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April2013 Vol.50 Issue:      2 Table of Contents
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Prevalence and Risk Factors of Primary Nocturnal Enuresis in Primary School Children in Qena Governorate-Egypt

Ahlam Ismail1, Khalid Abdelbasser1, Mohamed Abdel-moneim2

Departments of Pediatrics1, South Valley University; Neurology and Psychiatry2, Sohag University; Egypt

 



ABSTRACT

Background: Primary Nocturnal Enuresis (PNE) is an important developmental problem for school age children and children with PNE seem to have psychological problems which may be the results or the etiology of enuresis. PNE is multifactorial and many risk factors have been described to explain this phenomenon. Objective: To determine the prevalence of PNE in Qena Governorate primary school children and to assess risk factors that can cause or affect the disease. Methods: a cross-sectional study of PNE was performed. We distributed 10580 questionnaires in 17 primary schools in Qena Governorate. After exclusion of secondary, diurnal or mixed enuresis, we detected the prevalence and risk factors of PNE. Results: Students with enuresis were 1065 (11.4%). The prevalence of PNE was 10.13%. PNE was higher in younger age, male gender and large families, while positive family history, deep sleep, low socioeconomic, threatening toilet training and the response of the parents and siblings with psychic abuse, are the main risk factors of PNE. We found that the psychological and stressor factors are associated with mild to moderate forms of enuresis. The child responded to enuresis by depression, isolation, nervousness and violence and this affects his school success. Conclusion: The prevalence of PNE in primary school children in Qena Governorate constitutes about 10.13%. We recommend that the parents should be well informed about these risk factors to avoid them and advice them to seek for medical and psychiatric help. [Egypt J Neurol Psychiat Neurosurg.  2013; 50(2): 163-169]

 Key Words: nocturnal enuresis, children, psychological causes.

Correspondence to Ahlam Mohamed Ismail, Department of Pediatrics, South Valley University, Egypt. E-mail: Ahlam1967@hotmail.com.




INTRODUCTION

 

Enuresis is defined in the "Diagnostic and statistical manual of mental disorders" (DSM-IV) as the repeated voiding of urine into bed or clothes at least twice a week for at least three consecutive months in a child who is at least 5 years of age. Nocturnal enuresis (NE) refers to voiding during sleep; diurnal enuresis defines wetting while awake.1 NE is one of the most common developmental problems among the children.2 The reported prevalence of enuresis at different ages varies considerably because of differences in the method of data collection, and characteristics of the population sampled. The ratio of the incidence of enuresis in boys versus girls is 2:1; enuresis is more common at all ages in lower socioeconomic groups and in institutionalized children. The prevalence of nocturnal enuresis among the children older than five years of age was reported to be 6.7-14.7%.3,4 Nocturnal enuresis can be further categorized into primary nocturnal enuresis or secondary nocturnal enuresis. Primary nocturnal enuresis is therefore bedwetting in a child aged 5 years or more who has never been dry for extended periods, while secondary nocturnal

 

enuresis is the onset of wetting after a continuous dry period of more than 6-12 months which can be caused by such as urinary tract infection (UTI), diabetes mellitus, spina bifida and epilepsy.5

PNE is an important problem for school age children and it can cause emotional and social problems for the child as well as the family.6 Chronic anxiety, low self-esteem, and delayed developmental steps such as attending camps or sleeping at a friend's house may occur as secondary problems.7 The etiology of enuresis is not completely understood. This condition probably has a multifactor etiology. Most studies have consistently found that the risk factors for enuresis are male gender, smaller age, family history and divorced parents.8,9 The overall prevalence of nocturnal enuresis, as well as prevalence of nocturnal enuresis in different age groups, is greatly varied in different countries, ranging from 2.3% to 25%.9-11 Enuresis is frequently diagnosed among school children and is an important psychosocial problem both for parents and children. The relationship between enuresis and behavioral problems has been studied for several decades. Results range from enuretic children having no marked emotional, social or behavioral problems, to enuretic children with a 4.3-times increase in psychological difficulties compared with their non-enuretic peers, with this regard, nocturnal enuresis is evaluated as an important public health problem.12,13 Although enuretic children seem to have accompanying psychological problems, it must be investigated whether these problems are the results of enuresis or etiological factors. Nocturnal enuresis is multifactorial; few studies concluded that nocturnal enuresis might cause secondary emotional and social problems in children who continue to wet their bed.12-14 A number of etiologic factors have been described to explain this phenomenon.7,15

 

Aim of the Work

The aim of this study is to determine the prevalence of PNE in Qena Governorate primary school children and to assess risk factors that can cause or affect the disease such as general approach of family to the children, school success of the students, general behavioral attitudes, method of toilet training and socio-demographic factors.

