Nigerian Journal of Paediatrics 2012;39(1): 18 - 21
ORIGINAL
Paul NI
Prevalence of enuresis among primary
Alikor EAD
Anochie IC
school children in Port Harcourt
DOI: http://dx.doi.org/10.4314/njp.v39i1.4
Received: 10th September 2011
Abstract Background: Enuresis is
Results: A total of 922 school
Accepted: 28th October 2011
a common problem among
children, consisting of 463 (50.2%)
children and adolescents. It can
males and 459 (49.8%) females
Paul NI
( )
lead to important psychosocial
were studied. The response rate was
Alikor EAD Anochie IC
,
disturbances. Knowledge of the
82.2%. The overall prevalence of
Department of Paediatrics and
prevalence and types of enuresis in
enuresis was 23.2%. Enuresis was
Child Health,
a community would guide early
notably more common in boys
University of Port Harcourt
intervention.
(male: female ratio 1.4:1), and the
Teaching Hospital, Rivers State,
Objectives:
To determine the
prevalence rates decreased with
Nigeria.
prevalence of enuresis among
increasing age. Of all enuretic
E-mail: nsypaul@yahoo.co.uk
primary school children aged 6-
children, 92.1% had nocturnal
Tel: +2348033126056
12years in Port Harcourt (PHC)
enuresis, 0.9% had diurnal and
and the types of enuresis among
7.0% had nocturnal-diurnal
these children.
enuresis.
Methods: A cross sectional study
Conclusion: Enuresis is a common
of enuresis among school children
problem among school children in
in 13 primary schools in three
PHC, is more common in males.
school districts in PHC was
The predominant type is the
p e r f o r m e d .
P r e t e s t e d
primary nocturnal enuresis.
questionnaires completed by
parents/guardians and augmented
Key Words: Prevalence, Enuresis,
by history obtained from the
Primary school-children, Port-
children were used to collect data
Harcourt
from 922 school children.
Descriptive statistics and chi-
square test were used for data
analysis.
Introduction
secondary. Primary nocturnal enuresis (PNE) occurs
4
when a child has never achieved a six month period of
Enuresis, also known as bed-wetting, is the
continuous nighttime bladder control while
involuntary and undesirable repeated discharge of
secondary nocturnal enuresis (SNE) refers to a child
urine into clothes or beds beyond the age of
who has experienced a minimum six month period of
continence before the onset of bed-wetting. Enuresis
4
anticipated bladder control, usually after five years,
by night or day.
1-3
Day-time bed-wetting is referred
is seen worldwide in all cultures and races. The true
1,2
to as Diurnal.
incidence of enuresis is unknown because of under-
reporting and imprecise definitions.
1,2
Enuresis (DE) while nighttime bed-wetting is
referred to as Nocturnal Enuresis (NE). Combined
Enuresis is frequently diagnosed among school
day and night-time bed-wetting is referred to as
children and is an important psychosocial problem
Nocturnal/Diurnal Enuresis. NE may be primary or
for both parents and children. It places a child at risk
of being a target for name- calling and teasing
19
from peers, behaviour that can damage a child's self
University of Port Harcourt Teaching Hospital (UPTH)
esteem and place him or her at risk of rejection. The
4-6
approved the study protocol. Informed written consent
presence of enuresis can place a limit on participation
was obtained from the parents or guardians. In each
in highly desirable social experiences such as holiday
selected school 90 pupils (15 from each arm of class)
camps and sleepovers. These children are commonly
aged 6- 12 years were recruited by selecting all odd
punished and are at significant risk of emotional and
numbers using the class register. Children whose
physical abuse.
6
Feeling of embarrassment,
parents/ guardians refused consent for the study were
inferiority and anxiety; loss of self-esteem; negative
excluded from the study.
effects on self perception, interpersonal relationship
and school performance have been reported in
A pre-tested questionnaire was used to get information
children with enuresis.
