Relation between burden of disease and randomised evidence in sub-Saharan Africa: survey of research

Objective To evaluate whether the amount of randomised clinical research on various medical conditions is related to the burden of disease and health needs of the local populations in sub-Saharan Africa. Design Construction and analysis of comprehensive database of randomised controlled trials in sub-Saharan Africa based on Medline, the Cochrane Controlled Trials Register, and several African databases. Setting Sub-Saharan Africa. Main outcome measures Number of trials and randomised subjects for each category of disease in the global burden of disease taxonomy; ratios of disability adjusted life years (DALYs) per amount of randomised evidence. Results 1179 eligible randomised controlled trials were identified. The number of trials published each year increased over time. Almost half of the trials (n = 565) had been done in South Africa. There was relatively good correlation between the estimated burden of disease at year 2000 and the number of trials performed (r = 0.53, P = 0.024) and the number of participants randomised (r = 0.68, P = 0.002). However, some conditions-for example, injuries (over 20 000 DALYs per patient ever randomised)-were more neglected than others. Conclusion Despite recent improvements, few clinical trials are done in sub-Saharan Africa. Clinical research in this part of the world should focus more evenly on the major contributors to burden of disease.