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Objective: Preterm delivery is the second most leading cause of under-five deaths in the world and has been associated with poor neonatal outcomes especially in developing countries where management of severe and extreme preterm new-b is a challenge. This study aimed to determine matal and obstetric factors associated with preterm delivery among women who delivered at Kilimanjaro Christian Medical Centre.Methods: This was unmatched case-control study conducted at the Kilimanjaro Christian Medical Centre between April and May, 2014. A total of 1143 women were recorded to have delivered during the study period. Of these, 162 had preterm delivery which comprised the case group while controls were selected from women who had term birth (n = 209) making a final sample size of 371 women. All participants were interviewed using a standard questionnaire to determine factors associated with preterm delivery. Additional data were extracted from matal clinic cards and hospital records. Data analysis was performed using statistical package for social science version 20.0. Odds ratios with 95% CI for factors associated with preterm delivery were estimated in a multivariate logistic regression models. AP value of less than 0.05 was considered statistically significant.Results:The prevalence of preterm birth was 14.2%. Numerous factors were associated with preterm delivery including living alone (AOR 5.26, 95% CI: 1.1011–25.14), no formal education (AOR 1.2, 95% CI: 3.55–4.06), heavy physical works during pregnancy (AOR 3.13, 95% CI: 1.44–6. 81), being a peasant (AOR 2.24, 95% CI: 1.16–4.33), business women (OR 2.88, 95% CI: 1.44–5.74), and history of still birth (OR 4.93; 95% CI: 1.59–15.35). Furthermore, history of miscarriage (OR 1.84, 95% CI: 1.02–3.31), preeclampsia (OR 6.83, 95% CI: 2.92–15.96), placenta previa (OR 7.54, 95% CI: 1.65–34.51), abruption placenta (OR 4.04, 95% CI: 1.08–15.17), Caesarean section delivery (OR 1.60, 95% CI: 1.06–2.43), inadequate ANC visits < 4 (OR 3.25, 95% CI: 2.04–5.19), multiple pregnancy (OR 2.75, 95% CI: 1.15–6.61), low birth weight (OR 34.27, 95% CI: 15.93–73.7) and UTIs during pregnancy (OR 1.678, 95% CI: 1.064–2.649) were also independently associated with preterm delivery.Conclusion: The risk factors for preterm delivery identified in this study are consistent with previous studies. Clinicians and other health care providers should routinely assess women at high risk of preterm delivery during prenatal care to prevent the occurrence of preterm delivery and associated adverse perinatal outcomes.