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Original Article
3 (
); 16-24

The Pan African Thoracic Society Methods in Epidemiologic, Clinical and Operations Research Program: A story of success told through a history of publications

Department of Community Medicine, University of Calabar, Calabar, Cross River, Nigeria
Department of Medicine, Alex Ekwueme University Teaching Hospital, Abakaliki, Ebonyi, Nigeria
Department of Medicine, College of Medicine, University of Lagos, Lagos, Nigeria
Department of Community Medicine, University of Calabar Teaching Hospital, Calabar, Cross River, Nigeria
Department of Pediatrics, University of Calabar Teaching Hospital, Calabar, Cross River, Nigeria
Department of Pediatrics, Ola During Children’s Hospital, Freetown, Sierra Leone
Department of International Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
International Programs and Activities Unit, American Thoracic Society, New York
Division of Pulmonary and Critical Care Medicine, Oregon Health and Science University, Portland, Oregon
Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
Department of Pediatrics, University of Kwazulu Natal, Durban, South Africa
Corresponding author: Ogonna Nwota Odi Nwankwo, Department of Community Medicine, University of Calabar, Calabar, Cross River, Nigeria.
This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, transform, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

How to cite this article: Nwankwo ON, Ukwaja KN, Ozoh OB, Akpet O, Iwara NN, Nwankwo GI, et al. The Pan African Thoracic Society Methods in Epidemiologic, Clinical and Operations Research Program: A story of success told through a history of publications. J Pan Afr Thorac Soc 2022;3:16-24.



Despite bearing a substantial burden of respiratory diseases, low- and middle-income countries in Africa contribute little to the research literature. Since 2007, the Pan African Thoracic Society’s Methods in Epidemiologic, Clinical, and Operations Research (PATS-MECOR) program has been working to strengthen capacity in lung health research in Africa. The aim of this study was to assess the research productivity of previous PATS-MECOR participants.

Materials and Methods:

A systematic review of publications attributed to past PATS-MECOR participants up until 2018 was carried out using a systematic search strategy based on their names on PubMed database.


A total of 210 participants drawn from 21 African countries attended PATS-MECOR between 2007 and 2016, of which more than three-quarters (76.7%) had ever published. Of the total 1673 included publications, 303 (12.7%) had multiple course attendees as coauthors. The median publication per published participant was 5 (IQR 2–13) articles. The percentages of the first author, second authors, or last authors publications were 371 (22.2%), 239 (14.3%), and 99 (5.9%), respectively. The top three journals published in were PLOS One 108 (6.6%), Lancet 80 (4.9%), and the International Journal of Tuberculosis and Lung Disease 52 (3.2%). The median citation of their publications was 11 (4–26). There was approximately a double-fold rise in the publication output of participants in their 1st year following attendance to PATS-MECOR compared to the year before the course (123, 68.0% vs. 58, 32.0%).


The PATS-MECOR training program has been successful in research capacity building for African investigators as evidenced by a growing publication track record. There is a need to ensure sustainability and for increased collaboration and networking among the trained critical mass of researchers in the continent.


Medical education
Health research
Low- and middle-income countries


Low- and middle-income countries (LMICs), especially in Africa, bear a substantial global burden of communicable and non-communicable diseases such as tuberculosis, pneumonia, asthma, HIV, and chronic obstructive pulmonary disease.[1-4] Despite this burden, there is a low research spending and a correspondingly limited contribution to the research literature.[5-9] Indeed, the Commission on Health Research had previously described the “10/90” gap which highlights the disparity in disease burden and research output from African countries.[10,11] Further, despite hosting 15% of the global population, African countries contribute only about 1.5% of the global health research publications, which emanate mostly from South Africa, Egypt, and Nigeria.[7,12,13] Limited research activities in LMIC have been strongly associated with the perpetuation of poverty and provide a basis for actions to improve research capacity and output in these regions.[12]

High-quality research conducted in relevant local contexts is critical for informing strategies to control some of the prevalent diseases and setting national health priorities toward meeting the sustainable development goals.[14-16] One factor that may have contributed to low research output in Africa and other LMIC is the very low number of well-trained researchers relative to the population compared to high-income countries that fall in the range of 5 versus 363 full-time researchers per million population.[17,18]