5-8
on socio-demographic data and enuresis data. The
questionnaires were distributed to the pupils with a
Epidemiological studies of enuresis across the world
written consent letter explaining the aims and
report varied prevalence rates of 4-40% amongst
procedure of the study in an enclosed envelop to the
school children.
1,4,9-16
.
In the United States of
parents. The questionnaires were completed by the
America (USA) it ranges from 5-25% in children
parents at home and returned to the investigator. The
aged 4-10 years. It is reported to be 3.88%, 12.9%,
4
information obtained from the questionnaires was
and 18.9% in Turkey, Italy and Australia
augmented by history obtained from the children. In
respectively,
10,11,15
while it ranges from 6-9% in most
this study, a child is said to have enuresis if he/she is
1,2,9
Asian countries.
A prevalence of 35% was
incontinent of urine at night or day for at least once a
month. The obtained data were analyzed using the
reported in Moroccan children.
12
computer program EPI INFO version 6 and Statistical
Package for Social Sciences (version 16.0). Statistical
There is a dearth of literature about the prevalence of
significance at 95% confidence interval was p value <
enuresis in Nigeria among primary school children.
0.05. Different groups were compared by means of c
2
Two studies on this subject reported prevalence of
.
enuresis of 17.6% and 21.3% among children in
All enuretic children were given a written referral to the
Igbo-Ora, a rural community in South West Nigeria
paediatric Nephrologists in UPTH for further
and in Ehor community, Edo state respectively.
13,14
evaluation and treatment.
The sample size of these studies were relatively
small. Anochie and Ikpeme reported a prevalence of
enuresis of 25.3% among secondary school students
aged 10 - 19 years in Port Harcourt .
16
Results
There is evidence that effective intervention by
One thousand one hundred and seventy questionnaires
motivational therapy, behavior intervention and use
were given to pupils, nine hundred and sixty two
of drugs can reduce the duration of the problem and
completed questionnaires were returned giving an
help to improve the lives of these children and their
overall response rate of 82.2%. Forty questionnaires
families.
17
Studies
17-19
have shown restoration and
were excluded because of incomplete and inconsistent
new sense of confidence, improvement in self esteem
data; therefore 922 questionnaires were included in the
and academic performance.
final analysis. Of these 922 children, 463 (50.2%) were
males while 459 (49.8%) were females, giving a male
This study was conducted to determine the
female ratio of 1:1. The mean age of the study group
prevalence of enuresis and its types among school
was 8.6years±1.9years. The age and sex distribution of
children in Port-Harcourt city. It also seeks to
the study group is shown in Table 1. More females
determine the age and sex distribution of enuresis in
87(64.0%), and males 39 (60.9%) were represented
these children. It is envisaged that information from
among children who were eight years and eleven years
the study will assist health workers in planning
old respectively.
appropriate intervention in this regard.
Table 1: Age and Sex distribution of the study population
Age(yrs)
Males (%)
Females (%)
Total
Subjects and Methods
6
70 (46.4)
81 (53.6)
151
7
95 (54.6)
79 (45.4)
174
The study was carried out among 922 primary school
8
49 (36.0)
87 (64.0)
136
children aged 6-12 years in thirteen different schools
9
83 (49.4)
85 (50.6)
168
selected by multi-stage stratified random sampling,
10
72 (56.7)
55 (43.3)
127
between November 2008 and March 2009 in Port
11
39 (60.9)
25 (39.1)
64
Harcourt, Nigeria. The State Ministry of Education
12
55 (53.9)
47 (46.1)
102
and the Research and Ethics Committee of the
Total
463 (50.2)
459 (49.8)
922
20
Prevalence of Enuresis
Discussion
The prevalence of enuresis was 23.2%. The
The prevalence of enuresis of 23.2% in primary school
prevalence of enuresis was significantly higher in
children aged 6-12 years in Port Harcourt found in this
males than females (27.4% versus 19.0%, % = =9.29,
2
study falls within a wide range of 4% to 40% reported in
earlier studies.
