Community Health Visit: Klinik Kesihatan

Community Health Visit: Klinik Kesihatan An Introduction to the Malaysian Healthcare System Most of us have been exposed to the Malaysian healthecare system one way another, be it, private clinics or government ones, even hospitals at times. The Malaysian healthcare system can be said to consist of a broad umbrella structure that encompasses the provision of healthcare to both urban, not to mentioni also, the rural regions of our beloved country. In general however, it can be classified under the public or private sector, which is very obvious in our country. The public sector which is backed financially by the government, constitutes a whopping 80% of the total health services in our country, the remaining 20%, needless to say, is provided by the private sector. The backbone, or in other words, basis of Malaysian Healthcare, is formed on the foundations of the complementary network of private and government clinics together with hospitals that are available to the public. Each state of our country have their respective General Hospitals located in the states capital. District hospitals will be present in most administrative districts. Health Centers (Klinik Kesihatan) will supplement these district hospitals. Under Health Centers, are the Rural Clinics (Klinik Desa). Comparing the healthcare system in Malaysia with other first world countries such as the United States of America and the United Kingdom, the healthcare system in Malaysia is heavily subsidized by our government, in the aforementioned first world countries, treatment costs can rocket sky high. Our government has made sure that the price the people pay for treatment from the public sector his reasonable and affordable to the majority of citizens. At least 5% of the national budget is allocated to healthcare system expenditures. Our government has listed the 8 elements of primary healthcare. To fulfill the 8 ELEMENTS, they provide these services as follows: Maternal and Child Healthcare Outpatient services Basic Dental Health Nutrition Environmental sanitation Essential drugs Control of Communicable Diseases Health Education Laboratory services Organization of Klinik Kesihatan Bukit Pelanduk Klinik Kesihatan Bukit Pelanduk is located in the state of Negeri Sembilan, Port Dickson to be even more specific. There are 12 villages in the Jimah District area, and this Klinik Kesihatan is located there. On the 29th of July 1986, operations begin to go on in this clinic and the clinic has served as major centre for the treatment and recovery of the Japanese Encephalities and Nipah virus infected patients. The vaccination for the deadly Nipah virus. There are subsidiary clinics such as Klinik Desa Chuah under the jurisdiction of Klinik Kesihatan Bukit Pelanduk that provides the medical services such as maternal and child healthcare services. Klinik Kesihatan Bukit Pelanduk is also located within the radius of 30 km from the Tuanku Jaafar Hospital and the Port Dickson Hospital in Negeri Sembilan Oganisation Chart Community nurse Public Health assistant U19 (6) U17 (1) Altogether there are 33 staff workers. Klinik Kesihatan Mantin is headed by an Administrative Doctor, who is directly responsible to the District Health Officer. Under the Administrative Doctor are two posts, which are the Assistant Medical Officer, and the Head Nurse. The Head Nurse is an authoritative figure, there are 7 components of the staff directly under her, which are the Assistant Pharmaceutical officer Medical Lab Technician, Assistant Medical officer, Senior Community nurse, Public Health nurse, Health nurse, and the Trained nurse. Under the Senior Community nurse would be the Community nurse, and the Public Health assistant. Components of Health Services. The Klinik Kesihatan Bukit Pelandok has 6 main departments which are the Outpatient, Maternal and Child Health, Pharmacy, Laboratory, Dental Health, and Emergency Department. The outpatient department is by far the biggest service rendered to the public and can be broken down in the diagram below The outpatient department consists of the diabetic, hypertension, mental health, healthy teen and out patient clinic. The out patient procedures of obtaining medical services is shown in the diagram on the left. The outpatient department in other words, functions as the primary healthcare clinic. It is headed by an Administrator doctor( Medical Office). The out patient clinic sees an estimated 100 patients every single day. And the head nurse and assistant medical officers will do their utmost best to carry out their respective responsibilities to assist the Administrator doctor in any duties relevant to them. The Maternal and Child Health Clinic is headed together by the administrator doctor and the head nurse. This helps in reducing the workload of the administrator doctor. The head nurse together with the staff under her will such as community nurses, will conduct frequent home visits and provide antenatal check-ups for pregnant women within that area. Diagram on the left shows a brief summary of Maternal and Child Health services. The Laboratory Department, which is headed by a medical lab technician. The medical laboratory is not as well equipped as those major hospitals, hence the Laboratory Department of Klinik Kesihatan will collaborate with the Laboratory Department of the Tuanku JaafarHospital such as urine protein tests, thyroid function tests, lipid profile and renal function tests. Diagram on left shows a brief summary of services provided by the Laboratory Department of Bukit Pelandok. Another important component of Klinik Kesihatan Bukit Pelandok. After consulting the medical officers, patients who are eligible for prescriptions, will have their medication prescriptions handed to the assistant pharmaceutical officer, who will then supply the patients and inform them of the usage of the medication. Klinik Kesihatan Bukit Pelandok also has a dental department, the dental functions under the same operational hours of the clinic. Tooth extraction, filling, scaling, whitening are provided services. Major oral surgeries however would be referred to the Tuanku Jaafar and Port Dickson hospitals. Last but not least, there is also an Emergency Department, this department is equipped to handle minor emergencies, it also has an ambulance and paramedics. The bar chart on the left shows the ethnicity of the total number of patients in 2010. Services Provided by Klinik Kesihatan Bukit Pelandok. I have already stated the various departments of Klinik Kesihatan Bukit Pelandok in the Components of Health Services provided section. The departments of this clinic provides a wide range of treatment modalities, hence allowing the clinic to ensure that patients enjoy effective treatment. The outpatient department is the most busy of all the departments. The purposes of the outpatient department are to provide immediate treatment to patients who are acutely or chronically sick, and also to act as a control for the clinic against infective disease such as Tuberculosis. Klinik Kesihatan Bukit Pelandok also provides the Tuberculosis Direct Observed Therapy Short-course treatment. Moving on to the Maternal and Child Health care department, the clinic mainly focuses on prenatal, antenatal, not to forget postnatal care of both the mother and foetus. There is a target to be achieved, which is the target of zero