Providing healthcare training and increasing public awareness of neglected tropical diseases via national and international engagement activities
Submitting InstitutionUniversity of Manchester
Unit of AssessmentBiological Sciences
Summary Impact TypeHealth
Research Subject Area(s)
Medical and Health Sciences: Immunology
Summary of the impact
WHO estimates that 600 million school-age children need deworming
treatment and preventive intervention.
The University of Manchester (UoM) Immunology Group delivered an
educational programme on the immune response and biology of parasitic worm
infections in areas where worm infections are most prevalent, including
Uganda and Pakistan, and with UK immigrant communities.
International benefits include health worker and educator training, which
is critical for improving the understanding of worm infection and
distribution of health education messages to endemic communities.
Nationwide engagement activities provided immigrant communities and school
pupils with improved awareness of global health issues and a greater
understanding of immunology, and have inspired some participants to pursue
careers in science.
The impact is based on research conducted at UoM from 1993 to date. The
key researchers were:
Dr Sheena Cruickshank (Lecturer, 2007 to date)
Dr Joanne Pennock (Lecturer, 2007 to date; Post-Doctoral Research
Professor Richard Grencis (1998 to date; Reader, 1997; Senior Lecturer,
Professor Kathryn Else (2009 to date; Senior Lecturer, 2007-09; Wellcome
Trust Fellow, 1993-2007)
Professor Werner Muller (2006 to date)
The UoM Immunology Group focuses on understanding the biology of human
parasites and the role of the immune system in infection. The key steps in
the research are as follows:
(a) Defining the immune factors underlying susceptibility to parasitic
worm infection. Research from 1993 to date aims to characterise how the
specific immune response is switched on  and controlled [2, 3].
(b) Defining the function of parasite derived factors that dampen the
immune response and the mechanisms by which the immune response is
inhibited . External clinical trials using parasites have had mixed
results for treatment of conditions including allergy and autoimmunity.
Therefore Cruickshank and colleagues are working to elucidate the function
of the parasite derived secretions and immune response with a view to
developing better therapies.
(c) Developing a greater understanding of the biology of whipworm
infection. Cruickshank and colleagues have defined how parasite eggs hatch
in the body . They have also defined the intimate relationship with the
host and specifically the role of the gut barrier and immune response in
promoting worm expulsion by altering the rate of barrier renewal  and
the nature of the epithelial barrier mucus secretions.
References to the research
The research was published in leading journals, including top journals in
1. Cruickshank, S.M., Deschoolmeester, M.L., Svensson, M.,
Howell, G., Bazakou, A., Logunova, L., Little, M.C., English, N., Mack,
M., Grencis, R.K., Else, K.J., Carding, S.R. (2009) Rapid
dendritic cell mobilisation to the large intestinal epithelium is
associated with resistance to Trichuris muris infection. Journal
of Immunology. 182. p. 3055-3062. DOI: 10.4049/jimmunol.0802749
2. Fasnacht, N., Greweling, M.C., Bollati-Fogolín, M., Schippers, A., Muller,
W. (2009) T-cell-specific deletion of gp130 renders the highly
susceptible IL-10-deficient mouse resistant to intestinal nematode
infection. European Journal of Immunology. 39. p. 2173-2183. DOI:
3. Levison, S.E., McLaughlin, J.T., Zeef, L.A., Fisher, P., Grencis,
R.K., Pennock, J.L. (2010) Colonic transcriptional profiling in
resistance and susceptibility to Trichuriasis: phenotyping a chronic
colitis and lessons for iatrogenic helminthosis. Inflammatory Bowel
Diseases. 16. p. 2065-2079. DOI: 10.1002/ibd.21326
4. d'Elia, R., Behnke, J.M., Bradley, J.E., Else, K.J. (2009)
Regulatory T cells: a role in the control of helminth-driven intestinal
pathology and worm survival. Journal of Immunology. 182. p.
2340-2348. DOI: 10.4049/jimmunol.0802767
5. Hayes, K.S., Bancroft, A.J., Goldrick, M., Portsmouth, C., Roberts,
I.S., Grencis, R.K. (2010) Exploitation of the intestinal
microflora by the parasitic nematode Trichuris muris. Science.
328. p.1391-1394. DOI: 10.1126/science.1187703
6. Hasnain, S.Z., Wang, H., Ghia, J.E., Haq, N., Deng, Y., Velcich, A., Grencis,
R.K., Thornton, D.J., Khan, W.I. (2010) Mucin gene deficiency in
mice impairs host resistance to an enteric parasitic infection. Gastroenterology.
138. p.1763-1771. DOI:10.1053/j.gastro.2010.01.045
Details of the impact
Globally, ~two billion people have gut worm infections, with pregnant
women and children worst affected (WHO estimate). Worm infections have an
enormous impact on the primary education of children who become too ill to
go to school. Worm species also infect livestock, thus affecting the
global economy. Although there are cheap, effective medicines for gut
worms, their use encourages drug resistance and does not prevent
re-infection. Therefore these medicines are not a sustainable solution.
