How many cities dominate Africa's clinical trial landscape?
Top 5 Cities Share
71%
Top City
Cairo
Europe Top 5
23%
Monopoly Ratio
3.1x
Key Finding
Cairo hosted 11,752 of Egypt's trials, Johannesburg-Cape Town hosted the majority of South Africa's 3,654 trials, and Kampala dominated Uganda's 809 trials.
Regional Comparison
Cancer — Condition Analysis
Multi-Dimensional Equity Profile
Design Feature & Temporal Trend
Inequality Decomposition & Statistics
Cancer — Computed Statistics
Africa: 2,182 | US: 49,054 | Europe: 28,724 | Ratio: 22.5x
Africa share: 2.7% | HHI4-region = 0.565 | Shannon H = 1.6 bits
Adaptive: AF 140 vs US 2,986 (21.3x gap)
Ginicountry = 0.857 [0.61, 0.90] | αpower-law = 1.40 | Atkinson A(2) = 0.979
KL(obs||uniform) = 2.93 bits | ρSpearman(pop, trials/M) = −0.01
Why It Matters
Five cities control nearly three-quarters of all African clinical trials. Cairo alone hosts more trials than the entire West African region combined. This urban hub monopoly means that research priorities are shaped by the infrastructure of a few centres rather than the disease burden of the continent. In Europe, the top five cities account for less than a quarter of research activity.
The Evidence 145 words · target 156
In clinical research governance, does the concentration of trial activity in capital cities indicate an urban monopoly that excludes secondary cities from research participation? This audit of 23,873 African interventional trials mapped site locations to primary urban centres using ClinicalTrials.gov metadata through March 2026. Investigators computed the capital-city concentration ratio and reported the percentage of national trials located in each country's largest city. Cairo hosted 11,752 of Egypt's trials, Johannesburg-Cape Town hosted the majority of South Africa's 3,654 trials, and Kampala dominated Uganda's 809 trials. Across the continent, capital cities hosted an estimated seventy-one percent of all African trials compared to twenty-three percent in European capitals. These findings demonstrate that African clinical research is functionally a capital-city enterprise where secondary cities and regional centres are structurally excluded from innovation. Interpretation is limited by the granularity of location data which may not distinguish intra-city site distribution.
Sentence Structure
Question
In clinical research governance, does the concentration of trial activity in capital cities indicate an urban monopoly that excludes secondary cities from research participation?
Dataset
This audit of 23,873 African interventional trials mapped site locations to primary urban centres using ClinicalTrials.gov metadata through March 2026.
Method
Investigators computed the capital-city concentration ratio and reported the percentage of national trials located in each country's largest city.
Primary Result
Cairo hosted 11,752 of Egypt's trials, Johannesburg-Cape Town hosted the majority of South Africa's 3,654 trials, and Kampala dominated Uganda's 809 trials.
Robustness
Across the continent, capital cities hosted an estimated seventy-one percent of all African trials compared to twenty-three percent in European capitals.
Interpretation
These findings demonstrate that African clinical research is functionally a capital-city enterprise where secondary cities and regional centres are structurally excluded from innovation.
Boundary
Interpretation is limited by the granularity of location data which may not distinguish intra-city site distribution.