title: Comparison of coliform contamination in non-municipal waters consumed by the Mennonite versus the non-Mennonite rural populations.
abstract: OBJECTIVE
  Mennonites reside in clusters, do not use modern sewage systems and consume water from non-municipal sources. The purpose of this study is to assess risk of Escherichia coli exposure via consumption of non-municipal waters in Mennonite versus non-Mennonite rural households.
  
  
  METHODS
  Results were reviewed for non-municipal water samples collected by the local health department from Mennonite and non-Mennonite lifestyle households from 1998 through 2012. Water contamination was examined with the help of two study variables: water quality (potable, polluted) and gastrointestinal (GI) health risk (none, low, high). These variables were analyzed for association with lifestyle (Mennonite, non-Mennonite) and season (fall, winter, spring, summer) of sample collection. Data were split into two periods to adjust for the ceiling effect of laboratory instrument.
  
  
  RESULTS
  From the entire cohort, 82 % samples were polluted and 46 % samples contained E. coli, which is consistent with high GI health risk. In recent years (2009 through 2012), the presence of total coliforms was higher in non-Mennonites (39 %, P = 0.018) and presence of E. coli was higher in Mennonites (P = 0.012). Most polluted samples were collected during summer (45 %, P = 0.019) and had high GI health risk (51 %, P = 0.008) as compared to other seasons.
  
  
  CONCLUSIONS
  Majority of non-municipal waters in this region are polluted, consuming those poses a high GI health risk and contamination is prevalent in all households consuming these waters. An association of E. coli exposure with the Mennonite lifestyle was limited to recent years. Seasons with high heat index and increased surface runoffs were the riskiest to consume non-municipal waters.
authors.affiliation: Department of Medicine, University of Louisville, 550 S. Jackson St, ACB 3rd Floor, Louisville, KY, 40292, USA, a.amraotkar@gmail.com.
authors.forename: Alok Ravindra
authors.initials: AR
authors.lastname: Amraotkar
authors.forename: Charles William
authors.initials: CW
authors.lastname: Hargis
authors.forename: Alexander C
authors.initials: AC
authors.lastname: Cambon
authors.forename: Shesh Nath
authors.initials: SN
authors.lastname: Rai
authors.forename: Matthew Cody Lee
authors.initials: MC
authors.lastname: Keith
authors.forename: Shahab
authors.initials: S
authors.lastname: Ghafghazi
authors.forename: Roberto
authors.initials: R
authors.lastname: Bolli
authors.forename: Andrew Paul
authors.initials: AP
authors.lastname: DeFilippis
mesh_terms: D060766:Drinking Water / Q000382:microbiology*; D004755:Enterobacteriaceae / Q000302:isolation & purification*; D006801:Humans; D007629:Kentucky; D008019:Life Style; D033303:Protestantism; D012424:Rural Population; D012621:Seasons; D060753:Water Quality
chemical_list: D060766:Drinking Water