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Objective: Prematurity is one of the highest global health challenges of the 21 st century and has been named the first killer of young children. In Rwanda, it is the leading cause of death in neonates. It is expedient to explore the factors contributing to the observed high morbidity and mortality to plan appropriate interventions. The objective of the study was to identify factors contributing to morbidity and mortality among preterm neonates and neonatal outcomes at discharge. Methods: Adopting the descriptive design and quantitative approach, 125 preterm babies admitted in the Neonatal Intensive Care Unit (NICU) of the University Teaching Hospital of Kigali and Muhima hospital over ten weeks were recruited in the study using consecutive sampling method. Interviewer administered questionnaire to the mothers, files of mothers and babies were used as sources of data. Frequencies, chisquare, and logistic regression were used for analysis. A p-value <0.05 was considered significant. Results: Marital status of mothers, mother's participation in the care of her baby, and APGAR score ≤ 6 with a p-value (0.007), (0.02), (0.002) respectively, were statistically significantly associated with mortality. Controlling for confounders, neonates with APGAR score ≥ 6 had a lower odds of dying compared to those with an APGAR score ≤ 6 (OR=0.268 CI:0.102,0.700). Morbidities and mortality was high as gestational age, and birth weight decreased. The main morbidities were neonatal sepsis (88.8%), and Respiratory Distress Syndrome (RDS) (62.4%). Conclusion: Mothers social background, participation in care, low apgar score and birth weights are critical factors with neonatal sepsis and RDS accounting for highest morbidities in preterm care. Keywords: Preterm neonates, born too soon, neonatal mortality, neonatal morbidity

Factors contributing to morbidity and mortality among preterm neonates admitted at two major hospitals in Rwanda