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Ravi K, Bentounsi Z, Tariq A, Brazeal A, Daudu D, Back F, Elhadi M, Badwi N, Shah SSNH, Bandyopadhyay S, Khalil H, Kimura H, Sekyi-Djan MN, Abdelrahman A, Shaheen A, Mbonda Noula AG, Wong AT, Ndajiwo A, Souadka A, Maina AN, Nyalundja AD, Sabry A, Hind B, Nteranya DS, Ngugi DW, de Wet E, Tolis EA, Wafqui FZ, Essangri H, Moujtahid H, Moola H, Narain K, Ravi K, Wassim K, Odiero LA, Nyaboke LS, Metwalli M, Naisiae M, Pueschel MG, Turabi N, El Aroussi N, Makram OM, Shawky OA, Outani O, Carides P, Patil P, Halley-Stott RP, Kurbegovic S, Marchant S, Moujtahid S, El Hadrati S, Agarwal T, Kidavasi VA, Agarwal V, Steyn W, Matumo W, Fahmy YA, Omar Z, Amod Z, Eloff M, Hussein NA, Sharma D. Systematic analysis of authorship demographics in global surgery. BMJ Glob Health 2021; 6:bmjgh-2021-006672. [PMID: 34666988 PMCID: PMC8527109 DOI: 10.1136/bmjgh-2021-006672] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 09/09/2021] [Indexed: 02/06/2023] Open
Abstract
Background Global surgery has recently gained prominence as an academic discipline within global health. Authorship inequity has been a consistent feature of global health publications, with over-representation of authors from high-income countries (HICs), and disenfranchisement of researchers from low-income and middle-income countries (LMICs). In this study, we investigated authorship demographics within recently published global surgery literature. Methods We performed a systematic analysis of author characteristics, including gender, seniority and institutional affiliation, for global surgery studies published between 2016 and 2020 and indexed in the PubMed database. We compared the distribution of author gender and seniority across studies related to different topics; between authors affiliated with HICs and LMICs; and across studies with different authorship networks. Results 1240 articles were included for analysis. Most authors were male (60%), affiliated only with HICs (51%) and of high seniority (55% were fully qualified specialist or generalist clinicians, Principal Investigators, or in senior leadership or management roles). The proportion of male authors increased with increasing seniority for last and middle authors. Studies related to Obstetrics and Gynaecology had similar numbers of male and female authors, whereas there were more male authors in studies related to surgery (69% male) and Anaesthesia and Critical care (65% male). Compared with HIC authors, LMIC authors had a lower proportion of female authors at every seniority grade. This gender gap among LMIC middle authors was reduced in studies where all authors were affiliated only with LMICs. Conclusion Authorship disparities are evident within global surgery academia. Remedial actions to address the lack of authorship opportunities for LMIC authors and female authors are required.
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Affiliation(s)
- Krithi Ravi
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Zineb Bentounsi
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Aiman Tariq
- National Institute of Cardiovascular Diseases, Karachi, Pakistan
| | | | - Davina Daudu
- The University of Western Australia Faculty of Health and Medical Sciences, Perth, Western Australia, Australia
| | - Francesca Back
- University of Oxford Medical Sciences Division, Oxford, UK
| | | | - Nermin Badwi
- Zagazig University Faculty of Human Medicine, Zagazig, Egypt.,InciSioN Egypt, Zagazig, Egypt
| | | | | | - Halimah Khalil
- Birmingham Medical School, University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | | | | | | | - Ahmed Shaheen
- Alexandria University Faculty of Medicine, Alexandria, Egypt
| | | | - Ai-Ting Wong
- Red Cross War Memorial Children's Hospital, Rondebosch, South Africa
| | | | - Amine Souadka
- National Institute of Oncology, Mohammed V University of Rabat, Rabat, Morocco
| | | | | | | | - Bourja Hind
- Ibn Rochd University Hospital Center, Casablanca, Morocco
| | - Daniel Safari Nteranya
- Department of Surgery, Official University of Bukavu, Bukavu, Congo.,Association of Future African Neurosurgeons, Yaoundé, Cameroon
| | | | - Elsa de Wet
