A Bibliometric Analysis of African Cancer Research Output and its Implication for Cancer Incidence and Mortality

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Olawale, Holiness S. A. Olasore, Babatunde O. Adebesin, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6507435/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective: Cancer mortality has been a menace to the healthcare system over the past three decades. The majority of the cancer mortality globally comes from low- and middle-income countries, and it remains a significant public health challenge in Africa, with considerable disparities in research productivity, cancer incidence, and outcomes across the continent. Method: This study examines scholarly outputs in cancer research (n = 1331) from African authors by country in 12 journals on the Scopus database over the space of ten years (2014–2023). The publication counts, citation metrics, and 2020 cancer reports (cases, mortality, mortality-to-incidence ratio, and mortality rates) were used to explore potential relationships between research activity and health outcomes across African countries. Results: The findings show that Egypt and South Africa lead the continent in cancer research outputs, which correlates with lower cancer MIR, while many countries, particularly in sub-Saharan Africa with low research outputs, such as Somalia, Niger, and the Central African Republic, document some of the highest MIR, emphasizing the urgent need for investment in cancer research and healthcare systems. Conclusion: This study highlights significant disparities in cancer research productivity and outcomes across Africa, with higher research activity linked to reduced mortality rates. Furthermore, regional and international collaboration is essential to address these disparities and improve cancer outcomes across the continent. Africa authorship research output cancer burden bibliometric Figures Figure 1 Figure 2 1.0 INTRODUCTION Cancer is a pressing global public health challenge. About 1 in 5 people develop cancer in their lifetime, with lung cancer ranking first as the most commonly occurring cancer globally, then breast, colorectal, prostate, and stomach cancer in 2022 [ 1 ]. The global cancer burden is rapidly increasing due to population aging, genetic factors, and changing exposures to risk factors linked to socioeconomic development. Approximately 57% of new cancer cases globally arise in low- and middle-income countries (LMICs), largely driven by limited awareness and lack of preventive healthcare infrastructure [ 2 ]. This impact is felt deeply in Africa, where cancer mortality rates now surpass those for HIV/AIDS, tuberculosis, and malaria combined [ 3 ]. The rise in non-communicable diseases like cancer highlights the need for tailored interventions specific to regional challenges, unlike infectious disease controls, which can often be broadly applied across populations. In 2021, Africa accounted for only about 2% of global clinical trials, highlighting its significant underrepresentation in cancer research and clinical studies [ 4 ]. In a knowledge-driven global economy, a country’s investment in research, education, and innovation significantly shapes its economic competitiveness and future growth. For Africa, advancing research capacity is essential not only for economic progress but also for addressing pressing health challenges unique to the continent [ 5 ]. Despite the limited resources and economic challenges, African researchers are increasingly contributing to cancer research, yet these outputs are still minimal compared to global contributions [ 6 ]. A strong research foundation is essential for shaping effective policies and interventions specific to Africa's needs, including better cancer registries, improved funding, and collaborative research that prioritizes African health data [ 2 ]. This current study seeks to explore cancer research in Africa by analyzing bibliometric research output across the continent, with an emphasis on leading countries based on indexed publications in Scopus from 2014 to 2023. It seeks to highlight the growth of cancer research in Africa and evaluate the relationship between cancer research and mortality rates across African countries. 2.0 MATERIALS AND METHODS 2.1 Data Source The primary data source for this study was obtained from the Scopus database https://www.scopus.com/ . The Scopus database was chosen for its extensive coverage of highly cited research and the ability to track author affiliations by region and research outputs [ 7 ]. The articles for this study were retrieved using the search term “Cancer” under the topic category. The query yielded a comprehensive list of journals systematically arranged based on total publication output over a ten-year period (2014–2023). Key metrics were extracted from the Scopus database to provide insight into the scholarly outputs of African countries in cancer research from the top twelve journals from the search results. Table 1 presents information on the selected journals, including their publishers and highest percentile ranking. The selection of these journals for the bibliometric analysis was guided by specific considerations relevant to the research objectives. Key metrics, including journal percentile rankings and citation frequencies, have been used by authors to evaluate the journal's reputation and impact on their research publication. Moreover, publication policies, such as open access availability and article processing or publishing charges (APCs) waivers, were obtained from the Directory of Open Access Journals ( https://doaj.org/ ) , further guiding the selection, as they collectively informed the choice of journals for the analysis, ensuring a comprehensive representation of high-impact cancer research outputs African authors can easily subscribe to [ 8 ]. After selecting the journals, the data for African regional contributions, citation counts, and total research outputs of each African country-affiliated author that was published in the journal within the time frame was obtained. The exported data were processed through SciVal, a bibliometric analysis tool by Elsevier that allowed for easier visualization and regional comparison of contributions by different African countries. For further analysis, the data were exported to Excel spreadsheets, containing metrics such as Scholarly Output, Citation Count, and Field-Weighted Citation Impact. These data points were utilized to evaluate research productivity and the influence of publications from various African countries, thereby identifying trends in cancer research across the continent. It is worth noting that from this point onward, the mention of countries signifies the author's publication output in that country. The cancer case statistics, mortality, and population data for 2020 were retrieved from Sharma, et al. [ 9 ], GLOBOCAN 2020 [ 10 ], and the World Bank Population Data Bank ( https://databank.worldbank.org/ ) [ 11 ]. The mortality-to-incidence ratio (MIR), which provides a population-based indicator of survival, was calculated by dividing the mortality of cancer cases reported in 2020 by the number of incidences in the same year for each of the African countries represented. The formula can be expressed as follows: MIR = \(\:\frac{Number\:of\:Cancer\:Mortality}{Number\:of\:Cancer\:Case\:Incidence}\) The cancer mortality rate was computed to statistically quantify the number of deaths due to cancer in each of the represented African countries in 2020. This rate is expressed as the number of cancer deaths per 100,000 individuals. The formula for calculating the cancer mortality rate is: Mortality rate = \(\:\left(\frac{Number\:of\:Cancer\:Mortality}{Number\:of\:Cancer\:Case\:Incidence}\right)\:x\:100\:000\) 2.2 Data Visualization and Statistical Analysis The collected data were presented through bar graphs and geo charts to illustrate the geographic distribution of African research contributions. The statistical relationship between Mortality-to-Incidence Ratio (MIR), mortality rates, and publication counts was analyzed using SPSS version 27. Spearman's rank-order correlation was employed due to the non-parametric nature of the data. This method allowed for the assessment of monotonic relationships between the variables. Correlation coefficients and significance levels were reported to identify the strength and direction of associations. Table 1 Key metrics of selected journals in cancer research: percentile ranking, access model, and article processing charge fee. Journals Publisher Highest Percentile (%) Access Model APC charge # Asia Pacific Journal of Cancer Prevention Asian Pacific Organization for Cancer Prevention 46 Open Access 150–200 USD BMC Cancer Springer 68 Open Access 3190 USD * Frontiers of Oncology Frontiers Media 70 Open Access 3295 USD * Journal of the American Medical Association (JAMA) American Medical Association 99 Open Access 3000 USD * Journal of Cancer Research and Clinical Oncology Springer Verlag 48 Open Access 4190 USD * Cancer Open Access Multidisciplinary Digital Publishing Institute (MDPI) 74 Open Access 3200 USD * Cancer Medicine John Wiley and Sons Inc. 75 Open Access 4270 USD * Anticancer Research International Institute of Anticancer Research 43 Hybrid open access 170–2,390 USD Cancer Cell International Springer 89 Open Access 2190 USD * Clinical Cancer Research American Association for Cancer Research 94 Hybrid open access 100% waivers applicable to African countries PLoS Genetics Public Library of Science 90 Open Access 2,962 USD ( $ 800 for LMIC) Cell Death and Diseases Springer Nature 93 Open Access 4790 USD * The article processing charge (APC) fees are the standard charges expressed in United States dollars (USD). # - APC charge source https://doaj.org/ (last accessed in December 2024). * - APC policy for 50–100% waivers or discounts, particularly for authors from Low- and Middle-Income Countries (LMICs). 