| Abstract|| |
We attempted in this study, to estimate the prevalence of primary nocturnal enuresis (PNE) in children of Jordan, and to examine factors associated with PNE. We sent questionnaires to 950 parents of children aged 6-8 years, randomly selected from three primary schools in Jordan. The questionnaire was designed to evaluate the prevalence and factors associated with PNE. The response rate was 71.6%. The overall prevalence of PNE was 23.8%. This prevalence declined with age from 48.9% at 6 years to 21.1% at 7 years and 8.4% at 8 years. Our findsings indicate that the prevalence of PNE in Jordan is higher than that reported from other Asian or European countries, while the associated factors are similar.
Keywords: Primary nocturnal enuresis, Prevalence, School Children.
|How to cite this article:|
Hazza I, Tarawneh H. Primary Nocturnal Enuresis Among School Children in Jordan. Saudi J Kidney Dis Transpl 2002;13:478-80
|How to cite this URL:|
Hazza I, Tarawneh H. Primary Nocturnal Enuresis Among School Children in Jordan. Saudi J Kidney Dis Transpl [serial online] 2002 [cited 2014 Jul 29];13:478-80. Available from: http://www.sjkdt.org/text.asp?2002/13/4/478/33102
| Introduction|| |
Primary nocturnal enuresis (PNE) is a common clinical problem in children, affecting 7-20% of 7 years old; by adolescence the incidence drops to 1-2%.  There is variable prevalence of enuresis from 8 to 19% in Taiwanese, Korean, and Australian children. ,,
PNE is usually limited to children who have never gained complete night time control, without gross neurological or urological abnormalities. This is a source of discomfort to many pediatricians as it is difficult to explain its cause to parents. Many among us would even hesitate to label PNE as a disorder, thus enuresis is viewed by some as simply an additional milestone to be achieved. 
The prevalence of enuresis has not been studied previously in Jordan. We, therefore, conducted this study to determine the prevalence of PNE in elementary school children and to examine factors associated with PNE.
| Patients and Methods|| |
A questionnaire was distributed to the parents of all children aged 6-8 years in three primary schools in the eastern province of Jordan. The questionnaire was designed to collect data about age, sex, number of children in the family, socioeconomic status, sleeping habits, reaction of the parents to the bed wetting, type of management and family history of enuresis.
Nocturnal enuresis was defined as the involuntary voiding of urine on at least two nights per month beyond the age at which bladder control is normally attained (4-6 years), in the absence of congenital or acquired defects of the urinary tract. ,
Primary enuresis is defined as a child who never gained nocturnal urinary control. Secondary enuresis is where at least a 6 months period of dryness has preceded the onset of bed wetting. 
Data collected were analyzed using chisquare tests. P<0.05 considered to indicate significant association.
| Results|| |
Out of 950 questionnaires distributed, 681 were returned which gives a response rate of 71.6%; 45% of the responders were males with an overall prevalence rate of PNE of 23.8%.
Bedwetting was commonner in boys than girls. The prevalence rates among boys and girls were 33.7%, and 15.7% respectively [Table - 1]. The overall prevalence rate of PNE declined with age from 48.9% at 6 years to 21.1% at 7 years and 8.4% at 8 years [Table - 2]. Family history of enuresis was present in 50.5% of the cases, while low socioeconomic class was found in 67.3%. Fifty percent of the parents sought medical help and 75% of the children received drug therapy. At least 14% of parents reacted with anger and punished their children at some time.
| Discussion|| |
The overall prevalence of PNE in Jordanian children was 23.8%, this is higher than the 8-15% reported by others. ,,
Even when comparing the same age group in the Taiwanese and the Korean study the frequency of PNE was higher in our patients. , To our knowledge this is the first epidemiological study on enuresis to be carried out in Jordan. However, two studies from Turkey ,0 showed a prevalence rate of nocturnal enuresis of 11.5% and 13.7% in the 7-12 years, and 7-11 years old, respectively. Furthermore, our results showed PNE to be commonner in boys than girls, which is consistent with other reports. ,,
Enuresis is one of the commonnest developmental disorders among children.  Hague et al,  found that 61% of parents viewed bed wetting as a significant problem and that one third dealt with it by punishment. The Jordanian families appear to show great concern about the problem. Families of 50% of the enuretics had sought medical help and only 14% reverted to punishment. Parental concern was reported as minimal in 22%.
Association of enuresis with low socioeconomic status was high in our study. Previous reports have noted variable relations between PNE and socio-economic status. In some studies, no relation was obsserved between PNE and socio economic status, , while others  showed a high correlation.
We conclude that this is the first epidemiological research study of the prevalence of primary nocturnal enuresis in Jordanian children. It shows higher prevalence of the reported PNE elsewhere, however, with similar risk factors.
| References|| |
|1.||Mark SD, Frank JD. Nocturnal enuresis. Br J Urol 1995;75:427-34. [PUBMED] |
|2.||Chang P, Cheu WJ, Tasi WY, Chi YN. An epidemiological study of nocturnal enuresis in Taiwanese children. BJU Int 2001;87: 678-81. |
|3.||Lee SD, Sohn DW, Lee JZ, Park NC, Chung MK. An epidemiological study of enuresis in Korean children. BJU Int 2000;85:869-73 [PUBMED] [FULLTEXT]|
|4.||Bower WF, Moore KH, Shepherd RB, Adams RD. The epidemiology of childhood enuresis in Australia. Br J Urol 1996;78:602-6. [PUBMED] |
|5.||Dharnidharka V. Primary nocturnal enuresiswhere do we stand today. Indian Pediatr 2000; 37:135-40. [PUBMED] |
|6.||Friman PC, Warzak WJ. Nocturnal enuresis a prevalent, persistent yet curable parasomnia. Pediatrician 1990;17:38-45. [PUBMED] |
|7.||Butler RJ. Establishment of working defi-nitions in nocturnal enuresis. Arch Dis Child 1991;66:267-71. [PUBMED] |
|8.||Rushton HG. Nocturnal enuresis: epidemiology, evaluation and currently available treatment options. J Pediatr 1989;(Suppl 114):691-6. |
|9.||Serel TA, Akhan G, Koyoncuoglu HR, et al. Epidemiology of enuresis in Turkish children. Scand J Urol Nephol 1997;31(6):537-9. |
|10.||Gumus B, Vurgan N, Lekili M, et al. Preva-lence of nocturnal enuresis and accompanying sfactors in children aged 7-11 years in Turkey. Acta Pediatr 1999;(12):1369-72. |
|11.||Mark SD, Frank JD. Nocturnal enuresis. Br J Urol 1995;75:427-34. [PUBMED] |
|12.||Haque M, Ellerstein NS, Gundy JH, et al. Parental perceptions of enuresis. A collaborative study. Am J Dis Child 1981;135:809-11. |
|13.||Chiozza ML, Bernardinelli L, Caione P, et al. An Italian epidemiological multicentre study of nocturnal enuresis. Br J Urol 1998;81:86-9. [PUBMED] |
Consultant Pediatrician and Nephrologist, King Hussein Medical Center, P.O. Box 143924, Amman 11814
[Table - 1], [Table - 2]