Association of nocturnal enuresis and mental health problems among Children and Adolescents, in South Ethiopia

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Different physiological factors were implicated as an etiology of Nocturnal Enuresis (NE). Small body of research examined the mental health problem on NE in children and adolescents. Thus, this study aimed to identify children and adolescent mental health problems on NE among children and adolescents at Wolaita Sodo University Comprehensive Specialized Hospital who are aged 5–14 years old, South Ethiopia, in 2022. Method: At Wolaita Sodo University Comprehensive Specialized Hospital, a cross-sectional study was carried out between September 22, 2022, and November 22, 2022. 417 research participants were chosen at systematic random selection. A structured, in-person interviewer-administered questionnaire was used to collect the data. A Diagnostic Statistical Manual (DSM-5) were used to assess NE and Strengths and Difficulties questionnaire (SDQ) parent report version were used to screen for child and adolescent mental health problems. A chi-square test was used to determine the association between the outcome and independent variables. A 95% confidence interval (CI) and Risk Ratio (RR) with a corresponding p-value < 0.05 was used to determine the strength of the association. Result: The mean age of the participants was 8.3±2.3 years. 59.2% of the participants were between 5-8 years old and 271(65%) were males. The magnitude of NE was (n 57, 13.7%). Regarding the mental health status of the participant, (n 117, 28.1%) had behavioral problems, (n 137, 32.9%) had emotional problems, (n 73, 17.5%) had hyperactive-inattention, (n 89, 21.3%) had conduct problems, and (n 132, 31.7%) had peer problems. Emotional problems (RR = 2.63; 95% CI: 1.49, 4.63) and peer problems (RR = 4.31; 95% CI: 2.41, 7.72) predicts NE. Conclusion and Recommendation: This study showed emotional and peer problems predicts NE. Thus, a targeted early intervention needs to be planned in order to improve children’s and adolescents mental health and wellbeing. Children Adolescents Mental Health Problems Nocturnal Enuresis South Ethiopia Figures Figure 1 Figure 2 Figure 3 Introducation Diagnostic and statistical Manual (DSM-5) defines Nocturnal Enuresis (NE) as the involuntary or repeated voiding of urine into clothing or the bed at night in a child at least 5 years old, with a frequency of 2 times a week for at least 3 consecutive months, or the presence of clinically significant distress or impairment in social, academic (occupational), or other critical areas of functioning (1). Children who suffer from NE frequently experience distressing clinical issues. This disorder frequently results in significant mental health issues and causes anxiety for parents and children (2). NE is linked to a number of psychological issues, such as reduced wellbeing or self-esteem (3,4) or anxiety-depressive symptoms (5,6), and behavioral problems such as higher tendency of hyperactivity(7,8) or conduct problems (9). These associations are particularly pronounced above the age of 8 years (10). Notably, NE is placed eighth among stressful life events, including not getting along with friends or doing poorly academically, and is thought to be a very common distressing life experience during early adolescence (11). By the age of five, the percentage of adolescents with NE was 20%, and by the age of fifteen, only roughly 1% of adolescents had a problem with NE, with a spontaneous resolution rate of nearly 15% per year (12,13). Research on the relationship between nocturnal enuresis and mental health issues in children and adolescents is essential for promoting healthy physical development and outcomes in children. In spite of this pervasive issue, there isn't much research that addresses it. However, to the best of the researcher's work and evidence, there is a dearth of sufficient data regarding the link between nocturnal enuresis and mental health issues in children and adolescents. Small body of existing studies reported mixed findings on the association between mental health problems and NE in children and adolescents. Thus, this study aimed to identify children and adolescent mental health problems on NE among children and adolescents at Wolaita Sodo University Comprehensive Specialized Hospital who are aged 5–14 years old, South Ethiopia, in 2022. Methods Study area and period A study carried out between September 22, 2022, and November 22 At Wolaita Sodo University Comprehensive Specialized Hospital, in 2022. The hospital is located in Wolaita Sodo town, which is 329 kilometers south of Addis Ababa, the country's capital city. About 450–500 patients a day get inpatient, outpatient, and emergency care services from the hospital, which also acts as a referral source for the three million residents in the catchment region. The paediatric department is organized into 6 main units: the outpatient unit, the paediatric emergency (inpatient and outpatient unit), the paediatric surgical inpatient unit, the paediatric medical inpatient and stabilization unit, and the newborn intensive care unit (14). Study design This cross-sectional investigation was carried out in a hospital. Population The study encompassed all children and adolescents (ages 5 to 14) who utilized the services of WSUCSH's paediatric outpatient department during the time of data collection. Excluded from consideration were children and adolescents who were in critical condition, unable of speaking, and had known urinary system anatomical anomalies or enuresis brought on by medical (biogenic or neurological) causes. Sampling technique and procedure The sample size was calculated using a single population proportion calculation method. The following assumptions were considered: the proportion of (P) of NE to be 50%, 95% Confidence Interval (CI), a five percent margin of error (W), and a ten percent non-response rate. Accordingly, 417 participants were selected using a systematic random sampling method. Operational terms Nocturnal enuresis: in this study NE defined as frequency of wetting at night at least two times per week for consecutive three moth based on DSM-5 definition (15). Mental health problems: in this study mental health problems were the behavioral problems of children that challenge parents, teachers and his or her relatives, for children who have SDQ-PR overall ideal cutoff score > 17 for behavioral or mental health problems, and subscale (cutoff score > 7 for problems related to hyperactivity and inattention, > 4 for problems related to conduct and peers, and > 5 for emotional problems from the SDQ-PR subscale) (16). Data collection instrument Strengths and Difficulties Questionnaire Parent Report (SDQ-PR) Difficult behavioral issues with the kid were evaluated by using interviewer administered paper questionnaire of the strengths and difficulties questionnaire parent report (SDQ-PR). The five subscales contain twenty-five items. Peer relationship issues, conduct issues, emotional issues, hyperactivity, and pro-social behavioral issues are among these subscales. With a total score ranging from 0 to 40, all subscales—aside from the pro-social behavioral subscale—are assessed on a 3-point Likert scale. In the event that the pro-social behavioral subscale is absent, the overall ideal cutoff threshold for the SDQ-PR is > 17 for screening behavioral issues or mental health problems; with a sensitivity of 70.96% and a specificity of 69.15%. For the subscales pertaining to hyperactivity and inattention, the ideal cutoff scores are seven and above, for conduct and peer problems, greater than or equal to four, and for emotional problems, five and above (16). Cronbach's alpha for internal consistency in the current study's setting was 0.79. Diagnostic and statestical manual of mental disorder fifth edition The presence of nocturnal enuresis was assessed by the DSM-V definition as wetting at night with a frequency of at least 2wice a week for at least 3 consecutive months (15). Data collection procedure For children aged 5 to 8, data were collected from parents. For children and adolescents aged 9 to 14, a structured, in-person questionnaire was given by an interviewer. 