Ingabe ingane yakho izoba sengozini ngesikhathi sokuzalwa? Ake sifunde ngokulimala kokuzalwa.

Wonke umama nobaba bayesaba kancane uma belindele umntwana, akunjalo? Bayazibuza ukuthi umntwana uzoba nempilo enhle yini, ukuthi kuzoba nezinkinga yini. Esikhathini esiningi konke kuhamba kahle, kodwa ngezinye izikhathi lapho umntwana efika kuleli zwe, kungaba nokulimala okuncane, okubizwa ngokuthi 'ukulimala kokuzalwa'. Kodwa ungakhathazeki, lezi ngokuvamile ziyizinto ezincane.

Iyini le ngozi yokuzalwa?

Kalula nje, ukulimala kokubeletha, noma njengoba odokotela bekubiza kanjalo, 'ukulimala kokuzalwa kosana', yinoma yimuphi umonakalo owenzeka enganeni ngesikhathi sokuzalwa. Lokhu akuvamile kakhulu, futhi isikhathi esiningi kuba ukulimala okuncane. Kodwa-ke, akuvamile kakhulu, izimo ezimbi kakhulu zingavela futhi zidinga ukwelashwa okwengeziwe.

Odokotela nabahlengikazi abakwelapha wena nomntwana wakho bonke bazama ukuvimbela lezi zingozi noma okungenani ukunciphisa umthelela wazo. Kodwa khumbula, akekho ongalawula ngqo ukuthi ukubeletha kwakho kuzohamba kanjani . Futhi, khumbula ukuthi uma kwenzeka into efana nale, akulona iphutha lakho nhlobo .

Kodwa lokho akusho ukuthi awukwazi ukwenza lutho. Uma unemibuzo noma ukukhathazeka ngokubeletha, buza umhlinzeki wakho we-Ob/Gyn. Angakuqondisa futhi mhlawumbe akufundise nezindlela zokunciphisa ingozi yokubeletha okunzima.

Yiziphi izinhlobo zokulimala kokubeletha?

Ukulimala kokubeletha kungahlukaniswa ngezinhlobo eziningana eziyinhloko. Ake sibone ukuthi kuyini:

• Ukulimala kwesikhumba sekhanda: Ukulimala esikhumbeni sekhanda lomntwana. Lokhu yikona okuvame kakhulu.
• Ukuphuka kwamathambo: Ngezinye izikhathi, lapho umntwana ephuma, ithambo elingalweni, emlenzeni, noma entanyeni lingaphuka.
• Ukulimala kwamehlo: Kungaba nemihuzuko emincane esweni kanye nokopha okuncane kwangaphakathi.
• Ukopha ngaphakathi kwekhanda: Lesi yisimo esidinga ukukhathazeka okuthile.
• Ukulimala kwemizwa: Ngesikhathi sokubeletha, eminye imizwa ingalimala ngokucindezelwa.
• Ukulimala kobuchopho: Lokhu nakho akuvamile, kodwa kungaba kubi kakhulu uma kwenzeka.

Ukulimala kokubeletha akuvamile ngokuvamile. Ucwaningo lwango-2021 luthole ukuthi kwakunezimo zokubeletha ezingu-29 kuphela kwabangu-1,000 abazalwa bephila. Kulabo abangu-29, abangu-23 kwakuwukulimala kwesikhumba. Ngakho-ke akukho okuningi okufanele ukhathazeke ngakho, akunjalo?

Yiziphi izinkinga ezivamile zokubeletha?

Ake sixoxe ngezinye zezingozi ezivame kakhulu zokubeletha. Kungenzeka ukuthi uke wezwa ngezinye zazo.

