# Intra-African Disparity & Regional Fractures

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.

## References

1. Isaakidis P, et al. "Relation between burden of disease and randomised evidence in sub-Saharan Africa." BMJ. 2002;324:702.
2. Alemayehu C, et al. "Behind the mask of the African clinical trials landscape." Trials. 2018;19:519.
3. ClinicalTrials.gov API v2 Documentation. U.S. National Library of Medicine.

## Note Block

- Type: research
- App: https://mahmood726-cyber.github.io/africa-e156-students/geographic-equity/dashboards/intra-african-disparity.html
- Code: https://github.com/mahmood726-cyber/africa-e156-students/blob/master/geographic-equity/code/intra-african-disparity.py
- Data: ClinicalTrials.gov API v2
- Date: 2026-04-05