Bottom line: In this government hospital in Guinea-Bissau, mortality from childhood was reduced by 50% in an intervention that monitored and supervised staff supervision to guidelines, and also provided extra $$ to the staff as an incentive.
This clever study studied the effect of close adherence to guidelines using structured supervision of nurses and doctors, combined with financial incentives, on survival in childhood malaria. Children were randomized to one of two wards, control or intervention. All the staff were retrained in caring for patients with malaria, and all the children received free drugs for treatment. See "read more" for more details and discussion, or read the full article free.
"The reported incidence of indigenous cholera in sub-Saharan Africa in 2005 ... was 95 times higher than the reported incidence in Asia ... and 16,600 times higher than the reported incidence in Latin America .... In that same year, the cholera case fatality rate in sub-Saharan Africa (1.8%) was 3 times higher than that in Asia (0.6%); no cholera deaths were reported in Latin America. The persistence or control of cholera in Africa will be a key indicator of global efforts to reach the Millennium Development Goals and of recent commitments by leaders of the G-8 countries to increase development aid to the region."
RESULTS: In school-age children in Thailand, a pre-exposure immunization regimen of 3 intradermal doses of PCECV produced adequate immune responses. After primary vaccination, all subjects developed RVNA titers > or =0.5 IU/mL and demonstrated a rapid increase in RVNA titer after 2 simulated post-exposure booster immunizations 1 year after the primary vaccination series. No serious adverse drug reactions occurred. CONCLUSIONS: Rabies pre-exposure immunization with PCECV is safe and immunogenic, and its implementation could save the lives of many children in rabies-endemic areas.
Pre-exposure rabies vaccination using purified chick embryo cell rabies vaccine intradermally is immunogenic and safe. J Pediatr. 2007 Aug;151(2):173-7.
This article not only gives us some answers to the question, "can gentimicin be given once daily in children with UTI?", but it also takes us through the process of how to research and answer the question. A good example to use in teaching.
Clinical bottom line of this, quoted from the article: (OD = once daily)
Available evidence supports the efficacy of OD gentamicin in children with UTI. (Grade A)
There is limited evidence regarding the safety of OD gentamicin. (Grade B)
Issues of nephrotoxicity and ototoxicity require further clarification by well-structured RCTs with larger samples and complete follow-up of participants.
Journal Club 
