Dissertation (MSc Midwifery)Background: Birth asphyxia is reported to be higher in developing countries and sub Saharan Africa where neonates’ mortality rate is higher as 40-50/1000 live births. Methods: A matched case-control study of 517 random selected neonates was conducted in five districts in Kagera region from April to end of June 2018, controls were matched to the cases based on gestation age and birth weight of newborn with ratio 1:3 making a sample of 129 cases and 388 control. Partograph completeness was measured according to WHO guidelines while birth asphyxia was measured by Apgar score chart at one and fifth minute. Interview -administered questionnaire and checklist were used for data collection. Descriptive statistics were used to analyze the extent of partograph completeness and severity of birth asphyxia while in inferential statistics utilized chi- square and logistic regression were used in determining the association of birth asphyxia with partograph completeness and other variables. Results: A total of 517 partographs were reviewed 56.3 %( n=291) were incomplete and 43.7% (n=226) were complete, even though birth asphyxia was observed more for incomplete partograph 28.2 %( n=82) as compared to complete partograph 20.8 %( n=47). Chi-square test indicated that, there was a significant association between partograph completeness and birth asphyxia (p=0.034) but after regression findings show that, incomplete partograph was not associated with the presence of birth asphyxia. Age of the mother 15-19 years (AOR= 2.409 p=0.046) and ANC of ≥4 visits (p=˂0.001), primary level facility during ANC visits (p=0.040, p=0.045). Referral (AOR=1.694 .p=0.029) and oxytocin augmentation (AOR= 3.202, p=0.013), were the risk factors identified for birth asphyxia. Conclusion: Based on results of this study, partograph completeness rate was low but not associated with birth asphyxia. This could be explained that, there was a possibility of mothers being well cared during laboring but documentation in partograph was not done due to high work load of nurse midwife so we recommend further study to have a good conclusion . But other risk factors were observed including, age of the mother, number of ANC visits, and attending at primary level facility during ANC, referred mother and oxytocin augmentation showed a significant association for birth asphyxia.