Table 1 A comparison of the features of the two case studies

Cases

425

13059

Case fatality rate

53 %

30 %

Response features

National Task Force established within 4 days of MoH notification

Delay in notification of MoH

CDC establishes local field laboratory

Slow implementation of control measures

Effective co-ordination of international support

Sharp rise in cases 2 months after notification of MoH

Basic control measures still absent 7 months into outbreak

Human resource factors

Significant difficulties but evidence of intrinsic motivation; supportive environment and positive role of international NGOs and experts.

Insufficient numbers, inadequate and inappropriate training and poor motivation all documented

Media

Effective use for public communication

Antagonistic relationship between government and press; accusations of government incompetence and attempts at censorship

Limited scare mongering

Community level

Some problems of stigma and distrust between community and health authorities but some community responses highly consistent with public health recommendations

Significant problems of lack of co-operation and trust, and conflict between public health measures and traditional practices

Institutional development

Rapid development in South of country in preceding 15 years provided basis for national institutional response

Limited economic and political recovery post conflict probably contributed to failures

Importance of established faith based hospital

International response

Fast, effective emergency response of agencies such as WHO and CDC

Delayed response may have been premised on complacency and political concerns.