Prevalence and factors associated with Enuresis among children with Sickle Cell Anaemia attending Sickle Cell Clinic at Mulago National Referral Hospital; A Cross sectional study.

Abstract

Background:Sickle cell anaemia (SCA) can lead to complications in almost all body organs and the kidneys are frequently affected due to medullary infarction that occurs as a result of sickling events thus leading to hyposthenuria as well as renal tubular acidosis that in turn lead to enuresis. Globally the prevalence of enuresis in SCA ranges from 25% to 50.9% but the burden is not known in Uganda. We set out to determine the prevalence and factors associated with enuresis in SCA. Methods: A cross-sectional study was conducted 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 regarding responses to enuresis was collected using in depth interviews with caregivers and children. 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 5-7years aOR:2.03(95%CI:1.11-3.72) P value=0.022 and sibling history of bedwetting aOR:1.87(95%CI:1.08-3.24) P value=0.026 were significantly associated with enuresis while female gender aOR:0.58(95%CI:0.36-0.98) p value = 0.025 and fourth or higher birth order aOR:0.41(95%CI:0.22-0.78) P value= 0.007 were protective factors. 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 and younger age of 5-7 years while female gender and fourth or higher birth order were protective factors. Few caregivers employed strategies that included cultural and behavioral interventions.