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1 What Is a ‘Developing Nation’?

The International Monetary Fund (IMF) and the United Nations (UN) have both defined developing nations but depend on the country itself to declare whether or not it is still not developed. The Human Development Index (HDI) is easier to understand and is a comparative measure of four parameters—life expectancy, literacy, education, and standards of living for regions worldwide. Countries fall into four broad categories based on their HDI: very high (for developed countries), high and medium (for developing countries), and low (for least developed countries). Alternative classification exists based on the Gross Domestic Product which can classify countries into high- medium-, and low-income group. In this article we will use the HDI criteria of 2019 for our discussion [1].

Developing countries have a common set of problems. These include the lack of availability of clean drinking water, poor sanitation, poverty, pollution, low levels of education, poor economic growth, poor funding for health care, and common poverty-related illnesses. All these contribute to the health outcomes of their inhabitants.

We will discuss the health issues with reference to three developing regions:

  • Latin America

  • Africa

  • Asia

2 Which Continent Produces the Largest Number of Research Papers?

According to data from 2008 to 2012, the total number of publications worldwide during this period was almost four million, excluding review publications and this number had nearly doubled when compared to the years 1993–1997 (Fig. 6.1). America produces the largest number (35.5%), followed by Europe (33.7%) and Asia (24%) (for this data, the publications from Russia and Turkey were equally divided between Asia and Europe).

Fig. 6.1
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Global data on publications (Xu et al. 2014)

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3 Latin America

3.1 How Can the Developing Nations from Latin America Be Divided?

Latin America can be divided into three regions, i.e. South America, Mexico, Central America, and the Caribbean islands.

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3.2 Has There Been a Recent Increase in Biomedical Research from Latin America?

Over a 10-year period (2000–2010), Latin America has had a growth of more than 9% per year in its scientific output, which has resulted in a nearly 70% increase in its share of global manuscripts but it was just under 4.4% of the world’s annual output of scholarly papers. Among the various developing regions, South America’s research is growing and is becoming more visible. The citation impact for Latin America has been improving by 1.6% per year for the above period but is still less than the world’s average [2] (Fig. 6.2).

Fig. 6.2
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Latin America’s number of manuscripts over one decade and the citation index. (Source: Scopus)

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3.3 In Which Field Has Latin America Progressed?

In certain areas of science, Latin America’s stake in global scientific manuscripts is substantial. For example, in Dentistry and for Biological Sciences it is 10% and 11%, respectively. These areas of medicine have increased considerably together with their citation impact. For dentistry, it was 1% per year which is very close to the world’s average, which was 0.97 in 2010. For the years 2000–2010, it was 3% per year for the Biological Sciences [2] (Fig. 6.3).

Fig. 6.3
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The number of manuscripts in various fields of sciences and the citation index. (Source: Scopus)

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3.4 Who Are the Regional Leaders Among the Latin American Nations?

Latin America is composed of numerous states of diverse sizes, histories, and economies. The three Latin American republics with strong research outputs are Brazil, Mexico, and Argentina [2]. Of these, Argentina has a higher HDI compared to the other two [1]. The citation impact has also improved for all these countries (Fig. 6.4). Brazil also had the largest number of papers on dentistry in this region and is the only nation in the entire continent that spends more than 1% of its GDP on research and development. In the last 20 years, the quantity of research has increased fivefold (Scopus 2013).

Fig. 6.4
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Annual share of total scientific paper from Argentina, Brazil, and Mexico and the citation index. (Source: Scopus)

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3.5 Is There Any Data from the Medium Development Index Countries?

These include Cuba, Ecuador, Bolivia, Nicaragua, and the Honduras [3]. All these countries have similar economies and according to Scopus there has been a rapid surge in research output across the region. Cuba has more prominent and visible areas of research in basic sciences (pharmacology, toxicology, pharmacy, biological sciences, chemistry, biochemistry, genetics, and microbiology) and agriculture compared to the other countries.

3.6 Are There Any Specialties That Are Producing More Papers?

For the period 2003–2013, the most productive areas for publication included Public Health, Infectious Diseases, Surgery, Neurology, and Cardiovascular Medicine. The most high-volume countries were Brazil, Mexico, and Argentina and those having a greater impact and more international collaborations were from Peru, Puerto Rico, and Argentina. The most productive and visible fields, were Oncology, Cardiology, and Infectious Diseases [4].

