BackgroundPreventing mother-to-child transmission (PMTCT) of human immunodeficiency virus infection (HIV) has been a fundamental advancement in the acquired immunodeficiency syndrome (AIDS) response for the past decade. Several countries have made great strides in the efforts to prevent HIV through mother-to-child transmission. The objective of this study is to assess the determinant and outcome of early diagnosis of HIV infection among HIV-exposed infants in southwest Ethiopia.MethodsAn institutional based retrospective cohort study was conducted in a hospital. Medical records of HIV-exposed infants and their mothers enrolled into the program were reviewed. Data entry and analysis was carried out using SPSS version 20 for Windows.ResultsA total of 426 HIV exposed infant-mother pairs where both mother and infants received a minimum ARV intervention for PMTCT were included in the study. Two hundred fifty-four (59.6%) of mothers had attended antenatal care (ANC). Of all participants, 234(54.9%) mothers did not receive any PMTCT prophylaxis during ANC, while only 104(24.4) received antiretroviral (ART) as PMTCT prophylaxis and 163(38.3%) claimed that did not observe any infant PMTCT interventions while 135(31.7%) of the infants received single-dose NVP + AZT. About 385(90.4%) infants were not infected at their final infection status. Those mothers who did not attended ANC follow-up, infants on mixed and complementary feeding and infants weaned off and mothers who were in WHO clinical stage III and IV were more likely to have HIV sero positive infant.ConclusionThis study showed that 385(90.4%) of the infants were not infected at their final infection status. Therefore, encouraging pregnant women to visit health facilities during their course of pregnancy, focusing on exclusive breast feeding counseling and promotion, and early initiation of antiretroviral treatment to HIV infected pregnant women are recommend.

Through the course of this PhD, I have benefited greatly from the guidance and support of a number of people. First, my sincere gratitude to my supervisor Bendik Bygstad whose advice and input throughout my PhD has been invaluable. Thank you for always expecting more from me and for encouraging and challenging me to produce better work. I would also like to thank Margunn Aanestad whose constructive and insightful feedback has often allowed me to see my work from a different perspective. Thank you for your candid and supportive attitude.I would also like to express my appreciation to my colleagues and friends at the Information Systems Group in the Department of Informatics. Special thanks to Ellen Fruijter and Esther Namatovu whose support and friendship during this experience has been valuable. To those who especially provided feedback on my work at various stages: Egil Øvrelid, Elizabeth Davidson, and Sundeep Sahay, thank you. I am also grateful for the informants who participated in this study and for the financial support of this work by the Faculty of Mathematics and Natural Sciences under the Design for the Methods for Complex Architectures (DEMCA) initiative.Last but not least, I would like to thank my family without whom this would have not been attainable. Thank you, Dad, for being a constant voice of wisdom and support throughout my academic journey. Special thanks to the Gebre-Mariam's, Alemnesh Gosheme, Alemayheu Abebe and Kassa Keraga. To my wife, Bersabeh, this is not my accomplishment alone. My deepest gratitude for your unconditional love. Finally, to the orchestrator of all things, thank you God for this growing experience.

The paper investigates interorganizational health information system implementation in a developing country health sector and the influence of the sociopolitical context that constitutes the institutions of the global health system. It argues that a comprehensive understanding of interorganizational system (IOS) implementation should include the study of the institutional context and its stakeholders who exhibit complex social and political attributes that influences its implementation and trajectory.This paper charts this course by examining the key governance dimensions of coordination and alignment. Building on this, the study challenges the viability of the unstructured institutional arrangements and the ensuing development modalities for health information system implementation, which are largely facilitated by international nongovernmental organizations and leverage on information and communication technology. The paper concludes by discussing the implications of the study.These include (1) the influence of unstructured interorganizational relations, at both the organizational and sector levels, on IOS adoption, (2) how the social and political behaviors of opportunistic interorganizational participants are implicated in the IOS adoption process, and (3) the role of strategic alignment, largely driven by the informal interorganizational relationship and social dimensions, on the prioritization and fit between IOS technological and organizational components.

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