3.0 RESULTS 3.1 African Countries with Scholarly Output in Cancer Research (2014–2023): Regional Distribution, Output, and Citation Count The analysis of cancer research outputs in selected journals from 2014 to 2023 shows a significant pattern in publication volume, visibility, and citation impact as shown in Table 2 . Among the highlighted journals, the Asia Pacific Journal of Cancer Prevention leads in African scholar output, with 676 publications, indicating a strong publication volume but relatively moderate citation impact with 6,031 citations for the accumulated publications. Conversely, JAMA , despite having fewer African author’s contributions (70 publications), shows the highest citation count at 11,416 and an impressive view count of 17,151 of all the papers published by African authors in the space of 10 years. Other journals, such as BMC Cancer and Frontiers of Oncology , also exhibit significant view and citation counts, indicating considerable interest and influence within the African research community. Table 2 Distribution and metrics of cancer research output in the selected journals by African authors (2014–2023) Journals 2014–2023 Scholar Output Views Count Citation Count Number of Countries Asia Pacific Journal of Cancer Prevention 676 10641 6031 25 BMC Cancer 153 2761 2452 21 Frontiers of Oncology 91 1432 915 10 JAMA 70 17151 11416 19 Journal of Cancer Research and Clinical Oncology 66 1462 1333 10 Cancer Open Access 66 1089 682 16 Cancer Medicine 65 992 832 15 Anticancer Research 51 1014 627 11 Cancer Cell International 43 1263 1438 8 Clinical Cancer Research 24 666 870 8 PLoS Genetics 19 347 187 11 Cell Death and Diseases 7 85 26 2 3.2 Distribution of Publication Output and Citation by Country Research output on cancer across African countries based on scholarly contributions from 2014 to 2023 is represented in Table 3 . Northern African countries show a dominant research presence, with 879 publications. Egypt leads in this region with 689 publications, followed by Morocco (87 publications) and Tunisia (40 publications), making Northern African authors the highest contributors on the continent. Southern Africa followed, contributing 190, followed by Eastern Africa and Western Africa, each contributing 123 publications. Ethiopia (53 publications) and Kenya (22 publications) are the top contributors in Eastern Africa, while Nigeria (67 publications) and Ghana (19 publications) lead in Western Africa. Middle African countries show limited research output with only 16 publications, indicating the region's relatively lower research capacity in this field. The top 20 African countries in cancer research output are based on the number of scholarly publications from 2014 to 2023, represented in Fig. 1B. Egypt leads significantly with 689 publications, followed by South Africa with 160 and Morocco with 87, reflecting concentrated research efforts in these countries. Nigerian and Ethiopian authors also contribute substantially, with 67 and 53 publications, respectively. This distribution highlights regional disparities in research capacity, with North and Southern Africa producing the highest outputs overall. Table 3 African countries citations and citation per publication in cancer research from selected journals (2014–2023) Countries Citations Citation per publication Countries Citations Citation per publication Egypt 14256 20.69 Benin 55 13.75 South Africa 3340 20.88 Senegal 39 9.75 Morocco 1828 21.01 Côte d'Ivoire 79 19.75 Nigeria 970 14.48 Mozambique 17 4.25 Ethiopia 560 10.57 Rwanda 39 9.75 Tunisia 651 16.28 Burkina Faso 25 8.33 Sudan 906 30.2 Zimbabwe 55 18.33 Kenya 492 22.36 Mauritius 33 16.5 Uganda 348 15.82 Gambia 15 7.5 Ghana 212 11.16 Namibia 8 4 Libya 303 16.83 Reunion Island 165 82.5 Algeria 248 16.53 Central African Republic 7 7 Cameroon 158 12.15 Niger 45 45 Tanzania 184 14.15 Congo 8 8 Liberia 887 73.92 Guinea 15 15 Zambia 131 14.56 Angola 21 21 Botswana 317 45.29 Madagascar 154 154 Malawi 52 7.43 Swaziland 157 157 Togo 28 4.67 Somalia 1 1 Table 4 shows the research output distribution with cancer cases, mortality, mortality-to-incidence ratio (MIR), and mortality rates of the represented African countries with at least one publication in the space of 2014–2023 in the selected journals for the year 2020. With respect to the cancer cases reported in 2020, Egypt reported the highest number (134,632), followed by Nigeria (124,815) and South Africa (108,168). MIR reflects the proportion of deaths relative to the number of cases and varies widely for each country. South Africa has a relatively low MIR (0.525), whereas countries like Somalia (0.734), Gambia (0.782), and Niger (0.754) show significantly higher MIR, indicative of poorer cancer outcomes. Figure 2A and B show the disparity between the cancer cases and MIR in the countries with higher research outputs and lower research outputs. Egypt and South Africa, with substantial publications and citations, have MIRs of 0.661 and 0.525, respectively, which are lower than those of many countries with minimal research activity. In contrast, Somalia (0.734), Niger, and the Central African Republic, which recorded only one publication each in the selected journal, have some of the highest MIR, suggesting a potential correlation between low research activity and poor health outcomes. The correlation analysis presented in Table 5 highlights the statistical relationships between MIR, mortality rate, and publication counts. A statistically significant correlation (r = 0.392, p = 0.007) was found between publication counts and mortality rates. Similarly, a significant negative correlation (r = − 0.273, p = 0.049) was observed between publication counts and MIR, indicating that increased publication output is associated with a lower MIR. Table 4 African countries with scholarly output and citations in cancer research from selected journals (2014–2023) and 2020 cancer cases statistics, mortality, MIR, and mortality rate Countries Publications (2014–2023) 2020 Cancer Cases 2020 Cancer mortality Mortality-to-incidence ratio Mortality rate per 100,000 Egypt 689 134,632 89,042 0.661 82.86 South Africa 160 108,168 56,802 0.525 96.60 Morocco 87 59,370 35,265 0.594 96.12 Nigeria 67 124,815 78,899 0.632 37.87 Ethiopia 53 77,352 51,865 0.671 44.26 Tunisia 40 19,446 11,855 0.610 97.48 Sudan 30 27,382 17,055 0.623 38.38 Kenya 22 42,116 27,092 0.643 52.11 Uganda 22 34,008 22,992 0.676 51.78 Ghana 19 24,009 15,802 0.658 49.10 Libya 18 7,661 4,750 0.620 71.39 Algeria 15 58,418 32,802 0.562 75.49 Cameroon 13 20,745 13,199 0.636 49.82 Tanzania 13 40,464 26,945 0.666 43.67 Liberia 12 3,552 2,603 0.733 51.16 Zambia 9 13,831 8,672 0.627 45.82 Botswana 7 2,010 1,112 0.553 43.67 Malawi 7 17,936 12,454 0.694 64.27 Togo 6 5,208 3,468 0.666 41.08 Benin 4 6,747 4,662 0.691 36.87 Senegal 4 11,317 7,893 0.697 43.86 Côte d'Ivoire 4 17,300 11,760 0.680 57.78 Mozambique 4 25,446 18,014 0.708 45.97 Rwanda 4 8,835 6,044 0.684 48.02 Burkina Faso 3 12,045 8,695 0.722 40.40 Zimbabwe 3 16,083 10,676 0.664 68.13 Mauritius 2 3,050 1,504 0.493 31.47 Gambia 2 1,035 810 0.782 118.80 Namibia 2 3,345 1,876 0.561 75.37 Reunion Island 2 2,965 1,523 0.514 176.80 Central African Republic 1 2,675 1,957 0.732 37.69 Niger 1 9,787 7,382 0.754 36.63 Congo 1 2,478 1,595 0.644 27.97 Guinea 1 927 592 0.639 4.48 Angola 1 20,327 12,599 0.620 49.02 Madagascar 1 20,681 13,837 0.669 30.34 Swaziland 1 992 618 0.623 44.98 Somalia 1 10,134 7,439 0.734 52.34 Table 5 Spearman's correlation coefficients between publications counts, mortality-to-incidence ratio, and mortality rates cancer-related health indicators. Activity Correlation Coefficient (Spearman's rho) Significance ( p -value) MIR -0.273 0.049 Mortality rates 0.392 0.007 Correlations marked with p ≤ 0.05 are considered statistically significant. A negative correlation indicates an inverse relationship, while a positive correlation shows a direct relationship. MIR is the Mortality-to-Incidence Ratio. 4.0 DISCUSSION Studies comparing African research productivity with developed countries consistently show that African nations rank low, with research output remaining relatively poor due to limited engagement in research and development [ 12 , 13 ]. The current bibliometric analysis of research outputs on cancer across African countries shows a significant discrepancy between cancer burden and scholarly contributions. Several studies have shown that Egypt and South Africa are the leading contributors to research output in various fields of research in Africa [ 13 , 14 ], and a similar trend is also observed in this study on cancer research output in the selected twelve Scopus-indexed journals on cancer. Comparing the research output and African country records of various cancer cases as reported in 2020, this study shows that countries with higher research outputs—Egypt, South Africa, Morocco, and Nigeria—not only lead in publication counts but also demonstrate substantial citation counts compared to other countries with low scholarly outputs. This association between publication numbers and citations is consistent with prior findings, which suggest that countries producing a high volume of research are more likely to establish global visibility and contribute to scientific advancement [ 15 ]. It could be suggested that citation counts serve not only as indicators of research quality but may enhance visibility for researchers from developing countries. Increased citations can facilitate access to funding and foster collaborative networks, thereby promoting wider dissemination and international recognition of their work, which can, in turn, elevate the overall impact of their research [ 16 ]. The 2020 data on cancer cases and mortality in Africa show regional disparities in cancer burden across African countries [ 9 ]. These variations may highlight how differences in healthcare access, socioeconomic factors, cultural beliefs, early diagnosis, and treatment capabilities can impact cancer rates across regions. Additionally, limitations in data collection and reporting practices may influence recorded cancer statistics, especially in sub-Saharan countries [ 17 , 18 ]. Lombe, et al. [ 19 ] emphasized that late-stage diagnosis and limited access to advanced cancer therapies contribute significantly to the high cancer MIR as observed in this current study in countries such as Liberia, the Central African Republic, Niger, and Somalia, where the percentage of mortality to the recorded incidence of cancer exceeds 70%. South Africa, with relatively high publication rates and research activity, also demonstrates a high prevalence of cancer cases but a slightly lower MIR (52.5%) was observed compared to other countries with similar case counts. It is suggestive that this may be attributed to developed