Objective: This study was designed to examine the existence of pesticide residues in both indoor dust and consumable subsurface shallow ground water and its association with community health in an agro-ecosystem in the Nile Delta Region. Methods: Pesticide exposure via consumption of shallow groundwater and contact with indoor dust were assessed in 7 villages in the Nile Delta of Egypt. Hand-pumped water and households' dust samples were collected on a spatio-temporal monitoring basis. A total of 50 households were randomly selected and residents were interviewed using a structured questionnaire to determine pesticide usage, exposure pathways and behavioral/health risk factors. Results: Analyses revealed that the examined shallow groundwater and indoor dust samples failed to realize the respective standards of safety in most cases.  Pesticide residues detected in indoor dust were more abundant than those in groundwater. Pyrethroid compounds represented the highest residues detected in indoor dust samples, where their mean levels were 4.75, 2.69, and 15.21 ppm for permethrin, cypermethrin, and cyahalothrin respectively. DDT, HCH and endosulfan were also detected in many samples in mean concentrations of 10.42, 36.01 and 33.68 ppb; respectively. As for the link between environmental contamination and community health, through our field questionnaire, the villagers stated that water-related diseases particularly diarrhea and infectious hepatitis were predominant. Conclusion: Age, living in close proximity to agricultural fields, excessive use of pesticides indoors without adequate aeration, lack of awareness and poor water quality, represented the major risk factors. More exposure/risk assessment studies related to the Egyptian setting are necessary to enhance drinking water regulations and lower the health risks of pesticide exposure.