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Background: In children with severe acute malnutrition (SAM) tuberculosis is common, challenging to diagnose, and often fatal. We developed tuberculosis treatment decision algorithms (TDAs) for children under the age of 5 years with SAM. Methods: In this prospective diagnostic study, we enrolled and followed up children aged <60 months hospitalised with SAM at three tertiary hospitals in Zambia and Uganda from 4 November 2019 to 20 June 2022. We included children aged 2–59 months with SAM as defined by WHO and hospitalised following the WHO clinical criteria. We excluded children with current or history of antituberculosis treatment within the preceding 3 months. They underwent tuberculosis symptom screening, clinical assessment, chest X-ray, abdominal ultrasound, Xpert MTB/RIF Ultra (Ultra) and culture on respiratory and stool samples with 6 months follow-up. Tuberculosis was retrospectively defined using the 2015 standard case definition for childhood tuberculosis. We used logistic regression to develop diagnostic prediction models for a one-step diagnosis and a two-step screening and diagnostic approaches. We derived scores from models using WHO-recommended thresholds for sensitivity and proposed TDAs. This study is registered with ClinicalTrials.gov, NCT04240990. Findings: Of 1906 children hospitalised with SAM during the study period, 1230 were screened, 1152 were eligible and 603 were enrolled. Of the 603 children enrolled–median age 15 (inter-quartile range (IQR): 11–20) months and 65 (11.0%) living with HIV–114 (18.9%) were diagnosed with tuberculosis, including 51 (8.5%) with microbiological confirmation and 104 (17.2%) initiated treatment at a median of 6(IQR: 2–10) days after inclusion. 108 children were retrospectively classified as having tuberculosis resulting in a prevalence of 17.9% (95% confidence intervals (CI): 15.1; 21.2). 75 (69.4%) children with tuberculosis reported cough of any duration, 32 (29.6%) cough ≥2 weeks and 11 (10.2%) tuberculosis c

Construction has long been identified as an industry resistant to change and innovation, a reality that has prevailed to shape its overall reputation. The public sector includes an influential client type that dominates the major percentage of construction demand and is subject to public law. The Modern Methods of Construction (MMC) have been championed recently by the UK government and early adopters upon the emergence of data indicating their effectiveness in addressing key construction challenges. However, the uptake of MMC has been low among UK construction clients, particularly among public client organisations. Theories emerge across decades to inform researchers of variable clusters that can aid a broader understanding of decision-making and innovation adoption. One of the popular innovation theories suggests a relation between the characteristics of decision-makers and their own innovation decisions. This paper, therefore, aims to investigate the characteristics that are responsible for public clients’ low MMC uptake despite the associated relative advantages. Overall, 91 public client organisations have responded to this research’s survey, reflecting their organisation’s characteristics in line with the constructs adapted from the Diffusion of Innovation (DOI) theory. Results suggest that among the ten influences that are captured from a detailed review of the literature, confidence in MMC firms supersedes all other factors in critically influencing the organisation’s favourable decision towards using MMC. Evidence provided in this paper suggests that a communication issue is presenting itself in the public construction sector, which is evident by the lack of confidence that public clients have in MMC businesses. This is the first study to utilise quantitative means to examine construction clients’ characteristics and relate the same to the adoption of construction innovation. Future research is encouraged to acknowledge the most influencing characteristics

Different researchers have examined construction innovation from diverse perspectives and with varied conclusions, but what has commonly transpired is that the construction industry is a complex and ever‐changing environment that tends to have a selective perspective on innovation. Recently, digitalisation has offered critical enhancements in construction organisations’ internal processes. However, the uptake of these innovations is far from satisfactory. To integrate theory with practice, sensemaking theories provide an opportunity to help us understand and explain the social phenomenon behind achieving a common meaning across social systems. In the quest to sup‐ port research efforts through understanding and explaining the enablers of digital transformation, this paper aims to qualitatively apply the sensemaking perspective to digitalisation in construction organisations. To this end, an empirical qualitative approach was adopted using a questionnaire survey of 59 construction professionals, from different firms in the United Kingdom, providing a perspective on how sense is being developed by their organisations to foster digitalisation and achieve an effective digital transformation. Results suggest that a variety of aspects contribute to the indecision of construction firms towards digitalisation, informing research of the pressure points deemed critical at both leadership and employee levels. The findings point to the complexity of construction organisations and the non‐linear nature of embracing new ideas. Future research is encouraged to assess the empirically captured cues presented in this paper through other means of investigation toward a more robust sensemaking perspective in the construction industry.

