Prevalence and factors associated with enuresis among children with sickle cell anaemia attending sickle cell clinic at Mulago national referral hospital

Abstract

Background: Children with sickle cell anemia (SCA) may eventually end up with end-organ complications: the kidneys being one of the most frequently affected organs. The renal complications arise from medullary ischemia and infarction leading to hyposthenuria and renal tubular acidosis which lead to enuresis. This increases the enuresis risk among SCA and global prevalence rates among affected children range between 25 and 50.9% depending on the definition and methodology employed. We set out to determine the prevalence, associated factors and management strategies by both the affected children and caretakers of children with enuresis in SCA. Methods: A cross-sectional study was employed to collect data (qualitative and quantitative) at the Mulago sickle cell clinic between December 2020 and January 2021. Consecutive enrolment of children aged 5-17 years confirmed to have SCA by hemoglobin electrophoresis was done. Information on prevalence and factors associated with enuresis was collected using structured questionnaires. Urinalysis and RFTs were done in those found with enuresis. Qualitative data was collected using In-depth interviews. Bivariate and Multivariate analysis using logistic regression models were utilized to determine the factors associated with enuresis. Qualitative data was analysed using content thematic approach Results: We enrolled 404 children aged 5- 17, half of whom (52.5%) were male. Median age (IQR) was 8(7-11). One in four children had enuresis (26.2%) (95%CI: 22.2-30.8). All had primary enuresis and 90% had monosymptomatic enuresis. Age 5-10years aOR:1.87(95%CI:1.1-3.15) P value=0.018, parental childhood history of bedwetting aOR:1.94(95%CI:1.22-3.07) P value=0.005, sibling history of bedwetting aOR:2.19(95%CI:1.29-3.69) P value=0.003 and initiating toilet training after 3 years of age aOR:1.89(1.09-3.26) P value=0.023 were significantly associated with enuresis. Most caretakers had done nothing regarding bedwetting while others had used cultural practices and behavioral interventions but none had talked to a health worker about bedwetting and none had used enuresis alarms or medications. Conclusion: The prevalence of enuresis in children with SCA was 26.2% which is high. Enuresis was associated with family history of bedwetting; age of 5-10 years and age of initiating toilet use after 3years of age. Few employed remedical strategies that included cultural and behavioral interventions