الفهرس 
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Abstract
Nocturnal enuresis (NE) can be defined as an involuntary passage of urine during sleep beyond the age of 5 years .It can be further categorized into primary which is bedwetting in a child who had never been dry and secondary when occurs after a continuous dry period more than 6 months. The aetiology of enuresis is not completely understood. Several patho physiological mechanisms have been proposed,
including bladder dysfunction, small functional bladder capacity, abnormal vasopressin levels, nocturnal polyuria, and abnormal sleep patterns .Chronic renal
failure ,constipation, diabetes insipidus , diabetes mellitus, hyperthyroidism, pinworm infection, psychological stress , seizure disorders ,sickle cell disease and urinary tract infections were recorded in secondary enuresis .There is an increasing evidence to
support the fact that, the efficacy of many, if not all, enuresis’ treatment modalities are dependent upon the underlying pathophysiological mechanisms. So using of diagnostic tools is essential in order to target the treatment modality directly towards the pathophysiological mechanism .Nocturnal enuresis is crucial to be diagnosed and treated as soon as possible, as it can result in many psychological consequences such as low self-esteem, shame and embarrassment which affect how they interact with their friends and families .Nocturnal enuresis may cause secondary emotional
and social problems in children who continue to wet their beds. Although enuretic children seem to have many accompanying psychological problems, it must be investigated whether these problems are the results or etiological factors of enuresis.
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Aim of study
- The main goal of study:
Health promotion of children.
- Specific objectives:
The study will be conducted to:
1- Estimate the prevalence of nocturnal enuresis among primary school children in Zarka district, Damietta governorate.
2- To determine the risk factors for nocturnal enuresis in the studied children.
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Subject and method
-Type of study
Case – control nested in cross sectional study.
- Time of the study
The study started in the beginning of March 2013 and spend approximately two years.
- Site of study
Study conducted in Zarka district including the children in the primary schools in one urban &one rural area selected randomly.
- Population of study
A sample size at 80 % (power of study). Confidence interval 95% has been calculated and increased by 10 % to avoid DROP out during the study.
The study sample were selected by a multistage stratified random sample technique.
The selected sample of the study subjected to preliminary questionnaire for the diagnosis of the children suffering from nocturnal enuresis. The affected children were subjected to:
1- Complete history taking.
2- Complete clinical examination.
3- Urine & stool analysis.
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Our results revealed that;
NE is 15.4% among the selected children
The frequency decreases markedly by aging.
There was no significant difference between boys and girls.
The enuresis was more frequent in rural areas than urban areas.
Enuresis was more common in low socioeconomic levels than high levels.
Enuresis was more common among non working mothers.
The presence of family troubles as well as family history of enuresis did not affect NE.
Primary enuresis is more frequent than secondary enuresis.
Visiting a physician represents the first choice for parent’s attitude toward the problem of NE.
In most cases the underlying possible cause of NE was unknown.
Complaining from diurnal enuresis was associated with secondary enuresis more than primary enuresis.
Request a help represents the most common reaction of the child towards his problem.
Limiting drinks and awaking for voiding represent the most frequent used measures for handling NE.
4. Conclusion
Enuresis is a pediatric public health problem that associated with young age, low income, family history of enuresis and history of urinary tract infections in addition to a lot of emotional and psychological problems.
It leads to low self-esteem, some secondary psychological problems and low school success. Most of the children with enuresis do not have adequate attention about enuresis and didn’t receive any professional treatment.
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Recommendation
At the end we can recommend that, great efforts at all levels regarding NE among school children should be made including preventive, etiological determination,
psychological and behavioral exploration and management. The misconceptions among parents require health education intervention. Also true information about the medications is important for convincing the parents with different treatment modalities.
So the family physician is in a prime position to screen, early detect and treat the affected school children with conduction of health education program for the enuretic children and their parents with pediatric in support when needed