Izimbangela Ezingabangela Ukungafezeki Kwabesifazane

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Yini Ebangela Ukungafanisi Kwabesifazane?

Phakathi kuka-10 no-15% wemibhangqwana izobhekana nokungabi nabantwana. Lokhu kusho ukuthi ngeke bekhulelwe ngemuva okungenani ngonyaka wokuzama. Kule mibhangqwana engapheli, cishe ingxenye eyodwa kwezintathu izothola izinkinga zenzalo ohlangothini lwabesifazane, enye ingxenye yesithathu izothola inkinga kumuntu, kanti abanye bayothola izinkinga zombili zombili noma bathole ukuxilongwa kokungabonakali okungaqondakali.

Yini ebangela ukungabi nabesifazane okungenasifo?

Ngokwemibandela elula, ukungabi namuntu wesifazane kwenzeka uma omunye noma ngaphezulu kokulandelayo kwenzeka ...

• Okungahambi kahle nge-ovulation
• Okunye okuvimbela iqanda nesidoda ekuhlanganisweni
• Okuthile okuvimbela umbungu onempilo ukuthi ungadalwa (Lokhu kungabangelwa izinkinga ngakwesinye icala.)
• Okuthile kuvimbela ukutshalwa okunempilo kombungu

Yini engabangela izinkinga ezinokwenzeka zokuzala? Izifo eziningi, izimo, nezimo ezahlukene.

Nazi ezinye zezimbangela eziyisishiyagalolunye ezingabangela ukungabi nabesifazane, kanye nezimpawu zabo ezivame kakhulu, ukuthi zithinta kanjani ukuzala, kanye nokhetho lokunakekelwa kokuzala.

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I-Polycystic Ovarian Syndrome (i-PCOS)

Kungenzeka ukuthi uzwe nge-polycystic ovarian syndrome (i-PCOS.) I-PCOS iyimbangela evamile yokungabi nabesifazane futhi inomthelela ku-8% wabesifazane.

Abesifazane abane-PCOS bangase babe namazinga ajwayelekile we-androgens, noma ama-hormone "abesilisa". Lokhu kungaholela ezinkingeni nge-acne nokukhula kwezinwele ezingafuneki.

Abaningi kodwa hhayi bonke abesifazane abane-PCOS balwela isisindo sabo. Kungatholakala ukuthi bane-insulin ukumelana.

Lapho kuhlolwa ukuhlolwa kwe-ultrasound, ama-ovari wezinsikazi nge-PCOS angabonisa izintambo ezincane ezinjenge-pearl-like cysts.

• Okufanele Ukwazi Nge-PCOS

Izimpawu ezivame kakhulu : imijikelezo engavamile noma engekho esikhathini sokuya esikhathini, i-acne, isikhumba samafutha, ukukhula kwezinwele okungavamile, nokukhuluphala.

Indlela i-PCOS eyenza ngayo izinkinga zokuzala : i-PCOS ibangela ukuvuthwa okungavamile. Abanye besifazane abane-PCOS ngeke bavote. Ukungalingani kwama-hormonal futhi kwandisa ingozi yokukhulelwa kwesisu.

Ukwelapha okuvamile : Iningi labesifazane abane-PCOS lizophathwa ngemithi yokuzala yokuqala njenge- Clomid noma i- Femera (letrozole.) Uma lokhu kungaphumeleli, imithi yokondla enamandla njenge- gonadotropins ingase ilandwe ngokulandelayo.

Uma kungekho okunye kwalokhu kusebenza, i- IVF ingahle ilandwe ngokulandelayo.

Uma i-insulin yokumelana ikhona, ukwelashwa ngesifo sikashukela se- metformin singanconywa ngaphambi kokuqala ukwelashwa ngemithi yokuzala.

Izincomo ze-Lifestyle zingase zihlanganise ukulahlekelwa kwesisindo, ukuzivocavoca umzimba njalo nokushintsha kokudla.

• Indlela Yokuthola Ukukhulelwa Nge-PCOS

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I-Endometriosis

Kulinganiselwa ukuthi owesifazane oyedwa kwabayishumi uhlushwa yi-endometriosis. Ngoba ukuxilongwa kuyinkimbinkimbi - ayitholakali ngokuhlolwa kwegazi okulula noma i-ultrasound - abesifazane abaningi bahlupheka ngokuthula.

