Background:Awareness towards tobacco hazards has increased with time but its role alone towards cessation is questionable. With widespread menace of tobacco in developing countries like India, not much tobacco chewing prevalence and their quitting patterns data are available in urban Saurashtra region.Objectives:1. To find out prevalence of various forms of chewing tobacco and quitting attitudes in urban Jamnagar. 2. To study quitting patterns in relation with age of habit initiation, family background and habit duration.Materials and Methods:It was a cross-sectional study involving 2513 individuals as study population by 30-cluster sampling method. The study was carried out between June 2007 and March 2008. Pre-set, pre-tested questionnaire was used for interview purpose and the statistical analysis was done on proportion basis.Results:About 37.2% of study population was ever-tobacco-chewers; 32.9% of them were current-chewers and 4.3% were quitters. Approximately 28.4% of current-consumers were willing to quit. Mawa-masala (63.7%) and Gutka (57.6%) were preferred forms of chewing tobacco and 57.5% of the current-chewers chewed tobacco six to eight times a day. Tobacco initiation age between 20 and 30 years was commoner among quitters (84.2%), while a little younger in current-consumers (76.5%). About 58.3% quitters and 74.0% chewers showing willingness to quit had not consumed tobacco for more than five years, 63.8% of current-chewers had a family member consuming tobacco. With initiation of health problems, 72.2% subjects quit and 55.5% of them already knew about health hazards.Conclusions:Every 4 out of 10 residents was found to be exposed to chewing tobacco. With Mawa-masala and Gutka being the predominant forms, habit onset in late adolescence, years of consumption and family exposure seem to be hampering quitting. Awareness about tobacco hazards alone does not appear to be resulting in successful quitting.

Background and Objectives:Risk of vertical transmission (largest source of HIV in children) reduces from 33% to 3% with effective prevention of mother to child transmission (PMTCT) interventions. NACP-III has got an objective of testing all pregnant women for earliest linkage with PMTCT. Study was carried out to find out PPTCT service coverage, dropouts, intervention efficacy with other determinants.Materials and Methods:At ICTCs, registered ANCs are counseled and tested for HIV. HIV +ve ANCs are additionally linked to services and followed-up for institutional delivery, sdNVP, nutrition and children testing. HIV +ve ANCs since 2005 subsequently delivered till June 2008 and their exposed children in Gujarat’s category A, B districts constituted study cohort.Results:259622 pregnant women registered, 72.1% were counseled pre-test, 83.4% of them tested, 74.4% received post-test counseling. 541 ANCs were detected HIV+ve. 45.5% delivered institutionally, 12.8% were unregistered. 12.1% were cesarian section and 66% delivered vaginally. 96.8% were live births, 92.13% mother-baby pair received sdNVP. 35% children could be traced till 18 months, 89% were alive. 90% were tested, 3 were found HIV +ve. Of them, none received MB Pair. Two were delivered vaginally, two received mixed feeding, two children’s mothers were not linked with ART.Conclusions:PMTCT services – counseling and testing should be provided to all ANCs. EDD-based tracking, institutional deliveries, postnatal counseling to be encouraged along with complete MB pair coverage, capacity building of concerned staff regarding delivery of HIV+ve ANCs and exposed children tracking.

Background and Objectives:Current programs in medical education technology concentrate mainly upon “how-to-teach.” The focus is needed on learner's memory retention too. An innovative strategy like concept mapping might be a way forward. The study was carried out to assess its effectiveness and to know students' perceptions.Materials and Methods:During community medicine classes, a student-group was sensitized on how to make and use concept maps out of taught contents. At the end of epidemiology exercises sessions, this group was given additional minutes to prepare concept maps, interact, and brainstorm followed by quick QA session. Others were taught same contents in conventional way. Performances of both groups were assessed in one immediate (term-ending) and one distant (preliminary) exam. Feedback was also taken from study group.Results:Study group consistently scored higher in both exams. Difference in scored mean marks was highly significant in term-ending-examination (P < 0.0001, t = 5.754, df = 121.9). Largely positive feedback was received on utility of concept maps in memorizing, confidence-boosting, and understanding subject. Felt need for innovations in conventional teaching-learning (T-L) was palpable.Conclusion:Time has come to start focusing on enhancing students' learning. Performance-enhancing utility of concept maps is proven and should be integrated in regular T-L.