• Amathambo e-collarbone/clavicle aphukile:Lokhu kuvame ukwenzeka ngesikhathi sokubeletha uma umntwana enenkinga yokuphuma, njengalapho ihlombe libambekile. Kodwa liyaphola ngokushesha, futhi ngezinye izikhathi akudingeki ukwelashwa okukhethekile.
• 'I-Caput Succedaneum': Yilapho isikhumba esisekhanda lomntwana osanda kuzalwa sivuvukala khona. Sibukeka njengesigaxa ekhanda. Lokhu kuzophela ngokwaso ezinsukwini ezimbalwa. Akuyona into okufanele ukhathazeke ngayo.
• I-Cephalohematoma: Lena yiqoqo elincane legazi ngaphansi kwesikhumba sekhanda lomntwana. Litholakala kakhulu kune-'caput'. Lokhu kuvame ukuphola ngokwako phakathi namasonto ambalwa.
• Ukukhubazeka Kwemisipha: Lokhu kwenzeka lapho i-brachial plexus, inethiwekhi yezinzwa ezigijima kusukela entanyeni ziye engalweni, yonakaliswa. Lokhu kungabangela ubuthakathaka noma ukukhubazeka engalweni yengane. Lokhu kungadinga ukwelashwa njengokwelashwa ngokomzimba.
• Ukuvuvukala kwamehlo: Lokhu nakho kuyinto encane futhi kuzophola ngokushesha.
• I-necrosis yamafutha angaphansi kwesikhumba somntwana osanda kuzalwa: Lena indawo encane yomonakalo wengqimba yamafutha ngaphansi kwesikhumba somntwana. Kungase kubonakale njengamaqhubu amancane esikhumbeni. Lokhu kuvame ukuphola ngokwako.
• Ukukhubazeka kwemizwa yobuso: Kulesi simo, imizwa ohlangothini olulodwa lobuso bomntwana iyacindezelwa, okwenza ukuthi lolo hlangothi lugobe kancane. Isibonelo, umlomo ungase ugobe ohlangothini olulodwa uma ukhala. Esikhathini esiningi, lokhu kungokwesikhashana futhi kuxazululeka ezinsukwini ezimbalwa.
• Ukuphuka kwethambo lengalo engenhla (i-humerus).
• Ukuphuka kwe-femur. Lokhu akuvamile kakhulu njengokuphuka kwe-collarbone.
• Ukopha kwegazi ngaphakathi kobuchopho - isibonelo, ukopha kwegazi ngaphansi kobuchopho. Lezi yizimo ezidinga ukunakwa okuthile.
• Ukuqhekeka kobuso noma kwesikhumba sekhanda.
• Ukulimala ekhaleni, isibonelo, i-septum ephambukile.
• Ukopha kwe-Retinal noma kwe-Subconjunctival. Lokhu kuvame ukubangela ukubomvu esweni, kodwa kuphola ngokushesha futhi akuthinti ukubona.
• Ukuphuka kwekhanda. Lokhu akuvamile.

Ukulimala Kokubeletha Okungavamile Nokungajwayelekile

Manje ake sibheke ezinye zezingozi zokubeletha ezingavamile, noma ezingavamile. Ezinye zalezi zingaba zimbi kakhulu, ngakho-ke kuhle ukuzazi nazo.

• Izinhlobo zokopha ebuchosheni, njengokuphuma kwegazi e-epidural noma e-subarachnoid, yizimo ezidinga ukunakekelwa kwezokwelapha ngokushesha.
• Ukulimala kobuchopho ngenxa yokuntuleka komoya-mpilo (Hypoxic-Ischemic Encephalopathy / HIE).Lesi yisimo esibi kakhulu. Lokhu kungenzeka uma kunenkinga yokuthi ingane ithole umoya-mpilo ngesikhathi sokubeletha.
• Ukulimala kwezitho zangaphakathi, isibonelo, ukuphuma kwegazi esibindini noma ephentini.
• Ukuphuka kwembambo.
• Ukulimala komgogodla. Lesi futhi yisimo esingavamile kakhulu, kodwa esibi kakhulu.
• Ukopha kwegazi okungaphansi kwesikhumba: Lokhu ukopha okukhulu phakathi kwesikhumba sekhanda kanye nolwelwesi olumboze isikhumba sekhanda. Lesi futhi yisimo esidinga ukunakekelwa okusheshayo.

Ezinye zalezi zingozi ezingavamile zingaba zimbi kakhulu. Udokotela wakho uzokuchazela kahle ukuthi ingozi imbi kangakanani enganeni yakho. Kubalulekile ukulalela lokho abakushoyo ngaphandle kokwethuka.

Ziyini izimpawu zokulimala kokuzalwa?

