Ethnic Variation in Lipid Profile and Its Associations with Body Composition and Diet: Differences Between Iranians, Indians and Caucasians Living in Australia.

Dyslipidaemia is a known risk factor for developing cardiovascular disease. The impact of ethnicity on variations in lipid patterns has been studied in certain racial and ethnic groups with limited data on other ethnicities, particularly Asian subgroups. This cross-sectional study evaluated the ethnic variation in lipid profile and its association with body composition and diet in ninety-one overweight and obese Australians of European (n = 32), Indian (n = 28) and Iranian (n = 31) ancestries. Different measures of total and truncal adiposity were assessed using the method of whole body dual energy X-ray absorptiometry. The results showed that serum total cholesterol (TC) and low density lipoprotein cholesterol (LDL-chol) levels in Iranians were significantly lower than in Europeans and Indians. Both Iranian and Indian groups exhibited lower mean high density lipoprotein cholesterol (HDL-chol) relative to Europeans. Triglycerides (TG) and HDL-chol, but not TC and LDL-chol, were significantly associated with different truncal adiposity measurements; however the degree of associations varied in ethnic groups. Regression analysis showed ethnicity as a significant predictor of TC (p = 0.01), TG (p = 0.03) and HDL-chol (p = 0.04), after controlling for potential confounders. However, LDL-chol was significantly associated with the intake of total (p = 0.005), and saturated fats (p = 0.004), which were also other significant determinants of serum TC (p = 0.04 and p = 0.02, respectively). In conclusion, ethnicity was a strong predictor of serum lipids, except LDL-chol which was significantly determined by dietary fat intake. Prevention and management of obesity, particularly abdominal adiposity may effectively reduce the risk of low HDL-chol reported in Iranians and Indians.

A retrospective review of stillbirths at the national hospital in Timor-Leste.

BACKGROUND: Timor-Leste has high maternal and infant mortality rates. Estimates of stillbirths are unreliable and limited by poor collection of vital health statistics. Lack of accurate data impedes the development of interventions to address local determinants of stillbirth. AIMS: This study aimed to identify the rate, timing and causes of stillbirths at National Hospital Guido Valadares in Dili, Timor-Leste, between November 2009 and December 2010, during which data were available. METHODS: Hospital birth registry and maternal records were retrospectively reviewed to identify stillbirths during the study period. The simplified Cause of Death and Associated Conditions system was utilised to classify stillbirths. RESULTS: One hundred and fifty-three stillbirths were identified, producing a stillbirth rate of 29 per 1000 births. Of stillbirths with known timing, 70 (66.7%) occurred antepartum and 35 (33.3%) intrapartum. Cause of death could not be ascertained in 62.7% of cases due to poor or missing records. Where identified, the three most commonly classified causes of death were intrapartum fetal asphyxia, maternal infection and maternal hypertensive disorder. CONCLUSION: This study highlights the need for standardised recording and coding of perinatal deaths at HNGV. The high proportion of antenatal death transfers from community health centres demonstrates the need for community and hospital staff training to improve the quality of antenatal and intrapartum obstetric care. A prospective study of stillbirths is recommended to obtain reliable data on the determinants of stillbirths in Timor-Leste. These data would inform evidence-based interventions for the improvement of maternity and obstetric care in community and hospital settings.

Resettlement experiences and resilience in refugee youth in Perth, Western Australia.

BACKGROUND: In Australia, the two major pathways of refugee entry are the United Nations High Commissioner for Refugees resettlement programme and irregular maritime arrivals (IMAs) seeking asylum. The Australian Government's policies towards IMAs since July 2013 are controversial, uncompromising and consistently harsh, with asylum seekers held in detention centres for prolonged periods. Refugees and asylum seekers have distinct and unique stressors that make resettlement difficult. METHODS: This exploratory study examines resettlement experiences for refugee youth in Western Australia using the psychosocial conceptual framework and qualitative methods. Focus group discussions and key informant interviews were undertaken with verbatim transcripts analysed using thematic analysis to identify themes. RESULTS: Themes documented that language and its impact, and experience with education, health, and social activities, support structures provided to youth and supporting future aspirations as critical to successful resettlement. This exploratory study contributes to developing a broader understanding of the resettlement experiences of refugee youth, drawing on their current and past experiences, cultural differences and mechanisms for coping. CONCLUSION: Fluency in English language, especially spoken, was a facilitator of successful resettlement. Our results align with previous studies documenting that support programs are vital for successful resettlement. Although faced with immense difficulties refugee youth are resilient, want to succeed and have aspirations for the future. Strategies and recommendations suggested by refugee youth themselves could be used for developing interventions to assist successful resettlement.

