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Saudi Journal of Kidney Diseases and Transplantation
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ORIGINAL ARTICLE Table of Contents   
Year : 2002  |  Volume : 13  |  Issue : 2  |  Page : 151-154
Enuresis: Epidemiological Study in Moroccan Children

1 Pediatric Nephrology, Al-Amal Center, Casablanca, Morocco
2 Pediatric Psychiatry, Ibn Rochd Hospital, Casablanca, Morocco

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Enuresis is a common symptom that leads to significant psychosocial sequalae. In this study we analyzed three surveys in three different urban and suburban regions in Morocco in order to evaluate the epidemiological characteristics and profiles of the young patients who had enuresis and the attitudes of their parents towards this problem. There were 1,520 children and adolescents in this analysis whose age ranged between 5 and 15 years. They were attending various outpatient surgical and medical clinics when their parents were asked to answer a pre-prepared questionnaire. The prevalence of enuresis was 35% with preponderance of males (54%). The cause could not be defined (primary) in 91.5% of the patients with enuresis. There were familial factors associated with enuresis that included history of enuresis in the parents or siblings in 56% of the cases and coercion attitude of the parents in 23%. Enuresis was associated with impediment of learning in 23% and chastisement of children in 85.4% of the cases. Twenty three percent of the patients also had chronic organic disorders. The parents were concerned mostly when the children approached puberty or when enuresis was secondary to another problem. Spontaneous improvement was the rule by adolescence, hence only 8.7% sought medical advice for enuresis. Treatment was conventional in 67% of the cases and confined to restriction of fluids and food items in 73% of the treated patients. We conclude that enuresis is apparently higher in Moroccan children compared to reports from other countries. However, enuresis was not considered a major medical problem of concern to parents who rarely sought medical advice for it.

Keywords: Enuresis, Pediatric, Morocco.

How to cite this article:
Bourquia A, Chihabeddine K. Enuresis: Epidemiological Study in Moroccan Children. Saudi J Kidney Dis Transpl 2002;13:151-4

How to cite this URL:
Bourquia A, Chihabeddine K. Enuresis: Epidemiological Study in Moroccan Children. Saudi J Kidney Dis Transpl [serial online] 2002 [cited 2022 Aug 12];13:151-4. Available from: https://www.sjkdt.org/text.asp?2002/13/2/151/33127

   Introduction Top

Enuresis is a common problem, which may lead to important psychosocial sequalae. It can affect 5-18% of children in different age groups. [1],[2],[3],[4],[5] In this study we analyzed the results of surveys in three different urban and suburban regions in Morocco in order to evaluate the epidemiological characteristics and profiles of the young patients who had enuresis and the attitudes of parents towards this problem.

   Patients and Methods Top

Enuresis was defined in this study according to the criteria published by the American Society of psychiatry in 1987: "micturation during the day or night that leads to bed or clothes wetting voluntarily or involuntarily at least twice a month at chronological age of 5-6 years and mental age of four years in the absence of an organic cause".

The children with enuresis were selected from those attending various outpatient surgical and medical clinics in three regions in Morocco (Agadir, Casablanca and Alkala) over a 90 day period; the patients from urban areas formed 76% of the sample. One of the clinics was in a referral hospital, four in general hospitals and nine in dispensaries. [Table - 1] shows the reasons for the visits of the children to these health facilities.

The parents were asked to answer a pre­prepared questionnaire. [Table - 2] shows the content of the questionnaire; mothers answered the questionnaire in 73% of the cases. The children were subjected to a physical exami­nation, especially the urinary tract. Laboratory investigations were performed as required.

   Results Top

1,520 children and adolescents were included in the analysis. Their ages ranged from 5 to 15 years. The prevalence of enuresis was 35% with male preponderance (54%); the male: female ratio was 1.2 for children below nine years, while it was 2.6 for those above 10 years. Prevalence of enuresis was more in children living in urban areas (47%). Enuresis was primary in 91.5%, nocturnal in 93% and secondary in 7% of the children.

Enuresis was associated with diabetes and asthma in 23% of the children and with a urological disorder in 13% of the cases. Only 34% of the children attended clinics for enuresis; 3% of these had urinary tract infections.

Family-related predisposing factors for enuresis could be found in 67% of the cases. There was a family history of enuresis in 56% of the cases of which 33% were primary and 16% were secondary.

There was an association between enuresis and low socioeconomic status; the prevalence of enuresis was directly proportional to the number of children in the family.

Most parents (in 68% of the families) accepted the problem of enuresis and did not discuss it outside the home. [Table - 3] shows the interaction of the parents with the problem.

The concern of the parents increased when the children reached the age of nine years, especially if the enuresis was secondary or if it recurred. The reaction of the brothers and sisters were similar to those of the parents.

There were some behavioral disturbances associated with enuresis, which included sleep and speech disturbances in 22%. There was diminished achievement at school in these children in comparison to those without enuresis. [Table - 4] shows the reaction of the children to enuresis.

Consulted physicians recommended dietary precautions and therapeutic agents in 20% of the cases, while they ignored the problem or reassured the parents of spontaneous recovery in 45% of the cases.

