There’s been an alarming rise in cardiovascular diseases (CVDs) and non-communicable diseases (NCDs) in Africa, with 50% to 88% of deaths in at least seven countries on the continent due to non-communicable disease, according to the 2022 World Health Organisation (WHO) Non-communicable Disease Progress Monitor.
Yet the realm of research has yet to fully recognise the magnitude of this, write Ahmed Bendary and Abdelrahman Abushouk for Health Policy Watch, urging increased investment in training cardiovascular researchers and more resources for R&D in African countries, in line with the local disease burden and international recommendations.
They write:
These diseases are not confined to developed nations. Africa bears witness to their increasing impact, largely unseen by the global research community. Against this backdrop, we are committed to shifting the focus to the African narrative in cardiovascular medicine.
Closing research disparities
We are two young cardiologists, both graduates of Egypt’s medical schools. One of us went on to pursue his career in the United States, and is now a researcher at the Department of Internal Medicine at Yale School of Medicine. The other, determined to make a difference in his country, dedicated himself to the demanding work of a physician-scientist in Egypt.
Our paths converged when we decided to address the lack of randomised clinical trials (RCTs) in Africa. This scarcity robs the continent of vital disease-specific and population-specific data, which stalls progress in clinical outcomes.
This deficiency has global implications, as it dampens cardiology research on a global scale by preventing researchers from tapping into a vast, diverse, and treatment-naive population.
Our journey led us to a comprehensive evaluation of African-led clinical trials in cardiovascular medicine over the past three decades. We recently published our findings in a research letter in the journal Circulation: Cardiovascular Quality and Outcomes.
Our analysis revealed a stark reality: only 2% of published and registered clinical trials in cardiovascular medicine originated from Africa.
We examined 179 trials from African countries from 1990 to 2019. Egypt, South Africa and Nigeria were the most notable contributors, with Egypt leading the way. The number of African-led trials has surged over the past decade, with 2010 to 2019 seeing a remarkable increase.
The primary outcomes assessed in the trials included biochemical and cardiometabolic markers, haemodynamic outcomes, clinical events, and patient-related outcomes. African trials often had small sample sizes, few participating centres, and short follow-up periods.
The impact of published trials from different countries was measured using the H-index, a metric gauging the impact of scientific research by tracking how many times a published paper is cited by other researchers.
South African publications had the highest impact score, followed by Egypt and Nigeria. A significant number of trials were not published, as open access, and risk of bias assessment showed a number of studies had unclear or high risks of bias.
Collaborations transcended borders, as African centres actively participated in 45 multinational trials, contributing valuable insights to global research endeavours. On the issue of funding, the researchers noted that 91 trials did not disclose their funding sources, while 20 disclosed no external funding.
Of the remaining 68 trials, 35.7% had funding from private sources, 28.6% from academic sources, 28.6% from governmental sources, and 7.1% from non-governmental sources.
Our research letter underscores several critical points. First, there is a need for increased investment in training cardiovascular researchers, beyond just cardiologists, to strengthen the research workforce in Africa.
Second, it is important to allocate more resources for research and development in African countries, in line with the local disease burden and international recommendations.
Third, initiatives like the Clinical Trials Community platform and the Pan-African Clinical Trials Registry have the potential to improve research infrastructure and collaboration.
Last, there is a need for multifaceted interventions to address barriers to clinical research in Africa, including regulatory frameworks, electronic medical records adoption, and institutional partnerships.
Our findings have revealed challenges that, once addressed, could amplify the continent’s contributions. Trials across Africa often have limited sample sizes, are conducted at a small number of participating centres, and have short follow-up periods.
The intricate dance of collaboration also extended beyond African borders, with European and North American centres partnering to enhance the scope and impact of research.
To unleash the true potential of African-led clinical trials, key changes are needed. Increased investment in training for cardiovascular researchers, beyond just cardiologists, would enrich the research landscape. Clinical research is a cornerstone of sustainable progress, and local governments must invest more in it.
A call for change
To harmonise Africa’s cardiovascular research and amplify its impact on the world, we need multifaceted interventions. Expanding clinical research sites, standardising regulatory frameworks, and widely adopting electronic medical records will strengthen our research infrastructure.
Open-access publishing and robust institutional partnerships are our allies in the journey towards progress.
The song of African science, once muted, now crescendos as we work to break down barriers and illuminate a path toward equitable cardiovascular knowledge. In this rhythm of change, we are architects of transformation, orchestrating a symphony of research that resonates far beyond the boundaries of continents and borders.
Dr Ahmed Bendary is Associate Professor in the Cardiology Department at Benha University, a member of the Egyptian Society of Cardiology and a Fellow of the European Society of Cardiology (FESC). He also serves as an officer on the Board of the Egyptian Association of Vascular Biology and Atherosclerosis (EAVA).
Dr Abdelrahman Abushouk is an internal medicine resident at Yale-New Haven Hospital. Abdelrahman earned his medical degree from Ain Shams University (Summa Cum Laude with Honours). His research has won several awards, and been cited in many national and international guidelines.
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