thesis on leadership in ethiopia pdf

Leadership in Ethiopia

• First Online: 05 November 2016

Cite this chapter

• Abeba Beyene Mengistu 6 &
• Terri R. Lituchy 7  

Part of the book series: Palgrave Studies in African Leadership ((PSAL))

1001 Accesses

1 Citations

The objective of this chapter is to provide vital and well-researched information on indigenous and modern leadership practices and investment opportunities in Ethiopia. Secondary data was obtained from research articles, books, newspapers, and the Internet. Semi-structured interviews were conducted with two foreign and two local leaders. Findings indicate the existence of well-established and currently exercised indigenous and modern leadership practices in the country. Ethiopians were basically described as a very hospitable and respectful people having high self-respect and self-pride. Both secondary and primary data analysis confirm the suitability of the country for investments because of the prevailing huge investment opportunity, political stability, peace and self-security, sufficiently knowledgeable and experienced human resources, and the friendly nature of the Ethiopian people.

A powerful friend becomes a powerful enemy. (Ethiopian Proverb)

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

• Available as EPUB and PDF
• Read on any device
• Instant download
• Own it forever
• Compact, lightweight edition
• Dispatched in 3 to 5 business days
• Free shipping worldwide - see info
• Durable hardcover edition

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Addis Ababa Chamber of Commerce and Sectoral Associations (AACCSA). (2013). Overall background. Retrieved from http://tradedirectory.addischamber.com/countryprofile.php

Adeyemi, T. O., & Adu, E. T. (2013). Head teachers’ leadership styles’ and teachers job satisfaction in primary schools in Ekiti State, Nigeria. International Journal of Academic Research in Economics and Management Studies, 2 (2), 69–79.

Google Scholar  

AFP. (2015, July 24). Barak Obama leaves US for trip to Kenya, Ethiopia. The East African . Retrieved from http://www.theeastafrican.co.ke/news/Obama-leaves-US-Africa-trip-Kenya-Ethiopia--/-/2558/2805576/-/n7f9vhz/-/index.html

Alemnew, Z. (2012, August 19). Interview: Zumara Nuru, the founder of Awara Amba Community. Horn Affairs English. Retrieved from http://hornaffairs.com/en/2014/08/19/zumra-nuru-awra-amba-community/

Alemu, L. Akalu. (2012). A study of socio-cultural identity and adjustment of Ethiopian immigrants in Atlanta (Masters Thesis). Clark Atlanta University, Atlanta.

Alemu, A., Belay, E., Padmaja, K., & Gessesse, T. (2013). Socio-cultural sustainability of the Awra Amba community, and its implications for intervention. International Journal of Innovative Research and Development, 2 (10), 117–120.

Assefa, H., Bienen, D., & Ciuriak, D. (2013). Ethiopia’s investment prospects: A sectoral overview. African Review of Economics and Finance, 4 (2), 203–246.

Atlaw, D., Teklemariam, D., & Dong-Geun, H. (2014). Determinants of foreign direct investment: Reflections from Ethiopia. Social and Basic Sciences Research Review, 2 (2), 85–95.

Baker, C., & Campbell, B. (2013, November). Context matters: An Ethiopian case study. Adapting leadership development methods to serve different cultures. Center for Creative Leadership . Retrieved from http://insights.ccl.org/wp-content/uploads/2015/04/ContextMatters.pdf

Billene. (2014). Ethiopia’s first female deputy prime minister . African Feminism . Retrieved from http://africanfeminism.com/2014/04/11/ethiopias-first-female-deputy-pm/

Birhanu, F. M. (2014). Country report: Ethiopia—Green growth, investment, environment and sustainable development in Ethiopia. IUCNAEL Journal . Retrieved from www.iucnael.org/en/documents/1155-ethiopia/file

Bongela, M. (2012, June 27). Warm-hearted hospitality sets Ethiopia apart. Mail & Guardian . Retrieved from http://mg.co.za/article/2012-05-18-warm-hearted-hospitality-sets-ethiopia-apart

CSA. (2015). Central statistics agency of Ethiopia. Retrieved from http://www.csa.gov.et

Deloitte. (2014). Ethiopia, a growth miracle. Ethiopian Investment Commission . Retrieved from http://www2.deloitte.com/za/en/pages/strategy/articles/ethiopia-growth-miracle.html

Duressa, Z., & Asfaw, M. (2014). Transformational leadership and its applications in the public service organizations of Ethiopia. International Affairs and Global Strategy, 23 , 10–29.

Duressa, Z., & Debela, T. (2014). Leadership effectiveness in public service organizations of Ethiopia: Perceptions of leaders in public service organizations. Journal of Law, Policy and Globalization, 26 , 115–129.

Ekor, M., Adeniyi, O., & Saka, J. (2015). Ethiopia and the BRICS: An assessment of trade and investment flows. Economy , 2(1), 1–9. Retrieved from http://www.asianonlinejournals.com/index.php/Economy/article/view/254/pdf_13

Ethiopian Investment Commission. (2015). Strategic sectors. Retrieved from http://www.investethiopia.gov.et/investment-opportunities/strategic-sectors/ .

Fernandes, C., & Awamleh, R. (2004). The impact of transformational and transactional leadership styles on employee’s satisfaction and performance: An empirical test in a multicultural environment. International Business and Economics Research Journal, 3 (8), 65–76.

Firsing, S. (2015, July 17). Obama’s visit to strengthen America’s ties in East Africa. The Conversation . Retrieved from http://theconversation.com/obamas-visit-to-strengthen-americas-ties-in-east-africa-41740

Gebre-Medhin, S. (2015, March 4). Ethiopia: Ethiopian Herald interview with Prof Ephraim Issac. The Ethiopian Herald . Retrieved from http://nazret.com/blog/index.php/2015/03/04/ethiopia-ethiopian-herald-interview-with

Halpern, O. (2007, August 21). In Ethiopia, one man’s model for a just society. The Christian Science Monitor . Retrieved from http://www.csmonitor.com/2007/0821/p01s02-woaf.html

Hanges, P. J., Dorfaman, P. W., Shteynbrg, G., & Bates, A. L. (2006). Culture and leadership: A connectionist information processing model. Advances in Global Leadership, 4 , 7–37.

Article   Google Scholar  

Hofstede, G. (2001). Culture’s consequences: Comparing values, behaviors, institutions and organizations across nations (2nd ed.). Beverly Hills, CA: Sage.

Hora, E. A. (2014). Factors that affect women participation in leadership and decision making positions. Asian Journal of Humanity, Art and Literature, 1 (2), 98–118.

India Today. (2013). Narendra Modi when six-year-old sold tea at Vadnagar station, says a new book. Retrieved from http://indiatoday.intoday.in/story/narendra-modi-sold-tea-at-vadnagar-station-says-new-book/1/286117.html

Karbo, T. (2013). Religion and social cohesion in Ethiopia. International Journal of Peace and Development Studies, 4 (3), 43–52.

Kotter, J. P., & Schlesinger, L. A. (1992). Choosing strategies for change. In J. J. Gabarro (Ed.), Managing people and organizations (pp. 395–409). Boston: Harvard Business School Publication.

Kuhnert, K. W., & Lewis, P. (1987). Transactional and transformational leadership: A constructive/developmental analysis. Academy of Management Review, 12 (4), 648–657.

