Background: Tuberculosis (TB) is an infectious disease that is a major cause of ill health, one of the top 10 causes of death worldwide, and the leading cause of death from a single infectious agent in 2019. Ethiopia is one of the 30 designated high TB burden countries globally, with an annual estimated 157,000 cases and 21,000 deaths to TB in 2019. Because of very few national surveys, the burden of TB was not comprehensively assessed in Ethiopia over the last two decades. Therefore, the main aim of this study was to assess the levels and trends in the burden of TB in Ethiopia by sex, age group, drug­resistance status, and regions, from 1990 to 2019.

Methods: The National Data Management Center for health’s research team at the Ethiopian Public Health Institute has analyzed the most recent data from the Global Burden of Disease (GBD) 2019 for Ethiopia. In GBD 2019 data, TB deaths were estimated using the Cause of Death Ensemble model strategy to generate estimates of TB deaths among HIV-negative individuals by location, age group, sex, and year. While TB incidence and DALYs were calculated in the DisMod-MR 2.1, a Bayesian meta-regression tool. For changes over time, we calculated annualized rate of change (ARC) using the two-point continuously compounded rate-of-change formula separately 1990-2015 and 2016-2019.  Results are reported in absolute number and age-standardized rates (per 100K inhabitants) with 95% uncertainty intervals (UIs).

Results: Nationally in 2019, among HIV­ negative individuals, the number incident cases TB was 212,220 (95% UI, 182638.3–244741.6) and the number of tuberculosis deaths was 29, 874 (24, 664.9, 35, 365.4). Almost greater number of HIV­ negative TB incident cases 53% and deaths 65% were in males.  Most incident cases 93% and deaths 69% were in people younger than 65 years for both sexes. The annualized rate of change in age­standardized incidence of TB among HIV ­negative individuals was decreased by 2.2% from 1990 to 2015, which it is a higher rate of change than in 2016–2019(0.05%). The above rates of change are small compared with the decrease in the ARC in age­standardised TB mortality (4.2%) from 2016 to 2019, which is lower than the annualized rate of change from the period 1990–2015 (5.5%). However, the annualized rate of change in mortality was declined by 3.1% from 2016-2019 with high improvement from 1990-2015(9.2%). In 2019, the number of DALYs among HIV-negative individuals in Ethiopia was 1.28 million (95% UI 1.06–1.50). The age-standardized DALY rates due to TB among HIV-negative individuals declined by 80.0% from 10,326 DALYs/100,000 inhabitants (95% UI: 8,693.30 –12,373.73) in 1990 to 1,853 DALYs/100,000 inhabitants (95% UI: 1,539.82 –2,163.82) in 2019. Similar to the death rates and incidence rate, the TB burden was much higher for males than for females at all-time points.

Conclusion: The study shows an improving trend in TB disease burden among HIV-negative individuals in Ethiopia from 1990 to 2019. Despite this progress, this study suggests that additional efforts are still needed to ensure that Ethiopia is not left behind in the current global strategy to end TB disease. The findings reinforce the importance of strengthening TB control strategies in Ethiopia through integrated and multisectoral actions that enable access to prevention, early diagnosis, and timely treatment, with emphasis on high-risk groups and populations most vulnerable to the disease in the country.