Delivering sleep: Bed kit distributions to children living in poverty in Tanzania

Abstract

Background

Overcrowded housing, insufficient beds, and poor mosquito protection are major barriers to healthy sleep for children living in poverty in developing countries. This study aimed to address these barriers by providing children living in poverty in Tanzania with climate-appropriate items essential for creating a safe and comfortable micro-sleep environment.

Methods

From 2000 to 2024, Sleeping Children Around the World (SCAW) delivered 135,500 bed kits to children aged 7–11 years living in poverty in Tanzania. Since 2019, culturally adapted sleep education information was delivered orally to parents of bed kit recipients.

Results

Twenty-four distributions reached an average of 5646 children per cohort years. Mattresses and mosquito nets were consistently included; other items varied.

Conclusions

This study demonstrates a community-driven approach to improving the sleep environments of children living in poverty in a developing country, offering a scalable model for promoting sleep health in low-resource settings.

Highlights

• •Community-driven approach improved sleep environments for Tanzanian children living in poverty.
• •24 bed kit distributions reached 135,500 children aged 7–11 years.
• •Bed kits provided climate-appropriate items for safe, comfortable sleep spaces.
• •Intervention addressed determinants of poor sleep health in low-resource settings.
• •Scalable model for promoting child sleep health in developing countries.

1. Introduction

Healthy sleep is a fundamental component of healthy development [1]. Poor sleep health in early life impairs learning, memory, and executive functions [2,3]—skills critical for academic and social development. It is associated with emotional dysregulation, behavioral problems [4], and increases the risk of lifelong adverse outcomes [[5], [6], [7]].

Children living in poverty in developing countries face multiple barriers to healthy sleep, including overcrowded housing, noise, extreme temperatures, insufficient beds, and poor mosquito protection [4,8,9]. They are particularly vulnerable to the impact of poor sleep health.

Inadequate sleep environments among children are linked to impaired cognitive development, emotional regulation, and academic performance, perpetuating cycles of disadvantage [10]. Despite these consequences, sleep health remains underprioritized globally, particularly in low-resource settings.

Recent calls for action emphasize the need to address equity in sleep health, especially among children and individuals with lower socioeconomic status [11], yet actionable strategies are lacking. Awareness and interventions are limited, underscoring the need for scalable strategies targeting environmental determinants of sleep health [8,9].

Sleep health promotion involves enabling individuals and communities to increase control over determinants of sleep health, thereby improving overall health and well-being [12]. Sleeping Children Around the World (SCAW) is a Canadian charity that has supported sleep health for children in poverty across 36 developing countries by providing bed kits containing items needed to create a climate-appropriate personal sleeping space.

Core components of SCAW bed kits include culturally appropriate mattresses made from local materials, and WHO-approved insecticide-treated mosquito nets [13], with additional items such as bedding, clothing, and school supplies. These resources help children overcome environmental barriers to healthy sleep by creating a comfortable, protective micro-environment within their homes. SCAW selects countries for distribution based on a gross national income (GNI) below $8000 USD and the presence of committed local volunteer partners to facilitate distribution. Individual bed kit recipients are identified by these local partners.

The United Republic of Tanzania, located in East Africa, faces significant child poverty: approximately 63 % of children experience multidimensional poverty, and 58 % live in monetary poverty, defined as less than $1.90 per day [14]. Reports indicate that a large proportion of children lack safe sleeping environments [15,16]. While national school health programs exist in Tanzania, they rarely address sleep health [[17], [18], [19]]. The objective of SCAW's bed kit distribution in Tanzania was to promote the sleep health of children living in poverty by enabling the creation of climate-appropriate personal sleeping spaces for them.

1.1. Methods

Participants. A total of 135,500 children (67,750 boys and 67,750 girls), aged 7–11 years, living in poverty. Inclusion Criteria: Children were eligible to receive a bed kit if they were enrolled in participating schools, belonged to families meeting local poverty criteria, and were between 7 and 11 years of age.

Procedure. Bed kit distributions were conducted in Dar es Salaam, Tanzania, and surrounding regions across multiple cohorts between 2000 and 2024. Tanzania's SCAW Overseas Volunteer Partner (OVP) (MWM) requested and obtained formal authorization from the Tanzanian government to implement the program. The government approved participation and provided recommendations for target districts and schools in economically disadvantaged communities. The OVP contacted these schools and held in-person meetings with their administrators to present the SCAW mission and bed kit project. Schools expressing interest were included in the distribution plan. Since 2019, schools have also received culturally tailored sleep health education information delivered by the OVP to the parents of bed kit recipients.

1.2. Measures

Bed Kit Items. The bed kits distributed in Tanzania included combinations of the following items: a mattress, sheets, pillow, mosquito net, school supplies (exercise books, pens, pencils, and bags), clothing (uniforms, shirts, skirts, and/or pajamas), shoes (sandals, flip-flops, or thong shoes), face masks, and caps.

The Paediatric Sleep Education Package – Swahili Version [20] is an adaptation of the original tool [21] translated into Swahili and redesigned for oral delivery to support Tanzanian populations with low literacy levels.

