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Background: Bacterial vaginosis (BV) is associated with adverse pregnancy outcomes, especially preterm birth (PTB). Unfortunately, there is a dearth of evidence on the link between BV and PTB occurring in sub-Saharan Africa to inform preventive interventions targeting BV associated with PTB. Objectives: The objective of this study was to evaluate the association between genital tract colonization with BV and PTB. Methods: In this prospective case–control study design, 82 women with spontaneous PTB (cases) or term birth (TB) (controls) were screened for BV. The diagnosis of BV was based on the Nugent scoring system. The association between BV and PTB was evaluated using multivariate logistic regression analysis. Results: BV was significantly higher in women with PTB compared with those with TB (17 [41.5%] vs. 5 [12.2%]; P= 0.005). Furthermore, the odds of BV with PTB were higher among women who had PTB compared with TB after adjusting for a known factor, marital status, which differed significantly between women with preterm and TB (adjusted odds ratio 4.5, 95% confidence interval [1.4–14.4]). Conclusion: Women with BV in pregnancy have increased odds of having PTB. Given the challenge of preterm labor and PTB, screening and treatment of women for BV early in pregnancy may be a veritable strategy to prevent PTB and its consequences.