Prevalence of Nocturnal Enuresis and Associated Psychological Problems Among Children With Sickle Cell Disease Aged 6-14 Years Attending Healthcare Services at Homabay County Teaching and Referral Hospital

Abstract

Background Sickle cell disease (SCD) is a hereditary autosomal recessive hemoglobin disease condition characterized by sickling of red blood cells under conditions of stress and hypoxia. Studies have illustrated that children with sickle cell disease (SCD) present a higher likelihood for nocturnal enuresis (NE) compared to those children who have normal hemoglobin. Studies however report varying epidemiologic trends and prevalence rates of NE based on the diverse definition criteria and study methods. More poignantly, while NE prevalence is high in children with SCD, not much is known about the associated psychological problems in these children. Based on reports largely from Western studies, the stigma, ridicule and mental distress associated with NE among children are high. We set out to determine the prevalence of NE, as well as associated patient characteristics and psychological problems among children with SCD in our setting. Methodology: A cross sectional study was conducted in Homabay County Teaching and Referral Hospital among 250 children aged 6-14 years with a positive preliminary or a confirmatory test for SCD. Children on medications that may induce NE, those with disease conditions like cerebral palsy, profound mental retardation, diabetes, and those aged older than 7 years and declined assent to participate or whose parents denied consent were excluded. Stratified weighted sampling by age category was done to achieve the desired sample size. Data was obtained on presence or absence of NE as well as on children’s age, gender, sibling history of NE, school type and presence or absence of psychological disorders. The Pediatric Symptom Checklist (PSC) tool was used to evaluate psychological well-being of children. A cut off score of ≥ 28 defined presence of psychological impairment. Filled PSC questionnaires that had four or more blank items were considered incomplete and excluded from the analysis. xiv Results: Out of 250 participants there were 237 complete PSC forms. The prevalence of NE in the study population was 31.2% (95% CI 23.0-37.8). Only 1 participant had secondary NE giving a prevalence of 0.42%. Patient characteristics associated with NE were male gender, age less than 10 years and previous hospitalizations with an adjusted odds ratio (AOR) of 1.47(95% CI 1.14-1.89); 1.92(95% CI 1.45-2.53) and 2.13(95% CI 0-7.17) respectively. None of the children met the PSC threshold for psychological disorders as per the screening tool, however 6.7% presented with symptoms of attention problems, 9.7% with symptoms of internalizing problems, and 30% had symptoms of externalizing problems Conclusion: The prevalence of NE among children with SCD in Homa Bay is high while prevalence of associated psychological problems is low. Male gender, age and previous hospitalizations were identified as predictors of NE in children with SCD. Recommendations: Children with SCD should be routinely assessed for NE and appropriate treatment offered especially among boys, young children aged 6-9 years and children with increased frequency of hospitalization