A review of 1593 articles on randomized controlled trials for HIV/AIDS, malaria, and tuberculosis in LMICs revealed that although there was significant year-to-year rise in published articles from the African continent, most were first authored by researchers from high-income countries.[15] This inequity is due to a wide range of issues ranging from inadequate funding, poor training and expertise, poor institutional support, and capacity to absent mentorship.[7,11,19,20]

Recognizing these problems, the American Thoracic Society in collaboration with the Pan African Thoracic Society (PATS) set up a research capability strengthening program – Methods in Epidemiologic, Clinical, and Operations Research (PATS-MECOR) program – which seeks to improve global lung health through the development of local research capacity in Africa. “PATS-MECOR” commenced in 2007 and is organized as a three-level training course such that attendees can progress from one level each year to completion. The process and method of running the program has been more adequately written about by Buist and Parry.[21] Over the years, the course has drawn participants from different African countries, however, the level of achievement of its core mandate of improving research capacity through publications by participants has not been assessed.

There is always a need for the evaluation of the effectiveness of public health programs including research capacity building programs both as a learning and planning tool.[22] One approach is by evaluation of the publication history of participants using bibliometric methods that quantitatively and qualitatively evaluate published literature. This method has become a key part of modern assessment of academic productivity.[23,24] This study set out to objectively evaluate the research productivity of previous participants of the PATS-MECOR course through their publication history as a proxy measure of the effectiveness of the training program.


Study design, period, and location

This is a bibliometric study that utilizes databases, dissertations, and theses, as the primary sources of information for analyses.[25] Using the names of the past PATS-MECOR students who attended the course from 2007 up until 2016, a systematic search was conducted on PubMed database. This search was limited to participants who had attended any level of the course on or before 2016 as it was assumed that the cohort would have had the opportunity to have completed the last level of their training by 2018.

For each paper retrieved, the name of the author was cross-checked by triangulation of the author name and affiliation and comparing it with other basic information obtained about the author from the PATS-MECOR official list and other sources of personal profiles such as ResearchGate, Google Scholar, or LinkedIn.

Population or sample; inclusion and exclusion criteria

For each potential author, all publications attributed to the authors were retrieved and downloaded into Endnote and subsequently transferred into a Microsoft Excel sheet. Inclusion criteria were all papers published up until 2018 by the participants who had attended the course between 2007 and 2016. The search yielded 1677 articles, of which four were excluded as they were duplicates attributed to the same author, thereby leaving a total of 1673 articles that met the inclusion criteria. Thirty-nine of the included articles were published in French by nine of the participants. For any former PATS-MECOR participant whose name search on PubMed had no yield, we carried out a secondary search on Goggle,Google Scholar and on Researchgate. If Any articles are identified on this secondary search,the titles of such articles are then inputted into the PUB Med search engine to see if it is within its database for possible inclusion in the study.

Statistical analysis

The analysis was carried out using both Microsoft Excel sheet and IBM Statistical Package for the Social Sciences version 20.

Categorical variables were presented as frequencies and percentages, and the data on numerical variables such as citations and publications were presented as mean and standard deviation or median and interquartile range (IQR 25–75%) depending on the distribution of data. The ranking of publication output derived from the absolute number of publications by all participants from each country was subsequently adjusted to take into cognizance the number of participants from each country and the gross domestic product of each country.

Ethical approval

Ethical approvals are not needed for the study of this nature which uses publicly available data.


Profile of past PATS-MECOR participants

A total of 210 participants drawn from 21 African countries (seven low-income, 10 lower-middle-income, and four middle-income countries) had attended at least one level of the course [Table 1]. The average and standard deviation of the annual intake of new participants was 20 ± 5. Over two-thirds of the participants were male 144 (68.6%) with 61 (29.0%) completing all three levels of the training.

Table 1: Distribution and country of origin of past PATS-MECOR participants 2007–2016, n=210.
Country of participants Number of participants Percentage
Low-income countries*
Malawi 12 5.7
Ethiopia 9 4.3
Democratic Republic of Congo 5 2.4
Uganda 5 2.4
Sudan 2 1.0
Gambia 1 0.5
Guinea 1 0.5
Lower-middle-income countries*
Nigeria 71 33.8
Kenya 41 19.5
Benin 11 5.2
Tanzania 6 2.9
Zambia 4 1.9
Zimbabwe 4 1.9
Cameroon 3 1.4
Cote d’Ivoire 2 1.0
Ghana 1 0.5
Lesotho 1 0.5
Upper-middle-income countries*
Namibia 18 8.6
South Africa 8 3.8
Botswana 4 1.9
Gabon 1 0.5

Profile of publications

The 1673 retrieved articles that met the inclusion criteria were authored by 161 of 210 past participants (76.7%). Three hundred and three (12.7%) of the publications had multiple course participants as coauthors. Although participants were drawn from over 21 countries, only participants from 19 countries had articles attributed to them. [Table 2] shows the country distribution of the articles by the country of origin and domicile of the participants. Participants from Nigeria published the most papers (777; 46.4%) followed by Kenya (148; 8.8%) and Benin (142; 8.5%).