Purpose – Construction research comprises quality contributions to the Modern Methods of Construction (MMC) context in terms of their benefits and relative advantages. However, the uptake of MMC is yet deemed very low in the public sector. Knowing that public clients acquire the purchasing power and the influential status to drive industry change, understanding their low MMC uptake is necessary. Design/methodology/approach – A systematic review of literature has been chosen to extract the key variables contributing to the limited adoption of MMC across the public sector, reinforced by a qualitative semi-structured interview with twelve industry leaders and public clients. This methodology enables the authors to explore works from the past decade, paving a direction for an adequate empirical investigation by reviewing and critically analysing forty-nine academic articles and interviewing twelve industry leaders and public clients. Findings – The study captured and argued the characteristics that have an influence on public clients’ decision, inhibiting the extraction of values associated with greater MMC deployment. A critical analysis resulted in identifying 13 characteristics under 4 main themes, providing a new argument to existing knowledge by calling on the need to better understand public clients and the influence of their own characteristics on their MMC uptake. Originality/value – This paper utilises the Diffusion of Innovation theory (DOI) which offers constructs that help explain the influence of the characteristics of a decision-making unit. Our knowledge on public construction clients is limited, and more research in this direction may help in better aggregating construction demand. Overall, arguments provided in this paper enable relative improvements in contractors’ business models when approaching the public market. The study is believed to be in support of the relative governmental efforts to shape effective policies that can enhance innovation uptake

Purpose: Amidst all solutions posited to address sustainable construction practices in Nigeria, the implementation plans are repudiated by sustainable barriers. This study examines and confirms the strategy with the most significant impacts on the identified barrier to Sustainable Construction Practice (SCP). Design/Methodology/Approach: The study deployed a questionnaire survey to evaluate the perspective of 100 construction actors on the barriers and strategies of sustainable construction practice in Nigeria. Factor Analysis was employed to categorize key barriers and strategies into their underlying clusters for further analysis. Partial Least Squares Structural Equation Modelling (PLS-SEM) was used to confirm the constructs significant relationship and magnitude, thereby establishing the strategies with the highest impacts on the barriers to sustainable construction practices. Findings: The findings revealed three clusters of barriers and four groups of strategies to SCP, including techno-politic barrier, perception and awareness barrier, and sociocultural barrier. For the significant strategies, education and training, stakeholder regulation, incentive support and government and legislative support strategies were established. Overall, education and training strategy was identified as the most dominant and effective strategy to mitigate the barriers of SCP in Nigeria. Originality/Value: The paper establishes education and training as the key strategy to achieving sustainable quest in the AEC industry. The practical implication is that policy makers, educators and professional bodies can harness sustainable knowledge transfer through education and training to improve sustainable construction practices in Nigeria.

The benefits of integrating immersive technologies (ImTs) within a construction safety context are acknowledged within the literature, however its practical application on construction sites remains low. Whilst research into the integration of ImTs within the construction industry is underway, most have viewed this from a broader adoption context or within educational settings, and not specifically from a practical on-site safety perspective. Therefore the purpose of this study is to address the contributing factors to its integration within on-site safety processes, using the experiences of active construction professionals. This study adopts a qualitative approach. Data was collected through online focus groups involving UK based construction professionals with experience in using ImTs, recruited using selective sampling. Data sets were subsequently analysed using inductive thematic analysis and are presented within key themes. The results showed that amongst the experienced construction professionals, the use of ImTs specifically for on-site safety applications (including inductions/training/workshops) was rare on projects. The findings identified various contributing factors related to the integration of ImTs, including the potential improvements in on-site safety practices such as enhanced communication of hazards, safety planning, engagement during training and more accurate risk assessment. Critical challenges, concerns and frustrations included a lack of engagement from senior level management, inadequate leadership, limited investment, a need for digital expertise, fear of complacency and the acceptance of ImTs within existing safety processes from the wider project team. This study provides a fresh perspective to this field by using practical accounts from active and experienced on-site construction professionals. This study supports the integration of ImTs within the construction industry, presenting key contributing factors influencing its integration wi

