Editor-in-Chief Derege Kebede Associate Editor-in-Chief

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The Ethiopian Journal

of Health Development


Derege Kebede

Associate Editor-in-Chief

Gabre-Emanuel Teka

Editorial Board

Dawit Abebe

Gabremaskel Habtemariam

Hailu Yeneneh

Mehari Woldeab

Tesfaye Bulto

Tigest Ketsela

Wondimagegnehu Alemu

Zewdie Wolde-Gebriel

Publication officer

Fisseha Eshetu

Publication Assistant

Simon Tekle-Haimanot


Meskerem Bezuayehu
Ethiopian Public Health


Executive Committee

Derege Kebede (Chairman)

Chanyalew Kassa (Exec. secretary)

Seyoum Taticheff

Hailu Yeneneh

Wondimagegnehu Alemu

Desta Alamerew

Haregewoin Cherenet (Treasurer)

Mesfin Kassaye (Auditor)

Copyright  Department of commu-

nity Health, Addis Ababa University.

All rights reserved. This Journal, or

any parts thereof, may not be reprod-

uced in any manner without written


The Ethiopian Journal of Health Development is

published three times a year by the Department of

Community Health, Addis Ababa University .

The Journal is jointly sponsored by the Ethiopian

Public Health Association and the Addis Ababa


All articles published in the Journal, including editorials, represent the opinion of the authors and

do not necessarily reflect the official policy of the

Ethiopian Public Health Association, the Editorial

Board of the Journal or the institution with which

the author is affiliated, unless this is clearly


Address all correspondence to: The Ethiopian

Journal of Health Development, Tikur Anbessa

Hospital, P.O. Box 32812, Addis Ababa, Ethiopia.

Telephone:+251 1 513628, or +251 1 157701,

FAX: +251 1517701.

Annual subscription rates: Ethiopia 30.00 Birr;

outside Ethiopia 50.00 US Dollars. All prices

include postage. Checks should be payable to: Addis

Ababa University, with postal address: P.O.Box

32812, Addis Ababa, Ethiopia.

Publication of this issue was financially supported

by the Ethiopian Public Health Association (through

a grant from the Canadian Public Health

Association), the Ethiopian Science and Technology

Commission (through a grant from SAREC) , and

Addis Ababa University.

EPHA mission statement
The Ethiopian Public Health Association is a

national, independent and voluntary association of

professionals working or interested in public health.

Its mission is to constitute a special national resource

that advocates for, and contributes to, the national

effort of health promotion and disease prevention .

The Journal contributes to EPHA's mission

through publishing of peer-reviewed original

articles, reviews and correspondences on the broad

field of health development.

Style requirement for authors

The Ethiopian journal of Health Development is a multi-disciplinary peer-reviewed publication concerned

with all aspects of public health and preventive medicine. The language of the journal is English. Articles of

national importance written in Amharic might be accepted for special issues. All dates in manuscripts s~1d be based on the Gregorian calendar, not on the Ethiopian calendar.
Each manuscript will be assessed by at least two reviewers knowledgeable in the relevant subject. manuscripts that are accepted for publication become the property of the journal; rejected manuscripts will e

returned to the author .

The Editorial Board reserves the right of final acceptance, rejection and editorial correction of papers

submitted. Priority and time of publication are governed by the Editorial Board's decision.

If the text is on a wordprocessor, we request that a diskette, be sent once the paper has been accepted for

publication. Twenty five reprints will be supplied free to'the senior author. Additional reprints may be ordered and paid for in advance.

All manuscripts submitted to the journal must conform to the following requirements. These requirements are in accordance with the uniform requirements for manuscripts submitted to biomedical journals as published by the International Committee of Medical Journal Editors (Uniform requirements for manuscripts submitted to biomedical journals. N Engl J Med 1991; 324: 428-8).
Submission of manuscripts All manuscripts should be submitted to the Editor-in- Chief of the journal. Mail the required. number of manuscript copies in a heavy paper envelope, enclosing the manuscript.copies and figures in cardboard, if necessary, to prevent bending of photographs during mail handling. Place hotographs

and transparencies in a separate heavy paper envelope.

