Publication pattern
In total, 140 CARTA fellows enrolled in CARTA program published 806 articles during the period under review. The annual number of peer review articles published by the fellows increased from 11 articles in 2011 to 223 articles in 2018. Figure 1 shows the increase in the number of articles published over time. The publications were available in 6308 online versions and had been cited in 5529 publications (Table 2). The journals that the fellows published in have a median impact factor of 2.10 (IQR: 1.04 – 2.78). Given the nature of the programme and our inclusion criteria, all the publications considered in this paper had an author affiliated with an African university, 90% of the publications had an African university first author and 41% of the papers have CARTA fellows as the first author. Furthermore, 10% of the published papers was authored by more than one CARTA fellow. We also found that 70% of the publications were from fellows affiliated with participating universities in Kenya, Nigeria, and South Africa.
The average number of authors per publication was 5 (SD: 4). The majority of the papers were published by two to five authors (61.5%), and 34.8% of the published articles included more than five authors. Fewer publications (3.6%) had a single author. The median number of publications per fellow per year was three (IQR: 2 – 6). Table 2 also shows that the majority of the publications were quantitative research studies (72%).
Table 2: Summary of characteristics of publications and authors
Summary characteristics of publications and authors.
|
Total number of publications
|
806
|
Total authors
|
140
|
Median impact factor of the journals
|
2.10 (IQR: 1.04 – 2.78).
|
Number of online versions of published papers
|
6308
|
Number of times all papers have been cited
|
5529
|
Number of countries of author affiliation
|
10
|
Number of host institutions
|
9
|
Number of papers with a CARTA fellow as first author
|
318(41%)
|
Authorship teams
|
|
Single-authored publications (%)
|
29(3.6%)
|
Publications with 2–5 authors (%)
|
434(61.5%)
|
Publications with ≥ 5 authors (%)
|
246(34.9 %)
|
Mean number of authors per publication
|
5(sd:4)
|
Research approach
|
|
Mixed methods
|
6%
|
Qualitative
|
12%
|
Quantitative
|
72%
|
Review
|
10%
|
Publication by research area
About 69% of the 806 published papers fell into the nine priority areas. Among the papers published in the nine priority areas, the highest proportion of the publications were on infectious diseases with at least one out of four articles published (26.8%) in this priority area. This was followed by health systems and policy (17.6%), maternal and child health (14.7%), sexual reproductive health (14.3%), and NCDs (10.7%). A smaller proportion of articles were on contemporary challenges such as environmental health (6.5%), violence and injuries (4.4%), and food security and nutrition (2.4 %).
Approximately 28% of the publications in the different health priority areas listed in Table 1 were from studies that targeted females exclusive or a combination of females and males (67.9%) and few focused on males only (4.1%). The few males only publications were predominantly on infectious diseases (31.3%) and sexual and reproductive health (31.3%). By age group, 68.2% of the studies targeted people aged 20 years old and above, about 18.4% of the studies targeted children under 10 years old and 13.5% of the studies targeted adolescents (10 -19 year olds). Of note is that mental health and substance abuse publications were only among people aged 20 years old and above, with none among adolescents and children under 10 years old.
Infectious diseases
The 135 infectious disease publications focused on prevalent diseases common in Africa, including HIV and AIDS (48.1%), followed by malaria (25.9%), TB (11.9%), and other STIs (6.7%), as shown in Figure 3. There was minimal research in the areas of co-infections (5.9%) and neglected tropical diseases (NTDs) (1.5%). The majority of the infectious disease publications targeted females and males together (79.6%), followed by females only (15.7%) and males only (4.6%). By age group, most of the studies (67.4%) targeted people aged 20 years old and above, followed by children under 10 years old (18.6%) and for adolescents aged 10 to 19 years old (13.5%).
Maternal and child health (MCH)
The publications on MCH comprised of 80 papers constituting 14.7% of the research output. The main topics of focus in this priority area were maternal and child mortality (27.5%), antenatal care (20.0%), and immunisation (12.5%). Obstetric complications, and child growth and development contributed 7.5% to this category, followed by childhood illnesses (6.3%) as shown in Figure 4. The majority of the publications on MCH targeted females and males together (53.3%), followed by females only (41.9%) and males only (4.8%). By age group most of the studies targeted people aged 20 years old and above (52.4%) followed by children under 10 years old (46.3%) and adolescents aged 10 to 19 years old (1,6%).
Sexual and reproductive health (SRH)
Overall, 79 publications addressed SRH issues (17.7% of total publications). More than a quarter of the publications on this topic were on adolescent sexual health (26.6%), followed by culture and sexuality (17.7%) and family planning (14.0%). Research on fertility and abortion constituted 12.7% and 11.4%, respectively. Other areas under SRH included risky sexual behaviours and transactional sex (Figure 5). The majority of the publications on SRH targeted females only (53.9%), followed by females and males together (38.5%), and males only (7.7%). By age group, most of the studies targeted people aged 20 years old and above (64.4%) followed by adolescents at 35.6%.
Health systems and policy
The majority of health systems and policy publications (n=97) dealt with health system strengthening (76.0%) followed by the use of mHealth solutions (10.4%) and health economics (8.3%).
Non-communicable diseases (NCDs)
Fifty-nine publications (10.7%) of the total publications focused on NCDs. Half of the research output classified under NCDs was on cancers (51.0%), followed by cardiovascular diseases (27.0%), diabetes (16%), and obesity 5.0%. Approximately 5.0% of the publications on NCDs were among children and adolescents while 95% were among people aged 20 years old and above.
Violence and injuries
A total of 24 (4.4%) of the total publications were on violence and injuries. Most of these publications were on intimate partner violence (75.0%), and the rest were on bullying (12.5%) and general injuries (12.5%). While similar proportions of publications on violence and injuries were conducted among females only and males and females combined at 47% respectively, about 6% of the studies focused on males only.
Environmental health
About 6.5% of the total publications were on environmental health. Most of the publications on environmental health dealt with environmental impact assessment (45%) followed by historical public health challenges such as water and sanitation (37.1%) and indoor air pollution (20%).
Funding sources
Finally, about 50% of the published papers had information on additional sources of direct and indirect financial support and we counted at least 160 different sources of support. The most commonly reported sources of additional support were National Institute of Health (12.7%), United States Agency for International Development (4.3%), Wellcome Trust (3.8%), National Research Foundation (3.6%) and the South African Medical Research Council (3.3%).