6 psychiatry graduates with a Bachelor of Science degree collected the data under the supervision of 2 mental health specialists. Data quality management The query was first written in English, translated into Amharic and Wolaita, and then back into English by experts in all 3 languages, including mental health professionals, to guarantee consistency. Supervisors and data collectors attended two days of training. A pre-test was administered to five percent of the sample size out of the study area. The purpose of the test was to evaluate the instruments' reliability and find any possible problems with the questionnaire alterations and data collection techniques. Supervisors and the lead investigator regularly monitored and supported data collectors. Throughout the duration of the data collection, supervisors and principal investigators confirmed the accuracy and consistency of the data each day. Data processing, analysis and presentation For analysis, the data were exported from Epi Data Version 4.6 to the Statistical Package for Social Sciences (SPSS) Version 25. To describe sample characteristics and estimate the scope of NE and mental health issues, descriptive statistics were employed. The chi-square test was used to examine the relationship between the independent variables and the outcome variable. Variables with a p-value of <0.05 were deemed to have a significant association. The degree of association between the outcome variables and potential explanatory variables was assessed using 95% CI RR (relative risk) and p-value < 0.05. Results The current study included 417 children and adolescents. The mean age of the participants was 8.3 ± 2.3 years, ranging from five to fourteen years. 59.2% of the participants were between 5-8 years and (n = 146, 35%) were female participants. About three-fourth of the participants (71.2%) were living with their parents. As to the educational level of children and adolescents (n = 270, 64.7%) was primary school and above, while parents’ education level was 36.2% of parents had graduated high school (Table 1). Magnitude of NE and mental health problem The magnitude of nocturnal enuresis were found to be (n = 57, 13.7%) (figure1). It is evident that a higher magnitude of nocturnal enuresis among males (n = 45, 16.6%) than females (n = 12, 8.2%) (figure2). Regarding the mental health problem of the children and adolescents, (n = 117, 28.1%) had behavioral problems, (n = 137, 32.9%) had problematic emotion, (n = 73, 17.5%) had problems of hyperactive-inattention, (n = 89, 21.3%) had problems of conduct, and (n = 132, 31.7%) had problems in peer relationship (Figure 3). Accordingly (n = 22, 18.8%) of children and adolescents with behavioral problems had nocturnal enuresis; similarly, (n = 12, 16.4%) participants with hyperactive-inattention and peer problems were equally experienced nighttime wetting (Table 2). Association of nocturnal enuresis and mental health problems Table 3 shows the association between nocturnal enuresis and mental health problems among children and adolescents. There were significant associations between emotional problems and nocturnal enuresis (p-value < 0.001), and also peer problems had a significant association with bedwetting (p-value <0.0001). Discussion Epidemiological studies have reported that children with nocturnal enuresis are at greater risk of having mental health problem. In our study we found that one-fifth of children and adolescents with nocturnal enuresis also experienced mental health problems. Specifically, conduct problems were reported to be 14.6%, emotional problems to be 21.9%, and hyperactive-inattentive and peer problems were equally common in children and adolescents with nighttime wetting, which is 16.4%. These findings are consistent with several studies that have linked enuresis to an increased risk of attention-deficit/hyperactivity disorder (ADHD), with 4.1% to 74.9% of enuresis patients having ADHD (17,18). The occurrence of mental health problems in kids with bedwetting in our study is supported by previous studies that observed enuresis in children was associated with high frequencies and scores of emotional, behavioral, and hyperactivity-inattention symptoms as well as problems with peer relationships. In agreement with this finding, previous studies reported the link of emotional and hyperactive-inattentive disorders linked to bedwetting (19–21). This study observed that emotional problems are strongly linked to nocturnal enuresis, which is consistent with studies from Taiwan(22). This association might be Nocturnal enuresis by itself contributes to emotional problems because it is often troubling for children and adolescents, which puts them in stressful situations. Furthermore, nocturnal enuresis has serious consequences for the paediatric population(23). Many children with NE go through cognitive, social, behavioral and emotional problems, like low self-esteem, embarrassment, loss of dignity, aggressive behavior, loneliness, and anxiety symptoms. These things lead to emotional problems in children and adolescents in later life(24). Furthermore, one of the most typical causes of nocturnal enuresis is an emotional problem. A child's likelihood of bedwetting may increase if they are experiencing emotional problems, such as moving to a new home or school, witnessing their parents' divorce or other conflicts, losing a parent or other loved one, or going through another significant life event(25,26). Final we observed that significant association between peer problems and nocturnal enuresis which is in line with studies reported from Turkey(27). A plausible rationale for this linkage could be Peer problems may arise among children and adolescents with nocturnal enuresis who continue to wet their beds because enuresis can lead to feelings of shame, embarrassment, and social isolation. This may increase the likelihood of peer problems in the paediatric population who had enuresis. In comparison to their peers who are healthy, bedwetting children also have a poor self-image, poor self-esteem, decreased self-confidence, social avoidance and lower school performance. Consequently, there is a greater chance of peer problems and psychological distress in one-third of children with NE(28,29). Moreover, nocturnal enuresis and peer problems may be related since enuretic children take great effort to hide their condition from their friends, believing they are the only ones who suffer from it(30,31). Because of their condition, they were unable to participate in social activities with their friends. This can lead children and adolescents to suffer emotional and peer problems in many ways and forms(32). Moreover, peer problems impair children's ability to participate in social activities, which leads children to stress and anxiety when they want basic needs from their parents or friends. This can cause stress and anxiety-related urine incontinence in children and adolescents(33). Limitation of the study There were a few limitations to this study: it was single-cross-sectional and hospital-based, so the clinical severity of the cases may have been higher than average, and the results might be not generalized to community settings. Conclusion and Recommendation In conclusion, the present study revealed that NE is significantly associated with emotional and peer problems among children and adolescents. According to these results, it is critical to address the co-occurring behavioral and mental health problems in these children and their families in the treatment plan to give them and their families a better quality of life. Therefore, the early identification and management of this disorder is considered among the necessities for the preservation of children’s and families wellbeing. Acronyms and Abbreviations ADHD Attention-deficit/hyperactivity disorder, CI Confidence Interval, DSM-V Diagnostic and statestical manual of mental disorder fifth edition, IRB Institutional Review Board, NE Nocturnal enuresis, OR Odds Ratio, RR relative risk, SDQ-PR Strength and Difficulty Questionnaire Parent Report, WSUCSH Wolaita Sodo University Comprehensive Specialized Hospital Declarations Acknowledgements The authors express their gratitude to Jimma University for its financial assistance and to the study participants for supplying study data. Funding