Occupational noise regulation and hearing conservation in African LMICs: A narrative policy and implementation review

This narrative review critically examines the state of occupational noise regulation and hearing conservation in African low-and middle-income countries (LMICs), a region where the burden of noise-induced hearing loss (NIHL) is escalating due to rapid industrialization and systemic weaknesses in regulatory design and implementation. Using structured searches in PubMed, Scopus, and Web of Science, peer-reviewed literature published between 2000 and April 2025 was systematically identified and screened. Twelve eligible studies focusing on regulatory and policy aspects of occupational hearing conservation in African LMICs were included. An inductive thematic analysis revealed four core themes: The existence and variability of occupational noise regulations across countries, persistent implementation and enforcement challenges, limited and fragmented characteristics of hearing conservation programs (HCPs), and critical gaps in policy frameworks. The findings indicate that while several African LMICs have adopted regulations addressing occupational noise exposure, there is significant inconsistency in scope, content, and application. Weak enforcement mechanisms, inadequate training and monitoring systems, low health literacy among workers, and lack of integration with broader public health strategies hinder effective prevention of NIHL. High-risk industries such as mining, manufacturing, and construction remain disproportionately affected. Emerging evidence from innovative interventions and the underutilized role of audiologists highlights opportunities for integrated, contextually tailored HCPs. This review highlights the need for strengthened, context-sensitive, and enforceable regulatory frameworks that are aligned with international standards but tailored to local realities. It provides essential insights for policymakers, occupational health professionals, audiologists, and other stakeholders seeking to reduce the burden of NIHL and advance hearing conservation in Africa. By consolidating findings and offering implementation-focused recommendations, this review contributes to shaping more responsive and sustainable occupational health policy across the region.