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African Representation in Randomized Controlled Trials Published in Leading Medical and Cardiovascular Journals,
Bamba Gaye1, Moustafa I Morsy2, David Lagoro Kitara3
1Alliance for Medical Research in Africa, Dakar, Senegal; Institute of Health and Development, Cheikh Anta Diop University, Dakar, Senegal; Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, Georgia, USA; Paris Cardiovascular Research Centre, Université Paris Cité, Inserm U970, Paris, France.
Journal of the American College of Cardiology
|March 20, 2026
Summary
African countries are significantly underrepresented in major medical and cardiovascular randomized controlled trials (RCTs). This systematic review highlights the critical need to increase African participation and leadership in global research to ensure equitable evidence generation.
Area of Science:
- Clinical Trials
- Global Health Equity
- Medical Research
Background:
- African countries bear a substantial global disease burden but are underrepresented in clinical trials.
- Cardiovascular disease research, in particular, lacks adequate African participation in key studies.
Purpose of the Study:
- To quantify the representation of African countries in randomized controlled trials (RCTs).
- To analyze African participation in leading general medical and cardiovascular journals from 2019 to 2024.
Main Methods:
- Systematic review of RCTs published in 5 leading general medical journals and 3 leading cardiovascular journals (2019-2024).
- Assessment of African representation based on trial scope, geographic participation, disease category, and authorship.
Main Results:
- Only 3.9% of general medical RCTs and 0.6% of cardiovascular RCTs were conducted exclusively in Africa.
- Multicontinental trials including African sites were also limited (9.1% and 2.7% respectively).
- South Africa and southern Africa predominated; infectious diseases were common in Africa-only trials, while CVD was more frequent in multicontinental studies.
Conclusions:
- Profound underrepresentation of African countries in high-impact medical and cardiovascular RCTs.
- Urgent need to expand African participation, invest in local research capacity, and promote equitable leadership.
- Addressing this imbalance is crucial for the relevance and validity of global clinical evidence.
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