Prevalence and Risk Factors of Nocturnal Enuresis in a Rural Area of Assiut Governorate

Nocturnal enuresis is a common problem that can be troubling for children and their families. Nocturnal enuresis is the involuntary and undesirable wetting that occurs during sleep beyond the age of anticipated bladder control. Children are not considered enuretic until they have reached five years of age. Although comparison of studies are difficult because of variation in the definition of enuresis and in the age range of population studied, true geographical differences in prevalence and in natural history of enuresis seem to exist, arising from racial, cultural, or environmental factors. The literatures about the prevalence of enuresis in rural areas of Assiut governorate are limited. The aim of the study is to evaluate the prevalence of nocturnal enuresis among children aged 5-12 years old in a rural area of Assiut governorate, this is in addition to study risk factors associated with nocturnal enuresis among enuretic children in this rural area. A cross-sectional community-based study was carried out in Mankabad village. A total of 592 houses were visited. All eligible children (5-12 years) in the selected houses were included. The first house was selected randomly, and then every third house of the village was included. A well-designed questionnaire was used for data collection. The questionnaire sheet was developed to assess the prevalence and risk factors of nocturnal enuresis among children. This study included 1148 children distributed in 592 houses in Mankabad village. The prevalence of enuresis was found to be 17.8%. Diurnal as well as nocturnal enuresis occurs in 19.6% of the enuretic group. The most frequent cause of nocturnal enuresis expected by the mother was deep sleep (24.5%), followed by urinary tract infection (13.7%). As regards the dealing of the families with the problem of nocturnal enuresis, 15.7% mentioned that they consult others and about 29.4% consult a physician, 30.4% punish their children, while 24.4% do nothing. The prevalence of enuresis was insignificantly higher in males (51.9%) than females (48.1 %) (P= 0.209). The mean age of enuretic children (5.9 ± 2.1) years is significantly lower than that of non-enuretic children (8.7 ± 2.2) years (P<0.001). Birth order has no significant effect on the prevalence of enuresis. The prevalence of enuresis was significantly higher among children of illiterate fathers than among those of educated fathers (P=< 0.05), also maternal education has the same effect (P= <0.05). Enuresis history in the father and the mother is significantly associated with enuresis among children included in the study (P< 0.001 for each). The prevalence of enuresis is significantly lower among children with high socioeconomic status (11.7%) than those of low socioeconomic status (32.4%) (P=0.001). An insignificant difference was present between the enuretics and non-enuretics as regards presence or absence of family troubles. . The prevalence of enuresis is significantly associated with the presence of some urinary symptoms such as dysuria, stress incontinence, and urgency (P<0.001 for each). Also, it is significantly associated with some bowel disorders as constipation and encopresis (P<0.001 and< 0.001). Conclusions: The prevalence of NE in rural area of Assiut governorate is slightly higher than some other areas of the world. The low socioeconomic factors, low educational level and positive history of enuresis in the father or the mother may share in the problem. Urinary and GIT troubles may share in the pathogenesis of NE. The psychological factors were insignificantly sharing in the problem of NE but it may be a result of punishment and family comments. Abbreviations: NE: nocturnal enuresis, PNE: primary nocturnal enuresis, GIT: gastrointestinal tract, EEG: electroencephalogram.