Footprint of Reports From Low- and Low- to Middle-Income Countries in the Neurosurgical Data: A Study From 2015 to 2017

Abstract

In 2015, the Lancet Commission on Global Surgery highlighted the disparities in surgical care worldwide. The aim of the present study was to investigate the research productivity of low-income countries (LICs) and low-to middle-income countries (LMICs) in selected journals representing the worldwide neurosurgical data and their ability to report and communicate globally the existing differences between high-income countries (HICs) and LMICs.-METHODS: We performed a retrospective bibliometric analysis using PubMed and Scopus databases to record all the reports from 2015 to 2017 by investigators affiliated with neurosurgical departments in LICs and LMICs.-RESULTS: A total of 8459 reports by investigators selfidentified as members of neurosurgery departments worldwide were identified. Of these, 6708 reports were included in accordance with our method in the final analysis. The systematic search resulted in 459 studies reported by LICs and LMICs. Of these, 334 reports were included for the full text evaluation. Of the 6708 reports, 303 (4.52%) had been reported with an LMIC affiliation and only 31 (0.46%) with an LIC. The leading countries were India with 182 (54.5% among LMICs and LICs; 2.71% overall), followed by Egypt at 66 (19.76% among the LMICs and LICs; 0.98% overall), with a large difference compared with other countries such as Uganda at 9 (2.69% among the LMICs and LICs) and Tunisia and Pakistan at 8 each (2.4% among the LMICs and LICs). A few reports studies had been generated by collaboration with HIC neurosurgeons.-CONCLUSIONS: Our results have shown that research studies from LMICs are underrepresented. Understanding and discussing the reasons for this underrepresentation are necessary to start addressing the disparities in neurosurgical research and care capacity. Future engagements from international journals, more partnership collaboration from HICs, and tailored funding to support investigators, collaborations, and networks could be of help.

A comparison of publication to TBI burden ratio of low- and middle-income countries versus high-income countries: how can we improve worldwide care of TBI?

“…15 Because of these discrepancies, the development of relevant contextspecific clinical practice guidelines useful for LMICs requires the publication of research and other TBI-related papers from these countries. Previous bibliometric studies have already highlighted the contribution of different countries in the worldwide neurosurgical literature, 12,16,25 but none of them have taken into account the respective incidence of disease for each region. We conducted a bibliometric analysis of TBI-related papers published in the last 10 years and in 2018, and after collecting volumes of the pathology for each geographical region, we estimated the capacity of different and heterogeneous areas of the world to report and publish data on TBI.…”

Neurosurgeons’ experiences of conducting and disseminating clinical research in low- and middle-income countries: a qualitative study protocol

“…7 If journal publication is a reliable indicator of the quality and quantity of research, then LMICs are severely underrepresented in an international context. 5 In Strengths and limitations of this study ► First qualitative study to explore the challenges of neurosurgeons conducting and disseminating clinical research in low-income and middle-income countries (LMICs). ► Provides an in-depth exploration of neurosurgeons' understanding of how engagement in research could be improved.…”

“…4 5 The limited participation of LMICs in research contrasts sharply with their disproportionately high incidence of neurotrauma. 6 In a recent study of research productivity in LMICs, as evidenced by publication in journals, Servadei et al 5 found that only 4.52% of 6708 published reports had an LMIC affiliation. In a further bibliometric study, Africa and Southeast Asia were found to be responsible for less than 3% of publication productivity.…”

“… 7 If journal publication is a reliable indicator of the quality and quantity of research, then LMICs are severely under-represented in an international context. 5 In addition, Kolias et al 3 asserts that multicentre trials are typically conducted in high-income countries, making generalisability of these studies to environments with different treatment practices particularly problematic. A recent review to identify randomised trials of neurosurgical procedures used in cranial and spinal neurosurgical practice found only 8.8% of studies (excluding China) were LMIC-led studies.…”

“…Little is written in the academic literature about the reasons why there are so few studies conducted, and/or published, by neurosurgeons in LMICs, although lack of time and resources are a likely factor. 5 More specifically, Langer et al 4 suggested poor research production; poor preparation of manuscripts; poor access to scientific literature; poor participation in publication-related decision-making processes and bias of journals all exacerbate low engagement. However, there is little empirical data to underpin these assumptions; therefore, it is important to understand this so that any recommendations for enhancing research capacity in the future are context specific and borne out of an in-depth understanding of the problem.…”