Sexual and reproductive health communication among Sudanese and Eritrean women: an exploratory study from Brisbane, Australia.

This exploratory study piloted in Brisbane, Australia, reports on findings from in-depth focus-group discussions conducted with Sudanese and Eritrean women in Brisbane. We investigated and documented their experiences and knowledge of sexual and reproductive health and contraception, and explored their views on sexuality and relationships education within the family environment of minority ethnic communities in Australia. Underpinned by a qualitative psychosocial framework, the study also involved key-informant interviews with health and multicultural not-for-profit sector professionals. Through the knowledge and experiences shared by the participants, the key themes of cultural insensitivity, exclusion and poor communication within the family were highlighted by participants as determining factors in the achievement of sexual and reproductive health and good quality sex and relationships education. Participants proposed recommendations for how minority ethnic communities in Australia can more effectively support and communicate within the family environment to increase their own and their children's knowledge and understanding.

Modernization and development: impact on health care decision-making in Uganda.

Uganda has faced numerous challenges over the past 50 years from overcoming political conflict and civil unrest, to rapid population growth, to combating the HIV epidemic and ever-growing health needs. Women in Uganda have had a major role to play in the health of families and communities. The researchers' purpose in this study, undertaken in rural Uganda, was to a) identify a people-centered definition of development, b) compare it to the process of modernization, and c) investigate how these processes have changed the role women play in decision-making, in areas directly and indirectly related to their health and that of their families. Twenty-two men and women participated in focus group discussion and completed questionnaires. Based on our analysis of discussions it appears that both modernization and development have impacted health positively and negatively. Key themes distilled from interviews included that modernization has led to the breakdown of families; increased maternal responsibility for children; diminished land and economic resources; and an erosion of cultural values and practices that had previously provided stability for the society. In terms of development, women play an increasing role in decision-making processes in the household and are gaining increasing respect for their expertise in a number of areas, notably health care. We propose a movement of grassroots discourse on modernization. Development, and its effect on health, is necessary if the positive aspects of Ugandan culture and those of similar emerging societies are not to be lost (International Covenant on Economic, Social and Cultural Rights, 1966).

The involvement of men in maternal health care: cross-sectional, pilot case studies from Maligita and Kibibi, Uganda.

BACKGROUND: The International Conference on Population Development held in Cairo in 1994 identified the importance of male involvement in reproductive health programs. Since then, there has been an increase in reproductive health initiatives that target both men and women in an attempt to fulfill the 5th Millenium Development Goal. Yet, while the benefits of male involvement have been acknowledged, there continues to be a challenge in creating a space for and engaging men in maternal health. This is problematic due to the role of men as the head of the household in many countries, especially developing countries, which suffer from higher rates of maternal mortality. Furthermore, men are important as partners, fathers and health care professionals and as such it is important to involve and engage with men in maternal health education, and antenatal care. METHODS: The purpose of this study undertaken in two rural villages in southeastern Uganda, was twofold: firstly to understand men's current participation in antenatal, pregnancy care and childbirth and secondly to gain insight into both men and women's attitudes toward increased male involvement. Focus group discussions and semi-structured questionnaires were used to collect information from 35 men and women. The women were either pregnant or had been involved in a birth experience in the past 3 years and the men had wives who were pregnant or had given birth recently. RESULTS: Men interviewed in the two villages believed that issues related to pregnancy and childbirth were the domain of women. Involvement tended to be confined (to removed) strictly to traditional gender roles, with men's main responsibility being provision of funds. The women, on the other hand, were interested in receiving more support from their husband through planning, attendance to antenatal care and physical presence in the vicinity of where the birth was taking place. CONCLUSION: This cross-sectional study has highlighted the space for increased male involvement and participation in maternal health, proposed recommendations and the need for community health education directed at men that engages them in this important area.

A cross-generational study of contraception and reproductive health among Sudanese and Eritrean women in Brisbane, Australia.