Lunenburg, F. C. (2011). Leadership versus management: A key distinction—At least in theory. International Journal of Management, Business and Administration, 14 (1), 1–4.

Machumu, H. J., & Kaitila, M. M. (2014). Influence of leadership styles on teachers’ job satisfaction: A case of selected primary schools in Songea and Morogoro Districts, Tanzania. International Journal of Educational Administration and Policy Studies, 6 (4), 53–61.

Ministry for Foreign Affairs of Finland. (2014). Country strategy for development cooperation with Ethiopia: 2014–2017. Retrieved from http://formin.finland.fi/public/download.aspx?ID=137909&GUID=%7BA1BB9117-A768-42B0-A5E5-0D179FFE68BD%7D

Nigussie, N., & Demissie, A. (2013). Relationship between leadership styles of nurse managers and nurses’ job satisfaction in Jimma University Specialized Hospital. Ethiopian Journal of Health Science, 23 (1), 49–58.

Northouse, P. G. (2010). Leadership: Theory and practice (5th ed.). Thousand Oaks, CA: Sage.

Okock, O., & Asfaw, M. (2014). Assessment of gender equality in Ethiopia: The position of Ethiopian women’s political representation from the world, Sub-Saharan Africa, and Eastern Africa Ethiopian Civil Service University. Journal of Law, Policy and Globalization, 28 , 102–124.

Okorojo, L. I., Anyanwu, O. J., & Ukpere, W. I. (2014). Impact of leadership styles on teaching and learning process in Imo State. Mediterranean Journal of Social Sciences, 5 (4), 180–193.

Omar, W. A., & Hussin, F. (2013). Transformational leadership style and job satisfaction relationship: A study of structural equation modeling (SEM). International Journal of Academic Research in Business and Social Sciences, 3 (2), 346–365.

Roul, S. K. (2012). Practice and Problems of Principals’ Leadership Style and Teachers’ Job Performance in Secondary Schools of Ethiopia. e-Reflection. An International Multidisciplinary Peer Reviewed E Journal.1 (4), Pages, 227–243.

Sadeghi, A., & Pihie, A. (2013). The role of transformational leadership style in enhancing lecturers’ job satisfaction. International Journal of Business and Social Science, 4 (8), 264–271.

Shibru, B., & Darshan, G. M. (2011). Transformational leadership and its relationship with subordinate satisfaction with the leader (The Case of Leather Industry in Ethiopia). Interdisciplinary Journal of Contemporary Research in Business, 3 (5), 686–697.

Stogdill, R. M. (1974). Handbook of leadership . New York: Free Press.

Tadesse, D. (2013, November 16). The rule of law in the indigenous traditional Gada system. AllAfrica. Retrieved from http://allafrica.com/stories/201311260190.html

Tsegay, T. S. (2012). Some Ethiopian women leaders’ perceptions about their leadership. Advancing Women in Leadership, 33 , 75–86.

Wahab, J. A., Fuad, C. F., Ismail, H., & Majid, S. (2014). Headmasters’ transformational leadership and their relationship with teachers’ job satisfaction and teachers’ commitments. International Education Studies, 7 (13), 40–48.

Waters-Bayer, A. (2003). Daldal: Dams to trap silt and water, on Irob innovation in northern Ethiopia. United Nations Educational Scientific and Cultural Organization . Retrieved from http:// www.unesco.org/most/bpik9-2.htm

Yahaya, N., Mohammad, A., Talib, M., Ismail, J., Shariff, Z., Yahaya, A., et al. (2011). Relationship between leadership personality types and source of power and leadership styles among managers. African Journal of Business Management, 5 (22), 9635–9648.

Zewdu, B. (2002). Systems of local governance among the Gurage: The Yajoka Qicha and the Gordana Sera in Ethiopia. In B. Zewdu & S. Pausewang (Eds.), The challenge of democracy from below (pp. 17–28). Stockholm: ElandersGotab.

Download references

Author information

Authors and affiliations.

Addis Ababa University, Addis Ababa, Ethiopia

Abeba Beyene Mengistu

CETYS Universidad, Mexicali, Baja California, Mexico

Terri R. Lituchy

You can also search for this author in PubMed   Google Scholar

Corresponding author

Correspondence to Abeba Beyene Mengistu .

Copyright information

© 2017 The Author(s)

About this chapter

Mengistu, A.B., Lituchy, T.R. (2017). Leadership in Ethiopia. In: LEAD: Leadership Effectiveness in Africa and the African Diaspora. Palgrave Studies in African Leadership. Palgrave Macmillan, New York. https://doi.org/10.1057/978-1-137-59121-0_12

Download citation

DOI : https://doi.org/10.1057/978-1-137-59121-0_12

Published : 05 November 2016

Publisher Name : Palgrave Macmillan, New York

Print ISBN : 978-1-137-59119-7

Online ISBN : 978-1-137-59121-0

eBook Packages : Business and Management Business and Management (R0)

Share this chapter

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

• Publish with us

Policies and ethics

• Find a journal
• Track your research

Academia.edu no longer supports Internet Explorer.

To browse Academia.edu and the wider internet faster and more securely, please take a few seconds to  upgrade your browser .

Enter the email address you signed up with and we'll email you a reset link.

• We're Hiring!
• Help Center

Governance and Leadership Practices and Challenges in Ethiopia. The Case of Dukem Town, Oromia Regional state

Governance is a concept more inclusive than traditional government and administration and reflects the fact that increasingly there is a much wider range of participants in these processes than was traditionally the case. The attainment of good governance is a function of effective leadership. Leadership focuses on the accomplishment of the mission and goals of particular organization where the performance of leaders is measured by the delivery of products and services to meet the needs of its customers by ensuring effectiveness, openness, accountability, and participatory decision-making. The purpose of this study is to assess the impact of leadership on governance effectiveness in Dukem town. The population of this study were development team coordinators, representatives of private business organizations, and community institutions of the town. In addition, cabinet members and civil servants of the town administration were the target population for the source of data in this asse...

Related Papers

Fikre Fikadu Fufa

Leadership is an essential feature of all government and governance: weak leadership contributes to government failures, and strong leadership is indispensable if a government is to succeed (Masciulli, 2009). A good leader must be able to render selfless service and desist from selfishness, he must make provision for training and empowering his people and encourage self-employment, he must be serious about issues that concern the youths as they are the future leaders and should not look down on the adults. There abound different styles of leadership with attendant different effects. Effective leadership is helpful in ensuring organizational performance and in solving the challenges of good governance. As a result, many leadership theories have been proposed in the last fifty years which are claimed to have influenced the effectiveness of organizations where they have been employed through employee performance (Obasan and Banjo 2014).