Ukulimala kokuzalwa kungabangela izimpawu ezahlukahlukene, kuye ngohlobo lokulimala. Nazi izibonelo ezimbalwa:

• Izinguquko zangaphandle: Ukulimala (i-Ecchymosis) , ukuvuvukala (i-Edema) , amabala amancane ashintshe umbala wesikhumba (i-Petechiae) . Ezinye izingxenye zomntwana zingase zibe luhlaza okwesibhakabhaka futhi zivuvukele.
• Ukungakwazi ukunyakaza izingxenye ezithile zomzimba: Lokhu kungaba ngenxa yokulimala kwethambo noma imizwa. Isibonelo, uma ungakwazi ukunyakaza ingalo eyodwa, kungaba uphawu lwesimo esibizwa ngokuthi i-Erb's Palsy.
• Ubunzima bokuncelisa. Uma ingane ingamunyi kahle noma ihlanza ngemva kokuncelisa, lokho kufanele kuhlolwe.
• Izinguquko ekuziphatheni, njengokukhala njalo nokungahlaliseki. Uma ingane yakho ikhala njalo noma kunzima ukuyiduduza, tshela udokotela wakho ngalokho.
• Izwi elihoshozelayo, eliphefumulayo uma ukhala (Stridor).
• Ubunzima bokuphefumula.
• Izimo ezifana nokuquleka.

Uma ubona eyodwa noma ngaphezulu yalezi zimpawu, kungcono ukufuna iseluleko sezokwelapha ngokushesha.

Yiziphi izimbangela zokulimala kokubeletha?

Kunezimbangela eziningana eziyinhloko zokulimala kokubeletha. Ake sibheke ukuthi ziyini:

• Uma umntwana enenkinga yokuphuma emgodini wokuzalwa: Isibonelo, ezimweni ezifana ne-shoulder dystocia noma i-macrocephaly , ikhanda lomntwana liba likhulu kakhulu. Njengoba umntwana ekhula, kuba nzima ukuphuma emgodini wokuzalwa kamama.
• Uma bezama ukuhambisa umntwana futhi bambeke kahle ngesikhathi sokubeletha, odokotela ngezinye izikhathi kufanele bashintshe indawo yakhe.
• Ngenxa yemiphumela yokusikwa kwesisu emgudwini wokubeletha. Lokhu kusikwa kwesisu yikona okusunduza umntwana ngaphandle, kodwa ngezinye izikhathi lokho kucindezela kungabangela nokulimala okuncane.
• Uma usebenzisa amadivayisi okusiza: Isibonelo, uma ususa ingane nge-'vacuum' (Ukulethwa Kokukhishwa Kwe-Vacuum)Ukuhlinzwa Kwe-Forceps , noma Ukuhlinzwa Kwe-C-section ngezinye izikhathi kungabangela ukulimala okuncane. Lawa madivayisi asetshenziswa ezimweni eziphuthumayo, ukuze kuphephe umama nomntwana.

Yiziphi izici eziyingozi zokulimala kokuzalwa?

Kunezici eziningana ezingabangela ukulimala kokubeletha. Lezi yizi:

• Isisindo sokuzalwa esikhulayo: Le ngozi iphakeme ezinganeni ezinesisindo esingaphezu kwamakhilogremu angu-4 (amakhilogremu angu-8 nama-ounces angu-13), okungukuthi, izingane ezine-'fetal macrosomia '.
• Ukuzalwa kwesisindo esiphansi noma ukuzalwa kusenesikhathi: Le ngozi iphezulu ezinganeni ezizalwa ngaphambi kwesikhathi noma ezincane kakhulu, ngoba imizimba yazo ithambile kakhulu.
• Indawo yomntwana: Uma umntwana engabekwanga kahle, isibonelo, endaweni enomphetho womhlane , kunethuba elikhulu lezingozi.
• Usayizi wekhanda: Lokhu kungenzeka ezinganeni ezinekhanda elikhulu. Futhi, ezinye izimo zezokwelapha zingabangela ikhanda elikhulu.
• Ukubeletha okunzima: Uma ukubeletha kunzima futhi kuthatha isikhathi eside kakhulu, amathuba ezingozi aphezulu.
• Ukuzalwa ngokushesha: Le ngozi ikhona ngisho noma umntwana ezalwa ngokushesha kakhulu kunokujwayelekile.
• Isifo Sikashukela: Izingane ezizalwa omama abanesifo sikashukela zisengozini enkulu yokulimala kokuzalwa. Lokhu kungenxa yokuthi isifo sikashukela singabangela umntwana abe mkhulu. Ngakho-ke, kubaluleke kakhulu ukulawula amazinga kashukela egazini ngesikhathi sokukhulelwa.
• Izici zomzimba zikamama: Ngezinye izikhathi, izici ezithile zomzimba kamama, isibonelo, ukuma kwe- pelvis , zingenza kube nzima ukubeletha. Futhi, ubukhulu bekhanda lomntwana kanye ne-pelvis kamama kungathinta lokho.

