Public Health Action最新文献

{"title":"Contribution des diagnostics au points de service dans l’identification de la maladie à VIH avancée.","authors":"P Ditondo,&nbsp;A Luemba,&nbsp;R Ingwe Chuy,&nbsp;G Mucinya,&nbsp;S Ade","doi":"10.5588/pha.23.0005","DOIUrl":"https://doi.org/10.5588/pha.23.0005","url":null,"abstract":"<p><strong>Background: </strong>Médecins Sans Frontières Belgium installed point-of-care (POC) diagnostics for the early detection of advanced HIV disease (AHD), and in its presence, TB and cryptococcosis, in six health centres (Kasai, St Ambroise, St Joseph, Libondi, Lisanga and Kimia) in Kinshasa, Democratic Republic of the Congo (DRC).</p><p><strong>Objective: </strong>To document their contribution to the diagnosis of these conditions.</p><p><strong>Method: </strong>This is a retrospective cross-sectional study of HIV-positive adolescents and adults admitted with suspected AHD. A comparison 2 years before and 2 years after installation of POC was performed.</p><p><strong>Results: </strong>A total of 745 and 887 patients were included before and after POC, respectively. The mean age was 39.7 years (standard deviation [SD] 12.04); 66% (<i>n</i> = 1,077) were women. Patients with CD4 counts increased from 40.3% (<i>n</i> = 300) to 64.4% (<i>n</i> = 573) (<i>P</i> < 0.001). After the installation of POC, they ranged from 47.8% (Lisanga) to 97.1% (Kasai). The proportion of AHD was comparable (<i>n</i> = 158, 52.7% vs. <i>n</i> = 288, 50.3%; <i>P</i> = 0.779). Among patients with AHD, TB was detected in 28.5% (<i>n</i> = 82), of which 41.5% (<i>n</i> = 34) were confirmed; cryptococcosis was detected in 24.7% (<i>n</i> = 71), of which 9.9% (<i>n</i> = 7) were confirmed. Disparities between centres were observed.</p><p><strong>Conclusion: </strong>The POCs have increased patient access to CD4 testing and diagnosis of AHD in the six centres in DRC. However, actions are required to improve this performance, including screening for TB and cryptococcosis.</p>","PeriodicalId":46239,"journal":{"name":"Public Health Action","volume":"13 2 Suppl 1","pages":"7-12"},"PeriodicalIF":1.4,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10380412/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9928778","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Facteurs associés à une issue défavorable chez les brûlés hospitalisés.","authors":"F Niyonzima, H Mboma Kamosi, J Soro, O Ntihabose, D Hehadji, E Briskin","doi":"10.5588/pha.23.0007","DOIUrl":"10.5588/pha.23.0007","url":null,"abstract":"<p><strong>Background: </strong>In 2015, Médecins Sans Frontières opened the Arche Kigobe Trauma Centre in Bujumbura, Burundi, to treat victims of violence, and in 2016 extended the admission criteria to burns, without a specialised unit to treat these.</p><p><strong>Objective: </strong>To study the factors associated with an unfavourable outcome (death, referrals and discharges against medical advice) in burn patients hospitalised at this centre.</p><p><strong>Method: </strong>This is a retrospective descriptive and analytical study of hospitalised burn patients.</p><p><strong>Results: </strong>From 2016 to 2020, 477 patients were hospitalised at the Centre for burns, of whom 301 (63%) were less than 5 years old, 169 (35%) were female, and 48 (10%) had an unfavourable outcome. Anaemia (OR 11, 95% CI 2.7-48), infection (OR 11, 95% CI 5.7-22), and smoke inhalation (OR 28, 95% CI 7-111) were among the main factors associated with an unfavourable outcome.</p><p><strong>Conclusion: </strong>To minimise adverse outcomes related to inhalation and infection in burn patients, a septic isolation circuit, training, a bacteriology service and continuous positive airway pressure could be implemented even in resource-limited settings.</p>","PeriodicalId":46239,"journal":{"name":"Public Health Action","volume":"13 2 Suppl 1","pages":"25-29"},"PeriodicalIF":1.3,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10380414/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9922921","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mise à jour thérapeutique et pronostique de la rupture utérine dans une maternité à Bangui, CAR.","authors":"S Huyghe,&nbsp;S Telo,&nbsp;E Danwesse,&nbsp;E Ali,&nbsp;W van den Boogaard,&nbsp;D Lagrou,&nbsp;S Caluwaerts,&nbsp;R N Ngbalé","doi":"10.5588/pha.23.0004","DOIUrl":"https://doi.org/10.5588/pha.23.0004","url":null,"abstract":"<p><strong>Background: </strong>Maternal mortality rates remain high (882/100,000 births) in the Central African Republic (CAR), primarily due to frequent obstetric complications. Médecins Sans Frontières supports a referral maternity ward in the capital, Bangui.