Dissertation (MSc Midwifery)Hypertensive disorders of pregnancy comprising pre-eclampsia and eclampsia are the main causes of maternal, fetal and neonatal mortality. This study assessed the prevalence, predictors of pre-eclampsia and the readiness of healthcare facilities in relation to its antenatal care referral and management in Zanzibar. This was a cross sectional analytical study involved 54 healthcare facilities, 176 healthcare providers and 138 pregnant women with gestation age of 20 weeks. Systematic random sampling was used to select healthcare facilities while proportionate sampling method was used to select pregnant women and healthcare providers. Observation method was used to collect information about equipment and medications related to the management of pre-eclampsia by using a pre-prepared checklist, measurement and laboratory investigation was used to diagnosed pre-eclampsia, interviewer-administered questionnaire was used to collect information from healthcare providers to assess their knowledge and reported skill on the management of pre-eclampsia and obtain information about pregnant women while documentary review was used to collect information about the management of pre-eclampsia by using a pre-prepared checklist. Data were analysed using SPSS software, version 20. Descriptive analysis was used to compute frequencies, and percentages and inferential statistics were used to develop analytical association between variables by using the chi-square test and logistic regression. The 95% confidence interval (CI) and the p-value of < 0.05 were used to show statistically significant relationships. The results revealed that the prevalence of pre-eclampsia was 20 (14.5%) and it was predicted by family history of pre-eclampsia [AOR=5.772; 95%CI: 1.344-24.784; p=0.018], history of pre-eclampsia in the previous pregnant [AOR=11.998; 95%CI: 2.591-55.565; p=0.001] and history of using formal medication in the current pregnant [AOR=19.327; 95%CI: 3.906-95.632; p=0.001]. For equipment and medication all (100%) healthcare facilities of higher levels had all the necessary equipment for the management of pre-eclampsia while the same was available in less than half of facilities of lower levels, and for healthcare providers86(48.9%) of healthcare providers had adequate knowledge and 83(47.2%) had adequate skills related to the management of pre-eclampsia. Moreover more than two third cases of pre-eclampsia were kept on antihypertensive 8(72.2%) and all cases 31(100%) received Magnesium Sulphate loading dose, while only less than half of lower health facilities 4(16.7%) referred patient with signs of pre-eclampsia receiving pre-referral treatment. The proportion of pre-eclampsia was high while there was a huge gap between high level and lower level facilities in the availability of medications and equipment, as well as healthcare providers with adequate knowledge and skills related to the management of pre-eclampsia. Moreover in all healthcare facilities there is none adherence of guideline for management and for referral of patient with pre-eclampsia.