Beyond bedwetting: mental health, self-esteem, ADHD and school performance among children with nocturnal enuresis in Bukavu, Democratic Republic of the Congo

Nocturnal enuresis may affect well-being and school functioning, but evidence of its psychosocial and neurodevelopmental correlates remains limited in sub-Saharan Africa. We examined depressive symptoms, self-esteem, attention-deficit/hyperactivity disorder (ADHD), and parent-reported school performance among children with and without nocturnal enuresis in Bukavu, eastern Democratic Republic of the Congo. We conducted a school-based 1:1 classroom-matched case-control study among children aged 6–12 years. Screening information was sent to parents or legal guardians of 3,370 children and returned for 1,278 (37.9%). Of these, 320 were reported to have nocturnal bedwetting. Parents or guardians of 196 declined participation; the remaining 124 underwent interview and clinical assessment, met DSM-5 criteria, and were included as cases. Each case was matched to a non-enuretic control from the same classroom (n = 248). ADHD was assessed using DSM-5 criteria, depressive symptoms using the Children’s Depression Rating Scale (CDRS; predefined threshold ≥ 30), and self-esteem using the Rosenberg Self-Esteem Scale after reverse-coding negatively worded items. Multivariable logistic regression was performed. Parent-reported nocturnal bedwetting was identified in 320/1,278 children (25.0%). Mean age in the analytic sample was 8.5 ± 1.8 years, and 148 (59.7%) were boys. Depressive symptoms at the predefined CDRS threshold were present in 8/124 cases (6.5%) and 14/124 controls (11.3%); ADHD in 22/124 (17.7%) in each group; and low self-esteem in 34/124 cases (27.4%) and 43/124 controls (34.7%). Depressive symptoms (adjusted odds ratio [aOR] 0.45, 95% confidence interval [CI] 0.16–1.23), ADHD (aOR 1.30, 95% CI 0.63–2.67), and low self-esteem (aOR 0.75, 95% CI 0.43–1.33) were not independently associated with enuretic case status. Low parent-reported school performance was less frequent among cases than controls (aOR 0.35, 95% CI 0.19–0.65). Among children with returned screening information, one quarter were reported to have nocturnal bedwetting. Enuretic case status was not independently associated with depressive symptoms, ADHD, or low self-esteem. The inverse association with low parent-reported school performance should be interpreted cautiously. The low return of screening information (37.9%) limits the representativeness of these findings. Screening information was returned for only 1,278 of the 3,370 eligible children, and only 124 of the 320 children reported to experience nocturnal bedwetting were included following parental consent and clinical assessment.