3.7 What Is the Reason for the Low Visibility of Latin American Journals?

Although the total scientific research from South America grew from 2% of the global share in 1996 to 4% in 2012 the papers are published in the native languages and are therefore not widely accessible. According to the Thomson Institute for Scientific Information (ISI) (which includes only the most reputed scientific publications and is one of the ways of assessing the value and visibility of a journal the countries with the highest number of ISI journals in Latin America are Brazil, Chile, Mexico, and Colombia. Brazil and Chile are the countries with the largest increase in ISI-indexed journals language other than in English but their visibility was low [5] (Table 6.1).

Table 6.1 Language distribution of publications from Latin America
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3.8 What are the Other Reasons for the Low Scientific Output from Latin America?

Many bright young scientists continue to leave Latin America for developed countries. The reasons are [6, 7]:

  • Firstly, South America invests less in research compared to other developed nations. Most research allowances in Latin America are provided by Governmental organizations. They are often inadequate and range from $5000 to $40,000/ year. This is very low compared to the grants provided by developed nations.

  • Secondly, a career in science is poorly paid, most medical physicians are better off chasing a clinical practice rather than participating in research, even if it is part time.

  • Thirdly, to publish a manuscript in a high-impact journal, a publication fee of $3400–5000 is sometimes required in open access publications. These journals offer fee discounts if the scientist is based in a HINARI country (the world’s lowest-income countries as defined by the World Bank). Therefore, several Latin American experts prefer to publish their scientific papers in journals that do not charge for publication.

3.9 Are Open Access Journals the Way Forward for Latin America?

The scientific community of Latin America is slowly appreciating that publishing online will provide it an exposure to academics and more extensive audiences. In this way, with open access to journals, books, and all kinds of manuscripts from nations where the cost of posting a printed version overseas was more expensive than printing a book or journal. Many countries are now opting to change over to Open Access for publicly funded research. Many public universities and government organizations are also insisting on this. This is also known as ‘plan S’. Many feel that open access publishing is the way forward for scientific publications from developing nations [8].

4 Africa

4.1 How Can One Divide Africa’s Nations into Various Regions?

Africa can be divided into five large areas, i.e. north, west, east, central, and south.

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4.2 Is It True That Africa’s Research Output Has Increased?

Yes, in a Scopus-based analysis published in 2013, Africa has doubled its research output over a decade (1996–2012). This was a positive sign for Africa and at the same time its world’s share also increased from 1.2% to 2.3% of the world’s scientific publications [9] (Fig. 6.5)

Fig. 6.5
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Increase in Africa’s research output

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4.3 What Are the Factors Contributing to This Promising Trend?

There are many factors that have contributed to the surge in African research output [10, 11]. These include:

  • Augmented money for research.

  • Substantial changes in strategies.

  • Enhanced research infrastructure (human and physical).

  • Availability of journals that are open access or free.

  • Peer-reviewed literature that can be accessed free or at a low cost.

4.4 What Could Be the Key Contributor to This Promising Growth?

A public–private partnership called the ‘Research4life’ programme has been one of the contributing forces towards the increase in scientific papers. It includes more than 200 publishers and many associations which have provided free access to 6000 institutions in over 100 countries to scientific papers, books, and databases [2].

4.5 What Is the African Index Medicus?

This gives access to information published in or associated with Africa. This also encourages local publishers to publish scientific manuscripts. This has been possible due to the technical backing of the World Health Organization. Very few African health and biomedical information sources are included in the global leading databases and there is a treasure of untapped material in books, reports, and manuscripts which can be accessed [12].

4.6 Are There Any Countries That Are Leading?

In southern Africa, the leader is South Africa with 47,000 manuscripts published during 1999–2008. In the north, Egypt is the main country with 30,000 papers published over the same period, and Nigeria dominates the central region with more than 10,000 publications. These three nations dominate again when the data are broken down into areas of research, with South Africa publishing the most papers in clinical medicine and most other life sciences (e.g. microbiology, immunology, and neuroscience) [13].

In a research paper, biomedical analysis was done for the most productive countries in West Africa for over 10 years (2005–2014). Nigeria, Ghana, Senegal, Burkina Faso, and Mali had the highest number of publications [14].