The study was supported financially by Jimma University. Regarding the study's design, data collecting, analysis, and interpretation, as well as the manuscript's composition, Jimma University has no official involvement Authors’ contributions TB developed the proposal, was extensively involved in the data analysis, interpreted the data, and wrote the draft manuscript. YT, MA and SG; - revised the proposal, checked the data analysis, revised the manuscript, and read and approved the final manuscript. Ethical approval and consent to participate The Jimma University Institute of Health's Institutional Review Board (IRB) granted ethical approval for this study (Ref. No.JUIH/IRB/63/22). All parents of participating children and adolescents provided written informed consent, and the children and adolescents verbally consented to participate. Children and adolescents have nocturnal enuresis and mental health problems after screen was linked to a health care service for further treatment. Availability of data and materials No/Not applicable (this manuscript does not report data generation or analysis). Consent for publication Not applicable Competing interests The authors declare that they have no competing interests Clinical trial Not applicable References ALARCON RD. Synopsis of Psychiatry: Behavioral Sciences and Clinical Psychiatry, 6th ed. Vol. 149, American Journal of Psychiatry. 1992. 972–974 p. Kanungo S. Book Review. J Pediatr Adolesc Gynecol. 2009;22(1):67. Warne N, Heron J, von Gontard A, Joinson C. Mental health problems, stressful life events and new-onset urinary incontinence in primary school-age children: a prospective cohort study. Eur Child Adolesc Psychiatry. 2023;1–24. Butler RJ. Annotation: Night wetting in children: Psychological aspects. J Child Psychol Psychiatry Allied Discip. 1998;39(4):453–63. 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Tables Table 1: Socio-demographic and family related characteristics of children and adolescents age 5-14 year old attending paediatric outpatient, at Wolaita sodo university comprehensive specialized hospital, Wolaita sodo, south Ethiopia, 2022 Variable Category Frequency Percentage (%) Age 5-8 year old 247 59.2 9-11 year old 113 27.1 12-14 year old 57 13.7 Child sex Male 271 65.0 Female 146 35.0 Residency Urban 241 57.8 Rural 176 42.2 Religion Orthodox 124 29.7 Muslim 64 15.3 Protestant 185 44.4 Others* 44 10.6 Ethnicity Wolaita 287 68.8 Amhara 56 13.4 Gurage 38 9.1 Oromo 13 3.1 Others** 23 5.5 Educational level of child Kindergarten (KG) 147 35.3 Primary and above 270 64.7 Currently living With parents 297 71.2 Steep parents 62 14.9 Residential institution 30 7.2 Gordian 28 6.7 Family size = 4 203 48.7 Occupation of parents Government employ 144 34.5 Private 54 12.9 Merchant 64 15.3 Farmer 62 14.9 Housewife 19 4.6 Unemployed 35 8.4 Daily labor 39 9.4 Educational status of parents Illiterate 84 20.1 Primary school 182 43.6 High school and above 151 36.2 Parents marital status Married 298 71.5 Divorced 48 11.5 Separated 37 8.9 Widowed 23 5.5 Single 11 2.6 Average family monthly income = 3400 226 54.2 Table: 2 Characteristics of nocturnal enuresis and mental health status among children and adolescents age 5-14 year old attending paediatric outpatient, at Wolaita sodo university comprehensive specialized hospital, Wolaita sodo, south Ethiopia, 2022 Variables Category Nocturnal Enuresis No N (%) Yes N (%) Behavioral problems No 265(88.3%) 35(11.7%) Yes 95(81.2%) 22(18.8%) Conduct problem No 284(86.6%) 44(13.4%) Yes 76(85.4%) 13(14.6%) Hyperactivity-inattention No 299(86.9%) 45(13.1%) Yes 61(83.6%) 12(16.4%) Emotional problems No 253(90.4%) 27(9.64%) Yes 107(78.1%) 30(21.9%) Peer problems No 299(86.9%) 45(13.1%) Yes 61(83.6%) 12(16.4%) Table: 3 Associations of Nocturnal Enuresis and mental health problems among children and adolescents age 5-14 year old attending paediatric outpatient, at Wolaita sodo university comprehensive specialized hospital, Wolaita sodo, south Ethiopia, 2022 Variables Nocturnal Enuresis P-value Behavioral problems RR (95% CI) 1.753(0.979, 3.139) 0.08 Conduct problems RR (95% CI) 1.104(.566, 2.154) 0.731 Emotional Problems RR (95% CI) 2.627(1.490, 4.631) 0.001* Hyperactivity-inattention RR (95% CI) 1.307(.653, 2.616) 0.455 Peer Problems RR (95% CI) 4.313(2.411, 7.719) <0.001* Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 21 Aug, 2025 Reviews received at journal 15 Aug, 2025 Reviews received at journal 08 Aug, 2025 Reviewers agreed at journal 05 Aug, 2025 Reviewers agreed at journal 04 Aug, 2025 Reviewers invited by journal 04 Aug, 2025 Editor invited by journal 21 Jul, 2025 Editor assigned by journal 17 Jul, 2025 Submission checks completed at journal 17 Jul, 2025 First submitted to journal 08 Jul, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7077673","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":496048142,"identity":"c6139d9c-dd26-4388-a264-3112ff88b8b4","order_by":0,"name":"Tamene 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19:23:18","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7077673/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7077673/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":88652535,"identity":"5db3a5c9-5c35-4422-9fc7-3bd775c2cb2f","added_by":"auto","created_at":"2025-08-08 17:55:58","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":25882,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003emagnitude of nocturnal enuresis among children and adolescents age 5-14 year old attending paediatric outpatient, at Wolaita sodo university comprehensive specialized hospital, Wolaita sodo, south Ethiopia, 2022\u003c/em\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7077673/v1/f49d68bbe66edd94625e0178.png"},{"id":88652533,"identity":"de5a9792-4403-4ace-9e70-bb477ba321bc","added_by":"auto","created_at":"2025-08-08 17:55:58","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":31436,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eMagnitude of nocturnal enuresis by sex of children and adolescents age 5-14 year old attending paediatric outpatient, at Wolaita sodo university comprehensive specialized hospital, Wolaita sodo, south Ethiopia, 2022\u003c/em\u003e\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-7077673/v1/de04c9765f8731e7ac11a4fe.png"},{"id":88652536,"identity":"b28c90cb-c9a9-4655-ae80-d90c2d44444f","added_by":"auto","created_at":"2025-08-08 17:55:58","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":56304,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003edistribution of mental health status of children and adolescents age 5-14 year old attending paediatric outpatient, at Wolaita sodo university comprehensive specialized hospital, Wolaita sodo, south Ethiopia, 2022\u003c/em\u003e\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-7077673/v1/f660287ac99cdc8d951e2bfc.png"},{"id":88653587,"identity":"6f8ea65d-95a0-4480-b293-7cae0fa9fdff","added_by":"auto","created_at":"2025-08-08 18:12:00","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":880303,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7077673/v1/eca329d9-a185-4e88-bc7e-be50a1a67f09.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Association of nocturnal enuresis and mental health problems among Children and Adolescents, in South Ethiopia","fulltext":[{"header":"Introducation","content":"\u003cp\u003eDiagnostic and statistical Manual (DSM-5) defines Nocturnal Enuresis (NE) as the involuntary or repeated voiding of urine into clothing or the bed at night in a child at least 5 years old, with a frequency of 2 times a week for at least 3 consecutive months, or the presence of clinically significant distress or impairment in social, academic (occupational), or other critical areas of functioning (1). Children who suffer from NE frequently experience distressing clinical issues. This disorder frequently results in significant mental health issues and causes anxiety for parents and children (2).