# Barriers to global engagement for African researchers: A position paper from the Alliance for Medical Research in Africa (AMedRA)

Bamba Gaye, Nzechukwu Michael Isiozor, Gurbinder Singh, Ngone Diaba

Gaye, Mame Madjiguene Ka, Daouda Seck, Khadidiatou Gueye, David Lagoro

Kitara, Camille Lassale, Anne Malick, et al.

► To cite this version:

Bamba Gaye, Nzechukwu Michael Isiozor, Gurbinder Singh, Ngone Diaba Gaye, Mame Madjiguene Ka, et al. Barriers to global engagement for African researchers: A position paper from the Alliance for Medical Research in Africa (AMedRA). Journal of Global Health, 2024, 14, 10.7189/jogh.14.03042. hal-04974174

HAL Id: hal-04974174

https://cnrs.hal.science/hal-04974174v1

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# Barriers to global engagement for African researchers: A position paper from the Alliance for Medical Research in Africa (AMedRA)

Bamba Gaye<sup>1,2,3</sup>, Nzechukwu Michael Isiozor<sup>1,4</sup>, Gurbinder Singh<sup>1</sup>, Ngone Diaba Gaye<sup>1,5</sup>, Mame Madjiguene Ka<sup>1,6</sup>, Daouda Seck<sup>1,7</sup>, Khadidiatou Gueye<sup>1,8</sup>, David Lagoro Kitara<sup>1,9</sup>, Camille Lassale<sup>1,10,11,12</sup>, Anne Malick<sup>1,13</sup>, Mor Diaw<sup>1,2</sup>, Sidy M Seck<sup>1,14</sup>, Abdourahmane Sow<sup>7</sup>, Magaye Gaye<sup>1,15</sup>, Abdou Salam Fall<sup>16</sup>, Aïda Diongue<sup>1,17</sup>, Ibrahima Seck<sup>18</sup>, Jamal Belkhadir<sup>1,19</sup>, Issa Wone<sup>20</sup>, Serigne Magueye Gueye<sup>15</sup>, Papa Salif Sow<sup>21</sup>, Jamal Eddine Kohen<sup>1,22</sup>, Dorothea Vogelsang<sup>23</sup>, Maïmouna Ndour Mbaye<sup>1,24</sup>, Elisabeth Alice Liyong<sup>1,25</sup>, André Pascal Kengne<sup>26</sup>, Roberta Lamptey<sup>27</sup>, Ndeye Marième Sougou<sup>18</sup>, Eugène Sobngwi<sup>28</sup>, Awa Ba<sup>1,29</sup>, John Tukakira<sup>30</sup>, Thiess Lorenz<sup>31</sup>, Elise G Kabore<sup>1,32</sup>, Malaizyo Gabriel Muzumala<sup>1,33</sup>, Ahmed Olanrewaju<sup>1,34</sup>, Lamin ES Jaiteh<sup>35</sup>, Lucrèce M Delicat-Loembet<sup>36,37</sup>, Aimée Olivat Rakoto Alson<sup>1,38</sup>, Khadim Niang<sup>39</sup>, Ciira Wa Maina<sup>40</sup>, Ernest Mwebaze<sup>41</sup>, Joyce Nabende<sup>42</sup>, Dina Machuve<sup>43</sup>, Prestone Adie<sup>44</sup>, Fatoumata Hanne<sup>20</sup>, Roger Tine<sup>45</sup>, Marième Sougou<sup>1,45</sup>, Kouassi Gustave Koffi<sup>46</sup>, Lameck Luwanda<sup>47</sup>, Elisabeth Lilian Pia Sattler<sup>1,48</sup>, Demeke Mekonnen<sup>1,49,50</sup>, Fatma Ebeid<sup>1,51</sup>, Jean Paul Enama<sup>52</sup>, Mohamadi Zeba<sup>53,54</sup>, Fernand Guedou<sup>55</sup>, Pascal Mbelesso<sup>56,57</sup>, Jennifer Carter<sup>58,59</sup>, Bakary Coulibaly<sup>60</sup>, Mohamed Lamine Drame<sup>61</sup>, Alain Mouanga<sup>56,62</sup>, Pierre Marie Preux<sup>56,63</sup>, Philippe Lacroix<sup>56,63</sup>, Mouhamadou Diagana<sup>56,64</sup>, Didier Koumavi Ekouevi<sup>56,65</sup>, Dismand Houinato<sup>55,56</sup>, Adama Faye<sup>45</sup>, Vivien Wambugu<sup>1,66</sup>, Jean Kamaté<sup>1,67</sup>, Mathias Lalika<sup>1,68</sup>, Elaine Nsoesie<sup>69</sup>, Boni Maxime Ale<sup>70,71,72</sup>, Ibrahima Socé Fall<sup>1,73*</sup>, Abdoulaye Samb<sup>1,2*</sup>, Léon Tshilolo<sup>1,74,75*</sup>, Modou Jobe<sup>1,76*</sup>

