Sleep is a naturally recurring physiological process that is important for psychological, physical, and emotional well-being (1). Sleep is also an important role in cognitive functions like judgment and memory consolidation, and vital for academic performance (2). Sleep quality is a combination of quantitative and qualitative aspects, including duration and subjective feeling of restfulness upon awakening (3). Africa is a continent that is bounded by the Mediterranean Sea to the north, the Indian and Atlantic Oceans to the east, the Atlantic Ocean to the west, and the confluence of the two oceans to the south (4). According to recent studies, non-communicable illnesses (NCDs), such as sleep disorders, are becoming more common at an alarming rate across Africa, placing a strain on healthcare resources in addition to communicable diseases (5). Due to factors including urbanization, socioeconomic development, and globalization, NCDs are becoming more common among young Africans. Taking care of these risk factors in today’s youth can drastically change how NCDs are expected to develop in Africa (5–8). Nowadays, the majority of young individuals sleep for shorter periods of time than what is advised by science (9). Good sleep quality at night facilitates the brain’s physiological repair processes and nerve cell growth. Regular engagement in these processes enhances an individual’s memory and learning capacity (10, 11). Due to a lack of resources for education, young adults in Africa typically perform worse academically, especially if they live in rural areas (12). However, African students with lesser academic standing may experience sleep disturbances as a result, particularly if they attempt to find work and their grades fall short of most employer imposed requirements (13).

Poor sleep quality is a common problem for university students, and it has a detrimental effect on their academic performance (14, 15). Compared to the general population, university students had a twofold higher prevalence of poor quality of sleep (16). This is brought on by the change from high school to college, the lessening of the role of parents, and higher expectations for academic achievement (17, 18). Poor sleep quality was found to be highly prevalent among medical students 55.64% according to a global meta-analysis study (19). A cross-sectional study was carried out in seven countries the Dominican Republic, Egypt, Guyana, India, Mexico, Pakistan, and Sudan, and the prevalence of sleep quality among university students was found to be 73.5% (20). These rates are greater than those of the general population (21, 22). A complicated interaction between genetics, academic load, technology, environmental conditions, and comorbidities is blamed for this problem. In general, it has been noted that a sizable percentage of students have trouble sleeping, which may be connected to stress from their studies (22, 23).

Poor sleep quality among university students can lead to mental and physical health issues (24). Students who have poor quality of sleep typically report common mental health issues, which many will probably need to get support for in order to successfully resolve. Poor quality of sleep has an impact on several aspects of behavior, including executive function, hormone balance, emotional control, and attentiveness. Numerous studies that involved depriving small groups of healthy individuals of all sleep for one or two nights revealed a wide range of specific abnormalities (24–26). Among the findings in the field of emotional regulation is a rise in psychopathology symptoms, like depression (27–31), anxiety (28, 29), and stress (32–34) including substance use (18, 35). Sleep is also crucial for learning and memory processes. Nonetheless, there is still much to learn about the specifics of the connection between sleep and memory formation. According to the dual process theory, declarative memory may require non-REM sleep, and procedural memory may require rapid eye movement (REM) sleep. This is because different forms of memory are associated with different sleep states (36, 37). Therefore, poor sleep can impair attention, concentration, and memory and all this leads to poor academic performance (2, 36, 38, 39). It also leads to metabolic, hormonal, and immunologic effects, causing immune suppression (40–42). Undergraduate students often experience poor sleep quality due to various factors, including irregular sleep schedules fatigue, and co-morbid chronic illness (43, 44). Sleep disturbances can worsen a person’s quality of life in addition to contributing to the early onset of chronic diseases (45). Factors such as internet addiction, substance use, depression, stress, and poor academic performance (20, 35, 46–48) are associated with poor sleep quality. New social and academic environments, reduced parental supervision, and increased academic demands contribute to poor sleep quality among this population (18, 22, 49).

Poor sleep quality among college students in African countries is a significant issue, with mixed findings across studies. It is crucial to investigate patterns of poor sleep quality to create efficient interventions and reduce the likelihood of the detrimental effects associated with poor sleep quality, such as school dropout, poor academic performance, suicide, burnout, depression, and anxiety. To date, no meta-analysis, and systematic review has been carried out to investigate the prevalence of poor sleep quality among this population. To better understand the prevalence and associated factors of poor sleep quality among university students in African countries, we did a thorough meta-analysis and systematic review study.

The current meta-analysis and systematic review was registered (ID CRD42023493140) in the Prospective Register of Systemic Review (PROSPERO). Our search strategy and selection of publication for the review were conducted according to the (PRISMA 2020) guideline (50) ( Additional File 1 ).

Sleep is an important physiological process for humans. University students in African countries often report poor quality of Sleep due to changing social opportunities and increasing academic demands. However, the results of poor sleep quality among university students across nations and in between different studies vary. This systematic review and meta-analysis of 35 studies aimed to estimate the pooled prevalence and associated factors of poor sleep quality among university students in 11 African countries.

