Prevalence and Perception of Nocturnal Enuresis in Children of a Rural Community in Southwestern Nigeria

The influence of delay elimination communication on the prevalence of primary nocturnal enuresis-a survey from Mainland China

AIMS

A pilot survey shows that primary nocturnal enuresis (PNE) prevalence has increased significantly during the past decade in Mainland China. Whether it is related to the delay of elimination communication (EC) is unclear. This study retrospectively investigated the influence of delayed EC on the PNE prevalence in children and adolescents in mainland China.

METHODS

A cross-sectional study of PNE prevalence was performed by distributing 19 500 anonymous self-administered questionnaires to parents in five provinces of mainland China from July 2017 to October 2017. The questionnaires included sociodemographic data, family caregivers' information, and details about the disposable diapers (DD) usage, EC commencement date, psychological disorders, lower urinary tract symptoms, and family history of PNE in children and adolescents. The 2017 PNE prevalence was compared with that of 2006 in Mainland China.

RESULTS

The total response rate was 97.04% (18 631 of 19 500) and 92.39% (18 016 of 19 500) qualified for statistical analysis. The PNE prevalence in 2017 has increased significantly compared to that of 2006 (7.30% vs 4.07%, P < 0.001). The PNE prevalence in children with EC starting before 6 months of age was significantly lower than those who start after 12 months of age. The longer DD were used and the later the beginning of EC, the higher the PNE prevalence was found.

CONCLUSIONS

The PNE prevalence in Mainland China has increased significantly during the past 10 years. A longer use of DD and later onset of EC may be risk factors for PNE.

Current perspectives on the correlation of nocturnal enuresis with obstructive sleep apnea in children

BACKGROUND

Obstructive sleep apnea (OSA) and nocturnal enuresis (NE) are common clinical problems in children. OSA and NE are thought to be interrelated, but the exact pathophysiological mechanisms are not yet clear. This review aims to explain the possible pathogenesis of NE in children with OSA.

DATE SOURCES

We have retrieved all relevant original articles from Database that have been published so far, including the prevalence studies of NE and OSA in children, sleep characteristic studies that use polysomnography (PSG) to focus on children with NE, and studies on the relationship between OSA and NE.

RESULTS

Clinical studies have revealed that the risk of NE in children with OSA was increased compared with that of their healthy peers. This increased risk may be associated with sleep disorders, bladder instability, detrusor overactivity, nocturnal polyuria, endocrine and metabolic disorders, and inflammation.

CONCLUSIONS

Cardiopulmonary and renal reflex-induced neuroendocrine disorder may play an important role in the mechanism of NE in children with OSA, but this remains to be confirmed by animal studies. Other causes such as oxidative stress and inflammatory responses need to be further researched.

Study of behavioural disorders in children with primary enuresis

BACKGROUND

Enuresis results in behavioural disorder in children. This study investigated the behavioural disorders in children possessing primary enuresis.

MATERIALS AND METHODS

In this cross-sectional study, 100 children with primary enuresis were referred to children's hospital Khorramabad; the census method was used in this study. Data were collected using a short screening instrument for enuresis psychological problems, the reliability and validity of which have been confirmed in previous studies. First, a questionnaire was used to assess academic failure, anxiety, behavioural disorders, sleep, and psychological disorders. Results obtained were compared in terms of gender and age. Statistical analyses using inferential and descriptive statistics including Chi-square and Fisher test were employed.

RESULTS

The average age of children was 8.46 years. Sixty-six per cent of participants were male and the rest of them were female. Ninety per cent of subjects were between the age range of 1-9 years, and 10% were over 10 years old. Forty-three per cent of children suffered from anxiety disorders and 34% had sleep disorders, 4% also suffered from academic failure. Among behavioural disorders, hyperactivity and restlessness were the most common disorders, and they were significantly higher in nine boys. Headache, obsessive, and sleep disorders were more common in children above 10. There was a significant correlation between eating disorders, headache, sleep disorders, and strange movements in males, while feelings of sadness were more common in females.

CONCLUSION

Social personality development in children with enuresis can be improved by informing parents of enuresis.