This study conducted in Brisbane, Australia, was undertaken with a cross-section of Sudanese and Eritrean mothers and daughters. We explored and documented the women's intergenerational experiences and knowledge of reproductive health and contraception. Underpinned by a qualitative approach, focus group discussions were undertaken along with key informant interviews with health and multicultural sector professionals. Through examination of knowledge shared, the analysis distilled key aspects of intergenerational fears, cultural safety, and health. Participants proposed recommendations on how refugee and migrant women in Australia and resettled countries globally can more effectively and holistically exercise their sexual and reproductive health rights.

Between a rock and a hard place: stigma and the desire to have children among people living with HIV in northern Uganda.

BACKGROUND: HIV-related stigma, among other factors, has been shown to have an impact on the desire to have children among people living with HIV (PLHIV). Our objective was to explore the experiences of HIV-related stigma among PLHIV in post-conflict northern Uganda, a region of high HIV prevalence, high infant and child mortality and low contraception use, and to describe how stigma affected the desires of PLHIV to have children in the future. METHODS: Semi-structured interviews were conducted with 26 PLHIV in Gulu district, northern Uganda. The interviews, conducted in Luo, the local language, were audio recorded, transcribed and then translated into English. Thematic data analysis was undertaken using NVivo8 and was underpinned by the "Conceptual Model of HIV/AIDS Stigma". RESULTS: HIV-related stigma continues to affect the quality of life of PLHIV in Gulu district, northern Uganda, and also influences PLHIV's desire to have children. PLHIV in northern Uganda continue to experience stigma in various forms, including internal stigma and verbal abuse from community members. While many PLHIV desire to have children and are strongly influenced by several factors including societal and cultural obligations, stigma and discrimination also affect this desire. Several dimensions of stigma, such as types of stigma (received, internal and associated stigma), stigmatizing behaviours (abusing and desertion) and agents of stigmatization (families, communities and health systems), either directly, or indirectly, enhanced or reduced PLHIV's desire to have more children. CONCLUSIONS: The social-cultural context within which PLHIV continue to desire to have children must be better understood by all health professionals who hope to improve the quality of PLHIV's lives. By delineating the stigma process, the paper proposes interventions for reducing stigmatization of PLHIV in northern Uganda in order to improve the quality of life and health outcomes for PLHIV and their children.

Assessing women's understandings of health in rural Papua New Guinea: implications for health policy and practice.

In Papua New Guinea (PNG), women's health is addressed by applying biomedical solutions which often ignore the complexity of women's histories, cultural contexts and lived experiences. The objective of this study was to examine adult and older women's perceptions of health and well-being to identify priority areas for public service interventions. Rapid ethnographic assessment was conducted in the Wosera district, a rural area of PNG from mid-2005 to early 2006, to examine the health concerns of women. Twenty-seven adult women and 10 older women participated in the study. Health was not limited to one aspect of a woman's life, such as their biology or maternal roles; it was also connected with the social, cultural and spiritual dimensions of women's daily existence. Participants also identified access to money and supportive interpersonal relationships as significant for good health. A disconnect was found to exist between women's understandings of good health and socio-political health policies in PNG, something likely to be repeated in health service delivery to different cultural groups across the Asia Pacific region. Health and development practitioners in PNG must become responsive to the complexity of women's social relationships and to issues relating to the context of women's empowerment in their programmes.

Family planning among people living with HIV in post-conflict Northern Uganda: A mixed methods study.

BACKGROUND: Northern Uganda experienced severe civil conflict for over 20 years and is also a region of high HIV prevalence. This study examined knowledge of, access to, and factors associated with use of family planning services among people living with HIV (PLHIV) in this region. METHODS: Between February and May 2009, a total of 476 HIV clinic attendees from three health facilities in Gulu, Northern Uganda, were interviewed using a structured questionnaire. Semi-structured interviews were conducted with another 26 participants. Factors associated with use of family planning methods were examined using logistic regression methods, while qualitative data was analyzed within a social-ecological framework using thematic analysis. RESULTS: There was a high level of knowledge about family planning methods among the PLHIV surveyed (96%). However, there were a significantly higher proportion of males (52%) than females (25%) who reported using contraception. Factors significantly associated with the use of contraception were having ever gone to school [adjusted odds ratio (AOR) = 4.32, 95% confidence interval (CI): 1.33-14.07; p = .015], discussion of family planning with a health worker (AOR = 2.08, 95% CI: 1.01-4.27; p = .046), or with one's spouse (AOR = 5.13, 95% CI: 2.35-11.16; p = .000), not attending the Catholic-run clinic (AOR = 3.67, 95% CI: 1.79-7.54; p = .000), and spouses' non-desire for children (AOR = 2.19, 95% CI: 1.10-4.36; p = .025). Qualitative data revealed six major factors influencing contraception use among PLHIV in Gulu including personal and structural barriers to contraceptive use, perceptions of family planning, decision making, covert use of family planning methods and targeting of women for family planning services. CONCLUSIONS: Multilevel, context-specific health interventions including an integration of family planning services into HIV clinics could help overcome some of the individual and structural barriers to accessing family planning services among PLHIV in Gulu. The integration also has the potential to reduce HIV incidence in this post-conflict region.

