Experiences of children’s self-wetting (including incontinence) in Cox’s Bazar’s Rohingya refugee camps, Bangladesh

Self-wetting, including incontinence, affects people of all ages, ethnicities, and cultural backgrounds, and can have a significant negative impact on quality of life. We thus explored the attitudes towards self-wetting and experiences of children (ages five to 11), their caregivers, and humanitarian experts in the Rohingya refugee camps in Cox’s Bazar, Bangladesh. We purposively selected participants from two camps where our partner organisation, World Vision Bangladesh - Cox’s Bazar, works. We conducted Key Informant Interviews (KIIs) with community members and camp officials, Story Book (SB) sessions with Rohingya children and in-depth Interviews (IDIs) with caregivers of children who participated in the SB sessions, as well as surveying the communal toilets used by children of the caregivers. Self-wetting was commonly seen among the children. Due to self-wetting, children were likely to feel embarrassed, upset and uncomfortable, and frightened to use the toilet at night; many also indicated that they would be punished by their caregivers for self-wetting. Key informants indicated that caregivers have difficulty handling children’s self-wetting because they have a limited amount of clothing, pillows, and blankets, and difficulty cleaning these items. In the sanitation survey it was evident that the toilets are not appropriate and/or accessible for children. Children in the Rohingya camps studied self-wet due to both urinary incontinence (when unable to reach a toilet in time) and because the sanitation facilities offered are inappropriate. They are teased by their peers and punished by their caregivers. The lives of children who self-wet in these camps could be improved by increasing awareness on self-wetting to decrease stigma and ease the concerns of caregivers, as well as increasing the number of toilets, ensuring they are well-lit, providing child-friendly toilets and cubicles, fixing the roads/paths that lead to sanitation to facilities and increasing the provision of relevant continence management materials. ### Competing Interest Statement The authors declare only the following which may be considered as a potential non-financial competing interest: Mahbub-Ul Alam is currently serving on the editorial board of PLOS Global Public Health. This does not alter our adherence to PLOS policies on sharing data and materials. ### Funding Statement 'Understanding children and their caregivers’ experiences with incontinence in humanitarian contexts’ (Project #45432, Principal Investigator Dr Dani J Barrington) was funded and supported by Elhra’s Humanitarian Innovation Fund (HIF) programme, a grant-making facility which improves outcomes for people affected by humanitarian crises by identifying, nurturing, and sharing more effective, innovative, and scalable solutions. Elhra’s HIF is funded by aid from the Netherlands Ministry of Foreign Affairs. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Approval to conduct the project was granted by the Research Ethics Committee, Faculty of Engineering, University of Leeds, United Kingdom (Reference MEEC 19-020). Approval to conduct the research in Cox’s Bazar was granted by the Institutional Review Board of the Institute of Health Economics (University of Dhaka, Bangladesh), with authority to access the refugee camps granted by the Office of the Refugee Relief and Repatriation Commissioner (RRRC). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes There are ethical restrictions imposed by the Research Ethics Committee, Faculty of Engineering, University of Leeds, United Kingdom which prevent the public sharing of sensitive minimal data for this study. Data are available upon request from the Research Ethics Committee, Faculty of Engineering, University of Leeds, United Kingdom via email (MEECResearchEthics{at}leeds.ac.uk) for researchers who meet the criteria for access to confidential data.