The vast divide between Africa's research-rich and research-poor regions.
North Africa Trials
13,000+
Central Africa
<300
Disparity Ratio
43x
Top 2 Countries
Egypt & SA
Key Finding
Egypt alone hosted 11,752 trials (49% of the continental total), followed by South Africa with 3,654 and Uganda with 809 — three countries accounting for 68% of all African research.
Regional Comparison
Hiv — Condition Analysis
Multi-Dimensional Equity Profile
Design Feature & Temporal Trend
Inequality Decomposition & Statistics
Hiv — Computed Statistics
Africa: 1,793 | US: 5,071 | Europe: 1,451 | Ratio: 2.8x
Africa share: 21.6% | HHI4-region = 0.449 | Shannon H = 1.47 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
North Africa hosts over 13,000 trials — more than 43 times the number in Central Africa. Egypt and South Africa together account for over half of all African research. This internal colonialism of clinical evidence means that populations in the Democratic Republic of Congo, Chad, or the Central African Republic are as excluded from clinical innovation as the most remote communities on earth.
The Evidence 151 words · target 156
In the mapping of African clinical research, does the distribution of trials across fifty-four nations reveal a severe internal disparity? This cross-sectional audit evaluated trial volumes for all African countries using the ClinicalTrials.gov API v2 database through March 2026, computing Gini coefficients and concentration ratios. The primary estimand was the intra-continental concentration ratio measured by the share of trials in the top three nations. Egypt alone hosted 11,752 trials (49% of the continental total), followed by South Africa with 3,654 and Uganda with 809 — three countries accounting for 68% of all African research. The Gini coefficient of 0.857 for trial distribution exceeded South Africa's income Gini of 0.63 making it more unequal than the most unequal economy on earth. These findings reveal a research monopoly where three countries dominate and forty nations are functionally invisible. Interpretation is limited by reliance on a single registry which may undercount locally funded studies.
Sentence Structure
Question
In the mapping of African clinical research, does the distribution of trials across fifty-four nations reveal a severe internal disparity?
Dataset
This cross-sectional audit evaluated trial volumes for all African countries using the ClinicalTrials.gov API v2 database through March 2026, computing Gini coefficients and concentration ratios.
Method
The primary estimand was the intra-continental concentration ratio measured by the share of trials in the top three nations.
Primary Result
Egypt alone hosted 11,752 trials (49% of the continental total), followed by South Africa with 3,654 and Uganda with 809 — three countries accounting for 68% of all African research.
Robustness
The Gini coefficient of 0.857 for trial distribution exceeded South Africa's income Gini of 0.63 making it more unequal than the most unequal economy on earth.
Interpretation
These findings reveal a research monopoly where three countries dominate and forty nations are functionally invisible.
Boundary
Interpretation is limited by reliance on a single registry which may undercount locally funded studies.