Nigerian parents can harbour harmful views about the causes and treatment of childhood enuresis that result in child abuse

AIM

The aim of this study was to determine Nigerian parents' views about the causes and treatment of childhood enuresis.

METHODS

Parents of children aged 5-17 years were individually interviewed in an urban community in Nigeria using a pretested questionnaire. Their responses about the causes and treatment of enuresis were grouped under common themes.

RESULTS

We included 448 respondents in the study: 75.5% were mothers, 44.2% had at least one child with enuresis and only 1.3% had spoken to a doctor about it. Enuresis was thought to be due to playing too much and drinking too much fluid at night by 69.7% and 21.2% of the respondents, respectively. The two most common treatment methods that parents were aware of for enuresis were waking to void (23.7%) and urinating on hot charcoal (20.8%). The most common methods that parents actually employed included waking to void (49.0%), punishing the child (36.9%) and doing nothing (28.8%).

CONCLUSION

Most of the respondents believed that playing too much and drinking or eating too much were responsible for childhood enuresis. Parents rarely discussed childhood enuresis with their doctors and some of the self-help measures that were employed may be harmful and could constitute child abuse.

Prevalence of nocturnal enuresis and related risk factors in school-age children in Egypt: an epidemiological study

PURPOSE

To determine the prevalence of mono-symptomatic nocturnal enuresis (MNE) and its risk factors among school-age children in our community.

METHODS

A cross-sectional study included school-age children from two governorates in south of Egypt. A questionnaire was presented to randomly selected students. It consisted of 3 domains: Domain 1 included questions about MNE, domain 2 was about risk factors for MNE, and domain 3 was about management of MNE.

RESULTS

The study included 4652 students (9 ± 2 years) from 12 primary schools (51 % males and 49 % females). Of 4652 students, 834 (18 %) had NE, with no significant difference between rural and urban areas (17.5 vs. 18.4 %, p = 0.4). Younger age categories showed higher prevalence of MNE than in older children. MNE caused moderate-to-severe bother for 44.5 and 87.8 % of students and parents, respectively. Urinary tract infection, pinworm infestation, constipation, and caffeine over-consumption significantly associated with MNE. Family history of MNE was positive in 84.7 %. Daytime incontinence coexisted in 16 % of cases. Children with ≥4 siblings and birth order ≥3 had more prevalent MNE. Deep sleepers and exposure to problems/violence correlated positively with occurrence of MNE. Father's level of education and work status, mother education, number of children per room, and socioeconomic status significantly associated with occurrence of MNE. There was no significant correlation between gender and prevalence of MNE. No treatment was used in 53.2 % of cases.

CONCLUSION

In the Egyptian community, pinworm infestation, UTI, constipation, and overconsumption of caffeine-containing beverages are potential reversible risk factors for MNE in school-age children.

Prevalence and predictors of childhood enuresis in southwest Nigeria: Findings from a cross-sectional population study

INTRODUCTION

Childhood enuresis is common, but the prevalence and factors associated with childhood enuresis in Africa have been poorly described. Furthermore, most studies from the continent have not provided data distinguishing monosymptomatic from non-monosymptomatic enuresis. This distinction is important as it guides enuresis therapy.

OBJECTIVES

The primary objective of this study was to determine the prevalence of enuresis in children aged 5-17 years in a community in Nigeria. The secondary objectives were to determine the relative proportions of monosymptomatic and non-monosymptomatic enuresis and identify independent sociodemographic and clinical predictors of enuresis.

STUDY DESIGN

Parents or guardians in the community were interviewed using a pretested questionnaire. Standardized definitions were used, as recommended by the International Children's Continence Society.