Fikre Fikadu Fufa , Professor, Dr. Bhaskar Pillalamarri

Leadership is an essential feature of all government and governance: weak leadership contributes to government failures, and strong leadership is indispensable if a government is to succeed. The main directions of Stakeholders and public participation, strengthening democratic system and national consensus to be pursued during GTP II are building, strengthening and consolidating the system of democracy and good governance throughout the nation. Good governance is one of the pillars for rapid economic, social and political development. The FDRE in its countrywide strategic plans (PASDEP, currently GTP) highly emphasized the need to enhance community participation in policy formulation, planning, implementation, monitoring and evaluation. It comprised a range of interventions such as human development, democratization, enhancing peoples’ participation, integrated capacity building, transparency and accountability. The sustainability of the good governance civic engagements in creating citizens participation by using dialogue and interface meetings enhance citizen’s participation in planning, monitoring and evaluation of basic public service and that in turn promote the service provision. However, insufficient state-citizen relationship, weak application of good governance, and social inclusion hinder the smooth flow of the service provision in Addis Ketema sub-city. Sustainable participatory planning between Government leadership, stakeholders, communities and basic public service providers are still lacking in many of the sector offices. The performance of the service providers in providing quality service and good governance is not in a position to meet the need of service users. Therefore, the major purpose of the study was assessing the role of Government leadership and stakeholders in solving the Challenges of Good Governance and how it will be institutionalize in the government reform agenda in the future. It also identified the major areas of problems in implementing the good governance program related to service delivery, Government leadership, and the stakeholders’ engagements. The analysis was conducted by using a descriptive survey method by clustering the respondents in to citizens, government leadership, service providers, and stakeholder. The sample is selected using judgmental sampling technique. To do this, the citizen’s are first stratified in to age categories, and then questionnaires were distributed to 300 citizens by using simple random sampling technique. Both primary and secondary data was used in the study. Moreover, structured and semi-structured interviews and FGD were conducted to gather relevant information from key informant interview from service providers, government leadership, and Stakeholders. The major findings of the thesis identified that existence of rent-seeking thinking, lack of commitment from the leadership of the municipalities, lack of commitment of the employees, lack of qualified manpower in the municipalities, lack of standardized performance standards as major challenges of good governance among others. The greatest concern given, currently, for the expansion of good governance at the country level is also found the most important prospect. It can then be concluded that the condition of good governance in the study area was not satisfactory. Thus, it is recommended that the leaders and stakeholders of the municipalities should promote accountability, transparency, rule of laws, and enhance the participation of local communities in municipal developments. The opportunities, at the municipal level, to promote good governance have to be identified and properly harnessed. The municipalities should try to find qualified and competent human resource administrators for municipal services provision.

The leadership practices were conducted in many government institutions leadership practices was formed. From these institutions, 122 participants were selected through proportionate, simple random and purposive sampling techniques. Questionnaire and interview were employed to collect data from different part of society and leaders respectively. Both descriptive and inferential statistics, including mean, standard deviation and independent sample t-test were used to analyze the quantitative data. The data gathered through interviews were analyzed qualitatively using narration. The study found that the five transformational leadership models were being practiced low or below average in the different part of institutions. But, when the models were independently considered, the variable enabling others to act and model the way were rated relatively high whereas the remaining three leadership practices, inspiring a shared vision, challenging the process and encouraging the heart were rated low by the respondents. The result shows that majority of the trainers in the difference part of office were not satisfied with the leaders' engagement in the five leadership practice of Kouzes and Posner's transformational leadership models. Leaders' failure to effectively lead change and innovation, lack of professional support for leaders and their incapability to use various approaches in securing and utilizing resources were the major problems hindered effective implementation of change in the institutions. It is recommended that the Oromia difference part of office commission should plan and invest resources in the development of leadership in the difference office of the region. The plan should focus on the utilization of best leadership practices that directly influence institutional effectiveness, relevant to the management of training institutions. Leadership has become a key component of organization, management and administration of throughout the world. In the some decades, changes In Technology, economy, social, political and cultural aspects of the world have imposed changes their economic systems of both developed and developing countries. To cope with this, economic leaders are bewildered by the rigor of demands and increasing responsibilities that their governments specifically and the public, in general, have imposed upon .Ethiopia began to review its economic system comprehensively with the belief that human beings are the best resources for achieving comprehensive economic and social development. During the past few years, education and training system in Ethiopia have undergone both major quantitative and qualitative change. A succession of new policies was designed and implemented, with the Education and Training Policy being the first major framework for systems reform and transformation. It is believed that one of the main problems in achieving organizational goals and satisfying the need of the society in a developing country is the capacity and effectiveness of leadership. The key for successful implementation of educational reform in Ethiopia depends on how different actor such as scholars, policy makers, and other stakeholders perceive the meanings and opportunities of their roles during the reform process to maximize its potential benefit. At the same time, however, leaders of education institutions have always been viewed as critical to success of the reform and can exhibit tremendous influence on it (Cizek, 1999).

Yirga Goraw

Mulatu Lerra

This study aimed to identify the determinants of leadership in improve sound governance in education sector institutions of the South Nation Nationalities People Region (SNNPR). The study was used a quantitative method (QUAN). It used inferential approach for their appropriateness for defining the research problem. The survey questionnaire collected from 660 participants purposefully and randomly selected from the nine zones, nine Woredas, and nine town administrations sampled education institutions of the SNNPR. Multistage sampling techniques (purposive, random sampling techniques) were instrumental. The logit model and multicollinearity effect were employed were instrumental. It has been found that sampled education sector institutions were experiencing various leadership determinants that hindered the promotion of sound governance, on the logit model. It can be concluded that, despite some policy initiatives and directives introduced by the regional government, the study identi...

World Academy of Informatics and Management Sciences

Customer service, good governance and leadership effectiveness are pivotal issues in Developing countries like Ethiopia. This study attempted to assess customer service delivery, leadership effectiveness and good governance Practices of South Wollo and Dessie City Administration, Ethiopia. It is of descriptive and explanatory in its design. Probabilistic sampling of stratified and simple random type and non-probability sampling of a purposive type were applied to obtain data about the customer service delivery, leadership effectiveness and good governance Practices in the study areas. The researchers used questionnaire and interview to gather primary data. The dependent variable customer service was measured using the independent variables of tangibility, reliability, responsiveness, assurance and empathy. Moreover the other dependent variable leadership effectiveness was measured using the independent variables of Value, interdependence, communication, and valuing behavior. In addition, the other dependent variable good governance was measured using the independent variables transparency, democratic process, and accountability and integrity. The study applied descriptive and inferential analytical models. The researchers used version 20 of SPSS to analysis quantitative data and demographic data. Qualitative data was analyzed inductively through narration. The study identified that reliability, assurance; empathy, tangibility, and responsiveness have a significant positive relationship with customer service. Communication, value, independence and valuing diversity have a significant positive relationship with leadership effectiveness. Transparency, domestic process, integrity and accountability have a stronger positive relationship with good governance. Leadership effectiveness and customer service has a positive and strong relationship with good governance. The study concludes that the poor customer service and ineffective leadership in the Woredas under study leads to poor governance. Finally the study suggested that efforts have to be made in building the capacity of leaders. In developing leadership competencies, regional and federal leadership capacity center and Universities should provide continual trainings to leaders.

Mesele Woldemichael

Governance in the world of Globalization and competition matters in accelerating development and in reducing poverty particularly in most developing countries across the world. In line with this, good governance allows efficient resources for equitable and sustainable development. The objective of this study is to assess the challenges and prospects of good governance in Wolaita Sodo Town Administration. Quantitative and qualitative method approach was employed. Both primary and secondary data were used. In addition to that, simple random and purposive sampling techniques were used. The major findings of the study is that existence of rent seeking, lack of commitment and lack of qualified man power was considered. It can be concluded that the condition of good governance in the study area is not satisfactory. Therefore the following recommendation was drawn: the administration should promote accountability, transparency to enhance the participation of local communities.

