Short report Rajindrajith S, Devanarayana NM, Adhikari C, et al . Arch Dis Child (2010). doi:10.1136/adc.2009.173716 1 of 1 1 Department of Paediatrics, University of Kelaniya, Ragama, Sri Lanka 2 Department of Physiology, University of Kelaniya, Ragama, Sri Lanka 3 Department of Pediatric Gastroenterology and Nutrition, Emma Children’s Hospital, Academic Medical Centre, Amsterdam, The Netherlands Correspondence to Dr Shaman Rajindrajith, Department of Paediatrics, Faculty of Medicine, University of Kelaniya, Talagolla Road, Ragama 11010, Sri Lanka; rajindrajith@mfac.kln.ac.lk Accepted 18 May 2010 ABSTRACT Constipation is a common paediatric problem, but its prevalence in Asia is unknown. A cross-sectional survey using a previously validated, self-administered questionnaire was conducted in randomly selected children aged 10–16 years, in five randomly selected schools in Sri Lanka. Two schools were in Eastern Province, which has been affected by the separatist war. Constipation was defined using Rome III criteria. Of 2694 children included in the analysis, 416 (15.4%) had constipation. Symptoms independently associated with constipation were straining (71.6% vs 28.4% of controls), bleeding per rectum (14.2% vs 2.2%) and abdominal pain (55% vs 35.2%). The prevalence of constipation was significantly higher in those with a family history of constipation (49% vs 14.8%), living in a war affected area (18.1% vs 13.7%) and attending an urban school (16.7% vs 13.3%). In conclusion, chronic constipation is a significant problem affecting 15% of Sri Lankan school children and adolescents. INTRODUCTION Childhood constipation is a frequently overlooked global health problem, which is developing into a public health issue in many parts of the world. 1 Its impact on the quality of life of affected children and their parents is often under-appreciated. 2 Constipation was found to be the most common cause of abdominal pain in children presenting to acute care clinics and emergency departments, 3 and up to 30% of affected children continued to have symptoms beyond puberty. 4 The prevalence of childhood constipation varies from 0.7% to 29.6%. 1 Most epidemiological studies on consti- pation are from Western countries; there is a sig- nificant lack of epidemiological data from Asia on constipation. The present study assessed the prevalence of constipation in Sri Lankan children and adoles- cents aged 10–16 years. To our knowledge, this is the fi rst epidemiological survey on constipation in this age group using Rome III criteria, as most previous epidemiological studies on constipation were in younger children. 1 Furthermore, a previ- ous follow-up study has shown that a significant number of children with constipation continue to have symptoms as adults. 4 Therefore, studying this age group should help bridge the knowledge gap between younger children and adults. METHODS An island-wide cross-sectional survey was con- ducted in five randomly selected state schools Constipation in children: an epidemiological study in Sri Lanka using Rome III criteria Shaman Rajindrajith, 1 Niranga Manjuri Devanarayana, 2 Chandralatha Adhikari, 1 Waruni Pannala, 1 Marc A Benninga 3 (three urban and two rural) in three provinces of Sri Lanka (two schools were from Eastern Province which has been affected by the sepa- ratist war). Details regarding the subjects’ bowel habits and defecation behaviours were obtained together with information on demographic and family characteristics and other symptoms using a self-administered questionnaire, which was developed from the Questionnaire on Pediatric Gastrointestinal Symptoms. 5 Data were collected from January 2007 to June 2007, after obtaining consent from school admin- istrators and the children’s parents. The question- naire was distributed in an examination setting to ensure confidentiality and privacy. The questions were in the subjects’ native language (Sinhalese) and were simple and easy to understand. Research assistants were present while the children fi lled in the questionnaire and explanations were given. Constipation was defi ned using Rome III crite- ria. 6 Since this was an epidemiological study, we did not use the diagnostic criterion of palpable fae- cal mass in rectum. Data were analysed using EpiInfo version 6.04. Significance was set at p<0.05. Multiple logistic regression analysis was performed on variables that were found to have a significant association with constipation during univariable analysis. The study protocol was approved by the Ethics Review Committee of the Sri Lanka College of Paediatricians. RESULTS Overall, 2770 questionnaires were distributed and 2694 (97.3%) were included in the analysis (males 1368 (50.8%), mean age 13.2 years, SD 1.7 years). Information provided in 76 questionnaires was insufficient to either diagnose or exclude consti- pation and so these questionnaires were excluded from the study. According to Rome III criteria, 416 children (15.4%; 95% CI 14.04% to 16.76%) had constipa- tion (230 (55.3%) males). Figure 1 shows the mean predicted probabilities according to age and gen- der. There was a significant negative correlation between the prevalence of constipation and age in both males and females. Table 1 demonstrates the association between demographic and family factors and constipation. During multiple logistic regression analysis, living in a war affected area (adjusted OR 1.5, 95% CI 1.1 to 1.9; p=0.009), studying in an urban school (adjusted OR 1.4, 95% CI 1.1 to 1.9; p<0.02) and having a family history of constipation (adjusted ADC Online First, published on June 23, 2010 as 10.1136/adc.2009.173716 Copyright Article author (or their employer) 2010. Produced by BMJ Publishing Group Ltd (& RCPCH) under licence. group.bmj.com on April 21, 2011 - Published by adc.bmj.com Downloaded from