Content analysis of African emergency care publications published between 2013-2017

Abstract

Introduction: Despite global advances in clinical academic research, published research output emanating from the countries within the African continent remains disproportionately low when compared to that of western and other developed countries. While academic research is always encouraged, no matter the origin, the implications of the continued low rate of publication in Africa has the potential to increase dependency on research originating from settings and populations that are characteristically different to those in Africa. This may be done in order to support the evidence base that informs both the introduction of and support for prehospital patient care practice and the development of high-quality, emergency medical service systems. Therefore, although existing research may very well be robust clinically relevant research, it may not necessarily be contextually appropriate and applicable to African countries. In an effort to initiate and promote the development of an emergency care research agenda for Africa, this study focused on establishing the type of articles that have already been published in this space, and also whether the aim of these published articles has been to address the research gap as indicated in the continent’s burden of disease (BOD). Using the process of content analysis all research articles published on emergency care in Africa between 2013 and 2017 were analysed to establish themes and trends in the research. These trends were then compared the local BOD. Methodology: Published articles with a focus on emergency care, as identified by their medical subject headings (MeSH) and originating from the continent of Africa between 01 January 2013 and 31 December 2017 found within Scopus, Elsevier’s abstract and citation database, were extracted and reviewed using content analysis. Systematically coded and categorised themes, topics and patterns, as well as trends in the research, were identified and then compared to conditions, topics, illness and injuries that represented the continent’s prevailing BOD. Descriptive and inferential tests were then conducted to examine the relationship between the trends that emerged and the conditions representative of the BOD. Results: A total of 886 emergency care articles were initially identified as originating in the selected review period. However, 211 (24%) were then removed as a result of their not being relevant and not meeting the stipulated inclusion criteria. Accordingly, a total of 675 emergency care articles were analysed. Eleven core themes emerged as being representative of trends found in the research articles published between 2013 and 2017 and which were specfic to emergency care in Africa. The majority of emergency care articles were related to trauma emergencies (37.48%), ethics and professional practice (31.26%) and medical emergencies (15.85%). These core themes consistently emerged as the themes identified in the greatest number of publications within the 2013 to 2017 timeframe. Underpinning the 11 core themes, 24 subthemes were identified with articles related to, firstly, burns 135 (20%) which were classified into core Theme 1: Trauma emergencies – greatest number of articles. The number of articles on burns was followed by articles related to professional development, namely, 117 (17.3%) and to ethics and patients’ rights, namely, 91 (13.48%), with the last two both being classified into core Theme 2: Ethics and professional practice. In relation to the journal type and origin, the majority of the articles were published in the African Journal of Emergency Medicine (21.1%), followed by the Injury Journal 74 (10.9%) and the Burns Journal (10.5%) while, in terms of the citation numbers, it was found that the greatest number of articles reported on were ethics and professional practice (1223), with the most articles being published in 2013 (415). A total of 235 (34.8%) out of 675 published articles matched conditions representing the African BOD, specifically BOD Type III: Injuries, with the largest subcategory comprising unintentional injuries (29.33%), followed by intentional injuries (5.33%). Conclusion: The study found that the number of research articles on emergency care published in Africa was increasing year on year, with the majority of articles published being on trauma emergencies, specifically injuries related to burns. While there were a notable number of articles that matched with conditions representing the African BOD, specifically BOD Type III: Injuries, it was found that fewer articles addressed conditions classified as BOD Type I and Type II, which include conditions such as cardiovascular disease, respiratory disease, infectious and parasitic disease and HIV/AIDS.