Microbe-Literacy Germ-Watching Workshops for Hygiene and Vaccine Acceptance in Sargodha, Pakistan

Enhancing Vaccine Acceptance, Hygiene, and Trust in Community Health Workers Through a Microbe-Literacy Intervention: A Cluster Randomized Controlled Trial in Sargodha District, Pakistan

This cluster randomized controlled trial evaluated whether a single microscope-based "germ-watching" workshop, delivered by Lady Health Workers (LHWs) to mothers and female caregivers of children under three years, improves hygiene practices, vaccination attitudes and intentions, routine immunization, and trust in LHWs. Twelve Union Councils in Sargodha District, Pakistan, were allocated 1:1 to the intervention or routine services, with outcomes measured by structured baseline and endline surveys and facility immunization records.

In intervention clusters, LHWs used portable microscopes (>=400x) to show caregivers the microorganisms present in their own household water and food samples during a single 120-minute workshop for 25-30 participants, linking observed microbes to hygiene and vaccine-preventable disease. Control clusters received routine LHW services and standard national health messaging. Allocation used restricted, covariate-constrained randomization at the Union Council level; outcome data entry and analysis were blinded to allocation. Analyses accounted for clustering.

Inclusion Criteria:

• Mother or female caregiver, permanent resident of the study area
• At least one child aged under 3 years
• Written informed consent

Exclusion Criteria:

• Already enrolled in a similar intervention
• Unable to participate due to physical/psychological constraints
• Intending to relocate during the study period