Background: The use of substances is a growing concern in Ethiopia and their impacts on younger generation have been a concern of different professionals. Even though students are at high-risk of substance abuse, there is lack of comprehensive evidence for policy decision on substance use in students. Therefore, the aim of this systematic Review and Meta-analysis was to estimate the prevalence of common substances among students in Ethiopia.

Method: A comprehensive literature searches were done from electronic biomedical databases; Google scholar, PubMed/Medline, HINARI, African Journal Online, Ethiopian Journal of health development, African Journal of Health Science and Science Direct for article published until 31/12/2017. Reference list of identified studies were searched to obtain additional studies. Two authors autonomously selected studies, extracted data, and evaluated quality of studies. Q and I² were computed to measure the extents of between study variations. The prevalence of lifetime substances use was estimated using random effects model.

Results: A total 676 study articles were identified from electronic databases, and 28 of them were included in meta-analysis. The analysis revealed that the lifetime prevalence of any substance use was 52% (95% CI: 42-62, I²=98.80%, P<0.00). Analysis by types of substances showed that the pooled lifetime prevalence of khat, 25.0% (95% CI: 22.0-28.0, I²=95.40%, P<0.00), alcohol 46.0% (95%CI: 39.0-54.0, I²=98.70%, P<0.00), and smoking cigarette, 15.0% (95%CI: 11.0, 18.0, I²=96.67%, P<0.00). However, the analyses showed there were no statistically significant publication bias.

Conclusion: The pooled estimates of this meta-analysis highlighted the extent of lifetime prevalence of any substance, khat, alcohol and cigarette smoking among students in Ethiopia. Policy makers should devise and implement strictly binding regulation to curb widespread of substances around educational institution premises at national level. To clearly understand the magnitude, trajectory and consequences of substance use among students, national survey should be conducted in educational institutions at regular interval.

Systematic review registration: PROSPERO CRD42018082635