ENVIRONMENTAL NOISE POLLUTION – A SCOURGE RAVAGING UGANDA IN THE NAME OF DEVELOPMENT

ENVIRONMENTAL NOISE POLLUTION – A SCOURGE RAVAGING UGANDA IN THE NAME OF DEVELOPMENT
By Oweyegha-Afunaduula
Center for Critical Thinking and Alternative Analysis

All noise is environmental noise and occurs in all the dimensions of the environment. It occurs in the ecological-biological (or physical) dimension, the socioeconomic dimension, the sociocultural dimension and the temporal (or time) dimension.

When environmental noise is generated in the environment, it is a pollutant. One writer said that anything new in the environment is a pollutant. Therefore, any new environmental noise is immediately a pollutant and manifests as a form of environmental pollution so long as it persists in the environment.

Some environmental noise is natural, and some is unnatural or artificial. Man, Homo sapiens, is almost entirely the primary cause and ultimate sufferer of environmental noise. Natural environmental noise is variously made by animals, thunder, hurricanes, earthquakes, waterfalls, volcanic eruptions and even by wind rushing through the canopies of trees, to name but a few avenues of generating natural environmental noise. However, the boundary between natural and unnatural environmental noise pollution is disappearing, and it is becoming difficult to draw a distinction between natural and unnatural environmental noise. Man, Homo sapiens, is the explanation. Man, Homo sapiens, is at the centre of it all – causing all the artificial environmental noise as a pollutant of the environment. Man, Homo sapiens can initiate hurricanes, earthquakes, waterfalls, floods, volcanic eruptions and, hence the environmental noise they generate. Therefore, when we talk of natural disasters, we should remember they are in fact rendered unnatural by the interventions of Man, Homo sapiens.

For example, virtually all the destructive floods of Kampala, in Uganda, are man-made through avenues such as policies and laws that fuel environmental exploitation of the environment, ostensibly for development. Factories, business buildings, residences and slums are established in swamps and ancient waterways and hills are cleared of their trees to mine stones for construction, or to establish residences and hotels, thereby causing unnatural floods, especially during the rainy periods.

Every other time, Man, Homo sapiens, is generating new types or kinds of environmental noise in pursuit of what is called “development”. Therefore, Man, Homo sapiens, has become a specialist in generating environmental noise as a modern-day pollutant of the environment.

In the Table 1 below, I give a list of sources and types of environmental noise pollution.

Table 1: Sources and Types of Environmental Noise Pollution

• Products: Intruder alarms of buildings and motor vehicles
• Domestic buildings: Musical Instruments, etc
• Commercial buildings: Office buildings – air-conditioning systems; restaurants – air-conditioning systems, kitchen ventilating systems
• Industrial buildings: Factories – machineries, air-conditioning systems
• Transportation: Aircrafts, trains, road vehicles, vessels, ships
• Construction sites: Site formation (e.g. excavation), piling, road work, demolition, renovation

When I was growing up in the 1950s, in Bulawa where the Mulawa Clan historically belongs and is culturally, ecologically and biologically identified with, in Nawaka Parish of Ikumbya Subcounty of Luuka County (now Luuka District) of the then Busoga District, later named The Territory of Busoga in the Uganda Constitution 1962, and now Busoga Kingdom, the environment was almost free of artificial environmental noise pollution. Man, Homo sapiens, was ecologically-friendly to Nature. Roads were made using hoes. Farming was by the hoe. The popular mode of transport was walking but later the bicycle was introduced by the British colonialists. The popular bicycle was called Raleigh. The British had also introduced a very big, heavy motorcycle known as BSA, which was noisy before and during movement.

However, the bicycle and the motorcycle were beyond the reach of most people in my village. For a long time my father, Charles Afunaduula Ovuma Ngobi was the only one with a bicycle. He was also the first one in the whole subcounty of Ikumbya to acquire the BSA motorcycle. Apparently, he also became the first person to buy a car in my village and subcounty – a Ford Cortina manufactured in the United Kingdom. Therefore, if we are to accuse anyone for introducing artificial environmental noise in my village and subcounty, my father cannot escape.

