Emerging contaminants (ECs), including pharmaceutical residues, personal care products (PCPs), endocrine-disrupting compounds (EDCs), microplastics, and nanoparticles, are increasingly reported in Ghana’s aquatic environments. These substances resist conventional wastewater treatment and may bioaccumulate, posing serious risks to ecosystems and public health. This review synthesizes available evidence from peer-reviewed studies, technical reports, and Environmental Protection Agency data to assess the sources, occurrence, and persistence of ECs in wastewater. Findings show that pharmaceuticals and PCP ingredients are frequently present in treated effluents, while microplastics and nanoparticles act as carriers of adsorbed pollutants. Long-term exposure to these contaminants is linked to antimicrobial resistance, endocrine disruption, reproductive disorders, and ecological toxicity. Ghana currently lacks EC-specific regulations and systematic monitoring programs, while data remain sparse and fragmented. Most treatment facilities rely on primary or secondary processes that are ineffective in eliminating trace contaminants, and advanced methods such as ozonation, activated carbon, and membrane technologies are rarely applied due to financial and technical barriers. Low-cost alternatives, such as constructed wetlands and biofiltration systems, have shown promise in other contexts but remain under-explored locally. This study identifies critical knowledge gaps, weak institutional frameworks, and technological limitations that constrain effective management of ECs in Ghana. It emphasizes the urgent need for national monitoring frameworks, clear discharge standards, affordable treatment upgrades, and public awareness initiatives, including pharmaceutical take-back schemes. Lessons from international experiences, notably the European Union’s wastewater directives and Sweden’s pharmaceutical stewardship programs, offer practical pathways for safeguarding Ghana’s water quality, ecological integrity, and public health.

Highlights

• Review sources and occurrence of ECs in Ghana’s wastewater.
• Highlights treatment failures and ecological and human health risks.
• Recommends low-cost treatment innovations for sustainable management.