Quality of care for patients with diabetes done by family medicine team during the period 2013-2016.

Aim To assess whether the quality of diabetes care provided by a family medicine team changed over the course of four years and to identify potential gaps in our practice in order to improve it in the future. Methods An audit was carried out for randomly selected 120 medical records (MC) from the Diabetes Registry of patients with type 1 or 2 diabetes mellitus treated by one family medicine team for four consecutive years, from 2013 to 2016. We examined demographic data (gender, age, diabetes type, family history), annual examinations (glycated haemoglobin, blood glucose, lipid profile, neurological examination, urinalysis, foot care, ocular fundus and body mass index), prescribed insulin or other drugs and patients' education. Results Over the years females dominated with the maximum of 63% in 2013. In most years type 2 diabetes occurred in 93% of patients. The acceptable level of monitoring included examination of ocular fundus, lipid profile or total cholesterol, blood pressure, fasting and postprandial blood glucose with more than 80% annually. A low level of monitoring complications of diabetes was found on monofilament test, 26% in 2016, urinalysis, 20% in 2016 and examination of feet with the maximum of 46% in 2013. Outcome measurement showed satisfactory levels of glycated haemoglobin of 60% in 2014, blood pressure 76% in 2014, fast 56% and postprandial blood glucose of 73% in 2013. Conclusion We still need to find effective interventions that will lead to improvement of care for patients with diabetes in family medicine.

Identification of conditions which lead to unjustified requests for emergency treatment of hypertensive patients.

Aim To determine most common factors making patients with high blood pressure seek professionally unacceptable treatment of hypertension at the Emergency Department. Methods The survey was conducted at the Emergency Department of the Primary Health Care in Gradacac on randomly selected 207 patients who requested medical help because of high blood pressure. For all patients arterial blood pressure and body mass index (BMI) were measured. A survey about knowledge and attitudes regarding habits that affect high blood pressure as well as the socio-economic conditions was made. Results Prevalence of 10.3% was found with regard to visits to emergency care by patients due to high blood pressure. Most patients, 127(61.4 %), were overweight and 36(17.4%) were obese. Patients who rarely controlled their blood pressure were more frequent visitors of emergency medical services. Stressful situation occurs as a factor in a variety of forms. The survey showed that 76 (36.7%) patients sought medical help even though they had no blood pressure values that required emergency care. Conclusion Poorly organized health care system with no continuous and comprehensive preventive promotional programs caused by inappropriate use of resources in health care. The reorganization of primary care with full implementation of family medicine and greater integration of family medicine with other levels of the health care system should provide a better control and treatment of other diseases such as hypertension.

Public health significance of immunization and epidemic occurrence of measles.

Aim To investigate epidemiological characteristics of the measles epidemic (risk factors and reasons for its emergence) in order to establish better control and prevention of future epidemics as well as to determine an influence of poor collective immunization of children against measles on appearance of epidemic disease. Methods An open retrospective epidemiological study of measles infection was conducted during the epidemic in Zenica-Doboj Canton (ZDC) in the period 2014-2015. Disease reports, Disease Reporting Forms for measles and rubella cases and the Bulletin of the Institute for Health and Food Safety Zenica were used for data collection. Results A total of 325 patients with the diagnosis of measles were registered, 262 (80.61%) in 2014 and 63 (19.39%) in 2015 resulting in overall incidence of 81.25/100.000. The majority of patients were aged 0-6 (p<0.05). Of the total number of patients, only 13 (4.73%) were orderly vaccinated (p <0.05). In the period 2009- 2015 in ZDC 25.444 (83.34%) children (p <0.05) were vaccinated with measles, mumps, rubella (MMR) vaccine. Conclusion Results of the study show that the low level of vaccination of children continues to a risk of the emergence of epidemics of measles and other infectious diseases. Therefore, in order to prevent the disease there is a need for a better vaccination campaign.

Tobacco and alcohol usage as risk factors of non-communicable diseases among students of Zenica University (Bosnia and Herzegovina).

