In the shadow of the volcanoes: the impact of intervention on the nutrition and health status of Rwandan refugee children in Zaire two years from the exodus

Objective: To evaluate the public health and nutritional situation of refugee children in Katale camp, Eastern Zaire, after two years of nutritional and health intervention from 1994 to 1996.
Design: Cross-sectional survey using a two-stage cluster sampling method. Anthropometric data were collected from 28 May 1996 to 4 June 1996. Retrospective review of food basket monitoring data over the preceding six months and the United Nations High Commission for Refugees' weekly mortality data was conducted. Measles immunisation coverage data were surveyed simultaneously, using child health records.
Main outcome measures: Nutritional status measured by weight-for-height index (W/H), measles immunisation status, average daily energy content of the general food ration and crude mortality rate.
Setting: Katale refugee camp, Zaire, June 1996.
Analysis: Weight-for-height index and proportion of immunised children were computed using EPINUT, part of EPINFO computer package.
Results: Malnutrition was found to be most prevalent in children aged six to 29 months old (W/H < -2 Z-score and/or oedema: 6.2%; 95% CI: 3.4%, 10.6%), among whom the malnutrition rate was almost double the overall malnutrition prevalence (W/H < -2 Z-score and/or oedema: 3.5% (95% CI: 1.5%, 7.2%). The general food ration, although conforming to the World Food Program minimum standards of adequacy in terms of variety (being composed of cereals, oil, beans, blended cereal and legume mixes and salt), provided only 6240 kJ on average (95% CI: 5040, 7140 kJ) per person per day, thus meeting only 57% to 84% of the minimum energy requirements for an adult, and falling well below the needs for sub groups with higher nutritional requirements such as children, pregnant and breastfeeding women and the sick. Measles immunisation coverage in children nine to 59 months was 88.6%. The crude mortality rate was found to be 0.3 per 10 000 per day. Refugees received 15 litres of clean water per person per day.
Conclusion: Public health interventions in Katale camp 1994 to 1996 had reduced mortality and morbidity rates dramatically. This was not reflected in the malnutrition rates for children under five years, that remained stable after an initial fall despite two years of nutritional intervention. The factors contributed to this were related to an inadequate general food ration (due to food shortages), lack of ability to supplement the diet, (due to economic restrictions that were imposed in the camp) and inequities in the food distribution process (due to food being siphoned off by camp leaders for military purposes).

Sun exposure and sun protection behaviours among Australian adolescents: trends over time

Background
This study compared the sun exposure and sun protection behaviours of adolescent students between 1993 and 1999.

Methods
Schools from all Australian states and the two territories participated in each of the 1993, 1996, and 1999 surveys and a sample of students from years 7 to 12 were surveyed. In each of the states and territories a random sample of schools was selected within each education sector (government, Catholic, independent). The questionnaire was a self-completed booklet with questions about sunburn history during the previous summer, tan preferences, skin-type, and usual reported behaviour. Data from a total of 78,032 students were available for analysis.

Results
From 1993 to 1999 there was a significant increase in the number of students reporting sunburn during the previous summer (χ2 = 225.77, df = 2, P < 0.01). However, the percentage of students who preferred no tan at all increased over the same period (χ2 = 184.47, df = 2, P < 0.01). The percentage of students who usually or always wore clothing that covered most of their body decreased between 1993 and 1999 (χ2 = 20.46, df = 2, P < 0.01); the percentage of students usually or always wearing maximum protection sunscreen decreased over time (χ2 = 27.71, df = 2, P < 0.01). Staying in the shade increased from 1993 (26%) to 1996 (32%) but decreased slightly in 1999 (30%). Across all survey years, only 11% of students routinely followed all three protective behaviours of wearing a hat, sunscreen, and clothes that cover the body.

Conclusions
Sun protection practices among adolescents are still below optimal levels. Future educational programs require innovative approaches that aims to change attitudes toward tanning as being healthy and attractive and modify adolescent behaviours in relation to sun exposure.

Knowledge, attitudes and self-care practices related to sun protection among secondary students in Australia

The aim of this research was to ascertain changes in sun-related knowledge, attitudes and self-care practices among Australian secondary school students between 1993 and 1996. Two cross-sectional surveys of sun-related attitudes, beliefs and behavior of young people aged 12–17 years of age, were conducted in 1993 and 1996. Over 80% of adolescents at both time periods knew about the issues related to skin cancer prevention, frequency of burning and burning on cloudy days. Adolescent attitudes had shifted positively in the areas of staying inside in 1996 [relative risk (RR): 1.13; 95% confidence interval (CI): 1.09–1.17] and staying under shade in 1996 (RR: 1.16; 95% CI: 1.13–1.18). Desire for a moderate or dark tan was lower in 1996 (45%) than in 1993 (50%). Respondents reported that they were less likely to wear brief clothing to get a suntan in 1996 (RR: 0.81; 95% CI: 0.78–0.84) and were significantly more likely to stay in the shade in 1996 (RR: 1.19; 95% CI: 1.16–1.23). We conclude that there has been a shift in attitudes towards use of shade and avoidance of unnecessary exposure, and away from use of sunscreens and sunglasses. The results suggest that adolescents may be more ready to accept structural changes that move desired activities out of the sun.