1-4,13-21
p =0.002)
Specifically, it is similar to the
21.3% prevalence reported by Iduoriyekemwen et al
13
Prevalence of enuresis by age
in Edo State Nigeria among children aged 5-16 years
and 25% reported by Famuyiwa
20
among school
The highest prevalence rate of enuresis was seen at
children in Lagos. It contrasts with the lower
the age of 6 years and lowest at 11 years. The
prevalence rates of 7.6%, 9.2% and 12.9% reported
difference in the prevalence of enuresis in any of the
from epidemiological studies in India, Korea, and
Turkey respectively.
1,2,9
age groups compared with the rest of the study group
The different definitions of a
was only significant with respect to the 6 year age
case of enuresis as was used in this study compared
group as shown in Table 2. Generally, the prevalence
with the earlier studies may explain the lower
of enuresis decreased as the age increased and the
prevalence rates obtained. For example, the Indian
2
study defined enuresis as bedwetting for at least two
trend was statistically significant. ( c
for trend=
nights a week in children aged 6-12years. This stricter
2
3.98. p=0.045).
definition of enuresis when compared to the present
study will result in a lower prevalence of enuresis in the
Table 2: Prevalence of enuresis by age
Indian study. Differences in the age of the study
Age yr
no
Enuretic(%)
population may also contribute to this lower
prevalence. For example the Korean study by Lee et al
9
6
151
49 (32.5)
excluded children who were 6 year old, and since
7
174
38(21.8)
prevalence of enuresis reduces with increasing age, a
8
136
36(26.5)
lowered prevalence is not surprising. Many studies
from Asia
1,2,9
9
168
31(18.5)
showed a lower prevalence of enuresis.
10
127
24(18.9)
Genetic predisposition to enuresis is a known fact but
11
64
9(14.1)
racial relationship is uncertain.
12
102
27 (26.5)
Total
922
214 (23.2)
This present study showed that enuresis was more
prevalent in males and in the younger age group, with a
decreasing prevalence as the age increases. This
Types of Enuresis
finding is similar to that observed in previous studies.
1-16
This higher prevalence in males may be due to delayed
Among the enuretic children, 197(92.1%) had
functional maturation of the reported central nervous
nocturnal enuresis, 2(0.9%) had diurnal enuresis,
system (CNS) in males when compared to
females
4,21
while 15 (7%) had nocturnal-diurnal enuresis (Table
which reduces the ability of the child
3). Out of the 197 with nocturnal enuresis,
to inhibit bladder emptying at night.
181(92.0%) had primary nocturnal enuresis (PNE),
14(7%) had secondary nocturnal enuresis (SNE)
The preponderance (92.1%) of nocturnal enuresis and
while in 2(1%) the type of nocturnal enuresis was not
low prevalence of diurnal enuresis reported in this
known.
study is similar to that reported by Iduoriyekewen NJ et
al
14
in Ehor community, Edo state, who reported 91%
Table 3: Classification according to type of Enuresis
for nocturnal enuresis and no strict case of diurnal
Type of enuresis
Male(%)
Female (%)
Total (%)
enuresis. The difference in the prevalence of combined
nocturnal/diurnal enuresis in this study of 15% and 9%
Nocturnal
115(90.6)
82 (94.3)
197(92.1)
in Ehor study respectively may be due to the smaller
Diurnal
1 (0.7)
1 (1.1)
2(0.9)
sample size of 300. Primary nocturnal enuresis
Nocturnal/Diurnal
11(8.7)
4 (4.6)
15(7.0)
constituted 92.0% of all nocturnal enuresis and this is
similar to findings from other studies.
12,14,15
Total
127
87
214(100.0)
In conclusion, the study has shown that enuresis is
common in primary school children aged 6-12 years in
Port Harcourt City. It was commoner in males than
females and the prevalence decreased with increasing
age. Primary nocturnal enuresis is the predominant type
of enuresis in the study population. It is recommended
that greater attention should be paid to the early
identification and management of this condition by
health professionals.
21
References
1. Ozkan KU, Garipardic M,
8. Moffatt ME. Nocturnal
15. Bower WF, Moore KH,
Toktamis A, Karabiber H,
enuresis: psychologic
Shepherd RB, Adams RD.
