Stakeholder's experiences, expectations and decision making on reproductive care: An ethnographic study of three districts in northern Ghana
Identifieur interne : 004831 ( Ncbi/Merge ); précédent : 004830; suivant : 004832Stakeholder's experiences, expectations and decision making on reproductive care: An ethnographic study of three districts in northern Ghana
Auteurs : Martin Amogre Ayanore [Ghana, Pays-Bas] ; Milena Pavlova [Pays-Bas] ; Regien Biesma [Irlande (pays)] ; Wim Groot [Pays-Bas]Source :
- PLoS ONE [ 1932-6203 ] ; 2017.
Abstract
In Ghana, priority-setting for reproductive health service interventions is known to be rudimentary with little wider stakeholder involvement. In recognizing the need for broad stakeholder engagement to advance reproductive care provision and utilization, it is necessary to jointly study the varied stakeholder views on reproductive care services.
We applied an ethnographic study approach where field data was collected between March-May 2015 in three rural districts of northern Ghana. Data was collected among women with recent births experiences (n = 90), health care providers (n = 16) and policy actors (n = 6). In-depth interviews and focus group discussions was applied to collect all data. Each stakeholder participant’s audio file was transcribed, and repeatedly read through to identify similar and divergent views in data. A coding scheme guided coding processes. All transcripts were then imported into QSR NVivo 11 for further analysis.
Four themes emerged. Women participants accentuated that sex and sexuality values of men have changed over time, and drives gender roles, parity levels and decision making on reproductive care needs at community levels. Sexual stigma on reproductive care reduces the willingness of women to voice poor experiences related to their previous reproductive experiences. All stakeholders’ highlighted clinical treatments for post-abortion care are minimally covered under the fee exemption policy for antenatal and postnatal care. Policy processes on service delivery protocols still is top-down in Ghana.
Health teams working to improve sexual and reproductive health care must find suitable context strategies that effectively work to improve women reproductive care needs at their operational levels. Private sector participation and informal community support clutches are encouraged to advance the delivery of reproductive care services.
Url:
DOI: 10.1371/journal.pone.0186908
PubMed: 29091916
PubMed Central: 5665529
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and Life Sciences, Maastricht University, Maastricht, Netherlands</addr-line></nlm:aff><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Department of Health Services Research, CAPHRI, Maastricht University Medical Centre, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht</wicri:regionArea><wicri:noRegion>Maastricht</wicri:noRegion></affiliation><affiliation wicri:level="3"><nlm:aff id="aff003"><addr-line>Centre for Health Policy Advocacy, Innovation & Research in Africa (CHPAIR-Africa), Accra, Ghana</addr-line></nlm:aff><country xml:lang="fr">Ghana</country><wicri:regionArea>Centre for Health Policy Advocacy, Innovation & Research in Africa (CHPAIR-Africa), Accra</wicri:regionArea><placeName><settlement type="city">Accra</settlement><region nuts="2">Région du Grand Accra</region></placeName></affiliation></author><author><name sortKey="Pavlova, Milena" sort="Pavlova, Milena" uniqKey="Pavlova M" first="Milena" last="Pavlova">Milena Pavlova</name><affiliation wicri:level="1"><nlm:aff id="aff002"><addr-line>Department of Health Services Research, CAPHRI, Maastricht University Medical Centre, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands</addr-line></nlm:aff><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Department of Health Services Research, CAPHRI, Maastricht University Medical Centre, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht</wicri:regionArea><wicri:noRegion>Maastricht</wicri:noRegion></affiliation></author><author><name sortKey="Biesma, Regien" sort="Biesma, Regien" uniqKey="Biesma R" first="Regien" last="Biesma">Regien Biesma</name><affiliation wicri:level="1"><nlm:aff id="aff004"><addr-line>Department of Epidemiology and Public Health Medicine, Division of Population Health Sciences, Royal College of Surgeons in Ireland, Ireland</addr-line></nlm:aff><country xml:lang="fr">Irlande 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type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Checkpoint">000058</idno><idno type="wicri:Area/Ncbi/Merge">004831</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Stakeholder's experiences, expectations and decision making on reproductive care: An ethnographic study of three districts in northern Ghana</title><author><name sortKey="Ayanore, Martin Amogre" sort="Ayanore, Martin Amogre" uniqKey="Ayanore M" first="Martin Amogre" last="Ayanore">Martin Amogre Ayanore</name><affiliation wicri:level="1"><nlm:aff