Most of the noise of the village was made by wild animals such as lions, leopards, cheetahs, buffaloes, zebra, elephants, hyenas, foxes, wild dogs and wild pigs (which have virtually disappeared from the Busoga biocultural landscape) as well as birds and toads, whose biodiversity has greatly reduced with the supersonic rise and spread of the human population as well as urbanisation of the land. Human noise also dominated the biocultural landscape and included that made by artisans, local musicians, playing children and wailing villagers following the death of someone.

There were no clear regulations governing the environment, and for that matter, environmental noise that could be felt at village level. However, forests thrived and Homo sapiens forged a mutually beneficial relationship with the forests and all flora and fauna. The British colonialists called the forests forest reserves and the life therein wildlife, but the people regarded it as an integral aspect of their ecological-biological and biocultural landscape. They got everything that made life tick from the forests, ponds, swamps and streams that flowed throughout the year because the forests protected them. There were no durable roads, but paths to link homes connected in a social system called “extended family system.” However, one murram road, constructed under the supervision of the colonial occupants, linked Bulawa village with Ikumbya village and Nawaikoke, but during the rains it was impassable in many portions.

Later buses came as the new generators of environmental noise. We had two buses, introduced by an Indian called Rahemtulla, moving between Jinja in Butembe County of Busoga and Nawaikoke in Bulamogi County. There were also many lorries, owned by Indians, carrying crops, such as groundnuts, cotton and coffee, from the village to suburban areas for processing. They also carried manufactured goods, such as clothing, sugar, salt and others to the village from the shops of Indians.

About eight miles away from Bulawa village there was a railway station at Nawansega; one of the numerous railway stations of the extensive and intertwining railway system that crisscrossed Busoga, providing cheap transport for people and goods, thereby contributing greatly to the socioeconomic development, transformation and progress of Busoga. The trains used firewood to power them. They can be blamed for the extensive desertification of Busoga while they persisted in the landscape. The environmental noise produced by the trains could be heard from Bulawa, but it was occasional noise since it was not generated all the time.

Because of the role of trains, cooperatives and a good road transport system, Busoga became a success story economically, becoming next to Buganda as the most developed in British Uganda Protectorate. It could even lend money to British Uganda Protectorate government and to the then less developed countries in the Far East Asia.

The railway network and bus system in Busoga were destroyed, alongside the financially empowering cooperatives, by President Tibuhaburwa Museveni’s guerilla group called National Resistance Movement/National Resistance Army (NRM/NRA) during its five-year armed struggle for power in the Luwero Triangle of Buganda.

The rebellion, buttressed by a heavy load of Tutsi refugees who wanted to use Ugandan human and non-human resources to overthrow the Hutu Juvenal Habyarimana regime and capture the instruments of power in Kigali, Rwanda, has nonetheless been cast since 1981 as a liberation war to liberate Uganda and Ugandans. Its victory has been continuously celebrated, every year since 1986 since it captured the instruments of power from the Tito Okello-Basilio Okello Military Junta on January 25th 1986, as “Liberation Day”. However, the beneficiaries of what was called by President Tibuhaburwa Museveni “The Struggle for Freedom and Democracy” in his book Sowing the Mustard Seed: The Struggle for Freedom and Democracy in Uganda have largely remained the same: those who participated in the struggle and those who are connected to them as children, brothers, sisters, spouses, sisters-in-law, brothers-in-law, fathers-in-law, or those belonging to the dominant ethnic group in the government, army and police. Some of those who fought in Luwero and went back to Rwanda have also benefitted and continue to benefit. They grabbed land, especially in Buganda, own businesses such as hotels and supermarkets, mainly in Kampala and Mbarara.