maternal deaths. They are accomplishing this target in a certain number of ways which include immediate diagnosis and treatment of pre-eclampsia, immunization of the mother and frequent antenatal check-ups up until the estimated delivery date. There are also activities scheduled by the department for disabled children on a case by case basis. For the Laboratory Department, their main role is to enable the clinician in conducting relevant laboratory studies that will help in the diagnosis and management of the disease. The Laboratory Department allows the clinic to receive results much faster compared to the time it takes to receive results from a nearby hospital. Some common tests conducted by this department are as follows: Blood tests for HbA1c, lipid profile, platelet count, ESR Light microscopy on blood smears to detect blood disorders such as anemia, or parasites in the blood smears. Urinalysis for toxins, glycosuria, urea and red blood cell casts. Pregnancy test Other more intricate and complicated tests such as FTA-Abs for treponema pallidum, would require samples to be obtained and sent to the Tuanku Jaafar or Port Dickson General Hospital for processing. The pharmacy is responsible for dispensing medication in safe and legal amounts to patients, and to advise patients on practicing compliance in taking their medications. Patients will also be counseled on the side effects and contraindications of the drugs. Reflections From observing the complex structure of roles and responsibilities held by the different components and departments of Klinik Kesihatan Bukit Pelandok, it brings to light the vast value of this particular clinic in the provision and primary healthcare of the residents in Bukit Pelandok. Many of the patients who visit this clinic are of the Malay ethnicity, I for particular, am one who is not fluent in Bahasa Melayu compared to the English language. I learnt that this could be a barrier in communicating with patients who can only speak the Malay language. I have decided that I will brush up my Bahasa Melayu, and master a few of the colloquial terms so that next time I would be able to communicate even better in the Malay language. This clinic visit has taught me that every component of the staff has a part to play, and has managed to teach me invaluable lessons of becoming a team player. Section II: Household Survey Introduction Bukit Pelanduk is most famous for the Nipah outbreak. Prior to the outbreak, during the 90s, it contain the largest pig farming communities in Southeast Asia. In between October 1998 and May 1999, that was the darkest time in Bukit Pelanduk recent history, there were approximately 104 deaths out of 258 cases of Nipah infected patients. Towards the Chinese new year in the middle of March 1999, a pig breeder from Sungai Nipah, which is located south of seremban, died suddenly triggering massive panic. Nearly half the population of the village migrated elsewhere out of fear towards the killer disease. The virus spread like a raging wildfire out of control causing many pig farmers not to mention villagers to abandon their farms and homes in panic. By March 1999, Bukit Pelanduk had become something like a ghost town due to the mass exodus. The ministry of health then decided to raise the level of this epidemic to the level of national crisis. A Cabinet-level task force was set up, and then headed by the then Deputy Prime Minister Abdullah Ahmad Badawi. What was confusing was that at that time, the government adamantly insisted that it was right in tagging the disease as Japanese Encephalities, however both farmers and scientists opposed this theory and suspected that it was a different strain or virus altogether. The virus then spread to Kampung Sawah, Kampung India and even Sepang. Farmers consulted temple mediums, and promptly put up red banners at the mediums advice in and around their houses to ward off the angel of death. After months of futility in treating the outbreak as Japanese Encephalitis, the government finally decided to call in the Department of Medical Micribiology of University of Malaysas medical faculty for assistance in dealing with this disease. Dr Chua Kaw Bing was the doctor who managed to isolate the virus in five days. 12 days later, it was identified as a new Hendra-like virus and tagged as Nipah. Over one million pigs, or half our contrys pig population at that time, were culled. Around 36000 ppl suffered unemployment due to the destruction of farms. According to the United Nations Food and Agriculture Organization, it is estimated close to RM 500 million of pig production was lost. Today, pig farming is no longer allowed legally in Bukit Pelanduk. Since the outbreak, the young had drifted elsewhere in search of a living. Only the old remain, to live out their days. Objectives The objectives of the study are To describe the social demographic of community To identify vectors and pests To comprehend health seeking behaviour To determine the housing conditions To understand food, nutrition and health awareness To determine working environment And to determine the knowledge, attitude and practices on dengue among the community. Methodology (Methods and Materials) The household group consisting of 15 members. We met up before going to Bukit Pelandok in IMU to discuss our strategies and to plan ahead before the Bukit Pelandok visit. Household questions and objectives for the Bukit Pelandok visit was meticulously discussed and great care was poured into the formation of our questionnaire. The questionnaire was in the English language and pretested to make sure no discrepancies arose when certain terms were used. After countless hours of discussion we finally agreed on a descriptive cross-sectional study upon the target population which were the residents of Bukit Pelandok. Due to obvious time constraints, not to mention logistical ones, the art of the convenience sampling technique was called to the fore with households being identified as the basic unit of due analysis. The survey was conducted over 2 working days around the 7 housing areas within a five kilometer radius which are as follows Kampung Sawah Kampung Pachitan Kampung Jawa Kampung Cina Kampung India   Rumah Rakyat Taman Bayan Most of us were well conversant in English as well as the Malay language, and we were able to translate all of the questions confidently into Mandarin as well. As names and specific home addresses were not included as part and parcel of the questionnaire, we managed to obtain consent of participants as well as guaranteeing their anonymity and confidentiality of their responses in the survey. To display the results in an attractive and efficient manner, descriptive statistics were employed in the formulation of the results which would be put under the results chapter. Formulation of results in this survey was done with the SPSS 18 program together with the dedication of the data entry and analysis team. The following is a brief summary of the study: Study location: Bukit Pelandok, Negeri Sembilan Study period: 17-18 February 2011. Total population of Port Dickson: 90 000 people Target population: Community in the 7 areas mentioned above. Sampling technique: Convenience sampling technique Sample size: 234 Basic unit of analysis: Household Study design: Descriptive cross sectional study Study instruments: Pre-coded and pretested questionnaires in the English language