Poor local access to African emergency care publications without publisher subscription, a cross-sectional study
Creators: name: Bruijns, Stevan R.
name: Mmapheladi Maesela
name: Sinha, Suniti
name: Banner, Megan E.
Publisher: name: F1000Research
Year: 2017

description: Given the stark differences in emergency care resource requirements and availability, between high-income countries and low- and middle-income countries, it is important that African emergency care research is not only conducted, but also disseminated in accessible format within Africa. Evidence-based care from emergency care research conducted elsewhere often does not directly apply in the African context as the former assumes access to resources that often does not translate to the latter.  Publications from the  Africa region made up only 1.8% (829 of 46 901) of global emergency medicine publication output between 2010 and 2015; but this number is not representative of the relative size of the African continent, nor its relative higher burden of disease, morbidity and mortality compared to other world regions. This can be attributed, at least in part in part, to the small, local, emergency care academic community and the apparent lower interest from emergency care journals (mainly representing high-income settings) for research from low-and middle-income settings. Thus taking into account a local, developing emergency care knowledge economy, and the relative irrelevance  of high-income setting produced research, the importance of sharing local African-related emergency care research within Africa should be a given. <br><br>The aim of this study was to describe access to African emergency care publications (published between 2011 and 2015) in terms of publisher-based access (open access or subscription), alternate access (self-archived or author provided), and the cost of access or publication (article access, or process charges).<br><br>A cross sectional study using, secondary published data from Scopus (Elsevier, Amsterdam) was used. Publications were first described as either open access or subscription-based; article process and access charges were also collected at this time.  A keyword search (using publication title and author list) was undertaken to find self-archived versions of subscription-based articles using Google, PubMed Central, ResearchGate, Mendeley, and Academia.edu. We did not include a search of any of the torrent sites Libgen and Sci-Hub, given their unethical processes.[3]  Finally, an  email  request  was  made  for remaining articles to  authors  to  share the article. <br><br>The corrected out-of-pocket charge, using the World Health Organization (WHO) Purchasing Power Parity index, was calculated for article process and access charges.[4] We described the corrected charge for South Africa (high-middle), Ghana (low-middle) and Tanzania (low income country).<br><br>Of the small number of African emergency care articles published between 2010 and 2015, around one in six publications were unobtainable. The cost of accessing subscription-based publications is very likely to be prohibitive. For African emergency care to grow, increased research outputs are required to fuel its knowledge economy.  Only a small number of local higher learning institutions offer emergency medicine training, and only two offer research degrees. Furthermore, local emergency care researchers tend to be clinician-researchers, largely unattached from academic institutions.  African academic libraries for their part, similarly suffer from having to purchase subscriptions using devalued currencies. Van Hoving, et al. reported that 58% of African emergency care researchers struggled frequently with publication access, suggesting that local emergency care researchers are unable to afford the significantly higher out-of-pocket expense related to publication. These elements create a perfect storm that chokes the development of the specialty locally.  Fortunately article processing fee waivers and discounts exist for low-middle and low-income countries – which is likely why African authors were able to publish open access so often. It was disappointing to see though that authors from South African (a higher-middle-income country) would both incur significantly higher out-of-pocket cost and be excluded from waivers and discounts. <br><br>Presently, low-and middle-income populations, including those in Africa, make up around 85% of the world’s population, of which the most will have similar, unaffordable access problems. Publishers should consider revising pricing policies to allow more equitable access to publications for researchers in these regions.