title: Disparities in the contribution of low- and middle-income countries to palliative care research.
abstract: BACKGROUND
  Important aspects of the palliative care needs of patients from low- and middle-income countries (LMIC) are largely unexplored. About 44 million of the 56 million annual deaths worldwide occur in developing countries, and it is estimated that more than 33 million of those concerned would benefit from palliative care. In this context, the understanding of specific social and cultural needs is fundamental to the development of appropriate health policy and clinical practice concerning palliative and end-of-life care.
  
  
  OBJECTIVE
  This study aims to answer the question: what are the contributions, in terms of generation of knowledge, of LMIC to the published palliative care literature?
  
  
  METHODS
  A bibliometric analysis was conducted in Medline and EMBASE (to June 2008). Articles were included when either the first author (institutional affiliation or contact address) or the data collection was derived from LMIC, as defined by criteria of the World Bank. Excluded were articles done in migrant and non-palliative care populations.
  
  
  RESULTS
  The literature search resulted in 845 references. In total, 245 articles coming from LMIC were identified, being published by 34 LMIC (27.3% of LMIC). The first publications appeared in 1982. The study shows a rather modest contribution of publications from LMIC. However, the volume of publications within LMIC is distributed unequally: upper-middle-income countries published almost half of the articles (46.9%), whereas only 11% of the publications came from low-income countries. In contrast, 104 LMIC (72.7% of LMIC) do not have any registered publications. Surprisingly, 25% of the articles with data from LMIC have been done and published by high-income countries. Reasons for the underrepresentation, as well a possible correction of this imbalance, are discussed.
  
  
  CONCLUSIONS
  Palliative care research should be a priority in LMIC, where many patients could benefit tremendously from it, and publication of findings in these countries should be encouraged.
authors.affiliation: Department of Palliative Medicine, RWTH Aachen University, 52074 Aachen, Germany. tpastrana@ukaachen.de
authors.forename: Tania
authors.initials: T
authors.lastname: Pastrana
authors.forename: Nandini
authors.initials: N
authors.lastname: Vallath
authors.forename: John
authors.initials: J
authors.lastname: Mastrojohn
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Namukwaya
authors.forename: Suresh
authors.initials: S
authors.lastname: Kumar
authors.forename: Lukas
authors.initials: L
authors.lastname: Radbruch
authors.forename: David
authors.initials: D
authors.lastname: Clark
mesh_terms: D015706:Bibliometrics; D035843:Biomedical Research / Q000706:statistics & numerical data*; D003906:Developing Countries; D006801:Humans; D010166:Palliative Care / Q000706:statistics & numerical data*; D010506:Periodicals as Topic / Q000706:statistics & numerical data*