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PurposeSynthesizing from the institutional theory and social network theory, this study investigates factors influencing green innovation performance in new ventures.Design/methodology/approachThe findings show that the dimensions of internal social network; heterogeneous network and tie strength have significant positive effects on proactive environmental strategy based on a sample of 300 new ventures in China.FindingsThe results further support the mediating role of proactive environmental strategy on internal organizational networks and green innovation performance of new ventures. The study further investigated the moderating role of the regulatory quality as a dimension of institutional environment in China. The results show that the regulatory quality positively moderates the relationship between proactive environmental strategy and green innovation performance. Policy and managerial implications are further discussed.Originality/valueOver the past 20 years, green innovation has increasingly attracted the attention of policymakers and scholars. However, most studies have focused on mature ventures, and little attention has been given to how newly established ventures attain green innovation performance.

The political landscape of Botswana has become more competitive and unpredictable in recent years. Elections are central to the functioning of any democratic nation. Given the turbulent political environment surrounding the 2019 General Elections, the factors influencing voters' behavior have aroused controversy. Bearing this in mind, the purpose of this study is to investigate the salience of electoral gifts, political debates, patriotism, and social media political activism as determinants of voters’ behavior using the Theory of Reasoned Action (TRA). A questionnaire was used to collect data from 640 individuals who participated in the 2019 General Elections. The Structural Equation Modeling (SEM) technique was used to analyze data. The study discovered that electoral gifts from political candidates significantly impacted voters' intent and attitude toward voting. Additionally, our study found that patriotism influenced voters’ attitudes and intention to vote in the 2019 General Elections despite the tumultuous political environment.The study further confirmed the relevance of social media political activism on voters’ intent and attitudes towards voting. The study also corroborated the influence of political debates on voters’ behavior. The implications of this study and future research directions are further discussed in light of these findings.

Background Problem Solving for Better Health ® (PSBH ® ) is a system-strengthening workshop designed to empower healthcare workers (HCWs) to solve problems. We report on the perspectives of HCWs trained in PSBH to better understand the impact and challenges of PSBH in Lesotho, a country with among the highest prevalence of HIV and tuberculosis in the world.Methods HCWs who attended PSBH workshops in 2018 – 2019 were interviewed using a semi-structured interview guide developed from a hybrid conceptual framework that captured the HCWs’ personal, interpersonal, and systemic levels of experience. Interviews were transcribed and analyzed using the framework matrix analysis method using NVivo. Results We interviewed 22 of the 86 HCWs who participated in PSBH workshops in 2018-2019. Twenty out of 22 interview participants reported that they initiated a project that was planned during the PSBH workshop. Participants reported that PSBH provided them with a new way of viewing, addressing, and solving everyday problems that can have a tangible impact on the function of healthcare facilities and the health of the community. Trainees were motivated to see the impact of their work in their jobs and in the work of subordinates as a sustained ripple effect favoring quality improvement. Participants suggested that training of district administrative leaders in PSBH would facilitate successful dissemination and help overcome the challenge of adding more work for the already-overburdened HCWs.Conclusions HCWs in Lesotho report that PSBH assists them in solving problems in their everyday work. This led the national Ministry of Health Quality Assurance Unit to request that PSBH workshops be conducted to train Ministry personnel to allow them to oversee national dissemination of PSBH, thereby fulfilling a component of the National Quality Assurance Strategic Objectives.

The Nigerian economy has supported sustainable economic development with a variation of GDP for the past decades and at present. This research is to investigate the current relationship between the determinants of economic development and GDP in Nigeria for the period 1981 to 2017. This study used household final expenditure, FDI, government spending, export, and import to predict the variation of GDP. Initially, we performed the three root unit tests for each selected variable to validate whether the series is stationary or not before determining an optimal lag order and cointegration equation between the series. To assess the relationship within the variables, we applied Johansen cointegration tests. The Akaike Information Criterion (AIC) was used to evaluate the optimum lag order. The error correction term (ECT) was calculated to measure the GDP's adjustment speed to its equilibrium point. Also, Granger causality effects were assessed and the variance decomposition of the forecast error was also predicted. The results from ADF, PP, and KPSS test gave a strong conclusion that the series is stationary at the first difference. An adjustment coefficient value (-0.0858) implies an 8.58 percent-speed correction of the preceding year's deviation from the long run. The ECT's significant p-values (0.0187) showed a long-run relationship between the selected independent variables and GDP. Thus, the estimated error variance of 67.13 percent of GDP would be triggered in the long term by FDI net inflows. So, it means that FDI has a major effect on the Nigerian economy and GDP variation. From FDI to household consumption, government spending, import, as well as export, unidirectional causality effect of Granger was observed. Our study recommends policymakers concentrate on foreign direct investment inflows to ensure sustainable economic development to enhance the GDP value in this country. Policymakers are strongly encouraged to ensure political and economic stability to attract more foreign investors. Financial resources from FDI inflows can be dispersed impartially in the manufacturing and service sectors and hence the nation's export and import will effectively increase household and government spending.