oncology services, preventive screening, and research-informed interventions. The research productivity correlates moderately with cancer MIR despite high case counts in Egypt (MIR: 66.1%), South Africa (MIR: 52.5%), Morocco (MIR: 59.4%), Nigeria (MIR: 63.2%), and Ethiopia (MIR: 67.1%), which emerge as the top 5 countries with the highest publication counts (79% of all the recorded publications from the twelve journals selected). Conversely, countries with minimal research contributions, such as Somalia, Niger, and the Central African Republic, face much higher MIRs (73%, 75%, and 73%, respectively). This trend suggests that limited research output may correspond with underdeveloped healthcare systems, limited access to advanced cancer treatment options, and inadequate early detection efforts, as previously highlighted by Mbau, et al. [ 20 ]. By supporting the development of national research capacities, African nations could achieve improved public health outcomes, reduce the mortality-to-incidence ratio, and bridge the gap in cancer care quality across the continent. Most African researchers need higher levels of public investment in research and development. Locally funded grants for cancer research, such as the African Organization for Research and Training in Cancer–BIG Cat initiative and African Academy of Sciences (AAS) grants, which are available for African researchers, can leverage national-level performance data to evaluate international competitiveness and identify scientific strengths, thereby informing strategic research funding and policy development [ 21 ]. The trends observed in African cancer research outputs show both potential and challenges in research productivity and citation impact. Countries such as Egypt and South Africa demonstrate relatively higher publication output and citation counts, which could serve as benchmarks for reinforcing research in countries with lower outputs. Increasing funding from external organizations like the National Institutes of Health (NIH), the Gates Foundation, and the World Health Organization (WHO) can further support research in countries with lower scholarly output, helping to bridge gaps in capacity, infrastructure, and international visibility. Strengthening these networks may also improve citation impact as African research gains greater global dissemination and recognition [ 13 , 22 ]. Studies have highlighted several limitations regarding the representation and visibility of African researchers in high-impact journals, as many African researchers often choose to submit their research to locally published journals, due to accessibility, a platform for context-specific research, focus on the quantity of research output rather than quality, or resource constraints, which may not have achieved significant international visibility [ 23 – 25 ]. Additionally, high teaching workloads, limited institutional incentives, and inadequate financial support hinder their ability to engage in collaborative, high-impact research [ 26 , 27 ]. A significant limitation of this study is excluding locally published African journals. This may overlook valuable contributions from these journals, which could provide insight into region-specific cancer research and interventions. Therefore, future studies should explore the quality and impact of research published in African journals and examine their role in shaping cancer-related, research-informed interventions. By including a broader range of journals and assessing their local contributions 5.0 Summary and Conclusion The current study emphasizes the need for targeted support and investment in African cancer research. Countries with higher research contributions, such as Egypt, South Africa, Morocco, Nigeria, and Ethiopia, have better cancer outcomes with comparatively lower mortality-to-incidence ratios. In contrast, countries with limited research activity tend to have greater mortality-to-incidence ratios. The disparities in research output and cancer outcomes highlight an opportunity for African countries to strengthen their research capacity as a means of enhancing healthcare infrastructure and ultimately improving cancer survival rates on the continent. By supporting the development of national research capacities, African nations could achieve improved public health outcomes, reduce the mortality-to-incidence ratio, and bridge the gap in cancer care quality across the African continent. Declarations Conflicts of interest/Competing interests: The authors have no competing interest to declare Ethics approval: Not applicable. Consent to participate: Not applicable. Consent to Publish: Not applicable. Declaration of Competing Interest The authors declare no conflict of interest. Funding statement No funding was received for this study. Author Contribution M.O.O.: Conceptualization, data curation, formal analysis, methodology, manuscript writing (drafting, editing and review of the manuscript). H.S.A.O.: Conceptualization, data curation, formal analysis, methodology, manuscript writing (drafting, editing and review of the manuscript). B.O.A.: Conceptualization, methodology, manuscript writing (drafting, editing and review of the manuscript). A.O.A.: Formal analysis, methodology, manuscript writing (drafting, editing and review of the manuscript). J.O.F.: Methodology, manuscript writing (drafting, editing and review of the manuscript). Availability of data and material: Not applicable. References F. Bray et al. , "Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries," CA: a cancer journal for clinicians, vol. 74, no. 3, pp. 229-263, 2024. Y. Hamdi et al. , "Cancer in Africa: the untold story," Frontiers in oncology, vol. 11, p. 650117, 2021. T. R. Rebbeck, "Cancer in sub-saharan africa," Science, vol. 367, no. 6473, pp. 27-28, 2020. A. Ibraheem et al. , "Cancer clinical trials in Africa—An untapped opportunity: Recommendations from AORTIC 2019 conference special interest group in clinical trials," JCO Global Oncology, vol. 7, pp. 1358-1363, 2021. J. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6507435","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":459167931,"identity":"557afb97-662f-4688-8716-3f5dd3bb7416","order_by":0,"name":"Mathew O. Olawale","email":"","orcid":"","institution":"University of Lagos","correspondingAuthor":false,"prefix":"","firstName":"Mathew","middleName":"O.","lastName":"Olawale","suffix":""},{"id":459167932,"identity":"d6758022-58db-4556-b894-cb48aba6af04","order_by":1,"name":"Holiness S. A. Olasore","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA/ElEQVRIiWNgGAWjYBACAwbmBgbGBiCLHUgkFEAF8WthhGrhOQDUYkCSFokEuGL8WszZGxs//txhk88v+cbswQMDO7sG9uZtEow7anFqsew52CzNeybNcubsHHODBIPk5AaeY2USjGeO43bYjcQGaca2wwYGt3PMJBIMmJMZJIAMxrZj+LQ0//wJ1GJ/8wxIS30yg/wbglraJHhBtkjwgLQctmMAMRjbanBrOXOwzZq3Lc1A4kxaGVDL8QQ2nrRii8S2A7i1HG8+fPNnm40Bf/vhbZI/Kqrt+dkPb7zxsa0OpxYMkNgGIhMYDhOvxR5Kk2DLKBgFo2AUDHcAALXwUuHWfqz4AAAAAElFTkSuQmCC","orcid":"","institution":"University of Lagos","correspondingAuthor":true,"prefix":"","firstName":"Holiness","middleName":"S. A.","lastName":"Olasore","suffix":""},{"id":459167933,"identity":"078b1009-c53e-48fb-a6bd-04131499f5fe","order_by":2,"name":"Babatunde O. Adebesin","email":"","orcid":"","institution":"Hillside University of Science and Technology","correspondingAuthor":false,"prefix":"","firstName":"Babatunde","middleName":"O.","lastName":"Adebesin","suffix":""},{"id":459167934,"identity":"ab95d2ee-fe5b-40b3-8459-518899692ab9","order_by":3,"name":"Akinboye O. Arinola","email":"","orcid":"","institution":"Southwestern University Nigeria","correspondingAuthor":false,"prefix":"","firstName":"Akinboye","middleName":"O.","lastName":"Arinola","suffix":""},{"id":459167935,"identity":"2ac0de0d-b06b-4d4c-abcd-5a1165fcb68e","order_by":4,"name":"Joseph O. Faleti","email":"","orcid":"","institution":"University of Lagos","correspondingAuthor":false,"prefix":"","firstName":"Joseph","middleName":"O.","lastName":"Faleti","suffix":""}],"badges":[],"createdAt":"2025-04-22 22:08:11","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6507435/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6507435/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":83280570,"identity":"760c4ef5-18bb-4cba-ab10-4ed11df3b776","added_by":"auto","created_at":"2025-05-22 10:11:28","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":79643,"visible":true,"origin":"","legend":"\u003cp\u003ePublication output by African authors in the selected journals (a) African countries and their scholarly output in cancer research from selected journals (2014–2023) (b) leading 20 African countries by scholarly output in cancer research from selected journals (2014-2023)\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6507435/v1/70612e81375b3d5ef8fd8424.jpg"},{"id":83279541,"identity":"cd77f3ab-74d2-4afb-b788-feb090924b05","added_by":"auto","created_at":"2025-05-22 10:03:28","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":74999,"visible":true,"origin":"","legend":"\u003cp\u003eGeo-mapping of selected African countries under study in 2020: comparing the cancer incidence and the mortality-to-incidence ratio (a) cancer case (b) cancer MIR\u003c/p\u003e","description":"","filename":"2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6507435/v1/bd0db316823e1c7e0454e816.jpg"},{"id":86312692,"identity":"6223948d-04f3-47e1-9faf-230c0c07c5f2","added_by":"auto","created_at":"2025-07-09 08:24:03","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1272426,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6507435/v1/17cc5953-ab71-404e-bb4e-18665f2a4c9e.