregnancy (AOR 1.38, 95% CI: 1.18-1.61), pre-eclampsia (AOR 3.99, 95% CI: 3.31-4.81) and abruption of placenta (AOR 22.62, 95% CI: 15.41-33.19) were maternal factors associated with increased Odds SB. On the other hand ANC visits of <4 (AOR 0.47, 95% xii CI: 0.41-0.55), maternal age of <20 years (AOR 0.71, 95% CI: 0.57-0.88) placenta previa (AOR 0.32, 95% CI: 0.13-0.78) and PROM (AOR 0.3, 95% CI: 0.18-0.49) were significantly associated with lower odds of having SB. Furthermore non cephalic presentation (AOR 6.05, 95% CI: 4.77-7.66), pre-term birth (AOR 1.46, 95% CI: 1.24-1.71), birth weight of < 2500 (AOR 9.66, 95%CI: 8.66-10.77) and birth weight of >4000(AOR 2.33, 95%CI: 1.85-2.97) were the fetal factors which were significantly associated with increased odds of having SB. Nonspontaneous mode of delivery (AOR 0.73, 95% CI: 0.63-0.82) was significantly associated with reduced odds of having SB. While underweight, overweight, HIV positive status, PIH, Gestational diabetes, eclampsia, anemia, post-term births, and malformations were statistically not significant. Conclusion: The frequency of stillbirth is 3.5%. There were difference in stillbirth rate between fresh and macerated SB (1.3% Vs 1.2%) respectively. Numerous maternal and fetal factors associated with increased odds SB were analyzed; addressing these factors during prenatal care may reduce the frequency of SB. Early identification of these factors during prenatal care and provision of appropriate interventions may help to reduce the occurrence of SB. This study provides important information to help clinical counseling.