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These, and other studies, suggest such authorship inequi-ties may be more pronounced in sub- Saharan Africa.9

Despite multiple calls to ‘decolonise global health’, to build research capacity in LMICs, and to avoid exploitative research practices in LMICs,10–13 prior studies indicate that authorship parasitism, defined as articles with ‘no listed authors from the LMIC in which a study is conducted’, occurs in as much as 4%–13% of articles reporting research conducted in the African continent.8 14 Authorship para-sitism can damage partnerships between LMIC and HIC investigators while also perpetuating gaps in power and influence.15 Moreover, publishing papers without full representation of the personnel who meet authorship criteria is against the recommendation of the International Committee of Medical Journal Editors (ICMJE).16 Prior studies suggest that authorship parasitism is common when investigators from the USA, UK and Canada are involved and that ‘neo- colonial science’ may be to blame for such inequitable practices.14 17 However, these studies have not elucidated whether other factors, such as journal region, article language, funding source and number of authors are associated with authorship parasitism. Understanding such factors is needed to identify, and thereby eliminate, this extractive practice. Our objective was to determine the prevalence, location, contributing investigators and factors associated with authorship parasitism among arti-cles reporting research conducted in sub- Saharan Africa.

METHODSStudy designWe conducted a bibliometric review and analysis of authorship parasitism among articles indexed in PubMed

reporting original research performed in sub- Saharan Africa and published from 2014 through 2018. The list of sub- Saharan African countries was defined based on the World Bank region classification.18 This study period was selected because the National Center for Biotechnology Information (NCBI) began indexing author affiliations in PubMed starting 201419 and we aimed to encompass a 5- year period. We combined human review with a custom natural- language- processing algorithm to assign study country(ies) for each paper, and author affiliation(s) for each author in each article. Articles with authorship para-sitism were defined as those in which none of the listed authors were affiliated with the sub- Saharan African country(ies) in which those studies were conducted.8

Patient and public involvement statementThe development of the research question was informed by observed imbalances in research collaboration in sub- Saharan Africa. Patients were not involved in the design, recruitment or conduct of the study, nor were they advisers in this study. Results of this study will be made publicly available through publication.

Query design and eligibility criteriaTo retrieve articles reporting original research conducted in sub- Saharan Africa, we used the names of the 49 sub- Saharan African countries to query PubMed for articles published from 1 January 2014 through 31 December 2018. We performed the search on 1 August 2019. We used each country name to query each article’s title, abstract, keywords and Medical Subject Heading (MeSH) fields (online supplemental file 1). Articles published in all languages were included since the NCBI catalogues articles in other languages but indexes in English. Arti-cles reporting research conducted in more than one sub- Saharan African country were included.

The query was devised iteratively. In each iteration, two reviewers independently reviewed a 10% random sample of titles and abstracts. In so doing, we revised our query in two ways. First, we added Boolean ‘NOT’ operators to exclude non- specific articles. Representative examples include ‘guinea pig’ (to distinguish from the country Guinea) and ‘Aspergillus niger’ (to distinguish from Niger). Second, we added terms to exclude articles based on publication type suggesting non- original research (eg, editorials, reviews, case reports, commentaries, view-points, letters to the editor). Supplemental articles were also excluded as they contained requested articles, policy statements, and conference abstracts.

After running our devised query, we excluded articles (1) without listed authors, (2) without author affilia-tion data (provided there was no group author) and (3) articles where only the first author had affiliation data (provided that the affiliation field likely did not contain data for all authors). For this last condition, we used a set of ‘regular expressions’—a pattern- matching method for text—to query for patterns that could indicate the paper had information on multiple authors’ affiliations. Such

Key questions

What are the new findings? ► In a bibliometric review of 32 061 articles reporting original research performed in sub- Saharan Africa published from 2014 through 2018, 14.8% (n=4754) met the definition of authorship parasitism.

► Authorship parasitism was most common among research con-ducted in Somalia and Sao Tome and Principe.

► Articles demonstrating authorship parasitism were more likely to be published in journals based outside of sub- Saharan Africa, con-ducted in lower- middle income sub- Saharan African countries, low- income sub- Saharan African countries and multiple sub- Saharan African countries.

What do the new findings imply? ► Though imbalances in authorship in research conducted in sub- Saharan Africa is but one part of larger problems in inequities in academic global health, it is certainly a manifestation.

► Understanding the locations, contributing investigators’ location and factors associated with authorship parasitism will help inform policies and interventions to reduce this extractive practice in the future.

► Investigators working in sub- Saharan Africa should perform re-search, including its publication, in a collaborative and equitable manner.

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patterns include semicolons (often used as a delimiter between multiple affiliations), use of special symbols (eg, †, ‡, §), or use of English honorifics (eg, Dr, Ms, Mr). Regular expressions are akin to a keyword search but can incorporate advanced logic (eg, distinguishing nested country names such as ‘Guinea’ vs ‘Equatorial Guinea’, ‘Guinea- Bissau’, or ‘Papua New Guinea’). Finally, we excluded Global Burden of Disease studies as these repre-sent analyses of available data sets and are unlikely to represent original research done in sub- Saharan Africa; these studies were excluded based on the group author name listed.

Algorithm design, application and validationWe designed two natural- language- processing algorithms to assign study country(ies) and author affiliation coun-try(ies) to all articles meeting inclusion criteria. Each algorithm relied on ‘regular expressions’. Both classifica-tion algorithms primarily applied a dictionary of regular expressions to the relevant subset(s) of the textual meta-data. Specifically, to assign study country(ies), we searched the article title, keywords, MeSH terms and a subset of the abstract likely to contain the study country (ie, the last sentence of introduction, methods or results). To assign author affiliation country(ies), we searched each author’s affiliation field(s). Both algorithms allowed for multiple matches. The study country algorithm was restricted to the 49 sub- Saharan African countries, whereas the author affiliation country algorithm searched for 186 countries, according to the World Bank classification.17 To validate these algorithms, we randomly sampled and manually reviewed 5% of articles (n=1323, with 9044 authors) and compared the diagnostic performance of each algorithm compared with gold standard of manual review.

We designated the following set of article characteris-tics as high risk for algorithmic misassignment and manu-ally reviewed them: (1) absence of abstract, (2) single author, (3) presence of group author and (4) presence of the same number of affiliation fields for all authors (potentially indicating that all authors’ affiliations were reported in the same field). For articles with sole group authorship and no listed authors in PubMed, we reviewed the full text to assign author affiliations.

Variables and other data sourcesWe extracted the following variables from PubMed for articles meeting inclusion criteria: PubMed identifica-tion number, article title, abstract, number of authors, author name(s), author affiliation(s), year and month of publication, journal name, journal volume, MeSH terms and listed funding. We assigned each journal a World Bank region based on where the journal is published as reported in the Web of Science Journal Citation Report. Author country affiliations were categorised as low- income, lower- middle income, upper- middle- income and high- income using the World Bank country designations contemporaneous with the year of the article’s publica-tion.18

Statistical analysesWe determined the prevalence of authorship parasitism over the study period and created a choropleth map to visualise the relative frequency of articles with author-ship parasitism among sub- Saharan African countries. We calculated the error rate of our query against results from manual review of study country and author affilia-tion assignment.

For each pairwise relationship (ie, between a sub- Saharan African country and foreign country author affil-iation), we calculated the odds of authorship parasitism when ‘exposed’ to at least one author with that foreign affiliation, provided there were at least 10 articles with that pairwise relationship (eg, at least 10 articles with at least one author affiliated with the USA for articles reporting research conducted in Tanzania).

To analyse bivariate trends in authorship parasitism, we created a network diagram to demonstrate the rela-tive frequency of the relationship between authorship parasitism among countries in sub- Saharan Africa. Following the estimation of the number of parasitic arti-cles stratified by country, a pairwise parasitism index was calculated for countries. This was done by dividing the number of articles in each pairwise combination by the highest number in any pain- wise combination (548 for the Kenya–US combination). Each pairwise combination thus received a value between 0 and 1, with values closer to 0 representing low authorship parasitism and numbers at the opposite end of the spectrum representing high authorship parasitism. Countries comprising the rows and columns were arranged based on the patterns of parasitism, using the complexheatmap package in R (R Foundation for Statistical Computing, Vienna, Austria) to derive pairwise distances and subsequent pairwise distance trees.

We used univariable and multivariable logistic regres-sion to determine factors associated with authorship parasitism compared with articles with author represen-tation from the country where the study was conducted. The candidate variables included in our multivariable logistic regression model were selected a priori based on prior work suggesting power dynamics contributing to inequities in publication of work conducted in LMICs at the journal level20 21 and prior work suggesting that authorship parasitism is more common in low- income countries and among those conducted in multiple LMICs.8 Funding and the number of authors included were selected as candidate variables to assess this poten-tial association as well. Candidate variables in which the p value was <0.2 in the univariable model were included in the multivariable model. All analyses were conducted using R V.4.0.3 (R Foundation for Statistical Computing).

RESULTSThere were 38 536 articles identified through our initial query, 83.2% (n=32 061) met inclusion criteria (figure 1). Of the 32 061 articles meeting our inclusion criteria,

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14.8% (n=4754) met the definition of authorship para-sitism. The remaining 85.2% (n=27 319) had at least one author with an affiliation in the same sub- Saharan African country where the study was conducted. Charac-teristics of included articles are summarised in table 1. Our study country and author affiliation algorithms both demonstrated high global sensitivity and specificity (ie, >99%) in assigning study country and author affiliation country(ies) when compared with manual review as a reference standard. The annual frequency of authorship parasitism did not change appreciably during the study period (figure 2).

A significant proportion of articles also had few authors affiliated with the study country, regardless of the number of authors. Of 16 187 articles with 5–10 authors, local authors comprised ≤25% of authors in 4999 (30.9%) articles. Of 3901 articles with 11–15 authors, local authors comprised ≤25% of authors in 1115 (28.6%) articles. In 940 articles with 16–20 authors, local authors comprised ≤25% of authors in 349 (37.1%) arti-cles. And in 560 articles with >20 authors, local authors comprised ≤25% of authors in 231 (41.2%) articles.

There were 228 829 authors in the published arti-cles included in our analysis. Of authors with assigned

Figure 1 Selection of articles included in the analysis. *Eleven articles were previously excluded when devising query and had insufficient data for algorithmic processing. **The following set of article characteristics as high risk for algorithmic misassignment and were manually reviewed: (1) absence of abstract, (2) single author, (3) presence of group author and (4) presence of the same number of affiliation fields for all authors (potentially indicating that all authors’ affiliations were reported in the same field).

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country affiliations, 89 478 (39.1%) were affiliated with HICs, 25 073 (11.0%) were affiliated with upper- middle income countries, 34 565 (15.1%) were affiliated with lower- middle income countries, 55 503 (24.2%) were affiliated with low- income countries and 24 210 (10.6%) were affiliated with an HIC and a combination of income classifications.

Authorship parasitism occurred most commonly in published articles reporting research conducted in Somalia (n=175/233, 75.1%), Sao Tome and Principe (n=20/28, 71.4%), Comoros (n=30/46, 65.2%), Eritrea (n=41/67, 61.2%) and Cape Verde (n=25/47, 53.2%) (figure 3). Authorship parasitism occurred in as few as 7.3% (n=404/5554) of articles published on research conducted in South Africa. The USA (n=2079/11 800, 17.6%) and the UK (n=800/5611, 14.3%) were the countries most consistently involved in published arti-cles demonstrating authorship parasitism (figure 4).

Other notable authorship parasitism trends reflected the history of colonialism (eg, Angola and Portugal) and shared language (eg, Angola and Brazil). Proportionally, authorship parasitism occurred most commonly when the USA was involved in research conducted in South Africa, Kenya and Uganda. For studies in which the UK was involved, authorship parasitism was proportionally most commonly present when the study was conducted in South Africa, Kenya or Uganda. Though Canada and the Netherlands were less commonly involved in published articles demonstrating authorship parasitism, these two countries were most frequently involved in authorship parasitism in studies conducted in South Africa and Kenya, by proportion of articles. In pairwise compari-sons, the relative odds of authorship parasitism by each

Table 1 Characteristics of articles reporting research conducted in sub- Saharan Africa, 2014–2018

n (%)

Journal publisher region

Sub- Saharan Africa 2940 (9.2)

East Asia and Pacific 267 (0.8)

Europe and Central Asia 17 133 (53.4)

Latin America and the Caribbean 53 (0.2)

Middle East and North Africa 159 (0.5)

North America 11 094 (34.6)

South Asia 427 (1.3)

Language of article

English 31 262 (97.5)

French 742 (2.3)

Other languages or multiple languages* 69 (0.2)

Study country income group

Low- income 5697 (17.8)

Lower- middle income 13 906 (43.4)

Upper- middle income and high income†

9890 (30.9)

Multicountry study 2550 (8.0)

Funding agency type

US government 23 015 (71.8)

Non- US government 1019 (3.2)

Private foundation 440 (1.4)

Other 687 (2.1)

Multiple types 1823 (5.7)

None listed 5089 (15.9)

Number of authors, median (IQR) 6 (4–9)

Group authorship included 1037 (3.2)

*Other includes Chinese (n=26), German (n=39), and Dutch (n=4).†Includes two high- income countries in sub- Saharan Africa (ie, Equatorial Guinea and Seychelles).

Figure 2 Prevalence of authorship parasitism in sub- Saharan Africa in articles published from 2014 to 2018 among 32 061 articles indexed on PubMed.

Figure 3 Choropleth of proportion of papers indexed on PubMed without any local authors (authorship parasitism) for original research done in sub- Saharan Africa, 2014–2018.

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foreign country varied per sub- Saharan African country (online supplemental table 1). However, the presence of authors from the USA, UK and Canada remained commonly associated with authorship parasitism in these pairwise comparisons.

On multivariable regression, articles demonstrating authorship parasitism were more likely to be published in journals based in Latin America and the Caribbean (adjusted OR (aOR) 2.78, 95% CI 1.13 to 6.39), North America (aOR 1.26, 95% CI 1.07 to 1.50), Europe and Central Asia (aOR 1.42, 95% CI 1.22 to 1.68) and East Asia and Pacific (aOR 1.84, 95% CI 1.24 to 2.71) compared with journals based in sub- Saharan Africa (table 2). Articles published in French were less likely to have authorship parasitism (aOR 0.60, 95% CI 0.41 to 0.85) than articles published in English. In contrast, articles published in languages other than English or French, or multiple languages had over ninefold greater odds of demonstrating authorship parasitism (aOR 9.40, 95% CI 4.86 to 18.78) when compared with articles published in English. Compared with articles reporting work conducted in upper- middle income countries in sub- Saharan Africa, articles reporting research conducted in lower- middle income sub- Saharan African countries (aOR 2.05, 95% CI 1.83 to 2.30), low- income sub- Saharan African countries (aOR 1.76, 95% CI 1.57 to 1.99) and multiple sub- Saharan African countries (aOR 8.41, 95% CI 7.30 to 9.68) were more likely to exhibit authorship parasitism (table 2).

