The Burden of Measles and Subnational Disparities among Under-Five Children in Ethiopia: A Systematic Analysis of the GBD 2021 Study

Ethiopia is among the countries with a high burden of measles outbreaks.Moreover, studies investigating the burden of measles in Ethiopia, particularly those that systematically analyze measles cases at the subnational level and their determinants, are scarce.Hence, thirty years of measles data were extracted and evaluated from the Global Burden of Disease 2021 database.Descriptive statistics were used to quantify the overall burden of measles, including incidence, prevalence, deaths, and disability-adjusted life years (DALYs), and temporal trends from 1990 onwards were analyzed.Subnational disparities in measles burden were assessed to identify high-burden areas requiring targeted interventions.Uncertainty in the estimates was quantified through 1,000 iterations of the model, producing 95% uncertainty intervals (2.5th and 97.5th percentiles) for all metrics.Measles incidence, prevalence, death, and disability-adjusted life years were 709/100,000 (95% UI: 461.66-1017.29),19/100,000 (95% UI: 12.65-27.87),8/100,000 (95% UI: 4.28-14.35),and 728/100,000 (95% UI: 377.52-1264) in Ethiopia in 2021.Moreover, the national measles incidence rate decreased by 96% in 2021 compared to that of 1990.The measles burden was higher in the Afar, Somali, and Benishangul Gumuz regions and lower in Addis Ababa.After the introduction of the second dose of measles, there was a notable decrease in the burden.However, the measles burden remains substantial in Ethiopia, despite a notable decline over the past three decades.Therefore, our results suggest that there is an urgent need to improve measles vaccination service in Ethiopia, especially in high-burden regions.