- University of the Free State, Bloemfontein, South Africa
| | | | - F Z Wafqui
- Faculty of Medicine and Pharmacy, Casablanca, Morocco
| | - Hajar Essangri
- National Institute of Oncology, Mohammed V University of Rabat, Rabat, Morocco
| | - Hajar Moujtahid
- Faculty of Medicine and Pharmacy, Mohammed V University of Rabat, Rabat, Morocco
| | - Husna Moola
- University of Cape Town, Rondebosch, South Africa
| | - Kapil Narain
- University of KwaZulu-Natal Nelson R Mandela School of Medicine, Durban, South Africa
| | - Krupa Ravi
- University of Oxford Medical Sciences Division, Oxford, UK
| | - Kyrillos Wassim
- Cairo University Kasr Alainy Faculty of Medicine, Cairo, Egypt
| | | | | | | | - Maryanne Naisiae
- University of Nairobi College of Health Sciences, Nairobi, Kenya
| | | | - Nafisa Turabi
- Netaji Subhash Chandra Bose Medical College and Hospital, Jabalpur, India
| | - Nouhaila El Aroussi
- Faculty of Medicine and Pharmacy, Mohammed V University of Rabat, Rabat, Morocco
| | - Omar Mohamed Makram
- Department of Cardiology, Faculty of Medicine, October 6 University, 6th of October City, Egypt.,London School of Hygiene and Tropical Medicine Faculty of Public Health and Policy, London, UK
| | - Omar A Shawky
- Cairo University Kasr Alainy Faculty of Medicine, Cairo, Egypt
| | - Oumaima Outani
- Faculty of Medicine and Pharmacy, Mohammed V University of Rabat, Rabat, Morocco
| | - Peter Carides
- University of the Witwatersrand, Johannesburg-Braamfontein, South Africa
| | | | | | - Sabina Kurbegovic
- Medical Faculty, University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | | | - Sara Moujtahid
- Ibn Sina University Hospital Center, Rabat, Morocco.,Mohammed V University, Rabat, Morocco
| | - Soukaina El Hadrati
- Faculty of Medicine and Pharmacy, Mohammed V University of Rabat, Rabat, Morocco
| | | | | | | | - Wilme Steyn
- Chris Hani Baragwanath Hospital, Bertsham, South Africa
| | | | | | - Zaayid Omar
- Rondebosch Medical Centre, Cape Town, South Africa
| | - Zachary Amod
- University of Cape Town, Rondebosch, South Africa
| | - Madelein Eloff
- University of KwaZulu-Natal Nelson R Mandela School of Medicine, Durban, South Africa
| | | | - Dhananjaya Sharma
- Department of Surgery, Netaji Subhash Chandra Bose Medical College and Hospital, Jabalpur, India
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Motani P, Van de Walle A, Aryeetey R, Verstraeten R. Lessons learned from Evidence-Informed Decision-Making in Nutrition & Health (EVIDENT) in Africa: a project evaluation. Health Res Policy Syst 2019; 17:12. [PMID: 30704528 PMCID: PMC6357392 DOI: 10.1186/s12961-019-0413-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 01/07/2019] [Indexed: 11/10/2022] Open
Abstract
Background Evidence-informed Decision-making in Nutrition and Health (EVIDENT) is an international partnership that seeks to identify information needs in nutrition and health in Africa and build local capacity in knowledge management to help translate the best available evidence into context-appropriate recommendations aligned to the priorities of decision-makers. This study evaluates the extent to which EVIDENT achieved its intended activities, documents the lessons learned and draws on these lessons learned to inform future activities of EVIDENT, as well as in evidence-informed decision-making (EIDM) in nutrition overall. Methods Purposive and snowball sampling were used to identify participants that were either directly or indirectly involved with EVIDENT. An analytical framework of five key elements was developed to guide data collection from EVIDENT’s documentation, in-depth interviews (n = 20), online surveys (n = 26) and a participatory discussion. Interviews were transcribed verbatim and coded in NVivo 11, using deductive thematic content analysis and a phenomenological approach. Online surveys were analysed using Stata 14. Data were triangulated to address both objectives under each element of the analytical framework. Results EVIDENT succeeded in establishing a collaborative partnership, within which it delivered four short courses in EIDM. This capacity complemented case study activities in four partner African countries where EIDM processes were implemented and assessed. Identified