Cardiovascular Journal of Africa: Vol 27 No 3 (May/June 2016)

CARDIOVASCULAR JOURNAL OF AFRICA • Volume 27, No 3, May/June 2016

198

AFRICA

study.

5,6

In addition, the pressure to publish in these countries is

enormous, as promotion and tenure, institutional performance

and external funding are strongly tied to publication counts.

19,20

Collaboration in CVR between SSA and non-SSA countries

shows similarities with the patterns reported for international

collaborations across all scientific disciplines in Africa.

South

Africa remains the leading country both in terms of research

output and the extent of collaboration with countries outside

SSA. The top non-SSA countries involved in co-authorships

in CVR with SSA countries are: USA, England, Italy, France,

Germany and Canada. Most of these countries are reported in

the top 10 of the world’s leading countries in terms of scientific

output in cardiovascular research.

The reasons underlying this pattern of collaboration in CVR

are numerous. The strength of the national economies measured

as gross domestic product has been shown to be positively

associated with national research output.

Although data on

GDP was not utilised in the study, this association may partly

explain the position of South Africa and Nigeria as the leading

countries in CVR in the region.

Historical and political ties between countries may influence

the extent of collaboration in research,

as well as the dominant

language of use in research. France is well known to be a critical

partner with regard to international research collaboration in

French-speakingAfrica.

The highdegree centralityof Cameroon

in the CVR network of SSA countries can be attributed to the

presence of anglophone and francophone populations within

the country. This unique characteristic of Cameroon makes it

strategically important in creating and expanding collaborative

research networks within SSA, essentially co-developing joint

research projects with groups of cardiovascular researchers in

both English- and French-speaking countries in the region.

Such networks are critically important for improved rigour

and cost-effectiveness of research endeavours in SSA, with the

advantage of multi-country study designs and the possibility of

concurrent policy engagement strategies in different countries

using common evidence to influence health policy and practice

aimed at reducing cardiovascular morbidity and mortality rates

in the region.

International collaborations in SSA are strongly linked to

the source of research funding from countries outside the

region. A large number of research articles in public health

with African authorship can be linked to the grants awarded for

projects in specific countries from the major funding agencies,

such as USAID, the UK Medical Research Council, and the

Wellcome Trust.

In addition, research training opportunities for

students from SSA in developed countries provide avenues for

collaboration with researchers in the host universities.

Nigeria presents a unique case of low international

collaboration in spite of a relatively high CVR output compared

to most countries in the region. This may be due to the

availability of greater local funding for CVR and the relatively

higher number of universities with medical faculties compared

to most other SSA countries. The motivation for researchers

in Nigeria to publish for career advancement purposes may

positively influence the national research output in this field

without a significant influence from international funding and

collaboration.

The extent of collaboration within SSA is very limited

compared to the level of collaboration with other non-SSA

countries. This pattern has been observed with data for all of

the scientific output of the region.

5,8,9,24

Some studies have found

lower levels of collaboration between countries in West Africa

compared with their individual levels of collaboration with

France.

25,26

South Africa and Nigeria, which account for the

bulk of the cardiovascular research output in SSA, partly due to

the size of their cardiovascular research communities, are best

placed to serve as strategic hubs for promoting and coordinating

collaboration in this field.

In South Africa, the Hatter Institute of Cardiovascular

Research in Africa, located at the University of Cape Town,

is working to facilitate national and international research

collaborations to combat cardiovascular disease in Africa.

Two

key multinational collaborative projects underway at the institute

include: (1) the Pan-African Pulmonary Hypertension Cohort

(PAPUCO) study, which aims to describe the epidemiology of

pulmonary hypertension in patients from 10 African countries,

and (2) the THESUS-HF survey, which focuses on the causes,

treatment and outcome of acute heart failure in patients across

nine African countries.

These large, collaborative studies reflect

real intent and progress in building regional networks that fosters

international collaboration in cardiovascular research.

In the last few years, there has been a revival of the

Pan-African Society of Cardiology (PASCAR), leading to

improved networking among researchers and clinicians

involved in cardiovascular research across Africa.

Some of

the major multinational collaborative research projects that

involve PASCAR include: the Awareness Surveillance Advocacy

Prevention (ASAP) programme,

the ASTRAL study targeted

at controlling hypertension,

the IMPI trial for the management

of tuberculous pericarditis,

and the Human Heredity and

Health in Africa (H3Africa) initiative.

These large initiatives

are transforming the landscape of cardiovascular research in

Africa, and the resulting enhanced capacity of African scientists

will be evident from increased research productivity in this field

and the contributions to knowledge that will ultimately benefit

the continent.

A benefit of international collaboration in CVR is seen in

the greater citation impact that resulted from publications with

multi-country authorship compared with that from publications

with single-country authorship. Despite similar research outputs

over the 10-year period, the multi-country publications resulted

in over three times the number of citations garnered by the

single-country publications. While no analysis was done on the

range of journals in which the articles were published and how

these could influence citation rates, this finding likely reflects

the greater possibilities for dissemination and utilisation of

the knowledge generated through the networks associated with

the multiple authors and affiliated institutions in the countries

involved. These results are similar to those reported by other

authors.

35,36

Limitations

This study has a number of limitations. First, the analysis

involved publications contained in the Web of Science and

therefore excludes the numerous journals not indexed, particularly

journals in countries in SSA. Web of Science was used in this

study because it provided the affiliations of all the authors

listed in each record for the time period under consideration,