Preferences for formal and traditional sources of childbirth and postnatal care among women in rural Africa: A systematic review

English version

Autoři: Arone Wondwossen Fantaye ^aff001; Nathali Gunawardena ^aff002; Sanni Yaya ^aff003
Působiště autorů: Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, ON, Canada ^aff001; Faculty of Medicine, McGill University, Montreal, QC, Canada ^aff002; The George Institute, University of Oxford, Oxford, England, United Kingdom ^aff003
Vyšlo v časopise: PLoS ONE 14(9)
Kategorie: Research Article
doi: https://doi.org/10.1371/journal.pone.0222110

Souhrn

Background

The underutilization of formal, evidence-based maternal health services continues to contribute to poor maternal outcomes among women living in rural Africa. Women’s choice of the type of maternal care they receive strongly influences their utilization of maternal health services. There is therefore a need to understand rural women’s preferred choices to help set priorities for initiatives attempting to make formal maternal care more responsive to women’s needs. The aim of this review was to explore and identify women’s preferences for different sources of childbirth and postnatal care and the factors that contribute to these preferences.

Methods

A systematic literature search was conducted using the Ovid Medline, Embase, CINAHL, and Global Health databases. Thirty-seven studies that elicited women’s preferences for childbirth and postnatal care using qualitative methods were included in the review. A narrative synthesis was conducted to collate study findings and to report on patterns identified across findings.

Results

During the intrapartum period, preferences varied across communities, with some studies reporting preferences for traditional childbirth with traditional care-takers, and others reporting preferences for a formal facility-based childbirth with health professionals. During the postpartum period, the majority of relevant studies reported a preference for traditional postnatal services involving traditional rituals and customs. The factors that influenced the reported preferences were related to the perceived need for formal or traditional care providers, accessibility to maternal care, and cultural and religious norms.

Conclusion

Review findings identified a variety of preferences for sources of maternal care from intrapartum to postpartum. Future interventions aiming to improve access and utilization of evidence-based maternal healthcare services across rural Africa should first identify major challenges and priority needs of target populations and communities through formative research. Evidence-based services that meet rural women’s specific needs and expectations will increase the utilization of formal care and ultimately improve maternal outcomes across rural Africa.

Klíčová slova:

Africa – Birth – Culture – Labor and delivery – Maternal health – Postnatal care – Qualitative studies – Religion

Zdroje

1. Izugbara CO, Wekesah FM, Adedini SA. Maternal health in Nigeria: a situation update [Internet]. Nairobi: African Population and Health Research Center (APHRC); 2016. Available from http://aphrc.org/wp-content/uploads/2016/05/Maternal-Health-in-Nigeria_Final-Report.pdf.

2. World Health Organization. Maternal mortality. Key Facts. 2018 (cited 05 June 2019). Available from https://www.who.int/news-room/fact-sheets/detail/maternal-mortality (WHO, 2018).

3. Hogan M, Foreman K, Naghavi M, Ahn S, Wang M, & Makela S, et al. Maternal mortality for 181 countries, 1980–2008: a systematic analysis of progress towards Millennium Development Goal 5. The Lancet. 2010; 375(9726): 1609–23.

4. World Health Organization. Preventing early pregnancy and poor reproductive outcomes among adolescents in developing countries [Internet]. Geneva: World Health Organization; 2011. Available from http://apps.who.int/iris/bitstream/handle/10665/44691/9789241502214_eng.pdf?sequence=1. Accessed 26 May 2018.

5. Tey NP, Lai SL. Correlates of and Barriers to the Utilization of Health Services for Delivery in South Asia and sub-Saharan Africa. Sci World J. 2013; 2013: 1–11.

6. Kassebaum NJ, Bertozzi-Villa A, Coggeshall MS, Shackelford KA, Steiner C, Heuton KR, et al. Global, regional, and national levels and causes of maternal mortality during 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2014; 384: 980–1004. doi: 10.1016/S0140-6736(14)60696-6 24797575

7. Boutayeb A, Helmert U. Social inequalities, regional disparities and health inequity in North African countries. Int J Equity Health. 2011; 10(1):23.