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNE is linked to a number of psychological issues, such as reduced wellbeing or self-esteem (3,4) or anxiety-depressive symptoms (5,6), and behavioral problems such as higher tendency of hyperactivity(7,8) or conduct problems (9). These associations are particularly pronounced above \u0026nbsp;the age of 8 years (10). Notably, NE is placed eighth among stressful life events, including not getting along with friends or doing poorly academically, and is thought to be a very common distressing life experience during early adolescence (11). By the age of five, the percentage of adolescents with NE was 20%, and by the age of fifteen, only roughly 1% of adolescents had a problem with NE, with a spontaneous resolution rate of nearly 15% per year (12,13).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eResearch on the relationship between nocturnal enuresis and mental health issues in children and adolescents is essential for promoting healthy physical development and outcomes in children. In spite of this pervasive issue, there isn\u0026apos;t much research that addresses it. However, to the best of the researcher\u0026apos;s work and evidence, there is a dearth of sufficient data regarding the link between nocturnal enuresis and mental health issues in children and adolescents. Small body of existing studies reported mixed findings on the association between mental health problems and NE in children and adolescents. Thus, this study aimed to identify children and adolescent mental health problems on NE among children and adolescents at Wolaita Sodo University Comprehensive Specialized Hospital who are aged 5\u0026ndash;14 years old, South Ethiopia, in 2022.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003eStudy area and period\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA study carried out between September 22, 2022, and November 22 At Wolaita Sodo University Comprehensive Specialized Hospital, in 2022. The hospital is located in Wolaita Sodo town, which is 329 kilometers south of Addis Ababa, the country\u0026apos;s capital city. About 450\u0026ndash;500 patients a day get inpatient, outpatient, and emergency care services from the hospital, which also acts as a referral source for the three million residents in the catchment region. The paediatric department is organized into 6 main units: the outpatient unit, the paediatric emergency (inpatient and outpatient unit), the paediatric surgical inpatient unit, the paediatric medical inpatient and stabilization unit, and the newborn intensive care unit (14).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy design\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis cross-sectional investigation was carried out in a hospital.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePopulation\u003c/strong\u003e \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe study encompassed all children and adolescents (ages 5 to 14) who utilized the services of WSUCSH\u0026apos;s paediatric outpatient department during the time of data collection. Excluded from consideration were children and adolescents who were in critical condition, unable of speaking, and had known urinary system anatomical anomalies or enuresis brought on by medical (biogenic or neurological) causes. \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSampling technique and procedure \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe sample size was calculated using a single population proportion calculation method. The following assumptions were considered: the proportion of (P) of NE to be 50%, 95% Confidence Interval (CI), a five percent margin of error (W), and a ten percent non-response rate. Accordingly, 417 participants were selected using a systematic random sampling method.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOperational terms\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNocturnal enuresis:\u003c/strong\u003e in this study NE defined as frequency of wetting at night at least two times per week for consecutive three moth based on DSM-5 definition (15).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMental health problems:\u0026nbsp;\u003c/strong\u003ein this study\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003emental health problems\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003ewere the behavioral problems of children that challenge parents, teachers and his or her relatives, for children who have SDQ-PR overall ideal cutoff score \u003cu\u003e\u0026gt;\u003c/u\u003e17 for behavioral or mental health problems, and subscale (cutoff score \u003cu\u003e\u0026gt;\u003c/u\u003e7 for problems related to hyperactivity and inattention, \u003cu\u003e\u0026gt;\u003c/u\u003e4 for problems related to conduct and peers, and \u003cu\u003e\u0026gt;\u003c/u\u003e5 for emotional problems from the SDQ-PR subscale) (16).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData collection instrument\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStrengths and Difficulties Questionnaire Parent Report (SDQ-PR) \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDifficult behavioral issues with the kid were evaluated by using interviewer administered paper questionnaire of the strengths and difficulties questionnaire parent report (SDQ-PR). The five subscales contain twenty-five items. Peer relationship issues, conduct issues, emotional issues, hyperactivity, and pro-social behavioral issues are among these subscales. With a total score ranging from 0 to 40, all subscales\u0026mdash;aside from the pro-social behavioral subscale\u0026mdash;are assessed on a 3-point Likert scale. \u0026nbsp;In the event that the pro-social behavioral subscale is absent, the overall ideal cutoff threshold for the SDQ-PR is \u003cu\u003e\u0026gt;\u003c/u\u003e 17 for screening behavioral issues or mental health problems; with a sensitivity of 70.96% and a specificity of 69.15%. For the subscales pertaining to hyperactivity and inattention, the ideal cutoff scores are seven and above, for conduct and peer problems, greater than or equal to four, and for emotional problems, five and above (16). Cronbach\u0026apos;s alpha for internal consistency in the current study\u0026apos;s setting was 0.79.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDiagnostic and statestical manual of mental disorder fifth edition \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe presence of nocturnal enuresis was assessed by the DSM-V definition as wetting at night with a frequency of at least 2wice a week for at least 3 consecutive months (15).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData collection procedure\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFor children aged 5 to 8, data were collected from parents. For children and adolescents aged 9 to 14, a structured, in-person questionnaire was given by an interviewer. 6 psychiatry graduates with a Bachelor of Science degree collected the data under the supervision of 2 mental health specialists.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData quality management\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe query was first written in English, translated into Amharic and Wolaita, and then back into English by experts in all 3 languages, including mental health professionals, to guarantee consistency. Supervisors and data collectors attended two days of training. A pre-test was administered to five percent of the sample size out of the study area. The purpose of the test was to evaluate the instruments\u0026apos; reliability and find any possible problems with the questionnaire alterations and data collection techniques. Supervisors and the lead investigator regularly monitored and supported data collectors. Throughout the duration of the data collection, supervisors and principal investigators confirmed the accuracy and consistency of the data each day. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData processing, analysis and presentation\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFor analysis, the data were exported from Epi Data Version 4.6 to the Statistical Package for Social Sciences (SPSS) Version 25. To describe sample characteristics and estimate the scope of NE and mental health issues, descriptive statistics were employed. The chi-square test was used to examine the relationship between the independent variables and the outcome variable. Variables with a p-value of \u0026lt;0.05 were deemed to have a significant association. The degree of association between the outcome variables and potential explanatory variables was assessed using 95% CI RR (relative risk) and p-value \u0026lt; 0.05. \u0026nbsp;\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThe current study included 417 children and adolescents. The mean age of the participants was 8.3 \u0026plusmn; 2.3 years, ranging from five to fourteen years. 