Manuscripts must be accompanied by a covering letter signed by all authors. This must include (a) information on prior or duplicate publication or submission elsewhere of any part of the work as defined earlier in the document: (b) a statement of financial or other relationships that might lead to a conflict of interest; (c) a statement that the manuscript has been read and approved by all authors, that the requirements for authorship as previously stated in this document have been met, and furthermore, that each coauthor believes that the manuscript represents honest work; and (d) the name, address, and telephone number of the

corresponding author, who is responsible for communicating with the other authors about revisions d final approval of the proofs. The letter should give y additional information that may be helpful to the Editor-in-Chief, such as the type of article the manuscript represents and whether the author(s) will be willing to meet the cost of reproducing colour illustrations. The manuscript must be accompanied by copies of any permission to reproduce published material to the illustrations or report sensitive personal information of identifiable persons, or to name persons for their contributions.

Prior and duplicate publication

The Journal will not consider for publication a paper on work that has already been reported in a published paper or is described in a paper submitted or accepted for publication else where. This policy does not usually preclude consideration of a complete report that follows publication of a preliminary report, usually in the form of an abstract. Nor does it prevent consideration of paper that has been presented at a scientific meeting if not published in full in a proceedings in similar publication. Press reports of the meeting will not usually be considered as breaches of this rule, but such reports should not be amplified by additional data or copies of tables and illustrations. When submitting a paper an author should always make a full statement to the editor about all submissions and previous reports that might be regarded as prior or dupl icate publ ication of the same or very similar work. Copies of such material should be included with the submitted paper to help the editor decide how to deal with the matter .
Multiple publication-that is, the publication more than once of the same study, irrespective of whether the

wording is the same-is not acceptable. Secondary publication in another language is one possible justification, provided the following conditions are met.

(1) The Editorial Board of the Journal is fully informed and approves the secondary publication; the editor

concerned with secondary publication should have a photocopy, reprint, or manuscript of the primary ersion.

(2) The priority of the primary publication is respected by a publication interval of at least two weeks.

(3) The paper for secondary publication is written for a different group of readers and is not simply a translated version of the primary paper; an abbreviated version will often be sufficient.

(4) The secondary version reflects faithfully the data and interpretations of the primary version.

(5) A footnote on the title page of the secondary version informs readers, peers, and documenting agencies that the paper was edited, and is being published, for a national audience in parallel with a primary version

based on the same data and interpretation. A suitable footnote might read as follows: "This article is based on a study first reported in (title of journal, with full reference)".
Multiple publication other than as defined above is not acceptable to the Journal. If authors violate this rule they may expect appropriate editorial action to be taken. Preliminary release, usually to public media, of scientific information described in a paper that has been accepted but not yet published is a violation of the policy of the journal. In exceptional cases, and only by arrangement with the Editor-in-Chief, preliminary release of data may be acceptable-for example, to warn the public of health hazards.
Preparation of manuscript

Type the manuscript on white bond paper, 216 x 279 mm (1/2 x 11 in.) or 150 A4 (212 x 297 mm), with margins of at least 25 mm (1 in.). Type only on one side of the paper. Use double spacing throughout, including title page, abstract, text, acknowledgments, references, table, legends for illustrations. Begin each of the following sections on separate pages: title page, abstract And key words, text, acknowledgments, references, individual tables, and legends. Number pages consecutively, beginning with the title page. Type the page number in the upper or lower right-hand corner of each page.

Title page

To ensure anonymity in the peer review process, authors should supply identifying information on the title page of the original only; the title page for the two reviewers copies should list only the title. On the original, the title page should carry (a) the title of the article, which should be concise but informative; (b) first name, middle initial and last name of each author; with highest academic degree(s) and institutional affiliation; (c) name of department(s) and institutions(s) to which the work should be attributed; (d) disclaimers, if any; (e) name and address of author responsible for cqrrespondence about the manuscript; (I) name and address of author to whom requests for reprints should be addressed or statement that reprints will not be available from the author; (g) sources(s) of support in the form of grants, equipment, drugs, or all of these; and (h) a short running head or foot line of no more than 40 characters (count letters and spaces) placed at the foot of the title page and identified.


