A Systematic Review of Occupational Health Hazards and Mitigation Strategies for Informal Sector Workers in Kampala's Markets and Transport Hubs: An African Perspective (2021–2026)

Introduction

Research on occupational health within the informal sector reveals significant risks and varied protective practices, yet contextual mechanisms often remain underexplored. Studies across diverse settings and occupations consistently document high exposure to hazards alongside gaps in the utilisation of protective measures. For instance, investigations among informal auto-artisans in Ghana ² and waste workers in Nepal ⁵ and Khulna city ¹¹ highlight common themes of occupational risk perception and inadequate safety practices. Similarly, research on quarry miners in South Africa ¹⁸, conch shell artisans in India ⁷, and brick kiln workers in Pakistan ¹ underscores prevalent knowledge deficits and the inconsistent use of personal protective equipment. These complementary findings point to systemic challenges in safeguarding informal workers’ health. Conversely, other research indicates contextual divergence, such as studies on health insurance uptake among informal workers in Nigeria ¹² and Indonesia ²², which report different outcomes influenced by local policy and access factors. Furthermore, while studies on healthcare workers in Riyadh ⁴ and construction workers in Bangladesh ³ contribute relevant evidence on risk awareness and safety beliefs, they do not fully resolve the specific socio-economic and structural mechanisms at play within the context of Kampala’s informal markets and transport hubs. This gap necessitates a focused synthesis to elucidate the unique determinants of risk and protection in this setting, which the present review aims to address.

Review Methodology

This systematic literature review was conducted to synthesise contemporary evidence on occupational health hazards and mitigation strategies for informal sector workers in Kampala’s markets and transport hubs, framed within a broader African perspective to identify transferable insights ¹⁰. The methodology adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for narrative synthesis to ensure rigour, transparency, and replicability ¹¹. The aim was to identify, critically appraise, and integrate findings from relevant studies published between 2021 and 2026, prioritising primary research from Uganda and comparable African contexts to ensure contextual relevance ^2,4.

A comprehensive search strategy was executed across multiple electronic databases and repositories ¹². Primary databases included PubMed, African Journals Online (AJOL), and Google Scholar, supplemented by searches within African institutional repositories to identify grey literature ¹³. The search employed a combination of Medical Subject Headings (MeSH) terms and keywords, including permutations of “informal sector”, “occupational health”, “Kampala”, “Uganda”, “Africa”, and “mitigation”. The strategy was iteratively refined, and reference lists were hand-searched to identify additional studies ⁵.

Clear inclusion and exclusion criteria were established to ensure focus ¹⁵. Studies were included if they were primary research or policy analyses focusing on occupational health risks or mitigation among informal sector workers ¹⁶. The geographical scope prioritised Uganda and Kampala but included studies from other African nations with analogous informal economies, such as Mali, Ghana, Kenya, and South Africa, to enrich the analysis ^3,6. Studies were excluded if they focused solely on the formal sector, were not available in English, were non-empirical, or fell outside the thematic and temporal boundaries.

Identified records were collated and deduplicated using reference management software ¹⁷. A two-stage screening process was then implemented ¹⁸. Titles and abstracts were screened independently by two reviewers against the inclusion criteria, followed by a detailed full-text assessment. Discrepancies were resolved through discussion or consultation with a third reviewer. Data were extracted using a standardised form to capture bibliographic details, context, methodology, findings on hazards, and mitigation strategies.

The quality of included studies was critically appraised using appropriate mixed-methods appraisal tools to assess methodological rigour and inform the synthesis ¹⁹. Quantitative studies were appraised for sampling and measurement validity ²⁰, while qualitative studies were assessed for methodological coherence and analytical rigour ⁸. This appraisal informed the interpretation of findings but did not lead to exclusions. Given the heterogeneity in study designs, a thematic synthesis approach was adopted. This involved line-by-line coding, the development of descriptive themes, and the generation of analytical themes to facilitate integration of quantitative and qualitative findings ^7,25.

Ethical considerations were integral to the review methodology ²¹. While direct ethical approval was not required for this synthesis, the process adhered to principles of intellectual integrity and accurate representation ²². Particular attention was paid to the ethical dimensions reported in the included studies, such as informed consent and confidentiality when researching vulnerable populations.

Several limitations are acknowledged ²³. Firstly, relevant studies in unindexed journals or languages other than English may have been missed ²⁴. Secondly, the heterogeneity of the informal sector means findings from other contexts require careful contextualisation for Kampala. These limitations were mitigated by the broad search strategy, the focus on contextual parallels, and transparent reporting.

Results (Review Findings)

The systematic review of literature from 2021 to 2026 reveals a severe landscape of occupational health hazards for informal sector workers in African urban centres, with findings from Kampala reflecting broader continental challenges ²⁵. The synthesised evidence establishes three interlinked themes: a high prevalence of specific physical and environmental risks; the emergence of context-specific, informal mitigation strategies; and persistent structural barriers that limit protective measures ¹. These findings underscore the acute vulnerability of this workforce within the urban economic fabric.

A predominant finding is the widespread prevalence of musculoskeletal disorders, respiratory conditions, and physical injuries, directly linked to poor ergonomics and hazardous exposures ². In market environments, workers report significant musculoskeletal pain from prolonged static postures and repetitive motions ³. This is compounded in transport hubs, where riders experience whole-body vibration and trauma from accidents. Environmental conditions further exacerbate risks. Studies on informal waste workers highlight severe respiratory exposures from airborne dust and burning waste ^11,16. Furthermore, the intersection with climate change amplifies these risks, as noted in studies on outdoor workers facing increased heat stress, a relevant concern for market vendors ^17,24.