 

PATIENTS AND METHODS

 

A cross-sectional study of PNE was performed after it was approved by human research ethics committee of the Qena university hospital. We distributed 10580 questionnaires to parents of 6-12 years old students from 1st grade to 6th grade had taken as candidates for this research in 17 primary schools in Qena Governorate in the period from October 2011 to May 2012. The permission was obtained from the educational institute in Qena governorate and a written informed consent form was obtained from the parents, stating the study's objectives. The questionnaire contains 21 questions in a simple Arabic language, the questions include, the presence of nocturnal enuresis and, descriptive questions related to child and parents asked about socio-demographic data, NE data, physical or psychological disorders, and family stressors such as questions about the general approach of family to the child, the school success of the child, the general behavioral attributes, sleeping pattern and method of toilet training. Questionnaires were given to the students to be answered by their parents. The students were instructed to give it to their parents. Any parent (mother or father) can fill the questionnaires. The teachers help us in the collection of the questionnaires from children within one week. Those not wishing to participate were recorded as "not responding". Questionnaires were spread to 10580 students; only 9340 students return it back, with response rate of 88.3%. Those parents answered the questionnaire that their children have NE, were evaluated with detailed history & physical and laboratory examinations (in selected cases) as: complete urine analysis, random blood sugar, Lumbo-sacral x-ray and EEG. So, secondary reasons such as UTI, diabetes mellitus, spina bifida and epilepsy (clinically and by EEG) had been excluded. The DSM-IV criteria are used to define children with PNE and detect its severity.1

The data was statistically analyzed using Student’s t-test, one way ANOVA, and chi-square (linear by linear correlation) tests, as applicable (with a preset probability of P<0.05). Experimen­tal results are presented as arithmetic mean±SD. A logistic regression model was applied to estimate the odds ratios (OR) of significant predictive factors. Statistical tests were conducted using the SPSS software package, version 16 (SPSS Inc., Chicago, IL, USA) on a personal computer.

 

RESULTS

 

In our study, questionnaires were spread to 10580 students in 17 primary schools in Qena Governorate, only 9340 return it back; with response rate of 88.3%. The parents answered the questionnaire that their children are non-enuresis students were 8275 (88.6%) while those who had enuresis were 1065 students (11.4%). We excluded 16 cases with diurnal enuresis and 80 cases of mixed (diurnal & nocturnal) enuresis and 23 cases with secondary reasons of nocturnal enuresis such as urinary tract infection (UTI), diabetes mellitus, spina bifida and epilepsy. The latter (secondary) presented with pain or urgency during micturition, change in urine color, polyuria with loss of weight and convulsion. They were diagnosed as 10 cases with UTI, 2 cases with diabetes mellitus, 2 cases with spina bifida, 4 cases with epilepsy and 5 cases with bilharziasis.

Therefore, the number of students with primary nocturnal enuresis out of those 9340 responder students were 946 students. That represented prevalence of about 10.13% (Table 1).

Table (2) shows some data and characters of the students with and without nocturnal enuresis. It reveals that PNE frequency was higher in younger age of students as it was decreased by age from 63.2% at 6-8 years to 36.8% at 9-12 years (Figure 1) with p-value of 0.014.  Male gender was one of the risk factors of PNE as the frequency was high in males (69.1%) when compared with females (30.9%) with p-value of 0.029. In addition, we found that the incidence of PNE increased with large families with extra numbers of family members and siblings with p-value of 0.035 and 0.021 respectively, but it was not statistically significant with number of rooms in the house with p-value of 0.06.