Automatic speaker recognition is the task of automatically determining or verifying the identity of a speaker from a recording of his or her speech sample and has been studied for many decades. One of the most important steps of speaker recognition that significantly influences the speaker recognition performance is known as feature extraction. Acoustic features of speech have been researched by many researchers around the world, however, there is limited research conducted on African indigenous languages, South African official languages in particular. This paper presents the effects of acoustic features of speech towards the performance of speaker recognition systems focusing on South African low-resourced languages. This study investigates the acoustic features of speech using the National Centre for Human Language Technology (NCHLT) Sepedi speech data. Acoustic features of speech such as Time-domain, Frequency-domain and Cepstral-domain features are evaluated on four machine learning algorithms: K-Nearest Neighbours (K-NN), two kernel-based Support Vector Machines (SVM), and Multilayer Perceptrons (MLP). The results show that the performance is poor for time-domain features and good for spectral-domain features and even better for cepstral-domain features. However, the combination of these three features resulted in a higher accuracy and $F_{1}$ score of 98%.

Speech is the primary means of communication among people. Spoken dialogue system give out some means for people to be able to interact with computer systems. The automatic speech recognition system itself is forms part a of spoken dialogue systems. This type of system did a great job for European languages with more challenges encountered for the recognition of South African languages. In this study, we investigate the appropriate approaches for the development of language models for the recognition of Sepedi-English code-switched speech and their effect in ASR. The SRI Language Modeling (SRILM) toolkit was used to develop the Language Model (LM). The Kaldi toolkit to develop ASR system was chosen which is specifically used for speech recognition. This toolkit was used to evaluate the effects of the smoothing techniques. We have evaluated Four smoothing techniques namely Good-Turing (GT), Witten-Bell (WB), Modified Kneser-Ney (MKN), and Laplace (LP) Smoothing. The Witten-Bell smoothing technique was found to perform better than the other three smoothing techniques for Sepedi-English CS data in Language Modelling and also in our ASR.

Background: Strengthening primary care research capacity is a priority globally. Family medicine training programmes in sub-Saharan Africa represent an important opportunity to build primary care research; however, they are often limited by insufficient research training and mentorship. Peers can be used to extend research mentorship capacity, but have not been evaluated in this context. Aim: The aim of this study was to evaluate one family medicine training programme’s research capacity building efforts through a blended research curriculum and peer mentorship. Setting: Lesotho is a landlocked country within South Africa of approximately two million people. The Family Medicine Specialty Training Programme (FMSTP) is the only accredited postgraduate medical education programme in Lesotho. Methods: This two-year mixed-methods evaluation used: (1) Likert-scale surveys measuring trainee research confidence, (2) written evaluations by trainees, peers, programme faculty and administrators and (3) in-depth, semi-structured interviews. Survey data were analysed using Friedman and sign tests. Interview and written data were analysed thematically via a mixed inductive-deductive approach using Cooke’s framework. Results: Family Medicine Specialty Training Programme trainees ( n = 8) experienced moderate increases in research confidence that were statistically significant. Skill-building occurred primarily via experiential learning. Research was grounded in trainees’ clinical practice and locally relevant. A positive research culture was created, promising for sustainability. We identified infrastructure gaps, including funding and protected time. Peer research mentorship supported trainees’ motivation and provided a safe space for questions. Conclusion: The FMSTP research curriculum and peer mentorship programme were successful in positively impacting a number of Cooke’s research capacity domains. This evaluation identified improvements that are now being implemented.

