The under-five-mortality rate (U5MR), as a robust child health indicator, is 109 per 1000 live births in Africa, of which infectious diseases comprise the bulk of paediatric disease.1 The U5MR exceeds 100/1000 live births in 24 countries, of which 23 are in sub-Saharan Africa.2 The major causes of death include pneumonia (18%), malaria (17%), diarrhoea (12%) and the human immunodeficiency virus (3%).3 Fortunately there has been progress, with a reduction in the U5MR, since 1990 in six African countries, namely Ethiopia, Rwanda, Liberia, Malawi, Niger and Madagascar.2 To improve the survival of children in sub-Saharan Africa it is important to implement interventions that will reduce the U5MR. An important intervention in the management of common infections is the implementation of and strict adherence to standard treatment guidelines. This has been proven to reduce both morbidity and mortality rates for pneumonia in adults.4,5 Similar adherence has also been proven to reduce in-hospitality mortality for children suffering from malaria.6 The additional benefit of adherence to standard treatment guidelines is that it is a cost-saving tool for hospitals.7 This issue reports on the adherence to standard treatment guidelines introduced by Medecin Sans Frontieres (MSF) in two sub-Saharan African countries, with different findings. The two countries are Sierre Leone, with an U5MR of 185/1000 live births and Somalia with an U5MR of 180/1000 live births, both members of the 24 countries exceeding the U5MR of 100/1000 live births. De Bruycker et al. report on non-adherence to standard treatment guidelines for lower respiratory tract infections (LRTI) and malaria for hospitalised children in rural Sierra Leone.8 Non-adherence was more common for LRTI (cumulative 86%) than for malaria (12%). Non-adherence was, furthermore, significantly associated with unfavourable hospital outcome for both LRTI and malaria. Of note is the difference in non-adherence to guidelines for the two diseases. This is probably linked to the complexity of the guidelines for the disease, where the guidelines for malaria are standardised, with fewer drug options, than LRTI, which has more complex drug options. Ngoy et al., on the other hand, report a low adverse outcome of only 6% for their paediatric in-patient study population in Somalia, a conflict-torn country.9 The possible reasons for the low adverse outcome include adherence to guidelines standardised by MSF, as well as provision of all health services free of charge by aid organisations. Other reasons include the training of staff and the provision of a telemedicine service for continuing medical support. This achievement is of great importance in the face of very limited numbers of health care staff for the case load. Both studies add important findings to the literature on strategies to address Millennium Development Goal 4 in sub-Saharan Africa. Key findings include the improved outcome of hospitalised children if there is good adherence to guidelines and training of health care staff in the implementation of these guidelines. It is also important to regularly monitor the adherence to standard treatment guidelines in hospitals to ensure rational drug use and that adherence is maintained. It is encouraging to note this can be achieved even in conflict-stricken countries.