Factors associated with perceived stigma among people living with HIV/AIDS in post-conflict northern Uganda.

HIV-related stigma continues to persist in several African countries including Uganda. This study quantified the burden of stigma and examined factors associated with stigma among 476 people living with HIV (PLHTV) in Gulu, northern Uganda. Data were collected between February and May 2009 using the HIV/AIDS Stigma Instrument-PLWA. Females more than males, respondents aged above 30 years, and those who had been on antiretroviral therapy for a longer time experienced higher levels of stigma. Verbal abuse and negative self-perception were more common forms of stigma. The association between antiretroviral therapy and stigma suggested that organizational aspects of antiretroviral delivery may lead to stigmatization of PLHIV. Interventions such as counseling of PLHIV, education of health workers and the community would lead to reductions in negative self-perception and verbal abuse and in turn improve the quality of life for PLHIV in northern Uganda.

Widening the aim of health promotion to include the most disadvantaged: vulnerable adolescents and the social determinants of health.

Growing numbers of adolescents are marginalized by social factors beyond their control, leading to poor health outcomes for their families and future generations. Although the role of the social determinants of health has been recognized for many years, there is a gap in our knowledge about the strategies needed to address these factors in health promotion. Drawing on a review of literature on health promotion for marginalized and out-of-school adolescents, this paper highlights some urgent areas of focus for researchers and policy makers addressing adolescent health. Social determinants of health affecting marginalized adolescents identified by the review were education, gender, identity, homelessness, poverty, family structure, culture, religion and perceived racism, yet there is little solid evidence as to how to best address these factors. More systematic research, evaluation and global debate about long-term solutions to chronic poverty, lack of education and social marginalization are needed to break the cycle of ill health among vulnerable adolescents.

Stressors, coping, and social support among women in Papua New Guinea.

In this study we used an interpretive, ethnographic, qualitative approach to examine Papua New Guinean women's narratives and perceptions about their health and the ways in which these were linked to coping with personal adversity. Women used a variety of strategies to cope with psychosocial stressors and challenging life circumstances, including both reliance on their own agency and active efforts and the seeking of social and spiritual support. We observed that limited access to social and economic resources, combined with gender constraints, made women socially and culturally vulnerable to social strain that affected their physical and emotional health. A number of women used avoidance strategies that were related to lower levels of self-esteem and life satisfaction and displayed high levels of anxiety. We propose the need to understand the context in which coping takes place and to enhance resilience strategies used by women in developing countries such as Papua New Guinea to manage the multiple stressors associated with confronting life's challenges.

Beyond risk factors to lived experiences: young women's experiences of health in Papua New Guinea.

