LETTER TO THE EDITOR
Year : 2014 | Volume
: 25 | Issue : 5 | Page : 1095--1097
Remarks about the study on nocturnal enuresis among primary school children
Mahmood Dhahir Al-Mendalawi
Department of Pediatrics, Al-Kindy College of Medicine, Baghdad University, Baghdad, Iraq
Prof. Mahmood Dhahir Al-Mendalawi
Department of Pediatrics, Al-Kindy College of Medicine, Baghdad University, Baghdad
|How to cite this article:|
Al-Mendalawi MD. Remarks about the study on nocturnal enuresis among primary school children.Saudi J Kidney Dis Transpl 2014;25:1095-1097
|How to cite this URL:|
Al-Mendalawi MD. Remarks about the study on nocturnal enuresis among primary school children. Saudi J Kidney Dis Transpl [serial online] 2014 [cited 2020 Jul 4 ];25:1095-1097
Available from: http://www.sjkdt.org/text.asp?2014/25/5/1095/139960
To the Editor,
With reference to the interesting study by Aljefri et al,  the recently published International Children's Continence Society guidelines on diagnostic evaluation and therapy for children with nocturnal enuresis (NE) involve a careful medical history, including bladder diary, physical examination, urinalysis and ultra-sonography of the urinary tract system. However, urodynamic, radiological and endoscopic evaluations are not necessary unless additional daytime voiding problems are present.  Apart from the four limitations addressed by Aljefri et al  in their study, I presume that the following two methodological limitations might render the reported prevalence of NE (28.6%) among their studied cohort overestimated:
The methodology employed by Aljefri et al  on primary school children was a cross-sectional study primarily involving prerecorded questionnaires, which were completed by the help of parents of children with NE. Because illiteracy prevails among the Yemeni population (47%),  it is expected that the educational level of parents could markedly affect their optimum responses to the studies involving questionnaires. This is obvious from the notion that 54.7% of fathers and 84.6% of mothers included in Aljefri et al's study  had informal/basic educational level (Table 3).Aljefri et al  did not include exclusion criteria in their methodology, among which urinary tract infection represents a critical one as it was reported in 36.8% of Yemeni children. 
I realize that the limited resources and technical difficulties possibly impeded the application of the aforementioned diagnostic work-up  to confirm the diagnosis of NE and exclude other differential diagnosis in their studied pediatric population. Despite all addressed limitations, NE remains an important health problem warranting proper evaluation and treatment to curtail its adverse psychosocial outcomes on Yemeni children and their parents.
Conflict of Interest: None
Dr. Hasan Mohamed Aljefri 1 , Dr. Omer Abdullah Basurreh 1 , Dr. Faisel Yunus 2 , Dr. Amen Ahmed Bawazir 2,3
1 College of Medicine, Hadhramout University for Science and Technology, Hadhramout, Yemen,
2 College of Public Health and Health Informatics, King Saud Bin Abdul Aziz University for Health Sciences, Riyadh, Saudi Arabia,
3 College of Medicine, Aden University, Aden, Yemen
To the Editor,
We are grateful to Prof. Al-Mendalawi for his interest and thoughtful comments in reference to our article on Nocturnal Enuresis among Primary School Children, 1 and we appreciate the opportunity to respond.
With respect to the first comment, i.e., the impact of educational level on parents' opti-mum responses to our study questionnaires, we agree that this is an important issue and the educational level does affect the degree of understanding. However, we would like to point out, as has been mentioned in our study, that 54.7% of fathers and 84.6% of mothers in our study had informal/basic education. Hence, they were not completely illiterate as opposed to what Prof. Al-Mendalawi was trying to highlight. We understand that illiteracy prevails among the Yemeni population, but that was not the case in our study cohort. Furthermore, the research team did encourage the students, who were part of the study in all sites, to help their parents in completing the questionnaires. We note that Prof. Al-Mendalawi is of the opinion that, given the higher proportion of parents with informal/ basic education in our study cohort, our study may be overestimating the prevalence of nocturnal enuresis (NE). We are of the view that better educational level can, of course, improve the suitability of responses and hence can even further increase the prevalence of NE from the one that we have reported in our study. Therefore, it would be difficult to confirm a priori that better educational level would have led to a reduced prevalence of the condition in our study, as was suggested by Prof. Al-Mendalawi.
We completely agree with Prof. Al-Mendalawi's other comment on urinary tract infection (UTI). We did not have the technical resources to clinically diagnose and evaluate the children for NE in line with the International Children's Continence Society guide-lines. 2 Therefore, we did not exclude the children with UTIs as it would have been difficult to ascertain the exact clinical features on self-administered questionnaires. Hence, the non-exclusion of children with UTIs may have resulted in a higher prevalence of NE in our study cohort. As cross-sectional observational studies are prone to confounding, 3 we have, for that reason, stressed the need for longitudinal studies to evaluate the causal associations between NE and various risk factors.
Conflicts of Interest: None.
Aljefri HM, Basurreh OA, Yunus F, Bawazir AA. Nocturnal enuresis among primary school children. Saudi J Kidney Dis Transpl 2013; 24:1233-41.Franco I, von Gontard A, De Gennaro M; International Childrens's Continence Society. Evaluation and treatment of nonmonosymptomatic nocturnal enuresis: A standardization document from the International Children's Continence Society. J Pediatr Urol 2013;9: 234-43.Jepsen P, Johnsen SP, Gillman MW, Sørensen HT. Interpretation of observational studies. Heart 2004;90:956-60.
|1||Aljefri HM, Basurreh OA, Yunus F, Bawazir AA. Nocturnal enuresis among primary school children. Saudi J Kidney Dis Transpl 2013; 24:1233-41.|
|2||Franco I, von Gontard A, De Gennaro M; International Childrens′s Continence Society. Evaluation and treatment of nonmonosympto-matic nocturnal enuresis: A standardization docu-ment from the International Children′s Conti-nence Society. J Pediatr Urol 2013;9: 234-43.|
|3||Republic of Yemen, Ministry of Planning and International Cooperation, Central Statistical Organization, Select Statistical & Demogra-phic Indicators 2004. Available from: http://www.cso-yemen.org/content.php?lng=english&id=311 [Last cited on 2013 Nov 24].|
|4||Mohanna MA, Raja′a YA. Frequency and treatment of urinary tract infection in children subjected to urine culture, in Sana′a, Yemen. J Ayub Med Coll Abbottabad 2005;17:20-2.|