59.2% of the participants were between 5-8 years and (n = 146, 35%) were female participants. About three-fourth of the participants (71.2%) were living with their parents. As to the educational level of children and adolescents (n = 270, 64.7%) was primary school and above, while parents\u0026rsquo; education level was 36.2% of parents had graduated high school (Table 1).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMagnitude of NE and mental health problem\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe magnitude of nocturnal enuresis were found to be (n = 57, 13.7%) (figure1). It is evident that a higher magnitude of nocturnal enuresis among males (n = 45, 16.6%) than females (n = 12, 8.2%) (figure2). Regarding the mental health problem of the children and adolescents, (n = 117, 28.1%) had behavioral problems, (n = 137, 32.9%) had problematic emotion, (n = 73, 17.5%) had problems of hyperactive-inattention, (n = 89, 21.3%) had problems of conduct, and (n = 132, 31.7%) had problems in peer relationship (Figure 3). Accordingly\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e(n = 22, 18.8%) of children and adolescents with behavioral problems had nocturnal enuresis; similarly, (n = 12, 16.4%) participants with hyperactive-inattention and peer problems were equally experienced nighttime wetting (Table 2).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAssociation of nocturnal enuresis and mental health problems\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTable 3 shows the association between nocturnal enuresis and mental health problems among children and adolescents. There were significant associations between emotional problems and nocturnal enuresis (p-value \u0026lt; 0.001), and also peer problems had a significant association with bedwetting (p-value \u0026lt;0.0001).\u003cstrong\u003e\u003c/strong\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eEpidemiological studies have reported that children with nocturnal enuresis are at greater risk of having mental health problem. In our study we\u0026nbsp;found that one-fifth of children and adolescents with nocturnal enuresis also experienced mental health problems. Specifically, conduct problems were reported to be 14.6%, emotional problems to be 21.9%, and hyperactive-inattentive and peer problems were equally common in children and adolescents with nighttime wetting, which is 16.4%. These findings are consistent with several studies that have linked enuresis to an increased risk of attention-deficit/hyperactivity disorder (ADHD), with 4.1% to 74.9% of enuresis patients having ADHD (17,18).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe occurrence of mental health problems in kids with bedwetting in our study is supported by previous studies that observed enuresis in children was associated with high frequencies and scores of emotional, behavioral, and hyperactivity-inattention symptoms as well as problems with peer relationships. In agreement with this finding, previous studies reported the link \u0026nbsp;of emotional and hyperactive-inattentive disorders linked to bedwetting (19\u0026ndash;21).\u003c/p\u003e\n\u003cp\u003eThis study observed that emotional problems are strongly linked to nocturnal enuresis, which is consistent with studies from Taiwan(22). This association might be Nocturnal enuresis by itself contributes to emotional problems because it is often troubling for children and adolescents, which puts them in stressful situations. Furthermore, nocturnal enuresis has serious consequences for the paediatric population(23). Many children with NE go through cognitive, social, behavioral and emotional problems, like low self-esteem, embarrassment, loss of dignity, aggressive behavior, loneliness, and anxiety symptoms. These things lead to emotional problems in children and adolescents in later life(24). Furthermore, one of the most typical causes of nocturnal enuresis is an emotional problem. A child\u0026apos;s likelihood of bedwetting may increase if they are experiencing emotional problems, such as moving to a new home or school, witnessing their parents\u0026apos; divorce or other conflicts, losing a parent or other loved one, or going through another significant life event(25,26). \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFinal we observed that significant association between peer problems and nocturnal enuresis which is in line with studies reported from\u0026nbsp;Turkey(27). A plausible rationale for this linkage could be Peer problems may arise among children and adolescents with nocturnal enuresis who continue to wet their beds because enuresis can lead to feelings of shame, embarrassment, and social isolation. This may increase the likelihood of peer problems in the paediatric population who had enuresis. In comparison to their peers who are healthy, bedwetting children also have a poor self-image, poor self-esteem, decreased self-confidence, social avoidance and lower school performance. Consequently, there is a greater chance of peer problems and psychological distress in one-third of children with NE(28,29). Moreover, nocturnal enuresis and peer problems may be related since enuretic children take great effort to hide their condition from their friends, believing they are the only ones who suffer from it(30,31). Because of their condition, they were unable to participate in social activities with their friends. This can lead children and adolescents to suffer emotional and peer problems in many ways and forms(32). Moreover, peer problems impair children\u0026apos;s ability to participate in social activities, which leads children to stress and anxiety when they want basic needs from their parents or friends. This can cause stress and anxiety-related urine incontinence in children and adolescents(33).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLimitation of the study\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThere were a few limitations to this study: it was single-cross-sectional and hospital-based, so the clinical severity of the cases may have been higher than average, and the results might be not generalized to community settings. \u0026nbsp;\u003c/p\u003e"},{"header":"Conclusion and Recommendation","content":"\u003cp\u003eIn conclusion, the present study revealed that NE is significantly associated with emotional and peer problems among children and adolescents. According to these results, it is critical to address the co-occurring behavioral and mental health problems in these children and their families in the treatment plan to give them and their families a better quality of life. Therefore, the early identification and management of this disorder is considered among the necessities for the preservation of children\u0026rsquo;s and families wellbeing.\u0026nbsp;\u003c/p\u003e"},{"header":" Acronyms and Abbreviations","content":"\u003cp\u003eADHD Attention-deficit/hyperactivity disorder, CI Confidence Interval, DSM-V Diagnostic and statestical manual of mental disorder fifth edition, IRB Institutional Review Board, NE Nocturnal enuresis, OR Odds Ratio, RR relative risk, SDQ-PR Strength and Difficulty Questionnaire Parent Report, WSUCSH Wolaita Sodo University Comprehensive Specialized Hospital\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors express their gratitude to Jimma University for its financial assistance and to the study participants for supplying study data.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was supported financially by Jimma University. Regarding the study\u0026apos;s design, data collecting, analysis, and interpretation, as well as the manuscript\u0026apos;s composition, Jimma University has no official involvement\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTB developed the proposal, was extensively involved in the data analysis, interpreted the data, and wrote the draft manuscript. YT, MA and SG; - revised the proposal, checked the data analysis, revised the manuscript, and read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Jimma University Institute of Health\u0026apos;s Institutional Review Board (IRB) granted ethical approval for this study (Ref. No.JUIH/IRB/63/22). All parents of participating children and adolescents provided written informed consent, and the children and adolescents verbally consented to participate. Children and adolescents have nocturnal enuresis and mental health problems after screen was linked to a health care service for further treatment.