. 2023 Sep 4;13(9):e068498.

doi: 10.1136/bmjopen-2022-068498.

Burden of lower respiratory infections and associated risk factors across regions in Ethiopia: a subnational analysis of the Global Burden of Diseases 2019 study

Amanuel Yigezu¹, Awoke Misganaw^{2

3}, Fentabil Getnet^{2

4}, Tezera Moshago Berheto², Ally Walker³, Ababi Zergaw^{2

5}, Firehiwot Abebe Gobena⁶, Muluken Argaw Haile⁶, Alemayehu Hailu⁷, Solomon Tessema Memirie^{8

9}, Dereje Mengistu Tolosa⁶, Semagn Mekonnen Abate¹⁰, Mesafint Molla Adane¹¹, Gizachew Taddesse Akalu^{12

13}, Addis Aklilu¹⁴, Dejen Tsegaye¹⁵, Zeleke Gebru¹⁶, Mulusew Andualem Asemahagn¹⁷, Daniel Atlaw¹⁸, Tewachew Awoke¹⁹, Hunegnaw Abebe²⁰, Niguss Cherie Bekele²⁰, Melaku Ashagrie Belete²¹, Tekleberhan Hailemariam²², Alemeshet Yirga²³, Setognal Aychiluhm Birara²⁴, Belay Boda Abule Bodicha¹⁴, Chuchu Churko¹⁶, Feleke Mekonnen Demeke¹¹, Abebaw Alemayehu Desta²⁵, Lankamo Ena¹⁴, Tahir Eyayu²⁶, Zinabu Fentaw²⁷, Daniel Baza Gargamo²⁸, Mesfin Damtew Gebrehiwot²¹, Mathewos Alemu Gebremichael¹⁴, Melaku Getachew²⁹, Getahun Molla³⁰, Biniyam Sahiledengle³¹, Bereket Beyene¹⁴, Migbar Sibhat³², Negussie Boti Sidamo¹⁶, Damtew Solomon³³, Yonatan Solomon³⁴, Birhanu Wagaye^{2

21}, Shambel Wedajo²¹, Melat Weldemariam³⁵, Yazachew Engida Yismaw¹⁹, Moshen Naghavi³⁶

Affiliations

¹ Ethiopian Public Health Institute, Addis Ababa, Ethiopia yigezuamanuel@yahoo.com.
² Ethiopian Public Health Institute, Addis Ababa, Ethiopia.
³ Department of Health Metrics Sciences, University of Washington, Seattle, Washington, USA.
⁴ Jigjiga University, Jigjiga, Ethiopia.
⁵ Department of Health Systems and Policy, Addis Ababa University College of Health Sciences, Addis Ababa, Ethiopia.
⁶ Ethiopian Health Insurance Service, Addis Ababa, Ethiopia.
⁷ Department of Global Public Health and Primary Care Medicine, University of Bergen, Bergen, Norway.
⁸ Addis Center for Ethics and Priority Setting, Addis Ababa University, Addis Ababa, Ethiopia.
⁹ Harvard T.H. Chan School of Public Health, Harvard University, Cambridge, Massachusetts, USA.
¹⁰ Department of Anesthesiology, Dilla University College of Health Sciences, Dilla, Ethiopia.
¹¹ Bahir Dar University College of Medical and Health Sciences, Bahir Dar, Ethiopia.
¹² St Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia.
¹³ Addis Ababa University College of Health Sciences, Addis Ababa, Ethiopia.
¹⁴ Arba Minch University, Arba Minch, Ethiopia.
¹⁵ Adult Health Nursing, Debre Markos University College of Health Science, Debremarkos, Ethiopia.
¹⁶ Public Health, Arba Minch University, Arba Minch, Ethiopia.
¹⁷ School of Public Health, Bahir Dar University College of Medical and Health Sciences, Bahir Dar, Ethiopia.
¹⁸ Madda Walabu University, Bale-Goba, Ethiopia.
¹⁹ Bahir Dar University, Bahir Dar, Ethiopia.
²⁰ Department of Public Health, Wollo University, Dessie, Ethiopia.
²¹ Wollo University, Dessie, Ethiopia.
²² Mekelle University, Mekelle, Ethiopia.
²³ Department of Pharmacy, Bahir Dar University, Bahir Dar, Ethiopia.
²⁴ Department of Public Health, Samara University, Semera, Ethiopia.
²⁵ University of Gondar, Gondar, Ethiopia.
²⁶ Department of Medical Laboratory Sciences, Debre Tabor University, Debre Tabor, Ethiopia.
²⁷ Department of Epidemiology and Biostatistics, Wollo University, Dessie, Ethiopia.
²⁸ Wolaita Sodo University, Sodo, Ethiopia.
²⁹ Haramaya University College of Health and Medical Sciences, Harar, Ethiopia.
³⁰ University of Gondar Hospital, Gondar, Ethiopia.
³¹ Department of Public Health, Madda Walabu University, Balle-Goba, Ethiopia.
³² Department of Nursing, Dilla University College of Health Sciences, Dilla, Ethiopia.
³³ Madda Walabu University, Robe, Ethiopia.
³⁴ Dire Dawa University, Dire Dawa, Ethiopia.
³⁵ Department of Medical Laboratory Sciences, Arba Minch University, Arba Minch, Ethiopia.
³⁶ School of Public Health, University of Washington, Seattle, Washington, USA.

