In order to understand the limitations faced by African investigators in modern cardiology research, a group of researchers, led by Internal Medicine Resident Abdelrahman Abushouk, MD, analyzed 30 years of African-led clinical trials in cardiovascular medicine.
Previous research had demonstrated that although Africa contains almost one-fifth of the world population, only 2% of clinical trials had been conducted in the continent. Equitable clinical research on the global stage requires that investigators conducting trials accurately represent the patients who are enrolled in trials and ultimately receive the treatment. Consequently, this study primarily focused on trials led by investigators from African countries, distinguishing between trials conducted within the continent and those merely including African patients.
The study found that over the last three decades, fewer than 200 trials for cardiovascular medicine had been conducted in African countries that were led by African investigators. Of the 179 trials published between 1990 to 2019, approximately 80% originated from just three African countries: Egypt, South Africa, and Nigeria. Furthermore, African-led trials exhibited a higher level of collaboration with the United States and Europe than within the African continent itself.
"We need to address the hurdles that hinder other African nations from conducting research and contributing to scientific progress,” Abushouk said. “These findings highlight the need for greater cooperation between African countries. Collaboration within the continent is crucial to strengthening Africa’s research capabilities.”
The team also found that African-led cardiology trials were often published in smaller journals and frequently involved payments to access, both factors that may limit accessibility and global visibility of African-led research. "We must ensure that African research is accessible to the global community to foster collaboration and knowledge sharing,” Aboushouk said.
The researchers acknowledged that the study was limited in its reliance on the MEDLINE database to source trials. Abushouk recognized that this approach might have missed trials not included in PubMed-indexed journals, although he noted that this methodology ensured their sample comprised only published trials that had passed rigorous peer-review. Aside from this limitation, the team encountered challenges in assessing certain papers, especially those published in the earlier portion of the surveyed time period, due to missing reporting on critical methodological aspects. “Publishing guidelines for trials were not as standardized in the 1990s and 2000s,” Abushouk said. “Standardizing reporting practices is essential to improving the quality of African research.”
“This research has implications that we hope helps better engage African patients in clinical research,” Abushouk said. “Africa represents a significant untapped resource in clinical trials, and involving African patients is crucial. Participation from Africa is not only essential for the continent but also for the advancement of medical science worldwide.”
Abushouk and the team are optimistic that this research calls attention to ongoing concerns for equitable cardiology research inclusive of patients and investigators from African countries. This study sheds light on challenges faced by African-led cardiology trials and highlights the critical need for more African-led trials and increased collaboration within the continent.
There are several ongoing efforts at Yale that aim to enhance scientific collaboration and access to healthcare around the world and in Africa. The Yale in Africa initiative, launched in 2013, aims not only to enhance research efforts on African issues, but also to build local partnerships in the continent and increase teaching and scientific collaboration efforts. In addition, the Yale Global Cardiovascular Health Initiative is a non-profit organization that aims to promote cardiovascular disease care in low- and middle-income countries, including African countries.
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