Gender equity in health research publishing in Africa.

INTRODUCTION: Women researchers find it more difficult to publish in academic journals than men, an inequity that affects women's careers and was exacerbated during the pandemic, particularly for women in low-income and middle-income countries. We measured publishing by sub-Saharan African (SSA) women in prestigious authorship positions (first or last author, or single author) during the time frame 2014-2016. We also examined policies and practices at journals publishing high rates of women scientists from sub-Saharan Africa, to identify potential structural enablers affecting these women in publishing. METHODS: The study used Namsor V.2, an application programming interface, to conduct a secondary analysis of a bibliometric database. We also analysed policies and practices of ten journals with the highest number of SSA women publishing in first authorship positions. RESULTS: Based on regional analyses, the greatest magnitude of authorship inequity is in papers from sub-Saharan Africa, where men comprised 61% of first authors, 65% of last authors and 66% of single authors. Women from South Africa and Nigeria had greater success in publishing than those from other SSA countries, though women represented at least 20% of last authors in 25 SSA countries. The journals that published the most SSA women as prominent authors are journals based in SSA. Journals with overwhelmingly male leadership are also among those publishing the highest number of SSA women. CONCLUSION: Women scholars in SSA face substantial gender inequities in publishing in prestigious authorship positions in academic journals, though there is a cadre of women research leaders across the region. Journals in SSA are important for local women scholars and the inequities SSA women researchers face are not necessarily attributable to gender discrepancy in journals' editorial leadership.

Stuck in the middle: a systematic review of authorship in collaborative health research in Africa, 2014-2016.

BACKGROUND: Collaborations are often a cornerstone of global health research. Power dynamics can shape if and how local researchers are included in manuscripts. This article investigates how international collaborations affect the representation of local authors, overall and in first and last author positions, in African health research. METHODS: We extracted papers on 'health' in sub-Saharan Africa indexed in PubMed and published between 2014 and 2016. The author's affiliation was used to classify the individual as from the country of the paper's focus, from another African country, from Europe, from the USA/Canada or from another locale. Authors classified as from the USA/Canada were further subclassified if the author was from a top US university. In primary analyses, individuals with multiple affiliations were presumed to be from a high-income country if they contained any affiliation from a high-income country. In sensitivity analyses, these individuals were presumed to be from an African country if they contained any affiliation an African country. Differences in paper characteristics and representation of local coauthors are compared by collaborative type using χ² tests. RESULTS: Of the 7100 articles identified, 68.3% included collaborators from the USA, Canada, Europe and/or another African country. 54.0% of all 43 429 authors and 52.9% of 7100 first authors were from the country of the paper's focus. Representation dropped if any collaborators were from USA, Canada or Europe with the lowest representation for collaborators from top US universities-for these papers, 41.3% of all authors and 23.0% of first authors were from country of paper's focus. Local representation was highest with collaborators from another African country. 13.5% of all papers had no local coauthors. DISCUSSION: Individuals, institutions and funders from high-income countries should challenge persistent power differentials in global health research. South-South collaborations can help African researchers expand technical expertise while maintaining presence on the resulting research.

Problem of nonadherence in chronically ill adolescents: strategies for assessment and intervention.

PURPOSE OF REVIEW: Nonadherence to medical treatment is a significant problem for adolescents with chronic illness, with significant morbidity and mortality. Yet efforts to assess and treat the problem have been limited. We reviewed the literature on the factors associated with nonadherence and focused on nonadherence in a series of interviews with staff at a pediatric transplant program. This paper describes some of our findings, offers guidelines for assessing nonadherence in a primary care setting, and discusses strategies and interventions aimed at enhancing adherence. We refer to clinical cases derived from our interviews with renal transplant staff and our own clinical practice. RECENT FINDINGS: Nonadherence to treatment recommendations occurs in approximately one-third of adolescents with a chronic illness. Factors that have been associated with nonadherence include psychiatric illness, psychological factors, family issues, and health problems. Although extensive research has been done on the problem of poor patient adherence in pediatric chronic illnesses, the prevalence of nonadherence remains high, and the research itself is problematic because of different definitions and methods of assessment used. Novel treatment strategies to improve adherence have been proposed, and data on these are emerging. SUMMARY: Nonadherence in adolescents with chronic illness is a serious problem in need of greater recognition and intervention and further research. The primary care physician may be able to reduce nonadherence by routinely evaluating for adherence issues and initiating a targeted strategy to combat nonadherence when it is found. This review describes strategies and specific approaches for identifying and treating nonadherence in adolescents and their families.