Background: Though Ethiopia achieved the fourth Millennium Development Goal, commit to reducing under five child mortalities by the year 2015, but perinatal mortality has remained a major public health problem in Ethiopia, and the Tigray region is experiencing a high perinatal mortality rate. This study aimed to assess the risk factors attributed to perinatal death in the Tigray region. Methods: A retrospective cross-sectional study was used. The information collected from 2738 children born five years preceding the survey was considered. Variables such as maternal social and demographic characteristics, child demographic characteristics, health and environmental factors were considered as risk factors of perinatal death. The study used descriptive statistics, and logistic regression model to identify significant correlates of perinatal mortality. Results: The data showed that from total children included in the study, 4.1% are early neonatal deaths, and 2.1% are stillbirth. Overall the prevalence of experiencing perinatal mortality was 6.2% the Tigray region. The logistic analysis revealed, factors small birth interval (less than 15 months) (AOR = 7.902; 95% CI: (4.526-13.795)) and 16-26 months (AOR =2.088; 95% CI: (1.292-3.375)), poor wealth index (AOR = 1.948; 95% CI: (1.011-3.754)), having no toilet facility (AOR =1.649; 95% CI: (1.093-2.488)), child sex (being male) (AOR =1.74; 95% CI: (1.234-2.454)), giving birth at older maternal age (45-49 years) (AOR = 0.293; 95% CI: (0.128-0.668)), rural residence and using the unprotected well water were significantly associated with a higher risk of perinatal death. Conclusions: The study identified sex of a child, previous birth intervals, availability of toilet facilities, wealth index, birth type, mother's age, parity, place of residence, mother's occupation and source of drinking water were the factors significantly associated with perinatal mortality. The prevalence of perinatal mortality shows that Tigray region was experiencing a high perinatal mortality rate than the national.
