| BackgroundNocturnal enuresis(NE)and daytime urinary incontinence(DUI)are common disease in pediatric clinical practice.Children with NE void in bed while asleep and are generally not aroused by the wetting.Primary nocturnal enuresis is difined as monosymptomatic bedwetting in individuals who never have been dry at night for an uninterrupted period of at least 6 months.Urinary incontinence is defined as involuntary,intermittent leakage of urine and DUI is defined as UI happened during the daytime.Generally speaking,people will get the voiding control during the day and night with physical maturity after 5 years old.If the children still have PNE or DUI after 5 years old,they should be recommended to see doctors.In 2006,one of the studies in our country showed that the incidence of PNE aged 5 to 12 was 6.64%,but another survey in America implied that the children overall incidence of PNE was 10.63%.The 2 survey shows a significant difference,and reason is unclear.Urinary incontinence highly influenced the children’s mental and body health.According to the American Pediatrics guide,infants in Europe and USA are suggested to begin the Elimination communication(EC)after 2 years old,when is significant later than that in China at 10 year ago.So,a researcher provides a consequence that the UI was related to the EC.Its obviously disobey the traditional baby-care rule in ChinaTen years ago,Qingwei Wang found that the PNE prevalence in China is lower than western country and hypothesized that one of the reason was starting EC earily than those of EU and USA.In recent years,more and more children in China are choosing to use disposable diapers(DD)after born and starting toilet training after 2years old with the fast developing in economy.Probably,this results in the PNE and DUI increased gradually in children.However,the relationship between DD usage,EC,PNE prevalence and DUI have not been established.Meanwhile,there is no survey on prevalence of DUI,PNE and its relationship to the risk factors like DD and EC.Obviously,the relationship between DD usage,beginning EC and increasing PNE prevalence needs to be investigated.Henan Province is one of the most populous province and have a large number of children.It is a great to choose Henan as an investigation site.This study aims to verify whether PNE prevalence is significantly higher than a decade ago,what is its relationship to increased DD usage and the commencement of EC by a survey in children and adolescents aged 5 to 12years in Henan ProvinceObjective1.To investigate the incidence of PNE in Henan province,compare incidence rate with the data from decade ago,discuss the related factors especially like the using diapers and EC and provide the objective reference to reduce the PNE in clinical.2.To investigate the incidence of DUI in Henan province,discuss relevant factors like the using diaper after birth,toilet training and provide the objective reference to reduce the DUI.MethodsFrom March.2017 to June.2017,a cross-sectional study of the enuresis prevalence was performed by distributing self-administered questionnaires to parents of 5 to 12 years old children at 35 kindergartens and schools in Henan province,China.The questionnaires included sociodemographic data,family caregivers’information,and the period of using diapers,EC commencement date,psychological disorders,and family history of PNE in children and adolescents as well as the basic data of DUI and PNE Statistical analyses were performed using the Statistical Package for Social Sciences(SPSS),version 21.0 for windows.Chi-square tests were used and usingχ2 tests or Fisher’s exact tests where appropriate;p-values of<0·05were considered statistically significant.Logistic regression was used for multivariate analysis.ORs and their corresponding 95%CI were calculated to measure associations.The original alpha value was set at 0·05.According to multiple sets of classified information,adopting the method of Bonferroni correction inspection level,an inspection level alpha<0.05 was considered a statistically significant difference.Factors related to PNE were evaluated by logistic regression.Results1.The overall prevalence of PNE was 9.54%.The incidence rate of PNE in 5years old is 15.58%,and the prevalence is gradually decreasing to 4.02%in 12 years old.The risk factor of PNE were arousal disorder(χ~2=49.723,OR=1.719,95%CI=[1.478~1.998],p<0.01),DUI(χ~2=127.20,OR=4.419,95%CI=[3.413~5.721],p<0.01),immediate family NE history(χ~2=5.295,OR=1.433,95%CI=[1.055~1.946],p<0.05)and the use of diaper(χ~2=4.026,OR=1.372,95%CI=[1.007~1.870],p<0.05).The protective factor of PNE was EC(χ~2=9.347,OR=0.698,95%CI=[0.554~0.879],p<0.01).The overall prevalence of PNE is significantly higher compared with the data in 2004(9.54%vs6.64%,χ~2=29.44,p<0.01).2.The overall prevalence of DUI was 3.52%.The incidence rate of DUI in 5years old is 6.06%,and the prevalence is gradually decreasing to 3.02%in 12 years old.The risk factor of DUI were using more than 4 diapers a day(χ~2=8.766,OR=1.458,95%CI=[1.136~1.870],p<0.01),NE(χ~2=16.725,OR=2.397,95%CI=[1.577~3.644],p<0.01).The protective factor of DUI was EC(χ~2=127.2,OR=0.226,95%CI=[0.175~0.293],p<0.01).Conclusions1.The overall prevalence of PNE in children aged 5 to 12 in Henan province was 9.54%,and the incidence of PNE in 2017 was significantly higher than data in2006.2.The risk factors of PNE were the arousal disorder,positive immediate family NE history,using diapers.The protective factor of PNE in children was EC.Reducing the use of diapers,starting EC after the birth is beneficial to reduce the incidence of PNE in children.3.The prevalence of DUI in children aged 5 to 12 in Henan province is high,which should arouse the attention of parents and society.Unreasonable use of diaper and NE were the risk factors of DUI.The protective factor of DUI was starting EC as soon as possible.We should pay more attention to them. |
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