via face to face verbal interviews. Data entry and analysis: SPSS 18 Operational definitions Results Table 2.2 above shows the literacy level of respondents. For the male population, 50 out of 79 males ,63.29 % are literate whereas for the female population, 108 out of 155, 69.68% are literate. Women have a higher literacy level than men it appears. Figure 2.3 Figure 2.3 shows that the most common occupation of respondents are housewives, 108 out of 234, or 46.15%. the second most common occupation is the skilled manual/clerical which stands at 38 respondents, or 16.24%. Only 5 of the respondents were students, representing only a meager 2.14%. Figure 2.4 Figure 2.4 shows that the most of the respondents have a monthly household income of around RM 1000-RM1999 which was 84 out of 234, 35.90%. There were 11 respondents, 4.70% who were of the highest income bracket (>RM 5000) Figure 2.5 Figure 2.5 above shows that majority houses in Bukit Pelandok are of the detached type, 65.81%. Figure 2.6 Figure 2.6 shows that 53.2% of houses are made out of brick whereas 39.5% and 7.3% are made out of brick and wood, and wood respectively. Table 2.3 : The Housing Characteristics of Respondents in Bukit Pelandok (n = 234) Table 2.3 shows that 97.9% of the houses have 24 hour availability of electricity whereas 98.7 % have availability of piped water supply. Garbage collection facility was low as only 46.2% of the houses had that facility. Availability of a proper sewage system was high too at 85.9%. 231 out of 234 respondents did know where the nearest health clinic was, a 98.7% majority of them. 219, 93.7% of them claim they will seek medical assistance if sick. 70.5% would choose the government clinic for medical assistance whereas 26.9% will go to seek medical assistance from a private clinic. Discussion From Figure 2.3, the bar chart shows that a huge number of respondents are housewives. This is because the time we carried out the survey was during office working hours. Hence most respondents who were the most likely to be at home during this period of time tend to be housewives. From Table 2.3 more than half of respondents claim that they do not enjoy proper garbage collection privileges. When we asked more about garbage disposal practices in that area, we found out that about once a week, rubbish is brought to a place designated by the village chief (ketua kampung). There the rubbish is either burnt or buried. If villagers feel that this is a complicated process, they would burn or bury their own rubbish in their own backyards. From Figure 2.4, the majority of respondents household income can be appreciated to be below the RM 2000 mark. Most of the residents of this area belong to the skilled/ unskilled manual field of profession as stated in the operational definitions, hence their income is lower. Limitations While conducting the study, the survey team realized that we ran into several limitations. That was inevitable. And we will list it down below. The first limitation encountered by our team was the coverage in the area of our study. A limited area makes it difficult for any study to be effectively correlated and to allow for generalizations to be made. Certain questions in the survey were not specific for respondents such as the awareness of job related risks. If the head of household is not there to answer the questionnaire, the respondent might not be able to give a very accurate answer. Therefore certain conclusions about the population of Bukit Pelandok could not be accurately derived. There were variations between the way interviewers would ask the questions. Hence there might be a slight discrepancy between explanations of questions and answers from one interviewer to another. This means that the standardized understanding of questions by respondents would have been slightly affected. The reliability of the information provided by the respondents is very hard to verify also. We depend on truthful answers and had no concrete way to validate whatever the respondent answered. There were instances also where non responses were encountered. During the survey there were also noticeable language barriers between interviewers and respondents. There was an instance where an Indian lady could only communicate well in Mandarin, hence the Malay interviewers would have had a real difficult time if not for his Mandarin-speaking partner. Conclusion Bukit Pelandok is an area where the residents put more faith in western medicine and most of them will seek medical treatment and advice from the Government Health Clinic. Local authorities need to beef up their services and improve garbage collection facilities among this area to prevent air pollution which results from open burning. Reflections I feel that this project has taught me some very important lessons and even practical skills, for example, in the entering and formulation of graphs and tables by the SPSS 18 program. This will help me in my future career as a medical doctor in the world of medical presenting, teaching and learning. This project also gave me an experience of conducting a household survey together with my batch mates, we learnt how to delegate and carry out our respective responsibilities as a team. We also managed to learn from our mentors on how to facilitate this type of household survey research. Section III-Research Report Abstract The objectives of this research survey conducted were to investigate the social status of the community and the knowledge, attitude and practices (KAP) on dengue among rural communities in Bukit Pelandok, Negeri Sembilan. Convenient sampling was used as time was a major limiting factor. 234 and 250 people participated in the household and research survey respectively. Participants age were 18 years old and above, had the ability to converse and communicate in the Malay, English, and Mandarin language, resided permanently in the area, and holding a Malaysian citizenship. In our survey, we used a pretested, precoded, and well structured questionnaire in the English language for data collection via a face to face interview with participants. Introduction According to the WHO, the Dengue virus is transmitted through infected Aedes mosquitos with any single one of four dengue viruses when it bites a human being. This virus is more prevalent in the tropical and sub-tropical areas on Earth. After an infective bite, symptoms start presenting within the next 3-14 days. As the name dengue fever implies, it is a febrile illness that affects humans in all stages of life be it infants, young children or adults. The symptoms present with a wide range from a mild fever, to an immobilizing high fever, which is usually accompanied by severe headaches, muscle, joint pain and the occasional bout of rashes. Up to the present day, sadly, there are still no specific antiviral medicines to battle dengue. Hydration is of utmost importance when managing a patient with dengue fever. Aspirin or non steroidal anti-inflammatory drugs are not recommended for the treatment of dengue fever. The most widely feared complication is the dengue haemorrhagic fever which is accompanied with fever, abdominal pain, bleeding and vomiting. It is potentially lethal and usually this complication affects children. Prompt clinical diagnosis and meticulous clinical management by experienced doctors and nurses usually increase the rate of survival of patients. Over