Aim: To summarize the literature on the prevalence of pediatric hearing loss in low- and middle-income countries (LMICs). Method: A systematic review initially identified 2833 studies, of which 122 met the criteria for inclusion. Eighty-six of those studies included diagnoses and were included in a meta-analysis. Results: The meta-analysis indicated a 1% (95% confidence interval = 0.8–2.0) prevalence of childhood hearing loss across LMICs. There was significant heterogeneity between studies and evidence of publication bias. The prevalence of mild and moderate cases of hearing loss was higher than more severe cases and there were fewer cases of mixed hearing loss compared to conductive or sensorineural hearing loss. No differences were identified between the prevalence of unilateral versus bilateral hearing loss or hearing loss according to sex. The quality of the studies, age of participants, and location of data collection may have influenced the results. High variability in the reporting of etiology made the causes of hearing loss unclear. Interpretation: The literature indicates that 1% of children in LMICs have hearing losses. However, most studies missed children with acquired hearing loss, which may lead to under-reporting of global prevalence. This systematic review is an initial step toward developing and implementing population-appropriate treatment and prevention programs for childhood hearing loss in LMICs. What this paper adds: The prevalence of childhood hearing loss in low- and middle-income countries is 1%. Reporting of hearing loss etiology was highly variable.