Burden of lower respiratory infections and associated risk factors across regions in Ethiopia: a subnational analysis of the Global Burden of Diseases 2019 study
Authors: Yigezu Amanuel , Misganaw Awoke , Getnet Fentabil , Berheto Tezera Moshago , Walker Ally , Zergaw Ababi , Gobena Firehiwot Abebe , Haile Muluken Argaw , Hailu Alemayehu , Memirie Solomon Tessema , Tolosa Dereje Mengistu , Abate Semagn Mekonnen , Molla Adane Mesafint , Akalu Gizachew Taddesse , Aklilu Addis , Tsegaye Dejen , Gebru Zeleke , Asemahagn Mulusew Andualem , Atlaw Daniel , Awoke Tewachew , Abebe Hunegnaw , Bekele Niguss Cherie , Belete Melaku Ashagrie , Hailemariam Tekleberhan , Yirga Alemeshet , Birara Setognal Aychiluhm , Bodicha Belay Boda Abule , Churko Chuchu , Demeke Feleke Mekonnen , Desta Abebaw Alemayehu , Ena Lankamo , Eyayu Tahir , Fentaw Zinabu , Gargamo Daniel Baza , Gebrehiwot Mesfin Damtew , Gebremichael Mathewos Alemu , Getachew Melaku , Molla Getahun , Sahiledengle Biniyam , Beyene Bereket , Sibhat Migbar , Sidamo Negussie Boti , Solomon Damtew , Solomon Yonatan , Wagaye Birhanu , Wedajo Shambel , Weldemariam Melat , Yismaw Yazachew Engida , Naghavi Moshen 
Published: September 2023

ObjectiveThis analysis is to present the burden and trends of morbidity and mortality due to lower respiratory infections (LRIs), their contributing risk factors, and the disparity across administrative regions and cities from 1990 to 2019.DesignThis analysis used Global Burden of Disease 2019 framework to estimate morbidity and mortality outcomes of LRI and its contributing risk factors. The Global Burden of Disease study uses all available data sources and Cause of Death Ensemble model to estimate deaths from LRI and a meta-regression disease modelling technique to estimate LRI non-fatal outcomes with 95% uncertainty intervals (UI).Study settingThe study includes nine region states and two chartered cities of Ethiopia.Outcome measuresWe calculated incidence, death and years of life lost (YLLs) due to LRIs and contributing risk factors using all accessible data sources. We calculated 95% UIs for the point estimates.ResultsIn 2019, LRIs incidence, death and YLLs among all age groups were 8313.7 (95% UI 7757.6–8918), 59.4 (95% UI 49.8–71.4) and 2404.5 (95% UI 2059.4–2833.3) per 100 000 people, respectively. From 1990, the corresponding decline rates were 39%, 61% and 76%, respectively. Children under the age of 5 years account for 20% of episodes, 42% of mortalities and 70% of the YLL of the total burden of LRIs in 2019. The mortality rate was significantly higher in predominantly pastoralist regions—Benishangul-Gumuz 101.8 (95% UI 84.0–121.7) and Afar 103.7 (95% UI 86.6–122.6). The Somali region showed the least decline in mortality rates. More than three-fourths of under-5 child deaths due to LRIs were attributed to malnutrition. Household air pollution from solid fuel attributed to nearly half of the risk factors for all age mortalities due to LRIs in the country.ConclusionIn Ethiopia, LRIs have reduced significantly across the regions over the years (except in elders), however, are still the third-leading cause of mortality, disproportionately affecting children younger than 5 years old and predominantly pastoralist regions. Interventions need to consider leading risk factors, targeted age groups and pastoralist and cross-border communities.