Mining, regardless of its scale, poses significant risks to the health of workers, surrounding communities, and the environment in general. Artisanal and small-scale mining (ASM) is of particular concern, representing a significant portion of global mining activity. It is characterized by precarious working conditions, a lack of regulation, limited access to healthcare, and the use of often rudimentary and dangerous techniques [1] .

Mine safety refers to all the activities involved in maintaining and monitoring mining operations, and the tools or instruments used to reduce risks to individuals and the operating structure [2] .

The hazards present in mines expose workers to health and safety risks that can lead to occupational illness or fatal injury. Ground instability is one of the leading causes of death in underground mines in Ontario. Since 2000, ten workers have died and nearly 50 workers have been seriously injured in Ontario underground mines due to landslides or ground shaking [2] .

Globalization and the digital revolution have been transforming the world of work for more than twenty years, leading to greater flexibility in employment at the expense of job security. In this context, working hours, which had been in overall decline since the beginning of the 20th century, are now increasing. Worldwide, the number of people working more than 55 hours per week has increased over the last two decades, from an average of 8.1% of the working population in 2000 to 8.9% in 2016. In studies, the 55-hour workweek limit is predominantly used because this definition has been observed to be associated with negative impacts on health [3] .

According to the directive specific to temporary work, the responsibility for protecting the health and safety of temporary workers is shared by both the legal employer and the user company. However, it is explicitly stated that “Member States shall take the necessary measures to ensure that the user company and/or establishment are, for the duration of the assignment, responsible for the conditions under which the work is carried out; the conditions under which the work is carried out shall include, but are not limited to, those relating to safety, hygiene and health at work” [4] .

Health risks in mining areas are diverse and include factors such as age (mining children), gender (women), lack of personal protective equipment (PPE), and ignorance of protective measures [5] .

Of particular concern among these risks is exposure to chemicals such as mercury and cyanide, which are used in amalgamation and gold mining. These substances can be inhaled, absorbed, or ingested, leading to serious health problems [6] . In addition, the use of power-driven machinery in confined spaces increases the risk of poisoning due to insufficient ventilation [7] .

The most common biological diseases in these settings include vector-borne and water-borne infections, as well as sexually transmitted infections such as HIV/AIDS and tuberculosis. These risks are exacerbated by crowded conditions and poor water and sanitation infrastructure, which is often inadequate in mining camps [8] . Stagnant water in these environments promotes the breeding of mosquitoes, vectors of diseases such as malaria and dengue fever [9] .

Musculoskeletal disorders are also common among miners, often caused by heavy lifting and inappropriate postures while working [7] . Additionally, trauma resulting from rockfalls, explosions, and improper use of equipment are ever-present hazards, leading to biomechanical and other trauma injuries [10] .

The International Labour Organization (ILO) estimates that approximately 1 million children aged 5 to 7 are involved in small-scale mining activities worldwide [11] Their participation, which covers all stages of ASGM, is often considered one of the “worst forms of child labour” according to ILO Convention No. 182. Eliminating this practice is complex due to its family-based, temporary and informal nature, as well as the associated levels of poverty [11] .

In the Democratic Republic of Congo, studies conducted by the United Nations Environment Programme (UNEP) in 2016 revealed that the mining sector contributes to pollution, deforestation, and biodiversity loss, while posing security problems for local populations [12] .

ASM in the Aruwimi Basin, Tshopo Province, is a vital economic activity for many communities. Miners, often seasonal and from diverse backgrounds, often work as part of their families, increasing their vulnerability to health risks [13] . The low income generated by EMAPE increases this vulnerability, with negative consequences for the health of workers and surrounding populations [13] .

Evacuations for landslide accidents, drowning, respiratory infections, the increase in cases of diarrhea, the high frequency of STIs/AIDS and the recurrence of meningitis epidemics in the mining concentrations of Panga, fishing and Mangi in the territory of Banalia, where the victims are more the diggers or divers [14] , motivate us to conduct this study to try to answer the question. “What are the factors associated with occupational accidents in the aquatic mining centers of the Aruwimi basin in the DRC?”

The objective of this study was to determine the factors associated with occupational accidents among underwater diving minors in the Banalia territory in Tshopo province.

The mean age of aquatic miners was 38.2 ± 6.9 years, with the dominant age range being 41 to 45 years; secondary education and married marital status were dominant. The median duration of work by miners in our study was 10 years or more. ( Table 1 )

The most commonly observed illnesses, different from others, were malaria and STIs, and the dominant health problems were lower back pain and chest pain. The dominant symptoms upon leaving the dishwasher were dizziness, pain, and chills. Nearly three-quarters of the patients had already suffered occupational accidents and had good-quality PPE. ( Table 2 )

It is evident from this table that poor quality PPE increased the risk of accidents in the aquatic mining site twice (OR = 2.21 CI95: 1.4 - 3.8) and the duration of immersion of 1 to 2 hours in the water reduces the risk of accidents (OR = 0.32 IC95: 0.2 - 0.5). ( Table 3 )

Mining sites are characterized by a high prevalence of infectious and musculoskeletal diseases, which are fueled by the physical and socio-professional environmental conditions of the mines. Occupational accidents are fueled by the poor quality of protective equipment used and excessive diving time. It is essential to disseminate and enforce regulations on occupational health and safety in mining sites.

The validity of our data does not exclude the possibility of observing possible changes in the epidemiological profile under the influence of the seasonality of mining activities.

The cross-sectional design of the study, the use of self-reported data and the lack of control over potential confounding variables also constitute limitations for this study.

The insufficiency of factors likely to influence occupational accidents in mines, with the possibility of measurement bias or under-reporting, did not allow for a multivariate analysis to be carried out to control confounding factors and provide information on independent predictive factors.