This can explain why there are repressive laws in Uganda today, casting the NRM regime as a repressive regime in the same fashion as the Tutsi regime during the Belgian colonial times in Rwanda when colonial rule for Rwanda was changed by the League of Nations from Germany colonialists to Belgian colonialists.

While NRM/NRA destroyed the economy of Busoga — the cotton-coffee crop economy — the bus system, the railway system, the health system, the education system, the cooperative system and the agricultural system — through its probably intentional or unintentional actions, it helped reduce the environmental noise levels in the area to a bare minimum. Therefore, for every bad action the outcome could be beneficial. Busoga became one of the areas in East Africa least burdened by environmental noise. In fact, when the NRM/A ransacked the industries of Jinja, the once noisiest industrial town in East Africa was silenced. It is only waking up from its long NRM/A-imposed sleep. Environmental noise is now detectable everywhere in Jinja.

As the government in power for nearly 40 years, NRM/NRA (read NRM/UPDF) is trying to revive the economy of Busoga through strategies such as Myooga, Operation Wealth Creation and Parish Development Model. However, these target only a miniscule of people. They are instead serving as tools of mass impoverishment because the absolute majority of Basoga are not benefitting from them. The falsehood on which the strategies are based is that if a few people are economically empowered their success stories will trickle down to the rest of the people in the communities. It is not happening. Critical intellectuals in Uganda believe and are convinced the strategies are for mass impoverishment, not development. They argue that the NRM/NRA or NRM/UPDF regime thrives on poverty and corruption and that, therefore, it is weaponising poverty against the Basoga and other Ugandans (e.g., Oweyegha-Afunaduula, 2025) to retain and sustain itself in power well into the future towards building a monarchised military and creating a soldier king in Uganda (e.g., Oweyegha-Afunaduula, 2025). They think, believe and are convinced that this is being subserved by the emergence, nurturing and application of electoral authoritarianism by the NRM/UPDF in Uganda since 1996 and the institutionalisation of violence as a tool of governance (e.g., Oweyegha-Afunaduula, 2025).

Today, we have only a Costa bus, which is irregular, carrying people from Bulawa to Iganga Municipality and back. Motorcycles are the main means of transport of goods and people and producing most of the noise. Even the sick and the dead are carried on motorcycles. In the past, we always waited for ambulances to carry our sick to dispensaries and hospitals and for big black vehicles to bring our dead from the hospitals free of charge. This is not the case during the Musevenite times when we are repeatedly told that Uganda is developing.

Again today, environmental noise in Bulawa village is a mixture of that made by motorcycles, the Costa bus, motor vehicles, goats, pigs, cows, chicken, birds, toads, a few lorries carrying mainly sugar cane because my village is no longer famous for growing cotton and coffee, and intermittently by aircraft, maize-meals, slashing machines, playing children, dogs, pigs, chicken, and cows. Interestingly, people of Bulawa village no longer wail when a person passes away. However, the noise made by musical instruments at burials, marriage introductions and weddings can be deafening. Nevertheless, the noise in the village is not as perturbing as it is in Iganga, Mbale, Arua, Lira, Hoima, Gulu, Jinja, Kampala and other built-up areas of Uganda.

I must emphasise that environmental noise is an inevitable consequence of a mature and vibrant society, but it can have a negative effect on people’s quality of life, affecting their health and wellbeing.

Not long ago a nephew of mine brought her prospective husband for introduction to the family and Clan. A night before, there was merry-making until the next morning, which in Uganda is called Akasiki, characterised by dancing accompanied by the sound of modern musical instruments. It was held near my family residence. It was very sickening for me. The sound of music, and the shouting of the people, deprived me of sleep. The roof of my family residence vibrated. The combined noise of musical instruments, vibrating roof and shouting of the people deprived my wife Jane and myself of sleep. I developed pains in my chest and at one time I thought my last breath was coming.

