Abstract

Typhoid fever remains a persistent public health challenge in Uganda, with both urban and rural populations 
experiencing high disease and economic burdens. While antimicrobial treatment has historically been the mainstay 
of management, rising antimicrobial resistance (AMR) has significantly increased treatment costs and reduced 
effectiveness. This review compares the cost-effectiveness of typhoid treatment and vaccination across urban and 
rural Ugandan healthcare settings, highlighting differences in epidemiology, infrastructure, and socio-economic 
conditions. Evidence indicates that in urban centers, where population density and outbreak frequency are high, 
typhoid conjugate vaccines (TCVs) rapidly reduce healthcare costs through economies of scale, decreased 
hospitalizations, and prevention of resistant infections. In rural areas, despite higher delivery and logistical costs, 
vaccination often proves even more cost-effective given the severe indirect costs of illness, such as delayed care, 
transportation expenses, lost productivity, and poorer outcomes. Key challenges include data gaps, logistical 
barriers, vaccine acceptance, and financial constraints. Policy recommendations emphasize prioritizing high-burden 
urban slums while carefully expanding rural rollout, integrating vaccination with water, sanitation, and hygiene 
(WASH) improvements, strengthening rural health infrastructure, and enhancing AMR surveillance. Overall, 
vaccination emerges as a sustainable, equitable strategy to reduce Uganda’s typhoid burden and support broader 
global health goals. 
Keywords: Typhoid fever; cost-effectiveness; Uganda; rural health; urban health; vaccination.