Barriers to clinical research in Africa: a quantitative and qualitative survey of clinical researchers in 27 African countries

A. Conradie (Corresponding Author), R. Duys, P. Forget, B.M. Biccard

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59 Citations (Scopus)


Background There is a need for high quality research to improve perioperative patient care in Africa. The aim of this study was to understand the particular barriers to clinical research in this environment. Methods We conducted an electronic survey of African Surgical Outcomes Study (ASOS) investigators, including 29 quantitative Likert scale questions and eight qualitative questions with subsequent thematic analysis. Protocol compliant and non-compliant countries were compared according to WHO statistics for research and development, health workforce data, and world internet statistics. Results Responses were received from 134/418 of invited researchers in 24/25 (96%) of participating countries, and three non-participating countries. Barriers included lack of a dedicated research team (47.7%), reliable internet access (32.6%), staff skilled in research (31.8%), and team commitment (23.8%). Protocol compliant countries had significantly more physicians per 1000 population (4 vs 0.9, P<0.01), internet penetration (38% vs 28%, P=0.01) and published clinical trials (1461 vs 208, P<0.01) compared with non-compliant countries. Facilitators of research included establishing a research culture (86.9%), simple data collection tools (80%), and ASOS team interaction (77.9%). Most participants are interested in future research (93.8%). Qualitative data reiterated human resource, financial resource, and regulatory barriers. However, the desire to contribute to an African collaboration producing relevant data to improve patient outcomes was expressed strongly by ASOS investigators. Conclusions Barriers to successful participation in ASOS related to resource limitations and not motivation of the clinician investigators. Practical solutions to individual barriers may increase the success of multi-centre perioperative research in Africa.
Original languageEnglish
Pages (from-to)813-821
Number of pages9
JournalBritish Journal of Anaesthesia
Issue number4
Early online date19 Jul 2018
Publication statusPublished - Oct 2018

Bibliographical note

We thank all ASOS participants for their part in uncovering the unique set of challenges faced by researchers on the continent. We thank all those who completed our survey and so provided invaluable feedback for use in this article. We thank D. van Straaten of SSSA for design and administration of the REDCap platform, M. Flint for help with the initial literature review and design of the survey, and C. Gordon for her critical appraisal of our qualitative data.


  • Africa
  • biomedical research
  • global health
  • research personnel
  • surveys and questionnaires


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