</p><p><strong>Objectives: </strong>To describe the prevalence, associated factors and fatality of one of the most severe complications, uterine rupture, as well as the effect of a history of uterine surgery.</p><p><strong>Methods: </strong>This is a cross-sectional study based on retrospectively collected data between January 2018 and December 2021 for women who delivered new-borns weighing over 1,000 g.</p><p><strong>Results: </strong>Of 38,782 deliveries, 229 (0.6%) cases of uterine rupture were recorded. Factors associated with uterine rupture were parity ⩾5 (adjusted odds ratio [aOR] 7.5, 95% confidence interval [CI] 4.6-12.2), non-occipital foetal presentation (aOR 2.8, 95% CI 2.1-3.7) and macrosomia (OR 4, 95% CI 2.6-6.4). The fatality rate was 4.4%, and the stillbirth rate was 64%. Uterine rupture occurred in non-scarred uterus in 150 (66.1%) women. Adverse outcomes were more common in cases of uterine rupture on non-scarred uterus compared to scarred uterus, with higher maternal mortality (6% vs. 0%, <i>P</i> = 0.023) and lower Apgar scores (<2) for new-borns (69.1% vs. 45.8%, <i>P</i> < 0.001).</p><p><strong>Conclusion: </strong>Uterine rupture remains a major issue for maternal and perinatal health in the CAR, and efforts are needed to early detect risk factors and increase coverage of the comprehensive emergency obstetric and neonatal care.</p>","PeriodicalId":46239,"journal":{"name":"Public Health Action","volume":"13 2 Suppl 1","pages":"13-18"},"PeriodicalIF":1.4,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10380413/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9928777","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reference des cas de traumatisme par arme à feu en Afrique.","authors":"M G Tito,&nbsp;J P K Makelele,&nbsp;W van den Boogaard,&nbsp;S Ade,&nbsp;A Deselets,&nbsp;E Briskin,&nbsp;C Badjo,&nbsp;D Salviati,&nbsp;E T Akem,&nbsp;M Hejdenberg","doi":"10.5588/pha.23.0006","DOIUrl":"https://doi.org/10.5588/pha.23.0006","url":null,"abstract":"<p><strong>Background: </strong>In a war-torn African country, Médecins Sans Frontières supports two regional referral hospitals to address emergencies, including the treatment of firearm-related traumas. It facilitates access to healthcare and referrals, which are often hindered due to non-medical reasons.</p><p><strong>Objective: </strong>To determine the factors influencing the unfavourable outcome of cases referred for firearm trauma (December 2020-November 2021).</p><p><strong>Method: </strong>This was a cross-sectional study using routinely collected data.</p><p><strong>Results: </strong>A total of 381 patients who were victims of firearm-related trauma were admitted, with an average age of 29 years; 28.3% had severe injuries, including thoraco-abdominal injuries and fractures. The mortality rate was 4.9%, and 7.9% left against medical advice. Patients affiliated with the irregular armed forces accounted for 45.4%, and had a two-thirds higher rate of unsuccessful referral for non-medical reasons. Patients with severe injuries at triage, affiliation with the irregular forces and being in the regular army had 2 times (<i>P</i> < 0.01), 5.9 times (<i>P</i> < 0.01) and 8.1 times (<i>P</i> < 0.01), respectively, a higher risk of an unfavourable outcome.</p><p><strong>Conclusion: </strong>Serious cases caused by firearm injuries were more likely to have an adverse outcome. The risk was higher in those with a specific affiliation, who were more often denied access to higher referral care based on socio-political rather than medical reasons.</p>","PeriodicalId":46239,"journal":{"name":"Public Health Action","volume":"13 2 Suppl 1","pages":"30-35"},"PeriodicalIF":1.4,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10380415/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9926754","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Facteurs associés à la létalité chez les patients hospitalisés pour le VIH avancé.","authors":"D Abdourahimi,&nbsp;D Yehadji,&nbsp;E Briskin,&nbsp;E M Khine,&nbsp;C Arias,&nbsp;K S André,&nbsp;F K Mukebela,&nbsp;L Ndayisenga,&nbsp;P Isaakidis,&nbsp;E C Casas,&nbsp;S J Steele,&nbsp;F B Sacko,&nbsp;G Foromo","doi":"10.5588/pha.23.0009","DOIUrl":"https://doi.org/10.5588/pha.23.0009","url":null,"abstract":"<p><strong>Context: </strong>A unit supported by Médecins Sans Frontières (MSF) cares for patients with advanced HIV at Donka National Hospital, Conakry, Guinea.