All persons designated as authors should quality for authorship. The order of authorship should be a joint decision of the coauthors. Each author should have participated sufficiently in the work to take public responsibility for the content.
Authorship credit should be based only on substantial contributions to (a) conception and design, or analysis

and interpretation of data; and to (b) drafting the article or revision it critically for important intellectual content; and on (c) final approval of the version to be published. conditions (a), (b), and (c) must all be met. Participation solely in the acquisition of funding or the collection of data does not justify authorship. General supervision of the research group is also not sufficient for authorship. Any part of an article critical to its main conclusions must be the responsibility of at least one author. A paper with corporate (collective) authorship must specify the key persons responsible for the article; others contributing to the work should be recognized separately (see Acknowledgments).

Abstract and key words

The Second page should carry and abstract (of no more than 300 words). The abstract should state the purposes of the study or investigation, basic procedures (selection of study subjects or laboratory animal, observational and analytical methods), main findings (give specific data and their statistical significance, if possible), and the principal conclusion. Emphasize new and important aspect of the study of observations. Below the abstract provide, and identify as such 3 to 10 key words or short phrases that will assist indexers in

cross-indexing the article and may be published with the abstract. Use terms from the medical subject headings (MeSH) list of Index Medicus; if suitable MESH terms are not yet available for recently introduced terms, present terms may be used.


The text of observational and experimental articles should be divided into sections with the headings: Introduction, Methods, Results, and Discussion. Long articles may need subheadings within some sections to

clarify their content, especially the Results and Discussion sections. Other types of articles such as case reports, reviews, and editorials can have other formats.


State the purpose of the article. Summarize the rationale for the study or observation. Give only strictly pertinent references, and do not review the subject extensively. Do not include data or conclusions form the work being reported.


Describe your selection of the observational or experimental subjects (patients or laboratory animals, including controls) clearly. Identify the methods, apparatus (manufacturer's name and address in parentheses), and procedures in sufficient detail to allow other workers to reproduce the results. Give references to established methods, including statistical methods (see below); provide references and brief descriptions or methods that have been published but are not well known. Describe new or substantially modified methods, give reasons for using them, and evaluate their limitations. Identify precisely all drugs and chemicals used including generic names(s), dose(s), and route(s) of administration.


When reporting experiments on human subjects indicate whether the procedure followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional or regional) or with the Helsinki Declaration of 1975, as revised in 1983. Do not use patients' names, initials or hospital numbers. When reporting experiments on animals indicate whether the institution's or the national Research Council's guide for, or any national law on, the care and use of laboratory animals was followed.


Describe statistical methods with enough detail to enable a knowledgeable reader with access 10 the original data to verify the reported results. When possible, quantify findings and present them with appropriate indicators of measurement error or uncertainty (such as confidence intervals). Avoid sole reliance on statistical hypothesis testing, such as the use of P values, which fails to convey important quantitative information. Discuss eligibility of experimental subjects.
Give details about randomization. Describe the methods for and success of any blinding of observations. Report treatment complications. Give numbers of observations. Report losses to observation (such as dropouts from a clinical trial). References for study design and statistical methods should be to standard works (with pages stated) when possible rather than to papers in general-use computer programs used. Put general descriptions of methods in the Methods section. When data are summarized in the Results section specify the statistical methods used to analyze them. Restrict tables and figures to those needed to explain the argument of the paper and to assess its support. Use graphs as an alternative to table with many entries; do not duplicate data in graphs and tables. Avoid nontechnical uses of technical terms in statistics, such as "random" (which implies and randomizing device), "normal," "significant," "correlations," and "sample."


Present your results in logical sequence in the text, tables, and illustrations. Do not repeat in the text all the

data in the table on illustrations; emphasize or summarize only important observations.


Emphasize the new and important aspects of the study and the conclusions that follow from them. Do not repeat in detail data or other material given in the Introduction or the Results section. Include in the Discussion section the implications of the findings and their limitations, including implications for future research. Relate the observations to other relevant studies. link the conclusions with the goals of the study but avoid unqualified statements claiming priority and alluding to work that has not been completed. State new hypotheses when warranted, but clearly label them as such. Recommendations, when appropriate, may be included.