Worksew Argaw

Abstract The purpose of this paper was to assess the challenges of good Governance in Ethiopia. Governance, in the world of globalization and competition, matters in accelerating development and in reducing poverty particularly in most developing countries of the world. In line with this, good governance allows for sound and efficient management of resources for equitable and sustainable development. In Ethiopia, many people are poor; municipalities are very responsive areas because of the nature of services they provide. They are also highly susceptible areas for bad governance. The general objective of this seminar is to assess the challenges of good governance in Ethiopia. Concerning the methodology, quantitative and qualitative approaches of different researches were employed. Both primary and secondary sources of data were taken from different written documents and researches. The major findings of the paper identified that existence of rent seeking thinking (corruption), lack of commitment of the leadership, lack of commitment of the employees (work place deviation), lack of qualified man power in the leadership position, lack of standardized performance standards as major challenges of good governance among others. Currently, the greatest concern has been given by the Ethiopian Government to ensure the expansion of good governance at the country level; by undertaken the deep renewal and the fifth years performance evaluation programs, from top to down. It can then be concluded that the condition of good governance in the study area was not satisfactory. Thus, it is recommended that the Government leadership from top to down should promote accountability, transparency, rule of laws, democracy, and enhance the participation of local communities in municipal developments by taking corrective actions. The opportunities, at the municipal level, to promote good governance have to be identified and properly harnessed. The municipalities should try to find qualified and competent human resource administrators for municipal services provision. Improving the participation of the community to be minimizing the challenges of good governance in Ethiopia is very important. Because, ensuring good governance cannot be attained only through the efforts made by the government.

Costantinos Berhutesfa Costantinos

Ethiopia, a country now synonymous with food aid and safety nets, is endowed with over 70 million hectares of arable land out of which only 12% is utilised. It is also the water tower of Eastern Africa, its rivers scooping two million tons of soil out of the country every year. Yet Ethiopia has been on food aid for the last four decades. Hence, the research questions augur on: does leadership enter societies as an external ideology, constructing and deploying its concepts in sterile abstraction from local beliefs and values? Does it come into play in total opposition to, or in cooperation with historic national values and sentiments? Does leadership of human security alter power balances nationally breeding tyrannical societies and states? In the struggle over establishment of rules of economic & political engagement, do states equate this with production of broad-based concepts, norms & goals, which should temper their 'aim' of political rule? Thus, developing the agricultural sector means developing the economy. Domestic private investors have to be encouraged to go into the fertile lands of rural Ethiopia. The rural sector is one major area of domestic farming private sector development that has to be considered and supported by appropriate policies and procedures. The issue of rural sector development in rural Ethiopia is inextricably linked with the issue of rural land policies. The policies and legislative measures regarding rural land and the administrative mechanisms, policies and procedures and their ability to interpret and implement them would determine the fate of agriculture and the private sector in general. This is leadership. Leadership is above all about responsibility; requiring acceptance of the importance of one's self; coupled with an appreciation of the greater importance of others over oneself. Leaders are expected to develop the capacity, through their statements and actions, to shape debate and dialogue. Political leadership of human development and human security requires intimate knowledge of public policy analysis, formulation and management and development of strategic plans and implementing them An inspiring ‘job description’ of leaders must be not only the power over discourse but also their ability to shape morality, to determine what is socially acceptable, culturally sound and politically uplifting.

RELATED TOPICS

•   We're Hiring!
•   Help Center
• Find new research papers in:
• Health Sciences
• Earth Sciences
• Cognitive Science
• Mathematics
• Computer Science
• Academia ©2024

SYSTEMATIC REVIEW article

Prevalence and determinants of poor sleep quality among diabetic patients in ethiopia: systematic review.

• 1 Department Medical Nursing, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
• 2 Department of Immunology and Molecular Biology, School of Biomedical and Laboratory Science, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia

Background: Poor sleep quality can exacerbate many other physiological functions, such as obesity, cardiovascular disease, and high blood pressure. Although primary studies were conducted in Ethiopia, no studies concluded the pooled prevalence of poor sleep quality in Ethiopia. Therefore, this study was conducted to determine the pooled prevalence and its determinants of sleep quality among diabetes in Ethiopia.

Objective: Assess the pooled prevalence and its determinants of sleep quality among diabetes in Ethiopia.

Methods: The studies were searched systematically using international databases from PubMed, Google Scholar, Cochrane Library, Embase, and CINAHL. The quality of the articles searched was assessed using the New Castle Ottawa scale for a cross-sectional study design. Statistical analysis was performed using STATA version 14 and a systematic review was performed using a random effect model method. The Preferred Reporting Item for Systematic Review and Meta-analyses (PRISMA) guideline was followed for reporting results.

Results: From the total of 728 records screened, 8 studies with 2,471 participants who met the inclusion criteria were included in this systematic review. The estimated pooled prevalence of poor sleep quality in Ethiopia was 48.54%.

Conclusion: Almost half of diabetes patients had poor sleep quality. The preparation of brochures on diabetic information and the organization of health education about the negative impact of poor sleep quality on patients are among the best modalities to improve the problem of poor sleep quality.

Diabetes mellitus (DM) is a syndrome of metabolic disorder due to hyperglycemia as a result of dysfunction of the pancreatic β-cells of the human body ( 1 ). Diabetes is one of the leading causes of physiological instability, morbidity, disability, and death of the diabetic population ( 2 ).

Sleep is one of the physiological mechanisms of the body that maintains normal body function, tissue stability, and overall health of the body ( 3 ). Sleep disorder is one of the main problems for many chronic diseases such as diabetes and many other neurological disorders including migraine headache ( 4 ) Poor sleep quality is one of the major problems for diabetic patients compared to those of non-diabetic people. Poor sleep quality can exacerbate many other physiological functions such as obesity, cardiovascular diseases, and high blood pressure ( 5 , 6 ). Sleep deprivation in diabetes patients leads to long- and short-term effects that include increased anxiety and stress, reduced quality of life, major mental disorders, and other chronic medical conditions ( 7 ). Poor sleep quality prominently affects diabetic patients by increasing insulin resistance, long-term diabetes complications, and failure of major organs ( 8 ). Insufficient sleep is associated with many other negative health outcomes and increases the mortality of diabetes patients ( 9 ).

Based on the report of the International Diabetes Federation (IDF) for 2019, it was estimated that 9.3% (463 million) of the world population was diabetic cases ( 10 ). A systematic review in Ethiopia showed that the prevalence of diabetes ranges from 2 to 6.5% ( 11 ). Along with the increase in the prevalence of diabetics, the quality of sleep of individuals has been rising in the past decades ( 12 ). Evidence showed that long-lasting sleep deprivation was estimated to affect 7.5–20% total population ( 13 ). This problem is neglected until patients come to health institutions with other comorbidities ( 14 ). Various studies around the world have shown that many people who are faced with chronic diseases are faced with chronic poor sleep quality ( 15 – 17 ). This chronic sleep quality can lead to a poor prognosis of the disease, impaired exercise tolerance, decreased self-care behavior, and decreased total quality of life ( 18 , 19 ).

Poor sleep quality in diabetics was associated with many sociodemographic variables, such as being female, low wealth status, longer duration of the disease, poor body glucose control, and the presence of other comorbidities of chronic disease ( 20 , 21 ).

