The Burden of Tuberculosis across Regions in Ethiopia: A Systematic Subnational Analysis for the Global Burden of Disease Study 2019

Background: Tuberculosis remains a major global public health problem, with insufficient evidence at national and subnational levels.
Objective: The objective of this study was to assess the impact of tuberculosis on individuals who are HIV-negative in Ethiopia and regional states. It focused on comparing the progress made during the Millennium Development Goals (MDG) era with that achieved after the MDG era with regard to gender, age group, and drug resistance status.
Methods: We used the Global Burden of Disease 2019 collaborative study for computing age-standardized and age-specific Tuberculosis incidence, mortality, and disability-adjusted life years. Results are reported in absolute number and age-standardized rates (per 100,000 populations) with 95% uncertainty intervals.
Results: In 2019, 212,220 new TB cases and 29,874 TB-related deaths occurred among HIV-negative individuals in the country. TB affected more men than women in most age groups. The Annualized Rate of Change (ARC) in age-standardized TB incidence decreased by 2.2% from 1990 to 2015, but a 0.05% decrement was observed from 2016 to 2019. The ARC in age-standardized TB mortality dropped by 5.5% from 1990 to 2015 and 4.2% from 2016 to 2019. Multidrug-resistant Tuberculosis (MDR-TB) increased by only 1.3% from 2016 to 2019 nationally, but the ARC in mortality of MDR-TB declined by 3.1% from 2016-2019, a significant improvement from its initial increase of 9.2% between 1990-2015. ARC in the age-standardized incidence of extensively drug-resistant Tuberculosis (XDR-TB) increased by 4.2% from 2016 to 2019 and 22% from 1990 to 2015. In 2019, Dire Dawa had the lowest age-standardized TB incidence rate of 192 per 100,000, while Afar Region had the highest rate of 425 per 100,000. All regions except Somali, Gambella, and SNNPR showed a slow decline in ARC mortality between 1990-2015. Drug-susceptible TB was the most common variant, followed by MDR-TB in 2019. The age-standardized DALY rate due to TB has declined by 80% from 10,326 per 100,000 in 1990 to 1,853 per 100,000 in 2019.
Conclusion: The study reveals a decreasing TB burden among HIV-negative individuals in Ethiopia from 1990 to 2019. It emphasizes the need for Ethiopia's TB control strategies to enhance access to prevention, early diagnosis, and treatment, focusing on high-risk groups and vulnerable individuals. Targeted interventions, including social protections, are needed to engage more men in TB care and emphasize the importance of early diagnosis.