Despite growing recognition as a public health concern, the burden of autism spectrum disorder (ASD) in Ethiopia remains poorly characterised owing to limited diagnostic capacity and epidemiological data, hampering evidence-based policy and intervention planning.

This study aimed to quantify the longitudinal burden of ASD in the Ethiopian paediatric population from 1990 to 2023 and project future trends to 2050 to inform national health strategies.

Using Global Burden of Disease (GBD) 2023 data, we estimated ASD prevalence, incidence and disability-adjusted life-years (DALYs) among Ethiopian children and adolescents. Trends were analysed using joinpoint regression and future burden was forecast to 2050 using autoregressive integrated moving average (ARIMA) modelling.

Between 1990 and 2023, ASD prevalence increased by 155%, from 271 805 to 693 644 cases. Correspondingly, the age-standardised prevalence rate increased from 950 to 1185 cases per 100 000 population. Although annual incident cases nearly doubled (from 24 576 to 47 274), the age-standardised incidence rate declined slightly from 86 to 81 cases per 100 000. DALYs increased by 162% to 134 386 in 2023, while the age-standardised DALY rate increased from 179 to 230 per 100 000. Projections to 2050 suggest that the overall ASD burden will persist, with a stable incidence rate but an increasing DALY rate.

Nearly 700 000 Ethiopian children and adolescents were living with ASD in 2023. The significant increases in prevalence and DALYs over three decades underscore the urgent need for a comprehensive national strategy, including enhanced diagnostic infrastructure and early intervention programmes.