barriers to these processes included little experience in EIDM, difficulties in engaging stakeholders, challenging local environments (e.g. donor influence, bureaucracy, inaccessibility to scientific research, poor internet connectivity), and limited time and funding. However, EVIDENT activities were driven by a local need for EIDM, a sheer interest and commitment to the cause, and the opportunity for the Global North and South to work together and build relationships. Future activities of EVIDENT, and EIDM in nutrition overall, should focus on sustained capacity-building in EIDM processes, leadership and functional skills across the Global South, investment in stakeholder engagement, context-specific EIDM, enhanced communication and linking, and strengthening relationships with existing stakeholder organisations. Conclusions In its first 3 years, EVIDENT developed and strengthened partnership, capacity and visibility on EIDM in Africa. Innovative and long-term capacity-building, dedicated leadership, further stakeholder engagement and sustainable financing, are needed for future activities of EVIDENT and EIDM in nutrition. Electronic supplementary material The online version of this article (10.1186/s12961-019-0413-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Pankti Motani
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.,Independent Researcher, Antwerp, Belgium
| | - Anais Van de Walle
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Richmond Aryeetey
- Department of Population, Family and Reproductive Health, University of Ghana, Accra, Ghana.
| | - Roosmarijn Verstraeten
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.,Independent Researcher, Antwerp, Belgium
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Atal I, Trinquart L, Ravaud P, Porcher R. A mapping of 115,000 randomized trials revealed a mismatch between research effort and health needs in non-high-income regions. J Clin Epidemiol 2018; 98:123-132. [PMID: 29360559 DOI: 10.1016/j.jclinepi.2018.01.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 12/18/2017] [Accepted: 01/15/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND Concerns exist as to whether the allocation of resources in clinical research is aligned with public health needs. We evaluated the alignment between the effort of clinical research through the conduct of randomized controlled trials (RCTs) and health needs measured as the burden of diseases for all regions and a broad range of diseases. METHODS We grouped countries into seven regions and diseases into 27 groups. We mapped all RCTs initiated between 2006 and 2015 that were registered at the WHO International Clinical Trials Registry Platform to regions and diseases. The burden of diseases in 2005 was mapped as disability-adjusted life years (DALYs), based on the 2010 Global Burden of Diseases study. Within regions, we defined a research gap when the proportion of RCTs concerning a disease in the region was less than half the relative burden of the disease. RESULTS We mapped 117,180 RCTs planning to enroll 42.6 million patients and 2,220 million DALYs. In high- versus non-high-income countries, 130.9 versus 6.9 RCTs per million DALYs were conducted. We did not identify any research gap in high-income countries. We identified research gaps for all other regions. In particular, for Sub-Saharan Africa, we identified research gaps for common infectious diseases (CID) and neonatal disorders (ND): 5.8% (95% uncertainty interval 4.7-6.9) and 2.0% (0.9-4.5) of RCTs in Sub-Saharan Africa concerned CID and ND, although these diseases represented 22.9% and 11.6% of the burden in the region, respectively. For South Asia, we identified research gaps for the same two groups of diseases. CONCLUSIONS In non-high-income regions, the conduct of RCTs was misaligned with the distribution of major causes of burden, in particular infectious diseases and neonatal disorders in Sub-Saharan Africa and South Asia.
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Affiliation(s)
- Ignacio Atal
- Centre d'Épidémiologie Clinique, Hôpital Hôtel-Dieu, Paris, France; Team METHODS, INSERM U1153, Paris, France; Faculté de Médecine, Université Paris Descartes, Paris, France.
