BACKGROUND:
Poverty
has been implicated as a challenge in the control of the current Ebola outbreak
in West Africa. Although disparities between affected countries have been
appreciated, disparities within West African countries have not been
investigated as drivers of Ebola transmission. To quantify the role that
poverty plays in the transmission of Ebola, we analyzed heterogeneity of Ebola
incidence and transmission factors among over 300 communities, categorized by
socioeconomic status (SES), within Montserrado County, Liberia.
METHODOLOGY/PRINCIPAL FINDINGS:
We
evaluated 4,437 Ebola cases reported between February 28, 2014 and December 1,
2014 for Montserrado County to determine SES-stratified temporal trends and
drivers of Ebola transmission. A dataset including dates of symptom onset,
hospitalization, and death, and specified community of residence was used to
stratify cases into high, middle and low SES. Additionally, information about
9,129 contacts was provided for a subset of 1,585 traced individuals. To evaluate
transmission within and across socioeconomic subpopulations, as well as over
the trajectory of the outbreak, we analyzed these data with a time-dependent
stochastic model. Cases in the most impoverished communities reported three
more contacts on average than cases in high SES communities (p<0.001). Our
transmission model shows that infected individuals from middle and low SES
communities were associated with 1.5 (95% CI: 1.4-1.6) and 3.5 (95% CI:
3.1-3.9) times as many secondary cases as those from high SES communities,
respectively. Furthermore, most of the spread of Ebola across Montserrado
County originated from areas of lower SES.
CONCLUSIONS/SIGNIFICANCE:
Individuals
from areas of poverty were associated with high rates of transmission and
spread of Ebola to other regions. Thus, Ebola could most effectively be
prevented or contained if disease interventions were targeted to areas of
extreme poverty and funding was dedicated to development projects that meet
basic needs.
Below: Key factors of Ebola transmission based on socioeconomic status (SES) of probable and confirmed cases
- 1Community-Based Initiative, Ministry of Health, Monrovia, Liberia.
- 2National Institute of Allergy and Infectious Diseases, PREVAIL-III Study, Monrovia, Liberia.
- 3A.M. Dogliotti College of Medicine, University of Liberia, Monrovia, Liberia.
- 4Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, Connecticut, United States of America.
- 5Department of Industrial Engineering, Tel Aviv University, Tel Aviv, Israel.
- PLoS Negl Trop Dis. 2015 Dec 31;9(12):e0004260. doi: 10.1371/journal.pntd.0004260. eCollection 2015.
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