The Current State of Primary Clinical Spine Disease Research in Sub-Saharan Africa — A Scoping Review

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Abstract
Study Design: Scoping Review. Objective: Spine research is resource-intensive and thus often performed in high-income countries. Consequently, findings may not be generalizable to low-resource areas. This study aimed to assess the current state of primary clinical spine disease research in Sub-Saharan Africa. Methods: All spine studies published in English or French in Sub-Saharan Africa in the past 50 years with at least ten patients were included. A study quality variable was created that identified randomized studies, prospective studies, and studies that include a control group as having a higher level of scientific rigor. Results: A total of 154 spine studies have been published from at least 26 countries since 1975 (some included multiple). There was a significant increase in research productivity after 2005 (p<0.001). The highest number of publications came from Nigeria with 52 (34%), followed by Tanzania (25 papers, 16%) and Ethiopia (12 papers, 8%). Nearly half of studies involved collaborative partnerships. On univariate analysis, lower-income countries were more likely to engage in collaboration with other countries (OR 3.2, 95% CI: 1.2-9.8) and to receive external funding (OR 7.0, 95% CI: 2.3-20.4). Further, collaborative studies were found to produce higher quality academic publication (OR 2.0, 95% CI: 0.94-4.2). Conclusion: There is a relative paucity of spine literature from Sub-Saharan Africa. Higher research quality was associated with collaborative engagement. These results support the development of global health partnerships that may foster high-quality research aimed at addressing the burden of spine disease in Africa.

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