‘I get angry since the river is dirty’: multi-method qualitative findings from young adolescents and elders in climate-affected Kenyan regions on water, sanitation, and hygiene concerns

ABSTRACT Water, sanitation, and hygiene (WASH) insecurity presents significant health challenges in East Africa and is exacerbated by climate change. Yet, limited research has examined climate-related WASH challenges from the perspective of young adolescents. We explored experiences of water, food, and sanitation insecurity among young adolescents aged 10–14 and elders in climate-affected Kenyan regions. Between 2022 and 2024, we conducted a multi-method qualitative study across six sites representing diverse ecological and social contexts, including urban informal settlements (Nairobi), rural coastal (Kilifi) and nomadic pastoral (Isiolo) communities, fishing communities (Kisumu), flower farmer communities (Naivasha), and Kalobeyei refugee settlement. Data were collected through focus groups with n=119 elders, walk-along interviews with n=60 young adolescents, and participatory mapping workshops with n=118 young adolescents. Using framework-based thematic analysis, we identified three interconnected themes: water contamination concerns driven by human waste, animal waste, and flooding; waterborne infection exposure linked to water insecurity and inaccessible water treatment; and sanitation-related infection concerns associated with inadequate toilet access and infrastructure. Participants described how flooding and drought intensified existing WASH challenges and increased infection concerns. Findings highlight the need for climate-resilient WASH interventions that address structural inequalities, integrate intergenerational perspectives, and meaningfully engage young adolescents in climate-affected settings.