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BackgroundAs resource-limited health systems evolve to address complex diseases, attention must be returned to basic primary care delivery. Limited data exists detailing the quality of general adult and adolescent primary care delivered at front-line facilities in these regions. Here we describe the baseline quality of care for adults and adolescents in rural Rwanda.MethodsPatients aged 13 and older presenting to eight rural health center outpatient departments in one district in southeastern Rwanda between February and March 2011 were included. Routine nurse-delivered care was observed by clinical mentors trained in the WHO Integrated Management of Adolescent & Adult Illness (IMAI) protocol using standardized checklists, and compared to decisions made by the clinical mentor as the gold standard.ResultsFour hundred and seventy consultations were observed. Of these, only 1.5% were screened and triaged for emergency conditions. Fewer than 10% of patients were routinely screened for chronic conditions including HIV, tuberculosis, anemia or malnutrition. Nurses correctly diagnosed 50.1% of patient complaints (95% CI: 45.7%-54.5%) and determined the correct treatment 44.9% of the time (95% CI: 40.6%-49.3%). Correct diagnosis and treatment varied significantly across health centers (p = 0.03 and p = 0.04, respectively).ConclusionFundamental gaps exist in adult and adolescent primary care delivery in Rwanda, including triage, screening, diagnosis, and treatment, with significant variability across conditions and facilities. Research and innovation toward improving and standardizing primary care delivery in sub-Saharan Africa is required. IMAI, supported by routine mentorship, is one potentially important approach to establishing the standards necessary for high-quality care.

Introduction Cervical cancer is among the most common cancers and is the fourth most common cause of cancer death in women worldwide [1]. Women in low-and middle-income countries (LMICs) disproportionately bear the burden of cervical cancer; 85% of cervical cancer morbidity and 88% of cervical cancer mortality occur in this region [2-4]. In East Africa, among all types of cancers in women, cervical cancer is the leading cause of morbidity and mortality with 52,633 new cases and 37,017 deaths estimated in 2018 [5]. Without adequate investment in cervical cancer control, these rates are only expected to rise [2]. Treatment for cervical cancer is critical for control and secondary disease prevention in LMICs [2]. However, most LMICs have limited infrastructure and human resource capacity to support surgical screening and subsequent treatment with radiotherapy, evidenced by the lack of trained health personnel and inadequate availability of treatment equipment [2]. Where services are available, the cost of treatment often prohibits access [6, 7]. Further, issues such as late presentation at diagnosis, low pretreatment performance status, which indicates a patient's ability to tolerate chemotherapy, lack of adherence to treatment or post-treatment follow-up, and low quality of care worsen patient outcomes [2, 8-11]. Among important programmatic and patient-related aspects of cervical cancer treatment is post-treatment follow-up. Women receiving therapy for invasive cancer

The CanScreen5 project is a global cancer screening data repository that aims to report the status and performance of breast, cervical and colorectal cancer screening programs using a harmonized set of criteria and indicators. Data collected mainly from the Ministry of Health in each country underwent quality validation and ultimately became publicly available through a Web-based portal. Until September 2022, 84 participating countries reported data for breast (n = 57), cervical (n = 75) or colorectal (n = 51) cancer screening programs in the repository. Substantial heterogeneity was observed regarding program organization and performance. Reported screening coverage ranged from 1.7% (Bangladesh) to 85.5% (England, United Kingdom) for breast cancer, from 2.1% (Côte d’Ivoire) to 86.3% (Sweden) for cervical cancer, and from 0.6% (Hungary) to 64.5% (the Netherlands) for colorectal cancer screening programs. Large variability was observed regarding compliance to further assessment of screening programs and detection rates reported for precancers and cancers. A concern is lack of data to estimate performance indicators across the screening continuum. This underscores the need for programs to incorporate quality assurance protocols supported by robust information systems. Program organization requires improvement in resource-limited settings, where screening is likely to be resource-stratified and tailored to country-specific situations.