African researchers face a double bind: publish in high-impact paywalled journal...
Africa Trials
3,515
US Trials
159,433
Gap Ratio
45x
Nations
54
Key Finding
Africa hosts 23,873 trials across 54 nations with extreme geographic concentration.
Regional Comparison
Distribution Analysis
Inequality Profile
Temporal & Structural
Why It Matters
African researchers face a double bind: publish in high-impact paywalled journals for career advancement, or choose open access to benefit local readers — with OA article processing charges often unaffordable.
The Evidence 133 words · target 156
In the governance and sovereignty of African clinical trials, does the pattern of open access publication equity reveal structural inequity in African research investment? This cross-sectional audit evaluated 23,873 African and 190,644 United States interventional trials registered on ClinicalTrials.gov through April 2026. Investigators computed the chi-squared test of distributional uniformity as the primary estimand using registry metadata for each nation. Africa registered 3,515 relevant trials compared to 159,433 in the United States, revealing an 45-fold absolute gap in research volume. Temporal analysis showed 17.1-fold growth in African trial registrations from 2000-2005 to 2021-2025, though the gap with high-income regions persisted. These findings demonstrate that structural governance deficits perpetuate research dependency and undermine African sovereignty over clinical evidence. Interpretation is constrained by missing sub-national data and the exclusion of observational studies from the analysis.
Sentence Structure
Question
In the governance and sovereignty of African clinical trials, does the pattern of open access publication equity reveal structural inequity in African research investment?
Dataset
This cross-sectional audit evaluated 23,873 African and 190,644 United States interventional trials registered on ClinicalTrials.
Method
gov through April 2026.
Primary Result
Investigators computed the chi-squared test of distributional uniformity as the primary estimand using registry metadata for each nation.
Robustness
Africa registered 3,515 relevant trials compared to 159,433 in the United States, revealing an 45-fold absolute gap in research volume.
Interpretation
Temporal analysis showed 17.
Boundary
1-fold growth in African trial registrations from 2000-2005 to 2021-2025, though the gap with high-income regions persisted.
Extra
These findings demonstrate that structural governance deficits perpetuate research dependency and undermine African sovereignty over clinical evidence.
Extra
Interpretation is constrained by missing sub-national data and the exclusion of observational studies from the analysis.