Water sanitation hygiene — DTM&H MCQ

Instant feedback + full explanation. One question, done properly.

EasyEpidemiology and public healthWater sanitation hygieneDTM&H

A village has recurrent diarrhoeal disease and open defaecation near water sources. A borehole is functional but household water is often contaminated during storage. What is the most important public health measure?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: A — Safe storage, sanitation and hygiene promotion

The correct answer is A, safe storage, sanitation and hygiene promotion. The stem's key discriminator is that a functional borehole (an improved source) is being undermined by contamination during household storage and by ongoing open defaecation near water sources, which is a classic faecal-oral transmission pathway. Addressing this requires the full WASH package: eliminating open defaecation through sanitation, promoting hand hygiene, and ensuring safe storage in narrow-necked, covered containers to prevent recontamination after collection. Improving the source alone does not close the transmission loop if water is fouled between tap and mouth, which is why point-of-use safe storage and behaviour change are the most important intervention here. Why the other options are wrong: C. Hospital antibiotics for everyone: Mass antibiotic treatment does not address the environmental and behavioural drivers of transmission, risks promoting antimicrobial resistance, and is not indicated without a confirmed bacterial outbreak requiring individual case management. E. Schistosomiasis snail mapping alone: The vignette describes diarrhoeal disease from faecal-oral contamination, not schistosomiasis, and snail mapping alone does nothing to interrupt the described transmission route. B. Indoor residual spraying: This is a vector control measure for mosquito-borne disease such as malaria and has no role in preventing water and sanitation related diarrhoeal illness. D. Mass rabies vaccination: Rabies is transmitted by animal bites, entirely unrelated to the water contamination and open defaecation problem described. Key point: An improved water source only protects health if contamination during storage and handling, and faecal contamination of the environment, are also controlled through sanitation, safe storage and hygiene promotion.

Reference: WHO, Water, sanitation and hygiene (WASH) interventions and the prevention of diarrhoea, ELENA Library, https://www.who.int/tools/elena/bbc/wsh-diarrhoea