4.7 What Are the Top Diseases for which Research Is Going On in Africa?

Recent data published by Elsevier, stated that in HIV/AIDS-related research, for the period 2014 to 2018, South Africa was the third-highest global producer of papers. In another analysis, from 2003 to 2011, bibliometric assessment of sub-Saharan scientific search output was studied on ‘poverty related and neglected infectious diseases’. For the period 2007–2011, African countries produced 10% of the world’s share on infectious diseases. Tuberculosis, HIV/AIDS, Malaria, Hydatid diseases, Sleeping sickness, Leprosy, Kala Azar, and Schistosomiasis were those which were studied. With the help of European trial partnerships, African countries were able to increase the quality and quantity of papers and were able to publish in high-impact factor journals [15].

5 Asia

Asian countries can be divided into three regions:

  • East Asia

  • South Asia

  • West Asia

5.1 East Asian Countries According to the Human Development Index

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5.2 What Is the Research Output from South Asian Countries?

An analysis of the research output of eight countries of south Asia—India, Afghanistan, Bhutan, Sri Lanka, Pakistan, Nepal, Bangladesh, and Maldives is available—two with a high HDI (Sri Lanka, Maldives), four with a medium HDI (Bangladesh, Nepal, India, and Pakistan) and one with a low HDI (Afghanistan) and has been examined recently. The analysis was carried out over a 5-year period, i.e., from 2012 to 2017 [16]. The quantity and quality (as judged by the h Index) of publication was highest for India, followed by Sri Lanka and Nepal (Fig. 6.6). Unfortunately, these figures are very much lower than the h indices from the developed countries (e.g., the USA and the UK). The authors concluded that despite a recent increase in numbers, the overall quality and quantity of scientific output was still low in south Asia. This was not related to their HDI because Indian institutes outnumbered those from other countries. This finding is in contrast with studies reported from the Gulf Cooperation Council and ASEAN countries where they found that the research output of a country was directly related to its economic development [17].

Fig. 6.6
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Quality and Quantity of research from South Asian countries (2012–2017)

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5.3 Can India Be the Leader in South Asian Health Care Over the Coming Years?

India has the capacity to overcome many health challenges because although it is a poor country it has a large mass of trained, English speaking doctors some of whom have been trained in the best medical institutes in this country and abroad. India has eradicated smallpox and polio. It has a population of many phenotypes and genotypes and has produced a number of important publications on Kala-Azar [18], Tetanus [19], Takavasu’s Disease [20], Oral rehydration solution [21], Pulse polio programme [22], and sickle cell anaemia [23].

It is also the largest producer of generic drugs and exports antiretroviral, anticancer medicines, and vaccines to most of the world [24, 25, 26].

5.4 Among All the Developing Countries Where Does India Stand in Medical Research?

A scientometric research assessment of 16 developing nations was published in 2018 [27]. If that data is reanalyzed using the 2019 definition for developed and developing countries, it would exclude Argentina, Chile, Indonesia, Iran, Philippines that all have a high HDI. The other 11 countries can be reclassified into developing countries (Table 6.2). Although India had a sizeable number of publications their quality, as judged by the number of citations they receive, is low. The data from Panama shows that even with small numbers the citation index of that small country’s papers is high.

Table 6.2 Modified data for Scientometrics research of eleven developing countries (2009–2013)
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5.5 Is Collaborative Work on Research the Way Forward for All Developing Countries?

Collaboration is now seen as an important activity for the progress of science. It improves research and is now considered essential [28]. In the last decade many large-scale collaborative projects have been commissioned in Medicine, Diabetes, Oncology, Rheumatology, Molecular biology, and Genetics. Collaboration increases the number of co-authors and the citation index and increases the productivity of scientists as well. Collaboration in itself is thought to be a reflection of success for the investigator. Collaboration is beneficial to all, especially to young scientists.

In a study where six leading journals were studied for collaboration and citation index it was found that there was a correlation between the number of authors of manuscripts and the frequency of articles cited. Investigators who were open to collaborations produced superior manuscripts with higher impact factors [29].

With the available data, it seems the best way to do scientific work in developing countries is to seek help and guidance from our colleagues abroad [27].