Table 2: Country distribution of publications of past PATS-MECOR participants 2007–2016, n=1673.
Country* Number of publications Percentage
Nigeria 777 46.4
Kenya 148 8.8
Benin 142 8.5
Uganda 140 8.4
Malawi 97 5.8
Tanzania 65 3.9
South Africa 70 4.2
Zambia 48 2.9
Gambia 37 2.2
Cameroon 27 1.6
DRC 23 1.4
Ethiopia 21 1.3
Namibia 18 1.1
Cote d’Ivoire 18 1.1
Zimbabwe 14 0.8
Gabon 10 0.6
Sudan 7 0.4
Botswana 7 0.4
Ghana 4 0.2
Countries were no author had at least one publication are Guinea and Lesotho

The median publication attributable to each author was 5 (IQR 2–13) with the lowest number of published articles by authors being 1 and the highest number being 131 in total. [Table 3] summarizes the frequency distribution of number of publications by PATS-MECOR students. Over half of the participants 85 (52.8%) had published 1–5 articles while over 10% of all the published participants and 24 (14.9%) had published more than 20 articles. Ninety-seven (60.2%) of those who had published articles had at least one first author position while 22 (13.6%) had at least as the second author position.

Table 3: The frequency distribution of the number of publications by PATS-MECOR students, n=161.
Number of publications Number of published participants Percentage
1–5 85 52.8
6–10 26 16.1
11–15 18 11.2
16–20 8 5.0
21 and above 24 14.9

[Table 4] shows the frequency distribution of number of publications by PATS-MECOR students according to the country of residence. Nigeria has the highest number of authors with at least 16 papers (8.7%) followed jointly by Benin (1.9%) and Uganda (1.9%).

Table 4: The frequency distribution of number of publications by PATS-MECOR students according to country of residence, n=161.
Country Number of publications per author Total participants % of total
1–5 % 6–10 % 11–15 % >16 %
Nigeria 29 18.0 10 6.2 10 6.2 14 8.7 63 39.1
Kenya 17 10.6 5 3.1 3 1.9 1 0.6 26 16.1
Malawi 5 3.1 1 0.6 2 1.2 2 1.2 10 6.2
Benin 2 1.3 3 1.8 1 0.6 3 1.9 9 5.6
Ethiopia 9 5.6 0 0.0 0 0.0 0 0.0 9 5.6
South Africa 5 3.1 0 0.0 0 0.0 2 1.2 7 4.3
DRC 3 1.9 2 1.2 0 0.0 0 0.0 5 3.1
Tanzania 1 0.6 2 1.2 0 0.0 2 1.2 5 3.1
Uganda 2 1.2 0 0.0 0 0.0 3 1.9 5 3.1
Namibia 3 1.9 1 0.6 0 0.0 0 0.0 4 2.5
Zambia 1 0.6 0 0.0 1 0.6 2 1.2 4 2.5
Zimbabwe 2 1.2 0 0.0 1 0.6 0 0.0 3 1.9
Cameroon 0 0.0 1 0.6 0 0.0 1 0.6 2 1.2
Cote d’Ivoire 1 0.6 0 0.0 0 0.0 1 0.6 2 1.2
Sudan 2 1.2 0 0.0 0 0.0 0 0.0 2 1.2
Botswana 2 1.2 0 0.0 0 0.0 0 0.0 2 1.2
Gabon 0 0.0 1 0.6 0 0.0 0 0.0 1 0.6
Gambia 0 0.0 0 0.0 0 0.0 1 0.6 1 0.6
Ghana 1 0.6 0 0.0 0 0.0 0 0.0 1 0.6
Subtotal 85 52.8 26 16.1 18 11.2 32 19.9 161 100.0

Average publication rate per country adjusted by number of participants and GDP

After adjusting for the number of participants from different countries [Table 5], the Gambia had the highest average publication rate by participants (37.0), followed by Uganda (28.0) and Benin (12.9), Zambia (12.0), and Nigeria (10.9). However, when adjusted by the 2020 GDP of the countries according to the World Bank, the top five countries in descending order were the Gambia, Malawi, Benin, Uganda, and Zambia.