8. Kyei-Nimakoh M, Carolan-Olah M, Mccann TV. Access barriers to obstetric care at health facilities in sub-Saharan Africa—a systematic review. Syst Rev. 2017; 6(1):110. doi: 10.1186/s13643-017-0503-x 28587676

9. Tawiah E. Maternal health care in five sub-Saharan African countries. African Population Studies [Internet]. 2011; 25(1). Available from: http://www.bioline.org.br/pdf?ep11001. Accessed 25 Jun 2018.

10. Carter MC, Corry M, Delbanco S, Foster TCS, Friedland R, Gabel R, et al. 2020 Vision for a high-quality, high-value maternity care system. Womens Health Issues. 2010; 20: s7–s17. doi: 10.1016/j.whi.2009.11.006 20123185

11. Dirksen CD, Utens CMA, Joore MA, Van Barneveld TA, Boer B, Dreesens DHH, et al. Integrating evidence on patient preferences in healthcare policy decisions: protocol of the patient-VIP study. Implement Sci. 2013; 8:64. doi: 10.1186/1748-5908-8-64 23758977

12. Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21st Century [Internet]. Washington, DC: The National Academies Press. 2011. Available from https://www.ncbi.nlm.nih.gov/books/NBK222274/.

13. Lehtinen A. Preferences as total subjective comparative evaluations. Journal of Economic Methodology. 2013; 20(2):206–210.

14. Hausman D. Sympathy, commitment, and preference. Economics & Philosophy. 2005; 21(1):33–50.

15. Scherer KR. What are emotions? And how can they be measured. Social Science Information. 2005; 44(4): 695–729

16. Brennan PF, Strombom I. Improving health care by understanding patient preferences. J Am Med Inform Assoc. 1998; 5(3):257–262. doi: 10.1136/jamia.1998.0050257 9609495

17. Oneview. The Eight Principles of Patient-Centered Care. [Internet]. Chicago (US): Oneview; 2015. Available from: https://www.oneviewhealthcare.com/the-eight-principles-of-patient-centered-care/.

18. Gooberman-Hill R. Qualitative approaches to understanding patient preferences. Patient. 2012; 5(4): 215–223. doi: 10.2165/11633720-000000000-00000 23006055

19. Cochrane. EPOC resources for review authors [Internet]. EPOC resources for review authors | Cochrane Effective Practice and Organisation of Care. Cochrane; Available from: https://epoc.cochrane.org/resources/epoc-resources-review-authors.

20. Popay J, Roberts H, Sowden A, Petticrew M, Arai L, Rodgers M, et al. Guidance on the conduct of narrative synthesis in systematic reviews: A product from the ESRC Methods Programme, version 1 [Internet]. Lancaster: Institute of Health Research; 2006. Available from: http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.178.3100&rep=rep1&type=pdf.

21. Barnett-Page E, Thomas J. Methods for the synthesis of qualitative research: a critical review. BMC Med Res Methodol. 2009; 9:59. doi: 10.1186/1471-2288-9-59 19671152

22. Bree R, Gallagher G. Using Microsoft excel to code and thematically analyse qualitative data: a simple, cost-effective approach. AISHE-J. 2016; 8(2): 2811–19.

23. Critical Appraisal Skills Programme [Internet]. CASP qualitative checklist: 10 questions help you make sense of a Qualitative research. Summertown Pavilion; 2018. Available from: https://casp-uk.net/wp-content/uploads/2018/03/CASP-Qualitative-Checklist-Download.pdf.

24. Singh J. Critical appraisal skills programme. J Pharmacol Pharmacother. 2013; 4(1):76–7

25. Lewin S, Booth A, Glenton C, Munthe-Kaas H, Rashidian A, Wainwright M, et al. Applying GRADE-CERQual to qualitative evidence synthesis findings: introduction to the series. Implement Sci. 2018; 13(Suppl 1): 2. doi: 10.1186/s13012-017-0688-3 29384079

26. Munthe-Kass H, Bohren MA, Glenton C, Lewin S, Noyes J, Tuncalp O, et al. Applying GRADE-CERQual to qualitative evidence synthesis findings- paper 3: how to assess methodological limitations. Implement Sci. 2018; 13(Suppl 1): 9. doi: 10.1186/s13012-017-0690-9 29384078