Aim To establish the presence of two risk factors, smoking and alcohol use, for non-communicable diseases among students at the University of Zenica. Methods The research was conducted at eight schools of the University of Zenica in the academic year 2016/2017 during the period from 1 December 2016 to 15 February 2017. The study involved 600 students 19-29 years of age (all years of study). The research was carried out with a standardized and validated questionnaire, the STEPS non-communicable Disease Risk Factors survey, developed by the World Health Organization. Results Tobacco was used by 145 (24.2%) students, 68 (46.9%) of them being males and 77 (53.1%) females (p<0.05). Males smoked 15.62 and females 13 cigarettes per day (p<0.05). On average, male participants were 16.56 years old, and female participants 16.71 when they started consuming cigarettes (p<0.05). A total of 289 (48.1%) students consumed alcohol, of whom 135 (70.2%) were males and 154 (37.7%) females (p<0.05). Conclusion There is evidence of high prevalence of smoking and alcohol usage as the risk factors for non-communicable diseases. Two levels of the prevention measures should be applied in order to reduce the prevalence of such risk factors: strategic level with a definition of the population, actors, activities, target population and anticipated results, and tactic level which will show contingency activities at the University.

Contribution of Arabic Medicine and Pharmacy to the Development of Health Care Protection in Bosnia and Herzegovina - the First Part.

The time interval from the 9th to the 13th century remained known as the "Golden period of the Arab science", and a significant place among the taught sciences are occupied by Medicine and Pharmacy. In the history of medicine, Islamic medicine, also known as Arabic medicine, refers to the science of medicine developed in the Islamic Golden Age, and written in Arabic Arabs were able to use their cultural and natural resources and trade links to contribute to the strong development of pharmacy. After the collapse of the Arab rule, the Arab territorial expanses and cultural heritage were taken over by the Turks. Although scientific progress in the Turkish period slowed down due to numerous unfavorable political-economic and other circumstances, thanks to the Turks, Arab culture and useful Islamic principles expanded to the territory of our homeland of Bosnia and Herzegovina. Significant role in the transfer of Arabic medical and pharmaceutical knowledge was also attributed to the Sephardic Jews who, with their arrival, continued to perform their attar activities, which were largely based on Arab achievements. However, insufficiently elaborated, rich funds of oriental medical and pharmaceutical handwriting testify that Oriental science has nurtured in these areas as well, and that the Arab component in a specific way was intertwined with other cultures and traditions of Bosnia and Herzegovina.

Telemedicine in Cardiology - Perspectives in Bosnia and Herzegovina.

INTRODUCTION: Aim of article was to present perspectives of telemedicine in the field of cardiology in Bosnia and Herzegovina. MATERIAL AND METHODS: Article has descriptive character and present review of literature. RESULTS: Information technology can have the application in the education of students, starting from basic medical sciences up to clinical subjects. Information technologies are used for ECG analysis, 24h ECG Holter monitoring, which detects different rhythm disorders. By developing software packages for electrocardiogram analysis, which can be divided and interpreted by mobile phones, and complete the whole of the patient in the ambulance, specialist, experienced specialists, or even consultations in various illnesses and cities. Image segmentation algorithms have significance in the quantization and diagnostics of anatomic and pathological structures, and 3D representation has an important role in education, topography and clinical anatomy, radiology, pathology, as well as in clinical cardiology itself, especially in the sphere of coronary arteries identification in the multislice computerized angiography of coronary arteries. Interactive video consultations with subspecialists from the state and the region in adult cardiology, adult interventional cardiology, cardiovascular surgery, pediatric invasive and non-invasive cardiology enable better access to heart specialists and subspecialist, accurate diagnosis, better treatment, reduction of mortality, and a significant reduction in costs. CONCLUSION: Telemedicine by slow steps in entering the soil of Bosnia and Herzegovina, but the potential exists. It is necessary to educate the medical staff, as well as to provide a tempting environment for software engineers. Investing in infrastructure and equipment is imperative, as well as a positive climate for the its implementation.

Analysis of Food Toxin Trends in the Federation of Bosnia and Herzegovina Over Five Years Period.

INTRODUCTION: Alimentary toxoinfections represent a significant public health problem. Globalization of the market and food production, significant impoverishment of a large part of the population, and traditional approach with food preparation and consumption, cause a significant increase in the rates of population infections around the world. The epidemiological surveillance of the illness occurrence plays a significant role in monitoring and controlling the population's burden of diseases caused by unhygienically prepared and stored food. AIM: The aim of the article is to determine the rates and trends of food related diseases in the Federation of Bosnia and Herzegovina. RESULTS: The results of the analysis have shown that the rate of illness in the Federation of Bosnia and Herzegovina is declining but is still significantly higher than in developed western countries. Particularly great burden is on the population of the Zenica-Doboj Canton (ZDC), which can be due to the traditional relation to the preparation and storage of food, as well as to the relatively poorer economic situation in ZDC. CONCLUSION: We can conclude that the strengthening of the monitoring system, laboratory capacities, the availability of monitoring guides will enable responsible FBiH/Bosnia and Herzegovina institutions to better control and implement safer food practice.