Ukuze uqonde i-endometriosis, udinga ukwazi ukuthi i-endometrium iyini. I-endometrium yizicubu ezibeka isisu. Ikhula futhi ikhule njalo umjikelezo wokuya esikhathini, ilungiselela isibeletho sombungu.

Uma ukukhulelwa kungenzeki, i-endometrium yehla, ishiya umzimba wakho ngokuya esikhathini.

I-Endometriosis yilapho i-endometrium ikhula ngaphandle kwesibeletho. (Lokhu akufanele kwenzeke.) Bangase bafake eduze kwama-ovari nama-tublopian tubes, eduze nomgudu wokuvuthwa kwamathumbu namathumbu, futhi ngisho nasezikhungweni ezingavamile, emaphashini.

Izindleko ze-endometrial zingabangela ubuhlungu nokungabi namandla.

Izimpawu ezivame kakhulu: ukuhamba esikhathini esibuhlungu kakhulu, ubuhlungu be-pelvic hhayi ngesikhathi sokuya esikhathini, nokubuhlungu ngesikhathi sokuhlukumeza kanye / noma ukuchama, ikakhulukazi ngesikhathi sakho.

Kodwa-ke, abanye besifazane abanaso izimpawu ezicacile ze-endometriosis . Isibonakaliso sodwa okuthile okungalungile singase sibe ukungabi nabantwana.

Indlela i-endometriosis eyenza ngayo izinkinga zokuzala : i-endometrial deposits ingavimbela iqanda lingangeni emathinini omzimba. I-Endometriosis ingabangela nezinkinga nge-ovulation, ikakhulukazi uma ifomu le-cyometri ifomu kuma-ovari.

Ngisho noma izibhubhu ezikhohlisayo zicacile futhi zivunguza, ukuvuvukala okubangelwa i-endometriosis kungaphazamisa ukufakelwa kwempilo embryo. Akuwona konke okuphathelene ne-endometriosis nokuzala okuqondakalayo.

• Okudingeka Ukwazi Nge-Endometriosis
• Imibuzo: Ingabe Usengozini Ye-Endometriosis?

Ukwelashwa okuvamile : ukwelashwa kancane kuncike ekutheni i-endometriosis ilukhuni kanjani. (Ngendlela, ubuhlungu akuyona into ecacile yobunzima. Ungaba ne-endometriosis emnene ngobuhlungu obunzima, noma i-endometriosis enzima engenabuhlungu nakancane.)

Ukususwa kokuhlinzwa kwe-deposometer deposits kunganconywa ngaphambi kokwelashwa kokuzala.

Uma kunezinkinga nge-ovulation, imithi yokuzala ingahlolwa. Uma ama-tubes fallopian avinjelwe, ukwelashwa kwe-IVF kungadingeka.

Ukushintsha indlela yokuphila njengokudla nokuzivocavoca kungase kunconywe ukusiza ukubhekana nobuhlungu, kodwa kukhona ubufakazi obuncane obuzosiza ekukhulelwe.

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Ukungenzi lutho okuhlobene nobudala

Akuzona zonke izizathu zokungazalwa kwesifo yisifo noma isimo esingokwemvelo. Ukuguga okunempilo kuyimbangela evamile yokungabi nabesifazane.

Ngesikhathi bobabili amadoda nabesifazane behlile ukuzala njengoba bekhula, lokhu kuncipha kubonakala kakhulu kubantu besifazane.

Izimpawu ezivame kakhulu : ukungasebenzi kahle kwe-age ngokuvamile akunazo izimpawu ezibonakalayo.

Izinkinga zokuthola ukungabi nabantwana ziqala ukwanda kakhulu minyaka yonke kusukela ekuqaleni kweminyaka yobudala engama-35 futhi zikhulume nakakhulu emva kweminyaka engu-40.

Abanye besifazane bayoba nezibonakaliso, ezibandakanya izinguquko esikhathini sokuya esikhathini (ukuphuma kwegazi kukhanya), imijikelezo engavamile, nokomile kwesisu (ukunciphisa umcibisholo wesibeletho).

Yeka ubunzima obangela izinkinga zokuzala : noma ngabe u-ovulating, izinga leqanda liyehla uma ukhula. Yingakho abesifazane abangaphezu kweminyaka engama-35 basengozini enkulu yokuthola isisu noma ukuba nengane ene-genetic disorder.