Articles reporting funding from the US government were modestly less likely to have parasitic authorship bylines (aOR 0.79, 95% CI 0.63 to 0.98) than articles with no listed funding source (table 2). Articles reporting funding from multiple sources were less likely to demon-strate authorship parasitism when compared with articles with no funding source listed (aOR 0.86, 95% CI 0.77

to 0.96). The number of authors was associated with authorship parasitism among articles reporting research conducted in sub- Saharan Africa. Articles with <5 authors (aOR 14.46, 95% CI 12.81 to 16.35) and articles with 5–10 authors (aOR 2.80, 95% CI 2.50 to 3.15) were more likely to show authorship parasitism than articles with >10 authors. The presence of a group author was not associ-ated with authorship parasitism among articles reporting research conducted in sub- Saharan Africa (aOR 1.09, 95% CI 0.88 to 1.34).

The covariate most highly and consistently associated with authorship parasitism was the presence of a high- income author, particularly those from the USA (aOR 13.02, 95% CI 10.77 to 15.72), the UK (aOR 10.28, 95% CI 9.06 to 11.68) and both the USA and the UK (aOR 12.88, 95% CI 11.33 to 14.67).

DISCUSSIONIn our analysis of over 32 000 published articles reporting research conducted in sub- Saharan Africa, approxi-mately one in seven published articles did not include any authors from the country where the study was conducted, and many articles included only a moderate proportion of authors from the study country. Several HICs were commonly involved in articles demonstrating authorship parasitism. Authorship parasitism occurred more commonly in studies conducted in multiple sub- Saharan African countries and in low- income countries than in upper- middle- income sub- Saharan African countries. Though imbalance in authorship in research conducted in sub- Saharan Africa is but ‘the tip of the iceberg’ in inequities in academic global health,22 23 it is certainly a manifestation. Understanding the countries, contributing investigators’ countries and associated

Figure 4 Network diagram of relationships between sub- Saharan African countries and foreign authors’ country affiliations among papers without any local authors. *Parasitism index calculated by dividing the number of articles in each pairwise combination by the highest number in any pain- wise combination, which was 548 in the US- Kenya combination. Each pairwise combination thus received a value between 0 and 1, values closer to 0 represented low parasitism and numbers at the opposite end of the spectrum represented high parasitism.

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Table 2 Logistic regression of article- level factors associated with authorship parasitism

Article with any local authors, n (%)

Article without local authors, n (%)

OR(95% CI) P value Adjusted OR (95% CI)* P value

Journal publisher region

Sub- Saharan Africa 2719 (10.0) 220 (4.6) Referent Referent

East Asia and Pacific

219 (0.8) 48 (1.1) 2.71 (1.91 to 3.78) <0.001 1.84 (1.24 to 2.71) 0.002

Europe and Central Asia

14 333 (52.5) 2792 (58.7) 2.41 (2.09 to 2.78) <0.001 1.43 (1.22 to 1.68) <0.001

Latin America and the Caribbean

37 (0.1) 16 (0.3) 5.34 (2.85 to 9.59) <0.001 2.78 (1.13 to 6.39) 0.020

Middle East and North Africa

137 (0.5) 22 (0.4) 1.98 (1.21 to 3.11) <0.001 1.03 (0.58 to 1.75) 0.913

North America 9462 (34.7) 1629 (34.3) 2.13 (1.84 to 2.47) <0.001 1.26 (1.07 to 1.50) 0.006

South Asia 400 (1.4) 27 (0.6) 0.83 (0.54 to 1.23) 0.389 0.84 (0.52 to 1.30) 0.450

Language of article

English 26 577 (97.3) 4675 (98.3) Referent Referent

French 703 (2.5) 37 (0.8) 0.29 (0.21 to 0.41) <0.001 0.60 (0.41 to 0.85) 0.006

Other languages or multiple languages

27 (0.2) 42 (0.9) 8.84 (5.41 to 14.51) <0.001 9.40 (4.86 to 18.78) <0.001

Study country income group

Upper- middle income†

5213 (19.1) 484 (10.2) Referent Referent

Lower- middle income

11 822 (43.3) 2084 (43.9) 1.90 (1.71 to 2.11) <0.001 2.05 (1.83 to 2.30) <0.001

Low- income 8653 (31.7) 1237 (26.0) 1.54 (1.38 to 1.72) <0.001 1.76 (1.57 to 1.99) <0.001

Multicountry study 1604 (5.9) 946 (19.9) 6.35 (5.62 to 7.19) <0.001 8.41 (7.30 to 9.68) <0.001

Funding agency type

US government 4384 (16.1) 704 (14.8) 0.86 (0.79 to 0.94) <0.001 0.79 (0.63 to 0.98) 0.033

Non- US government

354 (1.3) 86 (1.8) 1.31 (1.02 to 1.65) 0.002 0.99 (0.76 to 1.29) 0.957

Private foundation 1671 (6.1) 148 (3.1) 0.48 (0.40 to 0.56) <0.001 0.84 (0.65 to 1.07) 0.161

Other* 595 (2.2) 92 (1.9) 0.83 (0.66 to 1.03) 0.103 0.53 (0.43 to 0.64) <0.001

Multiple types 903 (3.3) 115 (2.4) 0.68 (0.56 to 0.83) <0.001 0.86 (0.77 to 0.96) 0.005

None listed 19 400 (71.0) 3609 (76.0) Referent Referent

Number of authors

<5 7820 (28.6) 2614 (55.0) 4.64 (4.20 to 5.15) <0.001 14.46 (12.81 to 16.35) <0.001

5–10 12 699 (46.5) 1652 (34.7) 1.81 (1.63 to 2.01) <0.001 2.80 (2.50 to 3.15) <0.001

>10 6788 (24.9) 488 (10.3) Referent Referent

Any group author

No 26 409 (96.7) 4625 (97.3) Referent Referent

Yes 898 (3.3) 129 (2.7) 0.82 (0.67 to 0.98) 0.04 1.09 (0.88 to 1.34) 0.439

High- income country affiliated authors outside sub- Saharan Africa

None 9240 (33.8) 404 (8.5) Referent Referent

High- income country (not UK or USA)

5320 (19.5) 1482 (31.2) 6.37 (5.68 to 7.16) <0.001 8.16 (7.04 to 9.47) <0.001

At least one UK affiliation

3211 (11.8) 604 (12.7) 4.30 (3.77 to 4.91) <0.001 10.28 (9.06 to 11.68) <0.001

At least one US affiliation

8005 (29.3) 1999 (42.0) 5.71 (5.11 to 6.39) <0.001 13.02 (10.77 to 15.72) <0.001

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factors may help inform policies and interventions to reduce authorship parasitism in the future.

The prevalence of authorship parasitism among arti-cles reporting research conducted in sub- Saharan Africa in our study was similar to that reported previously in work assessing authorship in sub- Saharan Africa demon-strating authorship parasitism rates of 13%–14%.14 24 Other studies assessing authorship distribution among literature specific to infectious diseases25 and paedi-atrics8 demonstrated much lower rates of authorship parasitism in sub- Saharan Africa. The reasons behind these differences are likely multifactorial. The fields of infectious diseases and paediatrics traditionally receive more international funding than other fields26 and long- term collaborations between LMICs and HICs are common in these fields, which may contribute to less frequent authorship parasitism due to long- standing collaborations. We were unable to evaluate if rates of authorship parasitism differed by disease studied due to our use of bibliometrics and the presence of multiple disease categories found in MeSH terms in our article population. Further study of authorship parasitism in different fields may be merited to identify if investiga-tors in some fields are more culpable than others in such practices.

Authorship parasitism occurred most frequently in countries including Somalia, Sao Tome and Prin-cipe, Comoros, Eritrea and Cape Verde. These coun-tries are all classified as low- income or lower- middle income countries.27 Consistent with prior studies,8 14 we observed an inverse relationship between country income group defined by the World Bank and frequency of authorship parasitism, with less devel-oped sub- Saharan African countries experiencing more authorship parasitism. Given the more limited resources available in low- income countries in sub- Saharan Africa, research conducted in these countries may be more reliant on external support, which in turn may result in higher rates of authorship parasitism as a consequence. Our observation that authorship para-sitism was less common in upper- middle income coun-tries in sub- Saharan Africa such as South Africa and Nigeria, implies that economic development in such countries may lead to greater local investigator involve-ment, and subsequently less authorship parasitism.

The USA, UK and Canada were the HICs most frequently implicated in authorship parasitism. These

countries were also commonly involved in articles with authorship parasitism in a study by Hedt- Gauthier et al evaluating articles published from 2014 to 2016 and a study by Dahdouh- Guebas et al that included articles published between 1999 and 2000,17 suggesting that little has changed in terms of which HICs are commonly implicated in authorship parasitism, even though the relative frequency of authorship parasitism decreased dramatically, from 70% in 1999–200017 to 14.8% in 2014–2018. However, it should be noted that our use of PubMed, a US- based search engine, could have resulted in over- representation of research with authors affiliated with the USA. Furthermore, the USA alone accounts for ~30% of all published articles, and the US National Institutes of Health is the leading governmental source of funding in the world.28 29 Future studies employing different article search engines may elucidate if selec-tion bias results from the use of PubMed.

Our study extends the findings of Hedt- Gauthier et al and Dahdouh- Guebas et al in two important ways.14 17 First, we included articles published during a contem-porary, 5- year study period. Second, although similar to Hedt- Gauthier et al, we used PubMed to obtain arti-cles, our study adds to prior findings by elucidating journal region, article language, funding source and authorship number patterns associated with authorship parasitism in articles reporting research conducted in sub- Saharan Africa. Articles exhibiting authorship para-sitism were more common in journals based in non- sub- Saharan African countries, implying that either those local investigators were more likely to submit their work to journals based in sub- Saharan Africa or that non- sub- Saharan African based journals were more likely to publish work devoid of local authorship repre-sentation. Additionally, open- access publication fees in non- sub- Saharan African journals may be a barrier for investigators in sub- Saharan Africa to submit to such journals. Furthermore, articles published in French were less likely to exhibit authorship parasitism, which may suggest Francophone investigators in Francophone sub- Saharan African countries may more commonly submit their work to journals in French than work involving investigators from HICs, particularly those that are English speaking. Moreover, English language standards of journals may create barriers for authors for whom English is not their first language in sub- Saharan Africa for submission to journals published in English.

Article with any local authors, n (%)

Article without local authors, n (%)

OR(95% CI) P value Adjusted OR (95% CI)* P value

At least one US and UK

affiliations

1531 (5.6) 265 (5.6) 3.96 (3.36 to 4.66) <0.001 12.88 (11.33 to 14.67) <0.001

*Candidate variables in which the p value was <0.2 in the univariable model were included in the multivariable model.†Includes two high- income countries in sub- Saharan Africa (ie, Equatorial Guinea and Seychelles).

Table 2 Continued

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Articles reporting private foundation funding were less likely to exhibit authorship parasitism, perhaps suggesting more willingness of private foundations to directly award grants to investigators in LMICs. Furthermore, articles with >10 authors were the least likely to have author-ship parasitism. Though our study was not designed to assess for this, a lower prevalence of authorship para-sitism in articles with expanded authorship bylines may be a manifestation of ‘token authorship’, which has been commonly reported in work conducted in LMICs, partic-ularly sub- Saharan Africa.30–33 Lastly, studies reporting research conducted in more than one sub- Saharan African country commonly exhibited authorship para-sitism, which may reflect the dissipation of responsibility in reporting contributions from investigators at each site.

Though authorship dictates academic advancement, the award of future grants and denotes overall contribu-tions of investigators to published work,30 34 elucidating disparities in authorship in work reporting research in sub- Saharan Africa is only the ‘tip of the iceberg’ in understanding power imbalances in global health.23 Historical colonialism and neocolonialism,35 unequal access to research funds34 and capacity building in LMICs focused on transfer of technical skills instead of expertise on study design and manuscript writing23 may perpetuate historical imbalances in global health. There has been a recent increase in interest in both studying and implementing more equitable global health partnerships.36 37 The long- term benefits of such endeavours may provide frameworks that can be repli-cated and may reduce authorship parasitism over time. Lastly, given the recent surge in interest in decolonising global health,10 future studies are merited to assess the impact of this movement on authorship parasitism over time.

There are several areas in need of re- evaluation in order to reduce authorship parasitism in sub- Saharan Africa. First, investigators from HICs conducting research in sub- Saharan Africa should recognise authorship parasitism as neocolonialist, damaging to partners, and extractive and commit not to engage in such work. Instead, HIC inves-tigators working in sub- Saharan Africa should strive to build research capacity, including providing opportunities for colleagues in sub- Saharan Africa to make meaningful contributions for authorship. Second, HIC institutions should place more value on research when a collaborator from sub- Saharan Africa is in the first or senior author position and raise questions about publications reporting work conducted in sub- Saharan Africa without authors from the region.2 Third, funding agencies may consider implementing policies, similar to what has been done with the reporting of race and ethnicity,38 requiring balanced contributions leading to authorship in articles reporting federally- funded research conducted in sub- Saharan Africa. Fourth, both reviewers and editors of biomedical journals should recognise this extractive practice and discourage the publication of articles demonstrating authorship para-sitism. Fifth, investigators who were not part of the original

study design or implementation in sub- Saharan Africa but seek to use data for publications should receive clearance from site directors in the study country(ies). This may be accomplished using data transfer agreements in which all data belong to the study site and foreign collaborators are granted permission to use data by study site investigators. Sixth, given the relatively common occurrence of author-ship parasitism in our study, more journals may consider adopting policies requiring authorship from study country authors.39 40 Lastly, the ICMJE may consider adding recom-mendations specific to collaborative research conducted in resource- limited settings to encourage equitable opportu-nities for authorship.

LimitationsAuthor affiliation listed in published articles was used to determine an author’s country but may not reflect actual country of origin given potential expatriation. However, prior survey studies assessing authorship and perceptions of academic global health collaborations indicate that listed author affiliation strongly correlated with country of origin.30 41 We were not be able to determine if author-ship was inappropriately assigned based on ICMJE stand-ards, if ‘token authorship’ was granted to investigators, or if investigators were omitted from authorship, which are commonly reported in research conducted in LMICs.30–33 Though PubMed includes many journals, it may not include all journal articles that published on research conducted in sub- Saharan Africa during the study period. Particularly, as the NCBI is funded by the US government, our results may reflect an over- representation of journals from the USA. However, given the large sample size of journals based in multiple regions resulting from the query, our sample is broadly representative of research conducted in sub- Saharan Africa. Lastly, not all articles listed funding sources in PubMed which may have intro-duced some potential overestimation or underestima-tion of the potential role of funding in published arti-cles demonstrating authorship parasitism. Nevertheless, given our large and representative sample size, it would stand to reason that similar trends would be observed in articles reporting funding elsewhere.