RESULTS

A total of 928 children were included in the study. The prevalence of enuresis or daytime incontinence and enuresis was 28.3% (enuresis 24.4%, and daytime incontinence and enuresis 4%); it decreased with age. Primary and monosymptomatic enuresis were the most common types of enuresis. In multiple logistic regressions, children aged 5-9 years were 10.41 (5.14-21.05) times more likely to have enuresis or daytime incontinence and enuresis compared with those aged 14-17 years. Other predictors of enuresis or daytime incontinence and enuresis were: male gender (OR 1.56 (1.13-2.14)); constipation (OR 2.56 (1.33-4.93)); and a sibling (OR 2.20 (1.58-3.06)) or parent (OR 3.14 (2.13-4.63)) with enuresis. Enuresis or daytime incontinence and enuresis was 1.92 (1.06-3.48) times more likely in fourth-born, or higher, children compared with first-born children. Only parents of nine (3.4%) children with enuresis had consulted a medical doctor about it.

DISCUSSION

The high prevalence of childhood enuresis in the present study was consistent with most studies from developing countries and contrasted sharply with the lower rates reported among children in developed countries. Common reasons for this disparity were the influence of socioeconomic status on enuresis rates and the low utilization of effective enuresis therapies in developing countries. Consistent with published literature, monosymptomatic enuresis was the commonest form of enuresis in the present study. Furthermore, younger age, male gender and a family history of enuresis were strongly associated with enuresis. A major limitation of the study was the lack of use of a voiding diary.

CONCLUSION

Childhood enuresis was common in the community but parents rarely sought medical attention. Predictors of enuresis were younger age, male gender, constipation, higher birth order, and a family history of enuresis.

Enuresis in South African children: prevalence, associated factors and parental perception of treatment

Study Type--Symptom Prevalence (prospective cohort) Level of Evidence 2a. What's known on the subject? and What does the study add? Nocturnal enuresis is a common childhood problem. Although its prevalence is known in many countries, no data are available from South Africa and it is difficult to extrapolate data from developed countries to a population with such diverse conditions and resource-poor settings. This study is the first to report on the 16% prevalence rate and the low level of parental knowledge of enuresis in South African children aged between 5 and 10 years.

OBJECTIVES

• To establish the prevalence of NE in 5-10 year old South African children in a cross-sectional study using a parent-completed questionnaire. • To establish the parental perception and associated factors of mono-symptomatic nocturnal enuresis (MNE) treatment and treatment success rates in 5-10 year old children from South Africa.

PATIENTS AND METHODS

• A total of 4700 questionnaires were distributed to children at 37 selected schools willing to participate from South Africa. Parents anonymously filled out the questionnaire. • Data were reported as frequencies and percentages of NE in tables according to different gender and age groups. • The Chi-square test compared proportions between groups and Fisher's Exact test corrected for small numbers of observations (n ≤ 5). Age differences were determined using Student's t-test. A P-value ≤ 0.5 was considered to be statistically significant.

RESULTS

• The questionnaire's response rate was 72.1%, with 3389 children included in the study. • The overall prevalence of NE was 16.0%-14.4% of children suffered from mono-symptomatic NE (MNE). The prevalence of NE in boys was double that in that in girls. • Only 28.3% had received some form of treatment, whereas 13.5% had been medically treated by a doctor. Parents' awareness of treatment modalities available is outdated and most of the management of MNE was done by parents themselves, albeit with low success rates. • A positive family history was found in 50.5% of children suffering from MNE. • Constipation was a problem in 15.8% of children with enuresis.

CONCLUSIONS

• This is the first study to estimate the prevalence of NE and report on the parental perception and possible associated factors of enuresis in children from South Africa. The study showed that South African children have a similar prevalence rate of NE (16%) when compared with other countries. • The possible associated factors with MNE in South Africa include constipation and a family history of enuresis. • Finally, there are low levels of parental knowledge of treatment modalities of MNE, leaving many children untreated.

Prevalence of nocturnal enuresis, risk factors, associated familial factors and urinary pathology among school children in Iran

AIM

To estimate the prevalence of enuresis in school-age children in Iran and determine associated factors.

MATERIALS AND METHODS

A total of 7562 children, aged 5-18 years, enrolled in this cross-sectional study. Using a standard questionnaire, data on demographic characteristics, and familial and physical conditions were obtained from the parents by interview. The ICD-10 definition of enuresis was used. In the case of enuretics, a detailed history was taken, and physical and ultrasonographic examinations, urinalysis and urine culture were performed.

