Abstract
AIM: Preterm birth (PTB), delivery before 37 completed weeks of gestation, remains a major cause of neonatal morbidity and mortality. Evidence from conflict-affected, resource-limited settings such as the West Bank, Palestine, is limited. This study aimed to estimate PTB incidence and identify maternal, neonatal and socioeconomic risk factors using hospital-based data from government facilities. METHODS: A retrospective cohort study utilised the Avicenna Health Information System across three major governmental hospitals in the West Bank. All live births at ≥ 24 weeks' gestation between January 2023 and May 2024 were included. Descriptive statistics, chi-square tests and multivariable logistic regression were applied to assess PTB-associated factors. RESULTS: Among 18,760 live births, 1427 (7.6%) were preterm, mostly moderate to late preterm (7.0%). Higher PTB risk was observed among mothers aged < 20 years (aOR 1.53) or ≥ 35 years (aOR 1.32), male infants (aOR 1.16) and multiple pregnancies (twins aOR 4.98; triplets aOR 17.28). The Ramallah district had the highest PTB rate (aOR 2.35), likely reflecting referral to tertiary care. CONCLUSION: PTB incidence was lower than previous national estimates but may underestimate community rates. Findings highlight key determinants and emphasise the need for improved data systems and population-based perinatal surveillance in Palestine.