Yiziphi izinkinga zokulimala kokubeletha?

Ucwaningo luthole ukuthi ukulimala kokubeletha kungaholela ezinkingeni ezahlukahlukene. Ezinye zazo yilezi:

• I-Cerebral Palsy: Lena inkinga yokunyakaza kanye nokuma komzimba okubangelwa ukulimala kobuchopho.
• Ukucindezeleka kwengane: Ingane izwa ukungakhululeki okuthile ngesikhathi isesibelethweni.
• I-jaundice esanda kuzalwa ivela ngenxa yokwanda kwamazinga e-bilirubin (i-hyperbilirubinemia).
• I-Meconium Aspiration Syndrome: Lokhu kwenzeka lapho umntwana ekhipha indle ngesikhathi esesesibelethweni futhi ephefumula uketshezi. Lokhu kungaholela ekuthelelekeni kwamaphaphu.
• I-Respiratory Distress Syndrome: Ubunzima bokuphefumula.
• Isidingo semishini yokungenisa umoya noma imishini ye-CPAP (Continuous Positive Airway Pressure).
• Ukuquleka.
• I-Sepsis: Ukutheleleka okukhulu okusakazeka emzimbeni wonke.
• I-Tachypnea Yesikhashana: Ukuphefumula okusheshayo kwesikhashana.

Lezi zinkinga aziveli kuzo zonke izingozi zokuzalwa, kodwa kubalulekile ukuzazi.

Ungayibona kanjani ingozi yokuzalwa?

Odokotela bezifo zokubelethisa kanye nodokotela bezifo zabesifazane (Ob/Gyns), odokotela bezingane ezisanda kuzalwa, noma odokotela bezifo zabesifazane baxilonga lokhu kulimala kokubeletha. Basebenzisa inhlanganisela yezindlela:

• Ukuhlolwa komzimba: Kuyinqubo ejwayelekile ukuthi udokotela ahlole umntwana ngokushesha ngemva kokuzalwa. Lokhu kwenzelwa ukuhlola izimo zokuzalwa kanye nokulimala kokuzalwa. Ikhanda, izitho, kanye nesifuba konke kuhlolwa ngokucophelela.
• Ukuthwebula izithombe: Ukuhlolwa okufana ne-brain ultrasound , i-CT scan , noma i-X-ray kungasiza ekuboneni ukulimala kanye nokuqhekeka emzimbeni womntwana. Akuvamile ukusetshenziswa nama-MRI .
• Ukuhlolwa kwegazi: Ukuhlolwa kwelebhu kungasiza odokotela ukuthola ukulimala noma izinkinga ezithile zokubeletha, njengokutheleleka kanye namazinga e-bilirubin.

Ezinye izivivinyo zingenziwa kuye ngesimo. Udokotela wengane yakho angakutshela okwengeziwe ngalezi zivivinyo nokuthi kungani ziwusizo.

Ilashwa kanjani ingozi yokuzalwa?

Ukwelashwa kokulimala kokuzalwa kuncike kakhulu ohlotsheni lokulimala. Ezinye zezindlela zokwelapha ezivame kakhulu zifaka:

• Ukuqaphela Nokuqaphela: Ukulimala okuningi kokubeletha kuyaphola ngokwako. Isibonelo, ukuphuka okuncane kwe-collarbone, i-caput succedaneum, kanye nomonakalo omncane wemizwa ye-brachial plexus. Odokotela bazoqapha lokhu ukuze babone izimpawu zokulimala.
• Ukungasebenzi: Uma ithambo engalweni noma emlenzeni liphukile, umntwana kuzodingeka angasebenzi amasonto amaningana aze aphole. Lokhu kungase kuhilele ukugqoka i-splint noma i-harness eklanyelwe ngokukhethekile.
• Ukwelashwa ngokomzimba: Ukwelashwa ngokomzimba kuyasiza kakhulu ekulimaleni kwemithambo ye-brachial plexus. Kusiza ekuvimbeleni izinkinga ezifana nokulimala okuqhubekayo kwemizwa noma ubuthakathaka bemisipha. Umntwana unikezwa izivivinyo zokuqinisa imisipha.
• Ukuhlinzwa:Kwezinye izimo, kungase kudingeke ukuhlinzwa ukuze kulungiswe izinto ezifana nokusikeka. Ukuhlinzwa kwenziwa futhi ukuze kumiswe igazi ukuthi lingaqongeleli ngaphakathi kwekhanda lomntwana futhi kucindezele ubuchopho. Ngezinye izikhathi ukuhlinzwa kungasiza futhi ekulimaleni kwemizwa ngokusiza ukuthumela izimpawu zemizwa ebuchosheni.

Kuye ngesimo, ithimba lakho lezokwelapha lingancoma ezinye izindlela zokwelapha. Udokotela wengane yakho angakutshela okwengeziwe ngalokhu futhi ancome izinketho zokwelapha.

Kwenzekani uma ingane yami ithola ukulimala ngesikhathi sokuzalwa?

Umbono wokulimala kokubeletha uncike kakhulu ohlotsheni lokulimala nokuthi kuyingozi kangakanani. Kodwa ngokuvamile, umbono wokulimala okuningi kokubeletha—ikakhulukazi okuvame kakhulu—muhle kakhulu. Emashumini ambalwa eminyaka edlule, ochwepheshe basebenze kanzima ukuthuthukisa ingozi yokulimala kokubeletha kanye nezindlela zokwelashwa. Ukulimala okukhulu kokubeletha akusavamile kakhulu manje njengoba kwakunjalo eminyakeni engama-30 edlule. Ngo-1993, ukulimala kokubeletha kwakuyimbangela ye-11 ehamba phambili yokufa kwezinsana ezisanda kuzalwa. Kodwa kusukela ngo-2007, ukulimala kokubeletha akukaze kube kulolo hlu. Akuyona yini into enhle leyo?

Yini okufanele ngiyilindele uma ingane yami ithola ukulimala ngesikhathi sokuzalwa?

Uma ingane yakho ilimele ngesikhathi sokubeletha, ithimba lakho lezokwelapha lizokwenza konke okusemandleni alo ukulawula ukulimala futhi likhulume nawe ngalokho okwenzekayo. Iningi lokulimala ngesikhathi sokubeletha lincane futhi alidingi ukunakekelwa okuningi. Kodwa kwezinye izimo, udokotela wakho angase ancome ukuthi wena nomntwana wakho nihlale esibhedlela kuze kube yilapho ingane yakho isiphilile ngokwanele ukuba ibuyele ekhaya.

Uma usuya ekhaya, udokotela wakho uzokhuluma nawe ngendlela yokunakekela ingane yakho, okufanele uyiqaphele, nezinye izinto. Kungaba lula ukukhohlwa izinto ezihambisana nokungalali kahle okuhambisana nokubeletha, ngakho-ke kungaba usizo ukubhala phansi le miyalelo noma ukucela ikhophi ephrintiwe.

Into ebaluleke kakhulu ukuthi, uma ungaqondi okuthile, uma unokwesaba noma ukungabaza, ungalokothi unqikaze ukutshela udokotela. Abanankinga nokukuchazela izinto nokukwenza uzizwe ukhululekile. Ngoba bafuna nokwenza okungcono kakhulu kuwe nakumntanakho.

Ingabe Ukulimala Kokubeletha Kungavinjelwa?

Ukulimala kokubeletha akukwazi ukuvinjelwa ngokuphelele, kodwa kunezinto ezithile ongazenza ngesikhathi sokukhulelwa ezinganciphisa ingozi yakho yalokhu kulimala.