the past decade, dengue has emerged as one of the most common mosquito-borne viral disease among humans. On a global scale, an estimated 2.5 billion people reside in areas where the dengue viruse can be easily transmitted. From a geographical point of view, the spread of both the vectors (Aedes mosquito) and the dengue viruses has led to a resurgence globally of an epidemic dengue fever. Together with this epidemic, there is emergence of the dengue hemorrhagic fever (DHF) in the past quarter of the century. The main vector of dengue is the Aedes aegypti ¼Ã…’ there are four different but related viruses that cause dengue. The recovery from infection by one type will provide lifelong immunity only against that particular serotype. In other words, it means a human being can be infected by another serotype of dengue virus for a subsequent time. Dengue Hemorrhagic Fever was first identified during the 1950s in the Philippines and Thailand when those two countries experienced dengue epidemics. Around 1970, about nine countries had witnessed the DHF epidemic and continues to rise in our present day. All four dengue viruses are endemic in the Americas and Asia and has become one of the leading causes of hospitalization and mortalities among children in a few of their countries. Until now, vector control is the most widely used method for the dengue and DHF prevention. Broad research on dengue vaccines are still being conducted. Literature Review. A number of literature reviews provided me with a very handy guide to the socio-demography and KAP regarding dengue among the community of Bukit Pelandok, Negeri Sembilan. Since i had limited time to conduct the research, the literature reviews gave me an overview and acted as a stepping stone to getting the research report together. Even for professionals, literature reviews are useful reports that keep them updated about what is current in their field. 4 journals from the internet and online journal communities were reviewed before writing this report. This included studies on KAP among the adult population in Malaysia, Thailand and Myanmar. The quality of the journals was merely acceptable as most of them used convenience sampling. Only one journal used a cross sectional multistage sampling, this was the journal regarding Dengue-related Knowledge among Caregivers in Myanmar. From these journals, the group conducting the research managed to fine tune the questions in the questionnaire that was used so that the answers would be helpful and informative. According to the journal by Dr Farizah Hairi, out of all of the 200 respondents surveyed in Kuala Kangsar, only one had never heard of dengue. And the main source of information came from the television or radio. 88.5 % of the of the respondents thought that the cause of dengue was mosquitoes whereas only 2.5% knew it was the dengue virus to be exact. Out of these 200 respondents, only 91 could name Aedes as the type of mosquito that could transmit the dengue virus. The knowledge on the Aedes mosquito was quite poor. Only 25 percent of the respondents were able to mention that covering the stored water as a prevention method. The good news was that 192 (96%) of the respondents understood that presence of Aedes larvae in their residence was against the law. The practice of dengue control , the most common forms of prevention were using mosquito coils together with insecticides. Majority of respondents (96%) did consider the dengue virus as a very serious disease. All of the 200 respondents stated that they would seek treatment if they were infected with dengue. Out of the 200, 192 which is a large proportion felt that prevention was better than cure. 90.5% of the respondents support programmes or activities which are organized by the health authorities targeted at the elimination of Aedes mosquitoes. 91% of respondents too felt it was justified to punish those guilty of harbouring Aedes larvae in their residence. Based on the type of scoring system used which was described in the methodology of that particular journal, 68.5% of respondents possessed good knowledge of dengue and Aedes, whereas 91.5% had a positive attitude towards dengue control. What was disappointing was that only 51.5% of respondents actually adopted measures to prevent and control dengue and its vector. Research Question The following is the main research question that all the questions in the questionnaire are helping to answer. What is the current level of knowledge, attitudes practices for prevention of the Dengue virus among the semi-urban community? Objectives General objective To assess the Knowledge, Attitude and Practice on Dengue among the Bukit Pelanduk community. Specific Objectives: To determine the level of knowledge of the local communities on Dengue To appraise the attitude of the local communities towards Dengue To describe the practices taken by the local community to prevent Dengue infection Methodology For the KAP of dengue research survey, we used a cross-sectional study in Bukit Pelandok. Type of sampling used was convenience sampling. The sample size of the study was targeted at 250, we managed to hit that mark. A pre-tested and well structured questionnaire on KAP of Dengue was used. The household survey was carried out within the range of a 5 km radius around the Bukit Pelanduk Health Clinic which included -Kampung Chuah -Kampung Sawah -Kampung Pachitan -Kampung Cina -Rumah Rakyat -Taman Bayan From the 14th to the 16th of February 2011, we did some brainstorming to finalise the topic and questions. After that we sent the questionnaires for printing. 2 members of the group were sent to Bukit Pelandok to check out the area before the day we went to conduct the research. We then had to divide determine the criteria of interviewees which would be fit for selection to answer the questionnaires. The criteria the interviewees must fulfil is that they be above 18 years old, a resident of that household, and a Malaysian citizen. Our questionnaire had 4 main components which included socio-demographics, knowledge, attitude and practices. The medium used to conduct the interview were the Malay, English, and Mandarin language. On the 17th to 18th of February 2011, we proceeded to the execution of the research study. We divided the research group into 13 pairs. On the 1st day, we covered areas within walking distance, which was as far as up to Kampung Cina and Kampung Sawah. The 2nd day , we were dropped off by group members who had cars and managed to cover further areas as far as up to Taman Bayan and Chuah. As like the previous household survey, there was a key emphasis placed on obtaining consent from respondents of the survey as well as maintaining their anonymity and confidentiality of any of their responses to the survey. The descriptive statistics program, SPSS 18, was employed in the formulation of the results of the survey. The SPSS 18 greatly helped in data entry together with analysis. A P-value of less than 0.05 was used to prove the validity of the collected data unless otherwise stated. The scoring system used is as follows. Knowledge 10 vital questions à ¢Ã¢â‚¬ °Ã‚ ¥ 7 correct GOOD knowledge Attitude 6 vital questions à ¢Ã¢â‚¬ °Ã‚ ¥ 4 Yes GOOD attitude Practice 7 vital questions à ¢Ã¢â‚¬ °Ã‚ ¥ 4 Yes GOOD practice There were some protocols that we followed to reduce bias or error while conducting the interview. We did our best to