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AbstractThis paper examines the impact of US market access on local labour markets in a developing country, Vietnam. Following the implementation of the Vietnam–United States bilateral trade agreement (BTA) in December 2001, manufacturing employment increased in provinces that were more exposed to US tariff cuts. In those provinces, employment also increased in many service sectors, reflecting strong spillovers of job gains. Among three potential channels of local job gain spillovers, namely, demand, production and real estate, the demand channel is the most important. The BTA is also found to reduce employment gaps, especially in manufacturing, between females and males, rural and urban, and poor and rich households.

This study proposes a measurement instrument for port performance in the context of container transport logistics (CTLs) by taking perspectives from different port stakeholders. An importance-performance analysis (IPA) is used to develop an analytical tool for investigating the importance and performance (IP) of major container ports in South Korea against individual CTLs criterion. The main originality of this study is the development of a measurement instrument to provide managerial and operational insights to both port managers (i.e. terminal operating companies) and policy makers (i.e. port authorities and government) for stakeholder management in CTLs. The analysis helps port managers and policy makers to converge the different objectives and concerns for better management.

AbstractIn Kenya, adolescent pregnancy rates are high, contraception utilization is low, and adolescent sexuality is stigmatized. We describe how perceptions of sexuality and pregnancy stigma influence decision‐making among adolescents in the informal settlements of Kisumu. We used purposive sampling to recruit 120 adolescent boys and girls aged 15–19 for focus group discussions. A semistructured interview guide was used to elicit social norms and community attitudes about sexual and reproductive health. We analyzed the data using the Framework Approach. The social stigma of adolescent sexuality and the related fear of pregnancy as an unambiguous marker of sexual activity emerged as main themes. This stigma led adolescents to fear social retribution but did not lead to more frequent contraception use due to additional stigma. The intensity of this fear was most acutely expressed by girls, leading some to seek unsafe, sometimes fatal, abortions, and to contemplate suicide. Fear of pregnancy outweighed fear of contracting HIV that was viewed as both treatable and less stigmatized. Our findings illustrate how fear of pregnancy among these adolescents is driven primarily by fears that their community will discover that they are sexually active. Interventions are urgently needed to address adolescent sexual stigma and to prevent negative outcomes.

AbstractIntroductionIn 2020, Kenya had 19,000 new HIV infections among women aged 15+ years. Studies have shown sub‐optimal oral pre‐exposure prophylaxis (PrEP) use among sub‐populations of women. We assessed the uptake and continuation of oral PrEP among women 15–49 years in two health facilities in Kisumu County, Kenya.MethodsA retrospective cohort of 262 women aged 15–49 years, initiated into oral PrEP between 12 November 2019 and 31 March 2021, was identified from two health facilities in the urban setting of Kisumu County, Kenya. Data on baseline characteristics and oral PrEP continuation at months 1, 3 and 6 were abstracted from patient records and summarized using descriptive statistics. Missing data in the predictor variables were imputed within the joint modelling multiple imputation framework. Using logistic regression, we evaluated factors associated with the discontinuation of oral PrEP at month 1.ResultsOf the 66,054 women screened, 320 (0.5%) were eligible and 262 (82%) were initiated on oral PrEP. Uptake was higher among women 25–29 years as compared to those 15–24 years (77% vs. 33%). Oral PrEP continuation declined significantly with increasing duration of follow‐up; 37% at month 1, 21% at month 3 and 12% at month 6 (p<0.05). In the adjusted analysis, women 15–24 years had lower adjusted odds of continuing at month 1 than women ≥25 years (adjusted odds ratio [aOR]: 0.41, 95% CI: 0.21–0.82). There was no association between being sero‐discordant and continuation of oral PrEP at month 1 (aOR; 1.21, 95% CI 0.59–2.50). Women from the sub‐county hospital were more likely to continue at month 1 of follow‐up compared to women enrolled in the county referral hospital (aOR 5.11; 95% CI 2.24–11.70).ConclusionsThe low eligibility for oral PrEP observed among women 15–49 years in an urban setting with high HIV prevalence calls for a review of the screening process to validate the sensitivity of the screening tool and its proper application. The low uptake and continuation among adolescent girls and young women underscores the need to identify and address specific patient‐ and facility‐level barriers affecting different sub‐populations at risk for HIV acquisition.

OBJECTIVE: To assess the proportion of, and reasons for, households not utilising the policy of free healthcare for children under 6 years of age (FCCU6) for hospitalisation with diarrhoea, and assess the risk of catastrophic expenditure for households that forgo FCCU6 and pay out of pocket. METHODS: Invoices detailing insurance information and charges incurred from 472 hospitalised diarrhoeal cases in one paediatric hospital in Ho Chi Minh City were retrieved. Hospital charges and the utilisation of elective services were analysed for patients utilising and not utilising FCCU6. Associations between socio-economic factors with non-utilisation of FCCU6 were evaluated. RESULTS: Overall, 29% of patients were FCCU6 non-users. The FCCU6 non-users paid a median hospital charge of $29.13 (interquartile range, IQR: $18.57-46.24), consuming no more than 1.4% of a medium-income household's annual income. Seventy per cent of low-income FCCU6 non-users utilised less-expensive elective services, whereas only 43% of medium income patients and 21% of high-income patients did (P = 0.036). Patients from larger households and those with a parent working in government were more likely to use FCCU6. CONCLUSIONS: The rate of FCCU6 non-usage in this study population was 29%. A significant proportion of those that did not use FCCU6 was from lower income households and may perceive a justifiable cost-benefit ratio when forgoing FCCU6. Although a single diarrhoeal hospitalisation is unlikely to induce a catastrophic expenditure, FCCU6 non-usage may disproportionately increase the risk of catastrophic expenditure for lower income households over multiple illnesses.