In this meta-analysis and systematic review, the pooled prevalence of poor sleep quality was found to be 63.31% with a 95% CI (56.91-65.71). This result is in line with findings from other studies. According to a systematic review and meta-analysis, which was done to determine the global prevalence rate of poor sleep quality among university students, the result was 57% (89). The current finding is also comparable with a systematic review and a meta-analysis study conducted among Korean University Students yielded 59.2% (90). A global systematic and meta-analysis study of the general population found that 57.3% of respondents had poor sleep quality, which was consistent with the findings of the current study (91).The results of a systematic review of twelve studies among Indian university students range from 25 to 72%, which is consistent with the findings of the current meta-analysis on poor sleep quality among students in Africa (92).

On the contrary, the current finding was significantly higher than with a different systematic review and meta-analysis study that was carried out at a different period. For instance, in a global systematic review and meta-analysis study conducted on sleep disruption in medicine students and its relationship with impaired academic performance, 39.8% of them reported having poor sleep quality (93). The prevalence of poor sleep quality was 51.45% in the global systematic review and meta-analysis study on the prevalence of sleep problems among 59427 medical students from 109 Studies (19). However, the sub-group analysis in the current meta-analysis studies showed that the prevalence of poor sleep quality, specifically among African medical students was 60.33 (95% CI: 54.96-65.69). In a comprehensive meta-analysis of observational studies among 24,884 medical students across 50 studies, the prevalence of poor sleep quality was 52.7% (94). The current finding is also higher than the results of previous meta-analyses that were carried out in 28 different countries, with results of 9.6% (95), 55.6% in a global meta-analysis (19), 53% in the Ethiopian population (96), 51.0% in Brazil (97), 24.1% in China (98), and 43.4% in US college students (99). A review of the causes of poor sleep quality in African young dults indicates that poor sleep quality is higher in Africa than other continents (45). When young African people do manage to get into committed partnerships, they often wind up spending a large portion of their evenings on social media (100). Some of them may indulge in drug and alcohol abuse with several partners, frequent clubs, or spend a significant portion of their sleep hours in sexual activities (100, 101). Because of this, most young adults may suffer from sleep deprivation and excessive daytime sleepiness as their bodies attempt to harmonize their naturally delayed schedule with their daily social schedules and activities at school (102). The other possible reason could be the impact that an individual’s race or ethnicity has on the quality of their sleep. It follows that mental health concerns and sleep disturbances are related health problems. According to two studies, black people are more likely to have sleep problems, which raises the likelihood of poor sleep quality in Africa (45, 103, 104).

Poor sleep quality among university students is also higher in Africa than in other studies because of the different genes involved in sleep activity (105–107), and the immune system (108–110) that Africans have. The other explanation could be because health care providers, insurance companies, governments, and the general population in Africa have little knowledge about sleep disorders and the grave repercussions they can have. One of the main problems in many African countries is the state of the health and insurance systems. The low socioeconomic level is frequently accompanied by a lack of sleep labs, clinics, and diagnostic equipment as well as a high cost of medications (111, 112).

However, the current finding is lower than a multinational cross-sectional study involving medical students during the COVID-19 pandemic, which found that 73.5% of students had poor sleep quality (20). The COVID-19 pandemic has led to increased stress, anxiety, and psychological distress among students, potentially affecting their sleep quality. The restrictions and fear of infection also led to a negative mood, which can negatively impact sleep quality. The virus primarily targets the respiratory system, and sudden outbreaks, rising death counts, and social disruptions have contributed to a decline in sleep quality. The pandemic indirectly affects college students’ moods and sleep quality (113–117).

Regarding factors affecting poor sleep quality among university students, three of the included studies in this meta-analysis study disclosed that students who have been stressed were more likely to have poor sleep quality as compared with non-stressed. The pooled result of this meta-analysis indicated that stressed students were about 1.4 times more likely to have poor sleep quality as compared to their counterparts. University students’ various activities and stressors, including studying during the night, can lead to poor sleep quality due to psychological distress (118). Compared to other students, especially medical students, they experience stress more frequently. Medical students face a stressful environment due to academic requirements and workload. They often reduce sleep to cope with the demands, leading to poor mental and physical health. Factors such as on-call duties, disease contact, and examinations contribute to this stress. Consequently, they may not prioritize sleep, leading to poor sleeping quality (34, 119). Stress plays a big role in how well people sleep, and many stresses from daily lifeare associated with poor sleep. For example, a longitudinal study of people with good sleep quality at baseline found that the most significant predictors of disrupted sleep at follow-up were daytime stress level and nighttime worries (120). Similar to this, as measured by polysomnography, healthy volunteers who experienced higher levels of stress at work had substantially more fragmented sleep and lower sleep efficiency (121). Chronic activation of stress responses, such as the sympathetic-adrenal-medullary axis and hypothalamic-pituitary-adrenal axis, can produce epinephrine and cortisol, known as stress hormones. This stress hormone has a negative effect on students sleep quality and their academic performances (118, 122). Uncontrollable worries about stress events trigger emotional arousal, leading to cognitive biases and distorted evaluations, resulting in subjective sleep quality decline (123–126).

