Counselling of caregivers about common childhood diseases is an important component of health care services [1]. Patient’s rights constitute an important aspect of everyday hospital practice including the right to be counselled and be informed about one’s health [2]. Counselling is an integral but overlooked aspect of patient management [1]. Caregivers are often left in darkness because they are not informed about their child’s diagnosis, treatment and prognosis [3].

Adequate knowledge of diseases has been shown to improve caregiver’s participation in disease management with good and favourable outcome [4]. A doctor communication and interpersonal skill encompass the ability to gather information to facilitate accurate diagnosis, counsel appropriately, give therapeutic instructions and establish a caring relationship with patients [5]. Patients reporting good communication with their health care providers are more likely to be satisfied with their care and to share pertinent information for accurate diagnosis of their problems, follow up advice, and adhere to prescribed treatment [6]. Various factors limit the ability of healthcare workers to provide adequate counselling to caregivers, these include forgetfulness, ignorance and communication problems [7,8].

Barriers to effective communication between health care providers and caregivers include environmental barriers such as a lack of privacy, other barriers are the negative attitude of the health care workers, perception of the caregivers and patient about health care providers, as well as client personal barriers such shyness, and administrative barriers because management is responsible for adequate staffing and allocation of work duties and time barrier [9]. The quality of counselling is considered high if it meets the informational needs and expectation of patients and their family members [10].

There is a paucity of studies on quality of counselling offered by health care providers to caregivers in Nigerian Hospitals to the best of investigators knowledge, although researchers have shown that patient and caregivers are not satisfied with the quality of counselling they received from health care providers [10]. little is known about the quality of counselling offered to caregivers by health care providers in Nigerian hospitals, therefore the need for this study.

Inclusion criteria: Caregivers and their children that were less than 15years of age seen in the paediatric units of UDUTH, Sokoto with childhood illnesses.

Exclusion criteria: Caregivers that did not give written informed consent were excluded, as well as caregivers that lost their children while on admission.

Data collection procedure: A semi-structured interviewer-administered questionnaire was used to obtain information on demographic data of the respondents, awareness of child’s diagnosis, whether or not there was an explanation on how the child got the illness, explanation on the test to be done, whether or not the treatment was explained to caregivers including side effects and health education on preventive measures. Caregivers were also interviewed on where the counselling was done, whether they were satisfied with how the counselling was done, whether they were allowed to ask the question. And whether the healthcare provider introduces him/herself and was polite throughout or not.

The case notes of the children were reviewed to obtain data on a child’s diagnosis and to check whether the attending physicians have documented the content of the health information given to the caregivers. Members of the research team interviewed the caregivers consecutively each day after consultation in the clinic and the following admission into paediatric units of UDUTH in a separate room, away from the consulting room and wards, members of the research team were not part of the study, this is to avoid pre-emptying health care providers leading to bias, as they could be more conscious of their counselling. The identity and cadre of each health care provider were further confirmed by the research team, and from the call duty roaster and nurses on duty. Socio-economic class (SEC) of the caregivers was determined using Oyedeji’s classification [12].

The researchers counselled caregivers (according to the disease condition of the child) that were not counselled after data collection to prevent missed opportunity. Content of health information given to caregivers included diagnosis, disease aetiology, mode of transmission, treatment modalities and preventive measures of the disease.

Data analysis: Data were analysed using SPSS version 20. Quantitative variables were summarised using means and standard deviation.

The largest proportion of the children, 206 (49.0%) spent less than 72 hours on admission as shown in Table 1.

The mean age of the caregivers was 28.9±8.6 years (range of 15-64years). Majority of the caregivers 412 (98.1%) were mothers, while 8(1.9%) were grandmothers. Most of the caregivers 156 (37.1%) had no formal education, while 33 (7.9%), 102 (24.3%) and 129 (30.7%) had primary, secondary and tertiary level of education respectively.

The largest proportion of the caregivers 180 (42.9%) were in the lower SEC see Table 1.

Disease morbidities of the children: Most common disease condition documented in the folders of the children was complicated malaria in 117 (27.9%) and Neonatal septicaemia in 42 (10.0%), see Table 2.

Table-2: Disease morbidities of the children.

*Meningitis, Measles, Tuberculosis, Pharyngitis, Bronchial Asthma, Ichthyosis, Acute, diarrhoeal disease and sickle anaemia with complications.