• Khuluma nodokotela wakho wezifo zabesifazane/odokotela bezifo zabesifazane (Ob/Gyn) ngokushesha okukhulu. Angakusiza ukuthi ulungiselele ngaphambi kokuba ukhulelwe. Uma kudingeka, bangakudlulisela kochwepheshe abanjengodokotela bezifo zabesifazane.
• Lawula izimo zakho ezingamahlalakhona.Udokotela wakho wokubelethisa noma uchwepheshe wezokwelapha umbungu angakuqondisa ukuthi ungazisingatha kanjani lezi zimo. Lokhu kunganciphisa ingozi yokulimala kokubeletha okubangelwa yizimo ezifana nesifo sikashukela.
• Yenza uhlelo lokubeletha. Udokotela wakho angakweluleka ngezinqubo noma izindlela ezithile ezinganciphisa ingozi yokulimala kokubeletha. Bangakutshela futhi ngezinhlelo zokusekela, njengalapho ukuhlinzwa ngokuhlinzwa kwebele kuyindlela engcono kuwe nakwezokuphepha komntwana wakho.

Ithimba lakho lezokwelapha lizokwenza konke okusemandleni alo ukunciphisa ingozi yokulimala kokubeletha. Odokotela, abahlengikazi, kanye nabanye abasebenzi bezokwelapha bazosebenzisana ukuze bakusize wena nomntwana wakho.

Yimiphi imibuzo okufanele ngiyibuze udokotela wengane yami?

Kungumqondo omuhle ukubuza udokotela wengane yakho le mibuzo:

• Hlobo luni lokulimala kokubeletha ingane yami enalo?
• Kubaluleke kangakanani?
• Ingabe idinga ukwelashwa?
• Yikuphi ukwelashwa (uma kukhona) okuncomayo?
• Ingane yami ingaya nini ekhaya?
• Yini okufanele ngiyiqaphele lapho ngiyisa ingane yami ekhaya?
• Kufanele ngishayele nini ihhovisi lakho noma ngilethe umntwana esibhedlela?

Kufanele ngiyise nini ingane yami kudokotela?

Udokotela wengane yakho uzohlela isimiso sokulandelela, noma akuthumele kudokotela wezingane ongaqhubeka nokunakekelwa kwengane yakho. Bazoba nokuvakasha njalo ukuze baqaphe ukululama kwengane yakho futhi baqinisekise ukuthi konke kuhamba kahle. Bangenza nezinguquko ohlelweni lokwelashwa uma kudingeka.

Kufanele ngiyise nini ingane yami esibhedlela?

Udokotela wengane yakho uzokutshela ngezinto ezidinga ukwelashwa okuphuthumayo. Isibonelo (kodwa kungagcini lapho):

• Uma ingane inenkinga yokuphefumula .
• Uma umsebenzi unciphile (Ukuzola) , okungukuthi, uma kukhona umuzwa wokulala, ongenampilo.
• Uma isikhumba sibanda, siphuzi, noma sishintshe umbala .
• Uma inabukeni lomile amahora angu-12 noma ngaphezulu (okungukuthi, uma kungazange kukhishwe umchamo).
• Uma ungaphumuli ngendlela engavamile noma ulele .
• Uma ungaphuzi ubisi.

Uma ubona izinto ezinjengalezi, funa iseluleko sezokwelapha ngokushesha, futhi uma kudingeka, ziyise esibhedlela.

Okokugcina, izinto okufanele uzikhumbule

Cishe ubucabanga ukuzalwa komntwana wakho njengomzuzu ojabulisayo nophelele. Ukuthola ukuthi umntwana wakho ube nokulimala kokubeletha akuyona into umzali omusha afuna ukuyizwa. Ukulimala kokubeletha akuyona into engavamile. Kodwa noma ngabe wena nabo bonke abakunakekelayo nomntwana wakho nenza konke kahle, ngezinye izikhathi izinto ezinjengalezi zingenzeka.

Kodwa into ejabulisayo ukuthi,Iningi lokulimala kokubeletha lincane futhi lizixazulula ngokwalo ngosizo oluncane noma ngosizo oluncane. Ezimweni ezimbi kakhulu, odokotela bengane yakho bazoba khona ukuqala ukwelashwa ngokushesha okukhulu.

Uma ungaqondi okuthile, noma uma ukhathazekile noma wesaba okuthile, khuluma nodokotela wengane yakho. Bangakuchazela izinto futhi bakuxhumanise nabanye ochwepheshe abangakusiza ukuthi uphathe futhi ubhekane nalesi simo. Ungakhathazeki, awuwedwa!

Izingozi zokuzalwa, ukulimala kokuzalwa, usana olusanda kuzalwa, ukubeletha, ukulimala kosana, ukulimala kogebhezi, ukulimala kwemizwa, iseluleko sezokwelapha