id="aff001"><addr-line>Department of Family and Community Health, School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana</addr-line></nlm:aff><country xml:lang="fr">Ghana</country><wicri:regionArea>Department of Family and Community Health, School of Public Health, University of Health and Allied Sciences, Hohoe</wicri:regionArea><wicri:noRegion>Hohoe</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:aff id="aff002"><addr-line>Department of Health Services Research, CAPHRI, Maastricht University Medical Centre, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands</addr-line></nlm:aff><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Department of Health Services Research, CAPHRI, Maastricht University Medical Centre, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht</wicri:regionArea><wicri:noRegion>Maastricht</wicri:noRegion></affiliation><affiliation wicri:level="3"><nlm:aff id="aff003"><addr-line>Centre for Health Policy Advocacy, Innovation & Research in Africa (CHPAIR-Africa), Accra, Ghana</addr-line></nlm:aff><country xml:lang="fr">Ghana</country><wicri:regionArea>Centre for Health Policy Advocacy, Innovation & Research in Africa (CHPAIR-Africa), Accra</wicri:regionArea><placeName><settlement type="city">Accra</settlement><region nuts="2">Région du Grand Accra</region></placeName></affiliation></author><author><name sortKey="Pavlova, Milena" sort="Pavlova, Milena" uniqKey="Pavlova M" first="Milena" last="Pavlova">Milena Pavlova</name><affiliation wicri:level="1"><nlm:aff id="aff002"><addr-line>Department of Health Services Research, CAPHRI, Maastricht University Medical Centre, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands</addr-line></nlm:aff><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Department of Health Services Research, CAPHRI, Maastricht University Medical Centre, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht</wicri:regionArea><wicri:noRegion>Maastricht</wicri:noRegion></affiliation></author><author><name sortKey="Biesma, Regien" sort="Biesma, Regien" uniqKey="Biesma R" first="Regien" last="Biesma">Regien Biesma</name><affiliation wicri:level="1"><nlm:aff id="aff004"><addr-line>Department of Epidemiology and Public Health Medicine, Division of Population Health Sciences, Royal College of Surgeons in Ireland, Ireland</addr-line></nlm:aff><country xml:lang="fr">Irlande (pays)</country><wicri:regionArea>Department of Epidemiology and Public Health Medicine, Division of Population Health Sciences, Royal College of Surgeons in Ireland</wicri:regionArea><wicri:noRegion>Royal College of Surgeons in Ireland</wicri:noRegion></affiliation></author><author><name sortKey="Groot, Wim" sort="Groot, Wim" uniqKey="Groot W" first="Wim" last="Groot">Wim Groot</name><affiliation wicri:level="1"><nlm:aff id="aff002"><addr-line>Department of Health Services Research, CAPHRI, Maastricht University Medical Centre, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands</addr-line></nlm:aff><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Department of Health Services Research, CAPHRI, Maastricht University Medical Centre, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht</wicri:regionArea><wicri:noRegion>Maastricht</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:aff id="aff005"><addr-line>Top Institute Evidence-Based Education Research (TIER); Maastricht University; Maastricht, Netherlands</addr-line></nlm:aff><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Top Institute Evidence-Based Education Research (TIER); Maastricht University; Maastricht</wicri:regionArea></affiliation></author></analytic><series><title level="j">PLoS ONE</title><idno type="eISSN">1932-6203</idno><imprint><date when="2017">2017</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec id="sec001"><title>Background</title><p>In Ghana, priority-setting for reproductive health service interventions is known to be rudimentary with little wider stakeholder involvement. In recognizing the need for broad stakeholder engagement to advance reproductive care provision and utilization, it is necessary to jointly study the varied stakeholder views on reproductive care services.</p></sec><sec id="sec002"><title>Methods</title><p>We applied an ethnographic study approach where field data was collected between March-May 2015 in three rural districts of northern Ghana. Data was collected among women with recent births experiences (n = 90), health care providers (n = 16) and policy actors (n = 6). In-depth interviews and focus group discussions was applied to collect all data. Each stakeholder participant’s audio file was transcribed, and repeatedly read through to identify similar and divergent views in data. A coding scheme guided coding processes. All transcripts were then imported into QSR NVivo 11 for further analysis.