Mulat Ayele ^1* Eyob shitie lake ¹ Gizachew Yilak ² Getinet Kumie Gesesse ³ Biruk Beletew Abate ⁴ Alemu Birara Zemariam ⁴ Befkad Derese Tilahun ⁵

• ¹ Department of Midwifery, College of Health Science, Woldia University, Woldia, Ethiopia
• ² nursing, College of Health Science, Woldia University, Woldia, Amhara, Ethiopia
• ³ Department of Medical Laboratory Science, College of Health Sciences, Woldia University, Woldia, Ethiopia
• ⁴ Department of Pediatrics and Child Health, College of Health Science, Woldia University, Woldia, Ethiopia
• ⁵ Department of Nursing, College of Health Science, Woldia University, Woldia, Ethiopia

Introduction: Using the partograph effectively is crucial in identifying abnormal labor (prolonged and obstructed labor) and taking appropriate actions. However, in Ethiopia, the prevalence of obstructed labor is much higher at 11.8% and contributes to 14.4% of total maternal deaths due to underutilization of the partograph by obstetric caregivers. Although a previous systematic review and meta-analysis had been conducted, they were not representative on a national level as they included a limited number of studies and did not evaluate the current prevalence of partograph utilization beyond July 2019. Since then, inconsistent studies have assessed the proportion of partograph utilization and its associated factors. Therefore, the aim of this systematic review and meta-analysis is was to estimate the pooled prevalence of partograph utilization and its associated factors in Ethiopia Method: Comprehensive literature searches were conducted in PubMed, Google Scholar, and HINARI from September 1, 2013, to October 23, 2023. A random effect model was used to estimate pooled prevalence and adjusted odds ratio. Stata (version 11.0) was used to analyze the data. Cochrane I squared statistics were computed to assess heterogeneity among studies. A sub-group analysis was done based on study region to minimize underling heterogeneity. Funnel plot and Eggers test were done to assess publication bias.Result: Overall, six hundred sixty one articles were retrieved, and finally, twenty-three studies were included in this systematic review, including 7649 participants. The pooled prevalence of partograph utilization was 54.92% (95% ). Subgroup analysis showed that utilization of partograph was highest in Diredaw region and lowest in the Amhara region. Factors such as training about partograph (AOR = 3.63, 95% CI: 2.57-5.25), good knowledge about partograph (AOR = 2.63, 95% CI: 1.62-4.26), a favorable attitude towards partograph (AOR = 1.95, 95% CI:1.35-2.82), availability of partograph (AOR = 3.89, 95% CI: 2.24-6.61) and being midwife in profession (AOR = 3.09, 95% CI: 1.78-5.25) were significantly associated with partograph utilization.The pooled prevalence of partograph utilization in Ethiopia was low. Trained about partograph, good knowledge about partograph, favorable attitude towards partograph, partograph availability in the health facility, and being midwife in profession were significantly associated with partograph utilization.