Background: Approximately 1 million of the 3 million neonatal mortalities that occur annually worldwide are directly attributable to prematurity. The majority of nations report a preterm birth prevalence between 5% and 18%. However, many countries lack accurate, localized data on the burden and determinants of preterm birth. In The Gambia, limited research has been conducted to ascertain the magnitude of premature delivery. Therefore, the purpose of this study was to determine the incidence and feto-maternal factors of preterm neonates admitted at neonatal intensive care unit (NICU) of Edward Francis Small Teaching Hospital (EFSTH).
Methods: A hospital-based descriptive cross-sectional study was conducted, focusing on deliveries at EFSTH between January 1, 2021, and December 31, 2021. The overall incidence was calculated based on the total live births during the study period. Data collection tool was used to extract information from Neonatal Intensive Care Unit (NICU). Data was analyzed using Stata version 15.1. Simple descriptive statistics was used to express findings in frequency, percentages, graphs and tables. The binary logistics regression analysis was used to determine association of gestation age and neonatal death. 
Results: During the study period, there were 1,806 live births, of which 276 were admitted preterm neonates, yielding a hospital-based preterm admission prevalence of 15.3%. Analysis of the admitted preterm cases revealed that 42.4% of mothers had pregnancy-induced hypertension (PIH), 19.6% experienced premature rupture of membranes (PROM), 11.2% had antepartum hemorrhage (APH), and urinary tract infections (UTI) respectively. Gestational diabetes was present in 3.3% of cases, and chorioamnionitis in 5.4%. High parity (>4) and twin gestations (23.3%) were frequently observed among mothers of preterm infants. Fetal complications such as abnormal lie/presentation (3.3%) and fetal distress (2.2%) were uncommon. The preterm neonatal mortality rate among admitted cases was 38.7%, with respiratory distress syndrome (43.5%) and hypothermia (53.3%) being the most common morbidities. The binary logistics regression analysis further revealed that neonates born within the gestational age of 24-27 weeks were almost 1 and half (OR=1.4) times more likely to die compared to those with the gestational age of 28-31 weeks.
Conclusion: The incidence of preterm births requiring NICU admission at the tertiary hospital was 15.3%. Maternal obstetric complications, including PIH, PROM, APH, and UTI, as well as high parity and multiple gestations, were prominent factors among preterm deliveries. Enhancing antenatal screening and management of these high-risk obstetric conditions is crucial for reducing the burden of preterm births and improving neonatal survival in The Gambia.