Following the discussions, and on a separate page, one or more statements should specify (a) contributions that need acknowledging but do not justify authorship, such as general support by a departmental chairman; (b) acknowledgments of technical help; (b) acknowledgments of technical help; (c) acknowledgments of financial and material support, specifying the nature of the support; (d) financial relationships that may pose a conflict of interest. Persons who have contributed intellectually to the paper but whose contributions do not justify authorship may be named and their function or contribution described-for example, "scientific adviser", "critical review of study proposal", "data collection" or "participation in clinical trial". Such persons must have given their permission to be named. Authors are responsible for obtaining written permission from persons acknowledged by name, because readers may infer their endorsement of the data and conclusion.

Technical help should be acknowledged in a paragraph separate from those acknowledging other contributions.


Number references consecutively in the order in which they are first mentioned in the text. Identify references in text, tables, and legends by Arabic numerals in parentheses. References cited only in tables or in legends to figures should be numbered in accordance with a sequence established by the first identification in the text of the particular table or illustration. Use the style of the examples below, which are based with slight modifications on the formats used by the U.S. National library of Medicine in Index Medicus. The titles of journals should be abbreviated according to the style used in Index Medicus. Consult list of Journals

Indexed in Index Medicus, published annually as a separate publication by the library and as a list in the January issue of Index Medicus. Try to avoid using abstracts as references: "unpublished observations" and "personal communications" may not be used as references, although references to written, not oral, communications may be inserted (in parentheses) in the text. Include among the references papers accepted but not yet published; designate the journal and add "In press." Information from manuscripts submitted but not yet accepted should be cited in the text as "unpublished observations' (in parentheses).

The references must be verified by the author(s) against the original documents.

Ethiopian names should not be referenced differently from other names. For example, Almaz Abate should be referenced as Abate A.

Examples of correct forms of references are given below.

Articles in journals

(1) Standard journal article

(list all authors, but if the number exceeds six give six followed by et al.)

You CH, lee KY, Chey RY, Menguy R. Electrog- astrographic study of patients with unexplained nausea,

bloating and vomiting. Gastroenterology 1980 Aug; 79(2):311-4.

As an option, if a journal carries continuous pagination throughout a volume, the month and issue number may be omitted. You CH, lee KY, Chey RY, Menguy R. Electrog-astrographic study of patients with unexplained nausea, bloating and vomiting. Gastroenterology 1980;79:311- 4.
(2) Organization as author

The Royal Marsden Hospital Bone-Marrow Transplantation Team. Failure of syngeneic bone-marrow graft without preconditioning in post-hepatitis marrow aplasia. Lancet 1977;2:742-4.

(3) No author given Coffee drinking and cancer of the pancreas [editorial]. BMJ 1981;283:628.

(4) Article in a foreign language Massone L. Borghi S, Pestarino A, Piccini R, Gambini C. Localizations palmaires purpuriques de la dermatite herperiforme. Ann Dermatol Venereol1987; 114:1S45- 7.

(5) Volume with supplement

Magni F. Rossoni G. Berti F. BN-52021 protects guinea- pig from heart anaphylaxis. Pharmacol Res Commun 1988;20 Suppl 5:75-8.

(6) Issue with supplement

Gardos G, Cole JO. Haskell D, Marby D, Paine SS, Moore P, The natural history of tardive dyskinesia, J Clin Psychopharmacol 1988;8(4 Suppl):31 S-37S.

(7) Volume with part Hanly C. Metaphysics and innateness: a psychoanalytic perspective. Int J Psychoanal 1988:69(Pt 3):389-99.

(8) Issue with part Edwards L, Mcyskens F, Levine N, Effect of oral isotretinoin on dysplastic nevi, J Am Acad Dermatol 1989; 20(2 Pt 1 ):257-60.

(9) Issue with no volume Baumeister M. Origins and control of sterotyped movements. Monogr Am Assue Ment Defic 1978;(3):353-84.