Epidemiological characteristics of meningococcal meningitis in the area of Zenica-Doboj Canton in period from 2008 to 2012.

INTRODUCTION: Meningococcal meningitis now represents a significant public health problem, not only in developing countries but also in developed ones. The disease usually occurs sporadically, and much less in smaller epidemics. Material and methods: We retrospectively analyzed the epidemiological characteristics of meningococcal meningitis in the area of Zenica-Doboj Canton in the five-year period from 2008 to 2012th. In total there were 38 reported and hospitalized patients, with an average of 7-8 patients per year. RESULTS: Most commonly disease occurred in infants and young children (28.9%). The highest number was recorded in 2011, 10 cases or (26.3%). Most patients in the monitored period were registered in the municipality of Zenica-12 cases (31.6%) and Zepce 8 cases (21.1%). All hospitalized patients were sporadic cases, there has never been an epidemic in the observed period. CONCLUSIONS: Epidemic Meningitis is a very serious disease and a significant public health problem that requires a serious medical scientific approach for its resolution, primarily in finding adequate vaccine and its administration.

Cutaneous silent period in the assessment of small nerve fibers in patients on hemodialysis.

AIM: In hemodialysis patients renal disease may cause an impairment of central and peripheral nervous system. In most cases of the peripheral nervous system polyneuropathy is reported. The aim of this study was to evaluate the function of small A-delta nerve fibres, whose function is often overlooked. METHODS: The function of large diameter nerve fibers was performed by standard routine neurophysiological examination. Cutaneous silent period (CSP) was elicited by single electrical stimulations at the tip of digit II by the bipolar electrodes. The superficial electrodes were placed on the muscle belly of m. abductor pollicis brevis. The onset latency (L1) was recorded at the beginning of voluntary muscle activity suppression, the late latency (L2) at the start of new muscle activity. The difference between two latencies indicates the duration of CSP. RESULTS: The study included 38 consecutive patients (male/female - 21/17, median age 56.6±10.9 years) treated with hemodialysis (one month to 30 years) and 35 healthy subjects (male/female 23/17, age 47.4±10.1 years). The results of the conduction study demonstrated a significant prolongation of F-waves of the median and ulnar nerves, decreased motor and sensory velocities of both nervesin patients on hemodialysis (p less than 0.001). In patients with A-V fistulas a significant prolongation of the onset CSP latency L1 was obtained (p less than 0.001), whereas duration of CSP was not changed. CONCLUSION: In hemodialysis patients the significant impairment of small nerve fibers was recorded. The evaluation of small nerve fibers contributes to the assessment of the whole peripheral nerve function.

Epidemiological characteristics of meningococcal meningitis in the area of zenica-doboj canton in period from 2008 to 2012.

INTRODUCTION: Meningococcal meningitis now represents a significant public health problem, not only in developing countries but also in developed ones. The disease usually occurs sporadically, and much less in smaller epidemics. MATERIAL AND METHODS: We retrospectively analyzed the epidemiological characteristics of meningococcal meningitis in the area of Zenica-Doboj Canton in the five-year period from 2008 to 2012th. In total there were 38 reported and hospitalized patients, with an average of 7-8 patients per year. RESULTS: Most commonly disease occurred in infants and young children (28.9%). The highest number was recorded in 2011, 10 cases or (26.3%). Most patients in the monitored period were registered in the municipality of Zenica-12 cases (31.6%) and Zepce 8 cases (21.1%). All hospitalized patients were sporadic cases, there has never been an epidemic in the observed period. CONCLUSIONS: Epidemic Meningitis is a very serious disease and a significant public health problem that requires a serious medical scientific approach for its resolution, primarily in finding adequate vaccine and its administration.

Development of basic prequisites of quality education system in PhD studies at the faculties of health sciences in Bosnia and Herzegovina.