<footnote n="1"><sup>1</sup>Alliance for Medical Research in Africa (AMedRA)</footnote>

<footnote n="2"><sup>2</sup>Department of Physiology, Cheikh Anta Diop University of Dakar, Dakar, Senegal</footnote>

<footnote n="3"><sup>3</sup>Biomedical Informatics, Emory School of Medicine in Atlanta, Georgia, USA</footnote>

<footnote n="4"><sup>4</sup>Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland</footnote>

<footnote n="5"><sup>5</sup>Department of Cardiac Rehabilitation, Ibra Mamadou Wane Medical Center, Dakar, Senegal</footnote>

<footnote n="6"><sup>6</sup>Department of Cardiology, Principal Hospital of Dakar, Dakar, Senegal</footnote>

<footnote n="7"><sup>7</sup>Institut Pasteur de Dakar, Dakar, Senegal</footnote>

<footnote n="8"><sup>8</sup>Hospital Center University of Fann, Dakar, Senegal</footnote>

<footnote n="9"><sup>9</sup>Gulu University, Faculty of Medicine, Department of Surgery, Gulu, Uganda</footnote>

<footnote n="10"><sup>10</sup>Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain</footnote>

<footnote n="11"><sup>11</sup>Universitat Pompeu Fabra, Barcelona, Spain</footnote>

<footnote n="12"><sup>12</sup>CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Carlos III Health Institute (ISCIII), Madrid, Spain</footnote>

<footnote n="13"><sup>13</sup>Ministry of Health and Social Action, Dakar, Senegal</footnote>

<footnote n="14"><sup>14</sup>Faculty of Health Sciences, University Gaston Berger, Saint-Louis, Senegal</footnote>
¹⁵Surgery & Surgical Specialties Department, Cheikh Anta Diop University of Dakar, Dakar, Senegal

¹⁶Laboratoire des Transformations Économiques et Sociales, Institut Fondamental d'Afrique Noire Ante Cheikh Anta Diop, Cheikh Anta Diop University, Dakar, Senegal

¹⁷Senegalese National Agency of Civil Aviation and Meteorology (ANACIM), Dakar, Senegal

¹⁸Department of Public Health, University Cheikh Anta Diop, Dakar, Senegal

¹⁹Moroccan League for the Fight Against Diabetes, Rabat, Morocco

²⁰Département des Sciences de la Santé, Université Assane Seck de Ziguinchor, Ziguinchor, Sénégal

²¹Department of Infectious Diseases, Fann National University Hospital, Dakar, Senegal

²²Université Abulcasis (Cheikh Zaid), Rabat, Morocco

²³Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands

²⁴Department of Internal Medicine and Specialties, Cheikh Anta Diop University of Dakar, Dakar, Senegal

²⁵Likak Research, Dakar, Senegal

²⁶Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa

²⁷Family Medicine Department, Korle Bu Teaching Hospital, Accra, Ghana

²⁸Department of Internal Medicine and Specialties, University of Yaoundé 1, Yaoundé, Cameroon

²⁹Laboratoire de physiologie, département de médecine, UFR Santé et Développement Durable, Université Alioune Diop de Bambey, Bambey, Sénégal

³⁰Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA

³¹Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

³²Department of Cardiology, CHU Yalgado Ouedraogo, Ouagadougou, Burkina Faso

³³The University of Zambia, Department of Computer Science, University of Zambia Datalab and Enterprise Medical Imaging in Zambia Project, Lusaka, Zambia