INTRODUCTION: The health of young women in rural Papua New Guinea (PNG) is often examined using individual-based risk factors which are decontextualized from the social and cultural relationships within which women's lives are embedded. Understanding the health meanings and perceptions of rural PNG women is important for bridging the gap between current health program delivery and the real needs of women. The objective of this study was to explore the health perceptions of rural PNG young women and to identify points in the lifespan where support may be required. METHODS: Thirty-three young women aged between 15 and 29 years were involved in the research. Multiple data collection methods were used within interpretive qualitative methodology and these included in-depth interviews, focus group discussions, photo narrative and ranking exercises. The study was conducted in a rural community in the Wosera district of the East Sepik Province of PNG from mid-2005 to early 2006. Following a community meeting and targeted awareness about the project to female youth, purposive and snowball sampling was used to recruit young women aged 15-24 years. The mean age of participants was 21 years. Single and married participants, unmarried mothers, school leavers and current school attendees were represented. Informed consent was obtained prior to the sharing of women's narratives. Data were categorized and analysed for emerging themes and cross checked with participants for verification. RESULTS: Young women viewed their health in the context of their social and cultural world and in terms of their wider life experiences. The main theme uncovered young women's strong desires for independence. Young women depended on their parents for emotional support and material possessions, and positive parental support provided young women with the opportunity to move towards independence. Freedom from economic constraints was identified as important for autonomy, and having money was discussed as a requisite for good health. Young women discussed that building healthy relationships was integral to health. For single young women this was connected with having the freedom to spend time with friends and boyfriends. Married young women noted that their health was related to the quality of their marital and familial relationships and the level of support available to meet the demands of new roles and responsibilities. CONCLUSIONS: The young women's narratives document the importance of the connection between the diverse health needs of young women and the social and cultural environment in which they live. The role of connectedness with family, friends and community in young women's lives is an important issue and can provide opportunities for the delivery of culturally appropriate support to young women in response to key transitional points in their health experiences. Health practitioners and policy-makers in PNG need to reconsider their assumptions underlying women's health programs and interventions in rural areas, and broaden their perspective of health to recognise the ways in which women's personal experiences influence health.

General health in Timor-Leste: self-assessed health in a large household survey.

OBJECTIVE: Timor-Leste is one of the world's newest nations and became a democracy in 2002. Ranked 150 out of 177 in the 2007 UNDP Human Development Index, the country has the worst health indicators in the Asia-Pacific region. The objective of this study was to collect and analyse data on subjectively assessed general health, health service use, migration and mobility patterns. METHODS: The data collection involved recording self-reported status of general health using a structured questionnaire. The survey was administered to 1,213 Timorese households in six districts using a multi-stage random cluster sampling procedure. Basic descriptive statistical analyses were performed on all variables with SPSS version 13. RESULTS: More than a quarter (27%) of respondents reported a health problem at the time of the survey. Only approximately half of respondents assessed their health to be good (53%) or average (38%). Barriers reported in the uptake of healthcare services were no felt needed; difficulty in accessing services and unavailability of service. CONCLUSIONS: Results reveal that Timor-Leste needs a more decentralised provision of healthcare through primary healthcare centres or integrated health services. Trained traditional healers, who are familiar with the difficult terrain and understand cultural contexts and barriers, can be used to improve uptake of public health services. An adult literacy and community health education program is needed to further improve the extremely poor health indicators in the country. IMPLICATIONS: Key lessons that emerged were the importance of understanding cultural mechanisms in areas of protracted conflict and the need for integrated health services in communities.

There should be more help out here! A qualitative study of the needs of Aboriginal adolescents in rural Australia.

INTRODUCTION: Aboriginal adolescents living in or near rural towns have different social and cultural needs than Aboriginal adolescents living in large cities or remote areas. Identification of health needs by the community is an established principle of health promotion for improving community health. The objective of this study was to identify the views of rural Aboriginal adolescents regarding health promotion topics, the most important health problems they faced, their support networks and their beliefs about who should help them meet their health needs. METHODS: Ninety-nine adolescents aged between 12 and 18 years were involved in in-depth interviews or focus group discussions using a tested and trialled questionnaire. Data collection took place at three sites in rural Australia from 2006 to 2008: two Aboriginal-controlled communities and one rural town. All locations were de-identified at the request of participants because confidentiality and anonymity were concerns of the adolescents, who felt that identifying their own community would result in stereotyping. After preliminary interviews with parents, teachers, youth and health workers, snowball sampling was used to identify 'vulnerable' adolescents with low school attendance. The mean age of respondents was 13 years. There were 40 male participants and 59 female participants, representing 6 language groups. Informed consent was obtained from both participants and their guardians. Data were analysed using thematic matrices and cross-checked in subsequent interactions with participants. RESULTS: Alcohol, drugs and violence were identified as the biggest problems facing Aboriginal adolescents in rural areas and the topic they would most like to know about. The youth from a smaller Aboriginal community near a town with a population of 1500 stated that boredom was an equally important problem. Racism and bullying were noted as reasons for poor school attendance. Family members were the most important supports, and the people they felt would help solve their health problems. They strongly identified with sports and were proud to be Aboriginal although there were many adolescents who had no future plans or ambitions. Most participants wanted a 'safe and fun' place to go to in the evenings. CONCLUSIONS: The importance of engaging the community and being sensitive to social and cultural contexts in research and programming was confirmed. Policy-makers, health providers and agencies working with youth need to focus on inclusion of families in youth health promotion and drug and alcohol prevention for Aboriginal adolescents in rural areas. Mentorship and peer-support programs are more effective than health professionals and agencies in working with youth. The expertise of those traditionally working with youth could be channelled into coordinating a mentorship program. Personal wellbeing and safety is an important issue and multipurpose youth centres may provide a secure place for adolescents to learn, interact and develop a vision for their futures.

