Geospatial Analysis of Care and Mortality in the 2014 Liberia Ebola Outbreak

The Ebola outbreak in West Africa in 2014 to 2016 had more than 28,000 suspected, probable, and confirmed cases. It was the largest Ebola outbreak in history. Of the 28,000 cases in the three Ebola-affected countries, Liberia had 10,000 cases with almost 5,000 deaths. The Ebola Virus Disease (EVD) entered Liberia along the border of Guinea and moved to the capital city of Monrovia where the virus spread. Ebola Treatment Units (ETUs) were constructed throughout the response in locations where there were available facilities versus distance to care challenges. This study examined the association of distance from villages to ETUs and mortality. Using Geographic Information System (GIS) and statistics framed within the Social Ecological Model and the GIS Framework, this study geolocated the Ebola cases by village, mapped the travel routes and calculated the distance to the ETU. A logistic regression was then used to determine if there was an association between distance and mortality, with and without controlling for age and gender, and, to calculate the odds ratio. A logistic regression model showed there is an association between distance and mortality and that Ebola patients living within 12 kilometers of the ETU were 1.8 times less at risk of mortality (OR = 1.778, 95% CI [1.171 - 2.7]) than those living more than 12 kilometers. In addition, males had a 1.4 times lower risk of death due to EVD. This understanding can inform future outbreak responses and placement of treatment units. In addition, this information can lead to social change with respect to individual understanding of access to care, community expectations, and national health care planning