Background: The prevalence of postpartum haemorrhage (PPH) is increasing globally that is from 6.5% in 2000 to 11% in 2016. But there are regional variations where there is decrease of PPH in some parts of Asia and increase in Africa and developed countries. Objectives: The main objective of this study was to assess the prevalence, causes and associated factors for postpartum haemorrhage at St. Joseph referral hospital in Peramiho- Songea from November 2017 to December 2019. Method: The retrospective cross-sectional hospital-based study was used and data was obtained from maternity hospital registry book/data base of St. Joseph mission hospital in Peramiho Songea, from November 2017 to November 2019. Descriptive data was analysed by tables and graphs. Results: The prevalence of PPH in Peramiho referral hospital was 1.3% in 2017, 1.26% in 2018 and 1.4% in 2019. The overage prevalence for the three years is 1.3%. However, 73.3% of total prevalence is from home deliveries in rural areas. The main cause of PPH in the hospital was uterus atony (42%), retained placenta (15.5%), 3^rd and 4^th grade tears (11.2%), uterine rupture (8.1%) and coagulopathy (5.6%). The main attributing factors were age >35years (34%), other antenatal pregnancy complication (27%), previous PPH (18.6%), Antenatal anaemia (16%), placenta previa, Eclampsia, preeclampsia (12%) each. Conclusion: The prevalence of PPH from this study is slightly high with the main cause being uterine atony and affected mainly those undergone SVD where about two quarter were home deliveries. However further research studies are needed to investigate the main reason for higher home deliveries in Peramiho residence and nearby area.