SLEEP QUALITY AND ASSOCIATED FACTORS AMONG PREGNANT WOMEN ATTENDING ANTENATAL CARE IN PUBLIC HOSPITALS OF MEKELLE CITY, TIGRAY, ETHIOPIA, 2025

Abstract

Background: Sleep is a vital physiological process that supports maternal and fetal health during pregnancy. However, pregnant women are vulnerable to sleep disturbances because of hormonal, physical and psychological changes, which have been linked to negative health consequences including gestational diabetes mellitus, hypertension, preterm delivery, low birth weight, and postpartum depression. Despite this, evidence on sleep quality and its associated factors is limited in the Tigray region. Objective: To assess sleep quality and associated factors among pregnant women attending antenatal care services at public hospitals of Mekelle City, Tigray, Ethiopia, in 2025. Methods: The study was conducted from October 20 to November 18, 2025 using a mixed methods approach. A total of 282 pregnant women were selected using systematic random sampling. Data were collected through face-to-face interviews using structured and pre-tested questionnaire and sleep quality was measured using the standardized Pittsburgh Sleep Quality Index. Data were analyzed using SPSS version 26, and binary logistic regression was used to identify factors linked with poor sleep quality. Variables with a p < 0.25 in the Bivariable analysis were included in the multivariable logistic regression, and statistical significance was declared at a p < 0.05. For the qualitative component, ten in-depth interviews were conducted using convenience sampling, and data were analyzed using inductive thematic analysis. Results: The prevalence of poor sleep quality was 51.4% (95% CI= 45.6-57.3). Factors significantly associated with poor sleep quality were maternal Age ≥30 [AOR=9.56, 95%CI (2.96 -30.93)], pain [AOR=3.08, 95%CI (l.07-8.90), anxiety [AOR=7.60, 95%CI (2.00-28.93)], IPV [AOR=10.41, 95%CI (3.37-32.20)], and stress [AOR=3.74, 95%CI (1.02-13.75)] Qualitative findings revealed varied sleep experiences among pregnant women influenced by physical discomfort, psychological distress, and environmental factors, while personal coping strategies and family support helped to improve sleep. Conclusion and Recommendations: Poor sleep quality during pregnancy is a significant concern. The findings of this study reflect the combined influence of physical, psychological, and social factors on maternal sleep. Integrating sleep and mental health assessment in to routine antenatal care is essential to improve maternal sleep health during pregnancy.