Published randomized trials performed in Sub-Saharan Africa focus on high-burden diseases but are frequently funded and led by high-income countries.

ABSTRACT

BACKGROUND AND OBJECTIVE: In light of funding constraints in Sub-Saharan Africa (SSA), the value of research performed there must be increased. The objective of this study was to describe the epidemiology of published randomized controlled trials (RCTs) performed in SSA. METHODS: We searched PubMed, the Cochrane library, and African Index Medicus to identify reports of all RCTs performed in SSA and published between January 1, 2014 and March 31, 2015. We systematically recorded the country of the affiliation of the corresponding author and the funding source. The overall burden of disease was assessed by 2013 disability-adjusted life years (both sexes, all ages) in percentages for two locations SSA and high-income countries (HICs). RESULTS: Only 12 of 121 RCTs were conducted in both Sub-Saharan Africa and another region, with 109 of 121 RCTs (90%) having trial centers exclusively located in SSA. The corresponding author's only affiliation was in SSA for 44/109 trials (40%) and was institutions in HICs for almost half of the trials. The funding source was nonprofit for 77/109 trials (70%) and was from HICs for 81% (n = 63/77). Overall, most RCTs targeted diseases with a high burden in SSA; 46% of the trials targeted the five diseases with the highest burden in SSA, mainly malaria (n = 25), HIV/AIDS (n = 24), lower respiratory tract infection (n = 2), diarrheal diseases (n = 3), and preterm birth complications (n = 2). Nevertheless, among the 25 diseases or health-related conditions with the highest burden in SSA, 9 (36%) were not assessed in any RCT. CONCLUSIONS: Published RCTs performed in SSA were mainly funded and led by HIC institutions, although investigations concerned diseases highly prevalent in SSA.