In Ethiopia, different studies were conducted to estimate the prevalence of sleep quality and associated factors among diabetic patients. The estimated prevalence of poor sleep quality in Ethiopia ranges from 31.97% ( 22 ) to 80.7% ( 23 ) which was conducted in the Amhara regional state of Amhara in Ethiopia. The findings of these different studies showed that there were significant variations in the prevalence of poor sleep quality among adult patients with diabetes in Ethiopia.

Regarding the researchers’ search, there was no systematic review conducted in Ethiopia related to this review. The findings of this study will be used as feedback to healthcare care managers to formulate or revise policies to improve poor sleep quality. Therefore, this study was conducted to determine the pooled prevalence and its determinants of sleep quality among diabetes in Ethiopia.

This study was guided by the Newcastle-Ottawa Scale for cross-sectional studies for systematic review ( 24 , 25 ) and it was carried out based on the preferred reporting items for systematic review ( 26 ). This systematic review title and its protocol were registered in the PROSPERO online database with the registration number CRD42023444939.

Search strategies

International databases (PubMed, Scopus, Web of Science, and Cochran Library) and search engines (Google and Google Scholar) were used to locate research articles on the prevalence of poor sleep quality among diabetic patients in Ethiopia. The search string was developed using the Boolean operators “AND” and “OR” with keywords extracted from the Medical Subject Headings (MeSH) database. The search strategy was based on the research question of this review and used CoCoPop (Co = Condition, Co = Context, Pop = Population).

The article location strategy was through “poor sleep quality” OR “sleep quality” AND “diabetes” AND “Ethiopia”.

This search strategy aimed primarily to trace all primary studies reviewed (published) and unpublished. Sources of information range from electronic databases to direct contact with the principal investigator if mandatory. The first search through Pub Med, Cochran Library, Scopus, Web of Science, Google, and Google Scholar was carried out in March 2023. The final update search was carried out from July 6, 2023, to September 29, 2023. The publication date was used as a filter mechanism in which articles published from May 2017 to August 29/2023 in this systematic review and meta-analysis study were used to generate the most recent evidence for the scientific community.

Eligibility criteria

Study inclusion and exclusion criteria.

Quantitative studies that reported the prevalence of overall poor sleep quality among diabetic patients, master’s thesis, and dissertations were included in the study, while qualitative study design, single case study research reports, not fully accessed articles, and poor methodological quality were excluded from the analysis.

Study selection and results

After a comprehensive search, all located citations were selected and exported to Endnote Citation Manager software version X7. Subsequently, irrelevant and duplicate articles were removed. Then, two independent researchers (CKM and AWA) screened each particular article by far for its title, abstract, and full text and cross-checked it against the inclusion criteria. The other research team (HKA, MCA, and AFZ) verified the articles selected with the full text for details under the already defined criteria to take them to the final review process. Any kind of disagreement between the research team while including and excluding articles will be managed by predefined criteria. The result of the search for the further selection and inclusion process of articles in this review was carried out by the PRISMA guidelines for systematic review and meta-analysis 2020.

Quality appraisal of included studies

Articles searched in the database were collected and duplicate articles were manually removed using EndNote (version 7). The modified version of the Newcastle-Ottawa Scale is used as a quality assessment tool for cross-sectional studies to evaluate the quality of the included studies ( 25 ). This critical appraisal tool consists of three items that assess the selection of study subjects (which consists of four different questions that account for a maximum of 5 points), the comparability of the study (which has two different questions that account for 3 points for each), and the outcome of the study (which contains one question and a maximum 1 point for each) ( Supplementary Table S1 ). After critical evaluation, the reviewers decided to include or exclude screened articles based on the overall quality of the evaluation score of 9.

Two independent reviewers evaluated the methodological quality of each article before inclusion in the review using nine points from the three sections of the tool. The quality of each study was rated using three categorical algorithms. A scores ≥7 was considered “good quality” of the study, a score 4–6 was considered “fair quality” of the studies, and studies with quality ≤3 was “poor quality.” Studies with a final quality score of 4 points and above were included in the final review ( 25 ).

In this sense, there had to be a study ( 27 ) with poor quality categories to exclude the article from the review. Any sort of disagreement between the involved reviewers was resolved through the discussion of the reviewers. Furthermore, if disagreement develops, the fourth reviewer is indicated to supervise the source of doubt and reach a consensus. The exclusion of articles was presented with countable reasons that could be consistent with the predefined criteria. The result of the search for the further selection and inclusion process of articles in this review was carried out in agreement with the PRISMA guidelines for systematic review and meta-analysis 2020.

Data were independently extracted by four authors using a 2014 Joanna Briggs Institute Reviewers Manual (JBI) ( 28 ).

The tool includes authors; study year, study design, sample size, prevalence, and risk of bias assessment score were included in the extraction. Data were extracted by two independent reviewers and any inconsistent data was cross-checked ( Supplementary Table S2 ). Disagreement between reviewers was resolved through discussion.

Outcome measurements

The primary results of this meta-analysis and systematic review were the pooled prevalence of poor sleep quality among diabetes patients elsewhere in Ethiopia.

Data synthesis and analysis

The outcome of the included primary studies was presented narratively and expanded with additional material in text, tables, and figures, where necessary. All necessary and relevant information for each article was extracted using a Microsoft Excel spreadsheet and exported to STATA Version 11 for further analysis. The random effect model was used to estimate the size of the pooled effect of patients with poor sleep quality diabetes due to the presence of heterogeneity ( 29 ). The size of the pooled effect with a 95% confidence interval was presented by a forest plot and used to visualize the presence of heterogeneity graphically. For the possible difference in the primary study, we explored subgroup analysis and meta-regression subsequently using publication year, study design, study setting, sampling methods, sample size, sex, and region. Additionally, publication bias was evaluated through visual inspection of the funnel plot, Begg-Mazudar rank correlation test, and Egger test to see the funnel plot’s asymmetry ( 30 ). The influence of individual articles on the estimate of the overall pooled effect size or the prevalence of poor sleep quality among diabetes was assessed using sensitivity analysis. The forest plot with 95% CI was used to present the overall pooled prevalence, as well as the pooled subgroup prevalence of poor sleep quality among diabetes in Ethiopia. The logarithmic odds ratio was used to determine the associated factors of poor sleep quality among patients with diabetes in Ethiopia.

The systematic review

Article selection and outcomes.

In this systematic review and meta-analysis study, a total of 728 articles related to the prevalence of nonadherence to exercise in Ethiopia were identified using electronic databases and search engine websites. Among the overall articles found, 480 were removed because they were irrelevant and duplicated and the other 112 and 96 were removed because they were not eligible (study design and title difference) due to automation tools and other reasons, respectively. The remaining 40 articles were eligible for selection. Of these screened, 26 articles were excluded due to the study region not being conducted in Ethiopia and not similar to the target population. On further screening, 14 articles were sought for retrieval and 4 were not retrieved for one or the other reason. Furthermore, 10 research articles were evaluated for eligibility to be included in the review process, but with the outcome of interest and the ambiguity of the measurement tool, a total of 2 articles were excluded. Finally, eight original research articles were incorporated for systematic review and meta-analysis ( Figure 1 ).