Also and as shown in Table (3); the statistical analysis of some risk factors associated with severity of primary nocturnal enuresis.

Students who had mild to moderate PNE were 402 (42.5%) while those with severe PNE were 544 (57.5%). Positive family history of PNE, deep sleep pattern, low socioeconomic conditions, threatening methods of toilet training, and the response of the Parents & Brothers and sisters with verbal or psychic abuse to children with PNE, as risk factors significantly associated with the severity of enuresis in the students with p-value of 0.001, 0.006,  0.04, 0.012, 0.004 and 0.025 respectively. However, Psychological & Stressor factors associated with mild to moderate PNE and not with severe form of enuresis with p-value of 0.68. The severity of enuresis significantly affect the school success of the student in a p-value of 0.03. The child respond to enuresis by depression, isolation, nervousness & violence and this was significantly affects the severity of enuresis in a p-value of 0.01.

Parents of 690 (72.94%) students considered NE a big problem while 226 (23.89%) of them found it a small problem and only 30 (3.17%) said about it no problem. Parents were seeking for medical advice in adolescent group more than pediatrics group, we found that 549 (58.0%) out of the 946 enuretic students asked for medical advice (Figure 2). The treatment methods were: medication, water restriction, awaking for voiding but only 98 (17.8%) of them got excellent improvement, 112 (20.4%) got good improvement while 70 (12.8%) with some improvement. No improvement found in a big number of them, 269 (49.0%).


 

Table 1. Prevalence rate of primary nocturnal enuresis in primary school children.

 

 

  Responders

Enuresis

No Enuresis

Total

Primary

Secondary

Nocturnal

Mixed

Diurnal

Number

9340

1065

946

80

16

23

8275

% out of responders

 

11.4%

10.13%

0.9%

0.17%

0.2%

88.6%

 

Table 2. Data and Social characters in children with and without primary nocturnal enuresis.

 

Factor

PNE (946 students)

No enuresis (8275 students)

P-value

No

%

Mean±SD

no

%

Mean±SD

Age

6-8 years

9-12 years

 

598

348

 

63.2%

36.8%

6.8±2.5

 

1432

6843

 

17.3%

82.7%

8.3±1.3

0.014*

Sex

Male

Female

 

653

293

 

69.1%

30.9%

 

 

4586

3689

 

55.4%

44.6%

 

0.029*

Family members

3 -11

6.3±1.20

3 – 6

4.1±1.15

0.035*

Siblings

1 – 8

5.1±1.50

1 – 4

2.2±0.82

0.021*

House room

1 – 5

4.2±2.9

1 – 4

3.3±1.25

0.06

* Significant p-value <0.05

 

38.8%

 

63.2%

 

 

Figure 1. Age distribution of the Students with PNE.

Table 3. Analysis of some risk factors associated with severity of nocturnal enuresis.

 

Factor

Total PNE

Severity of enuresis

Univariate  analysis

n

%

Mild- moderate

(Total=402)

Severea

(Total=544)

N

%

N

%

OR

p-value

Family history

      Yes

       No

 

622

324

 

65.75%

34.25%

 

210

192

 

52.2%

47.8%

 

412

132

 

75.8%

24.2%

0.3504

0.001**

Sleep pattern

     Deep

     Light

 

629

317

 

66.5%

33.5%

 

230

172

 

57.2%

42.8%

 

399

145

 

73.3%

26.7%

0.4860

0.006**

Socioeconomic status

       Low

       Average

       High

 

434

316

196

 

45.9%

33.4%

20.7%

 

109

152

141

 

27.1%

37.8%

35.1%

 

325

164

55

 

59.7%

30.1%

10.2%

 

0.04*

Threatening toilet training

Yes

No

 

704

242

 

74.4%

25.6%

 

289

113

 

71.9%

28.1%

 

415

129

 

76.3%

23.7%

 

0.7950

 

0.012*

Stressors and psychological factors

Yes as

Violence

Divorce

Newborn

Transport

Frustration

No

 

560

209

3

15

7

326

386

 

59.2%

22.2%

0.3%

1.6%

0.7%

34.4%

40.8%

 

