# Time trend prediction of multidrug-resistant/rifampicin-resistant tuberculosis in treatment initiation centers of North East Ethiopia (2015–2023)

## TL;DR

This study analyzed MDR/RR-TB trends in Northeast Ethiopia from 2015 to 2023 and used forecasting models to predict future patterns.

## Contribution

The study introduces a forecasting model for MDR/RR-TB in Ethiopia, a region where such modeling is underexplored.

## Key findings

- MDR/RR-TB cases showed significant fluctuations, with a peak in 2017–2019 and a decline during 2020–2021.
- Seasonal patterns were observed, with case peaks during the dry season and troughs in August.
- The decline in 2020–2021 was likely due to the pandemic and regional conflict, while a surge followed in 2022.

## Abstract

Multidrug-resistant and rifampicin-resistant tuberculosis (MDR/RR-TB) represents a major public health threat and a significant obstacle to global TB control. Analysing trends and forecasting future patterns is critical for effective resource planning. However, the application of predictive modelling for MDR/RR-TB has not been widely explored in Ethiopia.

This study aimed to analyse the temporal trends and develop a forecasting model for MDR/RR-TB cases recorded at treatment initiation centres in Northeast Ethiopia between 2015 and 2023.

A retrospective study of all MDR/RR-TB cases diagnosed from January 2015 to December 2023 in Northeast Ethiopia was conducted using data retrieved from six treatment initiation centers (TIC) registries. Data were collected via Kobo Toolbox and analysed with SPSS v27 for descriptive statistics. Seasonal ARIMA models were developed in R to assess trends and generate forecasts, with model selection based on AIC, BIC, and residual diagnostics. Data quality was ensured through verification and consistency checks.

From an initial 409 identified individuals, 372 were included in the final analysis after excluding transferred cases. Annual case counts demonstrated instability, with a notable rise between 2017 and 2019 (up to 63.6%) and a distinct decline during 2020–2021, followed by a sharp increase in early 2022. A clear seasonal pattern was observed, with case troughs occurring in August and peaks during the dry season (Bega), followed by a decline in December.

MDR/RR-TB case trends in Northeast Ethiopia exhibited significant fluctuations over the study period. The pronounced decline in 2020–2021 was likely attributable to service disruptions from the COVID-19 pandemic and regional conflict, while the subsequent surge may reflect a recovery of case detection efforts and the conflict’s impact on transmission. TB control programs should prioritize high-risk seasonal periods and ensure resilient systems for timely diagnosis and treatment access amidst external shocks.