(10) No issue or volume

Danoek K. Skiining in and through the history of medicine. Nord Medicinhist Arsb 1982:86-100.

(11) Pagination in Roman numerals

Ronne V. Ansvarsfull. Blodtransfusion till fel patient. Vardfacket 1989:13:xxvi-xxvii.

(12) Type of article indicated as needed

Sprago PM, Manners JM. DDAVP and open heart surgery [letter] Anaesthesia 1989;44:363-4.

Fuhrman SA, Joiner KA. Binding of the third component of complement C3 by Toxoplasma gondii

[abstract]. Clin Res 1987:35:475A.

(13) Article containing retraction

Shishido A. Retraction notice: Effect of platinum compounds on murine lymphocyte mitogenesis (Retraction of Alsabti EA, Ghalib ON, Salem MP In: Jpn J Med Sci Bioi 1979;32:53-65). Jpn J Med Sci Bioi 1980;33:235-7.

(14) Article retracted

Aisabti EA, Ghalib ON, Salem MH. Effect of platinum compounds on murine lymphocyte mitogenesis [Retracted by Shishido A. In:Jpn Med Sci Bioi 1980;33:235-7). Jpn J Med Sci Bioi 1979;32:53-65.

(15) Article containing comment

Piccoli A, Bossani A. Early steroid therapy in 19A neuropathy: still an open question [comment]. Nephron 1989;51 :289-91. Comment on: Nephron 1988;48:12-7.

(16) Article commented on Kobayashi V, Fujii K, Hiki V, Tateno S, Kurokawa A, Kamiyama M. Steroid therapy in 19A nephropathy: a retrospective study in heavy proteinuric cases [see comments]. Nephron 1988;48:12-7 Comment in: Nephron 1989;51:289-91.

(17) Article with published erratum

Schofield A. The CAGE Questionnaire and psychological health [published erratum appears in Br I Addict 1989;84:7;01). Br I Addict 1988:83; 761-4. Books and Other Monographs

(18) Personal authors Colson IH, Armour WI. Sports injuries and their treatment. 2nd rev. ed. london: S. Paul, 1986.

(19) Editor(s), compiler as author

Diener HC, Wilkinson M, editors. Drug-induced headache. New York: Springer Verlag, 1988.

(20) Organization as author and publisher

Virginia law Foundation. The medical and legal implications of AIDS. Charlottesville: The Foundation, 1987.

(21) Chapters in book

Weinstein L. Swartz MN. Pathologic properties of invading microorganisms. In: Sodeman WA Ir, Sodeman WA, editors. Pathologic physiology:mechanisms of disease. Philadelphia: Saunders, 1974:457-72.
(22) Conference proceedings

Vivian Vl. editor. Child abuse and neglect: a medical community response Proceedings of the First AMA National Conference on Child Abuse and Neglect; 1984 Mar 30-31; Chicago. Chicago: American Medical Association, 1985.

(23) Conference paper

Harley NH. Comparing radon daughter dosimetric and risk models. In: Gammage RB. Kaye SV, editors. Indoor air and human health. Proceedings of the Seventh life Sciences Symposium; 1984 Oct 29-31; Knoxville (TN). Chelsea (MU; lewis, 1985:69-78.

(24) Scientific and technical report

Akutsu T. Total heart replacement device. Bethesda (MD): National Institutes on Health, National Heart and

lung Institute; 1974 Apr. Report No.:NIH-NHLI-69-2185-4.

(25) Dissertation

Youssef NM. School adjustment of children with congenital heart disease [dissertation]. Pitsburgh(PA):

Univ. of Pittsburgh, 1988.

(26) Patent

Harred IF, Knight AR, Mclntyre IS. inventors. Dow Chemical Company, assignee, Epoxidation process, US

pat net 3, 654,317. 1972 Apr 4. Other Published Material

27 Newspaper article

Rensberger B, Specter B. CFCs may be destroyed by natural process. The Washington Post 1989 Aug 7;

Sect. 1 :2(col.5).

