A simple, inexpensive screen for vaginal infections cut nearly in half the number of premature births in a new study. Babies born early are more likely to become sick and die than those who spend a full nine months in the womb. The British Medical Journal study says the screening procedure could dramatically reduce the impact premature babies have on health care systems. The University of Vienna researchers looked under a microscope for potentially harmful vaginal germs and treated them when they found them. Regardless of whether they were treated, only three percent of the women who were screened gave birth early. That's compared to 5.3 percent of the women who were not screened.

Lead author Herbert Kiss says the additional care may be partly responsible for the nearly 50 percent reduction. "This is not scientific, but it's my interpretation. They have the feeling that there is something done, and they feel safe, and the doctors feel safe if they did the screening program. And this also resulted in a reduction in preterm delivery," he says.

Doctor Kiss points out that treating women with vaginal infections did not reduce preterm births in other studies. But increasing health care for pregnant women by encouraging regular checkups did. More care may make the difference, he says, not necessarily more treatment. But he cautions that the study was done in Europe, where care for pregnant women is already good. The results might not apply in much of the developing world, where many pregnant women get little or no health care.

Refugees may be getting better health care in their camps than the communities hosting them. That's according to a new study in The Lancet, a major British journal. The study recommends integrating health services for refugees into the host community's health care system so both can benefit. Researchers in Uganda compared rates of caesarian section, hysterectomy, and other major treatments among pregnant women in refugee camps and in the surrounding areas.

They found that in remote areas, treatment rates were twice as high for refugees as for local residents. But in urban areas, close to hospitals, there was no significant difference. Lead author Christopher Garimoi Orach at Uganda's Makerere University says one important factor is that refugees in remote camps are more likely to have ambulance service to hospitals than their hosts do. "It shows, really, that the important thing is to improve access for these interventions, and then there is no difference," he says.

The study says refugee health services are also often better-funded, have more facilities per person, and have better-trained staff than the host communities. The authors give credit to the United Nations agencies and humanitarian groups that care for refugees. But Professor Garimoi Orach says they should work with governments to help build up the local health care system to improve access for everyone.

And finally today, twenty years after they graduated from a major Ugandan medical school, a new study finds nearly one third of the doctors have died, mostly from AIDS. And the British Medical Journal study shows 30 percent of Makerere University's surviving 1984 graduates have left the country. That figure is substantial, but it's lower than in some other African countries, where research shows 60 percent or more leave for more lucrative jobs in industrialized countries.

Experts say this "brain drain" is weakening Africa's already fragile health care systems at a time when disease burdens are increasing. 1984 Makerere graduate Yoswa Dambisya at South Africa's University of the North wrote the study. He says the high death toll is the worst form of brain drain. "When someone leaves one's country and goes to work somewhere else, the possibility exists that they can go back at some point. But once they die, that is it," he says.

Doctor Dambisya says the good news about the Makerere University graduates is that most of the remaining 55 doctors are practicing in the public sector, at ministries of health or at universities. He says many supplement their income with a private practice. But he credits his alma mater for inspiring so many of his classmates to go into public service.