³⁴University of Ibadan, Ibadan, Nigeria

³⁵Department of Surgery, Edward Francis Small Teaching Hospital. Banjul, Gambia

³⁶Department of Biology, University of Sciences and Technology of Masuku, Franceville, Haut-Ogooue, Gabon

³⁷NGO Sickle Cell Disease Organization of Gabon (SCDOGa), Franceville, Haut-Ogooue, Gabon

³⁸Laboratory of Molecular Biology of Joseph Ravoahangy Andrianavalona University Hospital Center (JRA UHC), Faculty of Medicine, University of Antananarivo, Antananarivo, Madagascar

³⁹UFR-2S, Université Gaston Berger, Saint-Louis, Senegal

⁴⁰Department of Electrical and Electronic Engineering, Dedan Kimathi University of Technology, Nyeri, Kenya

⁴¹College of Computing & Information Sciences, Makerere University, Kampala, Uganda

⁴²Department of Computer Science, Makerere University, Kampala, Uganda

⁴³Schools of Life Sciences and Bioengineering, Nelson Mandela African Institution of Science and Technology, Arusha, Tanzania

⁴⁴ENGINE Energy Access

⁴⁵Institut de Santé et Développement (ISED), Université Cheikh Anta Diop, Dakar, Senegal

⁴⁶Clinical Hematology Unit, CHU de Yopougon, BP 3709 Abidjan 08, Abidjan, Côte d'Ivoire

⁴⁷Haydom Lutheran Hospital in Manyara, Haydom, Tanzania

⁴⁸Department of Nutritional Sciences, University of Georgia, Athens, Georgia, USA

⁴⁹Department of Pediatrics and Child Health, St. Peter Specialized Hospital, Addis Ababa, Ethiopia

⁵⁰Medical Research Lounge Trading PLC, Addis Ababa, Ethiopia

⁵¹Pediatric Hematology Oncology and BMT, Ain Shams University, Cairo, Egypt; Faculty of Medicine, Ain Shams University Research Institute-Clinical Research Center, Cairo, Egypt

⁵²Humanity First, Yaoundé, Cameroon

⁵³International Research Laboratory Environnement, Santé Et Sociétés (IRL 3189, ESS), CNRST/CNRS/UCAD/UGB/USTTB, Ouagadougou, Burkina Faso

⁵⁴Laboratoire de Recherche en Maladies Infectieuses Et Parasitaires (LR/MIP), Institut de Recherche en Sciences de la Santé (IRSS/CNRST), Ouagadougou, Burkina Faso

⁵⁵Laboratory of Chronic and Neurologic Diseases Epidemiology, LEMACEN, Doctoral School of Health Sciences, University of Abomey-Calavi, Cotonou, Benin

⁵⁶EMAC-AOC Group (Epidemiology of Chronic Diseases - Central and Western Africa)

⁵⁷Department of Neurology, Amitié Hospital, Bangui, Central African Republic

⁵⁸Clinical Trial Service Unit & Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK

⁵⁹Health Data Research UK, University of Oxford (HDRUK-Oxford), Oxford, UK

⁶⁰Laboratoire de Biologie Moléculaire Appliquée, Bamako, Mali

⁶¹Health Policy and Health System Expert, International Consultant, Port Moresby, Guinea

⁶²Faculté des Sciences et Techniques, Université Marien Ngouabi, Brazzaville, Congo

⁶³Inserm U1094, IRD UMR270, Univ. Limoges, CHU Limoges, EpiMaCT – Epidemiology of chronic diseases in tropical zone, Institute of Epidemiology and Tropical Neurology, OmegaHealth, Limoges, France
⁶⁴Département de Neurologie, CHU de Nouakchott, Nouakchott, Mauritania

⁶⁵Faculté des Sciences de la Santé, Département de Santé Publique, Université de Lomé, Lomé, Togo

⁶⁶Duke University, Durham, USA; Duke-Margolis Center for Health Policy, Durham, North Carolina, USA

⁶⁷AGCS PLUS, Advocacy Officer, Dakar, Senegal

⁶⁸Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA

⁶⁹Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA

⁷⁰Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya

⁷¹Holo Global Health Research Institute, Nairobi, Kenya

⁷²School of Public Health, MOI University, Eldoret, Kenya

⁷³Department of Health Emergency Interventions, Health Emergencies Programme, World Health Organization, Geneva, Switzerland

⁷⁴Institut de Recherche Biomédicale, CEFA-Monkole, Kinshasa, Democratic Republic of the Congo

⁷⁵Département de Pédiatrie, Université Officielle de Mbujimayi (UOM), Mbujimayi, Democratic Republic of the Congo

⁷⁶Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Serrekunda, Gambia

*Joint senior authorship.