CONCLUSIONSAuthorship parasitism in studies conducted in sub- Saharan Africa occurred in approximately one in seven articles. Several high- income countries were most commonly involved in such work conducted in sub- Saharan Africa. With recent and growing recognition of the perils of imbalanced research collaborations, future studies are merited to evaluate changes in the preva-lence, location and associated factors in authorship para-sitism in the future. Investigators and institutions in high- income countries, as well as funding agencies and jour-nals should promote research from sub- Saharan Africa, including its publication, in a collaborative and equitable manner.

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Author affiliations1Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA2Division of Emergency Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia, USA3Divison of Infectious Diseases, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada4Department of Pediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania5Department of Pediatrics, John F. Kennedy Medical Center, Monrovia, Liberia6Department of Medicine, Weill Cornell Medicine, New York, New York, USA7Boston Combined Residency Program, Boston, Massachusetts, USA8Baylor Children's Foundation- Malawi, Lilongwe, Malawi9Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts, USA10Department of Pediatrics and Emergency Medicine, Harvard Medical School, Boston, Massachusetts, USA11Center for Nutrition, Division of Gastroenterology, Hepatology, and Nutrition, Boston Children's Hospital, Boston, Massachusetts, USA12Departments of Nutrition and Global Health and Population, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA

Twitter Mohsin Ali @mohsinali90

Acknowledgements We would like to thank Dr Imikomobong (‘Micky’) Ibia for his assistance with the query design. We also express our appreciation for the personnel at National Center for Biotechnology Information tools who assisted with the data query.

Contributors CAR, MA, RK, RCI, SJS, CDB, PNK, MN, CD and KM conceptualised and designed the study. CAR, MA and SJS oversaw data collection and verified the underlying data. MA designed the algorithms. MA and CDB verified the underlying data and conducted the statistical analyses. CAR wrote the first draft of the manuscript. CAR, MA, RK, RCI, SJS, CDB, PNK, MN, CD and KM interpreted the data, reviewed and provided input to the final draft. CAR had final responsibility for the decision to submit for publication.

Funding CPD was supported, in part, by the National Institutes of Health (K24 DK104676 and P30 DK040561). The funders had no role in the study design or in the collection, analysis, or interpretation of the data. The funders did not write the report and had no role in the decision to submit the paper for publication.

Map disclaimer The depiction of boundaries on this map does not imply the expression of any opinion whatsoever on the part of BMJ (or any member of its group) concerning the legal status of any country, territory, jurisdiction or area or of its authorities. This map is provided without any warranty of any kind, either express or implied.

Competing interests None declared.

Patient consent for publication Not applicable.

Ethics approval As this study involved no human subjects and used publicly available data, the Institutional Review Board of Boston Children’s Hospital exempted this study from review.

Provenance and peer review Not commissioned; externally peer reviewed.

Data availability statement Data may be made available upon reasonable request to the corresponding author.

Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer- reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

Open access This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY- NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non- commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non- commercial. See: http:// creativecommons. org/ licenses/ by- nc/ 4. 0/.

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Supplement 1. PubMed query to retrieve articles reporting original research conducted in sub-

Saharan Africa, published 2014–2018. (

(

( (Angola[tiab] OR Angola[mh]) OR

( (Benin[tiab] NOT "Benin haplotype"[tiab]) OR

Benin[mh] ) OR

(Botswana[tiab] OR Botswana[mh]) OR

(Burkina Faso[tiab] OR Burkina Faso[mh]) OR

(Burundi[tiab] OR Burundi[mh]) OR

(Cameroon[tiab] OR Cameroon[mh]) OR

(Cape Verde[tiab] OR Cape Verde[mh]) OR

(Cabo Verde[tiab] OR Cabo Verde[mh]) OR

(Central African Republic[tiab] OR Central African Republic[mh]) OR

(Chad[tiab] OR Chad[mh]) OR

(Comoros[tiab] OR Comoros[mh]) OR

(Democratic Republic of the Congo[tiab] OR Democratic Republic of the Congo[mh]) OR

(Republic of the Congo[tiab] OR Republic of the Congo[mh]) OR

(Cote d’Ivoire[tiab] OR Cote d’Ivoire[mh]) OR

(Ivory Coast[tiab] OR Ivory Coast[mh]) OR

(Djibouti[tiab] OR Djibouti[mh]) OR

(Equatorial Guinea[tiab] OR Equatorial Guinea[mh]) OR

(Eritrea[tiab] OR Eritrea[mh]) OR

(eSwatini[tiab] OR eSwatini[mh]) OR

(Swaziland[tiab] OR Swaziland[mh]) OR

(Ethiopia[tiab] OR Ethiopia[mh]) OR

(Gabon[tiab] OR Gabon[mh]) OR

(Gambia[tiab] OR Gambia[mh]) OR

(Ghana[tiab] OR Ghana[mh]) OR

(

(Guinea[tiab] NOT ( Papua New Guinea[tiab] OR

"guinea pig"[tiab] OR

"guinea pigs"[tiab] OR

"guinea fowl"[tiab])

) OR

Guinea[mh]

) OR

(Guinea-Bissau[tiab] OR Guinea-Bissau[mh]) OR

( (Kenya[tiab] NOT "hemoglobin kenya"[supplementary concept]) OR

Kenya[mh] ) OR

(Lesotho[tiab] OR Lesotho[mh]) OR

(Liberia[tiab] OR Liberia[mh]) OR

(Madagascar[tiab] OR Madagascar[mh]) OR

(Malawi[tiab] OR Malawi[mh]) OR

(Mali[tiab] OR Mali[mh]) OR

(Mauritania[tiab] OR Mauritania[mh]) OR

(Mauritius[tiab] OR Mauritius[mh]) OR

( (Mozambique[tiab] NOT "2004 Mozambique variant"[tiab]) OR

Mozambique[mh] ) OR

(Namibia[tiab] OR Namibia[mh]) OR

( (Niger[tiab] NOT "Aspergillus niger"[tiab]) OR

Niger[mh] ) OR

(Nigeria[tiab] OR Nigeria[mh]) OR

(Rwanda[tiab] OR Rwanda[mh]) OR

(Sao Tome and Principe[tiab] OR Sao Tome and Principe[mh]) OR

(Senegal[tiab] OR Senegal[mh]) OR

(Seychelles[tiab] OR Seychelles[mh]) OR

BMJ Publishing Group Limited (BMJ) disclaims all liability and responsibility arising from any relianceSupplemental material placed on this supplemental material which has been supplied by the author(s) BMJ Global Health

doi: 10.1136/bmjgh-2021-006982:e006982. 6 2021;BMJ Global Health, et al. Rees CA

(Sierra Leone[tiab] OR Sierra Leone[mh]) OR

(Somalia[tiab] OR Somalia[mh]) OR

(South Africa[tiab] OR South Africa[mh]) OR

( ( South Sudan[tiab] NOT ("sudan black"[tiab] OR "sudan iv"[tiab]) )

OR

South Sudan[mh] )

OR

( ( Sudan[tiab] NOT ("sudan black"[tiab] OR "sudan iv"[tiab]) )

OR

Sudan[mh] )

OR

(Tanzania[tiab] OR Tanzania[mh]) OR

(Togo[tiab] OR Togo[mh]) OR

(Uganda[tiab] OR Uganda[mh]) OR

(Zambia[tiab] OR Zambia[mh]) OR

(Zimbabwe[tiab] OR Zimbabwe[mh])

)

)

AND

( journal article[ptyp] NOT ( case reports[ptyp] OR

clinical trial protocol[ptyp] OR

"clinical trial, veterinary"[ptyp] OR

comment[ptyp] OR

historical article[ptyp] OR

history[sb] OR

review[ptyp] OR

editorial[ptyp] OR

guideline[ptyp] OR

introductory journal article[ptyp] OR

lecture[ptyp] OR

news[ptyp] OR

newspaper article[ptyp] OR

practice guideline[ptyp] )

)

AND

( "2014/01/01"[PDat] : "2018/12/31"[PDat] )

AND

Humans[Mesh]

)

NOT

( case report[ti] OR

clinical practice guide[ti] OR

clinical protocols[mh] OR

essay[ti] OR

history[sb] OR

"int nurs rev"[journal] OR

meta analysis[ti] OR

news[ti] OR

practice guidelines as topic[mh] OR

study protocol[ti] OR

systematic review[ti] OR

systematic[sb] OR

"wkly epidemiol rec"[journal])



Supplemental Table. Pairwise comparisons of the relative odds of authorship parasitism by author affiliation country for each sub-

Saharan Africa. Analyses included only if there were at least 10 papers with that bilateral relation.

ANGOLA

Author affiliation country Articles with >1 Affiliation,

n

Parasitism in Articles with >1

Affiliation, n (%)

Articles with No Affiliation, n

Parasitism in Articles with No Affiliation, n

(%)

Odds Ratio (95% CI)

GERMANY 13 7 (53.8) 177 65 (36.7) 2.01 (0.64–6.49)

UNITED KINGDOM 21 10 (47.6) 169 62 (36.7) 1.57 (0.62–3.93)

UNITED STATES OF AMERICA 58 26 (44.8) 132 46 (34.8) 1.52 (0.81–2.85)

PORTUGAL 61 27 (44.3) 129 45 (34.9) 1.48 (0.79–2.76)

BRAZIL 25 11 (44.0) 165 61 (37.0) 1.34 (0.56–3.13)

FRANCE 16 6 (37.5) 174 66 (37.9) 0.98 (0.32–2.77)

SOUTH AFRICA 11 4 (36.4) 179 68 (38.0) 0.93 (0.24–3.21)

SWITZERLAND 17 6 (35.3) 173 66 (38.2) 0.88 (0.29–2.44)

BENIN

Author affiliation country Articles with >1

Affiliation, n

Parasitism in Articles with >1 Affiliation, n (%)

Articles with No

Affiliation, n


(%)

Odds Ratio (95% CI)


NETHERLANDS 29 10 (34.5) 360 84 (23.3) 1.73 (0.75–3.79)

CANADA 32 10 (31.2) 357 84 (23.5) 1.48 (0.65–3.17)

SOUTH AFRICA 15 4 (26.7) 374 90 (24.1) 1.15 (0.31–3.45)

UNITED KINGDOM 62 15 (24.2) 327 79 (24.2) 1.00 (0.52–1.85)

SWITZERLAND 38 9 (23.7) 351 85 (24.2) 0.97 (0.42–2.06)

BELGIUM 41 9 (22.0) 348 85 (24.4) 0.87 (0.38–1.83)

GERMANY 16 3 (18.8) 373 91 (24.4) 0.72 (0.16–2.28)

SENEGAL 16 3 (18.8) 373 91 (24.4) 0.72 (0.16–2.28)

NIGERIA 25 4 (16.0) 364 90 (24.7) 0.58 (0.17–1.57)

FRANCE 128 16 (12.5) 261 78 (29.9) 0.34 (0.18–0.59)

MALI 13 1 (7.7) 376 93 (24.7) 0.25 (0.01–1.31)

TANZANIA 14 1 (7.1) 375 93 (24.8) 0.23 (0.01–1.19)

BURKINA FASO 29 2 (6.9) 360 92 (25.6) 0.22 (0.03–0.74)

GHANA 17 1 (5.9) 372 93 (25.0) 0.19 (0.01–0.94)



BOTSWANA Author affiliation country Articles with

>1 Affiliation, n

Parasitism in Articles with >1 Affiliation, n

(%)

Articles with No Affiliation,

n


(%)

Odds Ratio (95% CI)

AUSTRALIA 10 5 (50.0) 366 58 (15.8) 5.31 (1.44–19.66)

SWEDEN 11 3 (27.3) 365 60 (16.4) 1.91 (0.41–6.80)

SOUTH AFRICA 83 17 (20.5) 293 46 (15.7) 1.38 (0.73–2.53)

UNITED KINGDOM 41 5 (12.2) 335 58 (17.3) 0.66 (0.22–1.62)


CANADA 31 2 (6.5) 345 61 (17.7) 0.32 (0.05–1.11)

BURKINA FASO

Author affiliation country Articles with >1 Affiliation, n


(%)

Articles with No

Affiliation, n

Parasitism in Articles with No Affiliation, n (%)

Odds Ratio (95% CI)

SPAIN 14 5 (35.7) 761 121 (15.9) 2.94 (0.89–8.66)


CANADA 83 23 (27.7) 692 103 (14.9) 2.19 (1.28–3.66)

AUSTRALIA 21 6 (28.6) 754 120 (15.9) 2.11 (0.74–5.31)

SWITZERLAND 76 18 (23.7) 699 108 (15.5) 1.70 (0.94–2.94)

SOUTH AFRICA 43 8 (18.6) 732 118 (16.1) 1.19 (0.50–2.50)

SWEDEN 20 3 (15.0) 755 123 (16.3) 0.91 (0.21–2.75)

NIGERIA 21 3 (14.3) 754 123 (16.3) 0.86 (0.20–2.57)

ITALY 21 3 (14.3) 754 123 (16.3) 0.86 (0.20–2.57)

FRANCE 169 24 (14.2) 606 102 (16.8) 0.82 (0.50–1.30)

UNITED KINGDOM 143 19 (13.3) 632 107 (16.9) 0.75 (0.43–1.25)

BELGIUM 79 10 (12.7) 696 116 (16.7) 0.72 (0.34–1.39)

FINLAND 11 1 (9.1) 764 125 (16.4) 0.51 (0.03–2.70)

GERMANY 76 7 (9.2) 699 119 (17.0) 0.49 (0.20–1.03)

DENMARK 34 3 (8.8) 741 123 (16.6) 0.49 (0.12–1.39)

SENEGAL 56 5 (8.9) 719 121 (16.8) 0.48 (0.17–1.13)

TAIWAN 12 1 (8.3) 763 125 (16.4) 0.46 (0.03–2.42)

NETHERLANDS 40 3 (7.5) 735 123 (16.7) 0.40 (0.10–1.14)

BENIN 15 1 (6.7) 760 125 (16.4) 0.36 (0.02–1.83)

NORWAY 17 1 (5.9) 758 125 (16.5) 0.32 (0.02–1.57)

GHANA 46 2 (4.3) 729 124 (17.0) 0.22 (0.04–0.73)

UGANDA 28 1 (3.6) 747 125 (16.7) 0.18 (0.01–0.88)



MALI 29 1 (3.4) 746 125 (16.8) 0.18 (0.01–0.84)

KENYA 36 1 (2.8) 739 125 (16.9) 0.14 (0.01–0.66)

BURUNDI


Affiliation, n


(%)

Articles with No

Affiliation, n


Odds Ratio (95% CI)

AUSTRALIA 10 6 (60.0) 97 42 (43.3) 1.96 (0.53–8.10)


UNITED KINGDOM 25 11 (44.0) 82 37 (45.1) 0.96 (0.38–2.35)

NETHERLANDS 10 3 (30.0) 97 45 (46.4) 0.50 (0.10–1.90)

BELGIUM 19 5 (26.3) 88 43 (48.9) 0.37 (0.11–1.07)

FRANCE 10 2 (20.0) 97 46 (47.4) 0.28 (0.04–1.18)