27. Colvin CJ, Garside R, Wainwright M, Munthe-Kass H, Glenton C, Bohren MA, et al. Applying GRADE-CERQual to qualitative evidence synthesis findings- paper 4: how to assess coherence. Implement Sci. 2018; 13(Suppl 1): 13. doi: 10.1186/s13012-017-0691-8 29384081

28. Noyer J, Booth A, Lewin S, Carlsen B, Glenton C, Colvin CJ, et al. Applying GRADE-CERQual to qualitative evidence synthesis findings- paper 6: how to assess relevance of the data. Implement Sci. 2018; 13(Suppl 1): 4. doi: 10.1186/s13012-017-0693-6 29384080

29. Glenton C, Carlsen B, Lewin S, Munthe-Kaas H, Colvin CJ, Tuncalp O, et al. Applying GRADE-CERQual to qualitative evidence synthesis findings–paper 5: how to assess adequacy of data. Implement Sci. 2018; 13(Suppl 1): 14. doi: 10.1186/s13012-017-0692-7 29384077

30. United Nations Statistics Division. UNSD—Methodology [Internet]. United Nations. Available from: https://unstats.un.org/unsd/methodology/m49/.

31. Dahlberg M, Sodergard B, Thorson A, Alfvén T, Awiti-Ujiji O. Being perceived as ‘a real woman’ or following one’s own convictions: a qualitative study to understand individual, family, and community influences on the place of childbirth in Busia, Kenya. Cult Health Sex. 2015; 17(3):326–42. doi: 10.1080/13691058.2014.955825 25270333

32. Magoma M, Requejo J, Campbell OM, Cousens S, Filippi V. High ANC coverage and low skilled attendance in a rural Tanzanian district: a case for implementing a birth plan intervention. BMC Pregnancy and Childbirth. 2010; 10(1):13.

33. Ndirima Z, Neuhann F, Beiersmann C. Listening to their voices: understanding rural women’s perceptions of good delivery care at the Mibilizi District Hospital in Rwanda. BMC Women’s Health. 2018; 18(1):38. doi: 10.1186/s12905-018-0530-3 29433492

34. Mason L, Dellicour S, Kuile FT, Ouma P, Phillips-Howard P, Were F, et al. Barriers and facilitators to antenatal and delivery care in western Kenya: A qualitative study. BMC Pregnancy and Childbirth. 2015; 15: 26. doi: 10.1186/s12884-015-0453-z 25886593

35. Okafor IP, Sekoni AO, Ezeiru SS, Ugboaja JO, Inem V. Orthodox versus unorthodox care: A qualitative study on where rural women seek healthcare during pregnancy and childbirth in Southwest, Nigeria. Malawi Med J. 2014; 26(2): 45–9. 25157317

36. Al-Mujtaba M, Cornelius LJ, Galadanci H, Erekaha S, Okundaye JN, Adeyemi OA, et al. Evaluating religious influences on the utilization of maternal health services among Muslim and Christian women in North-Central Nigeria. BioMed Res Int. 2016; 2016:1–8.

37. Seljeskog L, Sundby J, Chimango J. Factors influencing women’s choice of place of delivery in rural Malawi-An explorative study. Afr J Reprod Health. 2006; 10(3):66–75. 17518132

38. Serizawa A, Ito K, Algaddal A, Eltaybe R. Cultural perceptions and health behaviors related to safe motherhood among village women in Eastern Sudan: Ethnographic study. Int J Nurs Stud. 2014; 51(4):572–81. doi: 10.1016/j.ijnurstu.2013.08.007 24054068

39. Myer L, Harrison A. Why do women seek antenatal care late? Perspectives from rural South Africa. J Midwifery Womens Health. 2003; 48(4):268–72. 12867911

40. Igboanugo G, Martin C. What are pregnant women in rural Niger Delta community’s perceptions of conventional maternity service provision? An exploratory qualitative study. Afr J of Reprod Health. 2011; 15(3): 59–72.