Education about worm transmission and appropriate treatment is critical to
reduce the impact of worm infection worldwide.
Pathways to impact
The research focuses on tropical diseases that do not affect the western
world, so Cruickshank and colleagues work with endemic communities to
improve their understanding of worm infections and appropriate treatment.
Grencis contributes to an internationally funded training/educational
course based in Uganda.
Nationally, the research is presented via `The Worm Wagon', which is a
comprehensive suite of engagement activities. Activities are designed for
groups of mixed age, ability and language. There is a direct link from
research to engagement activities, as shown in the table below:
|Immune factors underlying susceptibility to parasitic worm
||Interactive computer simulation of the immune response and card
|Immune response to parasite infection
||Displays of parasites and “parasite uses”
|Biology of whipworm infection
||Games, pamphlets, YouTube video
Events are assessed via resource uptake (e.g., number of video views),
participant feedback and engagement in activities, questionnaires and
participant drawings to demonstrate learning. Additionally, the UoM
Immunology Group trains researchers and museum educators in public
The success of these engagement activities has been recognised:
Cruickshank, Pennock and Else were awarded the Manchester International
Women's Day 2013 Award for Women in Science, Technology, Engineering and
Mathematics for their work with the Worm Wagon. Cruickshank was also
awarded the 2013 Society of Biology Science Communication Award for
Reach and significance of the impact
The impact has three components:
i. International impact: through the `Immunology in the Tropics' course
ii. Working with immigrant communities in the UK: via engagement with the
iii. National impact: through public events such as the `Big Bang'
science fair, and engagement with primary and secondary schools across the
UK, including a majority of students (>60%) from disadvantaged
Cruickshank and colleagues have hosted/been involved in over 40 events
from 2009 to date, with over 68,000 participants.
i. Training African healthcare workers
Trained health workers and educators in endemic countries are critical in
improving the understanding of worm infection and distributing health
Grencis contributes to the `Immunology in the Tropics' course in Uganda
(2009-2012). Attendees from across Africa are primarily from educational
and research establishments. This includes people from Uganda, Kenya,
Tanzania, Nigeria, Malawi, Cameroon, Ghana, Gabon, Rwanda and Burkina
Faso. Attendees highly rated the course with feedback including: "Gained
good experience in research involving worms and how they cause
infections in humans" [A].
A Ugandan doctor studying an MSc in Immunology at UoM, provided the
following feedback: "You gave wonderful presentations about helminths
infections. It was very interesting and I wanted to do some work in your
field... The course [Immunology in the Tropics] was very helpful
to me in making my decision to enroll for this course [MSc in
ii. Educating immigrant communities from Asia, Africa and the
In collaboration with the Development Education Project (DEP), the UoM
Immunology Group worked with the "Inspired Sisters" to raise their
awareness of the causes and impact of worm infection [D]. Inspired Sisters
are a female community group who are recent immigrants from Asia, Africa
or the Middle East, based in Manchester. It is important to educate this
community so that they can feed back information to relatives in affected
Cruickshank and colleagues correct misunderstandings about parasitic worm
infections, dispel mistrust and encourage uptake of anti-worm therapies. A
key message is the importance of worm treatments in preventing children
losing education and improving immunity to co-infections such as malaria.
Sample feedback: "this is really important thank you" (Inspired
Sister community group participant) and "You are breaking barriers"
(Student/ex refugee from Sierra Leone) [A].
iii. Increased student engagement with science and uptake of
Feedback from teachers states that events like the Worm Wagon enrich the
science curriculum and influence student career choices. For example: "It's
actually events like this that can determine what they [school
pupils] study and where they study at University" (Year 8 teacher,
Calday Grange Grammar School) [E].
Student questions indicate understanding/interest of fundamental
immunological processes, for example, "What happens to the debris once
the T cells have killed the bugs?" (Year 6 pupil, St Mary's Primary
School, Horwich) [A]. Students who had not been taught immunology were
able to answer questions and complete scientific drawings, such as
parasite life cycles [A].
Sources to corroborate the impact
A. Participant questionnaires and drawings from public engagement
activities, 2009 to date.
B. Email from a Ugandan doctor and participant of `Immunology in the
Tropics' course in March 2012. Describes how the course inspired her
to do an MSc.
C. Letter from Director of `Immunology in the Tropics' and Senior
Immunologist, MRC/UVRI Uganda Research Unit on AIDS. Corroborates
Grencis' contribution to the course.
D. Letter from Development Education Project (DEP) Director. Corroborates
the work of the UoM Immunology Group activities with the Inspired
E. Email from teacher at Calday Grange Grammar School. Corroborates
that the Worm Wagon influences student career choices.