Nigerian Journal of Paediatrics 2011; 38(2):78-81
Etuk, I. S
Nocturnal Enuresis And Its Treatment Among
Ikpeme O.
Primary School Children In Calabar Nigeria.
Essiet G. A.
Received: 10 February 2011
Abstract: Background: Enuresis
(6.0%) though this was not
Accepted: 23 May 2011
for most children is a source of
statistically significant (P=0.216).
shame and anxiety with a profound
Treatment methods used were
I. S. Etuk ( ), O. Ikpeme
m e d i c a t i o n
( 1 . 6 % ) ,
w a t e r
Department of Paediatrics
r e l a t i o n s h i p
a n d
s c h o o l
restriction (42.8%), awaking for
College Of Medical Science s
performance. Hence the study of
voiding (27.3%) use of alarm bell
University Of Calabar Calabar
nocturnal enuresis among primary
(0.5%), herbal medication (8.0%),
school children in Calabar-
while 19.8% received no form of
treatment. Help seeking behavior
Objectives: This was to determine
for this condition was poor as only
G. A. Essiet
the frequency of enuresis among
2.1% of this study population ever
Department Of Pharmacology
primary school children in Calabar
sought medical attention for this
College Of Medical Sciences
and to study the treatment
University Of Calabar
Conclusion: The frequency of
Patients And Methods: This was a
enuresis was similar to most reports
prospective cross sectional study.
in literature. Help-seeking behavior
A questionnaire was answered by
was poor. Parental education,
parents of 3,230 pupils from six
advocacy and awareness creation
selected schools during the school
on the availability of medical help
term between January to March,
for enuresis are suggested.
Key words:
Nocturnal enuresis,
nocturnal enuresis was 6.7%.
Treatment, School children.
Enuresis frequency was higher
among boys (7.3%) than girls
of this, less than 30 percent of parents of enuretics
seek medical attention for this social and behavioural
changing problem, particularly in the developing
Nocturnal enuresis, an involuntary voiding of urine
countries. 4,6
during sleep in the absence of congenital and
The prevalence and treatment modalities for enuresis
acquired defects of the central nervous system or
have been studied variedly in different parts of the
urinary tract in a child aged 5 years and above, is a
world including Africa. This seems to vary with age
major source of anxiety to the famil y. It is also a
and from country to country. Paucity of information
source of shame and embarrassment. That it causes
profound loss of self- esteem, self-perception and
continues to exist on this subject in this part of the
poor inter-personal relationship which may affect
world. The present study therefore aims at
the quality of life and school performance has been
determining the frequency, the help-seeking
Hence the goal of treatment of this
behaviour of parents and types of treatment offered to
condition is to reduce its social and psychological
enuretic children in Calabar.
impact and possibly eliminate the caus e.
. In spite
Subjects and methods
Primary nocturnal enuresis was defined as bed-
wetting at least once a week in a child who has not had
night-time bladder control for 6 months or more.
This was a descriptive, cross sectional, prospective
study carried out between January and March 2010
Secondary enuresis and diurnal enuresis without
among primary school children in Calabar Nigeria.
nocturnal enuresis were excluded from the study.
Calabar is the capital of Cross River State in the
Treatment were categorized as enuresis alarm,
South South geopolitical zone of Nigeria. It has an
medication, water restriction, awaking for voiding,
estimated population of 375,196 (report of 2006
use of herbal medication and untreated based on
National census). The inhabitants are mainly the
literature review. Those who have visited the hospital
Efiks, Quas, Ejagham, Efut, Ibibio, Annang and
for this condition were also noted.
others the migrant workers. They are mainly civil
The data obtained was presented as tables and chi-
servants, subsistence farmers, traders and
squared test was calculated using EPI info version
6.046 to test for frequency differences between the
Amulti-stage random sampling method was adopted
two sexes.
as a means of selecting the schools and pupils for the
A level of P < 0.05 was considered statistically
A list of all public and private nursery / primary
schools in Calabar was obtained from the Ministry of
Education, Cross River State. This was arranged
alphabetically; a table of random numbers was used
to select schools and pupils that would make up the
sample size.
According to the estimated prevalence of enuresis
Three thousand, two hundred and thirty (3,230)
and population size; a sample size of 3,223 with 95%
questionnaires were administered and two
confidence level was required.
thousand, seven hundred and eighty (2,780) of them
Based on this a total of 3 public and 3 private schools
were correctly filled and retrieved. This gives a
were selected. The pupils aged 6 12 yrs in these
retrieval rate of 86.1% and formed the basis of this
schools formed the study population.
analysis. Of the 2,780 respondents, 1,536 were
Before commencement of the survey, approval was
males and 1,244 were female giving a male to
obtained from Cross River State Primary Education
female ratio of 1.2:1. One hundred and eighty seven
School Board. In the schools, the head and class
children were reported by parents as having
teachers were briefed on the purpose of the study and
nocturnal enuresis giving a prevalence rate of 6.7%.
on the questionnaire.