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"A Bibliometric Analysis of African Cancer Research Output and its Implication for Cancer Incidence and Mortality","fulltext":[{"header":"1.0 INTRODUCTION","content":"\u003cp\u003eCancer is a pressing global public health challenge. About 1 in 5 people develop cancer in their lifetime, with lung cancer ranking first as the most commonly occurring cancer globally, then breast, colorectal, prostate, and stomach cancer in 2022 [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. The global cancer burden is rapidly increasing due to population aging, genetic factors, and changing exposures to risk factors linked to socioeconomic development. Approximately 57% of new cancer cases globally arise in low- and middle-income countries (LMICs), largely driven by limited awareness and lack of preventive healthcare infrastructure [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThis impact is felt deeply in Africa, where cancer mortality rates now surpass those for HIV/AIDS, tuberculosis, and malaria combined [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. The rise in non-communicable diseases like cancer highlights the need for tailored interventions specific to regional challenges, unlike infectious disease controls, which can often be broadly applied across populations. In 2021, Africa accounted for only about 2% of global clinical trials, highlighting its significant underrepresentation in cancer research and clinical studies [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. In a knowledge-driven global economy, a country\u0026rsquo;s investment in research, education, and innovation significantly shapes its economic competitiveness and future growth. For Africa, advancing research capacity is essential not only for economic progress but also for addressing pressing health challenges unique to the continent [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDespite the limited resources and economic challenges, African researchers are increasingly contributing to cancer research, yet these outputs are still minimal compared to global contributions [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. A strong research foundation is essential for shaping effective policies and interventions specific to Africa's needs, including better cancer registries, improved funding, and collaborative research that prioritizes African health data [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThis current study seeks to explore cancer research in Africa by analyzing bibliometric research output across the continent, with an emphasis on leading countries based on indexed publications in Scopus from 2014 to 2023. It seeks to highlight the growth of cancer research in Africa and evaluate the relationship between cancer research and mortality rates across African countries.\u003c/p\u003e"},{"header":"2.0 MATERIALS AND METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Data Source\u003c/h2\u003e \u003cp\u003eThe primary data source for this study was obtained from the Scopus database \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.scopus.com/\u003c/span\u003e\u003cspan address=\"https://www.scopus.com/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. The Scopus database was chosen for its extensive coverage of highly cited research and the ability to track author affiliations by region and research outputs [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. The articles for this study were retrieved using the search term \u0026ldquo;Cancer\u0026rdquo; under the topic category. The query yielded a comprehensive list of journals systematically arranged based on total publication output over a ten-year period (2014\u0026ndash;2023).\u003c/p\u003e \u003cp\u003eKey metrics were extracted from the Scopus database to provide insight into the scholarly outputs of African countries in cancer research from the top twelve journals from the search results. Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e presents information on the selected journals, including their publishers and highest percentile ranking. The selection of these journals for the bibliometric analysis was guided by specific considerations relevant to the research objectives. Key metrics, including journal percentile rankings and citation frequencies, have been used by authors to evaluate the journal's reputation and impact on their research publication. Moreover, publication policies, such as open access availability and article processing or publishing charges (APCs) waivers, were obtained from the Directory of Open Access Journals (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doaj.org/\u003c/span\u003e\u003cspan address=\"https://doaj.org/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e)\u003c/span\u003e, further guiding the selection, as they collectively informed the choice of journals for the analysis, ensuring a comprehensive representation of high-impact cancer research outputs African authors can easily subscribe to [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAfter selecting the journals, the data for African regional contributions, citation counts, and total research outputs of each African country-affiliated author that was published in the journal within the time frame was obtained. The exported data were processed through SciVal, a bibliometric analysis tool by Elsevier that allowed for easier visualization and regional comparison of contributions by different African countries. For further analysis, the data were exported to Excel spreadsheets, containing metrics such as Scholarly Output, Citation Count, and Field-Weighted Citation Impact. These data points were utilized to evaluate research productivity and the influence of publications from various African countries, thereby identifying trends in cancer research across the continent. It is worth noting that from this point onward, the mention of countries signifies the author's publication output in that country.\u003c/p\u003e \u003cp\u003eThe cancer case statistics, mortality, and population data for 2020 were retrieved from Sharma, et al. [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e], GLOBOCAN 2020 [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e], and the World Bank Population Data Bank (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://databank.worldbank.org/\u003c/span\u003e\u003cspan address=\"https://databank.worldbank.org/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e)\u003c/span\u003e [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. The mortality-to-incidence ratio (MIR), which provides a population-based indicator of survival, was calculated by dividing the mortality of cancer cases reported in 2020 by the number of incidences in the same year for each of the African countries represented. The formula can be expressed as follows:\u003c/p\u003e \u003cp\u003eMIR = \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\frac{Number\\:of\\:Cancer\\:Mortality}{Number\\:of\\:Cancer\\:Case\\:Incidence}\\)\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e \u003cp\u003eThe cancer mortality rate was computed to statistically quantify the number of deaths due to cancer in each of the represented African countries in 2020. This rate is expressed as the number of cancer deaths per 100,000 individuals. The formula for calculating the cancer mortality rate is:\u003c/p\u003e \u003cp\u003eMortality rate = \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\left(\\frac{Number\\:of\\:Cancer\\:Mortality}{Number\\:of\\:Cancer\\:Case\\:Incidence}\\right)\\:x\\:100\\:000\\)\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Data Visualization and Statistical Analysis\u003c/h2\u003e \u003cp\u003eThe collected data were presented through bar graphs and geo charts to illustrate the geographic distribution of African research contributions. The statistical relationship between Mortality-to-Incidence Ratio (MIR), mortality rates, and publication counts was analyzed using SPSS version 27. Spearman's rank-order correlation was employed due to the non-parametric nature of the data. This method allowed for the assessment of monotonic relationships between the variables. Correlation coefficients and significance levels were reported to identify the strength and direction of associations.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eKey metrics of selected journals in cancer research: percentile ranking, access model, and article processing charge fee.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eJournals\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePublisher\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eHighest Percentile (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAccess Model\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAPC charge\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAsia Pacific Journal of Cancer Prevention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAsian Pacific Organization for Cancer Prevention\u003c/p\u003e \u003c/td\u003e \u003ctd 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colname=\"c2\"\u003e \u003cp\u003eFrontiers Media\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eOpen Access\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3295 USD *\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eJournal of the American Medical Association (JAMA)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAmerican Medical Association\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eOpen Access\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3000 USD *\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e 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colname=\"c3\"\u003e \u003cp\u003e43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eHybrid open access\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e170\u0026ndash;2,390 USD\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCancer Cell International\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSpringer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eOpen Access\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2190 USD *\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClinical Cancer Research\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAmerican Association for Cancer Research\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eHybrid open access\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e100% waivers applicable to African countries\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePLoS Genetics\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePublic Library of Science\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eOpen Access\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2,962 USD (\u003cspan\u003e$\u003c/span\u003e800 for LMIC)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCell Death and Diseases\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSpringer Nature\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eOpen Access\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4790 USD *\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe article processing charge (APC) fees are the standard charges expressed in United States dollars (USD).