Protocol registration
This study follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines to ensure transparency and methodological rigor [9]. The protocol has been officially registered in the International Prospective Register of Systematic Reviews (PROSPERO) under registration number CRD42025643365.
Search strategy
A systematic search was conducted across multiple electronic databases, including PubMed, CINAHL, Google Scholar, and African Journals Online. The search strategy incorporated Medical Subject Headings (MeSH) and relevant keywords related to sleep quality, depressive symptoms, anxiety, stress, and Ethiopian women, ensuring comprehensive coverage. To eliminate duplicate records, the results were systematically screened and managed using Mendeley [10]. Two researchers individually screened titles and abstracts of studies. Any differences in their valuations were resolved through argument with a third researcher. A comprehensive search was conducted across all electronic sources, covering studies published up to February 2025. The Boolean operators OR & AND were used to retrieve more precise and relevant results. The detailed search strategy of databases is available in Supplementary File 1.
Eligibility criteria
Inclusion criteria
Studies will be included if they meet the following criteria: (a) conducted among reproductive age women in Ethiopia, (b) assessed both sleep quality, depressive symptoms, anxiety and stress (c) used validated measures to assess sleep quality and common mental disorders, and (d) reported the association between sleep quality and common mental disorders. To simplify the searching strategy and organization of search terms, this study is employed following the condition, context and population (CoCoPop) framework.
Conditions
The conditions were poor sleep quality, common mental disorders (depression, anxiety and stress).
Context
Ethiopia.
Population
All reproductive age women.
Language
English.
Study design
Observational studies.
Exclusion criteria
The following types of studies were excluded: (a) Studies on whole population, (b) studies that lacks enough statistical data to be extracted, (c) randomized controlled trials, systematic review and meta-analysis, editorials, conference abstracts and opinions were excluded.
Outcome measures
This study aims to achieve two key outcomes: first, to determine the overall prevalence of poor sleep quality among reproductive-age women in Ethiopia, and second, to assess how sleep disturbances are linked to common mental disorders such as depression, anxiety, and stress in this population.
Selection of studies
Two researchers evaluated the studies based on eligibility criteria. Firstly, the authors assessed titles and abstracts of the searched. The full texts were systematically screened for eligibility. Additionally, the rationale for the inclusion and exclusion of studies is documented in the PRISMA diagram. Lastly, the nominated studies were compiled for data extraction and analysis in the systematic review and meta-analysis.
Data extraction
Data extraction is done by two researchers independently. There was pretest the data extraction form on two pilot surveyed studies, to facilitate the collection of all necessary data required for the valuable systematic review and meta-analysis. Disagreements were handled by discussion. We extracted the following: first author’s last name, year, region, the study design, number of poor sleep quality cases, sample size, sampling method, instrument, study population, average age and prevalence of poor sleep quality and its level of association with CMDs such as depression, anxiety and stress.
Risk of bias assessment
Two researchers independently assessed the quality of the included studies using the Newcastle-Ottawa Scale (NOS) [11]. This evaluation considered three key parameters: selection, comparability, and assessment of exposure/outcome. Studies scoring below 5 were classified as low quality, those scoring 5–7 as moderate quality, and those with more than 7 as high quality [12]. Only studies rated moderate or higher were included in this analysis.
Data synthesis
The extracted data in Microsoft Excel were imported to Stata version 14.0 (Stata Corp, Collage Station, Texas, USA) software to conduct the meta-analysis. We calculated pooled prevalence with 95% confidence interval (CI) by using random-effect model with the generic inverse variance method. Assessment of heterogeneity was checked by I2 and Cochran’s Q-statistic [13, 14]. Subgroup analyses were performed by regions, year of publication and sampling methods used in individual studies to decide the source of heterogeneity. Publication bias was checked by DOI plot and Luis Furuya Kanamori (LFK) and Egger’s test. The DOI plot and the LFK index tools were used to determine asymmetry of studies with small sample size. According to the LFK index, a value outside the interval − 1 and 1 were considered as asymmetry (i.e., publication bias) [15].