Prevalence of Primary Nocturnal Enuresis and Treatment Among 6-13-year-old Children Attending Primary Schools in Mombasa County

Abstract

Background: Primary nocturnal enuresis is a common pediatric condition that affects children worldwide. It is a source of depression of child’s self-esteem and self-image. It has a significant impact on the well-being and health of the child as well as the family, thus, no longer considered a benign condition. Effective treatment for primary nocturnal enuresis is available, however, many studies show that most caregivers do not seek help from the professional. Primary Objective: To determine the prevalence of primary nocturnal enuresis among 6-13-year-old children attending primary schools in Mombasa county. Secondary Objectives: To determine the pattern of health-seeking, types of treatment offered, barriers and possible solutions to health-seeking behavior. Utility: Bedwetting is no longer a benign condition. It has a serious impact on the wellbeing and health of the child, as well as the family. The majority of caregivers do not seek help in the health facility as per the literature reviewed. However, the reasons for which caregivers do not seek help from the professionals in our context are not known. The study will, therefore, help us identify the barriers to seeking help if any and educate the parents, children, and community that nocturnal enuresis is a medical condition and that effective treatment is available. Study Design: A school based cross-sectional study design where both quantitative and qualitative methods were used. Methodology: The study participants were selected using a multistage sampling method. Data was collected through a structured over the phone questionnaire based on ICCS terminology with clinical questions recommended by NICE guidelines on the assessment and management of nocturnal enuresis in children and young people. The parents of the participants were contacted via mobile phone after digital consent has been obtained by the primary investigator. A qualitative interview guide was used. iv Data Analysis: The data was entered into R version and bivariate and multivariable logistic regression analysis was done at 95% confidence interval. Qualitative data was analyzed manually after verbatim transcription and translation. Thematic analysis based on a conceptual framework was conducted and a summary of results presented including representative quotes. Study results: The prevalence of primary nocturnal enuresis in primary school children aged 6-13-years in Mombasa county is found to be 15.8% with no statistically significant difference in distribution of children by gender (p=1.000). Among the treatment offered, 31(56.4%) of parents wake up their children at night to go to the toilet, 26 (47.2%) would limit their children from taking fluid before bedtime, 22 (40.0%) would make their children pee before going to sleep and up to 6 (10.9%) actually rewarded their children for dry nights. In addition, 5 (9.0%) of parents let their children outgrow it while 4 (7.3%) punished their children for wet nights and only 3 (5.5%) used enuretic alarms. Among the barriers that hinder parents to seek help from the doctors were lack of knowledge that the conditions can be treated medically, knowing that the child will outgrow the condition and the attitude of parents towards the importance of seeking help. Conclusion: Prevalence of PNE is high at 15.8%. Majority of parents have no knowledge about the condition and are unaware that the condition can be treated medically. Parents responded positively and were eager to get the information on how and where to take their children for help.