\u003c/p\u003e \u003cp\u003e \u003csup\u003e#\u003c/sup\u003e - APC charge source \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doaj.org/\u003c/span\u003e\u003cspan address=\"https://doaj.org/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (last accessed in December 2024).\u003c/p\u003e \u003cp\u003e* - APC policy for 50\u0026ndash;100% waivers or discounts, particularly for authors from Low- and Middle-Income Countries (LMICs).\u003c/p\u003e \u003c/div\u003e"},{"header":"3.0 RESULTS","content":"\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e3.1 African Countries with Scholarly Output in Cancer Research (2014\u0026ndash;2023): Regional Distribution, Output, and Citation Count\u003c/h2\u003e \u003cp\u003eThe analysis of cancer research outputs in selected journals from 2014 to 2023 shows a significant pattern in publication volume, visibility, and citation impact as shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. Among the highlighted journals, the \u003cem\u003eAsia Pacific Journal of Cancer Prevention\u003c/em\u003e leads in African scholar output, with 676 publications, indicating a strong publication volume but relatively moderate citation impact with 6,031 citations for the accumulated publications. Conversely, \u003cem\u003eJAMA\u003c/em\u003e, despite having fewer African author\u0026rsquo;s contributions (70 publications), shows the highest citation count at 11,416 and an impressive view count of 17,151 of all the papers published by African authors in the space of 10 years. Other journals, such as \u003cem\u003eBMC Cancer\u003c/em\u003e and \u003cem\u003eFrontiers of Oncology\u003c/em\u003e, also exhibit significant view and citation counts, indicating considerable interest and influence within the African research community.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDistribution and metrics of cancer research output in the selected journals by African authors (2014\u0026ndash;2023)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eJournals\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2014\u0026ndash;2023 Scholar Output\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eViews Count\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCitation Count\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNumber of Countries\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAsia Pacific Journal of Cancer Prevention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e676\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10641\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6031\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMC Cancer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e153\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2761\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2452\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFrontiers of Oncology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1432\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e915\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eJAMA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e17151\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e11416\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eJournal of Cancer Research and Clinical Oncology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1462\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1333\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCancer Open Access\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1089\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e682\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCancer Medicine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e992\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e832\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnticancer Research\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1014\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e627\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCancer Cell International\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1263\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1438\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClinical Cancer Research\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e666\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e870\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePLoS Genetics\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e347\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e187\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCell Death and Diseases\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e3.2 Distribution of Publication Output and Citation by Country\u003c/h2\u003e \u003cp\u003eResearch output on cancer across African countries based on scholarly contributions from 2014 to 2023 is represented in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. Northern African countries show a dominant research presence, with 879 publications. Egypt leads in this region with 689 publications, followed by Morocco (87 publications) and Tunisia (40 publications), making Northern African authors the highest contributors on the continent. Southern Africa followed, contributing 190, followed by Eastern Africa and Western Africa, each contributing 123 publications. Ethiopia (53 publications) and Kenya (22 publications) are the top contributors in Eastern Africa, while Nigeria (67 publications) and Ghana (19 publications) lead in Western Africa. Middle African countries show limited research output with only 16 publications, indicating the region's relatively lower research capacity in this field.\u003c/p\u003e \u003cp\u003eThe top 20 African countries in cancer research output are based on the number of scholarly publications from 2014 to 2023, represented in Fig.\u0026nbsp;1B. Egypt leads significantly with 689 publications, followed by South Africa with 160 and Morocco with 87, reflecting concentrated research efforts in these countries. Nigerian and Ethiopian authors also contribute substantially, with 67 and 53 publications, respectively. This distribution highlights regional disparities in research capacity, with North and Southern Africa producing the highest outputs overall.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAfrican countries citations and citation per publication in cancer research from selected journals (2014\u0026ndash;2023)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCountries\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCitations\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCitation per publication\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCountries\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCitations\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eCitation per publication\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEgypt\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e14256\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e20.69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBenin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e13.75\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSouth Africa\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3340\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e20.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSenegal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e9.75\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMorocco\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1828\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e21.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eC\u0026ocirc;te d'Ivoire\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e19.75\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNigeria\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e970\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMozambique\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4.25\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEthiopia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e560\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRwanda\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e9.75\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTunisia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e651\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBurkina Faso\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e8.33\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSudan\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e906\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e30.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eZimbabwe\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e18.33\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKenya\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e492\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e22.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMauritius\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e16.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUganda\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e348\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eGambia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e7.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGhana\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e212\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNamibia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLibya\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e303\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eReunion Island\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e165\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e82.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAlgeria\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e248\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCentral African Republic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCameroon\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e158\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNiger\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTanzania\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e184\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCongo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLiberia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e887\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e73.