UGANDA 10 2 (20.0) 97 46 (47.4) 0.28 (0.04–1.18)

CAPE VERDE


Affiliation, n


(%)

Articles with No

Affiliation, n


(%)

Odds Ratio (95% CI)


PORTUGAL 21 13 (61.9) 26 12 (46.2) 1.90 (0.60–6.30)

CAMEROON Author affiliation country Articles with >1

Affiliation, n


Affiliation, n (%)

Articles with No

Affiliation, n


(%)

Odds Ratio (95% CI)

SPAIN 18 9 (50.0) 1069 118 (11.0) 8.06 (3.09–21.03)

BRAZIL 15 7 (46.7) 1072 120 (11.2) 6.94 (2.39–19.67)

CANADA 56 18 (32.1) 1031 109 (10.6) 4.01 (2.17–7.17)

NETHERLANDS 24 8 (33.3) 1063 119 (11.2) 3.97 (1.58–9.22)

GERMANY 65 20 (30.8) 1022 107 (10.5) 3.80 (2.12–6.60)

SWEDEN 15 4 (26.7) 1072 123 (11.5) 2.81 (0.77–8.35)

AUSTRALIA 34 8 (23.5) 1053 119 (11.3) 2.41 (1.00–5.23)


BELGIUM 55 9 (16.4) 1032 118 (11.4) 1.52 (0.68–3.03)

KENYA 23 3 (13.0) 1064 124 (11.7) 1.14 (0.27–3.38)



UNITED KINGDOM 132 16 (12.1) 955 111 (11.6) 1.05 (0.58–1.79)

FRANCE 188 22 (11.7) 899 105 (11.7) 1.00 (0.60–1.61)

ITALY 36 4 (11.1) 1051 123 (11.7) 0.94 (0.28–2.43)

SOUTH AFRICA 146 16 (11.0) 941 111 (11.8) 0.92 (0.51–1.56)

SWITZERLAND 74 8 (10.8) 1013 119 (11.7) 0.91 (0.40–1.84)

BENIN 20 2 (10.0) 1067 125 (11.7) 0.84 (0.13–2.95)

GHANA 29 2 (6.9) 1058 125 (11.8) 0.55 (0.09–1.87)

UGANDA 20 1 (5.0) 1067 126 (11.8) 0.39 (0.02–1.92)

BURKINA FASO 23 1 (4.3) 1064 126 (11.8) 0.34 (0.02–1.63)

NIGERIA 47 1 (2.1) 1040 126 (12.1) 0.16 (0.01–0.73)

SENEGAL 25 0 (0.0) 1062 127 (12.0) 0.00 (0.00–60064.10)

CENTRAL AFRICAN REPUBLIC


Affiliation, n


Articles with No

Affiliation, n


Odds Ratio (95% CI)


CANADA 14 9 (64.3) 98 33 (33.7) 3.55 (1.13–12.34)

UNITED KINGDOM 20 9 (45.0) 92 33 (35.9) 1.46 (0.54–3.90)

SWITZERLAND 10 4 (40.0) 102 38 (37.3) 1.12 (0.27–4.18)

FRANCE 48 11 (22.9) 64 31 (48.4) 0.32 (0.13–0.71)

CZECH REPUBLIC 10 1 (10.0) 102 41 (40.2) 0.17 (0.01–0.93)

CHAD


Affiliation, n


(%)

Articles with No

Affiliation, n


(%)

Odds Ratio (95% CI)


UNITED KINGDOM 24 11 (45.8) 88 36 (40.9) 1.22 (0.49–3.04)

FRANCE 30 11 (36.7) 82 36 (43.9) 0.74 (0.31–1.73)

SWITZERLAND 35 7 (20.0) 77 40 (51.9) 0.23 (0.08–0.57)



CÔTE D’IVOIRE Author affiliation country Articles

with >1 Affiliation,

n


(%)



(%)

Odds Ratio (95% CI)


SOUTH AFRICA 17 5 (29.4) 352 46 (13.1) 2.77 (0.85–7.85)

CANADA 23 4 (17.4) 346 47 (13.6) 1.34 (0.38–3.75)

GERMANY 33 5 (15.2) 336 46 (13.7) 1.13 (0.37–2.84)

UNITED KINGDOM 38 5 (13.2) 331 46 (13.9) 0.94 (0.31–2.34)

BELGIUM 18 2 (11.1) 351 49 (14.0) 0.77 (0.12–2.82)

FRANCE 97 10 (10.3) 272 41 (15.1) 0.65 (0.30–1.30)

SWITZERLAND 88 5 (5.7) 281 46 (16.4) 0.31 (0.10–0.73)

BURKINA FASO 24 1 (4.2) 345 50 (14.5) 0.26 (0.01–1.26)

SENEGAL 29 1 (3.4) 340 50 (14.7) 0.21 (0.01–1.01)

DEMOCRATIC REPUBLIC OF THE CONGO


Affiliation, n


Affiliation, n (%)

Articles with No

Affiliation, n


(%)

Odds Ratio (95% CI)

BRAZIL 10 8 (80.0) 762 153 (20.1) 15.92 (3.94–106.20)


CANADA 38 13 (34.2) 734 148 (20.2) 2.06 (1.00–4.06)

ITALY 10 3 (30.0) 762 158 (20.7) 1.64 (0.35–5.97)

NETHERLANDS 34 10 (29.4) 738 151 (20.5) 1.62 (0.73–3.37)

UNITED KINGDOM 103 26 (25.2) 669 135 (20.2) 1.34 (0.81–2.14)

GERMANY 39 10 (25.6) 733 151 (20.6) 1.33 (0.60–2.70)

SWITZERLAND 75 19 (25.3) 697 142 (20.4) 1.33 (0.75–2.27)

AUSTRALIA 16 4 (25.0) 756 157 (20.8) 1.27 (0.35–3.71)

INDIA 16 4 (25.0) 756 157 (20.8) 1.27 (0.35–3.71)

REPUBLIC OF THE CONGO 24 5 (20.8) 748 156 (20.9) 1.00 (0.33–2.53)

SOUTH AFRICA 53 11 (20.8) 719 150 (20.9) 0.99 (0.48–1.91)

NORWAY 15 3 (20.0) 757 158 (20.9) 0.95 (0.21–3.03)

SWEDEN 15 3 (20.0) 757 158 (20.9) 0.95 (0.21–3.03)

GHANA 11 2 (18.2) 761 159 (20.9) 0.84 (0.13–3.30)

FRANCE 76 12 (15.8) 696 149 (21.4) 0.69 (0.35–1.26)

BURKINA FASO 14 2 (14.3) 758 159 (21.0) 0.63 (0.10–2.33)



BENIN 12 1 (8.3) 760 160 (21.1) 0.34 (0.02–1.77)

BELGIUM 173 16 (9.2) 599 145 (24.2) 0.32 (0.18–0.54)

GABON 14 1 (7.1) 758 160 (21.1) 0.29 (0.02–1.46)

CAMEROON 16 1 (6.2) 756 160 (21.2) 0.25 (0.01–1.24)

NIGERIA 18 1 (5.6) 754 160 (21.2) 0.22 (0.01–1.08)

UGANDA 28 1 (3.6) 744 160 (21.5) 0.14 (0.01–0.64)

KENYA 36 1 (2.8) 736 160 (21.7) 0.10 (0.01–0.48)

DJIBOUTI Author affiliation country Articles


n


Articles with No

Affiliation, n


Odds Ratio (95% CI)


UNITED KINGDOM 11 6 (54.5) 38 16 (42.1) 1.65 (0.43–6.66)

FRANCE 12 4 (33.3) 37 18 (48.6) 0.53 (0.12–1.99)

EQUATORIAL GUINEA


Affiliation, n


(%)

Articles with No

Affiliation, n


Odds Ratio (95% CI)


SPAIN 25 3 (12.0) 23 9 (39.1) 0.21 (0.04–0.85)

ERITREA


Affiliation, n


Affiliation, n (%)

Articles with No

Affiliation, n


Odds Ratio (95% CI)


ESWATINI


Affiliation, n


Affiliation, n (%)


n


(%)

Odds Ratio (95% CI)

CANADA 15 6 (40.0) 168 61 (36.3) 1.17 (0.38–3.40)

SOUTH AFRICA 66 23 (34.8) 117 44 (37.6) 0.89 (0.47–1.66)

UNITED KINGDOM 33 11 (33.3) 150 56 (37.3) 0.84 (0.37–1.83)




SWITZERLAND 20 3 (15.0) 163 64 (39.3) 0.27 (0.06–0.85)

KENYA 15 1 (6.7) 168 66 (39.3) 0.11 (0.01–0.57)

ETHIOPIA


n


(%)

Articles with No

Affiliation, n


Odds Ratio (95% CI)

SOUTH KOREA 26 17 (65.4) 3161 377 (11.9) 13.95 (6.31–32.95)

ISRAEL 54 32 (59.3) 3133 362 (11.6) 11.13 (6.44–19.61)

BRAZIL 16 6 (37.5) 3171 388 (12.2) 4.30 (1.46–11.66)


IRELAND 12 4 (33.3) 3175 390 (12.3) 3.57 (0.95–11.39)

PERU 16 5 (31.2) 3171 389 (12.3) 3.25 (1.02–8.99)

FRANCE 41 12 (29.3) 3146 382 (12.1) 2.99 (1.46–5.77)

SWITZERLAND 80 22 (27.5) 3107 372 (12.0) 2.79 (1.65–4.54)

BANGLADESH 11 3 (27.3) 3176 391 (12.3) 2.67 (0.58–9.28)

SAUDI ARABIA 11 3 (27.3) 3176 391 (12.3) 2.67 (0.58–9.28)

BOTSWANA 11 3 (27.3) 3176 391 (12.3) 2.67 (0.58–9.28)

JAPAN 15 4 (26.7) 3172 390 (12.3) 2.59 (0.72–7.63)

SOUTH AFRICA 132 32 (24.2) 3055 362 (11.8) 2.38 (1.55–3.56)

ITALY 35 8 (22.9) 3152 386 (12.2) 2.12 (0.90–4.50)

AUSTRALIA 121 25 (20.7) 3066 369 (12.0) 1.90 (1.19–2.95)

CANADA 119 23 (19.3) 3068 371 (12.1) 1.74 (1.07–2.73)

CHINA 18 3 (16.7) 3169 391 (12.3) 1.42 (0.33–4.33)

UNITED KINGDOM 371 58 (15.6) 2816 336 (11.9) 1.37 (1.00–1.84)

SPAIN 44 7 (15.9) 3143 387 (12.3) 1.35 (0.55–2.86)

SWEDEN 92 14 (15.2) 3095 380 (12.3) 1.28 (0.69–2.22)

GERMANY 119 18 (15.1) 3068 376 (12.3) 1.28 (0.74–2.08)

NORWAY 128 19 (14.8) 3059 375 (12.3) 1.25 (0.74–2.01)

TANZANIA 30 4 (13.3) 3157 390 (12.4) 1.09 (0.32–2.82)

NIGERIA 51 6 (11.8) 3136 388 (12.4) 0.94 (0.36–2.06)

NEPAL 18 2 (11.1) 3169 392 (12.4) 0.89 (0.14–3.13)

DENMARK 38 4 (10.5) 3149 390 (12.4) 0.83 (0.25–2.10)

INDIA 48 5 (10.4) 3139 389 (12.4) 0.82 (0.28–1.90)

VIETNAM 10 1 (10.0) 3177 393 (12.4) 0.79 (0.04–4.20)

NETHERLANDS 145 14 (9.7) 3042 380 (12.5) 0.75 (0.41–1.27)



BELGIUM 109 10 (9.2) 3078 384 (12.5) 0.71 (0.34–1.30)

DEMOCRATIC REPUBLIC OF THE

CONGO

11 1 (9.1) 3176 393 (12.4) 0.71 (0.04–3.71)

ZIMBABWE 13 1 (7.7) 3174 393 (12.4) 0.59 (0.03–3.00)

KENYA 69 5 (7.2) 3118 389 (12.5) 0.55 (0.19–1.24)

SENEGAL 15 1 (6.7) 3172 393 (12.4) 0.51 (0.03–2.52)

GHANA 29 1 (3.4) 3158 393 (12.4) 0.25 (0.01–1.18)

GABON


n


(%)

Articles with No

Affiliation, n


Odds Ratio (95% CI)

NETHERLANDS 37 10 (27.0) 167 19 (11.4) 2.88 (1.18–6.79)


SOUTH AFRICA 11 2 (18.2) 193 27 (14.0) 1.37 (0.20–5.67)

UNITED KINGDOM 20 2 (10.0) 184 27 (14.7) 0.65 (0.10–2.42)

SPAIN 15 1 (6.7) 189 28 (14.8) 0.41 (0.02–2.17)

FRANCE 62 3 (4.8) 142 26 (18.3) 0.23 (0.05–0.68)

GERMANY 69 3 (4.3) 135 26 (19.3) 0.19 (0.04–0.57)

THE GAMBIA


Affiliation, n


(%)

Articles with No

Affiliation, n


Odds Ratio (95% CI)


AUSTRALIA 25 6 (24.0) 271 33 (12.2) 2.28 (0.78–5.84)

GERMANY 14 3 (21.4) 282 36 (12.8) 1.86 (0.41–6.31)

CANADA 13 2 (15.4) 283 37 (13.1) 1.21 (0.18–4.73)

SOUTH AFRICA 21 3 (14.3) 275 36 (13.1) 1.11 (0.25–3.48)

SWITZERLAND 17 2 (11.8) 279 37 (13.3) 0.87 (0.13–3.26)

KENYA 18 2 (11.1) 278 37 (13.3) 0.81 (0.13–3.02)

SPAIN 10 1 (10.0) 286 38 (13.3) 0.73 (0.04–4.02)

NIGERIA 11 1 (9.1) 285 38 (13.3) 0.65 (0.03–3.54)

FRANCE 22 2 (9.1) 274 37 (13.5) 0.64 (0.10–2.32)

JAPAN 12 1 (8.3) 284 38 (13.4) 0.59 (0.03–3.16)

SENEGAL 14 1 (7.1) 282 38 (13.5) 0.49 (0.03–2.59)

BURKINA FASO 18 1 (5.6) 278 38 (13.7) 0.37 (0.02–1.89)



GHANA 18 1 (5.6) 278 38 (13.7) 0.37 (0.02–1.89)

NETHERLANDS 23 1 (4.3) 273 38 (13.9) 0.28 (0.02–1.40)

UNITED KINGDOM 199 14 (7.0) 97 25 (25.8) 0.22 (0.10–0.44)

BELGIUM 48 0 (0.0) 248 39 (15.7) 0.00 (0.00–496238069348.42)

GHANA


Affiliation, n


Affiliation, n (%)


n


(%)

Odds Ratio (95% CI)

ITALY 24 16 (66.7) 2200 387 (17.6) 9.37 (4.09–23.25)

SPAIN 42 21 (50.0) 2182 382 (17.5) 4.71 (2.54–8.75)

