Dissertation (MSc Midwifery)Background: It is estimated that, 25% of neonatal deaths is due to birth asphyxia, as may lead to permanent injury of the brain. In Sub-Saharan Africa, the major three cause of neonatal death are infection 39%, birth asphyxia 24% and preterm birth 25%. The aim of this study was to determine the predictors of birth asphyxia among neonate delivered in hospitals, in Zanzibar. Method: A matched case control study was used, 107 neonates were cases and 321 controls. Purposive sampling was used to select 4 hospitals. Proportion of representative from each hospital was selected by using proportionate sampling. Cases and controls were selected by using a simple random selection, lottery method. Data were collected by using structured questionnaires. Descriptive statistic and logistic regression were used for analysis. Result: A total of 428 postnatal mothers and their neonates were enrolled in the study, the mean age was 29.22, SD = 6.009, minimum 17 and maximum 49 years. Predictors associated with birth asphyxia were high blood pressure (AOR 2.934;CI: 95%; 1.114; 7.727), ANC visit < 4, Preterm rupture of membrane, abdominal pain not in labour, urinary tract infection, caesarian section, fetal distress and decreased fetal movement. Majority of predictors were preventable, therefore intervention needed to improve antenatal and obstetric care in order minimize birth asphyxia and Hypoxic ischemic encephalopathy. Conclusion: In this study, predictors of birth asphyxia were high blood pressure, ANC visits < 4, Preterm rupture of membrane, abdominal pain not in labour, urinary tract infection, caesarian section, fetal distress and decreased fetal movement. Majority of predictors were preventable, therefore intervention needed to improve antenatal and obstetric care in order minimize birth asphyxia and Hypoxic ischemic encephalopathy.