Table 5: Average publication rate per country adjusted by the number of participants and GDP.
Country (number of published participants) Total number of publications attributed to participants from the country Median publication rate per participant (IQR) Position based on absolute number of publication Position adjusted for number of participants from country Position adjusted for GDP per country of participants1
Nigeria 777 6 (3–15) 1 5 6
Kenya 148 3.5 (2–8) 2 14 7
Benin 142 6 (2.5–28) 3 3 3
Uganda 140 17 (4.5–57) 4 2 4
Malawi 97 4 (1.75–13.75) 5 11 2
South Africa 70 3 (2–20) 6 10 16
Tanzania 65 7 (4–25) 7 6 9
Zambia 48 14 (5.3–16.8) 8 4 5
Gambia 37 37 (37–37) 9 1 1
Cameroon 27 10.5 (8–10.5) 10 8 12
DRC 23 4 (2–7.5) 11 12 13
Ethiopia 21 3 (1–3.5) 12 17 17
Namibia 18 5 (2.75–5.75) 13 19 8
Cote d’Ivoire 18 2 (1–2) 13 8 18
Zimbabwe 14 2 (1–2) 15 15 10
Gabon 10 10 (10–10) 16 7 11
Sudan 7 3.5 (2–3.5) 17 15 15
Botswana 7 3.5 (2–3.5) 17 18 14
Ghana 4 4 (4–4) 19 13 19

Journals choice

The articles were published in 402 different journals. The top 20 journals which accounted for most (40.4%) of the publications are shown in [Table 6]. Twelve (60%) of these 20 journals were indexed in Clarivate analytics Web of Science and have an impact factor. The top five journals in which most of the articles were published were PLOS One 108 (6.5%), Lancet 80 (4.8%), the International Journal of Tuberculosis and Lung Disease 52 (3.1%), Clinical Infectious Diseases 46 (2.7%), and Pan African Medical Journal 46 (2.7%).

Table 6: The top 20 choice journals where the participants published in
Name of journal n % Impact factor 2021 (TR)
1 PLOS One 108 6.5 3.2 (Q2)
2 Lancet 80 4.8 79.3 (Q1)
3 Int J Tuberc Lung Dis 52 3.1 2.4 (Q4)
4 Clin Infect Dis 46 2.7 9.1 (Q1)
5 Pan Afr Med J 46 2.7 -
6 Niger J Clin Pract 33 2.0 0.9 (Q4)
7 J Acquir Immune Defic Syndr 29 1.7 3.7 (Q2)
8 Lancet Infect Dis 29 1.7 25.1 (Q1)
9 Niger Med J 29 1.7 -
10 West Afr J Med 29 1.7 -
11 Afr Health Sci 23 1.4 0.9 (Q4)
12 Lancet Respir Med 23 1.4 30.7 (Q1)
13 BMC Health Serv Res 21 1.3 2.6 (Q3)
14 Eur Respir J 19 1.1 16.7 (Q1)
15 Int J Environ Res Public Health 19 1.1 -
16 Trop Med Int Health 19 1.1 2.6 (Q2)
17 Afr J Med Med Sci 18 1.1 -
18 BMC Res Notes 18 1.1 -
19 Niger Postgrad Med J 18 1.1 -
20 East Afr Med J 17 1.0 -
21–402 Others 997 59.6

Authorship position in all published articles

The percentages of articles where past attendees were the first author, second authors, or last authors were 371 (22.2%), 239 (14.3%), and 99 (5.9%), respectively. Slightly over half of the articles had the participants as middle authors 964 (57.6%). Of these, male participants had more articles attributed to them compared to their female counterparts (68.2% vs. 31.8%).