A systematic review of factors influencing fertility desires and intentions among people living with HIV/AIDS: implications for policy and service delivery.

With availability of antiretroviral treatments, HIV is increasingly recognised as a chronic disease people live with for many years. This paper critically reviews the current literature on fertility desires and reproductive intentions among people living with HIV/AIDS (PLHIV) and critiques the theoretical frameworks and methodologies used. A systematic review was conducted using electronic databases: ISI Web of Knowledge, Science Direct, Proquest, Jstor and CINAHL for articles published between 1990 and 2008. The search terms used were fertility desire, pregnancy, HIV, reproductive decision making, reproductive intentions, motherhood, fatherhood and parenthood. Twenty-nine studies were reviewed. Fertility desires were influenced by a myriad of demographic, health, stigma-associated and psychosocial factors. Cultural factors were also important, particularly in Sub-Saharan Africa and Asia. Future research that examines fertility desires among PLHIV should include cultural beliefs and practices in the theoretical framework in order to provide a holistic understanding and to enable development of services that meet the reproductive needs of PLHIV.

Cataract surgery in Andhra Pradesh state, India: an investigation into uptake following outreach screening camps.

PURPOSE: Prevalence of cataract related blindness and visual impairment is extremely high in India. Service utilization, on the contrary, is sub-optimal. Services offered through outreach screening are often not taken up. Against this background, the decision making processes leading to the uptake of cataract surgery services offered during outreach screening camps were investigated in people with cataract in India. METHODS: The study used an exploratory, qualitative approach. Sixty one cataract patients from two eye hospitals in Hyderabad, India, were interviewed using convenience sampling. Two focus group discussions with cataract patients and interviews with seven key informants helped triangulate the information. RESULTS: Lack of access to personal funds limited and delayed the utilization of offered services by patients who had been advised of surgery at outreach screening camps or eye hospitals. Stigma, fatalism and ageism were other limiting factors. The majority of patients did not make the decision regarding uptake of services themselves. Hearsay reports of the outcome of surgery and quality of services had a strong influence on service uptake. Women, particularly widows and those from rural areas, were least likely to use cataract surgery services. CONCLUSION: Provision of affordable and accessible eye care does not guarantee that the care or service will be utilized. Within the decision making process about cataract surgery, dependency on and importance of the wider family was found to be an often cited context of patients' decisions. Future research and programming activities need to put an emphasis on underserved groups, especially those who may be marginalized or disempowered.

Understanding community perceptions of health and social needs in a rural Balinese village: results of a rapid participatory appraisal.

This article reviews the process and key recommendations derived from conducting a rapid participatory asset-focused health and social needs assessment in the small traditional rural village of Tulikup, Bali. The assessment aimed to develop recommendations for a community radio station based in Tulikup to promote social change and development. The health and social needs assessment utilized an asset-focused rapid participatory assessment cycle methodological framework, incorporating Annett and Rifkin's (1995) guidelines for rapid participatory appraisals (World Health Organization, Geneva), community-based action research (Sage Publications, California; Stringer, 1996) and asset-based community development. The study explored Tulikup's pre-existing assets and highlights the value of using rapid participatory appraisal techniques as a first step in involving communities in assessing needs and planning meaningful community development strategies. Data was collected over a 3-week in-country period and included interviews with key informants, informal individual and group discussions, field observations and reviews of existing secondary data sources. Triangulation using cultural interpreters, and participatory consultation processes with community members helped ensure data reliability and validity. Recent terrorist attacks in Indonesia and, most notably, Bali, have had widespread economic and social effects throughout Bali. In particular, secondary consequences of unemployment and a reduction in income have had negative impacts on population health and child labour at the village level. The findings and recommendations of the health and social needs rapid assessment have been utilized by the radio station to promote social change and development.