A Systems Approach to Improving Rural Care in Ethiopia

Background: Multiple interventions have been launched to improve the quality, access, and utilization of primary health care in rural, low-income settings; however, the success of these interventions varies substantially, even within single studies where the measured impact of interventions differs across sites, centers, and regions. Accordingly, we sought to examine the variation in impact of a health systems strengthening intervention and understand factors that might explain the variation in impact across primary health care units. Methodology/Principal Findings: We conducted a mixed methods positive deviance study of 20 Primary Health Care Units (PHCUs) in rural Ethiopia. Using longitudinal data from the Ethiopia Millennium Rural Initiative (EMRI), we identified PHCUs with consistently higher performance (n = 2), most improved performance (n = 3), or consistently lower performance (n = 2) in the provision of antenatal care, HIV testing in antenatal care, and skilled birth attendance rates. Using data from site visits and in-depth interviews (n = 51), we applied the constant comparative method of qualitative data analysis to identify key themes that distinguished PHCUs with different performance trajectories. Key themes that distinguished PHCUs were 1) managerial problem solving capacity, 2) relationship with the woreda (district) health office, and 3) community engagement. In higher performing PHCUs and those with the greatest improvement after the EMRI intervention, health center and health post staff were more able to solve day-to-day problems, staff had better relationships with the woreda health official, an

The Influence of Socioeconomic Disparities on Breast Cancer Tumor Biology and Prognosis: A Review

OBJECTIVE: Socioeconomic deprivation is associated with an increased risk of breast cancer mortality. This article summarizes the relationships between socioeconomic status (SES) and breast cancer in white European women compared with racial and ethnic groups in the United States. Furthermore, we examine the association between obesity and breast cancer within socioeconomic disparities. METHODS: Mortality rates were published by the American Cancer Society and the National Cancer Institute Surveillance, Epidemiology, and End Results Program. Obesity data were derived from the National Center for Health Statistics Behavioral Risk Factor Surveillance System. MEDLINE searches were performed using keywords, such as socioeconomic status, poverty, African American, Hispanic, race, and combined with related articles. RESULTS: Socioeconomic deprivation may be responsible for the increased risk of breast cancer mortality in African American and Hispanic patients, as they are more likely than white American patients to be diagnosed with advanced disease. Among white women, social deprivation is related to poor breast cancer prognosis, with increased prevalence rates of high-grade, estrogen receptor (ER)-negative tumors, similar to that of triple-negative breast cancers observed in African American and Hispanic women. Obesity is associated with advanced breast cancer at diagnosis, high tumor proliferation rates, and more triple-negative phenotypes, indicating that it may adversely contribute to prognosis. Conclusions: Most studies show an effect of SES on breast cancer incidence and prognosis. Research should focus on the influence of social deprivation on breast cancer characteristics, such as absence of ER expression, that occurs in African Americans and Hispanics and in white European women with a different genetic background

Visceral leishmaniasis: what are the needs for diagnosis, treatment and control?

Visceral leishmaniasis (VL) is a systemic protozoan disease that is transmitted by phlebotomine sandflies. Poor and neglected populations in East Africa and the Indian sub-continent are particularly affected. Early and accurate diagnosis and treatment remain key components of VL control. In addition to improved diagnostic tests, accurate and simple tests are needed to identify treatment failures. Miltefosine, paromomycin and liposomal amphotericin B are gradually replacing pentavalent antimonials and conventional amphotericin B as the preferred treatments in some regions, but in other areas these drugs are still being evaluated in both mono- and combination therapies. New diagnostic tools and new treatment strategies will only have an impact if they are made widely available to patients