Citation count

The median citation of the papers was 11 (4–26). The top 10 most-cited publication primarily led by one of the participants was published in the Lancet Infectious Diseases (262 citations);[26] New England Journal of Medicine (183 citations);[27] Nigeria Quarterly Journal of Hospital Medicine (137 citations);[28] BMC Health Services Research (104 citations);[29] BMC Health Services Research (91 citations);[30] Lancet Infectious Diseases (84 citations);[31] International Journal of Tuberculosis and Lung Diseases (82 citations);[32] Journal of Tropical Paediatrics (79 citations);[33] Annals of Ibadan Postgraduate Medicine (77 citations);[34] PLOS One (76 citations);[35] and anemia (76 citations).[36]

Effect of PATS-MECOR training on publication

There was a doubling of the total publication output in the 1st year following PATS-MECOR training compared to the year before attending PATS-MECOR course (123 articles vs. 58 articles) among the 143 participants who had published within 4 years before or post attending PATS-MECOR training. This trend was sustained when matched to comparable years prior and post-exposure to the program as shown in [Figure 1].

Figure 1:
Effect of exposure to PATS-MECOR training on publication by PATS-MECOR attendees (n = 143).

Furthermore, the number of participants who had published in the 1st year following attendance of the PATS-MECOR program was about twice the number that had published 1 year before attending the course (62 vs. 34).

In the 4 consecutive years following training, participants published an average and standard deviation of 0.84 ± 1.46 articles (1st year), 0.99 ± 1.61 articles (2nd year), 0.98 ± 1.70 articles (3rd year), and 1.06 ± 2.06 articles (4th year). This rate was higher compared to their 4 years consecutive rate of publication before attending the course where they published an average and standard deviation of 0.40 ± 1.13 articles in the 1st year, 0.38 ± 0.92 in the 2nd year, 0.37 ± 1.29 articles in the 3rd year, and 0.21 ± 0.89 articles in the 4th year before attending the PATS-MECOR training. In the whole 4 years period following first exposure to PATS-MECOR training, the median (IQR) publication rate of participants 2 (1–4) was far higher compared to their median publication outputs 4 years before attending PATS-MECOR 0 (0–1).


This study has demonstrated a significant success of the PATS-MECOR program in improving publication trends among attendees. A significant proportion (more than three-quarter) of the past attendees has published with slightly more than 20% being the first author in their publications. There is also a good median citation record of their publications and nearly half were published in top choice journals with impact factor. The number of publications per year increased in the years following attendance of PATS-MECOR.

Compared to the impact of similar courses on publication trend among attendees, our finding that more than three quarters of our participants had published at least a paper is higher than what was reported by the “The Structured Operational Research and Training Initiative (SORT-IT)” program organized by the International Union Against Tuberculosis and Lung Disease, MSF, and the World Health Organization (WHO) which was about 50%.[37] Furthermore, the publication output for PATS-MECOR participants for a comparable period of their assessment, 2007–2014, showed a higher publication output per year compared to the SORT-IT cohort. The publication output of PATS-MECOR attendees is likely to have contributed to the positive findings in a recent review that reports that Africans are now represented in about 49.9% of publications in the four most prominent general medicine and five most prominent general global health journals, respectively, based on impact factor.[9]

Author position on publications is recognized as a representative measure of participation and leadership in research. This study showed that more participants had a higher proportion who had served as the first authors or last authors in their studies compared to a study by Schneider and Maleka which found lower level of being the first authors and last authors at 14% and 11% for authors from low- and middle-income countries.[10] Furthermore, the proportion of first authorship in this present study was higher than found in the previous studies which sought to evaluate the scientific productivity primarily of country-based authors in Angola (19%)[38] and Malawi (20.9%).[39] The first authorship in our study is lower than that of a study evaluating global health research among LMIC affiliated authors which was over 50%.[10] This is not surprising considering that global health research is usually a global North-South collaboration and at present often led by authors from the global north who have more access to funding as has been alluded to Masekela et al.[40] More so, the study by Schneider and Maleka used institutional affiliations which may be misleading in representing the nationality of the authors, for example, in cases of temporary international mobility.

The last author position which usually denotes the most senior author in some settings is not high among our participants compared to that of authors with African institutional affiliation in a study assessing COVID-19 publications (53.5%).[41] This study by Guleid et al. evaluated the studies based on database from pre-print such as medRXiv, African Journals Online (AJOL), Collabovid, the WHO Global Research Database, and Google which are less restrictive compared to ours that used only PubMed database. Again, this depicts that attendees at the PATS-MECOR training are emerging and young investigators who are honing their skills in research and this meets the mandate of the program to build research capacity. Another dimension to the last author position is that some African academic institutions do not give as much importance to the position for the purposes of academic progression and recognition, thus making it less attractive for young African investigators.

