Growth and challenges of health research in the WHO Africa Region: new analysis in the BMJ

This was cross-posted to my own blog.


I have always been devoted to the principle of evidence-based policy and decision making in public health, but I have taken a keen interest in the finer points of research and methodology since taking my current position as an epidemiologist (and contemplating the pursuit of a doctorate more seriously). Earlier this month, I spotted an article from BMJ examining the output of health research in the WHO Africa region from 2000 to 2014 (h/t to Dr. Ron LaPorte, professor of epidemiology at the WHO Collaborating Center at the University of Pittsburgh and co-founder of the Supercourse project). The article, entitled “Increasing the value of health research in the WHO African Region beyond 2015,” is a bibliometric analysis of the health research publications from the WHO Africa region indexed on PubMed; it analyzes the influence of various factors, including GDP, population, and health spending on the number and growth of published papers by country over the time period. The abstract reads:

Objective To assess the profile and determinants of health research productivity in Africa since the onset of the new millennium.

Design Bibliometric analysis.

Data collection and synthesis In November 2014, we searched PubMed for articles published between 2000 and 2014 from the WHO African Region, and obtained country-level indicators from World Bank data. We used Poisson regression to examine time trends in research publications and negative binomial regression to explore determinants of research publications.

Results We identified 107 662 publications, with a median of 727 per country (range 25–31 757). Three countries (South Africa, Nigeria and Kenya) contributed 52% of the publications. The number of publications increased from 3623 in 2000 to 12 709 in 2014 (relative growth 251%). Similarly, the per cent share of worldwide research publications per year increased from 0.7% in 2000 to 1.3% in 2014. The trend analysis was also significant to confirm a continuous increase in health research publications from Africa, with productivity increasing by 10.3% per year (95% CIs +10.1% to +10.5%). The only independent predictor of publication outputs was national gross domestic product. For every one log US$ billion increase in gross domestic product, research publications rose by 105%: incidence rate ratio (IRR=2.05, 95% CI 1.39 to 3.04). The association of private health expenditure with publications was only marginally significant (IRR=1.86, 95% CI 1.00 to 3.47).

Conclusions There has been a significant improvement in health research in the WHO African Region since 2000, with some individual countries already having strong research profiles. Countries of the region should implement the WHO Strategy on Research for Health: reinforcing the research culture (organisation); focusing research on key health challenges (priorities); strengthening national health research systems (capacity); encouraging good research practice (standards); and consolidating linkages between health research and action (translation).

In the discussion, there is some fascinating commentary on the challenges facing researchers in the research and the barriers to publication, as well as to making those publications available to other researchers in the field. Some of them are familiar and strike me as a common symptom of the complicated relationship between politics and (especially evidence-based) policy making:

Although there is clearly a need for improving the performance of health researchers on the continent, African health decision makers should use the available research evidence to guide policy, strengthen practice and maximise the use of resources in order to improve the welfare of their citizens. However, there appears to be a failure to apply available research evidence to improve the health of populations on the continent. This unfortunate situation may be related to the lack of sharing of research evidence for translation into policy and practice, a non-alignment of research conducted in African countries to national research policies and/or the non-existence of national health research policies with clearly defined priorities.

However, others are somewhat unique to Africa. Not of them are economic (though funding plays a major role), and the paper goes so far as to describe some of the challenges as “intractable”:

The difficulties in research, publication, editorial bias and information access facing Africa are profound and seem almost intractable. Another difficulty facing African researchers is dissemination of findings to other parts of the world. Most of the information published in African journals is largely not included in major databases. Access to technological tools, information access and other equipment and supplies to ease research work is not always possible.

I hope this will influence the wider debate on the future of aid and health spending in Africa. The call for a shift in funding and emphasis from technologically-focused solutions to health-systems strengthening and sustainability has gained momentum, and research and academic exchange is a crucial part of the latter.

Global Health News Last Week

POLITICS AND POLICY

  • South Africa’s government has set out its plans to introduce a universal health care scheme with a pilot program in 10 areas by 2012 and nationally over the next 14 years.
  • The U.N. must make reducing salt intake a global health priority, sayUK scientists. Writing in the British Medical Journal they say a 15% cut in consumption could save 8.5 million lives around the world over the next decade.
  • IRIN reports on the story of Daniel Ng’etich, a Kenyan man who was arrested and jailed for not continuing his TB treatment.
  • Dr. Jill Biden is leading a high level American delegation toKenya, which includes Raj Shah, to look into the American response to the famine crisis in the Horn of Africa.
  • A report on the state of maternal health in South Africa by Human Rights Watch has uncovered some alarming trends.