African researchers continue to face numerous barriers that limit the global dissemination and advance-
ment of their research. These include high open-access publication fees, requirements for publishing
in high-impact journals, inability to attend or host international conferences, and limited access to
published papers and resources. In this viewpoint, we focus on the specific challenge of attending interna-
tional scientific conferences hosted in high-income settings and aim to propose practical solutions to address
this inequity. The related barriers include visa-related difficulties and prohibitive travel expenses (e.g. non-
reimbursable high visa fees, flight tickets, accommodation and subsistence, and conference registration costs).

The ‘indirect’ rationale justifying the need to have African researchers ‘at the table’

The coronavirus disease 2019 (COVID-19) pandemic has undoubtedly underscored the need for international collaborations among researchers worldwide, particularly in the health sector. Such collaborations are essential for combining resources, sharing expertise, and effectively addressing global health challenges through collective knowledge and coordinated efforts in a time-efficient manner. International conferences are key in this process, offering a platform for researchers from diverse backgrounds to exchange ideas, share findings, and collectively develop strategies for tackling challenging health issues.

African researchers encounter major
barriers, such as restrictive visa policies,
which hinder their participation in inter-
national conferences and their ability to
maintain global research collaborations.

The overall visa landscape

Despite relatively higher disease burden in several low- and middle-income countries (LMICs) compared to high-income countries (HICs) [1], high-profile conferences, such as the World Health Summit, the International Society of Global Health Conference, and the International AIDS Society (IAS) Conference, are usually hosted in high-income countries. These HIC host nations commonly have mutual visa waiver agreements with other HICs, but such agreements are rarely extended to LMICs, including African nations (Table 1) [2–5]. This situation leaves researchers from LMICs facing the significant challenge of securing visas for travel.

An overview of visa-waiver programmes for top health conference destinations – USA, UK, Canada, and the Schengen region (including European countries such as France, Germany, and Spain) – shows that no African country is included in the visa-waiver programmes for the USA and UK. Notably, only two African countries, Mauritius and Seychelles, are part of the Schengen visa-waiver programme [6].

Detailing visa-related challenges among African researchers

Most African researchers, whether conducting research within the African continent or abroad, face sig-
nificant challenges in physically attending these scientific gatherings. These barriers include the stress and
uncertainties associated with obtaining visas, in addition to financial challenges. The visa application pro-
cess, often with a processing period of several weeks or months or even up to a year, is lengthy, preventing
<table><caption>**Table 1.** Visa-waiver countries for the USA, UK, and the Schengen region</caption><thead><tr><th>USA [2]</th><th>UK [3,4]</th><th>Schengen [5]</th></tr></thead><tbody><tr><td>Andorra, Australia, Austria, Belgium, Brunei, Chile, Croatia, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Iceland, Ireland, Italy, Japan, Latvia, Liechtenstein, Lithuania, Luxembourg, Malta, Monaco, Netherlands, New Zealand, Norway, Poland, Portugal, San Marino, Singapore, Slovakia, Slovenia, South Korea, Spain, Sweden, Switzerland, Taiwan, United Kingdom</td><td>Australia, EU countries, USA, Iceland, Canada, Japan, Liechtenstein, New Zealand, Norway, Norway, Singapore, South Korea, Switzerland, Kuwait, Oman, Qatar, United Arab Emirates*</td><td>Albania, Antigua and Barbuda, Argentina, Australia, Bahamas, Barbados, Bosnia and Herzegovina, Brazil, Brunei, Canada, Chile, Colombia, Costa Rica, Dominica, El Salvador, Georgia, Grenada, Guatemala, Honduras, Hong Kong, Israel, Japan, Kiribati, Macao, North Macedonia, Malaysia, Marshall Islands, Mauritius, Mexico, Micronesia, Moldova, Montenegro, New Zealand, Nicaragua, Palau, Panama, Paraguay, Peru, Saint Kitts and Nevis, Saint Lucia, Saint Vincent, Samoa, Serbia, Seychelles, Singapore, Solomon Islands, South Korea, Taiwan, Timor Leste, Tonga, Trinidad and Tobago, Tuvalu, Ukraine, United Arab Emirates, United Kingdom, United States of America, Uruguay, Vanuatu, Venezuela†</td></tr></tbody></table>

