Occupational Noise-Induced Hearing Loss in Africa: Gaps, Barriers, and Strategies for Effective Prevention

Occupational noise-induced hearing loss (ONIHL) remains one of the most common and preventable occupational diseases globally, yet it exerts a disproportionate burden in low- and middle-income countries. In Africa, where hazardous noise exposure is widespread and occupational health systems are under-resourced, ONIHL continues to affect workers across both formal and informal sectors. This narrative review, conducted with Preferred Reporting Items for Systematic Reviews and Meta-Analyses-style transparency, synthesizes Africa-specific evidence from 49 sources, including epidemiological studies, policy documents, and qualitative research, to map prevalence and exposure patterns, identify systemic and contextual barriers, and highlight feasible prevention strategies. Literature published between 2000 and 2025 was sourced from PubMed, Scopus, Web of Science, and grey-literature databases. Reported prevalence rates remain consistently high, with 22-30% among South African miners, 47-48% among Tanzanian miners and steel workers, and over 20% among Ghanaian sawmill and stone-crushing workers. Although several African countries have occupational noise regulations, their impact is undermined by weak enforcement, poor compliance monitoring, and the near-total exclusion of informal workers. Barriers to prevention span multiple levels, including inadequate provision and use of hearing protection devices, critical shortages of audiologists, low awareness and stigma, and competing health priorities such as human immunodeficiency virus and tuberculosis. Promising approaches include comprehensive hearing conservation programs, engineering controls such as "buy quiet," and emerging fourth industrial revolution innovations (tele-audiology, mobile health, artificial intelligence). However, their effectiveness depends on addressing underlying infrastructure, workforce, and governance challenges. Preventing ONIHL in Africa requires a holistic, multi-sectoral approach that integrates occupational health with broader public health, labor, and development agendas, while extending protection to the majority employed in the informal economy.