At nearly 76 I was extremely vulnerable to unregulated environmental noise. I developed acute chest pain. I never knew noise could cause chest pain in the elderly, but it did in my case. It is a scourge; the price of modernity. Apparently, every time there is an election and people have to campaign, shout and play loud music, we suffer a lot. The thought of upcoming noise throws us in fear — noise fear — over which we have little control.

In Uganda, noise regulations are governed by the National Environment (Noise Standards and Control) Regulations, 2003. These regulations, rooted in the National Environment Act, Cap 153, aim to protect residents from excessive noise pollution and ensure a healthy environment. Regulations prohibit the emission of noise from various activities if it’s clearly audible in a neighborhood for more than two minutes, or within prohibited time zones in residential areas or Noise Control Zones. However, in my case I was exposed to the terrible noise for almost 6 hours.

When I was retiring to my village in 2015, I was convinced I was running away from noisy Kampala to continue with my academic and intellectual production. I was wrong. As I have indicated above, occasionally I have to come face to face with imposed environmental noise during elections. I suffer imposed electoral noise, when contestants compete in how much noise their camps can produce. I am told many elderly people have been killed by exacerbated environmental noise. It is as if there are no noise regulations in Uganda.

This is unlike what I experienced when I visited Europe and Belgium’s Brussels for the first time in 1995 and Germany’s Bonn in 2000. In Brussels I stayed in a hotel, whose name I cannot remember off head, that was completely cushioned against noise. In Bonn, I staid in a hotel close to the highways and was exposed to vehicular noise and the noise made by electric trains.

I learnt that there was the Environmental Noise Directive (END) of the European Commission (EU), which is the main EU law to identify noise pollution levels and act on them. The END focuses on two key indicators: Lden (day-evening-night average noise level) and Lnight (night-time average noise level), with thresholds of 55dB and 50dB respectively, to address annoyance and sleep disturbance.

I tasted the wrath of the END in 2000 when one of my hosts in Bonn decided that Henry Mayega (now Ambassador Henry Mayega) and myself visited his home in a city 80 Km away from Bonn. I don’t remember the name of the city. He was called Dr. Ama, a medical doctor who had stayed in Germany for 40 years, married a German lady and produced children. I am not sure he is still alive because he was a fairly old man. He drove us to his beautiful home.

When we arrived at his home, where we stayed for two days before flying back to Uganda, we felt very much at home. When he left us in his house the first thing we quickly wanted was to listen to music from his wonderful musical instrument. He forgot to warn us about the strict regulation in Germany regarding noise pollution. Oblivious of the noise pollution control measures of Europe, we played loud music, the way Ugandans do despite the country’s noise pollution control measures.

Soon the Police were knocking at the front door of the house. We opened the door. The police commander told us that neighbours had rung to complain about loud music, which had exceeded the allowed levels. He said in Germany it was a crime. Lucky enough, even before we apologised, our host arrived and apologised on our behalf, saying “They are my visitors. They have never been to Germany. They have not yet familiarised themselves with END. The mistake is mine because I did not detail them about END. I beg your pardon.” The Police listened, became human and told us “Never do it again.” And they left. If it was in Uganda, the police would most likely ask for a bribe from us or our host, thereby eroding their professionalism.

The potential health risks of environmental noise are gaining increasing attention. With increasing urban populations and changes in urban development, a growing number of people in Uganda are being exposed to environmental noise. The research literature has grown substantially, providing new insights into how people are being exposed to noise and potential health risks.

Risks of noise-induced hearing loss, cardiovascular disease, elevated blood pressure, diabetes, and adverse reproductive outcomes, stroke, anxiety, depression, mortality, stroke, anxiety and depression tend to increase with increasing noise exposure. Exposure to extreme environmental noise pollution can adversely affect behaviour as well. Noise can also cause stress. The stress can result in poor mental health. The noise may well cause slow but continual hearing damage. The poor mental health may, in some cases, result in self-harm or suicide, hypertension, psychological problems, fatigue and so on.