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eGuinea\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eZambia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e131\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAngola\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBotswana\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e317\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e45.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMadagascar\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e154\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e154\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMalawi\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSwaziland\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e157\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e157\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTogo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSomalia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e shows the research output distribution with cancer cases, mortality, mortality-to-incidence ratio (MIR), and mortality rates of the represented African countries with at least one publication in the space of 2014\u0026ndash;2023 in the selected journals for the year 2020. With respect to the cancer cases reported in 2020, Egypt reported the highest number (134,632), followed by Nigeria (124,815) and South Africa (108,168). MIR reflects the proportion of deaths relative to the number of cases and varies widely for each country. South Africa has a relatively low MIR (0.525), whereas countries like Somalia (0.734), Gambia (0.782), and Niger (0.754) show significantly higher MIR, indicative of poorer cancer outcomes. Figure\u0026nbsp;2A and B show the disparity between the cancer cases and MIR in the countries with higher research outputs and lower research outputs. Egypt and South Africa, with substantial publications and citations, have MIRs of 0.661 and 0.525, respectively, which are lower than those of many countries with minimal research activity. In contrast, Somalia (0.734), Niger, and the Central African Republic, which recorded only one publication each in the selected journal, have some of the highest MIR, suggesting a potential correlation between low research activity and poor health outcomes.\u003c/p\u003e \u003cp\u003eThe correlation analysis presented in Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e highlights the statistical relationships between MIR, mortality rate, and publication counts. A statistically significant correlation (r\u0026thinsp;=\u0026thinsp;0.392, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.007) was found between publication counts and mortality rates. Similarly, a significant negative correlation (r\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;0.273, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.049) was observed between publication counts and MIR, indicating that increased publication output is associated with a lower MIR.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAfrican countries with scholarly output and citations in cancer research from selected journals (2014\u0026ndash;2023) and 2020 cancer cases statistics, mortality, MIR, and mortality rate\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCountries\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePublications (2014\u0026ndash;2023)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2020 Cancer Cases\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2020 Cancer mortality\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eMortality-to-incidence ratio\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eMortality rate per 100,000\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEgypt\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e689\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e134,632\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e89,042\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.661\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e82.86\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSouth Africa\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e160\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e108,168\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e56,802\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.525\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e96.60\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMorocco\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e59,370\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e35,265\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.594\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e96.12\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNigeria\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e124,815\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e78,899\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.632\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e37.87\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEthiopia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e77,352\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e51,865\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.671\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e44.26\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTunisia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e19,446\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e11,855\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.610\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e97.48\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSudan\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e27,382\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e17,055\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.623\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e38.38\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKenya\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e42,116\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e27,092\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.643\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e52.11\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUganda\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e34,008\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e22,992\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.676\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e51.78\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGhana\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e24,009\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e15,802\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.658\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e49.10\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLibya\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7,661\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4,750\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.620\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e71.39\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAlgeria\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e58,418\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e32,802\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.562\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e75.49\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCameroon\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e20,745\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e13,199\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.636\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e49.82\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTanzania\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e40,464\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e26,945\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.666\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e43.67\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLiberia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3,552\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2,603\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.733\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e51.16\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eZambia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e13,831\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e8,672\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.627\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e45.82\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBotswana\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2,010\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1,112\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.553\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e43.67\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMalawi\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e17,936\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e12,454\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.694\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e64.27\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTogo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5,208\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3,468\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.666\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e41.08\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBenin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6,747\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4,662\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.691\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e36.87\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSenegal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11,317\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e7,893\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.697\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e43.86\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eC\u0026ocirc;te