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo/Not applicable (this manuscript does not report data generation or analysis).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eALARCON RD. Synopsis of Psychiatry: Behavioral Sciences and Clinical Psychiatry, 6th ed. 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Available from: http://dx.doi.org/10.1016/j.juro.2009.05.102\u003c/li\u003e\n\u003cli\u003eLang R, McLay L, Carnett A, Ledbetter-cho K, Sun X, Lancioni G. Complications and Side Effects Associated with a Lack of Toileting Skills. 2017;19\u0026ndash;31. \u003c/li\u003e\n\u003cli\u003eButler R, Heron J. An exploration of children\u0026rsquo;s views of bed-wetting at 9 years. Child Care Health Dev. 2008;34(1):65\u0026ndash;70. \u003c/li\u003e\n\u003cli\u003eLawless MR, McElderry DH. Nocturnal enuresis: Current concepts. Pediatr Rev. 2001;22(12):399\u0026ndash;407. \u003c/li\u003e\n\u003cli\u003eAhmed SMES, Shedeed SAS, Morsy RAA, Said HS. Frequency and Risk Factors of Nocturnal Enuresis among Primary School Children in Sharkia Governorate. Egypt J Hosp Med. 2022;88(1):3470\u0026ndash;6. \u003c/li\u003e\n\u003cli\u003eBerhanu T, Abera M, Girma S, Tesfaye Y. Elimination disorders and associated factors among children and adolescents age 5\u0026ndash;14 year-old attending paediatric outpatient clinic at Wolaita Sodo University comprehensive specialized hospital, South Ethiopia. Child Adolesc Psychiatry Ment Health [Internet]. 2024;18(1):1\u0026ndash;15. Available from: https://doi.org/10.1186/s13034-024-00739-7\u003c/li\u003e\n\u003cli\u003eOf M, Disorders M. DSM-5 DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDERS7 FIFTH EDI T ION. \u003c/li\u003e\n\u003cli\u003eWimbarti S, Siregar J, Oktaviana M, Astriningsih R. Strengths and Difficulties Questionnaire Parent Report ( SDQ-PR ) as Screening Instrument of Children Mental Health in Indonesia. 2019;46:130\u0026ndash;44. \u003c/li\u003e\n\u003cli\u003eShreeram S, He J, Kalaydjian A, Brothers S, Merikangas KR. Prevalence of Enuresis and Its Association With Attention-Deficit / Hyperactivity Disorder Among U . S . Children : Results From a Nationally Representative Study. J Am Acad Child Adolesc Psychiatry [Internet]. 2009;48(1):35\u0026ndash;41. Available from: http://dx.doi.org/10.1097/CHI.0b013e318190045c\u003c/li\u003e\n\u003cli\u003eAmiri S, Shafiee-Kandjani AR, Naghinezhad R, Farhang S, Abdi S. Comorbid psychiatric disorders in children and adolescents with nocturnal enuresis. Urol J. 2017;14(1):2968\u0026ndash;72. \u003c/li\u003e\n\u003cli\u003eNev\u0026eacute;us T, Sill\u0026eacute;n U. Lower urinary tract function in childhood; normal development and common functional disturbances. Acta Physiol. 2013;207(1):85\u0026ndash;92. \u003c/li\u003e\n\u003cli\u003eBailey JN, Ornitz EM, Gehricke JG, Gabikian P, Russell AT, Smalley SL. Transmission of primary nocturnal enuresis and attention deficit hyperactivity disorder. Acta Paediatr Int J Paediatr. 1999;88(12):1364\u0026ndash;8. \u003c/li\u003e\n\u003cli\u003ePark S, Kim BN, Kim JW, Hong SB, Shin MS, Yoo HJ, et al. Nocturnal enuresis is associated with attention deficit hyperactivity disorder and conduct problems. Psychiatry Investig. 2013;10(3):253\u0026ndash;8. \u003c/li\u003e\n\u003cli\u003eChristian C, Hospital CC, Hospital CC, Hospital C, Involvement F. BEHAVIORAL AND EMOTIONAL PROBLEMS IN CHILDREN AND PARENTING STRESS WITH PRIMARY NOCTURNAL ENURESIS IN. :44\u0026ndash;5. \u003c/li\u003e\n\u003cli\u003eZeitoun AE, Ragab HA. Social Competencies, Behavioral, Psychological. 1997;(January). \u003c/li\u003e\n\u003cli\u003eAjeliCABP M. Prevalence of Nocturnal Enuresis and Its Associated Factors in Primary School Children of Fallujah in 2018. Int J Adv Res. 2019;7(2):890\u0026ndash;5. \u003c/li\u003e\n\u003cli\u003eLefeber TP. Psychological Aspects of Enuresis in Childhood. Ann Urol Nephrol. 2018;1(1):17\u0026ndash;9. \u003c/li\u003e\n\u003cli\u003eJoinson C, Heron J. Psychological Problems in Children With. 2006;118(5). \u003c/li\u003e\n\u003cli\u003eGunes A, Gunes G, Acik Y, Akilli A. The epidemiology and factors associated with nocturnal enuresis among boarding and daytime school children in southeast of Turkey : a cross sectional study. 2009;8:1\u0026ndash;8. \u003c/li\u003e\n\u003cli\u003ePalareti G, Legnani C, Cosmi B, Antonucci E, Erba N, Poli D, et al. Comparison between different D-Dimer cutoff values to assess the individual risk of recurrent venous thromboembolism: Analysis of results obtained in the DULCIS study. Int J Lab Hematol. 2016;38(1):42\u0026ndash;9. \u003c/li\u003e\n\u003cli\u003eRedsell SA, Collier J. Bedwetting, behaviour and self-esteem: A review of the literature. Child Care Health Dev. 2001;27(2):149\u0026ndash;62. \u003c/li\u003e\n\u003cli\u003eWalle J Vande, Rittig S, Bauer S, Eggert P, Marschall-Kehrel D, Tekgul S. Practical consensus guidelines for the management of enuresis. Eur J Pediatr. 2012;171(6):971\u0026ndash;83. \u003c/li\u003e\n\u003cli\u003ePereira RF, Silvares EFM, Braga PF. Behavioral alarm treatment for nocturnal enuresis. Int Braz J Urol. 2010;36(3):332\u0026ndash;8. \u003c/li\u003e\n\u003cli\u003eBulut S, Nazir T. Implications of Enuresis in Children and Their Families. 2020;31\u0026ndash;42. \u003c/li\u003e\n\u003cli\u003eXu X. MICU1 mutation: A genetic cause for a type of neuromuscular disease in children. Clin Genet. 2015;87(4):327\u0026ndash;8. \u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cem\u003eTable 1: Socio-demographic and family related characteristics of children and adolescents age 5-14 year old attending paediatric outpatient, at Wolaita sodo university comprehensive specialized hospital, Wolaita sodo, south Ethiopia, 2022\u003c/em\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"636\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 235px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 174px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCategory\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercentage (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 235px;\"\u003e\n \u003cp\u003eAge\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 174px;\"\u003e\n \u003cp\u003e5-8 year old\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e247\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e59.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 174px;\"\u003e\n \u003cp\u003e9-11 year old\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e113\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e27.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 174px;\"\u003e\n \u003cp\u003e12-14 year old\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e13.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 235px;\"\u003e\n \u003cp\u003eChild sex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 174px;\"\u003e\n \u003cp\u003eMale\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e271\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e65.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 174px;\"\u003e\n \u003cp\u003eFemale\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e146\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e35.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 235px;\"\u003e\n \u003cp\u003eResidency\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 174px;\"\u003e\n \u003cp\u003eUrban\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e241\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e57.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 174px;\"\u003e\n \u003cp\u003eRural\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e176\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e42.