Study finds African representation in major clinical trials remains extremely limited
Published: 14 April 2026
A new study co-led by the School of Infection & Immunity's Professor Pasquale Maffia reveals that African countries remain severely underrepresented in randomised controlled trials published in the world’s leading medical and cardiovascular journals.
A new study co-led by the School of Infection & Immunity's Professor Pasquale Maffia reveals that African countries remain severely underrepresented in randomised controlled trials (RCTs) published in the world’s leading medical and cardiovascular journals.
Researchers analysed 2,472 randomised controlled trials published between 2019 and 2024 across eight major journals and found that only 3.9 per cent of trials in leading general medical journals were conducted exclusively in Africa, while just 0.6 per cent of trials in major cardiovascular journals were Africa-only studies.
Africa bears roughly 25 per cent of the global disease burden, yet African populations are rarely included in studies that shape international medical guidelines.
The study, published in the Journal of the American College of Cardiology, also found that African sites were included in only a small proportion of multicontinental trials, and African leadership was uncommon in these studies.
Dr Bamba Gaye, of the Alliance for Medical Research in Africa and Cheikh Anta Diop University in Dakar, Senegal, said: “Our analysis highlights a profound imbalance in the global clinical research landscape.
"Populations across Africa remain largely excluded from trials that guide clinical practice worldwide.”
The study also identified regional disparities within the continent. South Africa accounted for the majority of Africa-based trials, while large parts of central Africa had little or no representation.
Most trials conducted exclusively in Africa focused on infectious diseases, while non-communicable diseases, including cardiovascular disease, were underrepresented, despite their rapidly increasing burden on the continent.
Professor Maffia said: “Clinical trials underpin evidence-based medicine. If African populations are not adequately represented, global medical evidence risks being incomplete.”
The authors, also including Sii trio Moustafa Morsy, Mohsen Shoaran, and Ahmad Alsaeed, call for greater investment in African research infrastructure, funding for locally led studies, and stronger international collaborations to ensure global clinical research reflects the diversity of the world’s populations.
The systematic review evaluated randomised controlled trials published between 2019 and 2024 in leading journals, including The New England Journal of Medicine, The Lancet, JAMA, Nature Medicine, BMJ, Circulation, European Heart Journal, and the Journal of the American College of Cardiology.
In total, 2,472 eligible trials were analysed to assess geographic representation, disease focus, and authorship patterns.
Bamba Gaye, Moustafa I. Morsy, David Lagoro Kitara, Gurbinder Singh, Moustafa I. Morsy, David Lagoro Kitara, Gurbinder Singh, Mohsen Shoaran, Danila Gurgone, Daouda Seck, Ahmad Alsaeed, Modou Jobe, Jennifer Carter, Khadidiatou Gueye, Ngone Diaba Gaye, Mame Madjiguene Ka, Mohamed B. Jalloh, Elisabeth Alice Liyong, André Pascal Kengne, Thiess Lorenz, Tomasz J. Guzik, Mayowa O. Owolabi, Pierpaolo Pellicori, Anastase Dzudie, Eloi Marijon, David Preiss, Léon Tshilolo, Ibrahima Socé Fall, Elisabeth Lilian Pia Sattler, Ntobeko A.B. Ntusi, Ibrahima Seck, and Pasquale Maffia.
- Published: Friday, 20 March 2026
- DOI: https://doi.org/10.1016/j.jacc.2026.02.5097
Enquiries: ali.howard@glasgow.ac.uk or elizabeth.mcmeekin@glasgow.ac.uk
First published: 14 April 2026