The surveying profession in the UK construction industry continues to be blighted by a skills shortage, and this continues to constrict growth. Therefore, it is suggested that this should make it easier for women and other underrepresented groups to be employed in the construction industry. While this is the case, barriers to entry have been well researched. This study aimed to identify what methods have been previously successful at increasing female engagement within the surveying profession in the UK. This study followed a mixed-method, complementary approach, combining quantitative and qualitative questions in an online questionnaire, which was distributed via social media (LinkedIn) and the researchers’ contacts, and achieved 44 responses over a period of six weeks. The target population was female UK residents employed in surveying roles. Quantitative data on both awareness and opinion of the methods used during previous initiatives to engage women with surveying underwent reliability analysis, descriptive statistical analysis, and a Spearman’s rank order correlation to assess the relationship between time in industry and opinion on the efficacy of the methods used in each initiative; however, no statistically significant relationship was found. To better understand the opinions of women already in the industry, the qualitative data underwent thematic analysis via inductive coding, the results of which then underwent descriptive statistical analysis. The study found a broad lack of awareness of previous initiatives, with most respondents having little or no awareness of the five initiatives examined. However, evidence suggested there was general support for the methods used in those initiatives, such as intervention at school age, increasing the visibility of women in surveying roles, and changes to workplace culture. There was no statistically significant link between time in industry and opinion on the efficacy of each initiative. Key themes included concern

The staggering demand for construction projects to meet a spectrum of public needs is projected to outstrip the industry’s supply capability. The Modern Methods of Construction (MMC), are methods that relies on shifting key construction processes offsite, a transformation from traditional practices that offers wider control, transpiring as a critical necessity. Public clients play a significant role as drivers for innovation and as the industry’s purchasing power, however, their uptake of MMC projects is still low, despite the associated benefits. The purpose of this study is to reveal the reasoning behind such low adoption. The research gap, herewith, is our lack of understanding on the perception of public clients from MMC, and how the same is contributing to their adoption’s indecision. This study utilised a qualitative approach to investigate the motives behind the public sector’s low MMC adoption. Semi-structured interviews with 14 of the United Kingdom’s public sector’s decision-makers, industry leaders, and experts have been conducted. Perspectives were argued against the Diffusion of Innovation theory (DOI). Overall, the innovation’s attributes informed the authors of the positive perceptions from the public sector, demonstrating that the low adoption of MMC is not linked to any embedded issues with the innovation itself rather being predominantly related to the dynamics between supply and demand. The former (supply), reflected a failure in communicating confidence, and the latter (demand), attained characteristics that are limiting wider uptake. This is the first study to apply the Diffusion of Innovation theory to reveal the relationship between UK public clients’ perceptions and their decision-making. Moreover, this paper addresses the scant attention to the use of theories to explain the flow of innovations in the construction context.

Purpose – In the past decade, transforming key processes and activities towards a more digital nature has been the focus of most industries due to the associated advantages. Despite that, organisations in the construction sector are lagging the list of early adopters. The slow rate of a fundamental digital transformation is linked to the challenges facing an effective leadership. The purpose of this paper is, therefore, to shed light on the barriers to digital leadership enactment in the construction industry. Limited research has empirically analysed and discussed these barriers to explain the low transformation rate in the existing body of knowledge. Design/methodology/approach – This paper empirically investigates the perspectives of construction industry professionals acquiring various roles in the industry. Overall, the study comprises the views of 38 participants, adopting a qualitative methodological approach to explore relative barriers and explain the slow digital transformation rate. Findings – Findings are grouped into five themes: leadership characteristics, management and organisational issues, resource constraints, technological issues, and risk perceptions. The findings are helpful to business leaders, researchers, trainers, and educators to develop measures to encourage leaders in the industry to be at the forefront of digital transformation in their organisations. Originality/value – Literature, however, is discreet in reflecting the challenges and barriers facing today’s leadership in facilitating digital transformation among construction stakeholders. This paper provides insights into the variables that may be undermining wider digital adoption across the construction sector’s organisations.