(28) Audiovisual

AIDS epidemic:the physiciar)'s role [videorecording]. Cleveland (OH): Academy df Medicine of Cleveland,


(29) Computer file

Repal system [computer program]. Ms-DOs version. Edwardsvill(Ks): Medi Sun, 1988.

(30) Legal material

Toxic Substances Control Act: Hearing on s. 776 Before the subeomm on the Environment of the Senate

Comm. on Commerce. 94th Cong. 1 st sess. 343 (1975).

(31) Map

Scotland [Topographic map]. Washington: National Geographic Society (US), 1981.

(32) Book of the Bible

Ruth 3:1 18 The Holy Bible. Authorized King James version. New York: Oxford Univ. Press, 1972.

(33) Dictionary and similar references

Ectasis Dorland's illustrated medical dictionary. 27th ed. Philadelphia: saunders, 1988:527.

(34) Classical material

The Winter's Tale act 5. Scene 1, lines 13-66. The complete works of William Shakespeare. London: Rex,

1973. Unpublished material

(35) In press

Lillywhite HB. Donald JA. Puhnonany blood flow regulation in an aquatic snake, Science. In press.


Type each table double-spaced on a separate sheet. Do not submit tables as photographs. Number tables

consecutively in the order of their first citation in the text and supply a brief title for each. Give each column a short or abbreviated heading. Place explanatory matter in footnotes, not in the heading. Explain in footnotes all nonstandard abbreviations that are used in each table. Number footnotes consecutively in the order in which they appear in the table.

Identify statistical measures of variations such as standard deviation and standard error of the mean. Do not use internal horizontal and vertical rules. Be sure that each table is cited in the text. If you use data from another published or unpublished source obtain permission and acknowledge fully. The use of too many tables in relation to the length of the text may produce difficulties in the layout of pages. Only one table per 1000 words of text is acceptable. The Editor-in-Chief, on accepting a paper, may recommend that additional tables containing important backup data to extensive to publish be deposited with an archival service or made available by the authors. In that event an appropriate statement will be added to the text. Submit such tables for consideration with the paper.


Submit the required number of complete sets of figures. Figures should be professionally drawn and photographed; freehand or typewritten lettering is unacceptable. Instead of original drawings, and other material send sharp, glossy black-and-white photographic prints, usually 127x173 mm (5 x 7 in), but no larger than 203x254 mm (8x10 in.). letters, numbers, and symbols should be clear and even throughout and of sufficient size that when reduced for publication each item will still be legible. Titles and detailed explanations belong in the legends for illustrations, not on the illustrations themselves.
Each figure should have a label pasted on its back. indicating the number of the figure, author's name, and top of the figure. Do not write on the back of figures or scratch or mark them by using paper clips. Do not bend figures or mount them on cardboard. Photomicrographs must have internal scale marker. Symbols, arrows, or letters used in the photomicrographs should contrast with background. If Photographs of persons are used, either the subjects must not be identifiable or their pictures must be accompanied by written permission to use the photograph.
Figures should be numbered consecutively according to the order in which they have been first cited in the text. If a figure has been published acknowledge the original source and submit written permission from the copyright holder to reproduce the material. Permission is required irrespective of authorship or publisher, except for document's in the public domain. Coloured illustrations will be reproduced at the author's expense.

legends for Illustrations

Type legends for illustrations double-spaced, starting on a separate page, with Arabic numerals corresponding to the illustrations. When symbols, arrows, numbers, or letters are used to identify parts of the illustrations, identify and explain each one clearly in the legend. Explain the internal scale and identify method of staining in photomicrographs.

Units of measurement

Measurements of length, height, weight, and volume should be reported in metric units (meter, kilogram, or

litre) or their decimal multiples.

Temperatures should be given in degrees Celsius. Blood pressures should be given in millimetres of mercury.

All hematolgic and clinical-chemistry measurements should be reported in the metric system in terms of the

International System of Units (SI). Editors may request that alternative or non-SI units be added by the authors before publication.

Abbreviations and symbols

Use only standard abbreviations. Avoid abbreviations in the title and abstract. The full term for which an

abbreviation stands should precede its first use in the text unless it is a standard unit of measurement.

Original article
Evaluation of an Amharic version of the Composite

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