Geographic Inequity in African Clinical Trials: A Systematic Review Evidence of a Port-City Advantage

Abstract

Distribution of clinical trials among geographic areas poses questions regarding the involvement of African populations in global evidence from research. This systematic review examined clinical interventional trials conducted in Africa in comparison with the US and registered in the database of Clinical Trials.gov through April 2026, based on odds and temporal trends from 2000-2005 and 2021-2025. It was found that in comparison with 159433 trials conducted in the US, there were 3515 clinical trials in Africa. Thus, the difference in number between clinical trials in these regions is more than forty-fivefold. We also noted that the growth in research activities increased seventeen-fold over time in African countries, however, research is still concentrated in some urban and coastal centres in accordance with existing limitations of access to facilities. In Uganda, similar trends are seen, as research is mainly carried out in institutions such as the Makerere University. These findings highlight persistent inequities in trial distribution, underscoring the need for decentralised research capacity and stronger regulatory systems to ensure broader inclusion across Africa.