Abanye besifazane bazophinde babhekane nokuvuthwa okungavamile, ngaphezu kokunciphisa izinga leqanda.

• Kuyini Kunzima Ukuthola Ukukhulelwa Ngemuva kweminyaka engu-35?

Ukwelashwa okuvamile : lokhu kuhluka kakhulu. Abanye besifazane bazokwazi ukukhulelwa ngosizo lwezokwelapha ezincane ezifana ne-Clomid. Abanye bazodinga izidakamizwa ezinamandla zokuzala futhi mhlawumbe ngisho ne-IVF.

Isithiyo esikhulu sokungabi nalutho okuhlobene nobudala ukuthi imithi yokuzala ayiphumeli kahle.

Isibonelo, ngenkathi izinga le-IVF lokuphumelela elilinganiselwa ku-38% elineminyaka engu-38, izinga lokuphumelela elilinganiselwa ku-43 ubudala lineminyaka engu-10 kuphela.

• Yiziphi izintela ze-IVF Impumelelo?

Lokhu kungenxa yokunciphisa ama-ovarian reserves . Abanye besifazane bayodinga iqanda noma umsizi wombungu wokukhulelwa.

• 7 Izinto Okudingeka Uzazi Uma Uzama Ukuqonda Emva 35

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Ukungasebenzi kwe-Thyroid

I-thyroid iyigciwane elibalulekile le-endocrine system. Etholakala phambili entanyeni futhi ngaphezu kwe-collarbone yakho, i-gland yegciwane isebenzisa i-iodine ukuze ikhiqize ama-hormone e-thyroid. Lawa mahomoni alawula amandla kanye nesimetabolism kuwo wonke umzimba.

I-Hypothyroidism yilapho i-gland yegciwane engenzi lutho ngokwanele kula mahomoni. I-Hyperthyroidism (ngokuvamile evame ukubangelwa into eyaziwa ngokuthi yi-Graves 'Disease) lapho i-gland ikhiqiza ama-hormone e-thyroid.

Ngisho noma ingubo ye-thyroid ayiyona ingxenye yesimiso sokuzala, ama-hormone alawulayo angaba nomthelela ekuzaleni kwakho.

Izimpawu ezivame kakhulu : i-hypothyroidism, ukukhathala, inzuzo yesisindo, ukuzwa njalo kubanda, nokucindezeleka yizimpawu ezivamile.

Ku-hyperthyroidism, ukukhathazeka, ukuphefumula kalula, ukukhathala, ukulala, nokulahlekelwa kwesisindo okungavamile kungenzeka.

• Izimpawu zesifo se-Thyroid

Abesifazane abanenkinga ye-thyroid bangase babe nezikhathi ezingavamile.

Indlela ukungasebenzi kahle kwe-thyroid kubangela izinkinga zokuzala : kungakhathaliseki ukuthi unesifo se-thyroid esingaphansi noma esingasebenzi, noma ngabe isimo singaholela ekuvuthweni okungavamile. Lokhu kungabangela inkathazo ngokukhulelwa.

Labo abanezinkinga ze-thyroid ezingaphenduki nabo basengozini enkulu yokukhulelwa kwesisu nokukhubazeka kokuzalwa (uma bekhulelwa.)

Abesifazane abane-dysfunction ye-thyroid bangase babe nomngcipheko owengeziwe wokuba nezinye izifo zokuzala, ikakhulukazi i-endometriosis.

Ukwelashwa okuvamile : uma nje kungekho izinkinga ezengeziwe zokuzala, ukuxilongwa, nokwelapha inkinga ye -roid kuyolawula imijikelezo yokuya esikhathini kwabesifazane abaningi.

Ngemva kokuba ama-hormone abo alawulwa, angakwazi ukukhulelwa eyedwa.

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Ukukhuluphala

Ukukhuluphala kuyisisusa esivamile sokungakwazi ukuvimbela kokubili emadodeni nakwabesifazane.

Ngokusho kweMelika Society of Medicine Reproductive, 6% yabesifazane abanesifo sokuqala sokungakwazi ukuzala abangakwazi ukukhulelwa ngenxa yokukhuluphala.

