James Tumwine, professor of paediatrics in Kampala, reckons most people would agree on the need for urgent action to reduce mortality in children in resource constrained countries. We have good evidence to underpin that action, he urges, and yet “expenditure on health has not improved substantially, and the hospital wards in many of these countries are best described as pathetic” (doi: 10.1136/bmj.39371.586076.80).

Three years ago 1 in 8 children with malaria in the national hospital in Guinea-Bissau were dying as inpatients. The introduction of special drug kits for children with severe and complicated malaria had not cut mortality, and it became …