The existing body of knowledge on the Modern Methods of Construction (MMC) reflects their benefits and relative advantages, particularly in addressing contemporary construction challenges. However, the uptake of such methods is minimal, particularly in the public construction sector. The low uptake has led MMC firms to liquidation due to the lack of an economy of scale. Studies, particularly recently, explain that the low adoption rates are linked to the inappropriateness of existing business models responsible for driving broader demand. This paper assumes that the lag in MMC adoption could be related to the ability of supply business models to communicate confidence to demand. Public clients are foreseen as important target customers, acquiring influential status across the industry, with an expected potential to drive innovation adoption across the sector. A systematic review method allows scholars to assess existing literature by critically locating and analysing relative publications to approach the study’s aim. Through utilising this method, the study classifies the arguments against the Business Model Canvas (BMC), and argues the results with respect to contingency theory, and in turn, synthesizing a new meaning that reveals the considerations needed to boost business model performance when penetrating the public sector. Hence, the critical analyses of 70 studies relative to MMC, led to proposing the contingencies that are believed to better structure business models. Results suggest that MMC firms can embrace specific reforms and gain more momentum when communicating confidence to public client organisations; however, a guideline that conceptualises the interactions between the elements and their influence on the decision-making does not exist, and this may be inhibiting coherency on how MMC businesses drive broader demand. To the authors’ knowledge, this is the first study to utilise the contingency theory as an attempt to disseminate previous efforts to ex

Due to the practical complexity and fragmented nature of the construction industry, digitalisation, like other innovations, is not easily achieved. This study aimed to explore organisational influences on digitalisation within construction firms. Due to the practical complexity and fragmented nature of the construction industry, digitalisation, like other innovations, is not easily achieved. This study aimed to explore organisational influences on digitalisation within construction firms. Construction professionals from twenty-two organisations provided their perspectives on digital transformation and their organisations. Under four constructs- structure, culture, leadership, and internal processes, findings uncovered sixteen determinants critical to digitalisation in construction firms. The study offers a offers a theoretical perspective supported by empirical data to explore the complex dynamics and internal interactions of organisational influence on the uptake of digitalisation in the construction industry. This paper offers arguments from a theoretical lens by applying the organisational influence model and capturing the variables under each construct in an exploratory manner to highlight the reasoning behind the low digital uptake in construction firms. This research aids academia and practice on the pressure points responsible for enhancing, or undermining, digital uptake in construction firms at an organisational level.

The construction industry makes a significant contribution to the global green-house gas emission. It is, therefore, critical that construction industry professionals should be aware of and practise sustainable construction. However, there is a paucity of studies on the awareness of sustainability and their practices in developing countries, with some results seemingly contradicting. This article explored the awareness and practices of sustainability in the Zambian construction industry. Data was collected from construction industry professionals through a questionnaire survey and a total of 112 responses were received. The relative importance index (RII) and a series of linear regression analyses were used to analyse the data. The participants’ perception of sustainability was primarily enviro-centric as opposed to the economic or social context. However, social and economic sustainability practices ranked highest, while environmental sustainability practices ranked in the bottom five of the 16 practices. While the participants perceived the environmental context as more critical in their understanding of sustainability, their practice reflected a focus on the social and economic sustainability context. The findings imply that merely increasing the level of knowledge and awareness of environmental sustainability may not lead to gross improvements in environmental sustainability practices. Therefore, studies that recommended increasing knowledge and awareness, in order to increase the implementation of environmentally sustainable construction, may have neglected the effect of the other barriers to sustainable construction which may be more critical. Studies with multivariate analyses such as structural equation modelling are needed to establish the contributory effect of the various barriers to environmental sustainability practices and so establish the extent to which knowledge and awareness alone, and other factors, can improve environmental sustainability practic

Purpose – Challenges to energy access in Nigeria have resulted in the widespread use of fossil fuel generating sets (generators) despite their renewable energy (RE) potential. Given the climate crisis, combined with the country’s rapid population growth and expected rise in energy and building demand, transitioning to low-carbon electricity using REs like solar photovoltaic (PV) presents opportunities beyond securing its energy future. While PV use is growing in Nigeria, this is focused on the residential sector despite the identification of the commercial sector as a high energy consumer and a key platform for its integration. This paper investigates the challenges in transitioning to solar PV in commercial buildings from a building professionals perspective Design/methodology/approach – A qualitative approach in line with grounded theory was adopted using in-depth face-to-face interviews with industry experts. Findings – Two distinct but interrelated categories emerged: being held captive and being a saviour that represented a duality of systems, and/or processes formed the core category ‘Hostage Syndrome’. The core category (theory) was generated based on the explanations and expressions by participants about their concerns, interests, and the conditions under which they operate. The findings reveal the value attributed to generators beyond an operational role and the adjustments or mechanisms adopted by building professionals during their practice. It suggests a sphere of influence beyond the obvious financial and/or institutional aspects, as determining factors to what is viewed as sustainable which will be key to transitioning to REs. Originality/value – This paper provides new and in-depth insight into understanding the conditions under which building professionals operate associated with their interpretations of ‘being sustainable’. The study highlights the need to consider psychological and cultural factors in the development of interventions, strategies, a