Shadow boxing: Indonesian writers and the Ramayana in the new order

This article is a study of the ideas, visions, and styles of a number of Indonesia's writers in the New Order-in particular, the final years of the New Order-who chose to rework and reinterpret the Ramayana epic of the Javanese wayang kulit shadow puppet theatre. The deliberate choice by these writers to use Indonesian as their medium of linguistic communication has proven to be a decision in favor of distancing themselves from their mother-tongue, Javanese, and of targeting a larger "national" audience, thus signaling their concern for non-Javanese Indonesians. By the same token, the Indonesian language of wayang literary representations was often heavily Javanese in its flavor and style, and the indigenized wayang characters and plots appropriated were also, naturally, very much regional in origin.

Australian adolescents' sun protection behavior : who are we kidding?

Purpose
To examine the influence of tan preference and skin type on sun protection behaviors of Australian adolescents.

Methods
The Australian Secondary School Alcohol and Drug Questionnaires were conducted in 1993, 1996, 1999 and 2002 among randomly selected students aged 12–-17. Schools were randomly selected from each education sector in each state. The self-administered questionnaire contained questions about tan preferences, skin type and usual SunSmart behavior (use of sunscreen, hats and covering clothing).

Results
The routine use of SunSmart behavior was low in all survey years. There was a significant decrease over time in the proportion of students who practiced SunSmart behavior, with prevalence rates lower in 2002 than in any other survey year (males: p < 0.01 and females: p < 0.01). As desire for a tan increased, routine practice of SunSmart behaviors decreased. Across the four survey periods, male (p < 0.01) and female (p < 0.01) students who preferred no tan were significantly more likely to practice SunSmart behavior than students who preferred any sort of tan. Across the four survey years, male (p < 0.01) and female (p < 0.01) students with skin that ‘just burns’ were most likely to routinely practice SunSmart behavior.

Conclusions
Sun protection practices among adolescents have continued to decline significantly over time. Future educational programs require an innovative approach to modify adolescent behaviors in relation to sun exposure and sun protection.

Sun exposure and sun protection behaviours among young adult sport competitors

Objective: To explore the relationship between sun protection and physical activity in young adults (18-30 years) involved in four organised sports.

Methods: Participants (n=237) in field hockey, soccer, tennis and surf sports completed a self-administered survey on demographic and sun-protective behaviours while playing sport. Differences in sun-protective behaviour were explored by sport and by gender.

Results: Sunburn during the previous sporting season was high (69%). There were differences between sports for sunburn, sunscreen use and reapplication of sunscreen. Lifesaving had the highest rates compared with the other three sports. Hats and sunglasses worn by participants varied significantly by sports. A greater proportion of soccer and hockey players indicated they were not allowed to wear a hat or sunglasses during competition. For all sports, competition was played mainly in the open with no shade provision for competitors while they were playing. There were some gender differences within each of the sports. Female soccer and tennis players were more likely to wear sunscreen compared with males. Female hockey players were more likely to wear a hat compared with males.

Conclusions: Our findings highlight that there is still room for improvement in sun-protective behaviours among young adult sport competitors. There is a need for a systematic approach to sun protection in the sporting environments of young adults.

Implications: Health promotion efforts to increase physical activity need to be paired with sun protection messages.

Promoting comprehensive sun protection policies and practices in outdoor sports: a qualitative study of perceived priorities and practicalities

Sun protection policies, environments, practices, and attitudes in sporting club contexts might be significant determinants of sun exposure among adult sporting participants. Face-to-face interviews, using standardised, open-ended questions were conducted with 20 club officials from four sports: soccer, hockey, tennis and surf lifesaving. Thematic content analysis identified a number of salient themes. Formal sun protection policies were well-implemented in surf lifesaving, but less so in soccer, hockey and tennis clubs, which often had informal sun protection practices in place. Officials perceived sun protection to be important, which was related to perceived exposure levels, the type of sport, length of time played and the season. Consistent logistical and practical considerations emerged, including limited resources, availability of shade, and lack of control over sporting facilities, uniform regulations and games scheduling. Sun protection efforts often focused on children more than adult players. Reciprocal responsibility was an important theme, where it was perceived that responsibility for sun protection should be equally shared between the club and the member. In this study it was found that reciprocal responsibility, duty of care and sport-specific practical requirements might significantly influence the success of policy, environmental and education initiatives for sun protection in sporting settings.

Anything new under the sun? Lessons learned from community based natural resource management

Involving community in natural resource management has occurred under a wide variety of approaches, ideologies and titles over the last 30 odd years, with equally wide variety of outcomes for both the community and natural resource management!. Community Based Natural Resource Management (CBNRM) is now a commonly used and promoted, if not always well defined, approach. Claims about the benefits of CBNRM cover wildlife management and biodiversity, sustainable utilisation and management of natural resources, poverty reduction, increased livelihoods outcomes, improved food security, as well as less material benefits of livelihood diversification, empowerment, increased gender equality, and better institutional relations. There are also some fairly convincing criticisms of CBNRM reflecting on assumptions of the nature of communities, institutional arrangements and both institutional and community expectations. This paper reflects on the changing nature of community engagement in natural resource management, the emergence of CBNRM as an approach and the lessons learned from promoting CBNRM across case studies in the developing world.