41. King R, Jackson R, Dietsch E, Hailemariam A. Barriers and facilitators to accessing skilled birth attendants in Afar region, Ethiopia. Midwifery. 2015; 31(5):540–6. doi: 10.1016/j.midw.2015.02.004 25745841

42. Osubor KM, Fatusi AO, Chiwuzie JC. Maternal health-seeking behavior and associated factors in a Rural Nigerian community. Matern Child Health J. 2006; 10(2):159–69. doi: 10.1007/s10995-005-0037-z 16362233

43. Kyomuhendo GB. Low Use of Rural Maternity Services in Uganda: Impact of Womens Status, Traditional Beliefs and Limited Resources. Reprod Health Matters. 2003; 11(21):16–26. 12800700

44. Bedford J, Gandhi M, Admassu M, Girma A. ‘A Normal Delivery Takes Place at Home’: A qualitative study of the location of childbirth in rural Ethiopia. Matern Child Health J. 2012; 17(2):230–9.

45. Dodzo MK, Mhloyi M. Home is best: Why women in rural Zimbabwe deliver in the community. PLoS One. 2017; 12(8):e0181771. doi: 10.1371/journal.pone.0181771 28793315

46. Bazzano AN, Kirkwood B, Tawiah-Agyemang C, Owusu-Agyei S, Adongo P. Social costs of skilled attendance at birth in rural Ghana. Int J Gynaecol Obstet. 2008; 102(1):91–4. doi: 10.1016/j.ijgo.2008.02.004 18395724

47. Ganle JK. Why Muslim women in Northern Ghana do not use skilled maternal healthcare services at health facilities: a qualitative study. BMC Int Health Hum Rights. 2015; 15(1):10.

48. Moyer C, Adongo P, Aborigo R, Hodgson A, Engmann CM, DeVries R. ‘‘It’s up to the Woman’s People”: How social factors influence facility-based delivery in rural Northern Ghana. Matern Child Health J. 2014; 18 (1): 109–19. doi: 10.1007/s10995-013-1240-y 23423857

49. Engmann CM, Crissman H, Engmann CE, Adanu R, Nimako D, Crespo K, et al. Shifting Norms: Pregnant Women’s Perspectives on Skilled Birth Attendance and Facility-based Delivery in Rural Ghana. Afr J of Reprod Health. 2013; 17(1): 15–26.

50. Cofie LE, Barrington C, Singh K, Sodzi-Tettey S, Akaligaung A. Birth location preferences of mothers and fathers in rural Ghana: Implications for pregnancy, labor and birth outcomes. BMC Pregnancy and Childbirth. 2015; 15(1):15.

51. Caulfield T, Onyo P, Byrne A, Nduba J, Nyagero J, Morgan A, et al. Factors influencing place of delivery for pastoralist women in Kenya: a qualitative study. BMC Womens Health. 2016;16:52. doi: 10.1186/s12905-016-0333-3 27506199

52. Adinew YM, Assefa NA. Experience of facility based childbirth in rural Ethiopia: an exploratory study of women’s perspective. J Pregnancy. 2017; 2017.

53. Thwala S, Jones L, Holroyd E. An ethnographic account of the beliefs, values, and experiences of rural Swazi women during childbirth. Evidence Based Midwifery. 2012; 10(3): 101–6.

54. Pfeiffer C, Mwaipopo R. Delivering at home or in a health facility? health-seeking behaviour of women and the role of traditional birth attendants in Tanzania. BMC Pregnancy and Childbirth. 2013; 13(1):55.

55. De Allegri M, Tiendrebéogo J, Müller O, Yé M, Jahn A, Ridde V. Understanding home delivery in a context of user fee reduction: a cross-sectional mixed methods study in rural Burkina Faso. BMC Pregnancy and Childbirth. 2015; 15(1):330.

56. Kumbani L, Bjune G, Chirwa E, Malata A, Odland JO. Why some women fail to give birth at health facilities: a qualitative study of women’s perceptions of perinatal care from rural Southern Malawi. Reprod Health. 2013; 10(1):9.

57. Sialubanje C, Massar K, Hamer DH, Ruiter RA. Reasons for home delivery and use of traditional birth attendants in rural Zambia: a qualitative study. BMC Pregnancy and Childbirth. 2015; 15(1): 216.

58. Shiferaw S, Spigt M, Godefrooij M, Melkamu Y, Tekie M. Why do women prefer home births in Ethiopia? BMC Pregnancy and Childbirth. 2013; 13(1):5.

59. Sisay MM, Yirgu R, Gobezayehu AG, Sibley LM. A qualitative study of attitudes and values surrounding stillbirth and neonatal mortality among grandmothers, mothers, and unmarried girls in rural Amhara and Oromiya regions, Ethiopia: Unheard souls in the backyard. J Midwifery Womens Health. 2014; 59(s1): s110–7.