Figure 1 . PRISMA flow diagram of the included studies.

The methodological quality assessment of the included studies

A total of 8 articles have been assessed for methodological quality using the Newcastle-Ottawa scale of 9 points for the quality assessment tool for cross-sectional studies quality assessment tool ( 31 ). The outcome of the quality evaluation ranged from moderate to high methodological quality, in which two studies scored 9 points ( 19 , 23 ), three studies scored ( 22 , 27 , 32 ) and the other two studies scored ( 33 – 35 ) ( Supplementary Table S1 ).

Description of included studies

All research articles included in this systematic review were carried out by cross-sectional study design and published between January 2013 and September 29/2023. Eight published studies with 2,471 participants were included to determine the combined prevalence of poor sleep quality among diabetes patients. All articles were carried out with a cross-sectional study design with the lowest and highest prevalence of poor sleep quality in the state of Ethiopia 31.97% ( 22 ) and (80.7%) ( 32 ), respectively. In the same way, the smallest and largest sample sizes were from the Amhara region 66 ( 32 ) and 614 ( 33 ), respectively. This review includes six studies from the Amhara region ( 19 , 22 , 23 , 32 , 33 ), and two studies from the Oromia ( 27 , 34 ) region of Ethiopia ( Table 1 ).

Table 1 . Summary of the prevalence of poor sleep quality among diabetes using eight studies included in the systematic review and meta-analysis.

The pooled prevalence of poor sleep quality of diabetes in Ethiopia

The prevalence of poor sleep quality ranges from 31.97% ( 22 ) to 80.70% ( 32 ) in the Amhara regional state of Ethiopia. The pooled prevalence of poor sleep quality in patients with diabetes was 48.54% with 95% CI (43.55–04.04) based on the analysis of the DerSimonian-Laird random-effects model. The lowest and highest pooled prevalence of poor sleep quality among diabetes patients was found in the Amhara region in Ethiopia at 31.97% (95% CI (31.68–32.26)) and 80.7% (95% CI (79.47–81.93)), respectively ( Figure 2 ).

Figure 2 . Forest plot of the prevalence of poor sleep quality among diabetes patients in Ethiopia.

Assessment of heterogeneity

In this systematic review, a subgroup analysis was performed to assess heterogeneity, so that the p -value and I 2 statistics were used to assess heterogeneity between studies.

The source of heterogeneity was using the region, study years, and sampling techniques to identify the reason for the variation between studies, but none of them is the source of heterogeneity ( Table 2 ).

Table 2 . Subgroup analysis of pooled prevalence poor sleep quality among diabetes patients in Ethiopia, 2023.

Meta-regression

Furthermore, subgroup analysis and univariate meta-regression with sample size and publication year were performed for possible heterogeneity. The result of the analysis indicates that none of them significantly affected the heterogeneity between studies ( Table 3 ).

Table 3 . Meta-regression analysis of studies of poor sleep quality among diabetes patients in Ethiopia, 2023.

Publication bias

The funnel plot was done to show to check the publication bias. This study has no publication bias, as it is symmetrically distributed. Furthermore, statistically, the Begg and Egger test was performed with p -value = 0.42, which showed that there was no publication bias ( Figure 3 ).

Figure 3 . Funnel of poor sleep quality among diabetes in Ethiopia.

Sensitivity analysis

A sensitivity analysis was performed after observing lower and higher values in the review to show the effect of one study on the overall summary effect. However, the result of the analysis of the sensitivity test using the random effects model indicated that there was no single effect on the overall estimate ( Figure 4 ).

Figure 4 . Sensitivity analysis that indicates poor sleep quality among diabetes in Ethiopia.

In this systematic review and meta-analysis, the pooled prevalence of poor sleep quality among diabetes patients was 48.54% with 95% CI (43.05–54.04). Although there was no similar systematic review or meta-analysis evidence, related studies were conducted across the world. The finding of this study was supported by a meta-analysis conducted in (Asia, Europe, America, and Oceania countries) ( 36 ). Another related meta-analysis study conducted in Italy showed that the quantity and quality of sleep were poor among diabetic patients ( 37 ). The finding of this study was also supported by a systematic review and meta-analysis conducted in the Asia population ( 38 ). The possible justification might be that people who are diabetics might encounter diseases such as nocturia, nocturnal hypoglycemia, restless leg syndrome, peripheral neuropathy, and impaired breathing during sleep. These mentioned factors cause fragmented sleep and poor quality of sleep ( 39 ).

The findings of this study were lower than those of studies conducted in Jordan (81%) ( 40 ), in the USA (55%) ( 41 ), Ghana (64%) ( 42 ). The possible justification could be that poor sleep quality in developed countries might be high due to the occurrence of diabetic complications increasing as the duration of the disease is longer. Furthermore, diabetic patients with poor glycemic control developed nocturia that led to frequent awakenings resulting in poor sleep quality of diabetic patients ( 43 ).

The finding of this study was consistent with the studies conducted in China (47.1%) ( 44 ), Thailand (48.4%) ( 45 ), and Myanmar (48.4%) ( 45 ). The possible justification could be that diabetic patients may have similar physiological complications such as nocturia, nocturnal hypoglycemia, restless leg syndrome, sedentary breathing, and diabetic and heart failure problems. All of the above physiological complications can influence the normal sleep hours of diabetic patients ( 39 ).

The finding of this study was higher than that of the study conducted in Malaysia (32%) ( 46 ).

The possible justification could be because so many behavioral factors could be increased in developing countries, which could increase the quality of sleep quality of patients ( 47 ).

Limitations of the study

The studies included in this review were cross-sectional as a result; the outcome variable could be affected by other confounding variables. Furthermore, some regions of the country were not included because a lack of research may lead to an underestimate of this review.

Conclusions and recommendations

This systematic review and meta-analysis revealed that nearly half of diabetic patients had poor sleep quality compared to most previous studies conducted elsewhere in the world. This national evidence would be helpful for cross-country comparisons of the proportion of poor sleep quality among diabetes patients. It may be useful for healthcare policymakers to emphasize the overall quality of service by incorporating components of lifestyle modification, particularly for patients with substance use. The preparation of brochures on diabetic information and the organization of health education about the negative impact of poor sleep quality on patients are among the best modalities to improve the problem of poor sleep quality. The authors recommended that the coming researcher’s better conduct on continent-wide sleep quality of diabetic patients.

Data availability statement

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

Author contributions

HA: Conceptualization, Data curation, Formal analysis, Funding acquisition, Investigation, Methodology, Project administration, Resources, Software, Supervision, Validation, Visualization, Writing – original draft, Writing – review & editing. AA: Conceptualization, Data curation, Formal analysis, Funding acquisition, Investigation, Methodology, Project administration, Resources, Software, Supervision, Validation, Visualization, Writing – original draft, Writing – review & editing. GN: Conceptualization, Data curation, Formal analysis, Funding acquisition, Investigation, Methodology, Project administration, Resources, Software, Supervision, Validation, Visualization, Writing – original draft, Writing – review & editing. SB: Conceptualization, Data curation, Formal analysis, Funding acquisition, Investigation, Methodology, Project administration, Resources, Software, Supervision, Validation, Visualization, Writing – original draft, Writing – review & editing. CM: Conceptualization, Data curation, Formal analysis, Funding acquisition, Investigation, Methodology, Project administration, Resources, Software, Supervision, Validation, Visualization, Writing – original draft, Writing – review & editing.