IRELAND 15 7 (46.7) 2209 396 (17.9) 4.01 (1.40–11.22)

SWEDEN 37 17 (45.9) 2187 386 (17.6) 3.97 (2.04–7.64)

CANADA 130 56 (43.1) 2094 347 (16.6) 3.81 (2.63–5.48)

BRAZIL 19 8 (42.1) 2205 395 (17.9) 3.33 (1.28–8.29)

BELGIUM 32 13 (40.6) 2192 390 (17.8) 3.16 (1.51–6.40)

NEW ZEALAND 10 4 (40.0) 2214 399 (18.0) 3.03 (0.77–10.67)

AUSTRALIA 127 48 (37.8) 2097 355 (16.9) 2.98 (2.03–4.33)

HONG KONG 17 6 (35.3) 2207 397 (18.0) 2.49 (0.85–6.58)

NORWAY 29 9 (31.0) 2195 394 (17.9) 2.06 (0.88–4.42)

THAILAND 10 3 (30.0) 2214 400 (18.1) 1.94 (0.42–7.02)

FINLAND 38 11 (28.9) 2186 392 (17.9) 1.86 (0.88–3.69)

FRANCE 35 10 (28.6) 2189 393 (18.0) 1.83 (0.83–3.73)


CHINA 40 9 (22.5) 2184 394 (18.0) 1.32 (0.59–2.68)

UNITED KINGDOM 374 78 (20.9) 1850 325 (17.6) 1.24 (0.93–1.62)

MEXICO 15 3 (20.0) 2209 400 (18.1) 1.13 (0.26–3.58)

NETHERLANDS 187 37 (19.8) 2037 366 (18.0) 1.13 (0.76–1.62)

SWITZERLAND 166 31 (18.7) 2058 372 (18.1) 1.04 (0.68–1.54)

INDIA 32 5 (15.6) 2192 398 (18.2) 0.83 (0.28–2.00)

MALAYSIA 13 2 (15.4) 2211 401 (18.1) 0.82 (0.13–3.07)

DENMARK 73 11 (15.1) 2151 392 (18.2) 0.80 (0.39–1.46)

JAPAN 40 6 (15.0) 2184 397 (18.2) 0.79 (0.30–1.77)

SOUTH AFRICA 175 23 (13.1) 2049 380 (18.5) 0.66 (0.41–1.02)

GERMANY 176 20 (11.4) 2048 383 (18.7) 0.56 (0.34–0.88)

VIETNAM 10 1 (10.0) 2214 402 (18.2) 0.50 (0.03–2.68)

TANZANIA 40 3 (7.5) 2184 400 (18.3) 0.36 (0.09–1.01)

THE GAMBIA 15 1 (6.7) 2209 402 (18.2) 0.32 (0.02–1.60)



KENYA 55 3 (5.5) 2169 400 (18.4) 0.26 (0.06–0.70)

SOUTH KOREA 19 1 (5.3) 2205 402 (18.2) 0.25 (0.01–1.21)

BURKINA FASO 40 2 (5.0) 2184 401 (18.4) 0.23 (0.04–0.77)

NIGERIA 60 3 (5.0) 2164 400 (18.5) 0.23 (0.06–0.63)

UGANDA 119 1 (0.8) 2105 402 (19.1) 0.04 (0.00–0.16)

GUINEA



(%)

Articles with No

Affiliation, n


Odds Ratio (95% CI)

AUSTRALIA 14 10 (71.4) 306 114 (37.3) 4.21 (1.37–15.63)

SWEDEN 22 12 (54.5) 298 112 (37.6) 1.99 (0.83–4.87)

SPAIN 11 6 (54.5) 309 118 (38.2) 1.94 (0.57–6.87)


CANADA 24 12 (50.0) 296 112 (37.8) 1.64 (0.71–3.82)

ITALY 16 7 (43.8) 304 117 (38.5) 1.24 (0.43–3.43)

SOUTH AFRICA 23 8 (34.8) 297 116 (39.1) 0.83 (0.33–1.98)

GERMANY 28 8 (28.6) 292 116 (39.7) 0.61 (0.24–1.38)

GHANA 11 3 (27.3) 309 121 (39.2) 0.58 (0.13–2.06)

UNITED KINGDOM 61 17 (27.9) 259 107 (41.3) 0.55 (0.29–1.00)

NIGERIA 12 3 (25.0) 308 121 (39.3) 0.52 (0.11–1.77)

FRANCE 103 27 (26.2) 217 97 (44.7) 0.44 (0.26–0.73)

SWITZERLAND 55 12 (21.8) 265 112 (42.3) 0.38 (0.18–0.73)

BURKINA FASO 15 3 (20.0) 305 121 (39.7) 0.38 (0.09–1.23)

SENEGAL 28 4 (14.3) 292 120 (41.1) 0.24 (0.07–0.64)

CÔTE D’IVOIRE 16 2 (12.5) 304 122 (40.1) 0.21 (0.03–0.78)

JAPAN 10 1 (10.0) 310 123 (39.7) 0.17 (0.01–0.92)

BELGIUM 48 5 (10.4) 272 119 (43.8) 0.15 (0.05–0.36)

MALI 14 1 (7.1) 306 123 (40.2) 0.11 (0.01–0.59)

GUINEA-BISSAU Author affiliation country Articles with >1

Affiliation, n


Affiliation, n (%)


n


Odds Ratio (95% CI)

PORTUGAL 24 17 (70.8) 134 14 (10.4) 20.82 (7.67–62.57)

GERMANY 13 6 (46.2) 145 25 (17.2) 4.11 (1.23–13.44)




NETHERLANDS 10 3 (30.0) 148 28 (18.9) 1.84 (0.38–7.07)

UNITED KINGDOM 31 6 (19.4) 127 25 (19.7) 0.98 (0.34–2.52)

SWEDEN 19 2 (10.5) 139 29 (20.9) 0.45 (0.07–1.68)

AUSTRALIA 11 1 (9.1) 147 30 (20.4) 0.39 (0.02–2.16)

DENMARK 92 3 (3.3) 66 28 (42.4) 0.05 (0.01–0.14)

KENYA


Affiliation, n


(%)



Odds Ratio (95% CI)

GREECE 19 9 (47.4) 3008 476 (15.8) 4.79 (1.89–11.94)

SPAIN 36 13 (36.1) 2991 472 (15.8) 3.02 (1.48–5.91)

AUSTRALIA 78 23 (29.5) 2949 462 (15.7) 2.25 (1.35–3.65)

ITALY 42 10 (23.8) 2985 475 (15.9) 1.65 (0.77–3.26)

CANADA 211 45 (21.3) 2816 440 (15.6) 1.46 (1.03–2.05)

NORWAY 19 4 (21.1) 3008 481 (16.0) 1.40 (0.40–3.88)


SWITZERLAND 156 29 (18.6) 2871 456 (15.9) 1.21 (0.78–1.81)

DENMARK 38 7 (18.4) 2989 478 (16.0) 1.19 (0.48–2.56)

JAPAN 54 9 (16.7) 2973 476 (16.0) 1.05 (0.48–2.06)

PORTUGAL 12 2 (16.7) 3015 483 (16.0) 1.05 (0.16–3.99)

INDIA 68 11 (16.2) 2959 474 (16.0) 1.01 (0.50–1.87)

CHINA 31 5 (16.1) 2996 480 (16.0) 1.01 (0.34–2.43)

PHILIPPINES 13 2 (15.4) 3014 483 (16.0) 0.95 (0.15–3.56)

FINLAND 13 2 (15.4) 3014 483 (16.0) 0.95 (0.15–3.56)

SWEDEN 98 15 (15.3) 2929 470 (16.0) 0.95 (0.52–1.60)

BRAZIL 20 3 (15.0) 3007 482 (16.0) 0.92 (0.22–2.76)

GERMANY 102 15 (14.7) 2925 470 (16.1) 0.90 (0.50–1.52)

NETHERLANDS 169 24 (14.2) 2858 461 (16.1) 0.86 (0.54–1.32)

SOUTH AFRICA 253 34 (13.4) 2774 451 (16.3) 0.80 (0.54–1.15)

UNITED KINGDOM 706 96 (13.6) 2321 389 (16.8) 0.78 (0.61–0.99)

BELGIUM 95 12 (12.6) 2932 473 (16.1) 0.75 (0.39–1.33)

COLOMBIA 16 2 (12.5) 3011 483 (16.0) 0.75 (0.12–2.69)

FRANCE 65 7 (10.8) 2962 478 (16.1) 0.63 (0.26–1.29)

UNITED ARAB EMIRATES 10 1 (10.0) 3017 484 (16.0) 0.58 (0.03–3.10)

BANGLADESH 20 2 (10.0) 3007 483 (16.1) 0.58 (0.09–2.02)

NEW ZEALAND 21 2 (9.5) 3006 483 (16.1) 0.55 (0.09–1.90)



SENEGAL 22 2 (9.1) 3005 483 (16.1) 0.52 (0.08–1.80)

ETHIOPIA 46 4 (8.7) 2981 481 (16.1) 0.50 (0.15–1.23)

PERU 13 1 (7.7) 3014 484 (16.1) 0.44 (0.02–2.22)

AUSTRIA 13 1 (7.7) 3014 484 (16.1) 0.44 (0.02–2.22)

THAILAND 28 2 (7.1) 2999 483 (16.1) 0.40 (0.06–1.35)

GABON 17 1 (5.9) 3010 484 (16.1) 0.33 (0.02–1.60)

NIGERIA 41 2 (4.9) 2986 483 (16.2) 0.27 (0.04–0.87)

THE GAMBIA 21 1 (4.8) 3006 484 (16.1) 0.26 (0.01–1.25)

BURKINA FASO 30 1 (3.3) 2997 484 (16.1) 0.18 (0.01–0.84)

RWANDA 30 1 (3.3) 2997 484 (16.1) 0.18 (0.01–0.84)

MOZAMBIQUE 30 1 (3.3) 2997 484 (16.1) 0.18 (0.01–0.84)

TANZANIA 107 3 (2.8) 2920 482 (16.5) 0.15 (0.04–0.39)

ZIMBABWE 38 1 (2.6) 2989 484 (16.2) 0.14 (0.01–0.65)

UGANDA 144 3 (2.1) 2883 482 (16.7) 0.11 (0.03–0.28)

GHANA 52 1 (1.9) 2975 484 (16.3) 0.10 (0.01–0.46)


CONGO

25 0 (0.0) 3002 485 (16.2) 0.00 (0.00–4.99)

MALI 26 0 (0.0) 3001 485 (16.2) 0.00 (0.00–2.94)

PAKISTAN 27 0 (0.0) 3000 485 (16.2) 0.00 (0.00–1.80)

MALAWI 46 0 (0.0) 2981 485 (16.3) 0.00 (0.00–1.15)

ZAMBIA 62 0 (0.0) 2965 485 (16.4) 0.00 (0.00–0.04)

LESOTHO


Affiliation, n


(%)



(%)

Odds Ratio (95% CI)

UNITED KINGDOM 16 12 (75.0) 104 44 (42.3) 4.09 (1.33–15.41)

CANADA 15 8 (53.3) 105 48 (45.7) 1.36 (0.46–4.13)


SOUTH AFRICA 36 13 (36.1) 84 43 (51.2) 0.54 (0.24–1.19)

LIBERIA


n


(%)

Articles with No

Affiliation, n


Odds Ratio (95% CI)

CHINA 10 9 (90.0) 274 126 (46.0) 10.57 (1.95–196.29)



AUSTRALIA 11 9 (81.8) 273 126 (46.2) 5.25 (1.32–34.85)

SOUTH AFRICA 10 7 (70.0) 274 128 (46.7) 2.66 (0.72–12.54)

SWEDEN 10 7 (70.0) 274 128 (46.7) 2.66 (0.72–12.54)

KENYA 11 5 (45.5) 273 130 (47.6) 0.92 (0.26–3.11)

BELGIUM 11 4 (36.4) 273 131 (48.0) 0.62 (0.16–2.10)

CANADA 17 6 (35.3) 267 129 (48.3) 0.58 (0.20–1.58)


UNITED KINGDOM 51 17 (33.3) 233 118 (50.6) 0.49 (0.25–0.91)

UGANDA 10 3 (30.0) 274 132 (48.2) 0.46 (0.10–1.70)

SWITZERLAND 41 13 (31.7) 243 122 (50.2) 0.46 (0.22–0.91)

GERMANY 18 5 (27.8) 266 130 (48.9) 0.40 (0.13–1.10)

NIGERIA 13 3 (23.1) 271 132 (48.7) 0.32 (0.07–1.06)

FRANCE 17 2 (11.8) 267 133 (49.8) 0.13 (0.02–0.49)

MADAGASCAR


Affiliation, n


Affiliation, n (%)



(%)

Odds Ratio (95% CI)

CANADA 13 6 (46.2) 302 74 (24.5) 2.64 (0.83–8.19)


BELGIUM 13 4 (30.8) 302 76 (25.2) 1.32 (0.35–4.18)

ITALY 11 3 (27.3) 304 77 (25.3) 1.11 (0.24–3.93)

SOUTH AFRICA 21 5 (23.8) 294 75 (25.5) 0.91 (0.29–2.42)

AUSTRALIA 13 3 (23.1) 302 77 (25.5) 0.88 (0.19–2.95)

SWITZERLAND 22 5 (22.7) 293 75 (25.6) 0.85 (0.27–2.25)

UNITED KINGDOM 46 9 (19.6) 269 71 (26.4) 0.68 (0.29–1.42)

FRANCE 82 15 (18.3) 233 65 (27.9) 0.58 (0.30–1.06)

GERMANY 29 4 (13.8) 286 76 (26.6) 0.44 (0.13–1.18)

GHANA 11 1 (9.1) 304 79 (26.0) 0.28 (0.02–1.52)

KENYA 15 1 (6.7) 300 79 (26.3) 0.20 (0.01–1.02)

MALAWI


Affiliation, n


(%)

Articles with No

Affiliation, n


Odds Ratio (95% CI)

CHINA 10 5 (50.0) 1509 274 (18.2) 4.51 (1.25–16.31)

BELGIUM 24 7 (29.2) 1495 272 (18.2) 1.85 (0.71–4.34)



SWEDEN 16 4 (25.0) 1503 275 (18.3) 1.49 (0.41–4.31)

BRAZIL 12 3 (25.0) 1507 276 (18.3) 1.49 (0.33–5.02)

JAPAN 12 3 (25.0) 1507 276 (18.3) 1.49 (0.33–5.02)

NETHERLANDS 66 15 (22.7) 1453 264 (18.2) 1.32 (0.71–2.33)

CANADA 84 19 (22.6) 1435 260 (18.1) 1.32 (0.76–2.20)


SWITZERLAND 74 13 (17.6) 1445 266 (18.4) 0.94 (0.49–1.69)

SOUTH AFRICA 208 35 (16.8) 1311 244 (18.6) 0.88 (0.59–1.29)

GHANA 25 4 (16.0) 1494 275 (18.4) 0.84 (0.24–2.24)