   Discussion Top

This study demonstrates the high prevalence of enuresis in children in Morocco in comparison with the studies in different parts of the world [Table - 5]. [5],[6],[7],[8] In our study, prevalence rates were nearly the same regardless of the geographic, racial and cultural differences in the areas studied.

Most families in our society are not strict about the cleaning habits and sphincter control in children, except a few families in the urban areas.

In general, families tended to accept enuresis as a minor problem in the young child. However, most families no longer tolerated enuresis after adolescence. Adolescents were often confronted with social isolation from their environment. Most parents believed there was no available treatment for enuresis in modern medicine. Only a small percentage of patients/parents visited medical clinics for enuresis per se.

In our study, enuresis was not a worrisome problem to the parents who tolerated it and did not seek medical advice for it. However, tolerance of the parents decreased gradually after the age of seven to become significant at the age of nine with psychological and physical chastisement of those who had enuresis. Adolescents with enuresis were considered cursed or to have a disgraceful disease.

On the other hand, physicians did not encourage the parents to discuss this problem due to the common belief that enuresis was not a disease entity. At present, enuresis is studied as an entity in the curricula of the medical colleges in Morocco, which may allow comparative studies in the future.

Complete history of enuresis should be sought in every case before proceeding with prolonged and meticulous investigations in order to define the involved factor(s) in each case. Affected children should be counselled first with the parents then alone, which may give them better confidence and help rid them of the problem. [9],[10]

Physical examination should include looking for abnormalities in the external urinary sphincteral function, external genitalia, the urethral meatus and the sacro-coccygeal area.

It is prudent for the physicians to avoid aggressive medications since many cases of enuresis remit spontaneously. In the absence of effective therapeutic agents, other inter­ventions such as psychological therapies and conditioning are more feasible. These differ according to cultural backgrounds and usually aim at improving the personality of the affected child.

Conservative therapy should be given priority over medications. This includes interview with the child, placebo therapy that may lead to cure in 15-45%, and the use of an alarm system. The alarm system should be reserved for children older than seven or eight years who are also motivated and can handle this system; it is usually effective in 70-95% of the cases.

Other measures that may be useful include avoiding the use of diapers and using a schedule for micturation before sleep. On the other hand, it was found that adjusting the diet, restricting fluids during the day, waking up the child at night or punishment were not effective measures in treating enuresis.

Using medications should be the last resort in managing enuresis. Treatment is usually symptomatic and depends on medications with minimal side effects such as the following:

Imipramines, which have been in use since the sixties. However, pediatricians do not prefer this group of medications due to the psychotropic side effects and possible accidental intoxications.

Desmopressin, which is an analogue to antidiuretic hormone, may lead to decrease in urine output at night. At present, this drug is the most popular short-term therapy for enuresis. [10]

We conclude that there is a high prevalence of enuresis among Moroccan children. Increasing the awareness of the physicians and society at large about this problem and the importance of correct diagnosis and treatment may be effective in decreasing its psychological and physical impact on affected children.

   References Top

1.American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, toilsome edition revise-Washington DC, 1987.  Back to cited text no. 1    
2.Kalo BB, Bella H. Enuresis: prevalence and associated factors among primary school children in Saudi Arabia. Acta Paediatr 1996; 85(10):1217-22.  Back to cited text no. 2    
3.Bower WF, Moore KH, Shepherd RB, Adams RD. The epidemiology of childhood enuresis in Australia. Br J Urol 1996;78(4):602-6.  Back to cited text no. 3    
4.Lee SD, Sohn DW, Lee JZ, Park NC, Chung MK. An epidemiological study of enuresis in Korean children. BJU Int 2000;85(7):869-73.  Back to cited text no. 4    
5.Spee-van-der Wekke J, Hirasign RA, Meul­meester JF, Radder JJ. Childhood nocturnal enuresis in the Netherlands. Urology 1998; 51(6):1022-6.  Back to cited text no. 5    
6.Chiozza ML, Bernardinelli L, Caione P, et al. An Italian epidemiological multicentre study of nocturnal enuresis. Br J Urol 1998;Suppl 3:86-9.  Back to cited text no. 6    
7.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(12):1369-72.  Back to cited text no. 7    
8.Byrd RS, Weitzman M, Lanphear NE, Auinger P. Bed-wetting in US children: epidemiology and related behavior problems. Pediatrics 1996;98:414-9.  Back to cited text no. 8  [PUBMED]  
9.Bourquia A, Chihabeddine K. Le enuresis. Esperance Medical 1996;3(24):811-5.  Back to cited text no. 9    
10.Cochat P. Enuresis et troubles mictionneis de l'enfant. ElSEVIER, Paris 1997.  Back to cited text no. 10    

Correspondence Address:
Amal Bourquia
127, Boulevard Victor Hugo, Casablanca
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Source of Support: None, Conflict of Interest: None

PMID: 17660654

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  [Table - 1], [Table - 2], [Table - 3], [Table - 4], [Table - 5]


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