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 235px;\"\u003e\n \u003cp\u003eReligion\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 174px;\"\u003e\n \u003cp\u003eOrthodox\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e124\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e29.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 174px;\"\u003e\n \u003cp\u003eMuslim\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e15.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 174px;\"\u003e\n \u003cp\u003eProtestant\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e185\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e44.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 174px;\"\u003e\n \u003cp\u003eOthers*\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e10.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"5\" valign=\"top\" style=\"width: 235px;\"\u003e\n \u003cp\u003eEthnicity\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 174px;\"\u003e\n \u003cp\u003eWolaita\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e287\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e68.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 174px;\"\u003e\n \u003cp\u003eAmhara\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e13.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 174px;\"\u003e\n \u003cp\u003eGurage\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e9.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 174px;\"\u003e\n \u003cp\u003eOromo\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e3.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 174px;\"\u003e\n \u003cp\u003eOthers**\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e5.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 235px;\"\u003e\n \u003cp\u003eEducational level of child\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 174px;\"\u003e\n \u003cp\u003eKindergarten (KG)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e147\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e35.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 174px;\"\u003e\n \u003cp\u003ePrimary and above\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e270\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e64.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 235px;\"\u003e\n \u003cp\u003eCurrently living\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 174px;\"\u003e\n \u003cp\u003eWith parents\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e297\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e71.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 174px;\"\u003e\n \u003cp\u003eSteep parents\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e14.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 174px;\"\u003e\n \u003cp\u003eResidential institution\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e7.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 174px;\"\u003e\n \u003cp\u003eGordian\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e6.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 235px;\"\u003e\n \u003cp\u003eFamily size\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 174px;\"\u003e\n \u003cp\u003e\u0026lt; 4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e214\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e51.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 174px;\"\u003e\n \u003cp\u003e\u0026gt;= 4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e203\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e48.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"7\" valign=\"top\" style=\"width: 235px;\"\u003e\n \u003cp\u003eOccupation of parents\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 174px;\"\u003e\n \u003cp\u003eGovernment employ\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e144\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e34.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 174px;\"\u003e\n \u003cp\u003ePrivate\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e12.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 174px;\"\u003e\n \u003cp\u003eMerchant\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e15.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 174px;\"\u003e\n \u003cp\u003eFarmer\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e14.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 174px;\"\u003e\n \u003cp\u003eHousewife\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e4.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 174px;\"\u003e\n \u003cp\u003eUnemployed\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e8.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 174px;\"\u003e\n \u003cp\u003eDaily labor\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e9.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 235px;\"\u003e\n \u003cp\u003eEducational status of parents\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 174px;\"\u003e\n \u003cp\u003eIlliterate\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e20.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 174px;\"\u003e\n \u003cp\u003ePrimary school\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e182\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e43.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 174px;\"\u003e\n \u003cp\u003eHigh school and above\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e151\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e36.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"5\" valign=\"top\" style=\"width: 235px;\"\u003e\n \u003cp\u003eParents marital status\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 174px;\"\u003e\n \u003cp\u003eMarried\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e298\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e71.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 174px;\"\u003e\n \u003cp\u003eDivorced\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e11.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 174px;\"\u003e\n \u003cp\u003eSeparated\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e8.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 174px;\"\u003e\n \u003cp\u003eWidowed\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e5.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 174px;\"\u003e\n \u003cp\u003eSingle\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e2.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 235px;\"\u003e\n \u003cp\u003eAverage family monthly income\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 174px;\"\u003e\n \u003cp\u003e\u0026lt; 1000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e14.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 174px;\"\u003e\n \u003cp\u003e1000-2500\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e14.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 174px;\"\u003e\n \u003cp\u003e2500-3400\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e16.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 174px;\"\u003e\n \u003cp\u003e\u0026gt;= 3400\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e226\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e54.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eTable: 2 Characteristics of nocturnal enuresis and mental health status among children and adolescents age 5-14 year old attending paediatric outpatient, at Wolaita sodo university comprehensive specialized hospital, Wolaita sodo, south Ethiopia, 2022\u003c/em\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" class=\"fr-table-selection-hover\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 181px;\"\u003e\n \u003cp\u003eVariables\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003eCategory\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003eNocturnal \u0026nbsp; \u0026nbsp; Enuresis\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eN (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003eYes \u0026nbsp;\u003c/p\u003e\n \u003cp\u003eN (%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 181px;\"\u003e\n \u003cp\u003eBehavioral problems\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e265(88.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e35(11.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e95(81.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e22(18.