ITALY 41 6 (14.6) 1478 273 (18.5) 0.76 (0.28–1.69)

GERMANY 48 7 (14.6) 1471 272 (18.5) 0.75 (0.31–1.59)

NAMIBIA 16 2 (12.5) 1503 277 (18.4) 0.63 (0.10–2.28)

FRANCE 68 8 (11.8) 1451 271 (18.7) 0.58 (0.25–1.16)

AUSTRALIA 46 5 (10.9) 1473 274 (18.6) 0.53 (0.18–1.24)

UNITED KINGDOM 519 63 (12.1) 1000 216 (21.6) 0.50 (0.37–0.68)

THAILAND 10 1 (10.0) 1509 278 (18.4) 0.49 (0.03–2.63)

NIGERIA 20 2 (10.0) 1499 277 (18.5) 0.49 (0.08–1.71)

NORWAY 41 4 (9.8) 1478 275 (18.6) 0.47 (0.14–1.19)

IRELAND 32 3 (9.4) 1487 276 (18.6) 0.45 (0.11–1.29)

BANGLADESH 11 1 (9.1) 1508 278 (18.4) 0.44 (0.02–2.32)

THE GAMBIA 12 1 (8.3) 1507 278 (18.4) 0.40 (0.02–2.08)

UGANDA 63 5 (7.9) 1456 274 (18.8) 0.37 (0.13–0.85)

BURKINA FASO 13 1 (7.7) 1506 278 (18.5) 0.37 (0.02–1.88)

SINGAPORE 13 1 (7.7) 1506 278 (18.5) 0.37 (0.02–1.88)

KENYA 76 6 (7.9) 1443 273 (18.9) 0.37 (0.14–0.79)

TANZANIA 38 2 (5.3) 1481 277 (18.7) 0.24 (0.04–0.80)

ZAMBIA 40 2 (5.0) 1479 277 (18.7) 0.23 (0.04–0.75)

FINLAND 61 3 (4.9) 1458 276 (18.9) 0.22 (0.05–0.60)

ZIMBABWE 54 2 (3.7) 1465 277 (18.9) 0.16 (0.03–0.53)

MALI Author affiliation country Articles with

>1 Affiliation, n


(%)


n


Odds Ratio (95% CI)

ITALY 11 4 (36.4) 439 105 (23.9) 1.82 (0.47–6.14)

AUSTRALIA 14 5 (35.7) 436 104 (23.9) 1.77 (0.53–5.25)

SPAIN 12 4 (33.3) 438 105 (24.0) 1.59 (0.42–5.14)

SWITZERLAND 44 12 (27.3) 406 97 (23.9) 1.19 (0.57–2.35)



CANADA 46 11 (23.9) 404 98 (24.3) 0.98 (0.46–1.95)


INDIA 10 2 (20.0) 440 107 (24.3) 0.78 (0.12–3.16)

UNITED KINGDOM 89 16 (18.0) 361 93 (25.8) 0.63 (0.34–1.11)

SOUTH AFRICA 24 4 (16.7) 426 105 (24.6) 0.61 (0.17–1.66)

FRANCE 107 19 (17.8) 343 90 (26.2) 0.61 (0.34–1.03)

GERMANY 20 3 (15.0) 430 106 (24.7) 0.54 (0.12–1.64)

NETHERLANDS 23 3 (13.0) 427 106 (24.8) 0.45 (0.11–1.36)

KENYA 25 3 (12.0) 425 106 (24.9) 0.41 (0.10–1.21)

BELGIUM 27 3 (11.1) 423 106 (25.1) 0.37 (0.09–1.10)

DENMARK 10 1 (10.0) 440 108 (24.5) 0.34 (0.02–1.85)

MAR 10 1 (10.0) 440 108 (24.5) 0.34 (0.02–1.85)

NIGERIA 11 1 (9.1) 439 108 (24.6) 0.31 (0.02–1.63)

GHANA 12 1 (8.3) 438 108 (24.7) 0.28 (0.02–1.45)

BENIN 12 1 (8.3) 438 108 (24.7) 0.28 (0.02–1.45)

BURKINA FASO 39 2 (5.1) 411 107 (26.0) 0.15 (0.02–0.51)

MAURITANIA


n


Affiliation, n (%)

Articles with No

Affiliation, n


(%)

Odds Ratio (95% CI)


UNITED KINGDOM 14 6 (42.9) 50 16 (32.0) 1.59 (0.46–5.37)

FRANCE 23 5 (21.7) 41 17 (41.5) 0.39 (0.11–1.20)

SENEGAL 16 1 (6.2) 48 21 (43.8) 0.09 (0.00–0.48)

MAURITIUS Author affiliation country Articles with

>1 Affiliation, n


(%)

Articles with No

Affiliation, n


Odds Ratio (95% CI)


UNITED KINGDOM 13 7 (53.8) 50 13 (26.0) 3.32 (0.94–12.17)

CANADA 10 4 (40.0) 53 16 (30.2) 1.54 (0.35–6.16)

SOUTH AFRICA 10 1 (10.0) 53 19 (35.8) 0.20 (0.01–1.18)



MOZAMBIQUE


n


(%)

Articles with No

Affiliation, n


(%)

Odds Ratio (95% CI)

IRELAND 10 6 (60.0) 651 127 (19.5) 6.19 (1.74–24.51)

BRAZIL 50 15 (30.0) 611 118 (19.3) 1.79 (0.92–3.33)

UNITED KINGDOM 98 27 (27.6) 563 106 (18.8) 1.64 (0.99–2.65)


SWITZERLAND 46 10 (21.7) 615 123 (20.0) 1.11 (0.51–2.22)

SOUTH AFRICA 88 19 (21.6) 573 114 (19.9) 1.11 (0.63–1.88)

CANADA 29 6 (20.7) 632 127 (20.1) 1.04 (0.38–2.45)

AUSTRALIA 21 4 (19.0) 640 129 (20.2) 0.93 (0.26–2.57)

BURKINA FASO 11 2 (18.2) 650 131 (20.2) 0.88 (0.13–3.47)

FINLAND 12 2 (16.7) 649 131 (20.2) 0.79 (0.12–3.05)

INDIA 18 3 (16.7) 643 130 (20.2) 0.79 (0.18–2.44)

ITALY 26 4 (15.4) 635 129 (20.3) 0.71 (0.21–1.90)

PORTUGAL 46 7 (15.2) 615 126 (20.5) 0.70 (0.28–1.50)

TANZANIA 27 3 (11.1) 634 130 (20.5) 0.48 (0.11–1.41)

NETHERLANDS 37 4 (10.8) 624 129 (20.7) 0.47 (0.14–1.20)

UGANDA 21 2 (9.5) 640 131 (20.5) 0.41 (0.06–1.43)

SWEDEN 22 2 (9.1) 639 131 (20.5) 0.39 (0.06–1.35)

ZAMBIA 14 1 (7.1) 647 132 (20.4) 0.30 (0.02–1.53)

FRANCE 29 2 (6.9) 632 131 (20.7) 0.28 (0.05–0.96)

GERMANY 20 1 (5.0) 641 132 (20.6) 0.20 (0.01–0.99)

KENYA 38 1 (2.6) 623 132 (21.2) 0.10 (0.01–0.47)

SPAIN 104 3 (2.9) 557 130 (23.3) 0.10 (0.02–0.26)

BELGIUM 44 1 (2.3) 617 132 (21.4) 0.09 (0.00–0.40)

NAMIBIA


n


(%)

Articles with No

Affiliation, n


Odds Ratio (95% CI)

SWITZERLAND 12 7 (58.3) 187 84 (44.9) 1.72 (0.53–5.98)

CANADA 16 9 (56.2) 183 82 (44.8) 1.58 (0.57–4.60)




UNITED KINGDOM 43 19 (44.2) 156 72 (46.2) 0.92 (0.46–1.82)

SWEDEN 12 5 (41.7) 187 86 (46.0) 0.84 (0.24–2.72)

GERMANY 12 5 (41.7) 187 86 (46.0) 0.84 (0.24–2.72)

SOUTH AFRICA 41 14 (34.1) 158 77 (48.7) 0.55 (0.26–1.10)

KENYA 14 4 (28.6) 185 87 (47.0) 0.45 (0.12–1.40)

NETHERLANDS 14 3 (21.4) 185 88 (47.6) 0.30 (0.07–1.00)

UGANDA 10 1 (10.0) 189 90 (47.6) 0.12 (0.01–0.67)

NIGER


n


Affiliation, n (%)

Articles with No

Affiliation, n


(%)

Odds Ratio (95% CI)

AUSTRALIA 10 5 (50.0) 205 69 (33.7) 1.97 (0.53–7.31)

SWITZERLAND 32 13 (40.6) 183 61 (33.3) 1.37 (0.62–2.93)


CANADA 14 4 (28.6) 201 70 (34.8) 0.75 (0.20–2.33)

UNITED KINGDOM 45 12 (26.7) 170 62 (36.5) 0.63 (0.30–1.29)

BELGIUM 16 4 (25.0) 199 70 (35.2) 0.61 (0.17–1.84)

SOUTH AFRICA 20 5 (25.0) 195 69 (35.4) 0.61 (0.19–1.65)

SENEGAL 17 4 (23.5) 198 70 (35.4) 0.56 (0.15–1.66)

FRANCE 50 12 (24.0) 165 62 (37.6) 0.52 (0.25–1.05)

NIGERIA 19 3 (15.8) 196 71 (36.2) 0.33 (0.07–1.03)

BURKINA FASO 20 3 (15.0) 195 71 (36.4) 0.31 (0.07–0.96)

KENYA 11 1 (9.1) 204 73 (35.8) 0.18 (0.01–0.96)

MALI 14 1 (7.1) 201 73 (36.3) 0.13 (0.01–0.70)

NIGERIA


n


(%)


n


(%)

Odds Ratio (95% CI)

SOUTH KOREA 11 9 (81.8) 3612 415 (11.5) 34.67 (8.90–227.90)

SPAIN 36 17 (47.2) 3587 407 (11.3) 6.99 (3.57–13.58)

CANADA 86 31 (36.0) 3537 393 (11.1) 4.51 (2.84–7.04)

MEXICO 14 5 (35.7) 3609 419 (11.6) 4.23 (1.29–12.30)

MALAYSIA 26 9 (34.6) 3597 415 (11.5) 4.06 (1.72–8.96)

BRAZIL 36 12 (33.3) 3587 412 (11.5) 3.85 (1.85–7.61)

ITALY 18 6 (33.3) 3605 418 (11.6) 3.81 (1.32–9.87)




AUSTRALIA 102 31 (30.4) 3521 393 (11.2) 3.48 (2.22–5.32)

UNITED KINGDOM 462 110 (23.8) 3161 314 (9.9) 2.83 (2.21–3.61)

NETHERLANDS 82 21 (25.6) 3541 403 (11.4) 2.68 (1.58–4.38)

LUXEMBOURG 12 3 (25.0) 3611 421 (11.7) 2.53 (0.56–8.50)

ZAMBIA 14 3 (21.4) 3609 421 (11.7) 2.07 (0.47–6.64)

INDIA 62 13 (21.0) 3561 411 (11.5) 2.03 (1.05–3.67)

FRANCE 59 12 (20.3) 3564 412 (11.6) 1.95 (0.98–3.59)

KENYA 61 12 (19.7) 3562 412 (11.6) 1.87 (0.94–3.43)

SWEDEN 57 11 (19.3) 3566 413 (11.6) 1.83 (0.89–3.42)

DENMARK 16 3 (18.8) 3607 421 (11.7) 1.75 (0.40–5.44)

FINLAND 11 2 (18.2) 3612 422 (11.7) 1.68 (0.26–6.54)

SAUDI ARABIA 17 3 (17.6) 3606 421 (11.7) 1.62 (0.37–4.99)

SWITZERLAND 142 24 (16.9) 3481 400 (11.5) 1.57 (0.98–2.42)

SOUTH AFRICA 258 43 (16.7) 3365 381 (11.3) 1.57 (1.10–2.19)


CONGO

13 2 (15.4) 3610 422 (11.7) 1.37 (0.21–5.14)

BELGIUM 33 4 (12.1) 3590 420 (11.7) 1.04 (0.31–2.66)

CHINA 48 5 (10.4) 3575 419 (11.7) 0.88 (0.30–2.02)

JAPAN 20 2 (10.0) 3603 422 (11.7) 0.84 (0.13–2.91)

GERMANY 70 7 (10.0) 3553 417 (11.7) 0.84 (0.35–1.71)

MOZAMBIQUE 11 1 (9.1) 3612 423 (11.7) 0.75 (0.04–3.95)

BOTSWANA 11 1 (9.1) 3612 423 (11.7) 0.75 (0.04–3.95)

PAKISTAN 11 1 (9.1) 3612 423 (11.7) 0.75 (0.04–3.95)

AUSTRIA 11 1 (9.1) 3612 423 (11.7) 0.75 (0.04–3.95)

GHANA 68 5 (7.4) 3555 419 (11.8) 0.59 (0.21–1.34)

TANZANIA 28 2 (7.1) 3595 422 (11.7) 0.58 (0.09–1.94)

BURKINA FASO 29 2 (6.9) 3594 422 (11.7) 0.56 (0.09–1.87)

MALAWI 16 1 (6.2) 3607 423 (11.7) 0.50 (0.03–2.48)

SENEGAL 16 1 (6.2) 3607 423 (11.7) 0.50 (0.03–2.48)

THE GAMBIA 17 1 (5.9) 3606 423 (11.7) 0.47 (0.03–2.31)

NORWAY 18 1 (5.6) 3605 423 (11.7) 0.44 (0.02–2.16)

UGANDA 77 3 (3.9) 3546 421 (11.9) 0.30 (0.07–0.81)


BENIN 102 1 (1.0) 3521 423 (12.0) 0.07 (0.00–0.33)

CAMEROON 26 0 (0.0) 3597 424 (11.8) 0.00 (0.00–4.24)

NIGER 27 0 (0.0) 3596 424 (11.8) 0.00 (0.00–2.60)

ETHIOPIA 35 0 (0.0) 3588 424 (11.8) 0.00 (0.00–0.14)



REPUBLIC OF THE CONGO Author affiliation country Articles with >1

Affiliation, n


(%)

Articles with No

Affiliation, n


Odds Ratio (95% CI)


UNITED KINGDOM 20 10 (50.0) 99 25 (25.3) 2.96 (1.10–8.05)

FRANCE 44 9 (20.5) 75 26 (34.7) 0.48 (0.19–1.13)

GERMANY 21 3 (14.3) 98 32 (32.7) 0.34 (0.08–1.11)

RWANDA


Affiliation, n


Affiliation, n (%)


n


(%)

Odds Ratio (95% CI)

UNITED KINGDOM 79 18 (22.8) 545 112 (20.6) 1.14 (0.63–1.97)

CANADA 64 13 (20.3) 560 117 (20.9) 0.97 (0.49–1.78)


AUSTRALIA 25 5 (20.0) 599 125 (20.9) 0.95 (0.31–2.39)

