BackgroundPeople aged 60 years and above are predicted to outnumber those aged under 5 years in South Africa for the first time by 2040. This will put increased demands on the health system to address geriatric health needs. However, data on geriatric populations in sub-Saharan Africa are scarce. Health policymakers need to be informed of the expectations of the elderly people regarding health services, especially at primary care level.AimThe aim of this study was to explore the experiences and expectations of people aged 60 years and above regarding ageing and health services, and the factors that might improve the quality of primary care services for geriatric patients.SettingThe study was conducted at three public health primary care facilities in KwaZulu-Natal province, South Africa: one in a rural setting, one in a peri-urban and one in an urban setting.MethodsThis qualitative study involved a purposive sample of 28 participants, aged 60 years and above. Four focus group discussions were conducted in either isiZulu or English, depending on the preference of the participants. Data were analysed thematically using an inductive approach.ResultsNineteen of the 28 participants were women. Five key findings emerged from the study: (1) long waiting times – participants were distressed by lengthy waiting times, (2) illness-centred care – participants felt that they were seen as diseases to be treated, (3) lack of caring – health providers were perceived to lack compassion, (4) pill burden – participants experienced adverse effects of prescribed medication and (5) need for priority care – participants wanted a separate queue for the elderly.ConclusionHealth systems and health professions educators should consider the need for patient-centred and integrated care for geriatric populations. Further research is required on the unmet needs of geriatric people in the community.

Background: Since the roll-out of antiretroviral therapy (ART) in sub-Saharan Africa (sSA) in the early 2000s, the life expectancy of people infected with the human immunodeficiency virus (HIV) has increased. However, the gains made in reducing mortality from HIV-related complications have been mitigated by the emergence of age-related chronic non-communicable diseases (NCDs), such as hypertension. Protease inhibitors (PIs), and prolonged exposure to highly active ART (HAART) have been implicated in the development of hypertension in HIV-positive people.Aim: To investigate the prevalence of hypertension and its associated risk factors among HIV-positive patients receiving ART.Setting: The study was carried out at an urban-based clinic that provides HAART and primary care to HIV-positive people in Harare, Zimbabwe.Methods: A descriptive, cross-sectional study was conducted among non-pregnant adults on HAART attending the clinic between July and August 2018.Results: We studied 600 HIV-positive adult patients, of which 56% were women. The prevalence rate of hypertension was 29.9%. Of the participants in the hypertensive group, 11.2% were not previously diagnosed or on treatment. Factors associated with hypertension were advanced age, use of HAART for longer than 10 years, being overweight, a family history of hypertension and smoking. There was a 68.8% prevalence of body mass index greater than 25 kg/m2 among all participants.Conclusion: High hypertension prevalence was recorded. Hypertension was not associated with gender or use of PI regimens but being overweight was highly prevalent. Greater vigilance and integration of resources is required in the overall treatment and monitoring of HIV-positive patients for co-morbidities.

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BackgroundDiabetic patients on insulin and sulphonylureas are at risk of developing hypoglycaemia. Many patients do not respond appropriately because of poor knowledge and understanding of the symptoms of hypoglycaemia, which if not promptly treated can lead to permanent neurological and renal damage. Hypoglycaemic complications can be avoided if patients have a good knowledge of the early symptoms of hypoglycaemia and know how to respond appropriately.AimThe aim of this study was to assess the knowledge of adult diabetic patients attending a diabetic clinic about symptoms of hypoglycaemia and how they responded to these symptoms.SettingA hospital-based diabetic clinic in northern KwaZulu-Natal.MethodsThis was a cross-sectional, descriptive study involving 200 diabetic patients. Demographic data and details of current medication, knowledge of hypoglycaemia and how patients responded to the symptoms were collected using a validated questionnaire.ResultsThe majority of the patients had fair to good knowledge of hypoglycaemia; however, less than 25% knew what action to take when they experienced symptoms suggestive of hypoglycaemia.ConclusionThere is a need to improve the education given to diabetic patients on stepwise measures to take to avoid life-threatening complications associated with hypoglycaemia.

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Background. South African (SA) studies indicate that elderly patients receive poor-quality and inadequate medical care at primary care level. Medical schools must be responsive to the needs of the communities they serve. This article reviews medical students’ knowledge of and attitudes towards caring for older patients to identify areas to enhance their learning. Objective. To evaluate the knowledge and attitudes of final-year medical students regarding the care of older patients at the University of KwaZulu-Natal (UKZN), Durban, SA. Methods. All final-year medical students were invited to complete a self-administered questionnaire that evaluated their geriatric knowledge and attitudes. Geriatric knowledge was assessed with a modified Palmore’s Facts on Aging Quiz, and the UCLA geriatric attitudes scale was used to assess their attitudes. Ethical approval was obtained from the UKZN Biomedical Research Ethics Committee and data were collected from September to November 2019. Results. There was a 79% (n=173) response rate. The average age of participants was 24 (interquartile range (IQR) 23 - 24) years. The mean geriatric knowledge score was 56.8% (standard deviation 10.4). The mean attitude score was 3.67 out of 5, indicating mildly positive attitudes towards caring for older patients. The majority of students expressed difficulties in communicating with older patients. Conclusion. The poor knowledge and mildly positive attitudes of students necessitate educational interventions to stimulate student interest in geriatrics and improve learning in this field, including increased attention to communication skills training relevant to the care of older patients.