2. Results

Number Of Bed Kits Distributed. Between 2000 and 2024, SCAW conducted 24 bed kit distributions to school-age children in Tanzania, delivering a total of 135,500 bed kits. Fig. 1 presents the number of bed kits delivered in each distribution stacked by sex and ordered by cohort start.

Fig. 1.

Number of SCAW Tanzania bed kit recipients by cohort stacked by sex and ordered by cohort Start

Note: SCAW= sleeping children around the world.

The average distribution size was 5646 bed kits, ranging from 2000 to 9000. Distribution volume increased substantially over time. Early distributions (2000–2004) ranged from 3000 to 4000 bed kits, while later distributions (2005–2024) stabilized at 5000–9000. The largest distribution occurred in 2018, with 9000 bed kits delivered. In 2021, the distribution volume temporarily decreased to 2000 bed kits due to the coronavirus disease 2019 (COVID-19) pandemic, but returned to pre-pandemic levels the following year. Overall, these data indicate a progressive scale-up in distribution capacity, peaking in recent years while maintaining a consistent proportional allocation strategy.

Items Included in Distributed bed kits. Table 1 presents the items included in each SCAW bed kit distribution period to Tanzania. Fig. 2a illustrates the specific items included in each distribution period. Fig. 2b displays the frequency of inclusion for each item across all SCAW bed kit distributions to Tanzania between 2000 and 2024. Fig. 3 shows the total number of distinct items included in each bed kit distribution over time.

Table 1.

SCAW bedkit items distributed by year and distribution period.

Distribution Period	Mattress	Sheets	Pillow	Mosquito Net	School Supplies	Clothing	Shoes	Face Mask	Cap
23-Jul-2000 to 05-Aug-2000	✓	✓	✓	✓
31-Jul-2002 to 16-Aug-2002	✓	✓	✓	✓		✓	✓
22-Aug-2003 to 5-Sep-2003	✓	✓		✓	✓	✓	✓		✓
20-Aug-2004 to 28-Aug-2004	✓	✓		✓	✓	✓			✓
1-Aug-2005 to 19-Aug-2005	✓			✓	✓
1-Aug-2006 to 16-Aug-2006	✓	✓		✓	✓	✓	✓
13-Aug-2007 to 23-Aug-2007	✓	✓		✓	✓	✓	✓
6-Aug-2008 to 19-Aug-2008	✓	✓		✓		✓	✓
13-Aug-2009 to 26-Aug-2009	✓	✓		✓		✓	✓
4-Aug-2010 to 18-Aug-2010	✓	✓		✓	✓	✓	✓
10-Aug-2011 to 24-Aug-2011	✓	✓		✓	✓	✓	✓
11-Jul-2012 to 25-Jul-2012	✓	✓		✓	✓	✓	✓
24-Jul-2013 to 1-Aug-2013	✓	✓		✓	✓	✓	✓
19-Jul-2014 to 25-Jul-2014	✓	✓		✓	✓	✓	✓
14-Jul-2015 to 24-Jul-2015	✓	✓		✓	✓	✓	✓
11-Jul-2016 to 24-Jul-2016	✓	✓		✓	✓	✓	✓
26-Jul-2017 to 5-Aug-2017	✓	✓		✓	✓	✓	✓
07-Nov-2017 to 14-Nov-2017	✓	✓		✓	✓	✓	✓
11-Jul-2018 to 26-Jul-2018	✓	✓		✓	✓	✓	✓
5-Jul-2019 to 23-Jul-2019	✓	✓		✓	✓	✓	✓
11-Dec-2021 to 16-Dec-2021	✓	✓		✓	✓	✓	✓	✓
1-Jul-2022 to 31-Jul-2022	✓	✓		✓	✓	✓	✓	✓
21-Jul-2023 to 1-Aug-2023	✓	✓		✓	✓	✓	✓
18-Jul-2024 to 4-Aug-2024	✓	✓		✓	✓	✓	✓

Note. SCAW = Sleeping Children Around the World. A checkmark (✓) indicates that the item was included in the bedkit during the specified distribution period.

Fig. 2a.

SCAW Tanzania Bed Kit Contents by Distribution Period

Note: SCAW= Sleeping Children Around the World; A marked pattern signifies that the item was part of the bed kit during that specific distribution period.

Fig. 2b.

SCAW Tanzania Bed Kit Item Inclusion Frequency Across Distribution n Periods

Note: SCAW= Sleeping Children Around the World.

Fig. 3.

Total number of items included in SCAW Tanzania bed kits per distribution Period

Note: SCAW= sleeping children around the world.

The number of items per kit increased from 4 to 5 items in early years to 6–7 items per distribution in later years, with a temporary rise in 2021–2022 due to mask inclusion. Mattresses and mosquito nets were included in all 24 bed kit distributions. Sheets and school supplies were each present in 23 distributions, followed by clothing (n = 22), shoes (n = 21), and school supplies (n = 20). Pillows, face masks, and caps were least frequent (n = 2).

