Hoa Thi Minh Nguyen

Strengthening Tuberculosis Control Overseas: Who Benefits?

BACKGROUND Although tuberculosis is a major cause of morbidity and mortality worldwide, available funding falls far short of that required for effective control. Economic and spillover consequences of investments in the treatment of tuberculosis are unclear, particularly when steep gradients in the disease and response are linked by population movements, such as that between Papua New Guinea (PNG) and the Australian cross-border region. OBJECTIVE To undertake an economic evaluation of Australian support for the expansion of basic Directly Observed Treatment, Short Course in the PNG border area of the South Fly from the current level of 14% coverage. METHODS Both cost-utility analysis and cost-benefit analysis were applied to models that allow for population movement across regions with different characteristics of tuberculosis burden, transmission, and access to treatment. Cost-benefit data were drawn primarily from estimates published by the World Health Organization, and disease transmission data were drawn from a previously published model. RESULTS Investing

Food and biosecurity: livestock production and towards a world free of foot-and-mouth disease

16 million to increase basic Directly Observed Treatment, Short Course coverage in the South Fly generates a net present value of roughly

Comparison of alternatives to passive surveillance to detect foot and mouth disease incursions in Victoria, Australia.

74 million for Australia (discounted 2005 dollars). The cost per disability-adjusted life-year averted and quality-adjusted life-year saved for PNG is

Language, Mixed Communes and Infrastructure: Sources of Inequality and Ethnic Minorities in Vietnam

7 and

Optimal surveillance against foot-and-mouth disease: the case of bulk milk testing in Australia

4.6, respectively. CONCLUSIONS Where regions with major disparities in tuberculosis burden and health system resourcing are connected through population movements, investments in tuberculosis control are of mutual benefit, resulting in net health and economic gains on both sides of the border. These findings are likely to inform the case for appropriate investment in tuberculosis control globally.

On the fixed-effects vector decomposition

A key challenge for global livestock production is the prevalence of infectious animal diseases. These diseases result in low productivity in meat and dairy production, culled animals, and significant barriers to trade and lost income from meat and meat products. Foot-and-mouth disease (FMD) affects both developing countries, where it is often endemic and very costly, and developed countries where incursions result in considerable economic losses in the order of billions of dollars per year. In some cases, production levels of pork meat in developed countries have still not recovered to levels prior to past disease incursions, more than a decade ago. In developing countries, the export of animal products has exhibited sluggish growth for decades, constrained by ongoing animal disease problems. We make three contributions. First, we provide an overview of worldwide meat production, consumption and trade in the context of FMD. Second, we provide insights into the economics of biosecurity measures and how these activities should be optimally designed to enhance livestock production. Third, we analyse a case study of an FMD-endemic country, Vietnam, which has been trying to achieve FMD-free status for some time. Lessons learnt from this case study shed light on the challenges in achieving FMD-free status in developing countries, which is useful for a global FMD control strategy and the promotion of world food security.

FEVD: Just IV or Just Mistaken?

This study aimed to evaluate strategies to enhance the early detection of foot and mouth disease incursions in Australia. Two strategies were considered. First, improving the performance of the current passive surveillance system. Second, supplementing the current passive system with active surveillance strategies based on testing animals at saleyards or through bulk milk testing of dairy herds. Simulation modelling estimated the impact of producer education and awareness by either increasing the daily probability that a farmer will report the presence of diseased animals or by reducing the proportion of the herd showing clinical signs required to trigger a disease report. Both increasing the probability of reporting and reducing the proportion of animals showing clinical signs resulted in incremental decreases in the time to detection, the size and the duration of the outbreak. A gold standard system in which all producers reported the presence of disease once 10% of the herd showed clinical signs reduced the median time to detection of the outbreak from 20 to 15days, the duration of the subsequent outbreak from 53 to 42days and the number of infected farms from 46 to 32. Bulk milk testing reduced the median time to detection by two days and the number of infected farms by six but had no impact on the duration of the outbreak. Screening of animals at saleyards provided no improvement over the current passive surveillance system alone while having significant resource issues. It is concluded that the most effective way to achieve early detection of incursions of foot and mouth disease into Victoria, Australia is to invest in improving producer reporting.

Productivity, net returns and efficiency : land and market reform in Vietnamese rice production

This paper re-examines the sources of inequality in Vietnam, a transitional economy with large reductions in poverty from recent and dramatic economic growth, but vastly unequal gains across ethnic groups. Using an instrumental variable approach to provide consistent estimators of explanatory variables at household and commune levels for ethnic differences in real household expenditure per person, we draw four key conclusions. First, removing language barriers would signifcantly reduce inequality among ethnic groups, narrowing the ethnic gap, and especially so through enhancing the gains earned by minorities from education. Second, variations in returns to education exist in favour of the majority in mixed communes, suggesting that either the special needs of minority children have not been adequately addressed in the classroom, or preferential treatment and the possibility of some form of discrimination exists in the labour market. Third, in contrast to recent literature, there is little di erence between ethnic groups in terms of the benefits drawn from enhanced infrastructure, such as power and clean water, at the commune level. An exception is the returns to roads, which differentially benefits the minority group. Finally, contrary to established views, we find that as much as 50 to 70 percent of the ethnic gap is attributed to differences in endowments, and not to differences in the returns to endowments.

Rice Production, Trade and the Poor: Regional Effects of Rice Export Policy on Households in Vietnam

Previous foot-and-mouth disease (FMD) outbreaks and simulation-based analyses suggest substantial payoffs from detecting an incursion early. However, no economic measures for early detection have been analysed in an optimising framework. We investigate the use of bulk milk testing (BMT) for active surveillance against an FMD incursion in Australia. We find that BMT can be justified, but only when the FMD entry probability is sufficiently high or the cost of BMT is low. However, BMT is well suited for postoutbreak surveillance, to shorten the length of time and size of an epidemic and to facilitate an earlier return to market.