Abstract
OBJECTIVES: Few studies have assessed sleep among African adolescents. We aim to understand factors associated with subjective sleep quality among female Ugandan adolescents and the association of poor sleep quality with subsequent menstrual- and mental health, and educational performance. METHODS: We analyzed data from a cluster-randomized controlled trial that evaluated a menstrual health intervention in 60 Ugandan secondary schools. Data were collected through cross-sectional surveys at baseline (March-June 2022) and endline (July-August 2023), and prospective daily diaries (April-August 2023). We used logistic regression to analyze associations with poor sleep at baseline, and linear regression to analyze associations of poor sleep with subsequent menstrual and mental health, and education performance, adjusting for clustering. RESULTS: Of 3841 female participants (mean age=15.6years), 580 (15.1%) reported poor sleep quality and 829 (21.6%) reported feeling tired at baseline. Poor sleep was associated with socio-economic factors including smaller household size, lower socioeconomic status, and fewer meals consumed the previous day. There was strong evidence that poor sleep at baseline was associated with multiple dimensions of poor menstrual health including menstrual pain (adjusted odds ratio=1.74, 95%CI 1.29-2.33), more unmet menstrual practice needs (adjusted odds ratio=2.68, 95%CI 1.99-3.60), and with mental health problems (adjusted odds ratio=2.40, 95%CI 1.80-3.19). Results were similar for baseline tiredness. Prospectively reported poor sleep quality was associated with subsequent poor menstrual and mental health, and subsequent poor educational performance. CONCLUSIONS: Poor sleep is prevalent among in-school female Ugandan adolescents and is associated with subsequent poorer menstrual health, mental health, and educational performance. Improving sleep in this population could benefit menstrual health, mental health and education outcomes.