PROGRAMS

  • WHO has launched a new website to help those combating malnutrition. eLENA, a new e-library, gathers together evidence-informed guidelines for an expanding list of nutrition interventions. It is a single point of reference for the latest nutrition guidelines, recommendations and related information.

RESEARCH

  • A TB vaccine designed for those with HIV enters phase IIb trials this week in Senegal. The vaccine works by boosting response of T cells already stimulated by the traditional BCG vaccine.
  • Female smokers are more at risk for heart disease than male smokers, finds a systematic review and meta-analysis published in the Lancet.  This is a concern, as smoking rates are increasing in young women worldwide.
  • Scientists are in the second phase of research into using microwaves to kill malaria parasites in mice.
  • A USC researcher has developed a lentiviral vector that can track down HIV infected cells which can potentially act as a marker for targeted elimination of infected cells.
  • People living with HIV who receive the proper ARV treatment have no greater risk of death compared to people without HIV, finds Danish researchers.
  • Around 30 genetic risk factors for developing multiple sclerosis have been discovered by a UK-led team.
  • A new study, showing that a simple blood test can accurately determine the sex of a fetus 95 percent of the time, is great news for parents at high risk of having a baby with rare genetic diseases. But it is bad news to those concerned that the tests could be used to abort a fetus based on gender.
  • British researchers have discovered that the introduction of spermless male mosquitoes can lead to fewer malaria carrying females.
  • A device which can test blood for HIV/AIDS in a matter of minutes has been developed by University of Columbia scientists.

DISEASES AND DISASTERS

  • As if it did not have enough problems already, Somalia is now facing cholera epidemic, World Health Organization officials said.
  • In an August 4 article, Trustlaw’s Lisa Anderson exposes the “silent health emergency” faced by child brides around the globe.  Not yet physically mature, they face grave danger in childbirth, due to narrow pelvises. Girls younger than 15 years of age have a five times greater risk of dying during delivery than women over 20; most of these deaths occur in developing countries that lack adequate and accessible pre- and postnatal care.
  • Amid contradictory government statistics, a volunteer group in Japan has recorded 500,000 radiation points across the country.
  • A Mexican teenager is the first officially known person to die from vampire bat induced human rabies infection. The 19-year-old victim was a migrant farm worker in theUnited States.
  • An estimated 500,000 people in West Africaare infected with lassa fever every year, the World Health Organization (WHO) said on Wednesday, amid calls for more money to be spent on preventing its spread.
  • Over at Global Pulse, Human Rights Watch researcher Katherine Todrys guest blogs on the HIV epidemic in Uganda’s penitentiaries.Uganda, she explains, has often been presented as a success story in the global fight against HIV/AIDS, and has received over $1 billion from the US for AIDS programs. Many HIV-positive Ugandans have been excluded from these efforts, though, including gay men, drug users, sex workers, and prisoners.
  • Sleep apnea, a fairly common and treatable disorder that causes people to stop breathing momentarily while they sleep, may lead to cognitive impairment and even dementia.
  • Although cases of sexual violence have been under-counted during some wars, during others, such as the ongoing unrest in Libya, they have been vastly over-counted.
  • All patients getting cancer treatment should be told to do two and a half hours of physical exercise every week, says a report by Macmillan Cancer Support.

Global Health News Last Week

After the Lancet retracted the controversial Wakefield study last February, which suggested a link between the MMR vaccine and autism, BMJ has declared the study to be fraudulent after further investigation revealed that the author stood to make millions of dollars through lawsuits and diagnostic kits related to autism.

Kofi Annan urges the WHO executive board to set a date for measles eradication during their meeting, which will last until January 25.

Engineers Without Borders, Canada, is trying to change the way aid organizations represent their projects (and their failures) by launching Admittingfailure.com, a website where organizations can post their favorite failure. They hope to encourage groups to admit to, and learn from, their failures.

The Center for Global Development has posted an MDG progress index, which allows the user to see how different nations are progressing toward the MDG targets.

A research paper debunked claims made by UN environmental organizations that insecticide-free methods used in a malaria control project were effective at reducing transmission, thus making the case to stop the use of DDT.

End the Neglect posted a reading list on Thursday.

Developing nations continue to pressure the US and Russia to destroy their stocks of smallpox, though the WHO supports retention for research purposes.

Unlike many other countries, which are making progress in the fight against HIV/AIDS, Russia’s HIV epidemic is getting worse due to pervasive drug addiction. Meanwhile, religious leaders in Chechnya have declared the couples must obtain proof that they are HIV-negative in order to receive permission to marry.