Demystifying Snakebite Envenoming in Uganda: A Cost-Effectiveness Analysis of Life-Saving Prevention Strategies
1
Uganda Public Health Fellowship Program, Uganda National Institute of Public Health, Kampala, Uganda
2
CDC Foundation, Atlanta, United States
Popul. Med. 2026;8(Supplement Supplement 1):A1332
ABSTRACT
BACKGROUND:
Snakebite envenoming (SBE) is a neglected public health crisis in Uganda, with an annual incidence of 101 bites per 100,000.¹ Between 2020 and 2023, the country recorded 1,923 envenoming cases and 516 deaths, resulting in a staggering case-fatality rate (CFR) of 27%—six times the global average.² High mortality is driven by delayed treatment-seeking and knowledge gaps among the community and community health workers (CHWs).¹,³,⁴
OBJECTIVES:
This study aimed to identify the most cost-effective policy interventions to reduce SBE-related mortality, providing an evidence-based roadmap for national injury prevention and safety policy.
METHODS:
The team developed a decision-analytic model using a national population cohort of 46,246,800 from the Uganda Bureau of Statistics.⁵ Using a Ministry of Health perspective over a two-year horizon, three strategic options were micro-costed: (1) Status quo (antivenom restricted to general hospitals); (2) Expansion of antivenom stocking to Health Center IVs combined with CHWs training; and (3) Status quo combined with SBE community awareness campaigns. Outcomes were measured by snake bite-related deaths averted and Incremental Cost-Effectiveness Ratios (ICER). Sensitivity analyses were conducted by varying input parameters.
RESULTS:
Community awareness emerged as the most impactful strategy, averting 835 deaths over two years—a significant public health gain compared to other options. With an ICER of $3,003 USD per death averted, this strategy is highly cost-effective, falling well below Uganda's willingness-to-pay threshold (three times Uganda's per-capita GDP [$1,142 USD in 2024]). Conversely, expanding stock to lower-level facilities was the most expensive and least effective, averting 76 deaths.
CONCLUSIONS:
Availability of antivenom does not guarantee survival if community-level barriers to care persist. Integrating community-led awareness with existing stocking policies is the most feasible and cost-effective strategy to save lives. These findings provide a scalable model for other sub-Saharan African nations to reduce the burden of neglected injuries through targeted public safety education.
Snakebite envenoming (SBE) is a neglected public health crisis in Uganda, with an annual incidence of 101 bites per 100,000.¹ Between 2020 and 2023, the country recorded 1,923 envenoming cases and 516 deaths, resulting in a staggering case-fatality rate (CFR) of 27%—six times the global average.² High mortality is driven by delayed treatment-seeking and knowledge gaps among the community and community health workers (CHWs).¹,³,⁴
OBJECTIVES:
This study aimed to identify the most cost-effective policy interventions to reduce SBE-related mortality, providing an evidence-based roadmap for national injury prevention and safety policy.
METHODS:
The team developed a decision-analytic model using a national population cohort of 46,246,800 from the Uganda Bureau of Statistics.⁵ Using a Ministry of Health perspective over a two-year horizon, three strategic options were micro-costed: (1) Status quo (antivenom restricted to general hospitals); (2) Expansion of antivenom stocking to Health Center IVs combined with CHWs training; and (3) Status quo combined with SBE community awareness campaigns. Outcomes were measured by snake bite-related deaths averted and Incremental Cost-Effectiveness Ratios (ICER). Sensitivity analyses were conducted by varying input parameters.
RESULTS:
Community awareness emerged as the most impactful strategy, averting 835 deaths over two years—a significant public health gain compared to other options. With an ICER of $3,003 USD per death averted, this strategy is highly cost-effective, falling well below Uganda's willingness-to-pay threshold (three times Uganda's per-capita GDP [$1,142 USD in 2024]). Conversely, expanding stock to lower-level facilities was the most expensive and least effective, averting 76 deaths.
CONCLUSIONS:
Availability of antivenom does not guarantee survival if community-level barriers to care persist. Integrating community-led awareness with existing stocking policies is the most feasible and cost-effective strategy to save lives. These findings provide a scalable model for other sub-Saharan African nations to reduce the burden of neglected injuries through targeted public safety education.
| eISSN: | 2654-1459 |
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