Prevalence of poor sleep quality among nurses: a systematic review and meta-analysis

Aims This study aimed to determine the prevalence of poor sleep quality among nurses in African countries and to identify associated individual, occupational, and lifestyle-related factors through a systematic review and meta-analysis. Methods Following PRISMA 2020 guidelines, we conducted a comprehensive literature search in PubMed/MEDLINE, Web of Science, Scopus, Embase, and PsycINFO from inception to March 2025, supplemented by grey literature sources. Eligible studies were observational designs assessing poor sleep quality among nurses in African countries using validated tools such as the Pittsburgh Sleep Quality Index (PSQI) or the International Classification of Sleep Disorders (ICSD-3). Data extraction and quality assessment were performed independently by two reviewers, using standardized forms and the Newcastle–Ottawa Scale. Pooled prevalence was estimated using a DerSimonian–Laird random-effects model, with subgroup and sensitivity analyses conducted, and publication bias assessed via Egger's and Begg's tests. Findings Five cross-sectional studies conducted between 2017 and 2024 in Ethiopia, Nigeria, and Somalia met the inclusion criteria, encompassing a total of approximately 1741 nurses. Reported prevalence of poor sleep quality ranged from 25.6% to 75.5%, with a high pooled prevalence and substantial heterogeneity (I 2 > 75%, Q-test p < 0.001). Consistently reported occupational factors included night shifts and rotating work schedules, while individual and psychological factors such as female gender, depression, anxiety, and stress were strongly associated with poor sleep quality. Lifestyle-related factors, including obesity and substance use, were also frequently reported. Sensitivity analyses demonstrated robust results, and no significant publication bias was detected. Conclusion Poor sleep quality among nurses in African countries is highly prevalent and is influenced by a combination of occupational, psychological, and behavioral risk factors. Context-specific interventions targeting shift work organization, mental health support, and lifestyle modification are urgently needed to improve nurses' well-being, patient safety, and healthcare service quality.