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.


Students, You Should Go Abroad Too!

Leaving your comfort zone is one of the hardest, yet most rewarding experiences you can have. It was for me. During my undergraduate years, I spent three consecutive semesters studying abroad in Spain and Chile fulfilling my Spanish & Latin American Literature and Culture major. I realized the importance of expanding my horizons, gaining a multicultural perspective of the world and becoming more culturally competent. As a public health graduate student, my travels to Latin America took a global health perspective. My mind was once again exposed to another side of the world that we often miss while secluded in our comfort zones. In Central and South America, I volunteered on heath initiatives and sustainable development projects, and conducted research. I witnessed numerous global health disparities including lack of sanitation, children living in homes made with plastic walls and dirt floors, and physicians striving to provide quality reproductive care to low-income, immigrant women at a family planning clinic with scarce resources.

My ultimate goal is to become a primary care physician to help reduce health disparities globally. Going abroad was one step towards that goal.

Continue reading “Students, You Should Go Abroad Too!”

Global Health Weekly News Round-Up

Politics and Policies:

  • The Food and Drug Administration has announced that it will begin exercising its authority given under a 2009 law, power to regulate cigarettes and other tobacco products that they believe pose public health risks.
  • In an effort intensify campaign to publicize new health insurance options and to persuade consumers, the White House is recruiting mayors, county commissioners and other local officials.


  • A health check program has been launched in Accra, in order to reach out to the people of Ghana who are challenged with non-communicable diseases (NCDS), in an affordable and effective way.
  • The United Kingdom (UK) is starting a rotavirus vaccination program to protect the babies from infection which causes diarrhea, vomiting, abdominal pain, fever and dehydration.
  • Ben & Catherine Ivy foundation grants more that $9 million for brain cancer research.


  • To help avert 3 million AIDS deaths by 2025, the World Health Organization (WHO) through its guidelines is recommending the patients the start medicine at earlier stage of the deadly disease.
  • According to global Diabetes attitudes, wishes and needs 2 study one in five people with diabetes feel discriminated against them because of their condition. About 16% people suffering from this condition are at risk of depression.
  • According to the United Nations Program on HIV/AIDS (UNAIDS), Ghana cuts new HIV infections among children by 76% since 2009. It states that one three in ten children in need of treatment have access to it.
  • A report released by the United Nations state that Nigeria has highest number of children with HIV/AIDS virus in the world. It states that the incidence rate has not increased much but the increase in the prevalence rate has remained stagnant.
  • According to the scientists, new World Health Organization (WHO) test- based approach against malaria does not work everywhere. There must be a hard diagnosis before the disease is treated.
  • According to the research results published in the Journal of Infectious diseases, infant rotavirus vaccine is effective against this disease in Ghana. Results showed a significant response in parameters of efficacy, safety and immune impact of vaccine.
  • A study published in the journal’ Diabetologia’, ethnicity should be considered while making guidelines for physical activity. They state that south Asians need more exercise than white Europeans to reduce diabetes risk.
  • According to a research review published in BMJ, high consumption of fish reduces risk of breast cancer by 14%. It replenishes the body with all omega 3 essential fatty acids which can only be acquired from external sources as body cannot manufacture it.
  •  In a study published in Cell Transplantation journal, type 2 diabetes patients who receive self-donated bone marrow stem cells require less insulin. According to the scientist’s good glycemic control appeared as a critical factor in the transplanted and non-transplanted control group.
  • A study indicates that consuming more than 2-3 standard alcohol drinks per day is linked to deadly digestive tract cancers including mouth, throat, larynx and esophageal. They also warn of risk of bowel, breast and prostate cancers.
  • The scientists have found out that the patients of Crohn’s disease also have a virus – enterovirus in their intestines as compared to those who did not have this disease. It also said that the genes associated with the onset of this disease are vital for the immune response against this virus.
  • According to the researcher’s malaria parasite are full of iron which they cannot digest nor can excrete them. Their invention- hand-held battery operated malaria detector will use the power of magnets to detect them.

Diseases & Disasters:

  • Reports state that Lusaka (Zambia) records approximately 185 new HIV/ AIDS infections every day. It has high prevalence rate of 20.8 percent as compared to the other districts of Zambia.
  • The cholera epidemic in the Democratic Republic of the Congo claims lives of 257 people. Lack of proper sanitation and clear water are stated to be the main cause of the outbreak.
  • Polio outbreak in Somalia jeopardizes global eradication. Before this there was no case of this disease for more than five years. This outbreak is reported in its early stages and WHO experts see more cases coming in next few weeks.
  • A report released by Greenpeace suggests that a Chinese herbal medicine contains a variety of pesticides. It is increasingly accepted in the western countries for medicinal use.
  • Reports have shown a new trend of HIV infection among the youths of Manipur (India). Unsafe sex practice has been indicated to be the major mode of HIV transmission among them.
  • According to the UK’s Medicines and Healthcare Products Regulatory Agency (MHRA). Diclofenac, a common painkiller raises the risk of heart attack and stroke among the patients with serious underlying heart conditions.
  • Health officials are warning that tularemia cases are on rise in New Mexico. Four cases have been so far been reported.
  • Japan and Poland are facing epidemic of rubella. Travel warnings have been issued by the Centers for Disease Control and Prevention for the pregnant females visiting these countries.

