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Stuck in the middle: a systematic review of authorship in collaborative health research in Africa, 2014–2016
  1. Bethany L Hedt-Gauthier1,
  2. Herve Momo Jeufack2,
  3. Nicholas H Neufeld3,
  4. Atalay Alem4,
  5. Sara Sauer5,
  6. Jackline Odhiambo6,
  7. Yap Boum7,
  8. Miriam Shuchman3,
  9. Jimmy Volmink8
  1. 1Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
  2. 2Accenture Toronto, Toronto, Ontario, Canada
  3. 3Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
  4. 4Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Oromia, Ethiopia
  5. 5Department of Biostatistics, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
  6. 6Partners In Health, Boston, MA, United States
  7. 7Epicentre, Médecins Sans Frontières, Yaoundé, Cameroon
  8. 8Department of Global Health and Dean’s Office, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
  1. Correspondence to Dr Bethany L Hedt-Gauthier; bethany_hedt{at}


Background Collaborations are often a cornerstone of global health research. Power dynamics can shape if and how local researchers are included in manuscripts. This article investigates how international collaborations affect the representation of local authors, overall and in first and last author positions, in African health research.

Methods We extracted papers on ‘health’ in sub-Saharan Africa indexed in PubMed and published between 2014 and 2016. The author’s affiliation was used to classify the individual as from the country of the paper’s focus, from another African country, from Europe, from the USA/Canada or from another locale. Authors classified as from the USA/Canada were further subclassified if the author was from a top US university. In primary analyses, individuals with multiple affiliations were presumed to be from a high-income country if they contained any affiliation from a high-income country. In sensitivity analyses, these individuals were presumed to be from an African country if they contained any affiliation an African country. Differences in paper characteristics and representation of local coauthors are compared by collaborative type using χ² tests.

Results Of the 7100 articles identified, 68.3% included collaborators from the USA, Canada, Europe and/or another African country. 54.0% of all 43 429 authors and 52.9% of 7100 first authors were from the country of the paper’s focus. Representation dropped if any collaborators were from USA, Canada or Europe with the lowest representation for collaborators from top US universities—for these papers, 41.3% of all authors and 23.0% of first authors were from country of paper’s focus. Local representation was highest with collaborators from another African country. 13.5% of all papers had no local coauthors.

Discussion Individuals, institutions and funders from high-income countries should challenge persistent power differentials in global health research. South-South collaborations can help African researchers expand technical expertise while maintaining presence on the resulting research.

  • global health
  • research equity
  • decolonizing global health
  • academic collaboration

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  • Handling editor Seye Abimbola

  • Twitter @BHedtGauthier, @yap.boum2

  • Contributors BH-G, HMJ, NN, MS and JV conceived the idea for this paper. HMJ and NN carried out data extraction and SS and JO conducted data cleaning. AA and YB supported data interpretation. All authors provided overview of analysis, supported manuscript writing and read and approved the final draft of the manuscript.

  • Funding The authors received no additional funding for this work.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available on reasonable request.