RESULTS

The overall prevalence of enuresis was 6.8%. A significant relationship was found between the prevalence of enuresis and age (P=0.001), educational level of parents (P=0.001), number of family members (P=0.028), positive family history of enuresis (P=0.001), parenting methods (P=0.001), and deep sleep (P=0.001). Birth weight (P=0.07), monthly income (P=0.322), employment status of parents (P=0.08), ethnic differences (P=0.09), delayed development (P=0.062), drinking (P=0.072) or urination habit before sleep (P=0.06), and stool incontinence (P=0.062) were not significantly associated with enuresis. Prevalence of urinary tract pathology was 2.9% in enuretics.

CONCLUSIONS

This study provides a quantitative estimate of the prevalence and main risk factors for enuresis in Iranian children.

An Epidemiological Study of Primary Nocturnal Enuresis in Chinese Children and Adolescents

AIMS

Assessment of the prevalence of primary nocturnal enuresis (PNE) and its risk factors in Chinese children and adolescents in the central areas of mainland China.

METHODS

A cross-sectional study of PNE was performed by distributing 11799 self-administered questionnaires to parents of 5-18-year-old students in 32 schools of Henan province China. The questionnaire asked about sociodemographic data, PNE data, physical or psychological disorders, and family stressors. The PNE children were divided into a pediatric group (age 5-12) and an adolescent group (age 13-18).

RESULTS

The response rate was 88% (10383/11799) in which 10088 (85.5%) were qualified to enter the final statistical analysis. The overall prevalence of PNE was 4.07% (95%CI 3.68-4.46) and that of marked PNE was 1.46% (95%CI 1.23-1.69). PNE was significantly more in boys than in girls. The prevalence decreased with age without gender bias. Of all enuretic children, 21.17% had daytime urinary symptoms and 22.87% had a positive family history. Only 6.08% of PNE had sought professional help. The episodic severity of PNE, associated daytime symptoms, positive family history, and seeking for professional help in adolescent group were significantly higher than those of pediatric group. Age, inhabitation (living in rural or urban areas), arousal dysfunction, associated daytime symptoms and family history were found to be significant predictors of marked PNE. Among PNE cases with a positive family history, there was no significant difference in the familial distribution between boys and girls.

CONCLUSIONS

The prevalence of age-related PNE from Chinese school children is lower than those reported from western countries and other Asian countries. Age, inhabitation (rural or urban), arousal dysfunction, associated daytime symptom and family history are significant as predictors of marked PNE. The misconceptions among Chinese parents require health education intervention.

Epidemiology of enuresis among school-age children in Thailand

Enuresis is a very common developmental problem in young children. The aims of this study were to estimate the prevalence of enuresis in school-age children, to determine the factors associated with nocturnal enuresis, and to evaluate the parental strategies for managing enuresis. A randomly selected cross-sectional population-based study was conducted in eight elementary schools in Bangkok, Thailand. A total of 3453 parents of children aged 5 through 15 years completed the questionnaires. The overall response rate to the questionnaire was 70%. The prevalence of enuresis was 4.2% and that of nocturnal enuresis was 3.9%. The prevalence declined with increasing age from 10%, 5.3%, 3%, and 1.2% at ages 5, 7, 10, and 12 years, respectively. There was no enuretic child at ages 13 through 15 years. The prevalence of bed-wetting was slightly more frequent in females than males. Nocturnal enuresis was also found to be significantly associated with the history of encopresis and positive family history of enuresis. There was no significant associated with parental education, birth order, socioeconomic status, diaper use, toilet training, and behavioral and school problems. Behavioral techniques mostly used by parents for management of their children with bed-wetting were ensuring that the child voids before bedtime (72.9%), waking the child up at night to void (61.8%), and evening water intake restriction (28.5%). The overall prevalence rate of nocturnal enuresis in Bangkok school-age children is lower than that of many previous studies reported from other countries. The significant differences in the prevalence reported by other countries' studies attributed to the criteria selection for ranges of age, definition of enuresis, genetic predisposition, and traditional and cultural background.