Background and Objectives:Risk of vertical transmission (largest source of HIV in children) reduces from 33% to 3% with effective PPTCT interventions. NACP III has got an objective of testing all pregnant women for earliest linkage with PMTCT. Study was carried out to find out PPTCT service coverage, drop-outs, interventions efficacy with other determinants.Materials and Methods:At ICTCs, registered ANCs are counseled and tested for HIV. HIV+ve ANCs are linked to services and followed-up for institutional delivery, sdNVP, nutrition and children testing. HIV+ve ANCs since 2004 subsequently delivered till December 2009 and their exposed children in PPTCT-VSGH constituted study cohort.Results:29281 ANCs registered, 69.7% were counseled pre-test, 100% of them tested, 94.9% were counseled post-test. 60.5% were detected in 3rd trimester. CD4 testing was carried out in 71.6% HIV+ve ANCs. 81 ANCs were detected HIV+ve inclusive of 11 unregistered cases. 72 pregnancy outcomes reported institutionally, 77.6% were caesarian sections. Out of 59 live births, 56 sdNVP-MB-Pair were given. 88.1% children were traced till 18 months, 76.3% of live births were alive, 40.7% of live births were tested. 1 was found HIV+ve with history of adherence to all prescribed PPTCT guidelines.Conclusions:PMTCT services – counseling and testing should be provided to all ANCs. EDD-based tracking, institutional deliveries, postnatal counseling to be encouraged along with complete MB pair coverage, capacity building of concerned staff regarding delivery of HIV+ve ANCs and exposed children tracking.

Introduction: PMTCT under NACP-III cover exposed children born to sero-positive mothers. Baby's sero-status could be confirmed only at 18 months. Under EID, by DBS and/or WB collection, DNA-PCR can be performed earlier, with subsequent ART-linkage and 18-months-confirmation. In Ahmedabad, with 55,000 annual pregnancy-HIV-testing, sero-prevalence is 0.27%. Methodology: Entry-points in EID are at 6 weeks, 6 months or 12 months. Cohort of 213 exposed children since EID roll-out (June 2010-December 2011) at all tertiary care hospitals under Ahmedabad Municipal Corporation was assessed for sero-positivity-prevalence, DBS validity and assessment of baby's sero-status-determinants. De-identified, secondary data were captured under routine public-health-program. Necessary permissions taken. Results: 144 HIV sero-positive deliveries took place. 213 exposed children were enrolled in EID. Cumulatively, 18 (8.45%) were tested positive at all entry-points. Out of sero-positives confirmed at 18 months, 60% children's mothers were detected either in second or third trimester. In 40%, mothers remained undiagnosed intra-partum. Mothers were not on ART intra-partum in 80% (RR 1.8). Peri-partum ARV prophylaxis-single-dose-Nevirapine (sdNVP) was not given in 60%. [RR 18, CI 3.69 to 87.70 at 95% (p < 0.0003)]. In 60%, mode of delivery was vaginal, deliveries were handled in emergency. History of exclusive breastfeeding was in 60%. Discussion: Rise in yield of sero-positivity with age, highest proportion of sero-positivity and highest number of entrants at 6 weeks call for efforts targeted towards increasing earliest EID uptake clubbed with immunization visits. Feasibility, validity and early-ART-linkage to reduce mortality are features of DBS. Results justify its use in national program. Earliest pregnancy-HIV detection, HIV-testing for emergency deliveries, intra-partum sdNVP to both mother and baby, ART-linkage of eligible mothers and following infant feeding guidelines remain cornerstone of PMTCT success.