African researchers from making timely decisions to attend international conferences. Consequently, their participation in these scientific events largely depends on the visa-issuing authorities of the host countries. According to a previous study, African researchers are over three times more likely to encounter visa-related obstacles compared to their North American and European counterparts [7]. This issue was observed during the 2022 IAS conference, where numerous visa delays and denials by Canadian authorities prevented many registered delegates, including IAS staff, from participating [8]. A survey by the RAND Corporation for the Wellcome Trust identified the duration of visa requests, complexity of application forms, and application costs as the primary complaints among African and Asian researchers [7].

## The negative impact of visa-related barriers

A systematic review has reported the underrepresentation of participants from LMICs, which include all 54 African countries, in global health conferences [9]. Persistent visa-related challenges are likely to worsen this underrepresentation, resulting in missed opportunities for African researchers to enhance their knowledge, present their research on a global platform, and establish valuable networking connections with other inter-

national experts. In contrast, researchers from countries included in visa-waiver programmes offered by host nations experience fewer barriers to attendance and thus benefit more from these opportunities. Consequently, their participation rates are much higher, leading to greater knowledge exchange, more networking opportunities, and access to the latest information on current health issues. This disparity in participation and opportunity has been referred to as 'conference inequity' [9].

The burden of both communicable and non-communicable diseases (NCDs) in Africa remains a major challenge. NCDs are responsible for 41 million deaths annually, accounting for 74% of all deaths worldwide. Of those, 17 million people die from NCDs before reaching the age of 70, with 86% of these premature deaths occurring in LMICs. In fact, 77% of all NCD-related deaths happen in these regions [10]. The growing prevalence of chronic diseases, coupled with the existing burden of infectious diseases in the African

continent, underscores the necessity for African researchers to enhance their skills and integrate into established global networks. This integration would enable the African scientific community to present its research findings and interventional approaches for improving health at the international level.

However, several challenges must be addressed to achieve this, including visa application protocols and associated uncertainties, the rising visa fees, flight ticket costs, and registration fees, all of which are further complicated by fluctuating local exchange rates. Among these challenges, visa processing remains the most critical issue.

## Broadening the scope beyond conference attendance: Addressing global barriers to mobility and collaboration

To address the broader issue beyond just the challenges of attending international scientific conferences, it is essential to consider the full scope of barriers that African researchers face when attempting to collaborate globally. The constraints extend well beyond the logistics of conference attendance and include significant obstacles to international travel, research collaboration, and access to global research networks. These barriers

Visa restrictions within Africa pose challenges even for high-profile figures like Aliko Dangote, Africa's richest man, who needs 35 visas to travel across the continent—far more than European travellers require. This highlights the broader, continent-wide limitations affecting both research and business mobility.

<footnote>*Kuwait, Oman, Qatar, and the United Arab Emirates had a waiver of GBP 30.</footnote>

<footnote>†Seychelles and Mauritius are the only African countries in the programme.</footnote>
are not just administrative or financial, but are deeply rooted in systemic inequities that disproportionately affect researchers from LMICs. The issue is not just about missing out on conferences but also about missing out on critical opportunities for professional growth, knowledge exchange, and contribution to global scientific discourse.

Moreover, the isolation caused by these barriers delays the progress of African research, limiting the continent's ability to influence global health strategies and contribute solutions that are contextually relevant to the African experience. The global research community thereby loses out on the unique insights that African researchers provide, especially in fields where Africa bears a disproportionate share of the global burden and has developed extensive expertise, such as infectious diseases and emerging NCDs.

To truly bridge this gap, efforts must focus on creating more inclusive and accessible pathways for African researchers to travel, collaborate, and contribute on a global scale. This includes advocating for more equitable visa policies, securing funding for travel and collaboration, and fostering an international research environment that recognises and actively mitigates these barriers. Addressing the broader issue of mobility and collaboration will ensure that African researchers are fully integrated into the global research ecosystem, enriching it with their perspectives and expertise.