All this is true in Uganda. It combines with different deprivations to cause our people complicated diseases. Let me elaborate:

1. Hearing loss is a significant issue in Uganda, affecting about 5.8% of the population, with approximately 2 million individuals experiencing it. Congenital hearing loss, infections, and accidents are common causes. A large portion of those affected are children, with roughly 1 million children experiencing hearing loss. World Health Organisation (WHO) in its article of 07 October 2024 titled “Burden of Hearing Loss in Africa could rise to 54 million by 2030 over from 40 million today.”
2. Elevated blood pressure, or hypertension, is a significant public health concern in Uganda, affecting a substantial portion of the adult population. Studies indicate that around 32% of the 30–79 age group has elevated blood pressure, and only about 33% are aware they have hypertension (e.g., Kiggundu, et.al., 2024).
3. Diabetes, particularly type 2, is a growing health concern in Uganda, with a significant number of people remaining undiagnosed and untreated, leading to complications and high costs. While the prevalence of diabetes is higher than previously thought, there is also a need for improved awareness and prevention programs to address the rising burden of the disease (e.g., Otigo and Kiyingi, 2023).
4. Adverse reproductive outcomes, including miscarriages, stillbirths, and neonatal deaths, are a significant public health concern in Uganda, according to a study on psychosocial effects of adverse pregnancy outcomes. Specific outcomes include high rates of abortion, stillbirths, and neonatal mortality. These outcomes are preventable and efforts are focused on reducing them through interventions like Every Newborn Action Plan (e.g., Asiki, et.al., 2015).
5. Stroke is a significant health issue in Uganda, ranking among the top causes of adult death. It accounts for a substantial portion of hospital admissions, with a high prevalence of modifiable risk factors like hypertension playing a crucial role. While there is limited specific data on stroke outcomes in Uganda, research indicates a high burden of both ischemic and haemorrhagic stroke (e.g., Timm, et.al., 2023).
6. Najjuma, et.al. (2021) found the prevalence of mental health symptoms among participants was 80.7%, 98.4%, and 77.9% for depression, high levels of anxiety, and stress, respectively.
7. In Uganda, mental, neurological and substance use disorders are a major public health burden (Mugisha et.al., 2019 cited by James Kagaari, 2021). Depression, anxiety disorders, and elevated stress levels are the most common, sometimes leading to suicide attempts (Farai et.al., 2016 cited by James Kagaari, 2021). Uganda is ranked among the top six countries in Africa in rates of depressive disorders (4.6%; Miller et.al., 2020 cited by James Kagaari, 2021), while 2.9% live with anxiety disorders (WHO, 2017 cited by James Kagaari 2021). About 5.1% of females and 3.6% of males are affected.

In one sentence, Uganda is a sick society. In fact, one study showed that of the 45 million Ugandans, 14 million are mentally sick. One concerned person summarised the terrible situation by telling me that of the 4 people walking ahead of me 1 will be mentally sick.

Aber-Odonga, et.al. (2024) found that the overall prevalence of probable alcohol use disorders (AUD) and other substance use disorders (SUD) was 27.8% (95% CI 1.24–1.31) while that of probable AUD alone was 25.3% (95% CI 1.22–1.28). Peer substance use (APR = 1.24, 95% CI 1.10–1.32), sibling substance use (APR = 1.14, 95% CI 1.06–1.23), catholic caregiver religion (APR = 1.07, 95% CI 1.01–1.13), caregiver income of more than $128 (APR = 0.90, 95% CI 0.82–0.98), having no parental reprimand for substance use (APR = 1.05, 95% CI 1.01–1.10) and having no knowledge of how to decline an offer to use substances (APR = 1.06, 95% CI 1.01–1.12) were found to be significantly associated with probable AUD/SUD.