</p><p><strong>Objective: </strong>To determine the factors associated with the occurrence of death in patients hospitalised in the unit between 2017 and 2021.</p><p><strong>Design: </strong>This was a retrospective analysis of routine data from patients hospitalised with advanced HIV.</p><p><strong>Results: </strong>A total of 3,718 patients were included, with a median age of 40 years (IQR 33-51), of whom 2,241 (60.3%) were women. The mean mortality rate was 33.6% (<i>n</i> = 1,240), down from 40% in 2017 to 29% in 2021, but this was not statistically significant. The period most at risk of death was the first 25 days of hospitalisation. Among these patients, TB (43.8%) and toxoplasmosis (11.4%) were the most frequent diagnoses. After multivariate analysis using Cox regression, the factors associated with death were age 25-49 years (adjusted hazard ratio [aHR] 1.60; <i>P</i> = 0.002) or ≥50 years (aHR 1.80; <i>P</i> < 0.001), the presence of respiratory (aHR 1.23; <i>P</i> = 0.001) or abdominal symptoms (aHR 1.26; <i>P</i> < 0.001) and readmission (aHR 0.54; <i>P</i> < 0.001).</p><p><strong>Conclusion: </strong>Patients aged 25-49 years or older, or those presenting with respiratory or abdominal signs require increased surveillance, as they are at the greatest risk of dying from the disease, especially during the first 25 days of hospitalisation.</p>","PeriodicalId":46239,"journal":{"name":"Public Health Action","volume":"13 2 Suppl 1","pages":"19-24"},"PeriodicalIF":1.4,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10380417/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9926755","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Les traumatismes abdominaux en Haïti.","authors":"S J Baptiste,&nbsp;W van den Boogaard,&nbsp;J-P Letoquart,&nbsp;J-G NDong,&nbsp;G Jonacé,&nbsp;L-F Télémaque","doi":"10.5588/pha.23.0008","DOIUrl":"https://doi.org/10.5588/pha.23.0008","url":null,"abstract":"<p><strong>Context: </strong>Abdominal trauma (AT) appears to be frequent in Haiti, which is confronted with recurrent socio-political violence.</p><p><strong>Objective: </strong>To study patients admitted for AT to the Médecins Sans Frontières (MSF) Tabarre trauma centre (Port-au-Prince), and the circumstances of occurrence.</p><p><strong>Design: </strong>This was a cross-sectional study with retrospective data from January 2020 to December 2021.</p><p><strong>Results: </strong>Of 3,211 patients admitted for trauma, 541 (17.3%) had an AT, of which 500 (91.4%) were related to sociopolitical events. Their median age was 30 years (interquartile range [IQR] 23-38); 429 (85.8%) were male. A gunshot wound was noted in 371 (74.2%). The median distance from the scene of violence to the hospital was 11 km (IQR 7-15); however, 9 (1.8%) came within 1 hour of the trauma; transfusion was not done or insufficient in 169 (33.8%). An adverse outcome (death, referral, discharge against medical advice) was noted in 57 (11.4%), with 8.0% of deaths. Political instability was the main cause of violence. An adverse outcome was associated with inadequate transfusion (hazard ratio [HR] 2.4, 95% CI 1.4-4.3; <i>P</i> = 0.006) or gunshot wound (HR 2.4, 95% CI 1.1-5.2; <i>P</i> = 0.002).</p><p><strong>Conclusion: </strong>Firearm injuries were common during the period of sociopolitical events 2020-2021. The lack of blood products had a negative impact on patient outcomes. Safety measures and blood collection still need to be maintained and strengthened.</p>","PeriodicalId":46239,"journal":{"name":"Public Health Action","volume":"13 2 Suppl 1","pages":"1-6"},"PeriodicalIF":1.4,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10380416/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9922919","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Scoring tools to identify TB patients facing catastrophic costs in the Philippines.","authors":"T Yamanaka, A M C Garfin, D M G Gaviola, R M Arao, F Morishita, T Hiatt, N Nishikiori, R P Yadav","doi":"10.5588/pha.23.0014","DOIUrl":"10.5588/pha.23.0014","url":null,"abstract":"<p><strong>Background: </strong>This study was to meet a practical need to design a simple tool to identify TB patients who may potentially be facing catastrophic costs while seeking TB care in the public sector. Such a tool may help prevent and address catastrophic costs among individual patients.