Abstract
BACKGROUND: Health facility-based delivery (HFD) is a critical intervention for maternal and newborn health. In low- and middle-income countries, the proportion of pregnant women who deliver at health facilities has increased over time. Nevertheless, a proportion of women among urban slum settlers do not use this service. This study aimed to assess the prevalence and factors associated with a HFD among urban slum settlers in Lubaga Division, Kampala city, Central Uganda. METHODS: An analytical community-based cross-sectional study was conducted among 384 women aged 15–49 years who had delivered within two years prior to data collection, selected from randomly sampled households in slum settlements of Lubaga Division. Data were collected using a semi-structured questionnaire and analyzed in Stata 15. HFD was measured as a binary outcome (0 = non-facility delivery; 1 = facility delivery). Association between independent factors and a HFD were determined by multivariable regression across predisposing, enabling, and need factors based on the Andersen and Newman Health Services Utilization Framework. RESULTS: Out of the 384 women, 300 delivered in health facilities, representing an estimated prevalence of 78.1% (95% CI: 73.1–82.2) in the urban slum settlements of Lubaga Division. The key factors associated with health facility delivery included; parity (aOR = 272; 95% CI: (42.88-1725.4; p = < 0.001), waiting time of less than one hour at the health facility (aOR = 180.9; 95% CI: (7.54–434.1; p = < 0.001), health worker availability (aOR = 35.2; 95% CI: (5.87-194-61; p = 0.001), attending more than four antenatal visits (aOR = 24.1; 95% CI: (3.59-161.29; p = < 0.001), partner’s post-primary education (aOR = 18.5; 95% CI: (6.43-53-54; p = < 0.001); positive attitude of health workers (aOR = 6.9; 95% CI: (1.55–30.53; p = 0.011), and maternal age below 30years (aOR = 3.5; 95% CI: (1.06–4.36; p = 0.039). CONCLUSIONS: Most women in Lubaga Division delivered in health facilities. Factors associated with health facility-based delivery included parity, waiting time of less than one hour at the health facility, health worker availability, attending more than four antenatal visits, partner’s post-primary education, positive attitude of health workers, and maternal age below 30years. Targeted interventions focused on; education, economic empowerment, financial assistance programs and improved quality of care may further increase facility-based deliveries in Lubaga Division and similar settings. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12913-026-14445-x.