Since all the ailments mentioned in this article have been associated with environmental noise, we need multiple serious studies of the role of environmental noise in initiating them, especially mental health. Stansfeld SA, et.al. (2000) reviewed the studies of environmental and industrial noise and mental ill-health published between 1993 and 1998 and suggest possibilities for future research. Recent community-based studies suggest high levels of environmental noise are associated with mental health symptoms such as depression and anxiety but not with impaired psychological functioning (Stansfeld, et.al., 2000).

Several studies find that self-reported noise sensitivity does not interact with noise exposure to lead to increased vulnerability to mental ill-health. Xiangpu, Gong et.al. (2022) found a potential link between noise annoyance and poorer mental health based on a small number of studies. More evidence is needed to confirm these findings.

It is encouraging that Kampala authorities launched an operation to curb noise pollution and vibration pollution in the city (Nduwumwami, 2024). However, the rural areas in Uganda have become extremely vulnerable to noise pollution and vibration pollution, especially in areas where the government is pursuing big dam building. Such operations are needed in all the cities and towns of Uganda. What are also needed are studies linking environmental noise and rising incidence of mental sickness and other ailments in the rural areas such as in my area Nawaka in Ikumbya Subcounty, Luuka District, Busoga.

For God and My Country

Further Reading

Aber-Odonga, H., Babirye, J.N., Engebretsen, I.M.S. et al. Prevalence of probable substance use disorders among children in Ugandan health facilities. BMC Public Health 24, 314 (2024). https://doi.org/10.1186/s12889-024-17732-6 https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-024-17732-6#citeas Visited on 09 June 2025 at 19:10 pm EAT

Asiki, Gershim, et.al. (2015). Adverse pregnancy outcomes in rural Uganda (1996–2013): trends and associated factors from serial cross-sectional surveys. National Library of Medicine, National Center for Biotechnology Information, 29 October 2015 https://pmc.ncbi.nlm.nih.gov/articles/PMC4627380/ Visited on 07 June 2025 at 18:17 pm EAT

Britannica (2025). Rwanda Under German and Belgian Control. Britannica, IN: Rwanda in History, Updated June 09 2025 https://www.britannica.com/place/Rwanda/Rwanda-under-German-and-Belgian-control Visited 10 June 2025 at 12:35 pm EAT.

Bukenya, Badru et.al (2022). Depression, Anxiety, and Suicide Risk among Ugandan Youth in Vocational Training.

Kagaari, James (2021). Mental Health in Uganda. American Psychological Association, January 26 2021 https://www.apa.org/international/global-insights/uganda-mental-health Visited on 09 June 2025 18:55 pm EAT.

Kiggundu, Thomas, et.al. (2024). Trends and Distribution of Hypertension in Uganda. Uganda National Institute of Public Health, January 16 2024, https://uniph.go.ug/trends-and-distribution-of-hypertension-in-uganda-2016-2021/ Visited on 09 June 2025 at 17:58 pm EAT.

Museveni, Y.K (1997). Sowing the Mustard Seed: The Struggle for Freedom and Democracy in Uganda. Paperback – January 1, 1997. Amazon, https://www.amazon.com/Sowing-Mustard-Seed-Struggle-Democracy/dp/0333642341 Visited on 19 June 2025 at 12:26 pm EAT.

Najjuma, Sarah Maria, et al. (2021). Depression, anxiety, and stress among Ugandan university students during the COVID-19 lockdown: an online survey. Afr Health Sci. 2021 Dec;21(4):1533–1543. doi: 10.4314/ahs.v21i4.6 https://pmc.ncbi.nlm.nih.gov/articles/PMC8889827/ Visited on 09 June 2025 at 18:37

Nduwumwami, Lindah (2024). Kampala authorities launch operation to Curb Noise and Vibration pollution. Nile Post, October 21 2024 https://nilepost.co.ug/environment/222518/kampala-authorities-launch-operation-to-curb-noise-and-vibration-pollution Visited on 09 June 2025 at 19:41 pm

Olum, Sam, et. al. (2021). Stroke Mortality Outcomes. National Library of Medicine, 6 March 2021, https://pubmed.ncbi.nlm.nih.gov/33684710/ Visited on 09 June 2025 at 18:28 pm EAT.