avoid suggestive questions, and the questionnaire was pretested among our own group members. There was a briefing held to convey the standardization of questioning. House allocations were done to prevent overlap and we tried our best to extensive coverage of Bukit Pelandok. Our group also double checked the SPSS data after input. Results Socio Demographic data Gender Figure 3.1 shows the gender of respondents .60.4% and 39.6% were female and male respectively out of 250 respondents. Age group Figure 3.2 shows the age group of the respondents, a majority, 40.4% were middle aged. Ethinicity Figure 3.3 shows the Malay ethnicity is 59.6%, the majority. Figure 3.4 shows the educa Literature Review: Methods Of Virus Protection Literature Review: Methods Of Virus Protection Computer viruses are most critical area in computer science. All computer users in the world are suffering from this threat. Viruses reproduce themselves and spread through computer to computer as well as network to network. There are some antivirus software and some best practices to prevent from computer viruses. As well as this literature review contains the present situation of computer viruses, protection from computer viruses and how new antivirus software performs on computer viruses. end{abstract} section{Introduction} The only secure computer is one thats unplugged, locked in a safe and buried 20 feet under the ground in a secret locationÃÆ' ¯Ãƒâ€šÃ‚ ¿Ãƒâ€šÃ‚ ½ Dennis Huges, FBI begin{sloppypar} end{sloppypar} The above statement shows the current security situation of computers and the role computer viruses play in computer world. begin{sloppypar} end{sloppypar} Computer virus is a program that can execute itself with the help of another infected executable program without knowledge of computer user and infect to computer. Viruses usually copy itself in current host and another new host also. So generally viruses are infecting to executable files. Some kinds of viruses only reproduce itself within the current host and from the current host to another host and spread in the host. Those are harmless than viruses that damage to the computer program, activities and data in the computer. begin{sloppypar} end{sloppypar} But there are some other malicious software other than the viruses. Those are called malware. These malicious software can spread without help of executable program. begin{sloppypar} end{sloppypar} Computer viruses are also computer programs. So anyone who has a personal computer can create a virus program with few lines of codes. This means birth places of viruses are widely available. Also a virus is activated in host computer; the infection can spread through network (LAN or Internet) to other computers. begin{sloppypar} end{sloppypar} Virus attaches itself to other program and spreads with them. Most of the time virus attaches to executable program, when the infected executable program is running then virus is also executing behind that process. Also computer viruses can infiltrate to operating system. So all operating systems like MS Windows, PC Dos, Unix and Macintosh OS have probability to infect with viruses. begin{sloppypar} end{sloppypar} Some viruses do some destruction as soon as they enter a system. But some of others are programmed to lie dormant until activate by some signal. The signal may be mouse click, specific date, time or specific common sequence of keystrokes. As an example the famous Michelangelo virus, it is set to activate his birthday March 6. begin{sloppypar} end{sloppypar} Protecting the computers from the malicious software is the most challenging thing. But there are many ways to protect the computers from computer viruses. Although there are lots of methods to protect the computers from viruses, the computer users also have a responsibility to protect the computers from computer viruses. From the next section of review is considered about different types of Malware. cite{1} newpage section{Different types of Malware} There are different types of Malware spread in computer world. But it can mainly identified as follow. begin{itemize} item Viruses item Worms item Trojan Horses item Logic Bomb end{itemize} begin{figure}[h] par includegraphics[bb =0 0 100 325 ]{virus.png} caption{Malware Growth by Year} cite{10} par end{figure} newpage subsection{Viruses} Virus is block of executable code that is attached itself to another executable program by attaching external code, overwriting or replacing of the executable program code. When the computer user execute the infected program the automatically activate virus also by executing the hide block of code. This is the way how virus is infected to computer without knowing of user. But viruses get help from computer user to propagate in his machine. begin{sloppypar} end{sloppypar} There are several types of viruses; they are categorized into various categories according to the way how they infect to system and what part of system is. Figure1 shows how Malware growth with year. It clearly show increase of Malware in year by year. cite{1,5} begin{itemize} item Boot sector viruses item Macro viruses item File infecting viruses item Polymorphic viruses item Stealth viruses item Multi-partite viruses item Resident viruses item Companion viruses item FAT viruses end{itemize} subsubsection{Boot sector viruses} Boot sector viruses are infected to the boot sector of computer otherwise master boot record of computer. Boot sector viruses are very difficult to detect because the master boot sector is the first thing loaded when computer started. So if this virus effect to computer, the virus get fully control of the machine. begin{sloppypar} end{sloppypar} When boot sector virus infect to computer, they first move or replace the original boot code with infected boot code. Then the original boot code move to another sector of on disk and labeled that part as bad sector. So it will not use in future. The important thing is 75 per cent of viruses attacks are reported from boot sector viruses. The main and only way computer can infected with this virus is boot computer using infected disk. So some modern anti-virus software is designed to check infected disk, when boot using disk and before boot strap is loaded.cite{1,2} subsubsection{Macro viruses} In computing macro virus is virus that is crated using macro language. Macro language built into software such as word processor. So macro viruses propagate with applications which are used macros. In most of the time macro viruses infected with MS Office Word, MS Office Excel. However many of windows applications have to potential infected macro viruses too. begin{sloppypar} end{sloppypar} Because some applications allow macro program to be embedded in documents. So when the document is opening the macro run automatically. Also macro viruses spread rapidly because of peoples share data, documents and also use internet to get data and email document. Therefore Microsoft suggests opening file without macros or user can verify there is no damage macro with the document. But these methods are also not worked at all macro viruses.cite{2,3} subsubsection{File infecting viruses } File infecting viruses are infected to flies, and sometime they are allocated memory of computer. Files infecting viruses are infected with executable files, but most of the time it infect to executable files with extensions .COM, .EXE and .OVL. begin{sloppypar} end{sloppypar} Consider with boot sector viruses these are easy to detect. If the file infecting virus infects to some document, usually it increases the size of the file. Therefore Anti-virus software can detect those viruses using that feature.cite{1} subsubsection{Polymorphic viruses} Polymorphic viruses are change there appearance in each time when it infect to computer. So it is very difficult to detect theses type of viruses. begin{sloppypar} end{sloppypar} Polymorphic viruses also block of programming code, so they are encrypting there code using different algorithms every time they attack to system. Some polymorphic viruses can assume over two billion different guises. Therefore anti-virus software should make with good algorithmic scanning techniques instead of simple string based scanning techniques.cite{1,4} subsubsection{Stealth viruses} Stealth virus is a virus that hides its track after infecting to system. These types of viruses also try to hide from operating system and Anti-virus software. Therefore stealth viruses always stay in memory then they can intercept all attempts to use the operating system. Therefore these viruses waste memory available for user and hide it form both user and Anti-virus software. It hides changes it creates to files, directory structure and operating system also. begin{sloppypar} end{sloppypar} When detected theses type of viruses using Anti-viruses software, then first it should disable the virus before correct the memory location in memory because stealth viruses also stay in memory.cite{1,6} subsubsection{Multi-partite viruses} Multi-partite viruses infect both boot sector and executable program. Therefore this type of virus very difficulty detected.cite{1} subsubsection{Resident viruses} Permanent viruses reside in the RAM.cite{7} subsubsection{Companion viruses} These are working like resident viruses or direct action viruses. subsubsection{FAT viruses} These infect to the file allocation table. subsection{Worms} Worms is a self-replicating computer malware type. It spread copy of itself to other host using computer network. Worms different than viruses how the reproduce and spread. It was known viruses want host program or boot sector to activate it need file transfer (infected file) to another computer to spread to it. But worms did not want any host files to execute and they can execute independently and spread using network. Therefore they normally find addresses to propagate and they pick addresses in three ways, begin{itemize} item Randomly generate addresses item Find addresses in system tables item Find addresses in a program end{itemize} begin{sloppypar} end{sloppypar} The threat of worms is equivalent to that of viruses. Computer worms can damage and destroyed some important files and it can crash critical programs to stop working sometime. The very prominent examples of worms are the MS-Blaster and Sasser worms.cite{1,2,8} subsection{Trojan horses} Trojan horses are distractive programs that hide in some valuable and useful software in internet. Some time worms and viruses hide within Trojan horses. The different between virus an Trojan hours is Trojan did not spread itself. begin{sloppypar} end{sloppypar} Normally Trojan hours spread into two parts those are client side and server side. When the client Trojan executes in computer the server the attacker otherwise server can get high level control of the client computer. begin{sloppypar} end{sloppypar} The Trojan hours spread in several ways, most of the time with infected e-mail attachment. Also virus developers use some chat program like Yahoo messenger, Skype to spread these Trojans. begin{sloppypar} end{sloppypar} Commonly there are several types of Trojan horses like remote access Trojan, password sending Trojan, key loggers, destructive Trojan, FTP Trojan and proxy Trojan.cite{1,9} subsection{Logic bomb} The logic bomb virus is a piece of code that are inputted into a software system. When a certain and specific condition is met, such as clicking on an internet browser or opening a particular file, the logic bomb virus is set off. Many programmers set the malicious virus off during days such as April Fools Day or Friday the 13th. When the virus is activated, then various activities will take place. For example, files are permanently deleted.cite{1,10} newpage section{How viruses spread} Virus is one kind of malicious software which does some kind of harm to the activities of the computer. They always need a host program or any executable program to be executed its code. As viruses cannot execute its code by itself, the virus has to get the help of another file. Because of this reason, the viruses can effect only to several kinds of files such as html files with JavaScript, word documents and spread sheets. As the files with the extension .gif, .jpg,.wav,.mp3 files considered as pure data files, a virus cannot do a harm to these files. begin{sloppypar} end{sloppypar} What the viruses do to spread is copying its code to another executable file. Then when that executable file is executed by another person the code of the virus is also executing and it then starts to search for files it can reside in the same computer or in the other computer which has been connected to the computer. Then the newly attacked programs are also trying to search for files which it can attack. If the infected file sends to another computer by a removable media, the computer virus infects to that computer too. begin{sloppypar} end{sloppypar} There are number of ways which a virus can enter into a computer. Most of the time viruses are spreading through the internet. As creation of viruses is rapidly increasing and internet is everywhere available, spread of the computer viruses has increase more and more. Computer viruses are coming to the computer with e-mails in e-mail attachments. When the user opens the e-mail, the computer virus enters into the computer and grows in the computer. Another way of entering a virus into a users computer is by downloading something from some web sites. Through floppy disks or another removable media, it is possible for a virus to enter into a computer.cite{1} section{What the computer viruses and other malicious software can and cannot do} begin{itemize} item Use disk space by the computer viruses in vain. item Delete or modify the content of the infected files. item Interrupt to some operations of the infected computer. item Display some messages or images. item Decrease the performance of the computer. item Block the computer networks. item Do not do any harm to the hardware components that are connected to the computer. end{itemize} section{Protection from computer viruses} Once a computer infects with some computer viruses, the computer users cannot identify whether a computer virus has entered into the computer or computer system as some computer viruses are in idle mode for some period of time. The computer users can know that a computer virus has entered into the computer only by looking at the evidence of the destruction they have done. So the computer users must always consider about the safety of their computer before a virus do some destruction to the computer. begin{sloppypar} end{sloppypar} As most of the computer users are now aware of the computer viruses, they specially pay their attention to limit the chance for a computer virus to enter into their computer. By