The finding that participants from Nigeria and Kenya produced more publications compared to other participants was in line with other studies that have evaluated publications of health research in African countries[7,41-45] However, the finding that when adjusted for GDP and the number of participants other countries, especially those from low-income countries such as Malawi and Uganda were in the top five, is consistent with other previous studies.[46] This may also be a proxy indicator of the effect of the training in aiding participants irrespective of their background to become more productive researchers.

The citation rate for the papers authored by the participants appears higher compared to the rates achieved by authors with LMIC institutional affiliation as described by Gonzalez-Alcaide et al. While in this study, the articles median citation was 11, the work by Gonzalez-Alcaide et al. was <8 depending on the position and coauthors institutional affiliation.[47] Thus, the finding that participant’s publication has a good citation rate is indicative of the high quality of research conducted by the PATS-MECOR attendees.

The significant higher publication output by male participants compared to the female participants is in keeping with other studies that have pointed to gender differences in publications.[48,49] The reason for this may be due to the challenges females face in pursuing their career path early due to family considerations compared to their male counterparts. Given this situation, there may be need to be more deliberate in recruiting more females into the program and to encourage some of the outstanding ones to be mentors and serve as role models to encourage other females to become more active in pursuing research careers.

Strength and weakness

One major strength of our study was the use of the names of authors who are confirmed to be from one of the African countries and who have African affiliations compared to other studies that use only the affiliations of the author without knowing if they are Africans or not. Another strength is the use of the PubMed database given its wide acceptance for bibliometric studies and stringent method of indexing articles which also make our findings comparable to the previous studies. The use of only one database (PubMed) may also be considered a limitation because it may have excluded some publications by PATS-MECOR attendees which may be found in less visible and regional based journals or repositories such as AJOL. AJOL is more likely to index local or national journals where authors from African countries may publish given the challenges, they may face publishing in PubMed indexed journals as already highlighted by Nabyonga-Orem et al.[17] However, this approach in using only PubMed database may have enhanced the sensitivity to include high-quality publications. Another limitation is that we did not evaluate for involvement in the production of policy documents which may be another way participants may be involved in publications.


The PATS-MECOR program is a valuable research capacity building training for emerging African investigators as evidenced by an increased publication rate in reputable journals with good citation and visibility. With improving research capacity among Africans, there is a need to encourage sustained collaboration and networking among the trained critical mass of researchers in the continent. This will engender multidisciplinary research with greater policy impact across the continent. Future assessments of this program should include mapping of the research partnership and funding streams of the participants as well as the use of qualitative methodology to deeply explore the effects of the program and challenges to productivity.

Declaration of patient consent

Patient’s consent not required as there are no patients in this study.

Financial support and sponsorship

This work was supported by the ATS MECOR graduate grant.

Conflicts of interest

There are no conflicts of interest.


