Microbe Literacy Intervention

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Title: Microbe Literacy Intervention

Principal Investigators: Dr. Daniel Bennett (University of Chicago), Dr. Syed Ali Asjad Naqvi (CERP), Dr. Wolf-Peter Schmidt (London School of Hygiene and Tropical Medicine)

Implementing Partners: National Commission for Human Development (NCHD)

Project Consultant: Edward Higgins (New York)

Donors: ---

Project type: Large Scale (Rahim Yar Khan, Muzaffargarh, Bhawalnagar, Lodhran)

Start Date: February 2013

End Date: August 2015

Status: Completed



Project Background

CERP in partnership with the National Commission for Human Development (NCHD), the University of Chicago and the London School of Hygiene and Tropical Medicine (LSHTM) designed an intervention to improve health and hygiene practices among illiterate women in Pakistan. According to recent literature in public health, low-cost standard hygiene and sanitation messages that promote hand washing, safe food handling and safe water storage are not widely adopted. One reason people may not respond to (or have low “willingness to pay” for) hygiene promotion is that messages are not salient. Conventional recommendations encourage infection prevention by appealing to the germ theory of disease. This conception of illness does not resonate well with traditional “hot/cold” beliefs about the causes of illness that prevail in many traditional, culturally conservative communities. In Pakistan, 70 percent of the population practices some form of traditional medicine, which does not incorporate microscopic agents. Hygiene recommendations may not resonate for people who have never conceived of microscopic life, or who do not believe that microscopic pathogens cause illness.

Project Evaluation

In light of this information, researchers at CERP partnered with NCHD and conducted a Microbe Literacy (ML) hygiene education program that attempted to increase the salience of hygiene education and practices. The intervention targeted women and girls over age of 15 who are the primary caretakers for infants and small children.

The ML curriculum included two 90-minute interactive workshops.

  • In the microscope demonstration, participants used magnifying glasses to learn about magnification and then prepared microscope slides of samples from the environment. These samples may include standing water, buffalo dung, and spoiled food. Participants took turns looking directly through the microscope while the rest of the class watched on a closed-circuit television.
  • The infection-prevention workshop builds subsequent to previous workshop experience, by offering specific information on disease prevention, including hand washing, safe food handling, and latrine usage.

Both workshops followed prepared manuals, used gender-matched facilitators, and adopted an open-discussion approach. For viewing the manual, please click on the link below:


For evaluation, female facilitators presented the ML curriculum to participants in Adult Literacy Classes (ALCs) a flagship program of NCHD which specifically targeted illiterate women between the age of 11 and 45. The classes ran for six months covering language and math skills, and basic health and hygiene education. The Microbe Literacy intervention was paired with ALCs in four districts of Southern Punjab where literacy levels are the lowest and health indicators are the poorest (see MICS 2007-08).

Using a randomized impact evaluation design, the intervention incorporates two treatment arms:



The study was broken down into three survey phases;

  • Baseline
  • Midline after 1 month of intervention and,
  • After one year, follow up end line.

The evaluation measured short and long-run effects by tracking physical bacteria count across study participants. Data was also collected on beliefs and perceptions about disease causation, hygiene and sanitation behavior. Provided ML influences the beliefs of respondents, this design also allowed researchers to identify constraints on behavior and health.

Project Outcomes

Mr. Edward Heggins (Health consultant) trained 32 Master Trainers from 4 districts (Muzaffargarh, Rahim Yar Khan, Bahawalnagar and Lodhran) on Microbe literacy including DGMs, DPM, LC, LAS and JLCs

In the initial phase of survey 4 different teams collected data from each location of ALCs.

  1. Hand wash: collected hand wash data from 2821 Learners from 4 District.
  2. Sample of drinking water: collected sample of drinking water data from 434 Learners from 4 District.
  3. Interview of learners: conducted 4240 interview in the sample survey

Outcomes of Interactive Workshops:

Health interventions by the use of Microscopes

In 4 districts, 72 ALCs were selected for this activity: Bhawalnagar 7, Lodhran 31, Muzaffargarh 7 and Rahim Yar Khan 27 ALCs.

Lectures on Infection Preventions Method.

In 4 districts, 143 ALCs were selected for this activity: Bhawalnagar 17, Lodhran 62, Muzaffargarh 15 and Rahim Yar Khan 49 ALCs.

Both interventions were completed in all 4 districts


  1. 3912 Female having 1940 children attended the infection prevention lectures
  2. 2312 Female having 875 children attended the use of microbe prevention lectures



Session of Infection Prevention in Lodhran Session of Infection Prevention in Bhawalnagar

The final research paper was completed by principal investigators; Dr. Daniel Bennett, Dr. Syed Ali Asjad and Dr. Wolf Peter Schmidt. For more details please visit the link below:

Learning Hygiene and Traditional Medicine.pdf

Last modified on Friday, 10 August 2018 05:48