Dissertation (MMED Obstetrics and Gynaecology)Background Premalignant cervical lesions that precede cervical cancers are the highest in low income countries. However, in 2007 Tanzania had reported to have as high as 17 % with 9972 incident cases and 6695 deaths of cervical cancer. There is limited documented close association between individual risk factor(s) and prevalence of the pre-malignant cervical cancer. Objectives: This study was conducted to determine prevalence of premalignant cervical lesions and associated risks factors among women aged 21 to 69 years in Dodoma Regional Referral Hospital, Tanzania. Methodology: A cross section analytical, hospital-based study conducted at Dodoma Regional Referral Hospital between March and June 2020. Simple random sampling was used to obtain participants aged from 21 to 69 years. Data were collected by semi structured questionnaire on risk factors and screening test results using visual inspection with acetic acid. Analysis was done using SPSS version 20. Data were analysed using binary logistic regression model. Odds ratio with 95% CI were used to measure strengths of association. p value of < 0.05 was considered significant. Results: The study analysed 300 women for prevalence of premalignant cervical lesion which was revealed to be 19.9%. Associated risk factors to the prevalence estimate was infrequency screening p < .0001, having more than one unprotected sexual partners p=0.0490, early age of sex coitus p=0.0213, contacting STI p=0.0262, first degree relative with cervical cancer p=0.0264 and living remote to screening services p < .0001 Conclusion: Prevalence of premalignant cervical lesions was higher than reported at other sites in Tanzania. There was low screening uptake of pre-malignant cervical cancer. However, parity, first degree relative with cervical cancer as well as contacting STI were significant risk factors associated to high prevalence of premalignant cervical lesions.