Otigo, William and Kiyingi, Daisy (2023). A study on prevalence of diabetes mellitus type 2 among patients aged 30-60 years attending health service at Bukedea health Center IV in Bukedea district. A cross-sectional study. Students Journal of Health Research in Africa https://sjhresearchafrica.org/index.php/public-html/article/view/373 Visited on 09 June 2025 at 18:06 pm EAT.

Oweyegha-Afunaduula (2025). Is National Resistance Movement Governance weaponising Poverty Against Ugandans? Muwado, June 07 June 2025 https://muwado.com/is-the-national-resistance-movement-government-weaponising-poverty-against-ugandans/?v=2a0617accf8b Visited on 10 June 2025 at 13:03 pm EAT.

Oweyegha-Afunaduula (2025). Violent policies, violent laws in generating and sustaining violence in Uganda. Muwado, 08 June 2025 https://muwado.com/violent-policies-violent-laws-in-generating-and-sustaining-violence-in-uganda/?v=2a0617accf8b Visited on 10:29 pm EAT at 13:28 pm EAT.

Oweyegha-Afunaduula (2025). Uganda Towards a New Monarchised Military: Soldier King in the Making? Muwado, 09 2025 https://muwado.com/uganda-towards-a-new-monarchised-military-soldier-king-in-the-making/?v=2a0617accf8b Visited on 10 June 2025 at 12:10 pm EAT.

Oweyegha-Afunaduula (2025). The Emergence of Electoral Authoritarianism in Uganda – 1996 to Present. Muwado, 09 June 2025 https://muwado.com/the-emergence-of-electoral-authoritarianism-in-uganda-1996-to-present/?v=2a0617accf8b Visited on 10 June 2025 at 13:14 pm EAT.

Stansfeld SA, Haines MM, Burr M, Berry B, Lercher P. A Review of Environmental Noise and Mental Health. Noise Health. 2000;2(8):1-8. PMID: 12689457. https://pubmed.ncbi.nlm.nih.gov/12689457/ Visited on 09 June 2025 at 19:22 pm EAT.

Timm, L., Kamwesiga, J., Kigozi, S. et al. Struck by stroke – experiences of living with stroke in a rural area in Uganda. BMC Public Health 23, 1063 (2023). https://doi.org/10.1186/s12889-023-15832-3 https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-023-15832-3 Visited on 09 June 2025 at 16:22 pm EAT.

Xia Chen, Mingliang Liu, Lei Zuo, Xiaoyi Wu, Mengshi Chen, Xingli Li, Ting An, Li Chen, Wenbin Xu, Shuang Peng, Haiyan Chen, Xiaohua Liang, Guang Hao (2023). Environmental noise exposure and health outcomes: an umbrella review of systematic reviews and meta-analysis. Published by Oxford University Press on behalf of the European Public Health Association.

Xiangpu, Gong et.al. (2022). Association between Noise Annoyance and Mental Health Outcomes: A Systematic Review and Meta-Analysis. Int. J. Environ. Res. Public Health 2022, 19(5), 2696; 25 February 2022 https://doi.org/10.3390/ijerph19052696 https://www.mdpi.com/1660-4601/19/5/2696 Visited on 09 June 2025 at 19:54 pm EAT.

World Health Organisation (2024). Burden of Hearing Loss in Africa Could rise to 54 million by 2030: WHO Report. WHO, 07 October 2024. https://www.afro.who.int/news/burden-hearing-loss-africa-could-rise-54-million-2030-who-report Visited on 09 June 2025 at 17:48 pm EAT.