Background: Pain is a sensory and emotional experience associated with actual or potential tissue damage,rnor described in terms of such damage according to Association of the Study of Pain. Althoughrnadvances in medical science, poor post-operative pain management exists in developed as well as developingrncountries including Ethiopia. Several preoperative, intra-operative and postoperative factors are realized torncause enhancement of postoperative pain. Therefore in resource shortage settings to take appropriate plan ofrntreatment and proper use of multimodal analgesia, it is obliged to identify the problem and its factors.rnObjective: The aim of this study is to assess the incidence and associated factors of post-operative acute painrnafter cesarean section in the first 24 post-operative hours in Gandhi memorial Hospital, Ethiopia, 2020.rnMethods: An institutional based prospective follow up study was conducted in parturient undergonerncesarean section in Gandhi memorial hospital from December 1-2019 to February 30-2020, data wasrncollected by through interview and reviewing the patients chart after taking consent. Numerical rating scalernwas used to evaluate incidence of acute postoperative pain. Data was analyzed using SPSS version 20.rnLogistic regression was applied to point out independent risk factors for post-operative acute pain. Variablesrnwith a p-value of < 0.05 were taken as significant association with dependent variables.rnResult: A two hundred ninety parturient were participated in the study with a response rate of 98%.rnModerate â€“severe acute postoperative pain after cesarean section was 76.2 %( 95% CI: 71%, 81%)in thernfirst 24 hours postoperatively. On multivariable analysis, history of previous cesarean section (AOR: 2.80rn95% CI: 1.40, 5.55), preoperative anxiety (AOR: 2.70, 95%CI: 1.45, 5.05), transverse incision type (AOR:rn3.35, 95% CI: 1.67, 6.72), incision length (AOR: 2.46, 95% CI: 1.24, 4.85)were identified as associatedrnfactors of postoperative moderate-severe acute pain after cesarean section.rnConclusion: The study confirmed that moderate-severe acute postoperative pain after cesarean section isrnenormous in proportion and also undertreated. Previous cesarean section, preoperative anxiety, incision typernand incision length were determinants of post operative acute pain after cesarean section. Evaluate andrndocument the pain rating scale, communicate with other integrative departments for a better management andrnorganize a master plan to lessen the pain occurrence problem must be required.