# Regional Site Fragmentation

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.

## References

1. Alemayehu C, et al. "Behind the mask of the African clinical trials landscape." Trials. 2018;19:519.
2. Siegfried N, et al. "Where does all the money go?" Cochrane Database Syst Rev. 2022.

## Note Block

- Type: research
- App: https://mahmood726-cyber.github.io/africa-e156-students/geographic-equity/dashboards/angle-16_regional-site-fragmentation.html
- Code: https://github.com/mahmood726-cyber/africa-e156-students/blob/master/geographic-equity/code/angle-16-regional-site-fragmentation.py
- Data: ClinicalTrials.gov API v2
- Date: 2026-04-05