290

 

 

 

 

 

112

 

72.1%

 

 

 

 

 

27.9%

 

270

 

 

 

 

 

274

 

49.6%

 

 

 

 

 

50.4%

 

2.627

 

0.680

School success

Yes

No

533

413

56.6%

43.4%

310

92

77.1%

22.9%

223

321

23.6%

76.4%

4.85

0.03*

Parents response

     Plain & bad words

     Somatic punishment

     Deal nice with him

 

535

59

352

 

56.6%

6.2%

37.2%

 

154

33

215

 

38.3%

8.2%

53.5%

 

381

26

137

 

70.0%

4.8%%

25.2%

 

0.004**

Brothers and sisters response

      Laugh at him

      Psychic abuse

      No care

 

667

136

143

 

70.5%

14.4%

15.1%

 

254

  39

109

 

63.2%

9.7%

27.1%

 

413

97

34

 

75.9%

17.8%

6.3%

 

0.025*

The child response

Depression & isolation

Nervousness & violence

Not care

 

189

681

76

 

20%

72.0%

8%

 

78

272

52

 

19.4%

67.7%

12.9%

 

111

409

24

 

20.4%

75.2%

4.4%

 

0.01*

 

aSevere nocturnal enuresis >3 wet nights per week, OR odds ratio, * Significant at p-value <0.05 ** Significant at p-value <0.01

 



58%

 
 

 


Figure 2. Percentage of students with PNE who got treatment.


DISCUSSION

 

In our study, the parents, who answered the questionnaire that their children non-enuresis students were 8275 (88.6%) and those had enuresis, were 1065 students in a prevalence of primary enuresis as 11.4%. This result comes in concordance with many studies carried out in many countries who reported that the prevalence of enuresis among 6-11 year old children ranged from 1.4 to 28%.16,17 And also with many researches which concluded that the overall prevalence of nocturnal enuresis, as well as prevalence of nocturnal enuresis in different age groups, is greatly varied in different countries, ranging from 2.3% to 25%.8,10-12

After exclusion of diurnal, mixed and secondary nocturnal enuresis; we found that the prevalence of primary nocturnal enuresis in primary school children is about 10.13% which agrees with Piyasil and Udomsup, 200218  who found that the prevalence of primary nocturnal enuresis was 15.4 and with Yousef et al.19, who reported that the occurrence of primary nocturnal enuresis was 8.7% in schoolchildren of Aden Governorate, also we agree with Semolic et al.20, who recorded the occurrence of primary nocturnal enuresis as 8.7%. But our results not agree with the prevalence got by Tai et al 200721 which was 6.8% and not agree also with Kanaheswari 2003 which was 6.2%22 but we can explain this by different cultural societies and also by different number of students involved in their studies.

Our results revealed that PNE frequency was higher in younger age of students as it was decreased by age from 63.2% at 6-8 years to 36.8% at 9-12 years with p-value of 0.014 which come in harmony with the results of Yousef et al.19, which found that primary nocturnal enuresis decreased by age from 31.5% at 6-8 years to 8.7% at over 15 years. In addition, with Safarinejad23 who found a significant relationship between the prevalence of enuresis and age and also with Tai et al 2007.21 Male gender was one of the risk factors of PNE in our results  as the frequency was high in males (69.1%) when compared with females (30.9%) with p-value of 0.029 which agrees with many researchers as with Brockmann et al.24, Sureshkumar et al.25, Semolic et al.20, Tai et al.21 and Pashapour26 but it was not agree with Ali et al.27 or Piyasil and Udomsup18, who concluded that enuresis  not related to sex.

Also we found that the incidence of PEN increased with large families with extra- numbers of family members and siblings which agree with Ali et al.27, who found that low socio-economic status of the family was associated with nocturnal enuresis, Semolic et al.20 and with Yousef et al.19 found that the PNE was higher in families of low socioeconomic class.

According to our results we concluded that there was a significant association between Positive family history of PNE, deep sleep pattern and with the occurrence and severity of enuresis in the students, this come in harmony with Yousef et al.19, Safarinejad23 and Tai et al.21, who considered them important risk factors of incidence of PNE and also significantly associated with its severity.