d'Ivoire\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e17,300\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e11,760\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.680\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e57.78\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMozambique\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e25,446\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e18,014\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.708\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e45.97\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRwanda\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8,835\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6,044\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.684\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e48.02\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBurkina Faso\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12,045\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e8,695\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.722\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e40.40\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eZimbabwe\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16,083\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e10,676\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.664\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e68.13\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMauritius\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3,050\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1,504\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.493\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e31.47\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGambia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1,035\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e810\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.782\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e118.80\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNamibia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3,345\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1,876\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.561\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e75.37\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReunion Island\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2,965\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1,523\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.514\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e176.80\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCentral African Republic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2,675\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1,957\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.732\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e37.69\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNiger\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9,787\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e7,382\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.754\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e36.63\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCongo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2,478\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1,595\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.644\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e27.97\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGuinea\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e927\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e592\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.639\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e4.48\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAngola\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e20,327\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e12,599\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.620\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e49.02\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMadagascar\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e20,681\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e13,837\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.669\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e30.34\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSwaziland\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e992\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e618\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.623\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e44.98\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSomalia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10,134\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e7,439\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.734\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e52.34\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSpearman's correlation coefficients between publications counts, mortality-to-incidence ratio, and mortality rates cancer-related health indicators.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eActivity\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCorrelation Coefficient (Spearman's rho)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSignificance (\u003cem\u003ep\u003c/em\u003e-value)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMIR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.273\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.049\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMortality rates\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.392\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.007\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eCorrelations marked with \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026le;\u0026thinsp;0.05 are considered statistically significant.\u003c/p\u003e \u003cp\u003eA negative correlation indicates an inverse relationship, while a positive correlation shows a direct relationship.\u003c/p\u003e \u003cp\u003eMIR is the Mortality-to-Incidence Ratio.\u003c/p\u003e "},{"header":"4.0 DISCUSSION","content":"\u003cp\u003eStudies comparing African research productivity with developed countries consistently show that African nations rank low, with research output remaining relatively poor due to limited engagement in research and development [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. The current bibliometric analysis of research outputs on cancer across African countries shows a significant discrepancy between cancer burden and scholarly contributions. Several studies have shown that Egypt and South Africa are the leading contributors to research output in various fields of research in Africa [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e], and a similar trend is also observed in this study on cancer research output in the selected twelve Scopus-indexed journals on cancer.\u003c/p\u003e \u003cp\u003eComparing the research output and African country records of various cancer cases as reported in 2020, this study shows that countries with higher research outputs\u0026mdash;Egypt, South Africa, Morocco, and Nigeria\u0026mdash;not only lead in publication counts but also demonstrate substantial citation counts compared to other countries with low scholarly outputs. This association between publication numbers and citations is consistent with prior findings, which suggest that countries producing a high volume of research are more likely to establish global visibility and contribute to scientific advancement [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. It could be suggested that citation counts serve not only as indicators of research quality but may enhance visibility for researchers from developing countries. Increased citations can facilitate access to funding and foster collaborative networks, thereby promoting wider dissemination and international recognition of their work, which can, in turn, elevate the overall impact of their research [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe 2020 data on cancer cases and mortality in Africa show regional disparities in cancer burden across African countries [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. These variations may highlight how differences in healthcare access, socioeconomic factors, cultural beliefs, early diagnosis, and treatment capabilities can impact cancer rates across regions. Additionally, limitations in data collection and reporting practices may influence recorded cancer statistics, especially in sub-Saharan countries [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Lombe, et al. [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e] emphasized that late-stage diagnosis and limited access to advanced cancer therapies contribute significantly to the high cancer MIR as observed in this current study in countries such as Liberia, the Central African Republic, Niger, and Somalia, where the percentage of mortality to the recorded incidence of cancer exceeds 70%. South Africa, with relatively high publication rates and research activity, also demonstrates a high prevalence of cancer cases but a slightly lower MIR (52.5%) was observed compared to other countries with similar case counts. It is suggestive that this may be attributed to developed oncology services, preventive screening, and research-informed interventions.\u003c/p\u003e \u003cp\u003eThe research productivity correlates moderately with cancer MIR despite high case counts in Egypt (MIR: 66.1%), South Africa (MIR: 52.5%), Morocco (MIR: 59.4%), Nigeria (MIR: 63.2%), and Ethiopia (MIR: 67.1%), which emerge as the top 5 countries with the highest publication counts (79% of all the recorded publications from the twelve journals selected). Conversely, countries with minimal research contributions, such as Somalia, Niger, and the Central African Republic, face much higher MIRs (73%, 75%, and 73%, respectively). This trend suggests that limited research output may correspond with underdeveloped healthcare systems, limited access to advanced cancer treatment options, and inadequate early detection efforts, as previously highlighted by Mbau, et al. [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. By supporting the development of national research capacities, African nations could achieve improved public health outcomes, reduce the mortality-to-incidence ratio, and bridge the gap in cancer care quality across the continent.