Kwezinye izimo, ukukhuluphala kungumphumela wokungalingani kwe-hormonal. Isibonelo, kokubili i-PCOS (ikakhulukazi ukumelana ne-insulin) kanye ne-hypothyroidism kungaholela ezinkingeni zesisindo.

Izimpawu ezivame kakhulu : imijikelezo engavamile, izinkathi ezide ngokungavamile, nokugaya okukhulu ngesikhathi sokuya esikhathini kungenzeka. Abanye besifazane bangase bayeke imijikelezo yabo yokuya esikhathini. Abanye besifazane bazophinde bazwe ukukhula kwezinwele okungavamile.

Ukukhuluphala kwesibindi kubangela kanjani izinkinga zokuzala : ama-fat cells adlala indima emthethweni we-hormonal. Uma kunama-fat amaningi amaningi, umzimba uveza isrogen ngokweqile.

Lokhu kuthinta uhlelo lokuzala. I-estrogen encane ingafakazela ukuthi uhlelo lokuzala luvaliwe, okuholela ezinkingeni zokuvuthwa.

Ukuvuthwa okungajwayelekile noma ukugcoba kwenza kube nzima ukukhulelwa kwabafazi abakhuluphele.

• Kungani Izinto Zakho Zokulinganisa Uma Uzama Ukuqonda

Ukwelashwa okuvamile : ukulahlekelwa isisindo ngokudla nokuzivocavoca kuyindlela yokwelapha okuphumelelayo ekukhuliseni okuhlobene nokukhuluphala.

Amaphesenti angama-70% abesifazane abakhuluphele kakhulu abaletha isisindo sabo ezingeni eliphilile bazozicabangela bona ngaphandle kokwelashwa kokuzala.

Uma kunokungalingani kwe-hormonal okwenza kube nesisindo esingavamile noma ukwenza isisindo esivamile sibe nzima kakhulu, lokhu kufanele kuphulukwe kuqala. Uma kungenjalo, uhlelo lokulahlekelwa kwesisindo lungaphumeleli noma lukhuni kakhulu ukufeza.

Uma kunezinye izinkinga zokuzala, ukulahlekelwa isisindo kungenzeka ukuthi akumele. Kulesi simo, imithi yokwelapha nayo ingadingeka.

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Ukungafinyeleleki kwe-Ovarian esandulele (Ukuhluleka kwe-Ovarian esandulele)

Ukuntuleka kwe-ovarian ngaphambi kwesikhathi (i-POI) lapho ukulingana kanye nekhwalithi lamaqanda emaqanda omzimba kuncane kakhulu ngaphambi kokuba uneminyaka engama-40. Kuvele ngaphansi kwama-1% wabesifazane.

I-POI ngezinye izikhathi ibizwa ngokuthi ukuhluleka kwe-ovarian ngaphambi kwesikhathi (i-POF).

Ngama-POI, ama-ovari angeke aphendule emithini yemithi yokuzala ekhuthaza ukuvuthwa kwe-ovulation. Lokhu kwenza kube nzima ukuphatha.

Ezinye izimbangela ezikhona ze-POI zihlanganisa:

• Izimo ezibangelwa yi-Congenital noma zofuzo (njenge-Fragile X)
• Ukulimala kokuhlinzwa kuma-ovari
• Ukwehliswa kwe-toxin (njenge-chemotherapy)
• Akukwazi - lokhu kuyiqiniso kwamaningi amaningi

I-POI ibonakala igijima emindenini. Uma umama wakho noma ugogo wakho unakho, usengozini.

I-POI ibuye ibonakale ihlotshaniswa nezinye izifo ezizimele, kuhlanganise nokukhubazeka kwegciwane.

Izimpawu ezivame kakhulu : izikhathi ezingavamile noma ezingekho, ukumelela kwesisu, ukukhanya okushisayo, ukuguquka kwemizwelo nokulala.

Abanye besifazane abane-POI abanalo izimpawu ngaphandle kokungabi nabantwana.

Indlela i-POI eyenza ngayo izinkinga zokuzala : ikhwalithi namanani amaqanda aphansi. Kungase kungabi yi-ovulating nhlobo, noma i-ovulation ingaba yinkimbinkimbi. Uma i-ovulation isenzeka, izinga leqanda lingase libe mpofu. Lokhu kwehlisa ubunzima bokukhulelwa.