The enuretic child may be at increased risk for emotional or even physical abuse from family members and may experience stress related to fear of detection by peers. These factors contribute to the loss of self-esteem that the enuretic child often experiences.28 In our study we found that threatening methods of toilet training, the response of the Parents & Brothers and sisters with verbal or psychic abuse to children with PNE are very important risk factors significantly associated with the severity of enuresis in the students that agree with many studies carried out by Safarinejad23, Piyasil and  Udomsup18, and can  significantly affect the school success of the student. The child respond to enuresis by depression, isolation, nervousness & violence and this was significantly affects the severity of enuresis which come in concordance with the results of Brockmann et al.24, who found that PNE Children had a higher prevalence of hyperactive behavior and poor academic performance.

According to our data, Stressful events as violence, divorce, newborn, Transport & Frustration associated with PNE but Psychological and Stressor factors associated with mild to moderate PNE and not with severe form of enuresis that agrees with Sureshkumar et al.25 and Yousef et al.19.

Parents were found to be more disturbed by the problem than their children.20 Moreover, the seeking for professional help in adolescent group was significantly higher than those of pediatric group.16

According to our study, parents of 690 (72.94%) students considered NE a big problem and about 549 (58.0%) students asked for medical advice that agrees with the results of Piyasil and Udomsup, 200218  who found that 58% of the parents thought that the enuretic problem needed further treatment. Treatment methods used were medication, water restriction, awaking for voiding but only 98 (17.8%) of them got excellent improvement, 112 (20.4%) got good improvement while 70 (12.8%) with some improvement. No improvement found in a big number of them, 269 (49.0%).

 

Conclusions

Our study concluded that the prevalence of PNE in primary school children in Qena Governorate constitute about 10.13%

PNE frequency was higher in younger age, male gender, low socio-economic status of the family and in families with many siblings. Positive family history of PNE, deep sleep pattern with difficult in awaking the child, threatening methods of toilet training, the response of the parents, brothers and sisters with verbal or psychic abuse to children with PNE are very important risk factors & enuresis can significantly affect the school success of the student and the child may respond to enuresis by depression, isolation, nervousness & violence. Also we found that psychosocial factors appear to contribute to moderate but not severe nocturnal enuresis.

Therefore, we recommend that the parents should be well-informed about these risk factors to avoid them. Also, parents should seek for medical and psychiatric help firstly to treat the condition especially it is associated with secondary reasons and for psychic therapy to children.

 

[Disclosure: Authors report no conflict of interest]

 

REFERENCES

 

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4.        Eapen V, Mabrouk AM. Prevalence and nocturnal enuresis in the United Arab Emirates. Saudi Med J. 2003; 24:49-51.

5.        World Health Organization. The ICD-10 Classification of Mental and Behavioral Disorders: Diagnostic Criteria for Research. WHO, Geneva; 1993.

6.        Gόmόώ B, Vurgun N, Lekili M, Iώηan A, Mόezzinoπlu T, Bόyόksu C. Prevalence of nocturnal enuresis and accompanying factors in children aged 7-11 years in Turkey. Acta Paediatr. 1999; 88:1369-72.

7.        Fritz G, Rockney R, Bernet W, Arnold V, Beitchman J, Benson RS, et al. Practice parameter for the assessment and treatment of children and adolescents with enuresis. J Am Acad Child Adolesc Psychiatry. 2004; 43:1540-50.

8.        Ozden C, Ozdal OL, Altinova S, Oguzulgen I, Urgancioglu G, Memis A. Prevalence and associated factors of enuresis in Turkish children. Int Braz J Urol. 2007; 33(2):216-22.

9.        Wen JG, Wang QW, Chen Y, Wen JJ, Liu K. An epidemiological study of primary nocturnal enuresis in Chinese children and adolescents. Eur Urol. 2006; 49(6):1107-13.

10.     Bower WF, Moore KH, Shepherd RB, Adams RD. The epidemiology of childhood enuresis in Australia. Br J Urol. 1996; 78:602-6.

11.     Byrd RS, Weitzman M, Lanphear NE, Auinger P. Bedwetting in US children: Epidemiology and related behavior problems. Pediatrics. 1996; 98: 414-9.