IntroductionCountries with strong primary healthcare (PHC) report better health outcomes, fewer hospital admissions and lower expenditure. People-centred care that delivers essential elements of primary care (PC) leads to improved health outcomes and reduced costs and disparities. Such outcomes underscore the need for validated instruments that measure the extent to which essential, evidence-based features of PC are available and applied to users; and to ensure quality care and provider accountability.MethodsA systematic scoping review method was used to identify peer-reviewed African studies and grey literature on PC performance measurement. The service delivery dimension in the Primary Healthcare Performance Initiative conceptual framework was used to identify key measurable components of PC.ResultsThe review identified 19 African studies and reports that address measuring elements of PC performance. 13 studies included eight nationally validated performance measuring instruments. Of the eight, the South African and Malawian versions of Primary Care Assessment Tool measured service delivery comprehensively and involved PC user, provider and manager stakeholders.Conclusion40 years after Alma Ata and despite strong evidence for people-centred care, significant gaps remain regarding use of validated instruments to measure PC performance in Africa; few validated instruments have been used. Agreement on indicators, fit-for-purpose validated instruments and harmonising existing instruments is needed. Rigorous performance-based research is necessary to inform policy, resource allocation, practice and health worker training; and to ensure access to high quality care in a universal health coverage (UHC) system—research with potential to promote socially responsive, accountable PHC in the true spirit of the Alma Ata and Astana Declarations.

BACKGROUND HIV-exposed uninfected (HEU) children experience increased mortality compared with their HIV-unexposed uninfected (HUU) peers. It is unclear whether HEU children are also at increased risk for undernutrition, a modifiable risk factor for mortality. METHODS We conducted a cross-sectional, population-based survey of children

PURPOSE: Estimating the incremental costs of scaling-up novel technologies in low-income and middle-income countries is a methodologically challenging and substantial empirical undertaking, in the absence of routine cost data collection. We demonstrate a best practice pragmatic approach to estimate the incremental costs of new technologies in low-income and middle-income countries, using the example of costing the scale-up of Xpert Mycobacterium tuberculosis (MTB)/resistance to riframpicin (RIF) in South Africa. MATERIALS AND METHODS: We estimate costs, by applying two distinct approaches of bottom-up and top-down costing, together with an assessment of processes and capacity. RESULTS: The unit costs measured using the different methods of bottom-up and top-down costing, respectively, are $US16.9 and $US33.5 for Xpert MTB/RIF, and $US6.3 and $US8.5 for microscopy. The incremental cost of Xpert MTB/RIF is estimated to be between $US14.7 and $US17.7. While the average cost of Xpert MTB/RIF was higher than previous studies using standard methods, the incremental cost of Xpert MTB/RIF was found to be lower. CONCLUSION: Costs estimates are highly dependent on the method used, so an approach, which clearly identifies resource-use data collected from a bottom-up or top-down perspective, together with capacity measurement, is recommended as a pragmatic approach to capture true incremental cost where routine cost data are scarce.

South Africa implemented Xpert MTB/RIF as the initial diagnostic test for pulmonary tuberculosis (TB). Xpert MTB/RIF's accuracy for diagnosing extrapulmonary tuberculosis (EPTB) was investigated. EPTB specimens ( n = 7,916) from hospitalized patients received over a 6-month period at a high-throughput TB referral laboratory in Johannesburg were investigated. Large-volume specimens were centrifuged, tissue biopsy specimens homogenized, and all specimens checked for growth of contaminating bacteria on blood agar. Contaminated samples received NALC-NaOH ( N -acetyl- l -cysteine–sodium hydroxide) decontamination prior to liquid culture. Residual specimens (volumes > 1 ml) after inoculation of culture ( n = 1,175) were tested using the Xpert MTB/RIF sputum protocol. Using culture as the reference, Xpert MTB/RIF's overall sensitivity was 59% (95% confidence interval [95% CI], 53% to 65%) and specificity was 92% (CI, 90% to 94%), with the highest sensitivities of 91% (95% CI, 78% to 97%) for pus, 80% (95% CI, 56% to 94%) for lymph node aspirates, and 51% (95% CI, 44% to 58%) for fluids (ascitic, 59%; pleural, 47%). A difference in sensitivities was noticed between specimens classified as having a thick (87% [95% CI, 76% to 94%]) versus clear (watery) (48% [95% CI, 36% to 61%]) appearance. This was unchanged with traces of blood (52% [95% CI, 44% to 60%]) or precentrifugation (57% [95% CI, 28% to 82%]) among clear specimens. Xpert MTB/RIF generated an additional 124 specimen results that were contaminated by Mycobacterial Growth Indicator Tubes (MGIT; 10.5%) and diagnosed rifampin (RIF) resistance earlier (9.6% [25/260]). Xpert MTB/RIF's performance on EPTB specimens provides very promising results and should be considered for incorporation into national TB guidelines. Xpert MTB/RIF is less affected by contaminating bacteria and reduces laboratory labor and diagnostic delay compared to traditional methods.

