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This study surveyed healthcare facilities in Delta State, Nigeria in order to discover the major threats to medical records, to examine the strategies and methods of preserving medical information , and to examine the challenges militating against effective preservation of medical records in Delta State. The concepts of medical records and preservation of records were reviewed in literature. The survey method was used for the study. Medical staff members who are involved in handling health records in selected health facilities in Delta State were the target for this study. The questionnaire was the instrument used for data collection. The instrument was administered on respondents by hand, social media and e-mail. 300 questionnaires were administered on healthcare officials in 150 healthcare facilities in Delta State. Two questionnaires were administered on two officials of each facility. The healthcare facilities surveyed include public and private hospitals 84, Dental and Eye Clinics 15, Pharmacies 21, and Medical laboratory test centers 30. Thus, a total of 150 health facilities. A total of 280 questionnaires were completed and returned. This implies 93.3% return rate. Data was analyzed using graphical charts. The result indicate that the major threats to medical records in healthcare facilities include Rodents and pests 70%, Tampering 78%, Physical damage 89%, Lack of skilled staff 90%, Dust 90%, Wear and tear 90%, Misplacement 76%, Poor power supply 80%, Lack of ICT deployment 67%. Additional results indicate the strategies and methods of preserving medical records in healthcare facilities to include adherence to Records Preservation strategies 55%, shelving of records 66%, using Cabinets and drawers to store records 78%, use of air conditioners to control temperature 55%, providing alternative source of power supply 52%, and installation of CCTV Security system 50%. More results revealed the challenges militating against effective preservation of medical records to include nonchalant attitude towards preservation 90%, Poor funding of healthcare facility 86%, Lack of records storage space 86%, Lack of modern records storage equipment 92%, Lack of skilled manpower 78%, Lack of records management and preservation policy 90%, Excessive heat 94%, Harsh climatic conditions 88%, Pests and rodents attack 67%, Lack of ICT deployment 82%, Lack of temperature and humidity control equipment 68%, Insecurity 95%, and Erratic power supply 88%. it was consequently recommended that libraries/archives should be established in all healthcare facilities in Delta State, while librarians or archivist should be responsible for managing medical records. Also, healthcare facilities should deploy electronic health record system, while regulators of health facilities should create a comprehensive policy and regulations that guide the management and preservation of medical records.