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Abstract
Background: Inequities in global clinical research may influence participant compensation and ethical standards in low-resource settings
Methods: A cross-sectional analysis of 23,873 interventional trials conducted in Africa and 190,644 in the United States was performed using ClinicalTrials.gov data up to April 2026. Inequality in trial distribution across African countries was assessed using the Gini coefficient with bootstrap resampling for stability.
Results: Clinical trials were highly concentrated in a small number of African countries (Gini = 0.732). Sensitivity and bootstrap analyses confirmed the robustness of this estimate
Conclusion: The unequal distribution of trials reflects structural disparities in research investment and governance, which may limit regional autonomy in evidence generation and raise ethical concerns regarding participant engagement and compensation.
References
Emanuel, E. J., Wendler, D., Killen, J., & Grady, C. (2004). What makes clinical research in developing countries ethical? The benchmarks of ethical research. Journal of infectious diseases, 189(5), 930-937.
Glickman, S. W., McHutchison, J. G., Peterson, E. D., Cairns, C. B., Harrington, R. A., Califf, R. M., & Schulman, K. A. (2009). Ethical and scientific implications of the globalization of clinical research. In (Vol. 360, pp. 816-823): Mass Medical Soc.
Pratt, B., & Loff, B. (2011). Justice in international clinical research. Developing World Bioethics, 11(2), 75-81.
Viergever, R. F., & Li, K. (2015). Trends in global clinical trial registration: an analysis of numbers of registered clinical trials in different parts of the world from 2004 to 2013. BMJ open, 5(9), e008932.
WHO. (2023). Research and development landscape for childhood cancer: a 2023 perspective. World Health Organization.
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