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The 6.4 magnitude quake struck shortly before 4am (local time) the U.S. Geological Survey (USGS) said, the second powerful tremor to hit the region in two months.
It was centred 30km west of Tirana, at a shallow depth of 10km, the USGS said.
Two women were found in the rubble of an apartment building in the northern village of Thumane, and a man died in the town of Kurbin after panicking and jumping out of a building, a Defence Ministry spokeswoman said.
A body, the fourth victim of the earthquake, was pulled out from under a collapsed building in Durres, the defence ministry confirmed.
Emergency workers told local media one of those killed was an elderly woman who had managed to save her grandson by cradling him with her body.
Unverified video footage posted on social media showed what appeared to be a collapsed building in Durres, 40km west of Tirana, on the Adriatic coast. Other footage showed buildings with large cracks and fallen masonry, including one apartment with most of a bedroom wall missing.
"Firefighters and army staff are helping residents (caught) under the rubble", in Durres and the nearby village of Thumane, the Defence Ministry spokeswoman told reporters.
An unidentified man, with a wound dressing on his right cheek, told News24 TV his daughter and niece were among those trapped in a collapsed apartment building in Durres.
"I talked with my daughter and niece on the phone. They said they are well and are waiting for the rescue. Could not talk to my wife. There are other families, but I could not talk to them," the man said.
Two government spokesmen told Reuters the biggest damage to buildings was in Durres and a few people had been taken to hospital in Tirana.
A Reuters witness described residents fleeing apartment buildings in Tirana, some carrying babies. Power was down in several neighbourhoods.
Three hours after the main tremor, a strong aftershock rocked the city, which is known for its colourful mix of architecture from its Ottoman, Fascist and Soviet past.
Several smaller tremors were recorded in the hour before the main quake, which was also felt across the Balkans and in the southern Italian region of Puglia.
"We were awake because of the previous quakes, but the last one shook us around. Everything at home kept falling down," Refik, a Tirana resident, told Reuters of what happened in his sixth-floor apartment.
Located along the Adriatic and Ionian Seas, between Greece and Macedonia, Albania experiences regular seismic activity.
An earthquake with a magnitude of 5.6 shook the country on Sept. 21, damaging around 500 houses and destroying some. The Defence Ministry had said it was the most powerful quake in Albania in the last 30 years.
The images of collapsed or semi-collapsed buildings in urban areas suggested Tuesday's quake was more powerful than one in 1979 which razed a neighbourhood of the northern town of Shkoder, bordering Montenegro. Neither of those two earlier earthquakes caused any fatalities.
The Balkan nation is the poorest country in Europe, with an average income of less than a third of the European Union average, according to Eurostat data.