PMID: 37666561
PMCID: PMC10481843
DOI: 10.1136/bmjopen-2022-068498

Burden of lower respiratory infections and associated risk factors across regions in Ethiopia: a subnational analysis of the Global Burden of Diseases 2019 study

Amanuel Yigezu et al. BMJ Open. 2023.

. 2023 Sep 4;13(9):e068498.

doi: 10.1136/bmjopen-2022-068498.

Authors

Affiliations

¹ Ethiopian Public Health Institute, Addis Ababa, Ethiopia yigezuamanuel@yahoo.com.
² Ethiopian Public Health Institute, Addis Ababa, Ethiopia.
³ Department of Health Metrics Sciences, University of Washington, Seattle, Washington, USA.
⁴ Jigjiga University, Jigjiga, Ethiopia.
⁵ Department of Health Systems and Policy, Addis Ababa University College of Health Sciences, Addis Ababa, Ethiopia.
⁶ Ethiopian Health Insurance Service, Addis Ababa, Ethiopia.
⁷ Department of Global Public Health and Primary Care Medicine, University of Bergen, Bergen, Norway.
⁸ Addis Center for Ethics and Priority Setting, Addis Ababa University, Addis Ababa, Ethiopia.
⁹ Harvard T.H. Chan School of Public Health, Harvard University, Cambridge, Massachusetts, USA.
¹⁰ Department of Anesthesiology, Dilla University College of Health Sciences, Dilla, Ethiopia.
¹¹ Bahir Dar University College of Medical and Health Sciences, Bahir Dar, Ethiopia.
¹² St Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia.
¹³ Addis Ababa University College of Health Sciences, Addis Ababa, Ethiopia.
¹⁴ Arba Minch University, Arba Minch, Ethiopia.
¹⁵ Adult Health Nursing, Debre Markos University College of Health Science, Debremarkos, Ethiopia.
¹⁶ Public Health, Arba Minch University, Arba Minch, Ethiopia.
¹⁷ School of Public Health, Bahir Dar University College of Medical and Health Sciences, Bahir Dar, Ethiopia.
¹⁸ Madda Walabu University, Bale-Goba, Ethiopia.
¹⁹ Bahir Dar University, Bahir Dar, Ethiopia.
²⁰ Department of Public Health, Wollo University, Dessie, Ethiopia.
²¹ Wollo University, Dessie, Ethiopia.
²² Mekelle University, Mekelle, Ethiopia.
²³ Department of Pharmacy, Bahir Dar University, Bahir Dar, Ethiopia.
²⁴ Department of Public Health, Samara University, Semera, Ethiopia.
²⁵ University of Gondar, Gondar, Ethiopia.
²⁶ Department of Medical Laboratory Sciences, Debre Tabor University, Debre Tabor, Ethiopia.
²⁷ Department of Epidemiology and Biostatistics, Wollo University, Dessie, Ethiopia.
²⁸ Wolaita Sodo University, Sodo, Ethiopia.
²⁹ Haramaya University College of Health and Medical Sciences, Harar, Ethiopia.
³⁰ University of Gondar Hospital, Gondar, Ethiopia.
³¹ Department of Public Health, Madda Walabu University, Balle-Goba, Ethiopia.
³² Department of Nursing, Dilla University College of Health Sciences, Dilla, Ethiopia.
³³ Madda Walabu University, Robe, Ethiopia.
³⁴ Dire Dawa University, Dire Dawa, Ethiopia.
³⁵ Department of Medical Laboratory Sciences, Arba Minch University, Arba Minch, Ethiopia.
³⁶ School of Public Health, University of Washington, Seattle, Washington, USA.

PMID: 37666561
PMCID: PMC10481843
DOI: 10.1136/bmjopen-2022-068498

Abstract

Objective: This 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.

Design: This 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 setting: The study includes nine region states and two chartered cities of Ethiopia.

Outcome measures: We 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.

Results: In 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.

Conclusion: In 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.

Keywords: epidemiology; health policy; respiratory infections.

PubMed Disclaimer

Conflict of interest statement

Competing interests: None declared.

Figures

**Figure 1**
Sociodemographic index, Ethiopia, 2019. SNNPR, Southern Nations and Nationalities and Peoples Region.

**Figure 2**
Incidence of lower respiratory infections per 100 000 people in Ethiopia and its regions in 2019. AA, Addis Ababa; ASRM age-standardised rate; BG, Benishangul-Gumuz; DD, Dire Dawa; SNNPs, Southern Nations and Nationalities and Peoples.

**Figure 3**
Trend in LRIs age-standardised years of life lost rates per 100 000 people in Ethiopia, 1990–2019. LRIs, lower respiratory infections; SNNPs, Southern Nations and Nationalities and Peoples.

See this image and copyright information in PMC

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Burden of lower respiratory infections and associated risk factors across regions in Ethiopia: a subnational analysis of the Global Burden of Diseases 2019 study

Affiliations

Burden of lower respiratory infections and associated risk factors across regions in Ethiopia: a subnational analysis of the Global Burden of Diseases 2019 study

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Conflict of interest statement

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