Abesifazane abane-POI abanamathuba amancane okuzicabangela ngokwabo, futhi banamathuba amaningi okuthola ukuhluleka kokwelashwa kwehlulekile.

• Ama-Ovarian Reserves: Okuyikho Futhi Okushiwo Ngempela

Ukwelashwa okuvamile : ukwelashwa kuxhomeke ebukhulu besimo. Ezimweni ezinzima, izidakamizwa zokuzala, kanti ukwelashwa kwe-IVF kungasiza owesifazane ukuba acabange.

Akunakwenzeka ukuthi abesifazane abane-POI bakhulelwe amaqanda abo. Kulinganiselwa ukuthi abesifazane abangu-10% bazokhulelwa noma ngaphandle kosizo lwemithi yokuzala.

Ngalokho kusho, abesifazane abaningi abane-POI badinga amaqanda noma abanikeli bombungu.

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Ukuqeda Isikhathi Sokuqala Kwesilisa / Isikhathi Sokuqala Kwesilisa

Ukuyeka esikhathini sokuqala kungesikhathi sokunqamuka kwesikhashana ngaphambi kokuba uneminyaka engama-40.

Kuyafana kodwa akufani nokungafinyeleli kwe-ovarian ngaphambi kwesikhathi (i-POI). Ngama-POI, ungase uqhubeke uvunguza, futhi ukukhulelwa ngamaqanda akho kungase kwenzeke.

Ngesikhathi sokuya esikhathini esingakapheli, ukuvuthwa kwe-ovulation sekuphelile. Awukwazi ukukhulelwa ngokwakho noma ngamaqanda akho.

Ukweqa esikhathini sokuqala kuvele kugijime emindenini. Kungenzeka futhi emva kokwelashwa (njenge-chemotherapy) noma ukuhlinzeka (njengokususwa kokuhlinzwa kwama-ovari.)

Ezinye izimo zezakhi zofuzo nesifo sokuzimela kungase kuholele esikhathini sokuqala esikhathini sokuqala.

Izimpawu ezivame kakhulu : imijikelezo engekho esikhathini sokungena esikhathini okungenani izinyanga ezingu-12, ukukhanya okushisayo, ukoma komzimba wesisu, ukuguquka kwesimo sengqondo, nezinkinga zokulala.

Ukuqala kokuya esikhathini sokuqala kudala izinkinga zokuzala : abesifazane ekuqedeni kokuya esikhathini sokuqala ngeke bakwazi ukuvota. Ngakho-ke, abakwazi ukukhulelwa ngamaqanda abo.

Ukwelashwa okuvamile : I-IVF neqanda noma umsizi wombungu yilapho kuphela ukwelashwa okutholakala khona.

Imithi yokwelapha ayikwazi ukusetshenziselwa ukugqugquzela ama-ovari emva kokuya esikhathini sokuqala.

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Hyperprolactinemia

I-hyperprolactinemia iyisimo esivamile kodwa esingaphansi kakhulu esaziwayo sokuvuthwa okungavamile kwabesifazane.

Ngokusho kwe-American Society of Medicine Reproductive, owesifazane kwaba-1 kwabangu-3 abanezinkathi ezingavamile kodwa ngaphandle kwalokho ama-ovari aphilile ane-hyperprolactinemia.

I-prolactin iyi-hormone ekhuphula amabele futhi isiza ukukhiqiza ubisi lwebele. Amazinga e-prolactin aphezulu ngokwemvelo ngesikhathi sokukhulelwa nokuncelisa.

I-Hyperprolactinemia yilapho amazinga e-prolactin ephezulu, kodwa owesifazane akakhulelwe noma aluseli.

(Qaphela: Amadoda angathola futhi i-hyperprolactinemia, futhi ingabangela ukungabi namuntu wesilisa .)

Izimpawu ezivame kakhulu : ukukhishwa kwamanzi okuvela emanzini, izikhathi ezingavamile noma ezingekho, ubulili obubuhlungu ngenxa yokomile kwesisu, ukukhula kwezinwele okungadingeki, kanye namacne.

Abanye besifazane bazoba nezinkinga zekhanda noma izinkinga. Abanye besifazane abanazo izimpawu ezibonakalayo.

Indlela i-hyperprolactinemia eyenza ngayo izinkinga zokuzala : ngokuvamile, i-prolactin ikhishwa uma ukhulelwe noma uncelisa.

