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Abstract Background Academic performance is the extent to which a student, teacher, or institution has attained their short- or long-term educational goals and is measured either by continuous assessment or cumulative grade point average (CGPA). Good academic performance is defined as the students who scored a cumulative GPA of 3 and above. Even though few studies were done in Ethiopia, there was no clear evidence regarding the role of cognitive and learning issues such as academic competence, test competence, time management, strategic studying, and test anxiety on the academic performance of students. Objective To assess the magnitude academic performance and its associated factors among health science students at Eastern Ethiopian universities. Method An institution based cross sectional study design was implemented on a total of 924 regular undergraduate students of eastern Ethiopian universities. Good academic performance was measured as the students who scored a cumulative GPA of three and above. The study participants were selected using simple random sampling techniques, and a self-administered questionnaire was used to collect data. The collected data was entered and analyzed using SPSS version 25 software. A P-value