Bulletin of the World Health Organization
Volume 94, Number 6, June 2016, 405-480
http://www.who.int/bulletin/volumes/94/6/en/

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EDITORIALS
Defining the syndrome associated with congenital Zika virus infection
Anthony Costello, Tarun Dua, Pablo Duran, Metin Gülmezoglu, Olufemi T Oladapo, William Perea, João Pires, Pilar Ramon-Pardo, Nigel Rollins & Shekhar Saxena
http://dx.doi.org/10.2471/BLT.16.176990

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Innovation for healthy ageing: a call for papers
Islene Araujo de Carvalho, Isabella Aboderin, Eri Arikawa-Hirasawa, Matteo Cesari, Yoshiaki Furukawa, Luis Miguel Gutierrez Robledo, John E Morley, Anne Margriet Pot, Jean-Yves Reginster, Greg Shaw, Naoko Tomita & John R Beard
http://dx.doi.org/10.2471/BLT.16.176743

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Charting a path to end the AIDS epidemic
Michel Sidibé
http://dx.doi.org/10.2471/BLT.16.176875

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Research
Recommendations for dealing with waste contaminated with Ebola virus: a Hazard Analysis of Critical Control Points approach
Kelly L Edmunds, Samira Abd Elrahman, Diana J Bell, Julii Brainard, Samir Dervisevic, Tsimbiri P Fedha, Roger Few, Guy Howard, Iain Lake, Peter Maes, Joseph Matofari, Harvey Minnigh, Ahmed A Mohamedani, Maggie Montgomery, Sarah Morter, Edward Muchiri, Lutendo S Mudau, Benedict M Mutua, Julius M Ndambuki, Katherine Pond, Mark D Sobsey, Mike van der Es, Mark Zeitoun & Paul R Hunter
Objective
To assess, within communities experiencing Ebola virus outbreaks, the risks associated with the disposal of human waste and to generate recommendations for mitigating such risks.
Methods
A team with expertise in the Hazard Analysis of Critical Control Points framework identified waste products from the care of individuals with Ebola virus disease and constructed, tested and confirmed flow diagrams showing the creation of such products. After listing potential hazards associated with each step in each flow diagram, the team conducted a hazard analysis, determined critical control points and made recommendations to mitigate the transmission risks at each control point.
Findings
The collection, transportation, cleaning and shared use of blood-soiled fomites and the shared use of latrines contaminated with blood or bloodied faeces appeared to be associated with particularly high levels of risk of Ebola virus transmission. More moderate levels of risk were associated with the collection and transportation of material contaminated with bodily fluids other than blood, shared use of latrines soiled with such fluids, the cleaning and shared use of fomites soiled with such fluids, and the contamination of the environment during the collection and transportation of blood-contaminated waste.
Conclusion
The risk of the waste-related transmission of Ebola virus could be reduced by the use of full personal protective equipment, appropriate hand hygiene and an appropriate disinfectant after careful cleaning. Use of the Hazard Analysis of Critical Control Points framework could facilitate rapid responses to outbreaks of emerging infectious disease.

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Research
Vaccination timing of low-birth-weight infants in rural Ghana: a population-based, prospective cohort study
Maureen O’Leary, Sara Thomas, Lisa Hurt, Sian Floyd, Caitlin Shannon, Sam Newton, Gyan Thomas, Seeba Amenga-Etego, Charlotte Tawiah-Agyemang, Lu Gram, Chris Hurt, Rajiv Bahl, Seth Owusu-Agyei, Betty Kirkwood & Karen Edmond
http://dx.doi.org/10.2471/BLT.15.159699
Objective
To investigate delays in first and third dose diphtheria–tetanus–pertussis (DTP1 and DTP3) vaccination in low-birth-weight infants in Ghana, and the associated determinants.
Methods
We used data from a large, population-based vitamin A trial in 2010–2013, with 22 955 enrolled infants. We measured vaccination rate and maternal and infant characteristics and compared three categories of low-birth-weight infants (2.0–2.4 kg; 1.5–1.9 kg; and < 1.5 kg) with infants weighing ≥ 2.5 kg. Poisson regression was used to calculate vaccination rate ratios for DTP1 at 10, 14 and 18 weeks after birth, and for DTP3 at 18, 22 and 24 weeks (equivalent to 1, 2 and 3 months after the respective vaccination due dates of 6 and 14 weeks).
Findings
Compared with non-low-birth-weight infants (n = 18 979), those with low birth weight (n = 3382) had an almost 40% lower DTP1 vaccination rate at age 10 weeks (adjusted rate ratio, aRR: 0.58; 95% confidence interval, CI: 0.43–0.77) and at age 18 weeks (aRR: 0.63; 95% CI: 0.50–0.80). Infants weighing 1.5–1.9 kg (n = 386) had vaccination rates approximately 25% lower than infants weighing ≥ 2.5 kg at these time points. Similar results were observed for DTP3. Lower maternal age, educational attainment and longer distance to the nearest health facility were associated with lower DTP1 and DTP3 vaccination rates.
Conclusion
Low-birth-weight infants are a high-risk group for delayed vaccination in Ghana. Efforts to improve the vaccination of these infants are warranted, alongside further research to understand the reasons for the delays.

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POLICY & PRACTICE
Priority-setting for achieving universal health coverage
Kalipso Chalkidou, Amanda Glassman, Robert Marten, Jeanette Vega, Yot Teerawattananon, Nattha Tritasavit, Martha Gyansa-Lutterodt, Andreas Seiter, Marie Paule Kieny, Karen Hofman & Anthony J Culyer
http://dx.doi.org/10.2471/BLT.15.155721
Abstract
Governments in low- and middle-income countries are legitimizing the implementation of universal health coverage (UHC), following a United Nation’s resolution on UHC in 2012 and its reinforcement in the sustainable development goals set in 2015. UHC will differ in each country depending on country contexts and needs, as well as demand and supply in health care. Therefore, fundamental issues such as objectives, users and cost–effectiveness of UHC have been raised by policy-makers and stakeholders. While priority-setting is done on a daily basis by health authorities – implicitly or explicitly – it has not been made clear how priority-setting for UHC should be conducted. We provide justification for explicit health priority-setting and guidance to countries on how to set priorities for UHC.