IH News Global Health Weekly News Round-Up

Politics and Policies:

  • A new healthcare-for-all program in Indonesia’s capital, Jakarta is under scrutiny. National officials are monitoring the city’s response and experience ahead of the rollout of a government scheme to provide universal healthcare by 2019.
  • The ministry of Health and Population of Nepal has decided to upgrade all sub-health posts to health posts by 2015.
  • The Pediatric Society of New Zealand has called for funding for infant vaccinations against the disease as an urgent priority.
  • Bill in North Dakota bans abortion after heartbeat is found.


  • Solar-powered mobile health center equipped with remarkable range of facilities (- eye clinic, blood clinic and dental surgery) unveiled in Cape Town, South Africa.  Besides proving screening for conditions like diabetes, high blood pressure it will also emphasize on health education.
  • The United States will provide Burundi an additional $3.5 million in aid towards its fight against HIV/AIDS and mother-to-child transmission of disease.
  • The Association of Heath Journalists with a support from the UNAIDS will be trained on tuberculosis, HIV and co-infection.
  • Japan gives N443 million for childhood disease to Nigeria. This grant will partly support facilitation and monitoring of health sector performance in Nigeria.
  • Somaliland to vaccinate 600,000 young children against polio.
  • Scotia bank has announced pledge of $1 million to support the Carribbean –SickKids Paediatric Cancer and Blood Disorders Project. These funds will be used to support the projects telemedicine programs in Barbados, Jamaica, St. Lucia, St. Vincent and the Grenadines, Trinidad and Tobago and the Bahamas.
  • United Healthcare Awards $5.2 million in grants to California nonprofits-$2.2 million to three Los Angeles-area health organizations.


  • A team of scientists from the United States have claimed to have treated a child of the Human Immunodeficiency Virus (HIV) infection.
  • Mozambique is on its way to utilize tests for tuberculosis by the GeneXpert machine which would speed up its diagnosis from two to three months to two hours.
  • A three day campaign launched by the Chaadian government with support of the United Nations agencies to eradicate polio, boost vitamin A and de-warm four million children under the age of five years.
  • According to a study providing life-long antiretroviral treatment to HIV-infected pregnant women not only prevents HIV infections in infants, but also improves the 10 years survival rate in mothers.
  • Mozambique’s first HIV vaccine trial heralds new era in local research.
  • Rwanda Ministry of Health deploys technology to report potential disease outbreaks and help health workers contain the spread of disease.
  • Government of Rwanda is introducing its first combined Rubella-Measles vaccine. A nationwide campaign against these two diseases has been launched in the country.
  • The scientists from University of Toronto and SickKids Research Institute have mapped genome that causes Dutch elm disease.
  • Studies uncover risks and threats to Arctic inhabitant’s health that might be due to contaminants brought by warmer air and sea water currents resulting from climate change.

Diseases and Disasters:

  • Nearly fifteen people have died in Libya after consumption of home-made alcohol and more than 300 people are suffering from alcohol poisoning.
  • Since November 2012 about 389 people have been infected and nearly 10 people are killed because of cholera outbreak in Congo’s second largest city, Pointe-Noire.
  • Measles kills 17 in Niger state.
  • The report of United Nations has raised air safety concerns in India.
  • According to the officials,  hospitals in South Sudan.
  • According to a data posted on the health ministry website in China, from 1971 to 2010, a total of 328.9million abortions were carried out in the country.
  • Cluster of Vancomycin resistant enterococci cases has been reported in United Christian Hospital in Hong Kong.
  • According to a report by WHO, road safety is worst in India.
  • Undocumented children in Indonesia have no access to education and basic healthcare.
  • The swine flu virus isolated from the throat swab samples of six H1N1-infected patients at the National Institute of Virology (NIV) has shown small genetic mutation.
  • According to the reports of the Vietnamese Ministry of Health (MOH)’s Preventive Health Department, hand-foot-mouth (HFM) disease has affected over 10,000 Vietnamese people.
  • Health officials investigate norovirus outbreak at Andina in Porland.
  • Mexico fireworks blast death toll rises to 14.


Global Health Weekly News Round-Up

Politics and Policies



Diseases and Disasters