SOUTH AFRICA 53 9 (17.0) 571 121 (21.2) 0.76 (0.34–1.53)

SWITZERLAND 43 7 (16.3) 581 123 (21.2) 0.72 (0.29–1.57)

NETHERLANDS 52 8 (15.4) 572 122 (21.3) 0.67 (0.29–1.39)

FRANCE 15 2 (13.3) 609 128 (21.0) 0.58 (0.09–2.13)

ETHIOPIA 15 2 (13.3) 609 128 (21.0) 0.58 (0.09–2.13)

UGANDA 30 4 (13.3) 594 126 (21.2) 0.57 (0.17–1.50)

BELGIUM 47 6 (12.8) 577 124 (21.5) 0.53 (0.20–1.20)

GERMANY 37 4 (10.8) 587 126 (21.5) 0.44 (0.13–1.14)


DENMARK 10 1 (10.0) 614 129 (21.0) 0.42 (0.02–2.25)

KENYA 50 4 (8.0) 574 126 (22.0) 0.31 (0.09–0.78)

SWEDEN 42 3 (7.1) 582 127 (21.8) 0.28 (0.07–0.78)

ZAMBIA 26 0 (0.0) 598 130 (21.7) 0.00 (0.00–12259.95)

SAO TOME AND PRINCIPE



(%)

Articles with No

Affiliation, n


(%)

Odds Ratio (95% CI)

PORTUGAL 12 10 (83.3) 16 10 (62.5) 3.00 (0.54–24.03)



SENEGAL Author affiliation country Articles with

>1 Affiliation, n


(%)


n


(%)

Odds Ratio (95% CI)

SPAIN 17 11 (64.7) 716 138 (19.3) 7.68 (2.87–22.62)

AUSTRALIA 15 7 (46.7) 718 142 (19.8) 3.55 (1.23–10.05)

NETHERLANDS 12 5 (41.7) 721 144 (20.0) 2.86 (0.84–9.10)

ITALY 17 7 (41.2) 716 142 (19.8) 2.83 (1.01–7.50)

SWITZERLAND 39 14 (35.9) 694 135 (19.5) 2.32 (1.15–4.52)


CANADA 34 7 (20.6) 699 142 (20.3) 1.02 (0.40–2.26)

UNITED KINGDOM 81 16 (19.8) 652 133 (20.4) 0.96 (0.52–1.67)

GERMANY 27 5 (18.5) 706 144 (20.4) 0.89 (0.29–2.21)

BENIN 11 2 (18.2) 722 147 (20.4) 0.87 (0.13–3.42)

BELGIUM 34 6 (17.6) 699 143 (20.5) 0.83 (0.31–1.92)

SOUTH AFRICA 35 6 (17.1) 698 143 (20.5) 0.80 (0.30–1.84)

FRANCE 193 25 (13.0) 540 124 (23.0) 0.50 (0.31–0.78)

DENMARK 10 1 (10.0) 723 148 (20.5) 0.43 (0.02–2.32)

TOGO 11 1 (9.1) 722 148 (20.5) 0.39 (0.02–2.05)

VIETNAM 11 1 (9.1) 722 148 (20.5) 0.39 (0.02–2.05)

ETHIOPIA 14 1 (7.1) 719 148 (20.6) 0.30 (0.02–1.51)

KENYA 30 2 (6.7) 703 147 (20.9) 0.27 (0.04–0.91)

UGANDA 16 1 (6.2) 717 148 (20.6) 0.26 (0.01–1.28)

BURKINA FASO 52 2 (3.8) 681 147 (21.6) 0.15 (0.02–0.48)

MALI 34 1 (2.9) 699 148 (21.2) 0.11 (0.01–0.53)

SEYCHELLES


n


Affiliation, n (%)



Odds Ratio (95% CI)

SWITZERLAND 25 3 (12.0) 21 6 (28.6) 0.34 (0.06–1.50)




SIERRA LEONE


n


(%)

Articles with No

Affiliation, n


(%)

Odds Ratio (95% CI)

ITALY 18 9 (50.0) 470 201 (42.8) 1.34 (0.51–3.49)

CANADA 35 17 (48.6) 453 193 (42.6) 1.27 (0.63–2.54)


SOUTH AFRICA 30 13 (43.3) 458 197 (43.0) 1.01 (0.47–2.13)

AUSTRALIA 26 11 (42.3) 462 199 (43.1) 0.97 (0.43–2.14)

NETHERLANDS 20 8 (40.0) 468 202 (43.2) 0.88 (0.34–2.16)

SWEDEN 26 10 (38.5) 462 200 (43.3) 0.82 (0.35–1.82)

IRELAND 16 6 (37.5) 472 204 (43.2) 0.79 (0.26–2.16)

SWITZERLAND 49 18 (36.7) 439 192 (43.7) 0.75 (0.40–1.36)

FRANCE 22 8 (36.4) 466 202 (43.3) 0.75 (0.29–1.78)

NORWAY 17 6 (35.3) 471 204 (43.3) 0.71 (0.24–1.91)

BELGIUM 20 7 (35.0) 468 203 (43.4) 0.70 (0.26–1.75)

GERMANY 24 8 (33.3) 464 202 (43.5) 0.65 (0.26–1.51)

UNITED KINGDOM 173 59 (34.1) 315 151 (47.9) 0.56 (0.38–0.82)

CHINA 36 10 (27.8) 452 200 (44.2) 0.48 (0.22–1.00)

UGANDA 16 3 (18.8) 472 207 (43.9) 0.30 (0.07–0.93)

GHANA 11 2 (18.2) 477 208 (43.6) 0.29 (0.04–1.13)

NIGERIA 21 3 (14.3) 467 207 (44.3) 0.21 (0.05–0.63)

KENYA 15 1 (6.7) 473 209 (44.2) 0.09 (0.00–0.45)

SOMALIA


Affiliation, n


(%)

Articles with No

Affiliation, n


(%)

Odds Ratio (95% CI)

NORWAY 25 23 (92.0) 208 152 (73.1) 4.24 (1.20–26.94)


AUSTRALIA 16 13 (81.2) 217 162 (74.7) 1.47 (0.45–6.59)

SWEDEN 33 26 (78.8) 200 149 (74.5) 1.27 (0.55–3.33)

CANADA 16 11 (68.8) 217 164 (75.6) 0.71 (0.25–2.34)



UNITED KINGDOM 31 20 (64.5) 202 155 (76.7) 0.55 (0.25–1.27)

SOUTH AFRICA 15 8 (53.3) 218 167 (76.6) 0.35 (0.12–1.04)

KENYA 27 9 (33.3) 206 166 (80.6) 0.12 (0.05–0.28)

ETHIOPIA 12 2 (16.7) 221 173 (78.3) 0.06 (0.01–0.22)

SOUTH AFRICA



Affiliation, n (%)

Articles with No

Affiliation, n


Odds Ratio (95% CI)

POLAND 22 14 (63.6) 5532 390 (7.0) 23.07 (9.82–58.08)

TAIWAN 10 6 (60.0) 5544 398 (7.2) 19.39 (5.52–76.12)

CHILE 10 5 (50.0) 5544 399 (7.2) 12.89 (3.57–46.54)

FINLAND 27 11 (40.7) 5527 393 (7.1) 8.98 (4.03–19.31)

EGYPT 10 4 (40.0) 5544 400 (7.2) 8.57 (2.18–30.13)

ITALY 65 25 (38.5) 5489 379 (6.9) 8.43 (5.00–13.95)

SPAIN 71 27 (38.0) 5483 377 (6.9) 8.31 (5.03–13.48)

RUSSIAN FEDERATION 18 7 (38.9) 5536 397 (7.2) 8.24 (3.02–21.03)

COLOMBIA 24 8 (33.3) 5530 396 (7.2) 6.48 (2.61–14.83)

TURKEY 16 5 (31.2) 5538 399 (7.2) 5.85 (1.84–16.18)

CZECH REPUBLIC 16 5 (31.2) 5538 399 (7.2) 5.85 (1.84–16.18)

GREECE 18 5 (27.8) 5536 399 (7.2) 4.95 (1.58–13.20)

PORTUGAL 15 4 (26.7) 5539 400 (7.2) 4.67 (1.29–13.73)

ISRAEL 20 5 (25.0) 5534 399 (7.2) 4.29 (1.39–11.14)

CHINA 75 18 (24.0) 5479 386 (7.0) 4.17 (2.36–7.01)

DENMARK 47 11 (23.4) 5507 393 (7.1) 3.98 (1.92–7.62)

SAUDI ARABIA 14 3 (21.4) 5540 401 (7.2) 3.50 (0.79–11.25)

SWITZERLAND 238 43 (18.1) 5316 361 (6.8) 3.03 (2.12–4.24)

CANADA 249 43 (17.3) 5305 361 (6.8) 2.86 (2.00–4.00)

GERMANY 178 31 (17.4) 5376 373 (6.9) 2.83 (1.86–4.17)

IRELAND 41 7 (17.1) 5513 397 (7.2) 2.65 (1.07–5.67)

BRAZIL 71 12 (16.9) 5483 392 (7.1) 2.64 (1.34–4.78)

SINGAPORE 12 2 (16.7) 5542 402 (7.3) 2.56 (0.39–9.74)


AUSTRIA 19 3 (15.8) 5535 401 (7.2) 2.40 (0.56–7.24)

THAILAND 54 8 (14.8) 5500 396 (7.2) 2.24 (0.97–4.52)

AUSTRALIA 318 45 (14.2) 5236 359 (6.9) 2.24 (1.59–3.09)

ARGENTINA 27 4 (14.8) 5527 400 (7.2) 2.23 (0.65–5.83)



SWEDEN 180 20 (11.1) 5374 384 (7.1) 1.62 (0.98–2.55)

FRANCE 139 15 (10.8) 5415 389 (7.2) 1.56 (0.87–2.61)

JAPAN 28 3 (10.7) 5526 401 (7.3) 1.53 (0.36–4.39)

UNITED KINGDOM 1020 100 (9.8) 4534 304 (6.7) 1.51 (1.19–1.91)

PERU 39 4 (10.3) 5515 400 (7.3) 1.46 (0.44–3.68)

INDIA 126 12 (9.5) 5428 392 (7.2) 1.35 (0.70–2.37)

BELGIUM 153 14 (9.2) 5401 390 (7.2) 1.29 (0.71–2.18)

THE GAMBIA 11 1 (9.1) 5543 403 (7.3) 1.28 (0.07–6.68)

NETHERLANDS 294 26 (8.8) 5260 378 (7.2) 1.25 (0.81–1.86)

SOUTH KOREA 13 1 (7.7) 5541 403 (7.3) 1.06 (0.06–5.41)

PHILIPPINES 14 1 (7.1) 5540 403 (7.3) 0.98 (0.05–4.94)

MEXICO 31 2 (6.5) 5523 402 (7.3) 0.88 (0.14–2.93)

JAMAICA 16 1 (6.2) 5538 403 (7.3) 0.85 (0.05–4.21)

VIETNAM 18 1 (5.6) 5536 403 (7.3) 0.75 (0.04–3.66)

NORWAY 72 4 (5.6) 5482 400 (7.3) 0.75 (0.23–1.82)

PAKISTAN 21 1 (4.8) 5533 403 (7.3) 0.64 (0.04–3.06)

BURKINA FASO 23 1 (4.3) 5531 403 (7.3) 0.58 (0.03–2.76)

TANZANIA 69 3 (4.3) 5485 401 (7.3) 0.58 (0.14–1.56)

NEW ZEALAND 59 2 (3.4) 5495 402 (7.3) 0.44 (0.07–1.43)

ZIMBABWE 77 2 (2.6) 5477 402 (7.3) 0.34 (0.06–1.07)

KENYA 119 3 (2.5) 5435 401 (7.4) 0.32 (0.08–0.86)

NIGERIA 74 1 (1.4) 5480 403 (7.4) 0.17 (0.01–0.78)

GHANA 119 1 (0.8) 5435 403 (7.4) 0.11 (0.01–0.47)

UGANDA 123 1 (0.8) 5431 403 (7.4) 0.10 (0.01–0.46)

BANGLADESH 34 0 (0.0) 5520 404 (7.3) 0.00 (0.00–0.31)

ETHIOPIA 43 0 (0.0) 5511 404 (7.3) 0.00 (0.00–0.04)

MALAWI 63 0 (0.0) 5491 404 (7.4) 0.00 (0.00–0.08)

ZAMBIA 76 0 (0.0) 5478 404 (7.4) 0.00 (0.00–0.02)

SOUTH SUDAN


Affiliation, n


(%)



Odds Ratio (95% CI)

CANADA 14 12 (85.7) 120 48 (40.0) 9.00 (2.32–59.51)

AUSTRALIA 16 10 (62.5) 118 50 (42.4) 2.27 (0.79–7.05)

UNITED KINGDOM 35 18 (51.4) 99 42 (42.4) 1.44 (0.66–3.14)

NORWAY 12 6 (50.0) 122 54 (44.3) 1.26 (0.37–4.24)




NETHERLANDS 17 6 (35.3) 117 54 (46.2) 0.64 (0.21–1.79)

SWITZERLAND 24 8 (33.3) 110 52 (47.3) 0.56 (0.21–1.38)

FRANCE 14 4 (28.6) 120 56 (46.7) 0.46 (0.12–1.45)

SUDAN 11 3 (27.3) 123 57 (46.3) 0.43 (0.09–1.58)

KENYA 16 3 (18.8) 118 57 (48.3) 0.25 (0.05–0.81)

UGANDA 17 3 (17.6) 117 57 (48.7) 0.23 (0.05–0.74)

SUDAN



(%)

Articles with No

Affiliation, n


Odds Ratio (95% CI)

CANADA 16 11 (68.8) 491 132 (26.9) 5.98 (2.13–19.29)

SPAIN 11 7 (63.6) 496 136 (27.4) 4.63 (1.38–17.92)

AUSTRALIA 33 20 (60.6) 474 123 (25.9) 4.39 (2.14–9.30)


ISRAEL 10 5 (50.0) 497 138 (27.8) 2.60 (0.71–9.49)

CHINA 10 5 (50.0) 497 138 (27.8) 2.60 (0.71–9.49)

ITALY 15 7 (46.7) 492 136 (27.6) 2.29 (0.79–6.50)

INDIA 11 4 (36.4) 496 139 (28.0) 1.47 (0.38–4.94)

BELGIUM 17 6 (35.3) 490 137 (28.0) 1.41 (0.48–3.77)

SWEDEN 20 7 (35.0) 487 136 (27.9) 1.39 (0.51–3.47)

GERMANY 30 10 (33.3) 477 133 (27.9) 1.29 (0.57–2.78)

EGYPT 15 5 (33.3) 492 138 (28.0) 1.28 (0.39–3.68)

JAPAN 13 4 (30.8) 494 139 (28.1) 1.14 (0.30–3.55)

SWITZERLAND 36 11 (30.6) 471 132 (28.0) 1.13 (0.52–2.31)

