Household exposure pathways and perceived health risks associated with artisanal and small-scale gold mining around Lake Sonfon, Sierra Leone: a cross-sectional study

Artisanal and small-scale gold mining (ASGM) is widely associated with heavy metal contamination in rural communities, yet limited evidence links multiple household exposure behaviours to self-reported health outcomes, particularly in lake-dependent West African settings. This cross-sectional study assessed household exposure pathways and self-reported health outcomes among mining-affected communities around Lake Sonfon, Sierra Leone. A structured questionnaire was administered to a purposive sample of 70 households across six settlements to evaluate livelihood dependence, water-use practices, exposure behaviours, and self-reported symptoms; no environmental or biological exposure measurements were collected as part of this survey. Mining was the dominant livelihood, with 51.4% of men engaged in mining-related activities. Most households (61.4%) relied on Lake Sonfon water as their primary drinking source, with a substantial proportion consuming it untreated. Households in active mining areas were more likely to consume untreated lake water and to report perceived deterioration in water quality ( p < 0.05). Multiple overlapping exposure behaviours were identified including drinking, bathing/laundry, and consumption of locally caught fish with an average composite score of 2.28 (of a possible 4) concurrent risk behaviours among mining households. Households whose primary drinking source was Lake Sonfon more frequently reported symptom flare-ups following water contact (81.4% vs. 11.1% of non-users; unadjusted OR = 35.0, 95% CI 8.4–145.5; occupation-adjusted OR = 44.1, 95% CI 8.6–227.5, p < 0.001) and diagnosed respiratory illness (23.3% vs. 7.4%; occupation-adjusted OR = 8.1, 95% CI 1.1–59.1, p = 0.038). These associations are based on self-reported, cross-sectional data and cannot establish causation. Despite widespread awareness that the lake may be contaminated (75.7%), 48.6% of households reported taking no action to treat their drinking water, reflecting structural rather than purely informational barriers. Integrated water infrastructure, regulatory, and community-based risk-communication interventions are needed to reduce exposure, alongside further research incorporating environmental and biological monitoring.