Implications of forecasted disease burden on envisioning health strategies in Ethiopia; Findings from Global Burden of Disease 2017 Forecasting Study
Authors: Misganaw Awoke 
Published: April 2020

Abstract
Background Universal health coverage is the main goal of the health sector in the coming decade for Ethiopia, in the county’s transitions to a middle-income state. We used GBD 2017 forecasting 2017–2040 results to support Ethiopia’s envisioning framework with baseline scenario and calibration targetsMethods We used GBD 2017 forecasting estimates for Ethiopia which modelled 250 causes and cause of death from 2017–2040. The data sources for Ethiopia include surveys, surveillance, case notifications, facility reports, sibling history, verbal autopsy and police records to estimate mortality and causes of death. We reported Life Expectancy (LE), death and premature mortality rates using GBD broader and detail categories with 95% uncertainty Intervals (UI).Results Ethiopians average life expectancy will increase from 66.0 years (64.0-68.5) in 2017 to 73.8 years (70.3–77.3) in 2040. In 2040, the all-cause age-standardized death rate is 854 per 100,000 people of which NCDs caused 567.1 and CMNNDs caused 211.2 of the deaths. NCDs and injuries show a smaller reduction of 26% and 23% respectively between 2017 and 2040 compared to the 53% decrease for CMNNDs. Cardiovascular and neoplasm causes 224.7, 137.8 deaths/100,000 respectively. Diarrheal, lower respiratory infections, and other common infectious diseases combined caused 144.5 age-standardized deaths/100,000 in 2040. The combined age-standardized death rate for HIV/AIDs and tuberculosis is 35.2 deaths/100,000. The age-standardize premature mortality percentage contribution of CMNNDs declined from 62.4% in 1990, 45% in 2018 and 34% in 2040, whereas NCDs contribution increased from 25.2% in 1990, 46% in 2019 and 54% in 2040.Conclusions Ethiopians average life expectancy is expected to increase. This major gain is expected to be attributed to further reductions in under-five child mortality and decline in burden of major communicable, maternal and nutritional diseases. Ethiopia is more likely to achieve the success of LMI countries in terms of life expectancy; neonatal, child and maternal mortality rates; eradicating malaria, tuberculosis and HIV/AIDS causes of mortality however less likely to achieve the success of UMICs by 2040. Non-communicable disease and injuries are expected to be leading causes of age-standardized death rate from 2007 through 2040.Background Ethiopia has an estimated total population of 103 million in 2016, where half of them are dependent population (45% under the age of 15 years and 3% above the age of 65), and the sex ratio is almost equal (1). During the implementation of the 20-year Health Sector Development Plan (HSDPs) from 1997–2015, which also covers the MDG era, substantial decline has been recorded on under 5 morbidity and mortality, in maternal morbidity and mortality, in morbidities and mortalities due to HIV/AIDS, tuberculosis (TB) and malaria. Despite great progress over the past two decades, a huge burden of preventable mortality still persists in Ethiopia (2). The main contributors to this burden include child and maternal mortality, stillbirths, HIV/AIDS, TB, non-communicable diseases (NCDs) and injuries (3, 4). Ethiopia is currently experiencing double disease burden, that is communicable and non-communicable diseases, which was not recognized in the HSDP strategic plan of the country (2).