60. Adinew YM, Assefa NA, Adinew YM. Why do some Ethiopian women give birth at home after receiving antenatal care? phenomenological study. Biomed Res Int. 2018; 2018.

61. Chea SK, Mwangi TW, Ndirangu KK, Abdullahi OA, Munywoki PK, Abubakar A, et al. Prevalence and correlates of home delivery amongst HIV-infected women attending care at a rural public health facility in Coastal Kenya. PLoS ONE. 2018;13(3): e0194028. doi: 10.1371/journal.pone.0194028 29558474

62. Allou LA. Factors influencing the utilization of TBA services by women in the Tolon district of the northern region of Ghana. Scientific African. 2018; 1(2018): e00010.

63. Ibrhim MA, Demissie M, Medhanyie AA, Worku A, Berhane Y. Reasons for low level of skilled birth attendance in Afar pastoralist community, North East Ethiopia: A qualitative exploration. Pan Afr Med J. 2018;30:51. doi: 10.11604/pamj.2018.30.51.14420 30197742

64. Kea AZ, Tulluch O, Datiko DG, Theobald S, Kok MC. Exploring barriers to the use of formal maternal health services and priority areas for action in Sidama zone, Southern Ethiopia. BMC Pregnancy and Childbirth. 2018; 18:96. J Pregnancy. doi: 10.1186/s12884-018-1721-5 29649972

65. Kwagala B. Birthing choices among the Sabiny of Uganda. Cult Health Sex. 2013; 15(s3): s401–s414.

66. Wilunda C, Quaglio G, Putoto G, Lochoro P, Dall’Oglio G, Manenti F. A qualitative study on barriers to utilisation of institutional delivery services in Moroto and Napak districts, Uganda: implications for programming. BMC Pregnancy and Childbirth. 2014; 14:259. doi: 10.1186/1471-2393-14-259 25091866

67. Ahmed MAA, Hamelin-Brabant L, Gagnon MP. Sociocultural determinants of nomadic women’s utilization of assisted childbirth in Gossi, Mali: A qualitative study. BMC Pregnancy and Childbirth. 2018; 18: 388. doi: 10.1186/s12884-018-2027-3 30285658

68. Lewin S, Bohren M, Rashidian A, Munthe-Kaas H, Glenton C, Colvin CJ. Applying GRADE-CERQual to qualitative evidence synthesis findings- paper 2: how to make an overall CERQual assessment of confidence and create a Summary of Qualitative Findings table. Implement Sci. 2018; 13(Suppl 1): 10. doi: 10.1186/s13012-017-0689-2 29384082

69. Nilses C, Nystrom L, Munjanja S, Lindmark G. Self-reported reproductive outcome and implications in relation to use of care in women in rural Zimbabwe. Acta Obstret Gynecol Scand. 2002;81(6):508–15.

70. Lerberg PM, Sundby J, Jammeh A, Fretheim A. Barriers to skilled birth attendance: a survey among mothers in rural Gambia. Afr J Reprod Health. 2014; 18(1):35–43. 24796167

71. Akpabio II, Edet OB, Etifit RE, Robinson-Bassey GC. Women's preference for TBAs and modern health care practitioners in Akpabuyo community of Cross River State, Nigeria. Health care women int. 2014; 35(1): 100–9. doi: 10.1080/07399332.2013.815751 23980707

72. Kruk ME, Paczkowski M, Mbaruku G, de Pinho H, Galea S. Women’s preferences for place of delivery in Rural Tanzania: A population-based discrete choice experiment. Am J Public Health. 2009; 99(9):1666–72. doi: 10.2105/AJPH.2008.146209 19608959

73. Kruk ME, Paczkowski MM, Tegegn A, Tessema F, Hadley C, Asefa M, et al. Women’s preferences for obstetric care in rural Ethiopia: a population based discrete choice experiment in a region with low rates of facility delivery. J Epidemiol Community Health. 2010; 64(11): 984–8. doi: 10.1136/jech.2009.087973 19822558

74. Larson E, Vail D, Mbaruku GM, Kimweri A, Freedman LP, Kruk ME. Moving toward patient-centered care in Africa: a discrete choice experiment of preferences for delivery care among 3,003 Tanzanian women. Plos ONE. 2015; 10(8): e0135621. doi: 10.1371/journal.pone.0135621 26262840

75. Mekonnen MG, Yalew KN, Umer JY, Melese M. Determinants of delivery practices among Afar pastoralists of Ethiopia. Pan Afr Med J. 2012;13(Supp 1):17.