just installing an anti virus software the users cannot give the responsibility of protecting the computer from computer viruses only to the anti virus software programs. The computer users also have the responsibility of protecting the computer from computer viruses. Although most of the computer users trust and use an anti virus software to protect their computers from computer viruses, there are best practices which should be followed by the computer users. begin{itemize} item When downloading software or any other thing from web sites the users should always be careful to download them from reliable web sites. item As viruses can come with e-mail attachments when the computer user checks the e-mails, messages from unknown contacts should not be opened. item If the user is logging into the computer with admin privileges, the chance to be infected by some computer viruses or malware is greater than the user log into the computer with user privileges. As some viruses cannot enter into the computer when the user logged as a user, log into the computer with user privileges is safer. item Restrict the other users from write privilege is another option. item Put passwords that cannot be easily guessed by another person. item Backup data. item Use only trusted software. end{itemize} begin{sloppypar} end{sloppypar} How much the company or person has to pay for an anti virus software, today most of the computer users are used to get the service of an anti virus software as the data are worth than the amount they pay to protect their computer or computer system. So installing an anti virus software program has become the most popular and reliable method of protecting from computer viruses. cite{14} newpage subsection{Computer virus protection with anti virus software programs} As computer viruses are available everywhere in the world, the better way to protect the systems is installing an anti virus software in them. Because of that reason, there are lots of anti virus software providers to provide their services to the customers. Various anti virus software providers are providing their service to the customers in various ways. They are client pull method, provider push with consent method, subscription method and care taking method. begin{sloppypar} end{sloppypar} Client pull method After a request from the client or customer for the service of an anti virus software, the service provider provides their service to the client. In this method as its name said, client should take the initiative to get the service. begin{sloppypar} end{sloppypar} Provider push with consent method The service providers sends email notification about their product and then the customers download the anti virus software and install it on the computer. begin{sloppypar} end{sloppypar} Subscription method The client agree to an agreement with the service provider. In this method when the vendor updates the anti virus software, the updates will automatically downloaded into the customers computer. begin{sloppypar} end{sloppypar} Care taking method In this method none of the individual computer user should not do anything to protect the computer from viruses. The service provider provides the service as a whole. begin{sloppypar} end{sloppypar} The mechanisms used by various kinds of anti virus programs to detect a computer virus is not able to catch all the viruses or not able to not to catch the non virus things. Traditional anti virus software used two methods to detect a computer virus.cite{15,16} subsubsection{String matching technique} Some anti virus providers stored the codes of the computer viruses in a virus dictionary and when performing a scan, the anti virus software searches the scanning file for a piece of code from the virus dictionary. If a matching character is met, then the anti virus software detects that file as a suspicious file and alerts the user saying there is a suspicious file in the computer. begin{sloppypar} end{sloppypar} But if a virus creator creates and release a new computer virus, as the code of that virus is not available in the virus dictionary, the anti virus program is not able to detect that virus. So the anti virus software which use this technique cannot guarantee that all the computer viruses can be detected by itself.cite{17} subsubsection{Detecting a virus by monitoring the behavior of the program} The anti virus programs which use this technique is monitoring the behavior of the scanned program and if there is an unusual behavior, the anti virus program detect it as an infected program and report it to the user. begin{sloppypar} end{sloppypar} But if the anti virus software detect a non infected program as an infected program and after reporting it to the user if the user deletes it from the computer, a problem arise. begin{sloppypar} end{sloppypar} Although the anti virus software can be trusted, there are some fake anti virus software which do not provide a protection against computer viruses. They have created only with the objective of earning money from the computer users by intruding them. Because of this reason, the computer users also have the ability to download and install only the trusted anti virus software.cite{17} subsection{Antivirus software rating} The latest antivirus software rates in the world.cite{11} begin{itemize} item BitDefender Antivirus 2010 This provides a great security, simple usability, effective use of resources, and a valuable pricetag and provides up to date technologies to combat viruses and other malware.Active virus control is the latest technology they are looking for to give a great security by always observing the behavior of a file. cite{19} item Kaspersky Anti-Virus 2010 All around protection from number of threats like viruses, Trojans, bots, worms, and spyware. This is more easy to use as it has created with user friendly navigations. cite{20} item Webroot AntiVirus with SpySweeper 2010 A comprehensive desktop anti virus package which is used a multi-layered approach.Webroot AntiVirus with Spy Sweeper also features proactive technology to find malware before it does any harm to the computer. cite{21} item Norton AntiVirus 2010 Great protection level against malware but a problem arises when uninstalling the software as its partial ninstallation. This uses traditional signature based detection mechanism to detect malware. cite{22} item ESET Nod32 Antivirus 4 Kind of desktop anti virus software. But this doesnt provide a complete security and misses some protection. This is not in the competition with other anti virus software. cite{23} item AVG Anti-Virus 9 Includes antivirus and antispyware protection. provides complette protection from harmful downloads and web cites. cite{24} item F-Secure Anti-Virus 2010 Great desktop anti virus. Has one of the most effective scan procedure and test results are shown to prove that. When installing this anti virus software, it has been automatically configured to remove the other anti virus software installed to the computer. cite{25} item G DATA AntiVirus 2011 Uses two distinct antivirus scanning engines, behavioral/heuristic protection, and even self-learning fingerprinting.This provides protection against malware spreading via emails and IM. The types of malware which are detected by this anti virus software are,phishing scams, dialers, adware, malicious scripts, Trojans, rootkits and worms. cite{26} item Avira AntiVir