</p></sec><sec id="sec003"><title>Results</title><p>Four themes emerged. Women participants accentuated that sex and sexuality values of men have changed over time, and drives gender roles, parity levels and decision making on reproductive care needs at community levels. Sexual stigma on reproductive care reduces the willingness of women to voice poor experiences related to their previous reproductive experiences. All stakeholders’ highlighted clinical treatments for post-abortion care are minimally covered under the fee exemption policy for antenatal and postnatal care. Policy processes on service delivery protocols still is top-down in Ghana.</p></sec><sec id="sec004"><title>Conclusions</title><p>Health teams working to improve sexual and reproductive health care must find suitable context strategies that effectively work to improve women reproductive care needs at their operational levels. Private sector participation and informal community support clutches are encouraged to advance the delivery of reproductive care services.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Olaolorun, F" uniqKey="Olaolorun F">F OlaOlorun</name></author><author><name sortKey="Seme, A" uniqKey="Seme A">A Seme</name></author><author><name sortKey="Otupiri, E" uniqKey="Otupiri E">E Otupiri</name></author><author><name sortKey="Ogunjuyigbe, P" uniqKey="Ogunjuyigbe P">P Ogunjuyigbe</name></author><author><name sortKey="Tsui, A" uniqKey="Tsui A">A Tsui</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Dejong, J" uniqKey="Dejong J">J DeJong</name></author><author><name sortKey="Shepard, B" uniqKey="Shepard B">B Shepard</name></author><author><name sortKey="Roudi Fahimi, F" uniqKey="Roudi Fahimi F">F Roudi-Fahimi</name></author><author><name sortKey="Ashford, L" uniqKey="Ashford L">L 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<front><journal-meta><journal-id journal-id-type="nlm-ta">PLoS One</journal-id><journal-id journal-id-type="iso-abbrev">PLoS ONE</journal-id><journal-id journal-id-type="publisher-id">plos</journal-id><journal-id journal-id-type="pmc">plosone</journal-id><journal-title-group><journal-title>PLoS ONE</journal-title></journal-title-group><issn pub-type="epub">1932-6203</issn><publisher><publisher-name>Public Library of Science</publisher-name><publisher-loc>San Francisco, CA USA</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">29091916</article-id><article-id pub-id-type="pmc">5665529</article-id><article-id pub-id-type="doi">10.1371/journal.pone.0186908</article-id><article-id pub-id-type="publisher-id">PONE-D-17-00357</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Medicine and Health Sciences</subject><subj-group><subject>Health Care</subject><subj-group><subject>Health Care Policy</subject></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Biology and Life Sciences</subject><subj-group><subject>Neuroscience</subject><subj-group><subject>Cognitive Science</subject><subj-group><subject>Cognitive Psychology</subject><subj-group><subject>Decision Making</subject></subj-group></subj-group></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Biology and Life Sciences</subject><subj-group><subject>Psychology</subject><subj-group><subject>Cognitive Psychology</subject><subj-group><subject>Decision Making</subject></subj-group></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Social Sciences</subject><subj-group><subject>Psychology</subject><subj-group><subject>Cognitive Psychology</subject><subj-group><subject>Decision Making</subject></subj-group></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Biology and Life Sciences</subject><subj-group><subject>Neuroscience</subject><subj-group><subject>Cognitive Science</subject><subj-group><subject>Cognition</subject><subj-group><subject>Decision Making</subject></subj-group></subj-group></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Social Sciences</subject><subj-group><subject>Economics</subject><subj-group><subject>Health Economics</subject></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Medicine and Health Sciences</subject><subj-group><subject>Health Care</subject><subj-group><subject>Health Economics</subject></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Medicine and Health Sciences</subject><subj-group><subject>Public and Occupational Health</subject><subj-group><subject>Behavioral and Social Aspects of Health</subject></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Medicine and Health Sciences</subject><subj-group><subject>Health Care</subject><subj-group><subject>Health Care Policy</subject><subj-group><subject>Health Systems Strengthening</subject></subj-group></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>People and Places</subject><subj-group><subject>Geographical Locations</subject><subj-group><subject>Africa</subject><subj-group><subject>Ghana</subject></subj-group></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Medicine and Health Sciences</subject><subj-group><subject>Women's Health</subject><subj-group><subject>Obstetrics and Gynecology</subject><subj-group><subject>Contraception</subject><subj-group><subject>Female