76. James PB, Wardle J, Steel A, Adams J. Traditional, complementary and alternative medicine use in sub-Saharan Africa: a systematic review. BMJ Glob Health. 2018; 3 (5):e000895. doi: 10.1136/bmjgh-2018-000895 30483405

77. Anwar I, Sami M, Akhtar N, Chowdhury ME, Salma U, Rahman M, et al. Inequity in maternal health-care services: evidence from home-based skilled-birth-attendant programmes in Bangladesh. Bull World Health Organ. 2008; 86(4): 252–9. doi: 10.2471/BLT.07.042754 18438513

78. Stephenson R, Tsui AO. Contextual influences on reproductive health service use in Uttar Pradesh, India. Stud Fam Plann. 2002; 33(4): 309–20. 12561780

79. Withers M, Kharazmi N, Lim E. Traditional beliefs and practises in pregnancy, childbirth and postpartum: A review of the evidence from Asian countries. Midwifery. 2018; 56:158–70. doi: 10.1016/j.midw.2017.10.019 29132060

80. Sychareun V, Hansana V, Somphet V, Xayavong S, Phengsavanh A, Popenoe R. Reasons rural Laotians choose home deliveries over delivery at health facilities: a qualitative study. BMC Pregnancy and Childbirth. 2012; 12(1): 86.

81. Titaley CR, Hunter CL, Dibley MJ, Heywood P. Why do some women still prefer traditional birth attendants and home delivery? a qualitative study on delivery care services in West Java Province, Indonesia. BMC Pregnancy and Childbirth. 2010; 10(1): 43.

82. Sarker BK, Rahman M, Rahman T, Hossain J, Reichenbach L, Mitra DK. Reasons for preference of home delivery with traditional birth attendants (TBAs) in Rural Bangladesh: A qualitative exploration. PLoS ONE. 2016; 11(1): e0146161. doi: 10.1371/journal.pone.0146161 26731276

83. Arba MA, Darebo TD, Koyira MM. Institutional delivery service utilization among women from rural districts of Wolaita and Dawro Zones, Southern Ethiopia; A community based cross-sectional study. PloS ONE. 2016; 11(3): e0151082. doi: 10.1371/journal.pone.0151082 26986563

84. Anyait A, Mukanga D, Oundo GB, Nuwaha F. Predictors for health facility delivery in Busia district of Uganda: a cross sectional study. BMC Pregnancy and Childbirth. 2012;12: 132. doi: 10.1186/1471-2393-12-132 23167791

85. Campbell OM, Graham WJ. Strategies for reducing maternal mortality: getting on with what works. The Lancet. 2006; 368(9543):1284–99.

86. Say L, Raine R. A systematic review of inequalities in the use of maternal health care in developing countries: examining the scale of the problem and the importance of context. Bull World Health Organ. 2007; 85(10):812–9. doi: 10.2471/BLT.06.035659 18038064

87. Bhutta AZ, Lassi ZS, Pariyo G, Huicho L. Global Experience of Community Health Workers for Delivery of Health-Related Millennium Development Goals: A Systematic Review, Country Case Studies, and Recommendations for Integration into National Health Systems [Internet]. Geneva: World Health Organization; 2010. Available from http://chwcentral.org/sites/default/files/Global%20Experience%20of%20Community%20Health%20Workers%20for%20Delivery%20of%20Health%20Related%20Millennium%20Development%20Goals.pdf. Accessed 25 September 2018.

Preferences for formal and traditional sources of childbirth and postnatal care among women in rural Africa: A systematic review

Souhrn

Background

Methods

Results

Conclusion

Klíčová slova:

Zdroje

PLOS One

Současné pohledy na riziko v parodontologii

Svět praktické medicíny 3/2024 (znalostní test z časopisu)

Kardiologické projevy hypereozinofilií

Střevní příprava před kolonoskopií

Aktuální možnosti diagnostiky a léčby litiáz