12.     Chiozza ML, Bernardinelli L, Caione P, Del Gado R, Ferrara P, Giorgi PL, et al. An Italian epidemiological multi-centre study of nocturnal enuresis. Br J Urol. 1998; 81(Suppl 3): 86-9.

13.     Liu X, Sun Z, Uchiyama M, Li Y, Okawa M. Attaining nocturnal urinary control, nocturnal enuresis, and behavioral problems in Chinese children aged 6 through 16 years. J Am Acad Child Adolesc Psychiatry. 2000; 39: 1557-64.

14.     Chang SSY, Ng CFN, Wong SN. Behavioral problems in children and parenting stress associated with primary nocturnal enuresis in Hong Kong. Acta Paediatr. 2002; 91: 475-9.

15.     Ozkan KU, Garipardic M, Toktamis A, Karabiber H, Sahinkanat T. Enuresis prevalence and accompanying factors in school children: A questionnaire study from southeast Anatolia. Urol Int. 2004; 73: 149-55.

16.     Wen JG, Wang QW, Chen Y, Wen JJ, Liu K. An epidemiological study of primary nocturnal enuresis in Chinese children and adolescents. Eur Urol. 2006; 49(6): 1107-13.

17.     Gumus B, Vurgun N, Lekili M, Iscan A, Muezzinoglu T, Buyuksu C. Prevalence of nocturnal enuresis and accompanying factors in children aged 7-11 years in Turkey. Acta Paediatr. 1999; 88: 1369-72.

18.     Piyasil V, Udomsup J. Enuresis in children 5-15 years at Queen Sirikit National Institute of Child Health. J Med Assoc Thai. 2002; 85(1): 11-6.

19.     Yousef KA, Basaleem HO, bin Yahiya MT. Epidemiology of nocturnal enuresis in basic school children in Aden Governorate, Yemen. Saudi J Kidney Dis Transpl. 2011; 22(1): 167-73.

20.     Semolic N, Ravnikar A, Meglic A, Japelj-Pavesić B, Kenda RB. The occurrence of primary nocturnal enuresis and associated factors in 5-year-old outpatients in Slovenia. Acta Paediatr. 2009; 98(12): 1994-8.

21.     Tai HL, Chang YJ, Chang SC, Chen GD, Chang CP, Chou MC. The epidemiology and factors associated with nocturnal enuresis and its severity in primary school children in Taiwan. Acta Paediatr. 2007; 96(2): 242-5.

22.     Kanaheswari Y. Epidemiology of childhood nocturnal enuresis in Malaysia. J Paediatr Child Health. 2003; 39(2): 118-23.

23.     Safarinejad MR. Prevalence of nocturnal enuresis, risk factors, associated familial factors and urinary pathology among school children in Iran. J Pediatr Urol. 2007; 3(6): 443-52.

24.     Brockmann PE, Urschitz MS, Noehren A, Sokollik C, Schlaud M, Poets CF. Risk factors and consequences of excessive autonomic activation during sleep in children. Sleep Breath. 2011; 15(3): 409-16.

25.     Sureshkumar P, Jones M, Caldwell PH, Craig JC. Risk factors for nocturnal enuresis in school-age children. J Urol. 2009; 182(6):2893-9.

26.     Pashapour N, Golmahammadlou S, Mahmoodzadeh H. Nocturnal enuresis and its treatment among primary-school children in Oromieh, Islamic Republic of Iran. East Mediterr Health J. 2008; 14(2): 376-80.

27.     Ali G, Gulsen G, Yasemin A, Adem A. The epidemiology and factors associated with nocturnal enuresis among boarding and daytime school children in southeast of Turkey: a cross sectional study. BMC Public Health. 2009; 9: 357.