NORWAY 23 7 (30.4) 484 136 (28.1) 1.12 (0.42–2.68)

NETHERLANDS 25 7 (28.0) 482 136 (28.2) 0.99 (0.38–2.33)

FRANCE 18 5 (27.8) 489 138 (28.2) 0.98 (0.31–2.65)

UNITED KINGDOM 93 21 (22.6) 414 122 (29.5) 0.70 (0.40–1.17)

QATAR 10 2 (20.0) 497 141 (28.4) 0.63 (0.09–2.56)

SOUTH AFRICA 25 4 (16.0) 482 139 (28.8) 0.47 (0.14–1.26)

UGANDA 13 2 (15.4) 494 141 (28.5) 0.46 (0.07–1.72)

IRELAND 15 2 (13.3) 492 141 (28.7) 0.38 (0.06–1.41)

SAUDI ARABIA 91 13 (14.3) 416 130 (31.2) 0.37 (0.19–0.66)

KENYA 18 2 (11.1) 489 141 (28.8) 0.31 (0.05–1.10)

UNITED ARAB EMIRATES 12 1 (8.3) 495 142 (28.7) 0.23 (0.01–1.18)



TANZANIA Author affiliation country Articles


n


(%)

Articles with No

Affiliation, n


(%)

Odds Ratio (95% CI)

QATAR 10 4 (40.0) 2229 337 (15.1) 3.74 (0.95–13.17)

AUSTRALIA 59 18 (30.5) 2180 323 (14.8) 2.52 (1.40–4.38)

GREECE 13 4 (30.8) 2226 337 (15.1) 2.49 (0.67–7.70)

CANADA 102 28 (27.5) 2137 313 (14.6) 2.20 (1.38–3.42)

FRANCE 36 10 (27.8) 2203 331 (15.0) 2.18 (0.99–4.42)

AUSTRIA 20 5 (25.0) 2219 336 (15.1) 1.87 (0.60–4.86)

BELGIUM 56 13 (23.2) 2183 328 (15.0) 1.71 (0.87–3.13)

ITALY 46 10 (21.7) 2193 331 (15.1) 1.56 (0.73–3.06)


PERU 15 3 (20.0) 2224 338 (15.2) 1.39 (0.32–4.42)


NETHERLANDS 132 23 (17.4) 2107 318 (15.1) 1.19 (0.73–1.86)

SPAIN 36 6 (16.7) 2203 335 (15.2) 1.12 (0.42–2.52)

CHINA 18 3 (16.7) 2221 338 (15.2) 1.11 (0.26–3.40)

GERMANY 174 28 (16.1) 2065 313 (15.2) 1.07 (0.69–1.61)

SWITZERLAND 216 33 (15.3) 2023 308 (15.2) 1.00 (0.67–1.46)

INDIA 40 6 (15.0) 2199 335 (15.2) 0.98 (0.37–2.19)

UNITED KINGDOM 528 72 (13.6) 1711 269 (15.7) 0.85 (0.64–1.11)

NEW ZEALAND 24 3 (12.5) 2215 338 (15.3) 0.79 (0.19–2.32)

SWEDEN 153 17 (11.1) 2086 324 (15.5) 0.68 (0.39–1.11)

BRAZIL 19 2 (10.5) 2220 339 (15.3) 0.65 (0.10–2.29)

THAILAND 19 2 (10.5) 2220 339 (15.3) 0.65 (0.10–2.29)

CZECH REPUBLIC 10 1 (10.0) 2229 340 (15.3) 0.62 (0.03–3.30)

DENMARK 102 10 (9.8) 2137 331 (15.5) 0.59 (0.29–1.10)

SOUTH AFRICA 173 17 (9.8) 2066 324 (15.7) 0.59 (0.34–0.95)

THE GAMBIA 11 1 (9.1) 2228 340 (15.3) 0.56 (0.03–2.91)

BURKINA FASO 23 2 (8.7) 2216 339 (15.3) 0.53 (0.08–1.81)

SOUTH KOREA 25 2 (8.0) 2214 339 (15.3) 0.48 (0.08–1.64)

JAPAN 29 2 (6.9) 2210 339 (15.3) 0.41 (0.07–1.37)

GHANA 49 3 (6.1) 2190 338 (15.4) 0.36 (0.09–0.98)

NIGERIA 34 2 (5.9) 2205 339 (15.4) 0.34 (0.06–1.14)

ETHIOPIA 36 2 (5.6) 2203 339 (15.4) 0.32 (0.05–1.07)

NORWAY 116 6 (5.2) 2123 335 (15.8) 0.29 (0.11–0.61)



SENEGAL 22 1 (4.5) 2217 340 (15.3) 0.26 (0.01–1.26)

BANGLADESH 25 1 (4.0) 2214 340 (15.4) 0.23 (0.01–1.09)

MOZAMBIQUE 25 1 (4.0) 2214 340 (15.4) 0.23 (0.01–1.09)

KENYA 147 5 (3.4) 2092 336 (16.1) 0.18 (0.06–0.41)

ZIMBABWE 33 1 (3.0) 2206 340 (15.4) 0.17 (0.01–0.80)

UGANDA 98 2 (2.0) 2141 339 (15.8) 0.11 (0.02–0.35)

ZAMBIA 36 0 (0.0) 2203 341 (15.5) 0.00 (0.00–41.82)

MALAWI 39 0 (0.0) 2200 341 (15.5) 0.00 (0.00–12.04)

TOGO



(%)

Articles with No

Affiliation, n


Odds Ratio (95% CI)


UNITED KINGDOM 16 5 (31.2) 233 29 (12.4) 3.20 (0.95–9.49)

SWITZERLAND 20 6 (30.0) 229 28 (12.2) 3.08 (1.02–8.37)

CANADA 13 4 (30.8) 236 30 (12.7) 3.05 (0.79–10.02)

GERMANY 11 2 (18.2) 238 32 (13.4) 1.43 (0.21–5.87)

FRANCE 57 8 (14.0) 192 26 (13.5) 1.04 (0.42–2.36)

SOUTH AFRICA 15 2 (13.3) 234 32 (13.7) 0.97 (0.15–3.74)

BURKINA FASO 28 2 (7.1) 221 32 (14.5) 0.45 (0.07–1.63)

SENEGAL 16 1 (6.2) 233 33 (14.2) 0.40 (0.02–2.10)

UGANDA Author affiliation country Articles with

>1 Affiliation, n


Articles with No

Affiliation, n


(%)

Odds Ratio (95% CI)

SOUTH KOREA 11 8 (72.7) 2985 421 (14.1) 16.24 (4.68–74.38)

CHINA 12 6 (50.0) 2984 423 (14.2) 6.05 (1.89–19.44)

SPAIN 23 7 (30.4) 2973 422 (14.2) 2.64 (1.01–6.23)

IRELAND 10 3 (30.0) 2986 426 (14.3) 2.58 (0.55–9.30)

SENEGAL 18 5 (27.8) 2978 424 (14.2) 2.32 (0.74–6.18)

ISRAEL 11 3 (27.3) 2985 426 (14.3) 2.25 (0.49–7.82)

BOTSWANA 11 3 (27.3) 2985 426 (14.3) 2.25 (0.49–7.82)

NEW ZEALAND 11 3 (27.3) 2985 426 (14.3) 2.25 (0.49–7.82)

BRAZIL 23 6 (26.1) 2973 423 (14.2) 2.13 (0.76–5.15)

AUSTRALIA 88 20 (22.7) 2908 409 (14.1) 1.80 (1.05–2.93)



SWITZERLAND 140 31 (22.1) 2856 398 (13.9) 1.76 (1.14–2.62)

GERMANY 73 15 (20.5) 2923 414 (14.2) 1.57 (0.85–2.72)

ITALY 34 7 (20.6) 2962 422 (14.2) 1.56 (0.62–3.41)

CANADA 256 46 (18.0) 2740 383 (14.0) 1.35 (0.95–1.87)

FRANCE 79 14 (17.7) 2917 415 (14.2) 1.30 (0.69–2.26)


JAPAN 24 4 (16.7) 2972 425 (14.3) 1.20 (0.35–3.19)

UNITED KINGDOM 709 96 (13.5) 2287 333 (14.6) 0.92 (0.72–1.17)

NETHERLANDS 126 15 (11.9) 2870 414 (14.4) 0.80 (0.44–1.34)

THAILAND 19 2 (10.5) 2977 427 (14.3) 0.70 (0.11–2.46)

BELGIUM 134 14 (10.4) 2862 415 (14.5) 0.69 (0.37–1.17)

SOUTH AFRICA 261 27 (10.3) 2735 402 (14.7) 0.67 (0.43–0.99)

FINLAND 10 1 (10.0) 2986 428 (14.3) 0.66 (0.04–3.55)

DENMARK 71 7 (9.9) 2925 422 (14.4) 0.65 (0.27–1.33)

GREECE 25 2 (8.0) 2971 427 (14.4) 0.52 (0.08–1.76)

BURKINA FASO 26 2 (7.7) 2970 427 (14.4) 0.50 (0.08–1.68)

THE GAMBIA 14 1 (7.1) 2982 428 (14.4) 0.46 (0.03–2.31)

NORWAY 67 4 (6.0) 2929 425 (14.5) 0.37 (0.11–0.91)


CONGO

18 1 (5.6) 2978 428 (14.4) 0.35 (0.02–1.71)

INDIA 36 2 (5.6) 2960 427 (14.4) 0.35 (0.06–1.15)

SWEDEN 190 9 (4.7) 2806 420 (15.0) 0.28 (0.13–0.52)

GHANA 31 1 (3.2) 2965 428 (14.4) 0.20 (0.01–0.92)

KENYA 183 5 (2.7) 2813 424 (15.1) 0.16 (0.06–0.35)

ZIMBABWE 81 2 (2.5) 2915 427 (14.6) 0.15 (0.02–0.47)

ZAMBIA 48 0 (0.0) 2948 429 (14.6) 0.00 (0.00–0.77)

ETHIOPIA 51 0 (0.0) 2945 429 (14.6) 0.00 (0.00–0.37)

MALAWI 53 0 (0.0) 2943 429 (14.6) 0.00 (0.00–0.24)

NIGERIA 66 0 (0.0) 2930 429 (14.6) 0.00 (0.00–0.02)

TANZANIA 95 0 (0.0) 2901 429 (14.8) 0.00 (0.00–0.00)

ZAMBIA Author affiliation country Articles


n


(%)

Articles with No

Affiliation, n


(%)

Odds Ratio (95% CI)

ITALY 12 7 (58.3) 989 177 (17.9) 6.42 (2.03–21.92)

SPAIN 11 5 (45.5) 990 179 (18.1) 3.78 (1.08–12.67)



BRAZIL 11 3 (27.3) 990 181 (18.3) 1.68 (0.36–5.86)

FRANCE 26 6 (23.1) 975 178 (18.3) 1.34 (0.49–3.21)

CANADA 42 9 (21.4) 959 175 (18.2) 1.22 (0.54–2.50)


SWITZERLAND 74 13 (17.6) 927 171 (18.4) 0.94 (0.49–1.70)

GERMANY 23 4 (17.4) 978 180 (18.4) 0.93 (0.27–2.52)

UNITED KINGDOM 233 38 (16.3) 768 146 (19.0) 0.83 (0.56–1.22)

CHINA 13 2 (15.4) 988 182 (18.4) 0.81 (0.12–3.03)

AUSTRALIA 26 4 (15.4) 975 180 (18.5) 0.80 (0.23–2.13)

NETHERLANDS 53 8 (15.1) 948 176 (18.6) 0.78 (0.34–1.60)

DENMARK 15 2 (13.3) 986 182 (18.5) 0.68 (0.11–2.49)

SOUTH AFRICA 168 21 (12.5) 833 163 (19.6) 0.59 (0.35–0.94)

BELGIUM 29 3 (10.3) 972 181 (18.6) 0.50 (0.12–1.45)

SWEDEN 14 1 (7.1) 987 183 (18.5) 0.34 (0.02–1.71)

JAPAN 18 1 (5.6) 983 183 (18.6) 0.26 (0.01–1.26)

GHANA 20 1 (5.0) 981 183 (18.7) 0.23 (0.01–1.12)


CONGO

21 1 (4.8) 980 183 (18.7) 0.22 (0.01–1.05)

ZIMBABWE 46 2 (4.3) 955 182 (19.1) 0.19 (0.03–0.63)

INDIA 29 1 (3.4) 972 183 (18.8) 0.15 (0.01–0.73)

PAKISTAN 26 0 (0.0) 975 184 (18.9) 0.00 (0.00–14825.51)

MALAWI 32 0 (0.0) 969 184 (19.0) 0.00 (0.00–239.80)

TANZANIA 44 0 (0.0) 957 184 (19.2) 0.00 (0.00–15468.40)

UGANDA 48 0 (0.0) 953 184 (19.3) 0.00 (0.00–2421.92)

KENYA 67 0 (0.0) 934 184 (19.7) 0.00 (0.00–6.63)

ZIMBABWE


Affiliation, n


(%)


n


(%)

Odds Ratio (95% CI)

CANADA 30 13 (43.3) 714 119 (16.7) 3.82 (1.78–8.05)

CHINA 10 4 (40.0) 734 128 (17.4) 3.16 (0.80–11.21)

BRAZIL 12 4 (33.3) 732 128 (17.5) 2.36 (0.62–7.61)

AUSTRALIA 35 10 (28.6) 709 122 (17.2) 1.92 (0.86–4.00)

SWITZERLAND 45 10 (22.2) 699 122 (17.5) 1.35 (0.62–2.71)

GERMANY 19 4 (21.1) 725 128 (17.7) 1.24 (0.35–3.49)

SOUTH AFRICA 215 38 (17.7) 529 94 (17.8) 0.99 (0.65–1.49)

BELGIUM 13 2 (15.4) 731 130 (17.8) 0.84 (0.13–3.18)




FRANCE 23 3 (13.0) 721 129 (17.9) 0.69 (0.16–2.05)

NETHERLANDS 21 2 (9.5) 723 130 (18.0) 0.48 (0.08–1.68)

UNITED KINGDOM 242 26 (10.7) 502 106 (21.1) 0.45 (0.28–0.70)

NIGERIA 12 1 (8.3) 732 131 (17.9) 0.42 (0.02–2.17)

NORWAY 14 1 (7.1) 730 131 (17.9) 0.35 (0.02–1.79)

INDIA 15 1 (6.7) 729 131 (18.0) 0.33 (0.02–1.64)

ZAMBIA 30 1 (3.3) 714 131 (18.3) 0.15 (0.01–0.73)

KENYA 39 1 (2.6) 705 131 (18.6) 0.12 (0.01–0.54)

MALAWI 46 1 (2.2) 698 131 (18.8) 0.10 (0.01–0.45)

UGANDA 69 1 (1.4) 675 131 (19.4) 0.06 (0.00–0.28)

TANZANIA 34 0 (0.0) 710 132 (18.6) 0.00 (0.00–9820942.40)



where there is no local author: a network bibliometric

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