The author(s) declare that no financial support was received for the research, authorship, and/or publication of this article.

Acknowledgments

We would like to thank all the authors included in this systematic review and meta-analysis.

Conflict of interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Publisher’s note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

Supplementary material

The Supplementary material for this article can be found online at: https://www.frontiersin.org/articles/10.3389/fpubh.2024.1363408/full#supplementary-material

SUPPLEMENTARY TABLE S1 | Quality appraisal and data extraction of included studies.

SUPPLEMENTARY TABLE S2 | Methodological quality assessment of included studies.

Abbreviations

CI, confidence interval; IDF, International Diabetes Federation; OR, odds ratio; PRISMA, preferred reporting items for systematic review meta-analysis guidelines; STATA, software for statistics and data analysis.

1. Care D. Standards of medical care in diabetes 2019. Diabetes Care . (2019) 42:S124–38. doi: 10.2337/dc19-S011

Crossref Full Text | Google Scholar

2. Sun, H, Saeedi, P, Karuranga, S, Pinkepank, M, Ogurtsova, K, Duncan, BB, et al. IDF diabetes atlas: global, regional and country-level diabetes prevalence estimates for 2021 and projections for 2045. Diabetes Res Clin Pract . (2022) 183:109119. doi: 10.1016/j.diabres.2021.109119

PubMed Abstract | Crossref Full Text | Google Scholar

3. Irwin, MR, and Opp, MR. Sleep Health: Reciprocal Regulation of Sleep and Innate Immunity. Neuropsycho. Official Publication American College Neuropsycho . (2017)42:129–55.

Google Scholar

4. Waliszewska-Prosół, M, Nowakowska-Kotas, M, Chojdak-Łukasiewicz, J, and Budrewicz, S. Migraine and sleep—an unexplained association? Int J Mol Sci . (2021) 22:5539. doi: 10.3390/ijms22115539

5. Grandner, MA. Sleep, health, and society. Sleep Med Clin . (2017) 12:1–22. doi: 10.1016/j.jsmc.2016.10.012

6. Chattu, VK, Manzar, MD, Kumary, S, Burman, D, Spence, DW, and Pandi-Perumal, SR. The global problem of insufficient sleep and its serious public health implications. Healthcare : MDPI (2018)

7. Tobaldini, E, Costantino, G, Solbiati, M, Cogliati, C, Kara, T, Nobili, L, et al. Sleep, sleep deprivation, autonomic nervous system and cardiovascular diseases. Neurosci Biobehav Rev . (2017) 74:321–9. doi: 10.1016/j.neubiorev.2016.07.004

8. AlDabal, L, and BaHammam, AS. Metabolic, endocrine, and immune consequences of sleep deprivation. Open Respir Med J . (2011) 5:31–43. doi: 10.2174/1874306401105010031

9. Glick, DR, Abariga, SA, Thomas, I, Shipper, AG, Gunia, BC, Grandner, MA, et al. Economic impact of insufficient and disturbed sleep in the workplace. PharmacoEconomics . (2023) 41:771–85.

10. Saeedi, P, Petersohn, I, Salpea, P, Malanda, B, Karuranga, S, Unwin, N, et al. Global and regional diabetes prevalence estimates for 2019 and projections for 2030 and 2045: results from the international diabetes federation diabetes atlas. Diabetes Res Clin Pract . (2019) 157:107843. doi: 10.1016/j.diabres.2019.107843

11. Bishu, KG, Jenkins, C, Yebyo, HG, Atsbha, M, Wubayehu, T, and Gebregziabher, M. Diabetes in Ethiopia: a systematic review of prevalence, risk factors, complications, and cost. Obes Med . (2019) 15:100132. doi: 10.1016/j.obmed.2019.100132

12. Lee, SWH, Ng, KY, and Chin, WK. The impact of sleep amount and sleep quality on glycemic control in type 2 diabetes: a systematic review and meta-analysis. Sleep Med Rev . (2017) 31:91–101. doi: 10.1016/j.smrv.2016.02.001

13. Krishnan, V, and Auckley, D. Sleep deprivation: pathophysiology. Sleep Saf . (2011):13. doi: 10.2174/978160805271410013

14. Pandey, S, Bhattarai, S, and Bhatta, A. Sleep pattern and problems in young children visiting outpatient department of a tertiary level hospital in Kathmandu, Nepal. Sleep Disord . (2020) 2020:1–5. doi: 10.1155/2020/8846288

15. Kaya, Z, Kayrak, M, Demir, K, Gündüz, M, Alibasiç, H, Karanfil, M, et al. The relationship between white coat hypertension and sleep quality. Sleep Biol Rhythms . (2014) 12:203–11. doi: 10.1111/sbr.12070

16. Santos, MA, Guedes, ES, Barbosa, RL, and Cruz, DALM. Sleeping difficulties reported by patients with heart failure. Rev Lat Am Enfermagem . (2012) 20:644–50. doi: 10.1590/S0104-11692012000400003

17. Lee KS, Lennie TA, Heo S, Song EK, Moser DK, KS, Lennie, TA, Heo, S, Song, EK, and Moser, DK. Prognostic Importance of Sleep Quality in Patients With Heart Failure. American journal of critical care: an official publication. American Association Critical-Care Nurses . (2016) 25:516–25.

18. Awotidebe, TO, Adeyeye, VO, Adedoyin, RA, Ogunyemi, SA, Oke, KI, Ativie, RN, et al. Assessment of functional capacity and sleep quality of patients with chronic heart failure. Hong Kong Physiother J . (2017) 36:17–24. doi: 10.1016/j.hkpj.2016.10.001

19. Edmealem, A, Ademe, S, and Andualem, A. Sleep quality and associated factors among patients with chronic illness at south Wollo zone public hospitals, Northeast Ethiopia. Clin J Nurs Care Pract . (2021) 5:043–50. doi: 10.29328/journal.cjncp.1001036

20. Colbay, G, Cetin, M, Colbay, M, Berker, D, and Guler, S. Type 2 diabetes affects sleep quality by disrupting the respiratory function: 2 型糖尿病通过损害呼吸功能影响睡眠质量. J Diabetes . (2015) 7:664–71. doi: 10.1111/1753-0407.12225

21. Li, Y, and Buys, N. Sleep Quality and Its Determinants Among Type 2 Diabetes Patients with Comorbid Metabolic Syndrome. (2022) 15:3469–82.

22. Worku, A, Ayele, E, Alemu, S, Legese, GL, Yimam, SM, Kassaw, G, et al. Obstructive sleep apnea risk and determinant factors among type 2 diabetes mellitus patients at the chronic illness clinic of the University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia. Front Endocrinol . (2023) 14:1151124. doi: 10.3389/fendo.2023.1151124

23. Jemere, T, Mossie, A, Berhanu, H, and Yeshaw, Y. Poor sleep quality and its predictors among type 2 diabetes mellitus patients attending Jimma University medical center, Jimma, Ethiopia. BMC Res Notes . (2019) 12:1–6. doi: 10.1186/s13104-019-4531-6

24. Peterson, J, Welch, V, Losos, M, and Tugwell, P. The Newcastle-Ottawa scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses . Ottawa: Ottawa Hospital Research Institute. (2011);2:1–12.

