Social deprivation affects outcome of nocturnal enuresisBMJ 2002; 324 doi: https://doi.org/10.1136/bmj.324.7338.677/a (Published 16 March 2002) Cite this as: BMJ 2002;324:677
- Daisy Rolands (), staff grade community paediatrician,
- Eleni Stathopulu, consultant community paediatrician
EDITOR—Evans has written on evidence based management of nocturnal enuresis.1 This article, together with the guidelines of the Enuresis Resource and Information Centre (ERIC) on minimum standards of practice in the treatment of enuresis,2 should be used to provide a framework within which enuresis services can be audited and evaluated.
We recently completed the first cycle of an audit to evaluate the enuresis service in two of our clinics, run by the same team (a doctor and nurse). Clinic A caters for children from a higher socioeconomic background living in the more affluent villages, and clinic B caters for children from an area with a lower socioeconomic background. We looked through the files of 56 children treated for enuresis over one year (Jan-Dec 1999) in the clinics and evaluated the service provision, including the success rates of the interventions (reward charts, enuresis alarms, and drug treatment) as well as dropout rates.
The success rate for reward charts was 54% (7/13) for clinic A v 26% (8/31) for clinic B, while the success rate for the use of alarms was 100% (3/3) v 17% (1/6). Alarms in clinic B were not used by the family for a sufficient time for them to be effective as they were returned within a few days of being issued. Drop outs (those failing to attend two consecutive appointments without giving any reason) were higher in the more deprived area (23% (3/13) for clinic A v 45% (14/31) for clinic B).
Our results suggest that social deprivation has a negative bearing on the management of nocturnal enuresis. We need to develop more supportive services for parents in our enuresis clinic in the more deprived area to improve their cooperation and motivation, thereby improving the outcome.