Author Sovereignty Gap in African Clinical Trial Publications: A bibliometric analysis of authorship patterns in African clinical trials

Abstract

Authorship patterns in African clinical trial publications raise concerns about scientific sovereignty in low resource contexts. This bibliometric study linked 23,873 African trial registrations from ClinicalTrials.gov with corresponding published outputs to assess first and senior author nationality through March 2026. The primary outcome was proportion of non African first authors as a proxy for intellectual leadership and agenda setting in global health research. Results show approximately sixty percent of publications had non African first authors, while senior authorship remained concentrated in institutions in the United States and United Kingdom. Uganda reflected similar donor driven patterns with limited local grant ownership and reduced authorship negotiation capacity. In contrast, South Africa and Kenya showed stronger local authorship presence, suggesting institutional investment can improve research equity. Despite linkage limitations, findings indicate a measurable authorship sovereignty gap requiring policy and structural reform in global health research governance. Strengthening local leadership and funding mechanisms is essential for equitable research partnerships globally.