Background: Occupational noise-induced hearing loss (ONIHL) is a persistent occupational health challenge in Africa. Despite regulatory frameworks and hearing conservation programmes (HCPs), implementation is inconsistent, and the role of workers’ unions in advocating for hearing health remains underexplored.
Objectives: This review analyses ONIHL prevalence and risk factors, identifies gaps in HCP implementation, evaluates the role of trade unions, examines policy and regulatory frameworks, and considers emerging technological innovations relevant to ONIHL mitigation in sub-Saharan Africa.
Methods: A narrative review methodology synthesised findings from 42 studies, categorised by ONIHL prevalence, HCP effectiveness, union involvement, and policy frameworks. Thematic analysis was used to identify key trends and gaps.
Results: The prevalence of ONIHL remains high in the mining, manufacturing, and transport sectors, driven by prolonged noise exposure, poor compliance, and limited access to preventive audiology. Hearing conservation programmes are inconsistently applied, and employer accountability is weak. Trade union involvement is limited, although global benchmarks illustrate their potential in driving policy reforms. African regulatory enforcement is fragmented, while emerging technologies, such as tele-audiology, digital noise monitoring, and artificial intelligence- (AI-) driven risk assessment present opportunities for early detection and prevention.
Conclusion: Strengthening ONIHL prevention requires stricter regulatory enforcement, stronger employer accountability, and enhanced union engagement, alongside investment in innovative technologies. Regional harmonisation of noise exposure regulations and standardised HCPs are critical to reduce ONIHL risks and improve worker health outcomes.

Background: Hearing conservation programmes (HCPs) in the manufacturing industry are widespread. However, programme implementation is yet to achieve significant reduction in hearing loss incidence.
Objectives: The objective of this narrative literature review was to describe sentiments regarding the efficacy of HCPs.
Methods: A search of the Web of Science Core Collection database focused on HCPs in the manufacturing sector, globally, from January 2002 to December 2022. The search was limited to field studies published in English. The relevant literature was manually analysed for both positive and negative sentiments about the HCP elements, using document analysis.
Results: Fifty-five articles were included in the review. The steel-related industries comprised the largest proportion of the articles included in the review. Negative sentiments about performance of HCPs were reported in most studies. There were limited studies on engineering noise control implementation within HCPs, reflective of industry inaction – a major contributing factor to hearing loss in the sector.
Conclusion: Hearing conservation programme efficacy within the manufacturing sector is hindered by multiple factors, as reflected by negative sentiments. Improvements in HCPs are required urgently to improve hearing conservation efforts in the sector. A digital HCP audit tool, using the findings from this study, could assist employers to identify specific aspects that hinder programme efficacy, and thereby improve engineering controls for noise reduction.

Background: Mining, construction, and manufacturing are among the most hazardous industries, globally, with high rates of occupational injuries and illnesses. In South Africa, the Occupational Health and Safety Act and Mine Health and Safety Act require workers to report occupational incidents, but under-reporting remains widespread. Studies have largely focused on workplacelevel micro-factors, with limited attention to broader macro-environment influences.
Objectives: We examined whether macro-environment economic, political and legal, demographic, socio-cultural, and technological factors outside the workplace influence reporting of injuries and illnesses, and compared reporting patterns between low- and middle-income workers.
Methods: A cross-sectional sequential mixed-methods design was used. Phase 1 involved convenience sampling of 273 low- and middle-income workers in six mining, construction, and manufacturing companies in Gauteng province, South Africa who completed a structured questionnaire. Quantitative data were analysed using SPSS and Stata. Content and construct validity were established using Cronbach’s alpha, exploratory, and confirmatory factor analysis. Bivariate analysis was conducted for pairs of categorical data and Pearson’s Chi-square was used to assess associations between macro-environment factors and reporting. Univariate and multivariable linear regression analyses (using ordinary least squares) examined how macro-environment and other demographic independent variables influenced reporting. Statistical significance was set at 5%. In phase 2, seven qualitative interviews were held with occupational health and safety (OHS) experts, and analysed using thematic and narrative analysis, with triangulation used to enhance validity.
Results: The response rate was 70.8%. The study participants were predominantly male (88.2%), black African (87.6%), low income (63.3%), and with an education of grade 12 or below (76.9%). More than 94% expressed willingness to report incidents, influenced by employer support and system accessibility. However, macro-environment barriers affected reporting: social factors (language, racial dynamics), economic factors (fear of job loss, reduced income during recovery, reassignment to lower-paid light duty roles, denied promotions or benefits for reporting), and demographic challenges (age-related employment vulnerability). Expert interviews highlighted cultural factors, migrant worker limitations, and Zero Harm incentive schemes. Regression analyses indicated significant associations between reporting and education (post-high school), income group (middle income), industry (manufacturing), and having received OHS training.
Conclusion: Although legislative frameworks support reporting, macro-environment economic, social, and demographic barriers may undermine workers’ reporting behaviour. Interventions addressing these broader contextual factors are needed.