PURPOSE: Estimating the incremental costs of scaling-up novel technologies in low-income and middle-income countries is a methodologically challenging and substantial empirical undertaking, in the absence of routine cost data collection. We demonstrate a best practice pragmatic approach to estimate the incremental costs of new technologies in low-income and middle-income countries, using the example of costing the scale-up of Xpert Mycobacterium tuberculosis (MTB)/resistance to riframpicin (RIF) in South Africa. MATERIALS AND METHODS: We estimate costs, by applying two distinct approaches of bottom-up and top-down costing, together with an assessment of processes and capacity. RESULTS: The unit costs measured using the different methods of bottom-up and top-down costing, respectively, are $US16.9 and $US33.5 for Xpert MTB/RIF, and $US6.3 and $US8.5 for microscopy. The incremental cost of Xpert MTB/RIF is estimated to be between $US14.7 and $US17.7. While the average cost of Xpert MTB/RIF was higher than previous studies using standard methods, the incremental cost of Xpert MTB/RIF was found to be lower. CONCLUSION: Costs estimates are highly dependent on the method used, so an approach, which clearly identifies resource-use data collected from a bottom-up or top-down perspective, together with capacity measurement, is recommended as a pragmatic approach to capture true incremental cost where routine cost data are scarce.

Physical properties of bambara ( Vigna subterranea (L.) verdc.) seeds landraces from Botswana with mean moisture content (dry basis) 7.17–8.99% were evaluated in this study. The landraces were Zimbabwe Red (National Tested Seed Red – NTSR), Botswana Red (BotR), Diphiri cream (DipC1 & DipC2) and speckled (AS17). The mean value for length, width and thickness of bambara seeds ranged from 11.01 to 11.81 mm; 9.41 to 9.96 mm and thickness 9.05 to 9.48 mm, respectively. The size of the bambara seeds was graded as large (>10.5 mm), medium (9.50–10.49 mm) and small ( 3 , 2608 to 2987 mm 2 , respectively. The NTSR, BotR and DipC1 were significantly ( p 3 and 1000.2 to 1004.7 kg/m 3 , respectively. NTSR are longer while DipC2 are shorter in length than the others. DipC1 is wider and thicker while AS17 is less broad and thicker than others. The AS17 is significantly ( p

Purpose Estimating the incremental costs of scaling‐up novel technologies in low‐income and middle‐income countries is a methodologically challenging and substantial empirical undertaking, in the absence of routine cost data collection. We demonstrate a best practice pragmatic approach to estimate the incremental costs of new technologies in low‐income and middle‐income countries, using the example of costing the scale‐up of Xpert Mycobacterium tuberculosis (MTB)/resistance to riframpicin (RIF) in South Africa. Materials and methods We estimate costs, by applying two distinct approaches of bottom‐up and top‐down costing, together with an assessment of processes and capacity. Results The unit costs measured using the different methods of bottom‐up and top‐down costing, respectively, are $US16.9 and $US33.5 for Xpert MTB/RIF, and $US6.3 and $US8.5 for microscopy. The incremental cost of Xpert MTB/RIF is estimated to be between $US14.7 and $US17.7. While the average cost of Xpert MTB/RIF was higher than previous studies using standard methods, the incremental cost of Xpert MTB/RIF was found to be lower. Conclusion Costs estimates are highly dependent on the method used, so an approach, which clearly identifies resource‐use data collected from a bottom‐up or top‐down perspective, together with capacity measurement, is recommended as a pragmatic approach to capture true incremental cost where routine cost data are scarce.

Purpose – Hospital-based quality improvement (QI) programs are becoming increasingly common in developing countries as a sustainable method of strengthening health systems. The aim of this paper is to present the results and lessons learned from a QI program in a large, rural, district hospital in Lesotho, Southern Africa. Design/methodology/approach – Over a 15-month period, a locally-relevant, hospital-wide QI program was developed and implemented. The QI program consisted of: planning meetings with district and hospitals staff; creation of multi-disciplinary QI teams; establishment of a QI steering committee; design and implementation of a locally appropriate QI curriculum; and monthly consultation from technical advisers. Initial QI programming was developed in three distinct areas: maternity care, out-patient care, and referral systems. Findings – Partogram documentation in the maternity department increased by 78 percent, waiting time for critically ill patients in the out-patient department was reduced by 84 percent, and emergency referral times were reduced by 58 percent. Originality/value – The design and early implementation of QI programs should focus on easily achievable, locally-relevant improvement projects. It was found that early successes helped to fuel further QI gains and the authors believe that the work building sustainable QI skill sets within hospital staff could be useful in the future when attempting to tackle larger national-level quality of care indicators. The findings add to the existing evidence suggesting that an increased use of locally-relevant quality improvement programming could help strengthen health care systems in low resource settings.