Premium item Trend Micro AntiVirus + AntiSpyware end{itemize} section{Cryptography and viruses} Cryptography is technique use to safe some data from other unauthorized people. Most of the time this is used when transfers data from computer to another one. But the problem is virus programmers also use this technique to their viruses. begin{sloppypar} end{sloppypar} In cryptography there are different kind of cryptography methods available but most of the time the programmer who create viruses use symmetric single key cryptography. Actually what happen in cryptography is data encrypt using key and send that encrypted data to recipient then recipient decrypt and get original data using the key. This method is so safe because the encrypted data can not anyone understand. begin{sloppypar} end{sloppypar} Normally anti-virus program detect virus using the code of the virus. If there any virus with encrypted code then anti virus software can not identify those viruses. begin{sloppypar} end{sloppypar} Virus creators using cryptography, they encrypt the code of the virus. So some viruses change their aspects moment to moment and system to system but the key is same but is encrypted with virus code. So the virus is safe from anti-virus software, till the code is encrypted. begin{sloppypar} end{sloppypar} But some cryptography viruses keep their key in separate places instead of keep with the same file. So good anti virus software can detect the places which keys are stored. Then it can decrypt the virus code and delete it. begin{sloppypar} end{sloppypar} Therefore computer system is protected some operating system developers keep the system fies as encrypted. So even though, there are some advantages and the facilities in using cryptography systems to be it prctically applicapable in virus preventation more advanced features of cryptography should be applied.cite{13} newpage section{Conclusion} As computer usage and internet usage is increasing in the modern world, the computer virus creation and the computer virus infection has become a common thing. Computer viruses can destroy a whole computer system or computer network within few seconds. But for any kind of company, the data they have should have confidentiality, integrity and availability. But sometimes those three things will be lost by the computer viruses. So most of the computers users are now try to avoid from the computer viruses. begin{sloppypar} end{sloppypar} But computer virus infection has become so common thing because of the unawareness and the careless of the computer users about computer viruses. If the computer is attacked by a computer virus, the computer users do not do the correct thing to avoid spreading the virus to the other computers. That is why the computer viruses are spreading all over the world quickly. If a new computer virus is found from a users computer, the anti virus software providers are unable to provide a solution to the problem before it spread everywhere. The computer user has great responsibility to not to let a computer virus enter into the computer. To mitigate the destruction, this can happen to the computer from computer viruses, begin{itemize} item Aware the computer users about computer viruses. item Backup the data. item Put passwords which cannot easily guess by the outsiders. item Not to give write permission to the other persons. item Do not open suspicious e-mails from unknown contacts. item Download and use only the recommended software. item Install an anti virus software. item Always keep the anti virus database up to date. item Use only the recommended anti virus software. end{itemize} begin{sloppypar} end{sloppypar} As computer users are now searching for the best anti virus software which can give the best protection to their computers from computer malware, the anti virus market has grown and saturated with various kinds of anti virus software. But the problem is that though there are more anti virus software with the target of providing a better protection; virus creators are more powerful than anti virus program creators. They encrypt the code of the computer virus so that any of the anti viruses cannot detect that computer virus. begin{sloppypar} end{sloppypar} Considering all the fact we can come to a conclusion that any of the computer in the world cannot be there with no virus attack and any of the computer virus protection methods cannot eradicate the computer viruses from the computer forever. newpage begin{thebibliography}{widest entry} bibitem{1} McAfee,emph{An Introduction to Computer Viruses and other Destructive Programs},Available at: http://www.mcafee.com/common/media/vil/pdf/av_white.pdf bibitem{2} Markus Hanhisalo,emph{computer Viruses},Available at:http://www.tml.tkk.fi/Opinnot/Tik-110.501/1997/viruses.html# 1.Introduction% 20to% 20Computer% 20Viruses bibitem{3} Top Bits,2010, {http://www.topbits.com/types-of-computer-viruses.html} bibitem{4} Spamlaws,2009,emph{Understanding the Polymorphic Virus},Available at: http://www.spamlaws.com/polymorphic-virus.html bibitem{5} Ward Takamiya,Jocelyn Kasamoto,emph{An Introduction to Computer Viruses} bibitem{6} Spamlaws,2009,emph{Spotting the Stealth Virus},Available at:http://www.spamlaws.com/stealth-virus.html bibitem{7}Spamlaws,2009, emph{Understanding the Resident Virus},Available at:http://www.spamlaws.com/resident-virus.html bibitem{8} Top Bits,2010{http://www.topbits.com/computer-worm.html} bibitem{9} Top Bits,2010{http://www.topbits.com/trojan-virus.html} bibitem{10} Top Bits,2010,{http://www.topbits.com/logic-bomb.html} bibitem{11} emph{AntiVirus Software Review },http://anti-virus-software-review.toptenreviews.com/ bibitem{12} emph{Computer knowledge virus tutorial},Available at:www.cknow.com bibitem{13} Charles P. Pfleeger,Shari Lawrence Pfleeger emph{Security in Computing (4th Edition) } bibitem{14} Stanley A. Kurzban, emph{Defending against viruses and worms},Available at:http://portal.acm.org/citation.cfm?id=68697 bibitem{15} emph{How does anti-virus software work?},Available at:http://www.antivirusworld.com/articles/antivirus.php bibitem{16} emph{How Antivirus Software Detect Computer Viruses},Available at:http://security-antivirus-software.suite101.com/article.cfm/how-antivirus-software-detect-computer-viruses bibitem{17} emph{How AntiVirus Works},Available at:http://www.antivirusware.com/articles/how-anti-virus-works.htm bibitem{18} http://www.darkgovernment.com/news/tag/hacking bibitem{19} emph{BitDefender Antivirus 2010} http://anti-virus-software-review.toptenreviews.com/bitdefender-review.html bibitem{20} emph{Kaspersky Anti-Virus 2010}http://anti-virus-software-review.toptenreviews.com/kaspersky-review.html bibitem{21} emph{Webroot AntiVirus with SpySweeper Review}http://anti-virus-software-review.toptenreviews.com/webroot-antivirus-review.html bibitem{22} emph{Norton AntiVirus 2010}http://anti-virus-software-review.toptenreviews.com/norton-review.html bibitem{23} emph{ESET Nod32 Antivirus 4}http://anti-virus-software-review.toptenreviews.com/eset-nod32-review.html bibitem{24} emph{AVG Anti-Virus 9}http://anti-virus-software-review.toptenreviews.com/avg-review.html bibitem{25} emph{F-Secure Anti-Virus 2010}http://anti-virus-software-review.toptenreviews.com/f-secure-review.html bibitem{26} emph {GDATA AntiVirus 2011}http://anti-virus-software-review.toptenreviews.com/antiviruskit-review.html end{thebibliography} end{document}