Sheets were included in nearly all periods, whereas pillows and caps were included only in the very early distributions. Pillows were included in 2000 and 2002 but were discontinued thereafter to improve cultural tailoring, as pillows are not typically used at night in Tanzania. School supplies, clothing, and shoes were introduced early and remained common. Face masks appeared only in 2021–2022, reflecting pandemic-related adaptations.

3. Discussion

Between 2000 and 2024, SCAW distributed 135,500 bed kits to children living in poverty in Tanzania, addressing environmental determinants of poor sleep health including the lack of mattresses, bedding, and mosquito protection.

This intervention is consistent with the World Health Organization's definition of health promotion as “the process of enabling people to increase control over, and to improve their health” [22]. It operationalizes core health promotion strategies by creating supportive environments through improved sleep conditions at home, strengthening community action via local involvement in the distribution process, and developing personal skills through culturally adapted sleep education for parents [[22], [23], [24]].

This study demonstrates a pragmatic, community driven, approach to sleep health promotion where local partners identify needs, adapt interventions to context, and engage policy makers to facilitate collaboration in prioritizing sleep health within their populations.

Consistent with the findings of Brunton et al. [25], this program demonstrates that real-world impact can be achieved by empowering communities to identify their own needs and co-create solutions. This ‘push’ approach to sleep health promotion—driven by community engagement and immediate action—contrasts with academic models that emphasize a ‘pull’ strategy, where interventions are delayed until sufficient data is collected and high-quality evidence accumulates. It suggests that action itself can generate meaningful data and drive research forward.

The findings show that sleep health–promoting activities can be implemented in schools, homes, and communities without the delays and complexity of national policy changes [26,27].

Consistent with the Canadian approach to school-based sleep health promotion [28], the Tanzanian school system served as a key enabler for implementing the bed kits delivery program, reaching a large segment of the target population, providing platforms for health education, and acting as an intermediary between children, families, policymakers, and SCAW. Moreover, it aligns with previous research indicating that embedding health promotion within school systems enhances feasibility and sustainability by leveraging existing educational infrastructure and integrating interventions into daily routines [29]. Offering a scalable route for delivering sleep health promotion to children and adolescents in developing countries.

Importantly, this work challenges the assumption that sleep health data from high-income countries can be generalized to low-resource populations [30]. Differences in living conditions, cultural norms, and health system access necessitate a community-based participatory approach that values local expertise and lived experience.

3.1. Limitations and future directions

A primary limitation of this study is the absence of empirical data quantifying the impact of bed kits on recipients’ sleep and daytime functioning. Although qualitative reports from community members consistently suggest positive and sustained benefits, these observations require empirical validation to substantiate the effects of the intervention on sleep health and daytime functioning. Establishing such evidence is essential for developing a replicable framework capable of delivering measurable and lasting improvements in sleep health among populations experiencing the greatest need.

Additionally, the data presented were sourced from SCAW archival materials, including newsletters and blogs. As these records were documented by community members during distribution periods, the data are limited to what was captured at the time and may not reflect the full scope of activities or outcomes. Future research should incorporate systematic data collection methods—both qualitative and quantitative—to more comprehensively evaluate the impact of bed kit distribution and inform scalable, evidence-based sleep health interventions.

3.2. Lessons learned

To guide future work and strengthen implementation efforts, the following recommendations are proposed.

• 1.Engage Stakeholders Early and Continuously. Ensure meaningful involvement of community members and stakeholders before, during, and after implementation to support sustainability and relevance.
• 2.Adapt Knowledge to Local Contexts and Users. Tailor content and delivery mechanisms to local contexts and the needs of knowledge users across individual, organizational, and systemic levels.
• 3.Identify and Address Barriers and Facilitators. Systematically document and analyze barriers and facilitators to knowledge-to-action (KTA), using this information to refine implementation strategies and improve uptake.
• 4.Facilitate Local Change Through Clear Mechanisms. Define and implement actionable mechanisms aligned with existing structures and capacities to support local change.
• 5.Plan for Sustainability. Integrate strategies that promote ongoing use of knowledge beyond the initial intervention, including capacity building, policy integration, and continuous feedback loops.

Together, these recommendations support a push-oriented approach to sleep health promotion—one that prioritizes proactive, community-driven action—while also recognizing the value of a pull-oriented strategy that builds on emerging evidence. By balancing both approaches, future initiatives can foster innovation, responsiveness, and long-term impact in underserved populations.

4. Conclusions

The SCAW model demonstrates that empowering communities with knowledge and minimal resources can create sleep health “hot spots,” where local action drives meaningful change. It shows that producing sleep health within a population requires understanding local realities and co-developing solutions with communities. The findings support the notion that it takes a village, rather than policy alone, to promote sleep health effectively. This reframes the question posed by Buysse (2014): How do we produce sleep health within a population? [31]—by showing that the answer lies in the people themselves - community-led, context-sensitive action rather than centralized, data-driven mandates.

CRediT authorship contribution statement

Debbie Will-Dryden: Writing – original draft. Wandoa Mwambu: Resources. Teegan Nordstrom: Writing – review & editing. Reut Gruber: Conceptualization, Visualization.

Declaration of competing interest

The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Reut Gruber Canadian Institutes of Health Research that includes: funding grants. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.