Environment protection legislation is often inadequate and poorly implemented in Africa even though literature shows that it is important for environmental protection. Furthermore, there is a paucity of studies which examine the catalytic role of legislation in the building infrastructure sustainability agenda. Therefore, to bridge that knowledge gap, this study examined the adequacy of environment protection legislation for building infrastructure projects in Zambia and their associated challenges and solutions. The study used an exploratory qualitative approach using semi-structured interviews with key stakeholders on environment protection. The study theorises that environment protection legislation in Zambia is fairly adequate but with inadequacies in its implementation, some with omitted content, and poor understanding of the importance of environment protection. Solutions include increasing the level of implementation of the legislation and championing awareness of the importance of protecting the environment. The findings have implications for sustainability transitioning in Africa.

The use of immersive sensory technology for safety management is generally shown positively in academic literature. Many researchers have demonstrated applications of this technology for improving safety training in a risk-free environment. Despite the reported benefits and a global pandemic forcing the digital agenda, the uptake of this technology for this purpose remains slow. This study aims to investigate current drivers and challenges of implementing this technology for safety from an industry-based perspective. To achieve this, qualitative data was collected through 4 online focus groups involving 21 industry professionals working within the field. The findings identified that even amongst these experts, the technology was rarely implemented on projects specifically for safety. Despite this lack of adoption, participants agreed that if implemented correctly this technology has the potential to enhance site safety processes such as inductions, toolbox talks and general safety training. The commitment to safety and legislative requirements were identified as key drivers, whilst deep rooted challenges surrounding client demand, costs and leadership dominated the discussion. The onsite practicalities, personal comfort and lack of digital skills were also identified as concerns if this technology was to be adopted more mainstream in safety training. Further recommendations are made to develop understanding of these specific challenges, including investigating the industry need and availability of specific skills in immersive safety applications. In addition, it is recommended that further empirical evidence including the impact of this technology when implemented for safety on projects is provided in literature.

While previous studies have highlighted the importance of incorporating environmental sustainability in building designs, there is a paucity of studies which assess the extent to which design teams in developing countries consider environmental sustainability at the building design stage. Therefore, using Zambia as a case study, this study examined the extent to which infrastructure design teams in a developing country consider environmental sustainability at the design stage. The study employed a qualitative research approach using structured interviews because there are hardly any studies which have explored the extent to which designers incorporate environmental sustainability in infrastructure designs in developing countries. The data were analysed thematically using the ATLAS.ti software. The results show that environmental sustainability is not an important design consideration because it is secondary to functional, technical and aesthetic considerations. Environmental considerations are also made in an ad-hoc manner and when it is cost effective for the project. Regulatory requirements pertaining to environmental protection are adhered to without any cost considerations. It was therefore theorised that building design teams in developing countries make technical, functional and aesthetic consideration during the infrastructure design stage ahead of environmental considerations. There is a paucity of studies that have investigated whether building infrastructure designers consider issues of environmental sustainability at the design stage in developing countries. The findings have practical implications on how developing countries can foster environmental sustainability at the design stage and avoid generating a building infrastructure stock that will require environmental resilience adaptation in the future.

This study considers the role of leaders in driving digital transformation in their organisations. Considering that the construction industry is slow at adopting digital technology, the aim of the study was to explore the factors that inhibit leaders from driving digital transformation in their organisations. Data was collected through a qualitative questionnaire survey. Participants were asked to describe barriers to effective digital leadership in their organisations. The issues that hinder effective digital leadership were grouped under five themes: leadership characteristics, management and organisational issues, resource constraints, technological issues, and risk perceptions. The study shed light on the barriers to digital leadership enactment in the construction industry, an issue that has received limited attention in the existing literature. The findings are useful to business leaders, researchers, trainers and educators to develop measures to encourage leaders in the industry to be at the forefront of digital transformation in their organisations.

