Trends in Incidence and Premature Mortality (Years of Life Lost) From Acute Viral Hepatitis Among Children Under Five in Ethiopia, From 1990 to 2023: A Global Burden of Disease 2023 Study.

backgroundGlobally, acute viral hepatitis (AVH) causes an estimated 1.5 million new infections annually among children under five, with sub-Saharan Africa bearing a disproportionate burden. In Ethiopia, the Global Burden of Disease Study reported an age-standardized incidence rate of 3616 per 100,000 population across all ages in 2019, with children under five being especially vulnerable to fecal-oral transmission. Despite available vaccines for Hepatitis B and preventive measures for Hepatitis A and E, comprehensive national data on long-term trends and subnational disparities in this age group remained limited.

methodsWe used data from the Global Burden of Disease (GBD) 2023 study to assess the burden of AVH among children under five in Ethiopia from 1990 to 2023. Estimates were disaggregated by region, sex, and hepatitis type. The burden of AVH was described in terms of incidence and years of life lost across all regions in Ethiopia from 1990 to 2023. Each metric was reported with numbers and rates per 100,000 population, along with 95% uncertainty intervals (UIs). Statistical significance was evaluated based on a 95% UI.

resultsThis study examined trends in AVH incidence and premature mortality among Ethiopian children under five from 1990 to 2023. The analysis revealed a statistically significant national decline in hepatitis B incidence, with an annualized rate of change of -0.68% (95% UI: -0.72, -0.63) per year. However, the overall acute hepatitis incidence showed only a modest decline of -0.07% (95% UI: -0.10, -0.05) per year, as declines in Hepatitis B were offset by stagnant rates of Hepatitis A and E. The most substantial regional decreases in Hepatitis B occurred in Addis Ababa and Southwest Ethiopia. Premature mortality, measured in years of life lost, also showed significant improvement, decreasing at an annual rate of -0.52% (95% UI: -0.79, -0.08) per year nationally. While these positive trends were observed, most variation between regions and across sexes did not reach statistical significance, indicating relatively consistent progress across different demographic groups and geographic areas.

conclusionThe observed decline in Hepatitis B incidence is likely attributable to the introduction of the Hepatitis B vaccination program, while the persistent burden of Hepatitis A and E probably reflects ongoing water, sanitation, and hygiene (WASH) challenges. To build on this progress and address persistent inequities, targeted vaccination campaigns in high-burden regions must be combined with comprehensive water and sanitation improvements, alongside regionally adapted healthcare strategies. EVIDENCE BEFORE THIS STUDY: We searched PubMed, Embase, and the GBD repository for studies published from January 1, 1990, to December 31, 2023, using the terms "acute viral hepatitis," "children," "under-five," "incidence," "mortality," and "Ethiopia." Previous studies were limited to localized, short-term outbreaks or single-center reports. No comprehensive national time-trend analysis quantifying the long-term burden and premature mortality of AVH in Ethiopian children under five was identified. ADDED VALUE OF THIS STUDY: This is the first study to provide detailed, nationally representative estimates of the incidence and mortality due to AVH among children under five in Ethiopia over 33 years (1990-2023). We present subnational disparities, analyze trends, and examine the association with sociodemographic development. IMPLICATIONS OF ALL THE AVAILABLE EVIDENCE: The persistently high burden of AVH, driven largely by Hepatitis A and E, is a preventable cause of child mortality in Ethiopia. The evidence underscores the critical gap in preventive measures and calls for policy action integrating WASH improvements with vaccination strategy to achieve SDG targets for child survival.