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الملخص العربى

 

مدي انتشار وعوامل الخطورة في حالات التبول الليلي الأولي بين أطفال المدارس  الابتدائية  في محافظة قنا

 

مقدمة : يعزي البوال الليلي الأولي إلي حدوث تبول أثناء النوم, وإنه لمشكلة مهمة تتعلق بالنمو لأطفال المدارس ومن الممكن ان يسبب مشاكل اجتماعية ونفسية للطفل بالإضافة إلي المشاكل الأسرية. وفي الحقيقة فإن المشكلات النفسية والتطورية لمرض البوال الليلي تعد أكثر أهميةً وتدميراً للطفل من عرض التبول نفسه. إن البوال الليلي مشكله متعددة العوامل، وهناك بعض الأبحاث قد توصلت إلي أن البوال الليلي قد يسبب مشاكل نفسية واجتماعية للأطفال  وقد وصفت العديد من عوامل الاختطار التي توضح هذه الظاهرة.

الهدف: يهدف هذا البحث إلي تحديد معدل الانتشار للمرض البوال الليلي الأولي في مدارس محافظة قنا الابتدائية, وأيضا تحديد عوامل الاختطار التي قد تسبب أو تؤثر علي المرض.

المرضي وطرق البحث: تم عمل دراسة لمرض البوال الليلي الأولي, وعمل استبيان لآباء عدد 10580 تلميذاً ما بين سن 6 إلي 12 سنة من الصف الأول إلي الصف السادس الإبتدائي في مدارس محافظة قنا. تم استبعاد البوال الليلي الثانوي, والبوال النهاري, والبوال النهاري والليلي معا, واستطعنا تحديد مدي انتشار وعوامل الاختطار للبوال الليلي الأولي في هذه المدارس الابتدائية.

النتائج: بنشر استبيان علي حوالي 10580 تلميذاً في 17 مدرسة ابتدائية بمحافظة قنا, وعاد منهم 9340  تلميذاً بمعدل استجابة 88.3%. وبإجابة الآباء علي الاستبيان تبين أن عدد 8275 (88.6%) لا يعانون من البوال بصفة عامة. بينما الأطفال الذين يعانون من البوال هم 1065 تلميذاً (11.4%)  وباستثناء 16 حالة تعاني من البوال النهاري و80 حالة تعاني من البوال المختلط (ليلي ونهاري) وأيضاً 23 حالة تعاني من بوال لأسباب ثانوية.من ذلك يكون عدد الأطفال الذين يعانون من البوال الليلي الأولي هم 946 من 9340 تلميذاً بمعدل انتشار 10.13%.

كما أوضحت الدراسة أن البوال الليلي الأولي أكثر تكراراً في صغار السن من الذكور, والأسر كبيرة العدد,  وجود تاريخ عائلي موجب, والنوم العميق, وانخفاض مستوي المعيشة, و التهديد الشديد للتدريب علي دخول الحمام, ورد فعل الآباء والإخوة الأخوات بالاعتداء كلامياً ونفسياً علي الطفل الذي يعاني من البوال الليلي الأولي؛ هذه كانت أهم عوامل الاختطار للمرض وهي أيضا ضرورية في تحديد حدة المرض عندهم .إن العوامل النفسية والضغوط تكون مصاحبة للحالات البسيطة والمتوسطة وليس الشديدة من حالات البوال الليلي الأولي, فالتبول يؤثر علي الطفل في صور عدة مثل الاكتئاب أو الانعزال أو العصبية أو العنف وبالتالي تزيد من حدة المرض وأيضاً تؤثر علي معدل النجاح في المدرسة.

الخلاصة: تبين أن معدل الانتشار للبوال الليلي الأولي في المدارس الابتدائية بمحافظة قنا هو 10.13% تقريباً وأهم عوامل الاختطار للبوال الليلي الأولي هي صغر السن والجنس الذكري وانخفاض مستوي المعيشة للأسرة وفي الأسر كثيرة العدد ووجود تاريخ عائلي موجب وأصحاب النوم العميق و التهديد والتخويف للتدريب علي دخول الحمام  وكرد فعل للإيذاء الكلامي والنفسي للطفل من قبل الآباء والإخوة الأخوات.

التوصيات: توصي الدراسة بوجوب إعلام الآباء بعوامل الاختطار لهذا المرض ليتم تجنبها، وأيضاً نصح الآباء لطلب المساعدة الطبية والنفسية في الحالات الشديدة .

 



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