PhD degree in nursing is a relatively recent phenomenon and there is not enough experience in making the initial studies for the start of such studies. While nursing in the countries of Western Europe, USA, Asia, Canada and New Zealand develop as in the professional as well as in academic direction, our region has failed to catch up with these changes. The past 20 years is characterized by turbulent changes in the development of medical science and in line with these changes developed the idea of PhD studies. The necessity of the existence of this type of study is expressed in the fact that the doctors in the field of nursing are essential for the development of nursing in our area. Doctors in the field of nursing contribute to the development of education, quality assurance, development of scientific research and the advancement of nursing as a profession. Shortage of highly trained nurses and long-term stagnation in scientific research in nursing forced, especially developed countries, to develop doctoral studies in this field and then introduce reforms in nursing, which as the outcome given the improvement in the development of health systems, ways of education and science research in nursing. This article discusses the initial perquisites of the quality system for the development of efficient and high-quality doctoral studies at the health oriented faculties in Bosnia and Herzegovina and the region.

Retrocaecal appendix position--findings during the clasic appendectomy.

INTRODUCTION: Appendicitis is one of the most common diseases that require urgent surgical intervention. Due to its position, the inflamed appendix can cause many complications in abdominal cavity. Most of these complications are based on the anatomical position of the appendix. According to world literature over 65% of the anatomical positions of appendix is retrocaecal position, followed paracaecal and then the other positions of the appendix in different percentages. GOAL: The main goal of this research is to shown that anatomical retrocaecal position of the appendix can lead to prolonged hospitalization and more often occurrence of appendicitis complications. MATERIAL AND METHODS: The research is based on patients who had appendectomy during 2009 at the Cantonal Hospital Zenica and General Hospital Tesanj. The study included approximately 400 respondents and the method of research was of retrospective, descriptive and analytical type. RESULTS AND DISCUSSION: According to the results of this research we can conclude that in our country is not devoted enough attention to the anatomic position of the appendix and that we are not using enough diagnostic methods such as ultrasound and CT in determining the anatomic position to help determine the course of the disease. CONCLUSIONS: Retrocaecal appendix position according to the obtained data from this study did not cause many complications in classical appendectomy but this can be attributed to insufficient observation of the anatomical position of the appendix.

Quality of reporting on infectious diseases in Zenica-Doboj Canton.

GOAL: Reporting on infectious diseases is one of the most important measures for controlling the infectious diseases. In Bosnia and Herzegovina is in the implementation an archaic system of reporting, older than 20 years, which is incorporated into the partially reformed health system. The aim of this study is to determine and analyze the quality of keeping records of communicable diseases and quality of data obtained. It also sought to identify weaknesses in the system that contributes to poor reporting and poor data quality. METHODS: The study was retrospective-prospective, descriptive and analytical. Data were collected during June 2010 from all health facilities of Zenica-Doboj Canton. The data are collected from regular reports from medical institutions, received reports on contagious diseases, examination of 12.5% of the medical records of patients who were examined in June 2010, and the survey on 19% 9% physicians and 9% nurses. RESULTS: The survey showed that about 40% of infectious diseases do are not reported by individual application forms. Most often not reported are fungal infections (99.7% unreported) and intestinal infectious diseases. From found diseases in a sample of medical records reviewed, only 1.4% of them were reported. Health professionals in 51% agree that reporting is not satisfactory, and in 49% of the cases agree that the great merit of this situation have the management of health institutions and local epidemiologists who do not organize professional meetings regarding the reporting on infectious diseases. A large number of health professionals (40%) do not fill properly report on the illness, so we have a 58% incorrectly filled forms that arrived in the Institute of Public Health. CONCLUSIONS: The health workers from Zenica-Doboj Canton did not sufficiently developed awareness about the need to report infectious diseases. In order to overcome this situation, management of health care institutions must have a responsible attitude towards the medical documentation and records, and binding continued medical education of health professionals to raise awareness about the importance of proper medical documentation management.

Investigation of health effects of current levels of environmental sanitation and hygienic living conditions of rural population in the municipality of Zenica.