Due to the practical complexity and fragmented nature of the construction industry, digitalisation, like other innovations, is not easily achieved. This study aimed to explore organisational influences on digitalisation within construction firms. Due to the practical complexity and fragmented nature of the construction industry, digitalisation, like other innovations, is not easily achieved. This study aimed to explore organisational influences on digitalisation within construction firms. Construction professionals from twenty-two organisations provided their perspectives on digital transformation and their organisations. Under four constructs- structure, culture, leadership, and internal processes, findings uncovered sixteen determinants critical to digitalisation in construction firms. The study offers a offers a theoretical perspective supported by empirical data to explore the complex dynamics and internal interactions of organisational influence on the uptake of digitalisation in the construction industry. This paper offers arguments from a theoretical lens by applying the organisational influence model and capturing the variables under each construct in an exploratory manner to highlight the reasoning behind the low digital uptake in construction firms. This research aids academia and practice on the pressure points responsible for enhancing, or undermining, digital uptake in construction firms at an organisational level.

Zambia, and Sub-Sahara Africa (SSA) generally, is lagging behind in the area of sustainable construction due to several barriers to the implementation of sustainable construction. This study therefore explored drivers and barriers to the adoption of sustainable construction practices in Zambia. The study could inform stakeholders on measures which could improve the implementation of sustainable construction. The study used an online quantitative questionnaire survey of construction professionals and clients. A total of 112 responses were received representing various stakeholder groups in the construction industry. The data were subjected to factor analysis and ranked using the relative importance index. The data show that drivers to sustainable construction cluster into three constructs namely, environment and health-related factors, regulatory and industry-related factors and, economy and firm related factors. Barriers clustered into three groups namely, awareness and knowledge related factors, regulatory and industry-related factors and, economy and cost-related factors. Therefore, measures aimed at improving sustainable construction in Zambia should focus attention on these broad clusters.

Background: Tuberculosis diagnosis might be delayed or missed in children with severe pneumonia because this diagnosis is usually only considered in cases of prolonged symptoms or antibiotic failure. Systematic tuberculosis detection at hospital admission could increase case detection and reduce mortality. Methods: We did a stepped-wedge cluster-randomised trial in 16 hospitals from six countries (Cambodia, Cameroon, Côte d'Ivoire, Mozambique, Uganda, and Zambia) with high incidence of tuberculosis. Children younger than 5 years with WHO-defined severe pneumonia received either the standard of care (control group) or standard of care plus Xpert MTB/RIF Ultra (Xpert Ultra; Cepheid, Sunnyvale, CA, USA) on nasopharyngeal aspirate and stool samples (intervention group). Clusters (hospitals) were progressively switched from control to intervention at 5-week intervals, using a computer-generated random sequence, stratified on incidence rate of tuberculosis at country level, and masked to teams until 5 weeks before switch. We assessed the effect of the intervention on primary (12-week all-cause mortality) and secondary (including tuberculosis diagnosis) outcomes, using generalised linear mixed models. The primary analysis was by intention to treat. We described outcomes in children with severe acute malnutrition in a post hoc analysis. This study is registered with ClinicalTrials.gov (NCT03831906) and the Pan African Clinical Trial Registry (PACTR202101615120643). Findings: From March 21, 2019, to March 30, 2021, we enrolled 1401 children in the control group and 1169 children in the intervention group. In the intervention group, 1140 (97·5%) children had nasopharyngeal aspirates and 942 (80·6%) had their stool collected; 24 (2·1%) had positive Xpert Ultra. At 12 weeks, 110 (7·9%) children in the control group and 91 (7·8%) children in the intervention group had died (adjusted odds ratio [OR] 0·986, 95% CI 0·597–1·630, p=0·957), and 74 (5·3%) children in the control group

Businesses in the construction industry are experiencing pressure to modernise by embracing digital technologies. Like any other change initiative, digital transformation requires that leaders are at the forefront of their organisations’ pursuit for digital innovation. Therefore, the purpose of this study was to explore the different leadership approaches exhibited by construction industry leaders in influencing their organisations’ digital paths. Qualitative data collected from 41 construction industry professionals were analysed using an inductive thematic analysis approach. The main finding was a taxonomy of digital leadership types characterised under six themes: proactive and forward-thinking; supportive; uncoordinated; cautious; resistant and visionless & undriven leaders. These themes provide an insight into how leaders influence the digital transformation paths in organisations. As far as the authors are aware, this study is the first that developed a taxonomy of digital leadership approaches in the construction industry. This is a valuable step in understanding leaders' influence in driving digital transformation in the construction industry. Thus, the taxonomy of digital leadership can be used to evaluate leadership styles and attitude towards digitalisation. The findings are also a platform for further studies on digital leadership in construction.

