<sec> <title>SETTING</title> Non-adherence to treatment is one of the challenges facing global tuberculosis (TB) control. In Ethiopia, an extremely variable and high magnitude of TB treatment non-adherence have been reported from different parts of the country. However, there has been no attempt to estimate the pooled prevalence of non-adherence from this heterogeneous data. </sec> <sec> <title>OBJECTIVE</title> To review the available literature and estimate the overall prevalence of treatment non-adherence among patients with TB on first-line treatment in Ethiopia. </sec> <sec> <title>DESIGN</title> A systematic review and meta-analysis of published articles on TB treatment non-adherence. </sec> <sec> <title>RESULTS</title> We included 26 studies, which contained data on 37 381 patients with TB. The crude prevalence of non-adherence reported by the studies included was extremely variable (range 0.2-35%). The overall pooled estimate of non-adherence prevalence was 10.0% (95%CI 8.0-11.0). The pooled prevalence of patients lost to follow-up alone was 5.0% (95%CI 4.0-6.0), while the pooled prevalence of intermittent non-adherence was 20.0% (95%CI 15.0-25.0). </sec> <sec> <title>CONCLUSION</title> The rate of TB treatment non-adherence in Ethiopia remains too high to achieve target treatment success rates and prevent drug resistance. Implementing an effective patient retention scheme, along with the DOTS strategy, is critical to improving treatment adherence and preventing drug resistance. </sec>.