Effect of Drought on Tuberculosis (TB) in Ethiopia: A case study from Borena and Shebelle Zones.

Introduction Ethiopia has experienced increased climate change events, with recurrent floods and droughts severely damaging infrastructure and disrupting livelihoods, particularly in lowland pastoral areas. As Ethiopia is among the high TB burden countries, the recurrent severe droughts might have exacerbated TB burdens and affects service delivery. This study explores the impact of drought on TB burden and treatment outcomes in two frequent drought-affected geographic areas in Ethiopia, namely Borena and Shebelle Zones of Oromia and Somali Regional States, respectively. Methods This study used a mixed-methods approach to assess the impact of drought on TB burden in the two zones during 2020–2022. Quantitative analysis of TB program and climate data (from DHIS2 and the Ethiopian Meteorological Institute) examined trends in notifications and treatment outcomes. Descriptive statistics and correlation analysis was employed to assess the relationship between drought conditions measured by the Standard Precipitation Index (SPI) and TB indicators. Qualitative data from key informant interviews were thematically analyzed. Results The TB case notifications increased from 850 in 2020 to 1,500 in Borena Zone during the drought period. Regional TB focal persons attributed the rise to increased vulnerability from under nutrition, displacement, and overcrowding, with service continuity supporting case detection. Where as in Shebelle Zone, the TB notifications declined from 870 in 2020 to 470 in early 2023.These trends were linked to disrupted services and drought-driven migration of patients and health workers. The treatment success and cure rates for TB slightly declined, while the loss follow-up rate increased in both zones during the drought season. Conclusion Drought exacerbates TB burden and worsens outcomes. The impact of drought on Ethiopia’s TB response highlights the importance of building resilient health-care strategies and integrate TB care into emergency response plans, particularly in regions facing recurrent climate challenges.