Background: Aquaculture is one of the fastest growing food-producing sectors. Little is known of the occupational exposures, risk factors and their associated adverse health outcomes among aquaculture workers, particularly from low and middle income countries (LMICs). Aim: To gain better insight into the occupational exposures and associated occupational diseases and injuries among aquaculture workers. Methods: MEDLINE, Google Scholar and SCOPUS literature searches were undertaken to identify relevant studies (1960–2018). Furthermore, data from official country reports, industry, labour ministries and workers' compensation boards were reviewed. Results: The review identified that very few studies (3%) were reported from LMICs. Most studies that were reported focussed on farming fish and crustaceans, and less so molluscs and aquatic plants. Occupational exposure characterisation studies were mainly reported for noise (43.2–77.5 dB), chemicals such as formaldehyde in hatcheries (<0.045- > 2.0 ppm) and microorganisms such as E. coli bacteria in fish ponds (7.0 × 102–5.3x106CFU/100 ml). The most common occupational diseases included musculoskeletal disorders (MSD) (prevalence: 21–63%); respiratory symptoms and asthma (4–65%); skin infections (2.2–15.7%), dermatitis (6%) and urticaria (0.7%); occupational infections such as leptospirosis (incidence: 33/100,000PYS); and decompression illness in divers (incidence: 0.57–26.19/10,000PYS). Among crawfish farmers, tractor use was associated with increased risk of wrist pain (OR = 2.89) and lower-backache (OR = 2.41), while increased employment duration was associated with upper-backache (OR = 3.07). In fish farming, skin ailments were strongly associated with female gender (OR = 2.48); previous history of skin problems (OR = 8.50); waste-water exposure (OR = 2.74); fish farming-related jobs (OR = 3.47); lack of personal skin protective measures against wastewater (OR = 2.24) and work in the wet season (OR = 2.80). The most common injuries included falls (10–49/10,000 PYS), blows from an object (14–37/10,000 PYS), entanglement (29/10,000 PYS), pricks/cuts/punctures (29/10,000 PYS), high voltage exposures (8/10,000 PYS) and needlestick injuries (5 self-injections per 1,000,000 vaccinations). Seaweed farmers reported injuries mainly from hazardous aquatic animals and sharp shells on the seabed (54%). Preventive approaches based on the hierarchy of control measures to reduce health risks associated with hazardous exposures is existent mainly in predominantly well-resourced high income countries. Conclusion: Aquaculture workers are at increased risk of developing occupational diseases and injuries attributed to various occupational hazards, and that these risks are under-reported, especially from LMICs. Future studies should explore the interaction between these environmental exposures and work organization factors in causing occupational diseases and injuries. A better understanding of key occupational risk factors and the evaluation of interventions to reduce these risks is crucial in protecting and promoting the health of workers in this sector. © 2019 Elsevier B.V.