2025 Articles

Determinants of sleep quality among women living in informal settlements in Kenya

Ukoh, Ebula; Achieng, Stephanie O.; Plaxico, LaNae; Balakrishnan, Anna K.; Obara, Lena M.; Dzombo, Millicent; Ramchal, Meagan; Amponsah, Enoch; Brown, Haley; Musyimi, Christine; Witte, Susan S.; Winter, Samantha C.

Background
Sleep plays a critical role in overall health and well-being. While most sleep research focuses on high-income countries, there is limited knowledge about sleep quality in Sub-Saharan Africa (SSA), especially among women living in urban informal settlements. Many factors, including physical, psychological, cultural, and environmental influences, can affect sleep quality. This study, which uses Bronfenbrenner’s ecological model, aims to explore the prevalence of sleep disturbances and self-reported factors associated with poor sleep quality among a representative sample of 800 women living in two informal settlements in Nairobi, Kenya.

Methods
The data, collected in September 2022, are from the baseline assessment of an 18-month longitudinal cohort study examining mental health and climate change among women living in two informal settlements in Nairobi–Mathare and Kibera. Items from the Brief Pittsburgh Sleep Quality Index (B-PSQI) were collected to examine women’s sleep habits and quality. Quality of sleep scores were calculated. We used t-tests, bivariate regressions, and ANOVAs to assess the bivariate associations between key predictors of poor sleep with the Brief Pittsburgh Sleep Quality Index (B-PSQI) score. We also conducted a cross-sectional multivariable regression analysis to explore the factors influencing sleep disturbances. Open-ended questions were asked about factors contributing to sleep disturbance, and a thematic analysis was conducted to summarize the findings.

Findings
29% of women (N = 229) met the criteria for poor-quality sleep. Open-ended findings identify stress as the main factor affecting sleep. Childcare, financial instability, physical health, climate, grief, and loss also impacted women’s sleep. Significant quantitative predictors of poor sleep quality among women included the severity of disability, depression, and food insecurity. Anxiety also showed a trend toward significance, underscoring the complex interplay of physical, mental, and socioeconomic factors on sleep.

Interpretation
This study underscores the need for further research on sleep quality among women in SSA’s informal settlements. By enhancing understanding and awareness of sleep’s health impacts, policymakers and interventionists can develop more effective interventions tailored to the unique challenges faced by this population. Our findings contribute to the knowledge base, supporting the creation of targeted policies and practices that address and improve sleep quality for women in these communities.