Purpose: This study investigated the suitability and cost-benefit of using copper tailings as partial replacement of sand in concrete production. The study was motivated by the accumulation and non- utilisation of Copper Tailings in dams among them Tailing Dam 25 also known as TD 25 in Kitwe city of the Copperbelt province in Zambia that take up approximately 111 hectares of unutilised land. Design/methodology/approach: Laboratory experimental approach of concrete production based on water/cement ratios of 0.3 and 0.5 was used because this was an exploratory study designed to establish the primary performance of .concrete. 30 concrete cubes were cast based on the two water-cement ratios. 0% to 30% partial sand replacement with copper tailings was used in both mixes with the 0% copper tailings replacement being the control mix and reference point. Other concrete tests included workability, density, compressive strength and element composition analysis. Findings: Results revealed that copper tailings from TD 25 were suitable for partial replacement of sand in concrete. 30% of sand replacement with copper tailings was established as the maximum replacement amount in order to produce optimum compressive strength values from both mixes. The drier mix of 0.3 water-cement ratio produced higher compressive strength results of 23 MPa at 28 days of concrete curing with 2.34% as optimum concrete cost reduction. Originality/Value: The study provides guidance on optimum concrete grade produced and cost reduction details of copper tailing-based concrete to support for local authorities in suitable land wand waste management using real data.

In 2008, the Public Private Partnership (PPP) concept was identified by the Zambian Government as a vehicle for scaling up public infrastructure project delivery in the country. A platform for active private sector participation in the direct provision of public goods and services was created by enacting the PPP Act No. 14 of 2009. It was anticipated that this would encourage the local and international private sector to participate in delivering PPP projects. The aim of this research was therefore to investigate the role of this PPP Act on the private sector’s decision to participate in PPP projects in Zambia. A mixed method design was adopted for this research due to limited information and stakeholders on the ground. 43 industry practioners representing contractors, developers’ financiers and government were identified motivating a mixed method approach in order to obtain more data given a generally lower sample available. A total of 27 questionnaires were obtained. Findings revealed that the PPP Act had not played a significant role to influence private sector decision to participate in PPP projects. The findings from this research unlocks part of the reason why there is little participation by private sector in PPP projects. The research identifies presents areas of focus in amending the Act in order to attract and influence private investment in current critical areas such as energy, higher education and housing among others. The study recommends that the immediate revision of PPP Act to remove identified barriers which among others include inadequate and unclear governing PPP framework, obstruction by bureaucracy, inappropriate risk sharing mechanisms and absence of protection to the private sector stakeholders.

Background. A predominant feature of Schistosoma haematobium infection is urinary egg excretion, and microscopic egg detection remains the accepted standard field diagnostic tool. Praziquantel is the drug of choice for schistosomiasis, and the World Health Organization recommends that it should be administered to all children >4 years of age living in schistosomiasis-endemic areas. The frequency of mass drug administration depends on the prevalence rate in the community. Urinary schistosome egg output has a day-to-day and hour-to-hour intrasubject variation. Therefore, it is important to assess possible seasonal variations in egg excretion to improve the planning of drug treatment. Objectives. To assess the influence of seasonality on urinary schistosome egg excretion in South Africa (SA). Methods. We performed a prospective cohort study, exploring seasonal variations of S. haematobium egg excretion in 184 girls aged 10 - 12 years from randomly selected schools in a rural area of KwaZulu-Natal Province, SA. The area has a subtropical climate characterised by a cool dry season and a hot humid season. For children, water contact is higher in the latter season. At baseline, 108 girls were examined in the hot season, and 76 in the cold season. In the next year’s cold season the untreated patients were re-investigated before treatment. Results. There was a decrease in infection in the group initially tested in the hot season compared with the group tested in the cold season at both time points when adjusted for age and water contact (adjusted odds ratio 3.61 (95% confidence interval 1.14 - 11.44); p=0.03). Conclusions. This unique study shows that schistosomiasis prevalence determined by microscopy exhibits seasonal variation, with a higher prevalence in the hot rainy season. Precise community prevalence estimations are key in decisions to treat communities. There was significantly lower egg output in the cold season, and sampling in that season may therefore underest