Path modeling of socioeconomic, behavioral, and environmental attributes of the Ebola epidemic in West Africa

The 2014 Ebola outbreak stands as one of the most severe outbreaks of the virus, resulting in approximately 15,227 confirmed cases and 11,310 deaths. Despite substantial research conducted on the biological and epidemiological features of the virus, limited attention has been given to how an individual’s health behavior contributes to its spread. This study aimed to identify socioeconomic, behavioral, and environmental factors associated with Ebola infection. Guided by the Socioecological Model of Health, a correlational analysis was conducted using data from three English-speaking West African countries with the highest Ebola caseloads and fatalities: Liberia, Nigeria, and Sierra Leone. Each country’s Ministry of Health compiled daily reports on Ebola infections, including confirmed cases and deaths within each district. Possible health behavior determinants were gathered from surveys conducted by each country with the assistance of credible international agencies. Path analysis was then conducted to identify the size and direction of direct and indirect effects associated with an Ebola infection. The results revealed that female unemployment men with some secondary education, availability of hand washing soap, female literacy, and total health expenditure significantly predict initial confirmed cases with an R2 of 0.41. Along with the predictors of initial confirmed cases, the main source of drinking water accounted for 59% (R2) of the variance in the latest confirmed deaths. Officials in high-prevalence countries are suggested to address the availability of soap for hand washing, male secondary education proportion, female literacy and unemployment, health expenditure, and main sources of drinking water to reduce the transmission of the Ebola virus.