title: Published randomized trials performed in Sub-Saharan Africa focus on high-burden diseases but are frequently funded and led by high-income countries.
abstract: OBJECTIVE
  In light of funding constraints in Sub-Saharan Africa (SSA), the value of research performed there must be increased. The objective of this study was to describe the epidemiology of published randomized controlled trials (RCTs) performed in SSA.
  
  
  METHODS
  We searched PubMed, the Cochrane library, and African Index Medicus to identify reports of all RCTs performed in SSA and published between January 1, 2014 and March 31, 2015. We systematically recorded the country of the affiliation of the corresponding author and the funding source. The overall burden of disease was assessed by 2013 disability-adjusted life years (both sexes, all ages) in percentages for two locations: SSA and high-income countries (HICs).
  
  
  RESULTS
  Only 12 of 121 RCTs were conducted in both Sub-Saharan Africa and another region, with 109 of 121 RCTs (90%) having trial centers exclusively located in SSA. The corresponding author's only affiliation was in SSA for 44/109 trials (40%) and was institutions in HICs for almost half of the trials. The funding source was nonprofit for 77/109 trials (70%) and was from HICs for 81% (n = 63/77). Overall, most RCTs targeted diseases with a high burden in SSA; 46% of the trials targeted the five diseases with the highest burden in SSA, mainly malaria (n = 25), HIV/AIDS (n = 24), lower respiratory tract infection (n = 2), diarrheal diseases (n = 3), and preterm birth complications (n = 2). Nevertheless, among the 25 diseases or health-related conditions with the highest burden in SSA, 9 (36%) were not assessed in any RCT.
  
  
  CONCLUSIONS
  Published RCTs performed in SSA were mainly funded and led by HIC institutions, although investigations concerned diseases highly prevalent in SSA.
authors.affiliation: Fondation Congolaise pour la Recherche Médicale (FCRM), Faculté des sciences de la santé, BP 2672, Brazzaville, République du Congo; INSERM, UMR 1153 Epidemiology and Biostatistics Sorbonne Paris Cité Center (CRESS), METHODS Team, Hôtel-Dieu, 1 place du Parvis Notre-Dame, Paris 75004, France; Paris Descartes University, Faculty of Medicine, 15 rue de l'école de Médecine, Paris 75006, France. Electronic address: leeaymar.ndounga@aphp.fr.
authors.forename: Lee Aymar
authors.initials: LA
authors.lastname: Ndounga Diakou
authors.affiliation: Fondation Congolaise pour la Recherche Médicale (FCRM), Faculté des sciences de la santé, BP 2672, Brazzaville, République du Congo; Marien Ngouabi University, Faculty of Sciences and Techniques, P.O Box 69, Brazzaville, Republic of Congo; Institute for Tropical Medicine, University of Tübingen, Wilhelmstrasse 27, Tübingen 72074, Germany.
authors.forename: Francine
authors.initials: F
authors.lastname: Ntoumi
authors.affiliation: INSERM, UMR 1153 Epidemiology and Biostatistics Sorbonne Paris Cité Center (CRESS), METHODS Team, Hôtel-Dieu, 1 place du Parvis Notre-Dame, Paris 75004, France; Paris Descartes University, Faculty of Medicine, 15 rue de l'école de Médecine, Paris 75006, France; Centre d'Épidémiologie Clinique, Hôpital Hôtel Dieu, Assistance Publique des Hôpitaux de Paris, 1 place du Parvis Notre-Dame, Paris 75004, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Ravaud
authors.affiliation: INSERM, UMR 1153 Epidemiology and Biostatistics Sorbonne Paris Cité Center (CRESS), METHODS Team, Hôtel-Dieu, 1 place du Parvis Notre-Dame, Paris 75004, France; Paris Descartes University, Faculty of Medicine, 15 rue de l'école de Médecine, Paris 75006, France; Centre d'Épidémiologie Clinique, Hôpital Hôtel Dieu, Assistance Publique des Hôpitaux de Paris, 1 place du Parvis Notre-Dame, Paris 75004, France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Boutron
mesh_terms: D017954:Africa South of the Sahara; D017281:Cost of Illness; D019049:Developed Countries; D003906:Developing Countries; D006801:Humans; D016032:Randomized Controlled Trials as Topic / Q000191:economics* / Q000706:statistics & numerical data*
keywords: Epidemiology; Global burden of disease; High-income countries; International collaboration; Low- and middle-income countries; Randomized controlled trials; Research implementation; Sub-Saharan Africa