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 181px;\"\u003e\n \u003cp\u003eConduct problem\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e284(86.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e44(13.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e76(85.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e13(14.6%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 181px;\"\u003e\n \u003cp\u003eHyperactivity-inattention\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e299(86.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e45(13.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e61(83.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e12(16.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 181px;\"\u003e\n \u003cp\u003eEmotional problems\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e253(90.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e27(9.64%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e107(78.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e30(21.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 181px;\"\u003e\n \u003cp\u003ePeer problems\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e299(86.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e45(13.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e61(83.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e12(16.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eTable: 3\u003c/em\u003e\u003c/strong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003cem\u003eAssociations of Nocturnal Enuresis\u0026nbsp;\u003c/em\u003e\u003cem\u003eand mental health problems among\u0026nbsp;\u003c/em\u003e\u003cem\u003echildren and adolescents age 5-14 year old attending paediatric outpatient, at Wolaita sodo university comprehensive specialized hospital, Wolaita sodo, south Ethiopia, 2022\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"451\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 228px;\"\u003e\n \u003cp\u003eVariables\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eNocturnal Enuresis\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003eP-value\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 228px;\"\u003e\n \u003cp\u003eBehavioral problems\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eRR (95% CI)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e1.753(0.979, 3.139)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0.08\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 228px;\"\u003e\n \u003cp\u003eConduct problems\u003c/p\u003e\n \u003cp\u003eRR (95% CI)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e1.104(.566, 2.154)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0.731\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 228px;\"\u003e\n \u003cp\u003eEmotional Problems\u003c/p\u003e\n \u003cp\u003eRR (95% CI)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e2.627(1.490, 4.631)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 228px;\"\u003e\n \u003cp\u003eHyperactivity-inattention\u003c/p\u003e\n \u003cp\u003eRR (95% CI)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e1.307(.653, 2.616)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0.455\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 228px;\"\u003e\n \u003cp\u003ePeer Problems\u003c/p\u003e\n \u003cp\u003eRR (95% CI)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e4.313(2.411,\u0026nbsp;7.719)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026lt;0.001*\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"discover-mental-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"dimh","sideBox":"Learn more about [Discover Mental Health](https://www.springer.com/44192)","snPcode":"","submissionUrl":"","title":"Discover Mental Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Children, Adolescents, Mental Health Problems, Nocturnal Enuresis, South Ethiopia ","lastPublishedDoi":"10.21203/rs.3.rs-7077673/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7077673/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cem\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/em\u003e\u003cem\u003e: Mental health problem impacts the life of children, adolescents, and their family. Different physiological factors were implicated as an etiology of Nocturnal Enuresis (NE). Small body of research examined the mental health problem on NE in children and adolescents. Thus, this study aimed to identify children and adolescent mental health problems on NE among children and adolescents at Wolaita Sodo University Comprehensive Specialized Hospital who are aged 5–14 years old, South Ethiopia, in 2022.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eMethod:\u003c/strong\u003e\u003c/em\u003e\u003cem\u003eAt Wolaita Sodo University Comprehensive Specialized Hospital, a cross-sectional study was carried out between September 22, 2022, and November 22, 2022. 417 research participants were chosen at systematic random selection. A structured, in-person interviewer-administered questionnaire was used to collect the data. A Diagnostic Statistical Manual (DSM-5) were used to assess NE and Strengths and Difficulties questionnaire (SDQ) parent report version were used to screen for child and adolescent mental health problems. A chi-square test was used to determine the association between the outcome and independent variables. A 95% confidence interval (CI) and Risk Ratio (RR) with a corresponding p-value \u0026lt; 0.05 was used to determine the strength of the association.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eResult:\u003c/strong\u003e\u003c/em\u003e\u003cem\u003eThe mean age of the participants was 8.3±2.3 years. 59.2% of the participants were between 5-8 years old and 271(65%) were males. The magnitude of NE was (n 57, 13.7%). Regarding the mental health status of the participant, (n 117, 28.1%) had behavioral problems, (n 137, 32.9%) had emotional problems, (n 73, 17.5%) had hyperactive-inattention, (n 89, 21.3%) had conduct problems, and (n 132, 31.7%) had peer problems. Emotional problems (RR = 2.63; 95% CI: 1.49, 4.63) and peer problems (RR = 4.31; 95% CI: 2.41, 7.72) predicts NE.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eConclusion and Recommendation:\u003c/strong\u003e\u003c/em\u003e\u003cem\u003e This study showed emotional and peer problems predicts NE. Thus, a targeted early intervention needs to be planned in order to improve children’s and adolescents mental health and wellbeing.\u003c/em\u003e\u003c/p\u003e","manuscriptTitle":"Association of nocturnal enuresis and mental health problems among Children and Adolescents, in South Ethiopia","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-08 17:55:54","doi":"10.21203/rs.3.rs-7077673/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-08-21T11:13:01+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-15T19:07:27+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-08T12:27:05+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"148770485931900984876393701752657540360","date":"2025-08-05T13:29:26+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"9441470136526972240095069911273980731","date":"2025-08-05T03:00:59+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-08-04T20:31:29+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-07-21T19:01:44+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-07-17T10:29:24+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-07-17T10:28:32+00:00","index":"","fulltext":""},{"type":"submitted","content":"Discover Mental Health","date":"2025-07-08T19:18:54+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"discover-mental-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"dimh","sideBox":"Learn more about [Discover Mental Health](https://www.springer.com/44192)","snPcode":"","submissionUrl":"","title":"Discover Mental Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"8377d5d5-037d-4f04-a9a0-676879ce82b0","owner":[],"postedDate":"August 8th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-10-21T11:38:37+00:00","versionOfRecord":[],"versionCreatedAt":"2025-08-08 17:55:54","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7077673","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7077673","identity":"rs-7077673","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}