In this meta-analysis, the year of study is also one of the factors contributing to poor sleep quality among university students. The year 2 students were more than 3 times to have poor sleep quality compared with students in other academic years. Several other investigations also discovered that the distribution of sleep quality varied across the years of study. A study in Saudi Arabian and Brazilian students showed that the odds of having poor sleep were significantly higher among second and fourth-year students (127, 128). However, according to a study in Greece, sixth-year medical students were more odds to have poor sleep quality than other students (129). A study conducted at a Chinese university revealed that fifth-year students were more negatively impacted by sleep deprivation (130), while other studies found no differences in the general quality of sleep by academic years (131). This variety may be the result of variations in the curriculum used in different countries and universities, as well as differences in social and academic demands (58, 132).

University students who use electronic devices at bedtime had approximately four times higher rates of poor sleep quality than their counterparts. This study is supported by a global meta-analysis study in which using electronic devices like smartphones was associated with poor sleep quality (133). Excessive use of electronic devices is significantly associated with poor sleep quality, according to two further global meta-analyses, one of which was conducted on medical students and the other on adolescents (89, 134). The quality of sleep is greatly impacted by using electronic devices before and during bedtime, including computers, music players, televisions, social networking sites, and cell phones. Intimate relationship-seeking young adults in Africa often find themselves interacting with their partners on mobile social media platforms like Facebook, Instagram, Snapchat, WhatsApp, and TikTok late at night, before going to bed early the next day (135, 136). Regular use of such material thus increases the likelihood of prolonged sleep onset, short duration, and extended start latency (136–138). There are physiological changes in students’ circadian rhythm and homeostatic sleep patterns. Because of this, the majority of young adults may experience sleep deprivation and excessive fatigue during the day as their bodies try to adjust to their naturally delayed schedule in order to fit in with their everyday social routines and academic obligations (102, 139). Researchers have hypothesized that using mobile devices also affects the quality of one’s sleep through a variety of mechanisms, including electromagnetic fields emitted by the device, which change melatonin rhythms, cerebral blood flow, and other related brain activities recorded in waking electroencephalograms (136, 140–142).

In this systematic review and meta-analysis study, a substantial association between having comorbid medical illness and poor sleep quality was also found. The prevalence of poor sleep quality among students was 2.7 times more common among students who had comorbid medical illnesses than those who did not. This was supported by a worldwide investigation involving seven nations as well as a US study on multi-campus students (20, 99). Poor sleep quality can also be brought on by the stress of a chronic condition. Heartburn, which is brought on by stomach acid backing up into the esophagus, is frequently linked to trouble sleeping. Uncontrolled diabetes can also contribute to trouble sleeping through night sweats, and frequent urination. Students with heart failure may experience dyspnea when they wake up in the middle of the night. People with arthritis pain may find it difficult to go off to sleep. Furthermore, a variety of over-the-counter and prescription drugs used to address these and other health issues might lower the quality of sleep (143–145).

The study’s strength lies in its pooled effect of multiple studies (35 articles) and large sample size of 16,275 university students. Additionally, we included articles from all regions of Africa (North, South, East, and West) to help generalize the findings throughout the continent. The study’s limitations include the fact that the age range was not adequately defined in the primary studies included in the review and meta-analysis and that only English-language publications were taken into consideration because of language bias. This review revealed significant between-study heterogeneity. Other than the ones currently listed, there may be more factors contributing to heterogeneity.

According to this study, there is a high pooled prevalence of poor sleep quality among university students in Africa. Being stressed, using electronic devices in bed, being a second year, and having concomitant medical conditions were all associated with poor sleep quality. Thus, early detection and adequate intervention are important for improving sleep quality among university students. The establishment of academic counseling centers with an emphasis on improving sleep quality, bolstering students’ study skills, and helping them cope with their stressful surroundings is advised for the management of the sleep quality of university students. University students can also benefit from improved physical health and reduced stress levels to get better sleep. Students are also recommended to limit their use of electronic devices, such as smartphones, right before bed.

The original contributions presented in the study are included in the article/ Supplementary Material . Further inquiries can be directed to the corresponding author.

GN: Conceptualization, Formal analysis, Investigation, Methodology, Project administration, Supervision, Writing – original draft, Writing – review & editing. GMT: Data curation, Formal analysis, Investigation, Methodology, Writing – original draft, Writing – review & editing. GR: Methodology, Writing – original draft, Writing – review & editing. FA: Data curation, Investigation, Methodology, Writing – original draft, Writing – review & editing. TT: Methodology, Writing – original draft. MAK: Data curation, Investigation, Writing – original draft. GT: Formal analysis, Writing – original draft, Writing – review & editing. SF: Formal analysis, Methodology, Writing – original draft, Writing – review & editing. YW: Formal analysis, Methodology, Writing – original draft, Writing – review & editing. TS: Formal analysis, Methodology, Writing – original draft. GK: Formal analysis, Investigation, Writing – original draft, Writing – review & editing. MM: Formal analysis, Investigation, Methodology, Writing – original draft, Writing – review & editing.