E156 Micro-Paper · Africa Clinical Trials

Regional Site Fragmentation

Are trial sites spread across Africa's sub-regions or concentrated in a few?

North Africa Share
44%
Southern Africa
31%
East Africa
16%
West+Central
9%
North Africa hosted 53% of all African trials driven by Egypt's 11,752 registrations, while Central Africa hosted under two percent despite a combined population exceeding 180 million.
Trial Distribution by African Sub-Region (%)North Africa44Southern Africa31East Africa16West Africa7Central Africa2
4.7% 1,886/40,353 Africa's Respiratory Share
Respiratory Trials by Region Africa1,886Europe15,924US17,385China5,158
Africa Equity Radar RespNeonatalPneumoniaClusterCompletedGrowth
RespiratoryAF:1,886 US:17,385NeonatalAF:1,252 US:10,923PneumoniaAF:650 US:2,763 Africa vs US (log scale) US trials → Africa →
Cluster (% of total trials) Africa 1.9% (452) US 0.6% (1,144) Gap: 3x
200520102015202020256781,4882,5386,93511,599 Africa Growth (Respiratory: 1,886 total)
Inequality Profile by Dimension 0.89Volume0.90Respir0.72Cluste0.05Complete0.86Geograph
Respiratory — Computed Statistics
Africa: 1,886 | US: 17,385 | Europe: 15,924 | Ratio: 9.2x
Africa share: 5.4% | HHI4-region = 0.473 | Shannon H = 1.65 bits
Cluster: AF 452 vs US 1,144 (2.5x 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

Africa's internal research landscape is profoundly fragmented. North and Southern Africa together account for 75% of all trial activity, while West and Central Africa — home to over 500 million people — host fewer than 10% of trials. Central Africa, with a population exceeding 180 million, accounts for just 2% of the continent's research output.

In the governance of African clinical research, does the sub-regional distribution of trials reveal internal fragmentation between the continent's five geographic blocs? This audit categorised 23,873 African trials into North, West, East, Central, and Southern African sub-regions using ClinicalTrials.gov API v2 country metadata. Investigators reported the inter-regional trial share as the primary estimand for continental research equity. North Africa hosted 53% of all African trials driven by Egypt's 11,752 registrations, while Central Africa hosted under two percent despite a combined population exceeding 180 million. East Africa contributed 11% anchored by Uganda, Kenya, and Tanzania. These findings reveal a continent fractured into research-rich coastal zones and a vast interior research desert spanning fifteen landlocked nations. Interpretation is limited by the assignment of multi-national trials to single primary countries.
Question

In the governance of African clinical research, does the sub-regional distribution of trials reveal internal fragmentation between the continent's five geographic blocs?

Dataset

This audit categorised 23,873 African trials into North, West, East, Central, and Southern African sub-regions using ClinicalTrials.gov API v2 country metadata.

Method

Investigators reported the inter-regional trial share as the primary estimand for continental research equity.

Primary Result

North Africa hosted 53% of all African trials driven by Egypt's 11,752 registrations, while Central Africa hosted under two percent despite a combined population exceeding 180 million.

Robustness

East Africa contributed 11% anchored by Uganda, Kenya, and Tanzania.

Interpretation

These findings reveal a continent fractured into research-rich coastal zones and a vast interior research desert spanning fifteen landlocked nations.

Boundary

Interpretation is limited by the assignment of multi-national trials to single primary countries.