\u003c/p\u003e \u003cp\u003eMost African researchers need higher levels of public investment in research and development. Locally funded grants for cancer research, such as the African Organization for Research and Training in Cancer\u0026ndash;BIG Cat initiative and African Academy of Sciences (AAS) grants, which are available for African researchers, can leverage national-level performance data to evaluate international competitiveness and identify scientific strengths, thereby informing strategic research funding and policy development [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. The trends observed in African cancer research outputs show both potential and challenges in research productivity and citation impact. Countries such as Egypt and South Africa demonstrate relatively higher publication output and citation counts, which could serve as benchmarks for reinforcing research in countries with lower outputs. Increasing funding from external organizations like the National Institutes of Health (NIH), the Gates Foundation, and the World Health Organization (WHO) can further support research in countries with lower scholarly output, helping to bridge gaps in capacity, infrastructure, and international visibility. Strengthening these networks may also improve citation impact as African research gains greater global dissemination and recognition [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eStudies have highlighted several limitations regarding the representation and visibility of African researchers in high-impact journals, as many African researchers often choose to submit their research to locally published journals, due to accessibility, a platform for context-specific research, focus on the quantity of research output rather than quality, or resource constraints, which may not have achieved significant international visibility [\u003cspan additionalcitationids=\"CR24\" citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Additionally, high teaching workloads, limited institutional incentives, and inadequate financial support hinder their ability to engage in collaborative, high-impact research [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. A significant limitation of this study is excluding locally published African journals. This may overlook valuable contributions from these journals, which could provide insight into region-specific cancer research and interventions. Therefore, future studies should explore the quality and impact of research published in African journals and examine their role in shaping cancer-related, research-informed interventions. By including a broader range of journals and assessing their local contributions\u003c/p\u003e"},{"header":"5.0 Summary and Conclusion","content":"\u003cp\u003eThe current study emphasizes the need for targeted support and investment in African cancer research. Countries with higher research contributions, such as Egypt, South Africa, Morocco, Nigeria, and Ethiopia, have better cancer outcomes with comparatively lower mortality-to-incidence ratios. In contrast, countries with limited research activity tend to have greater mortality-to-incidence ratios. The disparities in research output and cancer outcomes highlight an opportunity for African countries to strengthen their research capacity as a means of enhancing healthcare infrastructure and ultimately improving cancer survival rates on the continent. By supporting the development of national research capacities, African nations could achieve improved public health outcomes, reduce the mortality-to-incidence ratio, and bridge the gap in cancer care quality across the African continent.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003cstrong\u003eConflicts of interest/Competing interests:\u003c/strong\u003e \u003cp\u003eThe authors have no competing interest to declare\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eEthics approval:\u003c/strong\u003e \u003cp\u003eNot applicable.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent to participate:\u003c/strong\u003e \u003cp\u003eNot applicable.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent to Publish:\u003c/strong\u003e \u003cp\u003eNot applicable.\u003c/p\u003e \u003c/p\u003e\u003cp\u003e \u003ch2\u003eDeclaration of Competing Interest\u003c/h2\u003e \u003cp\u003eThe authors declare no conflict of interest.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding statement\u003c/h2\u003e \u003cp\u003eNo funding was received for this study.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eM.O.O.: Conceptualization, data curation, formal analysis, methodology, manuscript writing (drafting, editing and review of the manuscript). H.S.A.O.: Conceptualization, data curation, formal analysis, methodology, manuscript writing (drafting, editing and review of the manuscript). B.O.A.: Conceptualization, methodology, manuscript writing (drafting, editing and review of the manuscript). A.O.A.: Formal analysis, methodology, manuscript writing (drafting, editing and review of the manuscript). J.O.F.: Methodology, manuscript writing (drafting, editing and review of the manuscript).\u003c/p\u003e\u003ch2\u003eAvailability of data and material:\u003c/h2\u003e \u003cp\u003eNot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eF. Bray\u003cem\u003e et al.\u003c/em\u003e, \u0026quot;Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries,\u0026quot; \u003cem\u003eCA: a cancer journal for clinicians, \u003c/em\u003evol. 74, no. 3, pp. 229-263, 2024.\u003c/li\u003e\n\u003cli\u003eY. 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Parigi, \u0026quot;Leading countries in global science increasingly receive more citations than other countries doing similar research,\u0026quot; \u003cem\u003eNature Human Behaviour, \u003c/em\u003evol. 6, no. 7, pp. 919-929, 2022.\u003c/li\u003e\n\u003cli\u003eA. G. Abo-Khalil, \u0026quot;Integrating sustainability into higher education challenges and opportunities for universities worldwide,\u0026quot; \u003cem\u003eHeliyon, \u003c/em\u003e2024.\u003c/li\u003e\n\u003cli\u003eO. Omotoso\u003cem\u003e et al.\u003c/em\u003e, \u0026quot;Addressing cancer care inequities in sub-Saharan Africa: current challenges and proposed solutions,\u0026quot; \u003cem\u003eInternational Journal for Equity in Health, \u003c/em\u003evol. 22, no. 1, p. 189, 2023.\u003c/li\u003e\n\u003cli\u003eI. O. 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Wolhuter, \u0026quot;The salience of African scholars in education research,\u0026quot; \u003cem\u003eAfrica education review, \u003c/em\u003evol. 16, no. 1, pp. 142-157, 2019.\u003c/li\u003e\n\u003cli\u003eF. Ndumbaro and E. Wema, \u0026quot;Awareness, access and use of locally published journals among researchers in the Tanzanian universities,\u0026quot; \u003cem\u003eUniversity of Dar es Salaam Library Journal, \u003c/em\u003evol. 11, no. 2, pp. 1-16, 2016.\u003c/li\u003e\n\u003cli\u003eJ. Opele, T. Onayinka, and F. K, \u0026quot;Hindrances to Research Productivity among Nigerian University Lecturers,\u0026quot; vol. 15, pp. 126-139, 12/05 2023.\u003c/li\u003e\n\u003cli\u003eJ. E. Kazoka and E. F. Wema, \u0026quot;An analysis of the factors influencing research capacity developments in higher education institutions in Tanzania,\u0026quot; \u003cem\u003eUniversity of Dar es Salaam Library Journal, \u003c/em\u003evol. 15, no. 1, pp. 45-66, 2020.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Africa, authorship, research output, cancer burden, bibliometric","lastPublishedDoi":"10.21203/rs.3.rs-6507435/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6507435/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjective:\u003c/h2\u003e \u003cp\u003eCancer mortality has been a menace to the healthcare system over the past three decades. The majority of the cancer mortality globally comes from low- and middle-income countries, and it remains a significant public health challenge in Africa, with considerable disparities in research productivity, cancer incidence, and outcomes across the continent.\u003c/p\u003e\u003ch2\u003eMethod:\u003c/h2\u003e \u003cp\u003eThis study examines scholarly outputs in cancer research (n\u0026thinsp;=\u0026thinsp;1331) from African authors by country in 12 journals on the Scopus database over the space of ten years (2014\u0026ndash;2023). The publication counts, citation metrics, and 2020 cancer reports (cases, mortality, mortality-to-incidence ratio, and mortality rates) were used to explore potential relationships between research activity and health outcomes across African countries.\u003c/p\u003e\u003ch2\u003eResults:\u003c/h2\u003e \u003cp\u003eThe findings show that Egypt and South Africa lead the continent in cancer research outputs, which correlates with lower cancer MIR, while many countries, particularly in sub-Saharan Africa with low research outputs, such as Somalia, Niger, and the Central African Republic, document some of the highest MIR, emphasizing the urgent need for investment in cancer research and healthcare systems.\u003c/p\u003e\u003ch2\u003eConclusion:\u003c/h2\u003e \u003cp\u003eThis study highlights significant disparities in cancer research productivity and outcomes across Africa, with higher research activity linked to reduced mortality rates. Furthermore, regional and international collaboration is essential to address these disparities and improve cancer outcomes across the continent.\u003c/p\u003e","manuscriptTitle":"A Bibliometric Analysis of African Cancer Research Output and its Implication for Cancer Incidence and Mortality","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-22 10:03:23","doi":"10.21203/rs.3.rs-6507435/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"845e153f-b2d5-44cf-90ea-07a5ac1bc1bd","owner":[],"postedDate":"May 22nd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-07-09T08:23:13+00:00","versionOfRecord":[],"versionCreatedAt":"2025-05-22 10:03:23","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6507435","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6507435","identity":"rs-6507435","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}