  1. , , , , , , et al. Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980-2015: A systematic analysis for the Global Burden of Disease Study 2015. Lancet. 2016;388:1459-544.
    [CrossRef] [Google Scholar]
  2. , , . The epidemiology of noncommunicable respiratory disease in Sub-Saharan Africa, the Middle East, and North Africa. Malawi Med J. 2017;29:203-11.
    [CrossRef] [PubMed] [Google Scholar]
  3. , , , , , , et al. Improving lung health in low-income and middle-income countries: From challenges to solutions. Lancet. 2021;397:928-40.
    [CrossRef] [Google Scholar]
  4. , , , , , , et al. Africa's respiratory “Big Five”. Pan Afr Thorac. 2021;2:64-72.
    [CrossRef] [Google Scholar]
  5. , , , , . Investing in African research training institutions creates sustainable capacity for Africa: The case of the University of the Witwatersrand School of Public Health masters programme in epidemiology and biostatistics. Health Res Policy Syst. 2012;10:11.
    [CrossRef] [PubMed] [Google Scholar]
  6. , , , , . Worldwide trends in quantity and quality of published articles in the field of infectious diseases. BMC Infect Dis. 2005;5:16.
    [CrossRef] [PubMed] [Google Scholar]
  7. , , , , , , et al. Increasing the value of health research in the WHO African Region beyond 2015-reflecting on the past, celebrating the present and building the future: A bibliometric analysis. BMJ Open. 2015;5:e006340.
    [CrossRef] [PubMed] [Google Scholar]
  8. , , , , , , et al. Consensus statement on measures to promote equitable authorship in the publication of research from international partnerships. Anaesthesia 2021
    [CrossRef] [PubMed] [Google Scholar]
  9. , , , , . Geographic, subject, and authorship trends among LMIC-based scientific publications in high-impact global health and general medicine journals: A 30-month bibliometric analysis. J Epidemiol Glob Health. 2021;11:92-7.
    [CrossRef] [PubMed] [Google Scholar]
  10. , . Patterns of authorship on community health workers in low-and-middle-income countries: An analysis of publications (2012-2016) BMJ Glob Health. 2018;3:e000797.
    [CrossRef] [PubMed] [Google Scholar]
  11. , , . Health research capacity development in low and middle income countries: Reality or rhetoric? A systematic meta-narrative review of the qualitative literature. BMJ Open. 2017;7:e012332.
    [CrossRef] [PubMed] [Google Scholar]
  12. , , , . External funding to strengthen capacity for research in low-income and middle-income countries: Exigence, excellence and equity. BMJ Glob Health. 2020;5:e002212.
    [CrossRef] [PubMed] [Google Scholar]
  13. , . Strengthening health research capacity in sub-Saharan Africa: Mapping the 2012-2017 landscape of externally funded international postgraduate training at institutions in the region. Global Health. 2018;14:77.
    [CrossRef] [PubMed] [Google Scholar]
  14. , , , , , , et al. Causes and remedies for low research productivity among postgraduate scholars and early career researchers on non-communicable diseases in Nigeria. BMC Res Notes. 2019;12:403.
    [CrossRef] [PubMed] [Google Scholar]
  15. , , , . Equity in global health research in the new millennium: Trends in first-authorship for randomized controlled trials among low-and middle-income country researchers 1990-2013. Int J Epidemiol. 2016;45:2174-83.
    [CrossRef] [PubMed] [Google Scholar]
  16. , , , , . National health research systems in the WHO African Region: Current status and the way forward. Health Res Policy Syst. 2015;13:61.
    [CrossRef] [PubMed] [Google Scholar]
  17. , , , . Article processing charges are stalling the progress of African researchers: A call for urgent reforms. BMJ Glob Health. 2020;5:e003650.
    [CrossRef] [PubMed] [Google Scholar]
  18. . World Health Organisation Global Observatory on Health R&D. . Geneva: WHO; Available from: [Last accessed on 2021 Dec 03]
    [Google Scholar]
  19. , , , , , . Advancing equitable global health research partnerships in Africa. BMJ Glob Health. 2018;3:e000868.
    [CrossRef] [PubMed] [Google Scholar]
  20. , , , . Understanding collaboration in a multi-national research capacity-building partnership: A qualitative study. Health Res Policy Syst. 2016;14:64.
    [CrossRef] [PubMed] [Google Scholar]
  21. , . The American thoracic society methods in epidemiologic, clinical, and operations research program. A research capacity-building program in low-and middle-income countries. Ann Am Thorac Soc. 2013;10:281-9.
    [CrossRef] [PubMed] [Google Scholar]
  22. , , , , , , et al. Evaluation of the Developing Operational Research Capacity in the Health Sector Project.
    [Google Scholar]