</p><p><strong>Methods: </strong>We used data from the national TB patient cost survey in the Philippines. We randomly allocated TB patients to either the derivation or validation sample. Using adjusted odds ratios (ORs) and β coefficients of logistic regression, we developed four scoring systems to identify TB patients who may be facing catastrophic costs from the derivation sample. We validated each scoring system in the validation sample.</p><p><strong>Results: </strong>We identified a total of 12 factors as predictive indicators associated with catastrophic costs. Using all 12 factors, the β coefficients-based scoring system (area under the curve [AUC] 0.783, 95% CI 0.754-0.812) had a high validity. Even with seven selected factors with OR > 2.0, the validity remained in the acceptable range (β coefficients-based: AUC 0.767, 95% CI 0.737-0.798).</p><p><strong>Conclusion: </strong>The β coefficients-based scoring systems in this analysis can be used to identify those at high risk of facing catastrophic costs due to TB in the Philippines. Operational feasibility needs to be investigated further to implement this in routine TB surveillance.</p>","PeriodicalId":46239,"journal":{"name":"Public Health Action","volume":"13 2","pages":"53-59"},"PeriodicalIF":1.3,"publicationDate":"2023-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10290262/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10195252","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diphtheria in Europe.","authors":"J P Mangion,&nbsp;S Mancini,&nbsp;C Bachy,&nbsp;A de Weggheleire,&nbsp;F Zamatto","doi":"10.5588/pha.23.0011","DOIUrl":"https://doi.org/10.5588/pha.23.0011","url":null,"abstract":"<p><p>A rising number of diphtheria cases were recorded in Europe in 2022, including in Belgium, within the newly arriving young migrant population. In October 2022, Médecins Sans Frontières (MSF) opened a temporary roadside container-clinic offering free medical consultations. Over 3 months of activity, the temporary clinic detected 147 suspected cases of cutaneous diphtheria with 8 laboratory-confirmed cases growing toxigenic <i>Corynebacterium diphtheriae</i>. This was followed by a mobile vaccination campaign, during which 433 individuals living rough in squats and informal shelters were vaccinated. This intervention has shown how even in Europe's capital, access to preventive and curative medical services remains difficult for those who need it the most. Appropriate access to health services, including routine vaccination, are crucial to improve the health status among migrants.</p>","PeriodicalId":46239,"journal":{"name":"Public Health Action","volume":"13 2","pages":"31-33"},"PeriodicalIF":1.4,"publicationDate":"2023-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10290257/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9717166","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"COVID-19 impact on health service- and TB-related practices among private providers in Indonesia.","authors":"B W Lestari,&nbsp;A Alifia,&nbsp;F N Soekotjo,&nbsp;Hariyah,&nbsp;A F Sumantri,&nbsp;I D Kulsum,&nbsp;B Alisjahbana","doi":"10.5588/pha.23.0056","DOIUrl":"https://doi.org/10.5588/pha.23.0056","url":null,"abstract":"<p><strong>Setting: </strong>The COVID-19 pandemic has caused disruptions to healthcare services worldwide, including in private healthcare facilities (HCFs), where TB patients mostly initiate their care-seeking journey.</p><p><strong>Objective: </strong>To identify adjustments to TB-related practices made by HCFs during the pandemic.</p><p><strong>Design: </strong>We identified, contacted and invited private HCFs across West Java, Indonesia, to fill an online questionnaire. The questionnaire explored participants' sociodemographic characteristics, adaptations and TB management practices implemented in their facilities during the pandemic. Data were analysed using descriptive statistics.