Quantifying Poverty as a Driver of Ebola Transmission

Mosoka P. Fallah*, Laura A. Skrip, Shai Gertler, Dan Yamin, Alison P. Galvani

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

54 Scopus citations


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.

Original languageEnglish
Article numbere0004260
JournalPLoS Neglected Tropical Diseases
Issue number12
StatePublished - 31 Dec 2015


FundersFunder number
National Science Foundation1514673
National Institutes of Health
National Institute of General Medical SciencesU01GM087719


    Dive into the research topics of 'Quantifying Poverty as a Driver of Ebola Transmission'. Together they form a unique fingerprint.

    Cite this