  23. , , , , , , et al. Global surgery: A 30-year bibliometric analysis (1987-2017) World J Surg. 2019;43:2689-98.
    [CrossRef] [PubMed] [Google Scholar]
  24. , , , . Inequalities in global health inequalities research: A 50-year bibliometric analysis (1966-2015) PLoS One. 2018;13:e0191901.
    [CrossRef] [PubMed] [Google Scholar]
  25. , , , . Nursing higher education in MERCOSUR: A bibliometric study. Revi Bras Enferm. 2018;71(Suppl 4):1732-9.
    [CrossRef] [PubMed] [Google Scholar]
  26. , . Rifampicin and moxifloxacin for tuberculous meningitis. Lancet Infect Dis. 2013;13:569-70.
    [CrossRef] [Google Scholar]
  27. , . A trial of mass isoniazid preventive therapy for tuberculosis control. N Engl J Med. 2014;370:1661.
    [CrossRef] [Google Scholar]
  28. , . Hearing loss due to wax impaction. Nig Q J Hosp Med. 2012;22:117-20.
    [Google Scholar]
  29. , , , . Healthcare-seeking behavior, treatment delays and its determinants among pulmonary tuberculosis patients in rural Nigeria: A cross-sectional study. BMC Health Serv Res. 2013;13:25.
    [CrossRef] [PubMed] [Google Scholar]
  30. , , , . Delay in tuberculosis case detection in Pwani region, Tanzania. A cross sectional study. BMC Health Serv Res. 2009;9:196.
    [CrossRef] [PubMed] [Google Scholar]
  31. . Public-private mix in tuberculosis. Lancet Infect Dis. 2012;12:908.
    [CrossRef] [Google Scholar]
  32. , , , . The economic burden of tuberculosis care for patients and households in Africa: A systematic review. Int J Tuberc Lung Dis. 2012;16:733-9.
    [CrossRef] [PubMed] [Google Scholar]
  33. , , . Prevalence of congenital malaria in Ile-ife, Nigeria. J Trop Pediatr. 2005;51:219-22.
    [CrossRef] [PubMed] [Google Scholar]
  34. , . Peripheral blood film-a review. Ann Ib Postgrad Med. 2014;12:71-9.
    [Google Scholar]
  35. , , , . Paediatric acute kidney injury in a tertiary hospital in Nigeria: Prevalence, causes and mortality rate. PLoS One. 2012;7:e51229.
    [CrossRef] [PubMed] [Google Scholar]
  36. . Management of sickle cell disease: A review for physician education in Nigeria (Sub-Saharan Africa) Anemia. 2015;2015:791498.
    [CrossRef] [PubMed] [Google Scholar]
  37. , , , , , , et al. Evaluation of the Developing Operational Research Capacity in the Health Sector Project, Final Report Stockholm, Sweden: Technopolis Group; . p. :140.
    [Google Scholar]
  38. , . Current status on health sciences research productivity pertaining to Angola up to 2014. Health Res Policy Syst. 2015;13:32.
    [CrossRef] [PubMed] [Google Scholar]
  39. , . An analysis of Malawi's publication productivity. Malawi Med J. 2008;20:90-2.
    [CrossRef] [PubMed] [Google Scholar]
  40. , , , . Building research capacity to correct global health's wrongs. Lancet Glob Health. 2021;2021:S2214-109X(21)00491-5.
    [Google Scholar]
  41. , , , , , . A bibliometric analysis of COVID-19 research in Africa. BMJ Glob Health. 2021;6:e005690.
    [CrossRef] [PubMed] [Google Scholar]
  42. , , , , , , et al. Current status and future prospects of epidemiology and public health training and research in the WHO African region. Int J Epidemiol. 2012;41:1829-46.
    [CrossRef] [PubMed] [Google Scholar]
  43. , . Geography of Africa biomedical publications: An analysis of 1996-2005 PubMed papers. Int J Health Geogr. 2007;6:46.
    [CrossRef] [PubMed] [Google Scholar]
  44. , , , . A bibliometric analysis of childhood immunization research productivity in Africa since the onset of the expanded program on immunization in 1974. BMC Med. 2013;11:66.
    [CrossRef] [PubMed] [Google Scholar]
  45. , , , , , , et al. Publication practices of Sub-Saharan African Cochrane authors: A bibliometric study. BMJ Open. 2021;11:e051839.
    [CrossRef] [PubMed] [Google Scholar]
  46. . Pattern and determinants of HIV research productivity in sub-Saharan Africa: Bibliometric analysis of 1981 to 2009 PubMed papers. BMC Infect Dis. 2010;10:47.
    [CrossRef] [PubMed] [Google Scholar]
  47. , , , . Dominance and leadership in research activities: Collaboration between countries of differing human development is reflected through authorship order and designation as corresponding authors in scientific publications. PLoS One. 2017;12:e0182513.
    [CrossRef] [PubMed] [Google Scholar]
  48. , , , , . Gender gaps in research productivity and recognition among elite scientists in the U.S. Canada, and South Africa. PLoS One. 2020;15:e0240903.
    [CrossRef] [PubMed] [Google Scholar]
  49. , , , , , , et al. Sex disparities in authorship order of cardiology scientific publications. Circ Cardiovasc Qual Outcomes. 2018;11:e005040.
    [CrossRef] [PubMed] [Google Scholar]
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