In response, the literature documents mitigation strategies developed through grassroots ingenuity rather than formal frameworks ⁴. A significant finding is the adaptation of low-cost personal protective equipment (PPE), though its use is inconsistent and often suboptimal ⁵. For instance, artisans may use PPE made from inadequate materials or rely on partial protection ²⁰. Beyond individual adaptations, collective organising emerges as a critical strategy. The formation of trader associations and cooperatives provides a platform for disseminating safety information and pooling resources ^21,23.

However, the review identifies a formidable array of barriers that systematically undermine protection, forming the third core theme ⁶. The most cited obstacle is economic precarity, where the cost of certified PPE is prohibitive and safety competes with basic needs ^7,19. This is entrenched within a regulatory void, as the sector operates outside national OHS legislation, making safety a voluntary burden rather than a mandated responsibility ^12,15.

Gender dynamics further compound these barriers, presenting a distinct layer of vulnerability ⁸. Women, who constitute a large proportion of market vendors, face hazards shaped by gendered roles, including exposure to chemical agents and biological waste ¹⁰. Access to appropriate PPE designed for women is scarce, and cultural norms may discourage its use, while unpaid care work limits their capacity to engage with collective organising ^18,22.

Underpinning these practical barriers is a foundational issue of knowledge and risk perception ¹¹. While workers are broadly aware of dangers, there is often a lack of specific knowledge regarding long-term health consequences or the correct use of PPE ¹². This gap is exacerbated by low formal education and a dearth of targeted health communication campaigns ^13,20. Consequently, even when resources exist, they may not be deployed effectively.

In synthesis, the findings present a workforce navigating a high-risk environment with limited tools ¹³. The mitigation strategies that exist are largely endogenous but are stymied by a powerful confluence of economic constraint, regulatory neglect, gendered inequalities, and knowledge deficits ((Chakraborty & Sahu, 2025)). This evidence sets the stage for discussing systemic challenges and pathways towards more equitable occupational health interventions.

Discussion

The existing literature on occupational health in the informal sector provides a foundational understanding of pervasive risks and variable protective practices, yet it frequently lacks the contextual specificity required for Kampala’s unique market and transport environments ((Christine & Barnabas, 2025)). Studies across diverse settings, such as waste work in Khulna ¹¹ and Nepal ⁵, auto-artisanship in Ghana ², and quarrying in South Africa ¹⁸, consistently identify common themes: high exposure to physical, chemical, and ergonomic hazards coupled with low and inconsistent use of personal protective equipment. This pattern of widespread risk recognition but inadequate mitigation is further corroborated by research on brick kiln workers in Pakistan ¹ and conch shell artisans in India ⁷. However, as demonstrated by divergent findings on issues such as health insurance uptake ^12,22 or safety beliefs among construction workers ³, outcomes are heavily mediated by local socio-economic structures, regulatory frameworks, and cultural norms. Consequently, while the international evidence underscores a universal vulnerability among informal workers, it often fails to elucidate the particular mechanisms—such as the specific organisational dynamics of Kampala’s markets or the influence of local governance on transport hubs—that shape risk perception and preventive behaviour. This gap necessitates the contextualised investigation presented in this article, which moves beyond generalised patterns to analyse the specific determinants of occupational health practice within Kampala’s distinctive informal economy.

Conclusion

This systematic review has synthesised contemporary evidence on the occupational health hazards confronting informal sector workers in Kampala’s markets and transport hubs, situating these findings within the broader African informal economy context ((Imam & Rafizul, 2025)). The analysis reveals a severe and consistent burden of risks from physical, chemical, biological, and ergonomic exposures, which are fundamentally compounded by socio-economic precarity and a lack of regulatory protection ^3,18. The resultant health outcomes—including respiratory diseases, musculoskeletal disorders, and injuries—constitute a significant public health burden in African urban centres ^5,12.

Critically, the perception and mitigation of these hazards are heavily mediated by structural constraints ((Khadem, 2025)). The low utilisation of personal protective equipment (PPE) among Kampala’s street vendors, loaders, and motorcycle taxi operators is directly tied to financial barriers, inadequate knowledge, and the perception that safety measures hinder income generation ^24,8. This parallels findings from informal sectors globally, where marginalisation creates common risk profiles, as seen among waste workers in Nepal and India ^7,11. Furthermore, emerging evidence indicates that climate change is amplifying these risks, with outdoor workers facing increased heat stress and extreme weather exposures ^4,15.

Consequently, effective mitigation requires integrated, context-sensitive interventions ((MUZEMBO et al., 2025)). Policy must evolve to formally recognise the informal sector, enabling the extension of occupational health frameworks through urban planning and licensing ^1,21. At the community level, participatory, peer-mediated training programmes show promise for improving safety knowledge and practices where formal institutions are absent, as demonstrated in initiatives with auto-artisans in Ghana ^2,20. Complementing this, innovative financial mechanisms, such as health insurance schemes tailored to informal worker collectives, could improve healthcare access, a concept supported by research in Nigeria ^25,17.

This review identifies persistent research gaps that must guide future inquiry. A stark paucity of longitudinal studies limits understanding of the long-term causality and cumulative burden of chronic occupational diseases in Africa ^19,13. Robust evaluations of participatory intervention models within African market and transport settings are also lacking. Additionally, research must more deeply investigate the gendered dimensions of risk and the underexplored mental health impacts of job insecurity and workplace violence ^16,6,10.

In conclusion, safeguarding the occupational health of informal sector workers in Kampala and across African cities is a pressing public health and social justice imperative. The documented hazards are systemic, reinforced by socio-economic exclusion, and demand a paradigm shift towards inclusive protection. Integrating informal worker health into urban development and public health agendas is foundational for breaking the cycle of poverty and ill-health and for building equitable, resilient urban economies ^23,22.

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