# Global RCT Equity (Africa vs Europe)

In global health research, does the geographic distribution of interventional trials reveal a fundamental equity gap between Africa and Europe? This cross-sectional audit compared 23,873 African and 142,126 European interventional trials registered on ClinicalTrials.gov API v2 through March 2026. Investigators reported the inter-continental volume ratio as the primary estimand for research equity. Europe hosted 6.0x more trials than Africa despite having less than half the population, yielding a per-capita disparity exceeding ten-fold. Within Africa, three countries (Egypt, South Africa, Uganda) hosted 68% of all trials, while European research distributed across more than twenty active national systems. Africa's growth from 678 trials in 2000-2005 to 11,599 in 2021-2025 demonstrated 17x expansion but failed to narrow the proportional gap. These findings confirm that Africa functions as a validation ground rather than a discovery hub for new medicines. Interpretation is limited by reliance on public registrations which may underreport locally funded trials.

## References

1. Ndounga Diakou LA, et al. "Mapping of clinical trials in sub-Saharan Africa." Trials. 2022;23:490.
2. Isaakidis P, et al. "Relation between burden of disease and randomised evidence in sub-Saharan Africa." BMJ. 2002;324:702.
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/health-disease/dashboards/rct_equity.html
- Code: https://github.com/mahmood726-cyber/africa-e156-students/blob/master/health-disease/code/rct-equity.py
- Data: ClinicalTrials.gov API v2
- Date: 2026-04-05