The aim of this article is to investigate and identify all the relevant ways of epidemiology significance for transmitting infectious diseases in the existing unsatisfactory hygienic and sanitary conditions in rural areas of the municipality of Zenica, which are positively correlated with occurrence and spread of infectious intestinal diseases. The study was conducted in seven rural localities of Zenica municipality where the dominant livestock are sheep and cows, and the population is mostly dealing with individual production of cheese and milk. This research aimed to examine and identify the conditions favoring life as the primary issues that affect the increase in the risk of and maintenance of intestinal infectious diseases such as: the level of environmental sanitation in investigated villages, sanitary and hygiene habits of families living in the villages studied, ratio of population to personal hygiene, health safety of water supply, hygienic disposal of fecal waste and waste generated in the breeding of animals. The study included the monitoring and statistical analysis of the epidemiological situation in the values of average prevalence rates of the intestinal infectious diseases in the 1000 inhabitants of each village studied. The study identified five major negative epidemiological indicators that have a major impact on the appearance and maintenance of intestinal infectious diseases. The leading indicator is a negative relationship and personal hygiene attitude in the broader sense, the pending state of water supply, sanitary toilets and unresolved rubbish dump with a negative attitude and stance toward general hygiene. Identified are all the relevant ways of epidemiology importance that are positively correlated with occurrence and spread of infectious intestinal disease. Investigations of the epidemiological situation regarding the occurrence of intestinal infectious disease in the study population showed that intestinal infectious diseases in the investigated area is constantly maintained and that the average prevalence rate is shown suffering intestinal infectious diseases in the 1000 inhabitants significantly higher than the prevalence of these diseases in the urban area where they can be identified in a significant number of negative epidemiological indicators.

To classics of Arabic medicine.

The slamic authors of the medical and other works have become very known for West, but under well changed names, as for example Razes for Ar-Razi, Avicenna for Ibn Sina, Alhazen for Ibn Haitham, Avenzoar for Ibn Zuhr, Avveroes for Ibn Rusd etc. Up to those changes in the names has not come at any case come accidentally. This was the result of the religious striving to the cultural worls of the West, and not to speak about the plebs, only the giants are represented wich was imppossible to avoid. It is indusputable the great contribution of the Islamic authors to the development of the biomedical sciences. They not only succeeded to preserve the achievements of the pre Islamic authors, than they by the own researches gave the great contribution to the development of these sciences and their disciplines, and they have overgiven to us as a dowry.

How to rationally use information diagnostic technologies in family and general medicine practice.

CONFLICT OF INTEREST: NONE DECLARED New discoveries in technology indeed enabled significant improvement of health care in the last three decades. Only during the last few years a significant breakthrough is achieved in the field of antiviral drugs, biotechnology, digital diagnostic technology, molecular diagnosis, tissues and organs transplantation as well as surgical and information technologies, which all contributed to the improvement of health care. Rapid growth of medical technology has led to the increase in costs of health care, increased access to these technologies and improvement of health care that is permanently encouraging the further development of technology. Technology encompasses the skills, knowledge and ability to understand, use and create useful things. It is the practical application of knowledge. Evaluation of health technology is the systematic evaluation of characteristics, results or impact of health technologies. The primary purpose of evaluation is to provide information to responsible parties for the technology in the health care system, which will be used in decision-making and introduction of these technologies. Information technology in medicine and health care represents all medical and health technology in the process of work, monitoring and evaluation done using computer technology. Progress of medical science in recent years especially needs to thank to the development of information technologies. The health care system of Bosnia and Herzegovina is currently operating in the two sub-systems of primary health care. One is inherited from the past system, in which the primary health care is provided by general practitioners, specialists in general practice, as well as gynecologists, pediatricians and pulmologists, and the second subsystem occurs when in PHC is introduced the system of family medicine doctors and family medicine specialists. Family medicine, based on the concept of orientation towards the methods which are more effective, rational and cost-effective health care, use of defined procedures and evidence-based medicine, and more adequate education can empower and stimulate general practice doctors, especially family medicine specialists, who have passed various forms of training and courses in this area, to more rational and efficient use of diagnostic technology in their daily practice, without unnecessary duplication of tests. With this they make savings to the healthcare system, improve the financial position of overall health system, especially in the PHC segment, increase satisfaction of doctors providing that health care, but also the users of health services.

[Epidemiological variation of Q-fever in Zenica Doboj Canton during period 2000-2005]. / Epidemioloske varijacije Q groznice u Ze-Do Kantonu u periodu od 2000. do 2005. godine.