Ngaphandle kokusiza ukhiqiza ubisi lwebele, amazinga aphezulu weprolactin avimbela uhlelo lokuzala. Ngale ndlela, uma unesana lokubeletha, awuncane amathuba okukhulelwa omunye umntwana.

(Ukwenyuka kwemvelo kokuya esikhathini lapho uncelisa ibele kuyaziwa ngokuthi i-amenctrhea ye-lactational.)

Nge-hyperprolactinemia, uhlelo lokuzala luyasuswa ngaphandle kwesizathu esihle. Ukuvuthwa kuyaba okungajwayelekile noma ukuyeka ngokuphelele, futhi lokhu kubangela ukungabi nabantwana.

Ukwelashwa okuvamile : ukwelashwa kuxhomeke ekubambeni kwe-hyperprolactinemia.

Imithi ye-bromocriptine ne-cabergoline isetshenziselwa kakhulu ukunciphisa amazinga e-prolactin nokubuyisela ukuvuthwa okuvamile.

Amanye imithi ingabangela i-hyperprolactinemia. Uma lokhu kungesimo sakho, udokotela wakho angakucosha imithi yokwelashwa.

Abanye besifazane bathola i-hyperprolactinemia ngenxa yenkinga ye -roid. Ukwelapha inkinga ye-thyroid kufanele ihlehlise amazinga e-prolactin.

• 17 Izinketho zokwelashwa kwesibeletho

_Imithombo:

_{UG. William Bates, MD Isisindo somzimba esingavamile: Isizathu esivimbelayo sokungenzi lutho. https://www.asrm.org/Abnormal_Body_Weight/}

_{Hyperthyroidism. I-MedlinePlus. https://www.nlm.nih.gov/medlineplus/hyperthyroidism.html}

_{I-Hypothyroidism. I-MedlinePlus. https://www.nlm.nih.gov/medlineplus/article/000353.htm}

_{I-Hypothyroidism. I-MayoClinic. http://www.mayoclinic.org/diseases-conditions/female-infertility/expert-answers/hypothyroidism-and-infertility/faq-20058311}

_{I-Hyperprolactinemia (amazinga aphezulu e-prolactin). I-Fact Sheets. UkukhiqizaFacts.org. https://www.asrm.org/FACTSHEET_Hyperproctectememia_Prolactin_Excess/}

_{Krassas GE1, Poppe K, Glinoer D. "Umsebenzi we-Thyroid nokuphila komuntu wokuzala." I-Endocr Rev. 2010 Oct; 31 (5): 702-55. i-doi: 10.1210 / er.2009-0041. Epub 2010 Jun 23. http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2265.2007.02752.x/full}

_{Ukunqamuka kwesikhashana: Isikhathi sokuqala seMesopause. WomensHealth.gov. http://womenshealth.gov/menopause/early-premature-menopause/}

_{Ukuhluleka kwe-Ovarian kusengaphambili. I-MedlinePlus. https://www.nlm.nih.gov/medlineplus/prematureovarianfailure.html}

_{Ukuhluleka kwe-Ovarian kusengaphambili (i-POF). I-American Society of Medicine Yokuzala. https://www.asrm.org/FACTSHEET_Premature_Ovarian_Failure/}

_{I-prolactinoma: Izifo nemibandela. MayoClinic.org. http://www.mayoclinic.org/diseases-conditions/prolactinoma/basics/symptoms/con-20028094}

_{Priya DM1, Akhtar N1, Ahmad J2. "Ukuvama kwe-hypothyroidism kwabesifazane abangenasifo nokuhlola ukuphendula kokwelashwa kwe-hypothyroidism ekungenasifo." I-Indian J Endocrinol Metab. 2015 Jul-Aug; 19 (4): 504-6. doi: 10.4103 / 2230-8210.159058. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3657979/}

_{Yuk JS1, Park EJ, Seo YS, Kim HJ, Kwon SY, Park WI. "Izifo Zezingcwaba Zihlangene Ne-Endometriosis: Isifundo Sezinhlangothi Eziyisikhombisa Esisekelwe Esikhathini Sabantu Esisekelwe Esikhathini Sabantu." Imithi (Baltimore). 2016 Mar; 95 (10): e2975. i-doi: 10.1097 / MD.0000000000002975. https://www.ncbi.nlm.nih.gov/pubmed/26962803}