E156 Micro-Paper · Africa Clinical Trials

Trial Registration Transparency Score

Prospective trial registration — registering before the first participant is enr...

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
No data
Trial Registration Transparency Score by Country Egypt: 11752 Algeria: N/A Morocco: 162 Tunisia: 540 Senegal: N/A Ghana: 261 Nigeria: 379 Cameroon: N/A DRC: N/A Ethiopia: 302 Kenya: 788 Uganda: 809 Tanzania: 460 Rwanda: N/A South Africa: 3654 Egy 11752 Sou 3654 Uga 809 Ken 788 Tun 540 162 11752
Distribution Analysis
Contribution Breakdown 11752 Egypt 3654 South Afri 809 Uganda 788 Kenya 540 Tunisia 2814 Others
Research Profile Volume Growth Phase3 Complete Diversity
Inequality Profile
Enrollment Distribution Africa Reference 10000 20000
Growth 2010-2026 Before After Africa 0 0 US 0 0 Europe 0 0
Temporal & Structural
Regional Comparison Africa US Europe 0 50000 100000 150000 200000
Phase Distribution Africa US Europe Phase 1 11 87.4 87.0 Phase 2 20 250.8 61.1 Phase 3 52 630.7 289.5 Phase 4 12 156.0 85.2 630.7 11
Why It Matters

Prospective trial registration — registering before the first participant is enrolled — is an ICMJE requirement that many African trials fail to meet, undermining the integrity of the evidence base.

The Evidence   134 words · target 156
In the governance and sovereignty of African clinical trials, does the pattern of trial registration transparency score 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 limited by the use of a single registry and the absence of non-English trial databases.
Sentence Structure
Question

In the governance and sovereignty of African clinical trials, does the pattern of trial registration transparency score 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 limited by the use of a single registry and the absence of non-English trial databases.

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