After the war in Bosnia and Herzegovina there is a sudden increase in number of infected with the Q-fever, which becomes huge public health and economic problem. Although this disease occurred in very different geographic areas of Bosnia and Herzegovina the Zenica-Doboj Canton was among the most affected. Infections of Q-fever at the Zenica-Doboj Canton represent very complex epidemiology problem, because it is in highest incidence rates not only for Bosnia and Herzegovina, but also for Europe. The total number of population affected by Q-fever in Zenica-Doboj Canton since the beginning of 1998 until the end of 2005 was 193, with the average morbidity rate of 48.30 %000. In Zenica-Doboj canton affected by Q-fever was the inhabitants of both genders, all ages and on wide territory, which in majority of cases did not have the contact with domestic animals. Incubation period varies from 14 to 27 days. Actual incidence rate due to asymptomatic occurrence of this disease is for sure higher. Researches of spreading manner for the Q-fever among humans showed that this disease can be spread in epidemic and sporadic manner in Zenica-Doboj Canton, and that there are many risk factors which influence its occurrence.

Epidemiology features of brucellosis at the Zenica-Doboj Canton area in period 2000-2007.

Area of Zenica Doboj Canton (ZDC), as well as other areas in Bosnia and Herzegovina, due to geographic, climate and agricultural features, also because of the fact, that animal farms and human habitats are closely related, as well as due to the poor hygiene conditions in places with dominant sheep farming, have fruitful conditions for endemic persistence and spreading of brucellosis, as a typical zoonosis. Lack of systematic research about farms that keeping the animals, and Program of control and suppression of brucellosis, as well as other veterinary measures in order to control the health of domestic animals, in order to protect the health of the human population, have the consequence in continuous presence of brucellosis among animals and humans in this area. As the confirmation of this is also the data about the frequency of this disease in the period 2000-2007, is analyzed in this paper. Follow up and control of brucellosis within human population in ZDC during the period observed showed continuous presence of brucellosis with changing morbidity rate and with the tendency for increasing in this period. During observed time period also noticed was the epidemic occurrence of this disease in two municipalities with the largest number and concentration of herds and sheep farms in ZDC (Zenica and Zepce). In total during the epidemic and non epidemic period we registered 294 patients. The number of occasional cases is contained within the total number of cases reported during epidemics.

The advantages and limitations of international classification of diseases, injuries and causes of death from aspect of existing health care system of bosnia and herzegovina.

CONFLICT OF INTEREST: NONE DECLARED. INTRODUCTION: The International classification of diseases (ICD) is the most important classification in medicine. It is used by all medical professionals. CONCEPT: The basic concept of ICD is founded on the standardization of the nomenclature for the names of diseases and their basic systematization in the hierarchically structured category. ADVANTAGES AND DISADVANTAGES: The health care provider institutions such as hospitals are subjects that should facilitate implementation of medical applications that follows the patient medical condition and facts connected with him. The definitive diagnosis that can be coded using ICD can be achieved after several visits of patient and rarely during the first visit. CONCLUSION: The ICD classification is one of the oldest and most important classifications in medicine. In the scope of ICD are all fields of medicine. It is used in statistical purpose and as a coding system in medical databases.

Epidemiology of the viral hepatitis A at the Zenica municipality ara in period from 1987 until 2003.

Viral hepatitis A is an endemic disease with periodic epidemics, or sporadic cases within endemic areas. It is present in a majority of world countries, more often in undeveloped ones. In our country it occurs occasionally, so it still cannot be considered as solved problem. This is because Bosnia and Herzegovina until 1990 was in the group of countries with the largest hepatitis A morbidity in Europe, and municipality Zenica within B&H with the largest morbidity in the period from 1987 until 1996. By studying the occurrence of the viral hepatitis A according to age groups, we can notice that the largest number of patients is at the age between 7 and 18 years (school children and youth) with 68.86% of baseline, than follows patients up to 6 years of age with 15.34%. In analysis of occurrence season, it is noticed that disease have a season features with the peak occurrence during November and December. Regarding the area of living, it is noticed that the disease occurs significantly less frequently among urban than rural and suburban population (78%). Among total number of patients within the period of epidemic we have registered 82.0% of patients, and only 18.0% was occasional cases. In majority of cases virus spreads by contact, which is the consequence of poor hygiene and sanitation that was, or still are present in the rural areas, because of inadequate infrastructure and lack of sufficient quantity of clean drinking water, or to say low level of health knowledge among rural population.