Water, sanitation, and hygiene challenges in last-mile artisanal mining communities in Ghana and Uganda.

Introduction: Access to water, sanitation, and hygiene (WASH) is critical for public health but remains inadequate in marginalized areas, particularly in sub-Saharan Africa's artisanal and small-scale mining (ASM) communities. Adolescent girls and young women (AGYW) in these settings face unique challenges that impact their health and wellbeing. Objective: This study aimed to assess WASH access among adolescent girls and young women (aged 10-24) in last-mile ASM communities in Ghana and Uganda, identifying disparities and factors influencing access. Methods: A cross-sectional, mixed-methods design was employed between March and May 2022 in selected ASM communities in Ghana and Uganda. The quantitative component included a sample of 1618 AGYW (808 in Ghana, 810 in Uganda) recruited through random household selection. Data were collected using interviewer-administered questionnaires adapted from validated sources, covering socio-demographics, water sources, sanitation, and hygiene practices. Descriptive statistics, chi-square tests, and logistic regression were conducted, stratified by country, to examine associations between WASH access and sociodemographic factors. For the qualitative component, AGYW, community leaders, district officers, policymakers, and global experts were purposively selected. Data was collected through focus group discussions and in-depth/key informant interviews conducted in local languages. Thematic analysis was performed using NVivo 12, with illustrative participant quotes. Results: Quantitative findings showed that 86.2 % reported access to improved water sources, but only 10.1 % had access to improved toilet facilities. In Ghana, 83 % lacked any toilet facility; in Uganda, 65 % used unimproved latrines. Water access was associated with religion and education in Ghana, and toilet access was linked to residence and wealth in both countries. Qualitative findings revealed concerns about water quality, reliability, distance to water points, and major sanitation challenges, especially for women and girls. Cultural norms and mining-related environmental impacts further exacerbated WASH vulnerabilities. Conclusion: Significant disparities in WASH persist in ASM communities, particularly for sanitation. Context-specific, community-engaged interventions are urgently needed to address these gaps and promote health equity for AGYW in rural mining settings.