Sahinkanat T. Enuresis-
implications of treatment and
The epidemiology of
prevalence and
nontreatment. J Pediatr Apr
accompanying factors in
1989; 114(4 Pt 2):697-704.
childhood enuresis in
school children: A
9. Lee SD, Sohn DW, Lee JZ,
Australia. Br J Urol 1996;
questionnaire study from
Park NC, Chung MK. An
78(4): 602-6.
Southeast Anatolia. Urol Int
epidemiological study of
16. Anochie IC, Ikpeme E.
2004; 73:149-55
enuresis in Korean children.
Nocturnal enuresis among
.2. De Sousa A, Kapoor H,
BJU Int 2000; 85:869-73.
secondary school students
Jagtap J, Sen M. Prevalence
10. Ozden C, Ozdal OL,
in Port Harcourt, Nigeria.
and factors affecting
Altonova S, Oguzulgen I,
PHM J 2006; 1:12-16.
enuresis amongst primary
Urgancioglu G,Memis A.
17. Weaver A , Dobson P .
school children. Indian J
Prevalence and associated
Noc turnal enuresis in
Urol 2007; 23:354-7
factors of enuresis in Turkish
children. J Fam Health
3. Neil WB, Richard D.
children. Int. Braz. J Urol
Enuresis (Bed-wetting). In:
2007; 33 (2): 216-22
Care 2007; 17(5):159-61
Berhrman RE, Kliegman
11. Chiozza ML, Bernardinelli
18. Pennesi M, Pitter M,
RM, Jenson HB. (editors).
L , Caione P, Del Gado R,
Bordugo A, Minisini S,
Nelson textbook of
Ferrara P, Giorgi PL, et al .
Peratoner L. Behavioral
Pediatrics 17 Edition.
th
An Italian multicentre
therapy for primary
Philadelphia, W.B. Sanders
epidemiological study of
nocturnal enuresis. J Urol
Company 2003; chapter
2004; 171(1):408-10
20.3:74-75
nocturnal enuresis. Br J
19. Monge ZM, Mendez AM,
4. Robson WLM. Enuresis.
Urol 1998;81:86-89
Nieto V. Effectiveness of
http://www. eMedicine
12. Bourquia A, Chihabeddine
behavioral intervention in
.com/ped/Topic 689. HTM.
K. Enuresis:
nocturnal enuresis. An
oct. 2007. Accessed nov.
epidemiological study in
Pediatr (Barc) 2005;
2008
morocco children. Saudi J
63(5):444 447
5. Gumus B, Vurgun N, Lekili
Kid Dis Transpl 2002; 13
20. Famuyiwa OO. Enuresis.
M. Prevalence of nocturnal
(2): 151-4
Nig Med Pract 2001;
enuresis and
13. Osungbade KO, Oshiname
10:97-102.
accompanying factors in
FO. Prevalence and
21. Touchette E, Petit D,
children aged 7-11 years in
perception of nocturnal
Paquet J,Tremblay RE,
Turkey. Acta Paediatr 1999;
Boivin M. et al. Bedwetting
88:1369-1372
enuresis in children of a
and Its association With
6. Marshall S, Marshall HH,
rural community in
developmental milestones in
Lyon RP. Enuresis: an
southwestern Nigeria. Trop
early childhood
analysis of various
Doct 2003; 33(4): 234-6.
therapeutic approaches.
14. Iduoriyekemwen NJ,
Arch Pediatr Adolesc Med
Pediatrics 1973; 52:813-7.
Ibadin MO, Abiodun PO.
2005; 159(12): 1129 -
7. Kalo BB, Bella H. Enuresis:
Survey of childhood
1134.
Prevalence and associated
enuresis in Ehor
factors among primary
community, the Edo state,
school children in Suadi
Nigeria. Saudi J Kid Dis
Arabia. Acta Paediatr 1996;
Transpl 2006; 17(2): 177-
85:1217-1222
82.