## The issue of citizenship and brain drain

A persistent and often overlooked consequence of the stringent visa and mobility barriers faced by African researchers is the forced prolongation of their stay in Western countries to secure citizenship. This situation arises because, after completing their studies or research training abroad, many African citizens find themselves in a vulnerable position. Returning to their home countries often means giving up the opportunity to apply for permanent residency or citizenship in the host country, which would facilitate easier future travels and career opportunities.

Consequently, numerous African researchers opt to remain in Western countries for several years after their formal training, navigating the lengthy and complex process of obtaining permanent residency or citizenship. This extended stay is not merely a personal choice, but rather a strategic decision to avoid the recurring visa-related challenges that significantly limit their ability to participate in global scientific engagements.

However, this decision comes at a substantial cost to the African continent. The delayed return of highly skilled professionals intensifies the already critical issue of brain drain, wherein talented and educated individuals are lost to nations that offer more favourable conditions for professional growth and mobility. The resultant effect is a weakening of the research and development capabilities within African nations, which are in urgent need of these skilled individuals to address pressing local and regional health challenges. Moreover, the prolonged absence of these researchers diminishes their immediate contribution to the academic and scientific landscape in Africa, creating a gap in mentorship for the next generation of African scientists. It also delays the potential for establishing robust, locally-led research initiatives that are crucial for Africa's sustainable development.

Addressing this issue requires a multi-faceted approach. Host countries should consider policy reforms that facilitate the return of African researchers by granting them the flexibility to engage in international research collaborations without the fear of losing residency rights. Additionally, African governments and institutions should provide stronger incentives and support systems to encourage the return of their diaspora, ensuring that the skills and knowledge gained abroad are reinvested into the continent's development.

Ultimately, the goal should be to create an environment where African researchers can thrive both at home and abroad, without being forced into difficult decisions that contribute to the brain drain phenomenon. This requires global recognition of the unique challenges they face and concerted efforts to remove the barriers that drive them away from their home countries.
<figure><img src="image_3.png" /></figure>

**Funding:** We received no funding for this study.

**Authorship contributions:** Gaye B conceived the presented idea. Gaye B, Isiozor NM, Fall IS, Samb A, Tshilolo L, and Jobe M contributed to the design, implementation, and direction of the manuscript. Gaye B and Isiozor NM drafted the manuscript. All other authors provided critical feedback and revisions, significantly enhancing the final manuscript: Gaye B, Isiozor NM, Singh G, Gaye ND, Ka MM, Seck D, Gueye K, Kitara DL, Lassale C, Anne M, Diaw M, Seck SM, Sow A, Gaye M, Fall AS, Diongue A, Seck I, Belkhadir J, Wone I, Gueye SM, Sow PS, Kohen JE, Vogelsang D, Mbaye MN, Liyong EA, Kengne AP, Lamptey R, Sougou NM, Sobngwi E, Ba A, Tukakira J, Lorenz T, Kabore EG, Muzumala MG, Olanrewayu A, Jaiteh L, Delicat-Loembet LM, Alson AOR, Niang K, Maina CW, Mwebaze E, Nabende J, Machuve D, Adie P, Hanne F, Tine R, Sougou M, Koffi KG, Luwanda L, Sattler ELP, Mekonnen D, Ebeid F, Enama JP, Zeba M, Guedou F, Mbelesso P, Carter J, Coulibaly B, Drame ML, Mouanga A, Preux PM, Lacroix P, Diagana M, Ekouevi DK, Houinato D, Faye A, Wambugu V, Kamaté J, Lalika M, Nsoesie E, Ale BM, Maffia P, Fall IS, Samb A, Tshilolo L, and Jobe M.

**Disclosure of interest:** The authors completed the ICMJE Disclosure of Interest Form (available upon request from the corresponding author) and disclose no relevant interests.

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**Correspondence to:**

Dr Bamba Gaye
Department of Physiology, Cheikh Anta Diop University of Dakar
UCAD, BP 5005 Dakar
Senegal
m.bamba.gaye@gmail.com