| | - Ludovic Trinquart
- Centre d'Épidémiologie Clinique, Hôpital Hôtel-Dieu, Paris, France; Team METHODS, INSERM U1153, Paris, France; Department of Epidemiology, Columbia University, Mailman School of Public Health, New York, NY, USA; School of Public Health, Boston University, MA, USA
| | - Philippe Ravaud
- Centre d'Épidémiologie Clinique, Hôpital Hôtel-Dieu, Paris, France; Team METHODS, INSERM U1153, Paris, France; Faculté de Médecine, Université Paris Descartes, Paris, France; Department of Epidemiology, Columbia University, Mailman School of Public Health, New York, NY, USA
| | - Raphaël Porcher
- Centre d'Épidémiologie Clinique, Hôpital Hôtel-Dieu, Paris, France; Team METHODS, INSERM U1153, Paris, France; Faculté de Médecine, Université Paris Descartes, Paris, France
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Ndounga Diakou LA, Ntoumi F, Ravaud P, Boutron I. Avoidable waste related to inadequate methods and incomplete reporting of interventions: a systematic review of randomized trials performed in Sub-Saharan Africa. Trials 2017; 18:291. [PMID: 28676066 PMCID: PMC5497345 DOI: 10.1186/s13063-017-2034-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 05/17/2017] [Indexed: 11/26/2022] Open
Abstract
Background Randomized controlled trials (RCTs) are needed to improve health care in Sub-Saharan Africa (SSA). However, inadequate methods and incomplete reporting of interventions can prevent the transposition of research in practice which leads waste of research. The aim of this systematic review was to assess the avoidable waste in research related to inadequate methods and incomplete reporting of interventions in RCTs performed in SSA. Methods We performed a methodological systematic review of RCTs performed in SSA and published between 1 January 2014 and 31 March 2015. We searched PubMed, the Cochrane library and the African Index Medicus to identify reports. We assessed the risk of bias using the Cochrane Risk of Bias tool, and for each risk of bias item, determined whether easy adjustments with no or minor cost could change the domain to low risk of bias. The reporting of interventions was assessed by using standardized checklists based on the Consolidated Standards for Reporting Trials, and core items of the Template for Intervention Description and Replication. Corresponding authors of reports with incomplete reporting of interventions were contacted to obtain additional information. Data were descriptively analyzed. Results Among 121 RCTs selected, 74 (61%) evaluated pharmacological treatments (PTs), including drugs and nutritional supplements; and 47 (39%) nonpharmacological treatments (NPTs) (40 participative interventions, 1 surgical procedure, 3 medical devices and 3 therapeutic strategies). Overall, the randomization sequence was adequately generated in 76 reports (62%) and the intervention allocation concealed in 48 (39%). The primary outcome was described as blinded in 46 reports (38%), and incomplete outcome data were adequately addressed in 78 (64%). Applying easy methodological adjustments with no or minor additional cost to trials with at least one domain at high risk of bias could have reduced the number of domains at high risk for 24 RCTs (19%). Interventions were completely reported for 73/121 (60%) RCTs: 51/74 (68%) of PTs and 22/47 (46%) of NPTs. Additional information was obtained from corresponding authors for 11/48 reports (22%). Conclusion Inadequate methods and incomplete reporting of published SSA RCTs could be improved by easy and inexpensive methodological adjustments and adherence to reporting guidelines. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-2034-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lee Aymar Ndounga Diakou
- Fondation Congolaise pour la Recherche Médicale (FCRM), Brazzaville, Congo. .,INSERM, UMR 1153 Epidemiology and Biostatistics Sorbonne Paris Cité Center (CRESS), METHODS Team, Paris, France. .,Paris Descartes University, Paris, France.
| | - Francine Ntoumi
- Fondation Congolaise pour la Recherche Médicale (FCRM), Brazzaville, Congo.,Marien Ngouabi University, Brazzaville, Democratic Republic of the Congo.,Institute for Tropical Medicine, University of Tubingen, Tubingen, Germany
| | - Philippe Ravaud
- INSERM, UMR 1153 Epidemiology and Biostatistics Sorbonne Paris Cité Center (CRESS), METHODS Team, Paris, France.,Paris Descartes University, Paris, France.,Centre d'Épidémiologie Clinique, Hôpital Hôtel Dieu, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Isabelle Boutron
- INSERM, UMR 1153 Epidemiology and Biostatistics Sorbonne Paris Cité Center (CRESS), METHODS Team, Paris, France.,Paris Descartes University, Paris, France.,Centre d'Épidémiologie Clinique, Hôpital Hôtel Dieu, Assistance Publique des Hôpitaux de Paris, Paris, France
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