Water quality, availability, and acute gastroenteritis on the Navajo Nation - A pilot case-control study

Scott P. Grytdal, Robert Weatherholtz, Douglas H. Esposito, James Campbell, Raymond Reid, Nicole Gregoricus, Chandra Schneeberger, Tina S. Lusk, Lihua Xiao, Nancy Garrett, Cheryl Bopp, Laura L. Hammitt, Jan Vinjé, Vincent R. Hill, Katherine L. O'Brien, Aron J. Hall

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


The Navajo Nation includes approximately 250,000 American Indians living in a remote high desert environment with limited access to public water systems. We conducted a pilot case-control study to assess associations between acute gastroenteritis (AGE) and water availability, use patterns, and quality. Case patients with AGE and non-AGE controls who presented for care to two Indian Health Service hospitals were recruited. Data on demographics and water use practices were collected using a standard questionnaire. Household drinking water was tested for presence of pathogens, coliforms, and residual chlorine. Sixty-one subjects (32 cases and 29 controls) participated in the study. Cases and controls were not significantly different with respect to water sources, quality, or patterns of use. Twenty-one percent (n = 12) of study participants resided in dwellings not connected to a community water system. Eleven percent (n = 7) of subjects reported drinking hauled water from unregulated sources. Coliform bacteria were present in 44% (n = 27) of household water samples, and 68% (n = 40) of samples contained residual chlorine concentrations of <0.2 mg/L. This study highlights issues with water availability, quality, and use patterns within the Navajo Nation, including sub-optimal access to community water systems, and use of water hauled from unregulated sources.

Original languageEnglish (US)
Pages (from-to)1018-1028
Number of pages11
JournalJournal of Water and Health
Issue number6
StatePublished - Dec 2018


  • Acute gastroenteritis
  • Coliforms
  • Hauled water
  • Navajo Nation

ASJC Scopus subject areas

  • Water Science and Technology
  • Waste Management and Disposal
  • Public Health, Environmental and Occupational Health
  • Microbiology (medical)
  • Infectious Diseases


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