Contraception</subject></subj-group></subj-group></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Medicine and Health Sciences</subject><subj-group><subject>Health Care</subject><subj-group><subject>Health Services Administration and Management</subject></subj-group></subj-group></subj-group></article-categories><title-group><article-title>Stakeholder's experiences, expectations and decision making on reproductive care: An ethnographic study of three districts in northern Ghana</article-title><alt-title alt-title-type="running-head">Stakeholder's experiences, expectations and decision making on reproductive care</alt-title></title-group><contrib-group><contrib contrib-type="author"><contrib-id authenticated="true" contrib-id-type="orcid">http://orcid.org/0000-0002-4095-3047</contrib-id><name><surname>Ayanore</surname><given-names>Martin Amogre</given-names></name><role content-type="http://credit.casrai.org/">Conceptualization</role><role content-type="http://credit.casrai.org/">Data curation</role><role content-type="http://credit.casrai.org/">Formal analysis</role><role content-type="http://credit.casrai.org/">Investigation</role><role content-type="http://credit.casrai.org/">Methodology</role><role content-type="http://credit.casrai.org/">Project administration</role><role content-type="http://credit.casrai.org/">Writing – original draft</role><role content-type="http://credit.casrai.org/">Writing – review & editing</role><xref ref-type="aff" rid="aff001"><sup>1</sup></xref><xref ref-type="aff" rid="aff002"><sup>2</sup></xref><xref ref-type="aff" rid="aff003"><sup>3</sup></xref><xref ref-type="corresp" rid="cor001">*</xref></contrib><contrib contrib-type="author"><name><surname>Pavlova</surname><given-names>Milena</given-names></name><role content-type="http://credit.casrai.org/">Formal analysis</role><role content-type="http://credit.casrai.org/">Methodology</role><role content-type="http://credit.casrai.org/">Software</role><role content-type="http://credit.casrai.org/">Supervision</role><role content-type="http://credit.casrai.org/">Validation</role><role content-type="http://credit.casrai.org/">Writing – review & editing</role><xref ref-type="aff" rid="aff002"><sup>2</sup></xref></contrib><contrib contrib-type="author"><name><surname>Biesma</surname><given-names>Regien</given-names></name><role content-type="http://credit.casrai.org/">Formal analysis</role><role content-type="http://credit.casrai.org/">Investigation</role><role content-type="http://credit.casrai.org/">Methodology</role><role content-type="http://credit.casrai.org/">Supervision</role><role content-type="http://credit.casrai.org/">Writing – review & editing</role><xref ref-type="aff" rid="aff004"><sup>4</sup></xref></contrib><contrib contrib-type="author"><name><surname>Groot</surname><given-names>Wim</given-names></name><role content-type="http://credit.casrai.org/">Formal analysis</role><role content-type="http://credit.casrai.org/">Methodology</role><role content-type="http://credit.casrai.org/">Software</role><role content-type="http://credit.casrai.org/">Supervision</role><role content-type="http://credit.casrai.org/">Validation</role><role content-type="http://credit.casrai.org/">Writing – review & editing</role><xref ref-type="aff" rid="aff002"><sup>2</sup></xref><xref ref-type="aff" rid="aff005"><sup>5</sup></xref></contrib></contrib-group><aff id="aff001"><label>1</label><addr-line>Department of Family and Community Health, School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana</addr-line></aff><aff id="aff002"><label>2</label><addr-line>Department of Health Services Research, CAPHRI, Maastricht University Medical Centre, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands</addr-line></aff><aff id="aff003"><label>3</label><addr-line>Centre for Health Policy Advocacy, Innovation & Research in Africa (CHPAIR-Africa), Accra, Ghana</addr-line></aff><aff id="aff004"><label>4</label><addr-line>Department of Epidemiology and Public Health Medicine, Division of Population Health Sciences, Royal College of Surgeons in Ireland, Ireland</addr-line></aff><aff id="aff005"><label>5</label><addr-line>Top Institute Evidence-Based Education Research (TIER); Maastricht University; Maastricht, Netherlands</addr-line></aff><contrib-group><contrib contrib-type="editor"><name><surname>Dangal</surname><given-names>Ganesh</given-names></name><role>Editor</role><xref ref-type="aff" rid="edit1"></xref></contrib></contrib-group><aff id="edit1"><addr-line>National Academy of Medical Sciences, NEPAL</addr-line></aff><author-notes><fn fn-type="COI-statement" id="coi001"><p><bold>Competing Interests: </bold>The authors have declared that no competing interests exist.