Health care providers counselling of caregivers

There were 420 caregivers interviewed, only 218 (51.9%) were counselled by the health care providers, of the 218 caregivers counselled, 214 (98.2%) were counselled by the doctors, while 4 (1.8%) by the nurses, but there was no documentation of the content of counselling in the case notes of all their children nor the nurse's notes about the health information rendered by the nurses.

The highest proportion of the doctors that counselled the caregivers were predominantly resident doctors in 115 (52.8%), while 65 (29.8%) and 29 (6.9%) were counselled by the consultants and house officers respectively as shown in Table 3.

Health care providers attitude and conduct of counselling

Of the 218 caregivers counselled, 123 (56.4%) were satisfied with how the counselling was done, 107 (49.0%) were allowed to ask questions. Health care providers did not introduce themselves to 126 (57.8%) of the caregivers but the majority, 203 (93.1%) of healthcare providers were polite to the caregivers. See Table 6.

Table-6: Healthcare providers attitude of counselling.

The largest proportion of the caregivers 156 (71.6%) were counselled in an open ward and only 6 (2.8%) were counselled in a private consulting room. See Table 7.

Table-7: Place of counselling.

This study aimed to determine the quality of counselling offered to caregivers by health care providers during their routine work, most of the available studies were in adults, [10.13]. the researcher found only one study that was done in children [7].

The caregivers were predominantly mothers, a finding similar to Nwaneri et al [7] and Nwosu et al [14] in Nigeria where most of the caregivers presenting to the hospital with their children were mothers. Emmanuel et al [15].

reported that children are more likely to be brought to the clinic by their mothers. In contrast to the finding of Nwaneri et al [7] and Nwosu et al [14], in the present study, the majority of the caregivers had no formal education and belong to lower SEC.

The finding of this study showed that healthcare providers do not routinely counsel caregivers on their children condition, a similar finding was reported by Nwaneri et al [7].

While in the past patient's perception was not taking into account or no differences in perception were found, more recent studies show that lower SEC patients have the feeling that doctors fail to explain things in a way they can understand and spend less time with them [19]. Health care providers should counsel all caregivers and patients irrespective of their social class and in the language that they will understand [20-21].

Lack of sufficient explanation to patients and caregivers results in poor patient understanding, and lack of consensus between doctor and patient may lead to therapeutic failure [22]. Patients reporting good communication with their doctors are more likely to be satisfied with their care, and especially to share pertinent information for accurate diagnosis of their problems, follow advice, and adhere to the prescribed treatment [23]. When there is good doctor-communication, patients are more satisfied and are less likely to lodge formal complaints or initiate malpractice complaints [24].

None of the health care providers documented the content of health information given to the caregivers, although there are few studies on physician documentation, a similar finding was reported by Nwaneri et al [7]. Studies had shown that doctors have poor documentation practices ranging from non-writing of discharge summary [25] to omission of documentation of vital information of patients [26-27]. Inadequate documentation practices were also reported among the nurses, where more than half of the nurses did not document nursing care for patients [28]. The medical record is valuable for research, audit and medico-legal purpose but its primary function is for patient care [29]. Reasons for poor documentation include habit, time restraints, lack of training, and examples being set by others were reasons that were given for poor quality documentation in a study by Raza [30].

This study showed 37.2% of the diagnosis mentioned by caregivers did not tally with was documented in the case notes of their children, this is similar to report by Nwaneri et al [7], where 64.8% of the caregivers correctly mentioned the diagnosis of their children. This disparity may be because the largest proportion of the caregivers in the present study belong to the lower SEC, with the majority having no formal education. Barriers to information retention also include anxiety, denial, memory deficits, pain, stress, or unfamiliarity [31-32].

There is a need for further studies to explore the reasons for inadequate and poor counselling practices in the hospital.

Dr. Adamu Asma’u: Conceptualised and designed the study, collected data, analysis, drafted the manuscript.

Dr. Isezuo Khadijat Omeneke: Statistical analysis and revised the manuscript.

Dr. Sani Usman M: Literature searches and revised the manuscript.

Dr. Ibitoye Paul Kehinde: Reviewed the analyses of the study and revised the manuscript.

Dr. Ugege Modupe Omoshalewa: Reviewed the analyses of the study and revised the manuscript.

Dr. Garba Bilkisu Ilah: Study design.

Dr. Ali Muhammad: Statistical analysis and revised the manuscript.

Dr. Ango Umar Mohammed: Study design

Dr. Jiya Fatima Bello: Gave necessary guidance and added intellectual content.

The authors are particularly grateful to all the staff of the paediatric department and medical records for their cooperation during the study.