The frequency of enuresis was higher in boys 112
Following this, 3,230 questionnaires on enuresis
(7.3%) than girls 75 (6.0%) but this difference was
not statistically significant X = 1.53, P = 0.216.
were given out to the children who were aged
between 6-12 years in the six schools. These were
( Table 1)
filled in by the parents at home and retuned by the
The treatment methods are as shown in table 2. One
pupil the following day. The class teachers were
hundred and fifty (80.2%) of the children with
instructed to help clarify issues with the parents on
enuresis received some form of treatment but only 4
some questions where necessary.
(2.1%) ever consulted doctors by way of seeking
Each parent was to indicate whether his/her child
help for their children's condition. Only one child
had suffered from nocturnal enuresis in the previous
(0.5%) was using alarm bell. Drug medication was
6months and if so, the kind of treatment that was
used by 1.6% of the subjects. Water restriction,
offered either at home or in hospital.
awaking for voiding, and herbal treatment was used
For the purpose of this study, the following
by 42.8%, 27.3% and 8.0% of the subjects
definitions were made.
respectively. About Twenty percent of the patients
received no form of treatment for their condition.
Table 1
Distribution of population and frequency of nocturnal enuresis by
Population no
Sample size no
Enuresis cases no
Enuresis frequency (%)
Female 6,094
1, 24475
X = 1.53 p= 0-216
Table: 2
studies show higher enuresis rates in males than
Methods of treatment of nocturnal enuresis in 187
. However, spontaneous remission rate
was found to be higher in girls.
Children in calabar
The present study showed that small percentage
(0.5 % ) of the subjects used enuresis alarm as a mode
Water restriction
of treatment. Alarm treatment is the most successful
Awaking for voiding
treatment for bed wetting up to now, with initial and
Use of alarm bell
long-term success rates of 70% - 90% and 50-70%
respectively , but unfortunately they are not
Herbal treatment
available in our environment.
No treatment
Children successfully treated with an enuresis alarm
are less likely to relapse compared with those treated
with pharmacological intervention. It is recognized in
UK as the only therapy capable of effecting a long
term “cure” to enuresis
About 20% of the subjects in the present study never
received any form of therapy for their condition and
only 4 (2.1%) of the parents sought the services of a
medical doctor. This is in contrast to the findings in
most studies in the Western world,
7, 10-12
Enuresis is a common world-wide medical and
where as high
psychological problem among school age children .
as 90% of families seek medical help for their
In our study the overall prevalence of nocturnal
enuretic children, probably suggesting a low level of
enuresis was 6.7%. This is similar to the rate
concern among parents in this city.
reported by some authors
4, 10, 11
and at variance to
In Turkish families, only 19.8% of enuretic children
use medical treatment . Parents there rather prefer to
The prevalence of reported nocturnal enuresis
wait for spontaneous recovery or use traditional
methods of treatment. In Australia, 34% of families
depends on its definition. In this study, primary
seek professional help and in Pakistan 26% while
school children with bed wetting at least once a week
were included. A near similar prevalence rate of
about 20% used traditional methods. In the present
7.7% was obtained in a study in the Republic of Iran
study 8.0% sought traditional treatment in form of
as this same definition was applied. In a study in
herbs while majority employed mainly behavioural
UK an overall prevalence rate of 18.9% was
recorded but reduced to 5.1% when the inclusion
criteria were weekly incidences .
Demography reports from Sweden
nocturnal enuresis prevalence rates of 5-10%
involving mostly boys. In Saudi Arabia enuresis
The frequency of enuresis among primary school
prevalence rate of 15% was reported in children
children in Calabar, Nigeria is similar to that reported
between 6-12 years. In Nigeria, Famuyiwa noted a
in literature within and outside the country.
rate of 25% of primary nocturnal enuresis among
The frequency of overall medical help-seeking
primary school children in Lagos. The definitions
behaviour is low compared to other reports,
used in these studies with high prevalence rates were
suggesting a low level of concern among parents in
enuresis of at least once a month. If the definition
Calabar. The use rate of enuresis alarm is very low.
was further fine tuned, the high prevalence rate
This calls for parental education, advocacy and
would likely reduce, similar to the finding in the UK
awareness creation on the availability of medical help
for enuretic children. Further research is needed into
A questionnaire survey in the United Arab emirate
the methods of promoting effective and quality
recorded a prevalence of 5.5% among 6-12 years old
enuresis treatment.
which is lower than what the current study showed.
The proportion of younger children in their sample
was small as against the present study. Another
observation is that most of the studies with high rates
used interviews instead of questionnaires methods.
We would like to thank Madam Edak O. Asuquo the
Parents may place less emphasis on the problem
Executive Secretary Cross River State Education
when questionnaires methods are used.
authority who gave approval for the schools to be
The prevalence of enuresis in this study was higher
used for this study. Our appreciation also go to all the
in boys 7.3% than in girls 6.0%. However this was
head and class teachers of the schools studied who
not statistically significant (p = 0.216). Most of the
patiently assisted in all stages of the study.
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