</p></fn><corresp id="cor001">* E-mail: <email>mayanore@uhas.edu.gh</email></corresp></author-notes><pub-date pub-type="epub"><day>1</day><month>11</month><year>2017</year></pub-date><pub-date pub-type="collection"><year>2017</year></pub-date><volume>12</volume><issue>11</issue><elocation-id>e0186908</elocation-id><history><date date-type="received"><day>4</day><month>1</month><year>2017</year></date><date date-type="accepted"><day>22</day><month>9</month><year>2017</year></date></history><permissions><copyright-statement>© 2017 Ayanore et al</copyright-statement><copyright-year>2017</copyright-year><copyright-holder>Ayanore et al</copyright-holder><license xlink:href="http://creativecommons.org/licenses/by/4.0/"><license-p>This is an open access article distributed under the terms of the <ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by/4.0/">Creative Commons Attribution License</ext-link>, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.</license-p></license></permissions><self-uri content-type="pdf" xlink:href="pone.0186908.pdf"></self-uri><abstract><sec id="sec001"><title>Background</title><p>In Ghana, priority-setting for reproductive health service interventions is known to be rudimentary with little wider stakeholder involvement. In recognizing the need for broad stakeholder engagement to advance reproductive care provision and utilization, it is necessary to jointly study the varied stakeholder views on reproductive care services.</p></sec><sec id="sec002"><title>Methods</title><p>We applied an ethnographic study approach where field data was collected between March-May 2015 in three rural districts of northern Ghana. Data was collected among women with recent births experiences (n = 90), health care providers (n = 16) and policy actors (n = 6). In-depth interviews and focus group discussions was applied to collect all data. Each stakeholder participant’s audio file was transcribed, and repeatedly read through to identify similar and divergent views in data. A coding scheme guided coding processes. All transcripts were then imported into QSR NVivo 11 for further analysis.</p></sec><sec id="sec003"><title>Results</title><p>Four themes emerged. Women participants accentuated that sex and sexuality values of men have changed over time, and drives gender roles, parity levels and decision making on reproductive care needs at community levels. Sexual stigma on reproductive care reduces the willingness of women to voice poor experiences related to their previous reproductive experiences. All stakeholders’ highlighted clinical treatments for post-abortion care are minimally covered under the fee exemption policy for antenatal and postnatal care. Policy processes on service delivery protocols still is top-down in Ghana.</p></sec><sec id="sec004"><title>Conclusions</title><p>Health teams working to improve sexual and reproductive health care must find suitable context strategies that effectively work to improve women reproductive care needs at their operational levels. Private sector participation and informal community support clutches are encouraged to advance the delivery of reproductive care services.</p></sec></abstract><funding-group><funding-statement>The authors received no specific funding for this work.</funding-statement></funding-group><counts><fig-count count="0"></fig-count><table-count count="5"></table-count><page-count count="21"></page-count></counts><custom-meta-group><custom-meta id="data-availability"><meta-name>Data Availability</meta-name><meta-value>Data are from field obtained using different qualitative approaches. All relevant data are within the paper.</meta-value></custom-meta></custom-meta-group></article-meta><notes><title>Data Availability</title><p>Data are from field obtained using different qualitative approaches. All relevant data are within the paper.</p></notes></front></pmc><affiliations><list><country><li>Ghana</li><li>Irlande (pays)</li><li>Pays-Bas</li></country><region><li>Région du Grand Accra</li></region><settlement><li>Accra</li></settlement></list><tree><country name="Ghana"><noRegion><name sortKey="Ayanore, Martin Amogre" sort="Ayanore, Martin Amogre" uniqKey="Ayanore M" first="Martin Amogre" last="Ayanore">Martin Amogre Ayanore</name></noRegion><name sortKey="Ayanore, Martin Amogre" sort="Ayanore, Martin Amogre" uniqKey="Ayanore M" first="Martin Amogre" last="Ayanore">Martin Amogre Ayanore</name></country><country name="Pays-Bas"><noRegion><name sortKey="Ayanore, Martin Amogre" sort="Ayanore, Martin Amogre" uniqKey="Ayanore M" first="Martin Amogre" last="Ayanore">Martin Amogre Ayanore</name></noRegion><name sortKey="Groot, Wim" sort="Groot, Wim" uniqKey="Groot W" first="Wim" last="Groot">Wim Groot</name><name sortKey="Groot, Wim" sort="Groot, Wim" uniqKey="Groot W" first="Wim" last="Groot">Wim Groot</name><name sortKey="Pavlova, Milena" sort="Pavlova, Milena" uniqKey="Pavlova M" first="Milena" last="Pavlova">Milena Pavlova</name></country><country name="Irlande (pays)"><noRegion><name sortKey="Biesma, Regien" sort="Biesma, Regien" uniqKey="Biesma R" first="Regien" last="Biesma">Regien Biesma</name></noRegion></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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