Microbe Literacy Intervention

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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) is designing 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 even though ubiquitous 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.


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

The ML curriculum includes two 90-minute interactive workshops.

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

Both workshops follow prepared manuals, use gender-matched facilitators, and utilize an open-discussion approach.

For this evaluation, female facilitators will present the ML curriculum to participants in Adult Literacy Classes (ALCs) a flagship program of NCHD which is specifically targeted towards illiterate women between the age of 11 and 45. The classes run for six months covering language and math skills, and basic health and hygiene education. The Microbe Literacy intervention is 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 is broken down into three survey phases; a baseline, a midline after 1 month of intervention, and a one year follow up endline. The evaluation measures short and long-run effects by tracking physical bacteria count across study participants. Data is also collected on beliefs and perceptions about disease causation, hygiene and sanitation behavior. Provided that ML influences the beliefs of respondents, this design will also allow researchers to identify constraints on behavior and health.

Last modified on Thursday, 12 October 2017 08:30