25. Hartling, L, Milne, A, Hamm, MP, Vandermeer, B, Ansari, M, Tsertsvadze, A, et al. Testing the Newcastle Ottawa scale showed low reliability between individual reviewers. J Clin Epidemiol . (2013) 66:982–93. doi: 10.1016/j.jclinepi.2013.03.003

26. Page, MJ, McKenzie, JE, Bossuyt, PM, Boutron, I, Hoffmann, TC, Mulrow, CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Int J Surg . (2021) 88:105906. doi: 10.1016/j.ijsu.2021.105906

27. Abdissa, D. Prevalence of obstructive sleep apnea risk and associated factors among patients with type 2 diabetes mellitus on follow up at Jimma medical center, Southwest Ethiopia. J Clin Transl Endocrinol . (2020) 21:100234. doi: 10.1016/j.jcte.2020.100234

28. Munn, Z, Tufanaru, C, and Aromataris, E. JBI's systematic reviews: data extraction and synthesis. Am J Nurs . (2014) 114:49–54. doi: 10.1097/01.NAJ.0000451683.66447.89

29. Borenstein, M, Hedges, LV, Higgins, JP, and Rothstein, HR. A basic introduction to fixed-effect and random-effects models for meta-analysis. Res Synth Methods . (2010) 1:97–111. doi: 10.1002/jrsm.12

30. Begg, CB, and Mazumdar, M. Operating characteristics of a rank correlation test for publication bias. Biometrics . (1994) 50:1088-101.

31. Moskalewicz, A, and Oremus, M. No clear choice between Newcastle–Ottawa scale and appraisal tool for cross-sectional studies to assess methodological quality in cross-sectional studies of health-related quality of life and breast cancer. J Clin Epidemiol . (2020) 120:94–103. doi: 10.1016/j.jclinepi.2019.12.013

32. Mersha, GA, Alemu, DS, Ferede, MG, Tegegn, MT, Tilahun, MM, Lorato, MM, et al. Association of Poor Quality of sleep with vision-threatening diabetic retinopathy: a matched case–control study. Ophthalmol Therapy . (2023) 12:1141–53. doi: 10.1007/s40123-023-00663-7

33. Bayush, G. Poor sleep quality, poor glycemic control and associated factors among adult diabetes mellitus patients . Amhara, Ethiopia: North Shoa Zone Governmental Hospitals (2022).

34. Wondie, A, Taderegew, MM, Girma, B, Getawey, A, Tsega, D, Terefe, TF, et al. Obstructive sleep apnea risk and its associated factors among type 2 diabetes mellitus patients at wolkite university specialized hospital, Wolkite, southern Ethiopia, 2021. A comparative cross-sectional study. Diabetol Metab Syndr . (2022) 14:157. doi: 10.1186/s13098-022-00931-9

35. Zewdu, D, Gedamu, H, Beyene, Y, Tadesse, M, Tamirat, M, and Muluken, S. Sleep quality and associated factors among type 2 Dm patients and non-Dm individuals in Bahir Dar governmental hospitals: comparative cross-sectional study. Sleep Sci Pract . (2022) 6:10. doi: 10.1186/s41606-022-00079-5

36. Lu, H, Yang, Q, Tian, F, Lyu, Y, He, H, Xin, X, et al. A meta-analysis of a cohort study on the association between sleep duration and type 2 diabetes mellitus. J Diabetes Res . (2021) 2021:1–15. doi: 10.1155/2021/8861038

37. Cappuccio, FP, D'Elia, L, Strazzullo, P, and Miller, MA. Quantity and quality of sleep and incidence of type 2 diabetes: a systematic review and meta-analysis. Diabetes Care . (2010) 33:414–20. doi: 10.2337/dc09-1124

38. Azharuddin, M, Kapur, P, Adil, M, Ghosh, P, and Sharma, M. The impact of sleep duration and sleep quality on glycaemic control in Asian population with type 2 diabetes mellitus: a systematic literature review and meta-analysis of observational studies. Clin Epidemiol Glob Health . (2020) 8:967–75. doi: 10.1016/j.cegh.2020.03.006

39. Surani, S, Brito, V, Surani, A, and Ghamande, S. Effect of diabetes mellitus on sleep quality. World J Diabetes . (2015) 6:868–73. doi: 10.4239/wjd.v6.i6.868

40. Barakat, S, Abujbara, M, Banimustafa, R, Batieha, A, and Ajlouni, K. Sleep quality in patients with type 2 diabetes mellitus. J Clin Med Res . (2019) 11:261–6. doi: 10.14740/jocmr2947w

41. Luyster, FS, and Dunbar-Jacob, J. Sleep quality and quality of life in adults with type 2 diabetes. Diabetes Educ . (2011) 37:347–55. doi: 10.1177/0145721711400663

42. Agyekum, JA, Gyamfi, T, and Yeboah, K. Depression, poor sleep quality, and diabetic control in type 2 diabetes patients at Sunyani regional hospital, Ghana: a case–control study. Middle East Curr Psychiatr . (2023) 30:1–10. doi: 10.1186/s43045-023-00317-1

43. Cunha, MCB, Zanetti, ML, and Hass, VJ. Calidad del sueño en diabéticos tipo 2. Rev Lat Am Enfermagem . (2008) 16:850–5. doi: 10.1590/S0104-11692008000500009

44. Zhu, B-Q, Li, X-M, Wang, D, and Yu, X-F. Sleep quality and its impact on glycaemic control in patients with type 2 diabetes mellitus. Int J Nurs Sci . (2014) 1:260–5. doi: 10.1016/j.ijnss.2014.05.020

45. Htut, HN, Howteerakul, N, Suwannapong, N, and Rawdaree, P. Sleep quality among type 2 diabetes mellitus patients in a private hospital setting in Yangon, Myanmar. J Health Res . (2020) 35:186–98. doi: 10.1108/JHR-09-2019-0214

46. Nasir, NFM, Draman, N, Zulkifli, MM, Muhamad, R, and Draman, S. Sleep quality among patients with type 2 diabetes: a cross-sectional study in the East Coast region of peninsular Malaysia. Int J Environ Res Public Health . (2022) 19:5211. doi: 10.3390/ijerph19095211

47. Nigussie, K, Sertsu, A, Ayana, GM, Dessie, Y, Bete, T, Abdisa, L, et al. Determinants of depression and anxiety among type 2 diabetes patients in governments’ hospitals at Harari regional state, eastern Ethiopia: a multi-center cross-sectional study. BMC Psychiatry . (2023) 23:13. doi: 10.1186/s12888-022-04494-x

Keywords: poor sleep quality, diabetes patients, Ethiopia, sleep quality, diabetes sleep

Citation: Abate HK, Azagew AW, Nega GA, Birru SM and Mekonnen CK (2024) Prevalence and determinants of poor sleep quality among diabetic patients in Ethiopia: systematic review. Front. Public Health . 12:1363408. doi: 10.3389/fpubh.2024.1363408

Received: 30 December 2023; Accepted: 10 April 2024; Published: 14 May 2024.

Reviewed by:

Copyright © 2024 Abate, Azagew, Nega, Birru and Mekonnen. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

*Correspondence: Hailemicahel Kindie Abate, [email protected]

Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.