Abstract
BACKGROUND: Irritable bowel syndrome (IBS) is a common disorder of gut-brain interaction, yet data from sub-Saharan Africa remain limited. In Ethiopia, evidence on IBS among medical students is particularly limited, despite this group's high exposure to academic and psychosocial stressors. OBJECTIVES: To estimate the prevalence of IBS among Ethiopian medical students and to examine its demographic, lifestyle, and psychological correlates. METHODS: A cross-sectional analytical study was conducted between 1 June and 31 August 2024 among undergraduate medical students from eleven Ethiopian universities. Participants completed a self-administered online questionnaire incorporating the Rome IV criteria for IBS and the Hospital Anxiety and Depression Scale (HADS). Descriptive statistics summarized participant characteristics. A mixed-effects logistic regression with a random intercept for university was used to assess associations between IBS and prespecified predictors (sex, anxiety, and depression). Wald odds ratios (ORs) with 95% confidence intervals (CIs) were reported. Sensitivity analyses used Firth penalised logistic regression, exclusion of small clusters, and binary recoding of HADS categories. Model discrimination and calibration were assessed using the area under the receiver operating characteristic curve (AUC) and calibration slope and intercept. RESULTS: A total of 290 medical students participated (mean age = 23 years). Twenty students met the Rome IV criteria for IBS, corresponding to a prevalence of 6.9% (95% CI 4.2-10.4). In the adjusted model, anxiety classified as "case" was associated with higher odds of IBS (OR 7.25, 95% CI 1.83-28.72; p < 0.01). Borderline anxiety, depression (borderline or case), and female sex were not statistically significant. Sensitivity analyses produced similar estimates. The model showed acceptable discrimination (AUC = 0.78; optimism-corrected AUC = 0.73) and good calibration (intercept = 0.00; slope = 1.00). CONCLUSIONS: The prevalence of IBS among Ethiopian medical students was 6.9%. Anxiety was statistically associated with IBS, whereas depression and sex were not. The findings highlight the presence of IBS and psychological correlates among this population. Broader longitudinal research could further clarify the epidemiology and psychosocial factors related to IBS in Ethiopian medical students.