CAMO-Net Uganda has published the country’s first national cost-of-illness study to estimate the societal economic burden of antibiotic resistance (ABR), revealing a substantial toll on patients, families, and the wider economy. Published in Springer Nature, the study also highlights the disproportionate impact ABR has on women.
Drawing on detailed costing and clinical outcomes data from nine regional referral hospitals, the study estimates that ABR cost Uganda US$1.43 million in 2024, equivalent to 0.003% of the country’s GDP. Of this, 82% of the total economic burden was attributed to lost productivity, reflecting the long-term consequences of prolonged illness, complications, and premature mortality associated with resistant infections.
The research team used a societal perspective to capture direct healthcare costs, informal care, and productivity losses. They found that the average annual cost per ABR patient was US$4,983, with families shouldering the overwhelming majority of this burden.
While CAMO-Net’s work typically focuses on antimicrobial resistance (AMR) more broadly, including resistance to antibiotics, antivirals, antifungals, and antiparasitic medicines, this study examines antibiotic resistance (ABR) specifically. ABR refers to resistance in bacteria alone, which is the dominant driver of hospital admissions, prolonged treatment, and patient-level costs in Uganda’s health system. Using ABR as the central analytic category aligns with the study’s clinical dataset and ensures precision when estimating direct healthcare, informal care, and productivity losses.
A gendered burden
One of the study’s most striking findings is the gender disparity: women experienced 29% higher total societal costs and 21% higher per-patient costs from resistant infections compared with men. Costs on informal care, lost productivity, and direct healthcare, all fell more heavily on women.
These differences reflect broader social and economic factors, including women’s roles as caregivers, their increased likelihood of self-medication, and barriers to accessing timely healthcare.
Evidence to guide action
The study fills a critical evidence gap in Uganda and the wider region. While ABR is widely recognised as a growing public health challenge, very little empirical data has been available to support national decision-making, economic planning, or the design of stewardship interventions.
Dr Andrew Kambugu, CAMO-Net Uganda Lead, emphasised the importance of these findings for national planning:
“For years, Uganda has lacked robust evidence showing the true economic impact of antibiotic resistance on households and the health system. This study finally provides that clarity. It shows that ABR is not only a clinical problem but a major development issue – one that affects productivity, household finances, and gender equity. Policymakers can now act with greater precision and urgency.”
The study found that:
- Lost productivity, including early retirement, sick leave, reduced productivity at work (presenteeism), and premature mortality, was the largest contributor to national losses.
- Informal care, including transport, accommodation, food, foregone leisure, reduced productivity at work (presenteeism), and time away from work (absenteeism), accounted for 10% of total costs.
- Direct healthcare costs, such as hospital care, personnel, equipment, and antibiotics, made up 8% of the total economic burden.
- Premature mortality alone represented 62% of all productivity losses.
These findings underscore how ABR extends far beyond the hospital, affecting families’ livelihoods and long-term well-being.
Strengthening antimicrobial stewardship
Elly Nuwamanya, CAMO-Net Researcher and Health Economist, and lead author on the paper, highlighted the importance of this evidence for designing targeted interventions:
“Our analysis shows that the economic burden of ABR is real, measurable, and unevenly distributed. Women are particularly more affected, and this must shape how Uganda designs stewardship and prevention programmes. By understanding where the costs fall, whether in lost productivity, informal care, or prolonged hospital stays, we can prioritise the interventions that offer the greatest societal benefit.”
The research also supports the implementation of Uganda’s National Action Plan on Antimicrobial Resistance and complements CAMO-Net Uganda’s ongoing work to strengthen surveillance, stewardship, and cross-sector collaboration.
Next steps for Uganda and the region
The authors recommend that the findings be used to:
- guide resource allocation for stewardship programmes
- strengthen infection prevention and control strategies
- prioritise gender-responsive interventions
- inform future economic evaluations of AMR-related investments
- support ongoing advocacy for sustainable AMR financing
With ABR already widespread – affecting 88% of patients with bacterial growth in the study sample – the cost of inaction is likely to rise.
CAMO-Net Uganda, through the Infectious Diseases Institute at Makerere University, will continue to work with the Ministry of Health and national partners to translate this evidence into policy, practice, and improved patient outcomes across the country.
