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Low-income Countries’ Orthopaedic Information Needs: Challenges and Opportunities

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The Internet should, in theory, facilitate access to peer-reviewed scientific articles for orthopaedic surgeons in low-income countries (LIC). However, there are major barriers to access, and most full-text journal articles are available only on a subscription basis, which many in LIC cannot afford. Various models exist to remove such barriers. We set out to examine the potential, and reality, of journal article access for surgeons in LIC by studying readership patterns and journal access through a number of Internet-based initiatives, including an open access journal (“PLoS Medicine”), and programs from the University of Toronto (The Ptolemy Project) and World Health Organization (WHO) (Health InterNetwork Access to Research Initiative [HINARI]).


Do Internet-based initiatives that focus on peer-reviewed journal articles deliver clinically relevant information to those who need it? More specifically: (1) Can the WHO’s program meet the information needs of practicing surgeons in Africa? (2) Are healthcare workers across the globe aware of, and using, open access journals in a manner that reflects global burden of disease (GBD)?


We compared actual Ptolemy use to HINARI holdings. We also compared “PLoS Medicine” readership patterns among low-, middle-, and high-income regions.


Many of the electronic resources used through Ptolemy are not available through HINARI. In contrast to higher-income regions, “PLoS Medicine” readership in Africa is proportional to both the density of healthcare workers and the GBD there.


Free or low-cost Internet-based initiatives can improve access to the medical literature in LIC. Open access journals are a key component to providing clinically relevant literature to the regions and healthcare workers who need it most.

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We thank “PLoS Medicine” for access to data.

Author information

Correspondence to Andrew Howard MD, MSc, FRCSC.

Additional information

Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

The present study involved the analysis of anonymized Internet log files that cannot be tracked to individual human subjects. All participants in the Ptolemy project have provided written consent for such use. Ethics approval was obtained from the University of Toronto.

This work was performed at the Hospital for Sick Children, Toronto, Ontario, Canada.

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Cite this article

Doughty, K., Rothman, L., Johnston, L. et al. Low-income Countries’ Orthopaedic Information Needs: Challenges and Opportunities. Clin Orthop Relat Res 468, 2598–2603 (2010).

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