</p><p><strong>Results: </strong>Of the 240 HCFs surveyed, 40.0% shortened their operational hours and 21.3% have ever closed their practices during the pandemic; 217 (90.4%) made adjustments to keep delivering services, 77.9% by requiring the use of personal protective equipment (PPE); 137 (57.1%) observed fewer patient visits; 140 (58.3%) used telemedicine, a few of which (7.9%) ever handled TB patients on that platform. Respectively 89.5%, 87.5% and 73.3% of HCFs referred patients for chest radiography, smear microscopy and Xpert testing. Only a median of 1 (IQR 1-3) TB patient per month was diagnosed by the HCFs.</p><p><strong>Conclusion: </strong>Two major adaptations rolled out during COVID-19 were the use of telemedicine and PPE. Optimisation of the diagnostic referral system to increase TB case detection in private HCFs is warranted.</p>","PeriodicalId":46239,"journal":{"name":"Public Health Action","volume":"13 2","pages":"37-42"},"PeriodicalIF":1.4,"publicationDate":"2023-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10290258/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9717159","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reviewing 75 years of the WHO: successes, challenges and opportunities.","authors":"G N Kazi","doi":"10.5588/pha.23.0029","DOIUrl":"https://doi.org/10.5588/pha.23.0029","url":null,"abstract":"B congratulations to the WHO, which was created on 7 April 1948 and has now reached its Diamond Jubilee. The anniversary fell on World Health Day, with the theme of ‘Health For All’, which has been the WHO’s focus since ‘the attainment by all people of the highest possible standards of health’ was written into its constitution. The WHO has been the United Nations leading agency for global health and currently has over 7,000 staff members at its headquarters in Geneva, Switzerland, six regional offices (catering to the differing health needs of each region) and 150 country offices providing technical support to its 194 Member States. During its 75-year history, it has achieved singular successes, such as launching the primary healthcare (PHC) approach in 1978, the eradication of small pox in 1979, creation of the Stop TB Partnership and responding to disease outbreaks, most notably, the COVID-19 pandemic. The theme of ‘Health For All’ is particularly relevant at this crucial time – there are less than 7 years left to attain Universal Health Coverage and other targets encompassed in Sustainable Development Goal (SDG) 3 (including the elimination of TB, AIDS, malaria and diabetes). The WHO coordinates international health issues, advises governments on developing public health and social services, supports governments in eradicating disease, formulates standards for medical education and scientific research, and is mandated as the directing and co-ordinating authority on international health. The world has dramatically changed since the First World Health Assembly met in Geneva in 1948 and established malaria, TB, venereal diseases, maternal and child health, sanitary engineering, and nutrition as its priorities.1 The WHO has a strong normative role to play, and many lowto middle-income countries are heavily dependent on its technical and scientific support to fulfill their obligations on the right to health. Many years after the Alma Ata Declaration in 2005, the World Health Assembly ratified a resolution demanding that every person should be able to access health services and not be subjected to financial hardship. The Union has the role of a non-State actor in official relations with the WHO: ‘official relations’ is granted to non-governmental organisations that contribute significantly to the advancement of public health, and have a sustained and systematic engagement in the interest of the WHO. The Union has collaborated with the WHO on several issues, such as prioritising TB care during COVID-19, following up on fulfilling pledges made at the 2018 United Nations High-Level Meeting on TB, air pollution, access to medicines and vaccines, antimicrobial resistance, health of refugees and migrants, new diagnostic tools and investing in research and development.2 Dr Halfdan Mahler was a highly effective Director General of WHO for three terms (1973–1988); during which time the PHC approach gained international recognition. Thirty years later in 2008","PeriodicalId":46239,"journal":{"name":"Public Health Action","volume":"13 2","pages":"29-30"},"PeriodicalIF":1.4,"publicationDate":"2023-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10290256/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9717162","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}