Preterm birth in a conflict-affected setting: prevalence and determinants in the West Bank, Palestine

Preterm birth (PTB) is a leading cause of neonatal morbidity and mortality worldwide, with heightened risks in conflict-affected settings. In the West Bank, political instability and healthcare barriers may increase adverse birth outcomes but hospital-based evidence remains limited. This study estimated hospital-based PTB prevalence in selected public hospitals and identified maternal, household and healthcare determinants.

A cross-sectional study was conducted between April and August 2025 in purposively selected governmental hospitals across the northern, central and southern West Bank. Women delivering singleton live births were approached consecutively within 24-48 hours post partum. Data were collected using a structured interviewer-administered questionnaire and medical record abstraction. PTB was defined as birth before 37 completed weeks. Multivariable logistic regression estimated adjusted ORs (aORs) and 95% CIs.

Among 1235 eligible women, 174 had PTBs, yielding a hospital-based prevalence of 14.1% (95% CI 12.1% to 16.3%). Higher odds of PTB were observed among women aged 19-24 years (aOR 1.90, 95% CI 1.07 to 3.37) and 25-34 years (aOR 1.72, 95% CI 1.06 to 2.79), households with

PTB is highly prevalent in selected public hospitals in the West Bank, influenced by structural, social and geographic factors. Policies improving healthcare access and addressing regional disparities are essential to reduce PTB in conflict-affected settings.