Current Medicine Research and Practice 9 (2019) 129e137 Contents lists available at ScienceDirect Current Medicine Research and Practice journal homepage: www.elsevier.com/locate/cmrp Original article The research output from medical institutions in South Asia between 2012 and 2017: An analysis of their quantity and quality * Samrat Ray a, , Abdullah Al Mamun Choudhury b, Shantanu Biswas c, Zulfiqar A. Bhutta d, e, Samiran Nundy a a Department of Surgical Gastroenterology and Liver Transplantation, Sir Ganga Ram Hospital, New Delhi, India b Department of Surgery, Upazilla Health Complex, Chandanaish, Chittagong, Bangladesh c Department of Surgery, Chittagong General Hospital, Bangladesh d Center of Excellence in Women and Child Health, The Aga Khan University, Karachi, Pakistan e Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada article info abstract Article history: Introduction: The eight countries of South Asia share similar backgrounds, together with similar health Received 6 May 2019 care related problems and a lack of medical facilities. They also have a total of 828 medical institutions Received in revised form both in the public and private sectors but sadly, their research output is generally thought to be poor 2 July 2019 both in quality and quantity. Accepted 8 July 2019 Methods: We analyzed the research output from this region in terms of the number of publications in Available online 18 July 2019 indexed journals, their citations and the h-index of the institutions using the Scopus database between 201217. These were compared with ten randomly selected leading institutes of the world. Keywords: Research Results: Only 353 (42.7%) had produced a single indexed research article in the six years of the study Qualitative period. The cumulative research output of all the countries during this period was 97,170, the biggest Quantitative contributor being India (86.3%) followed by Pakistan (9.9%) and Bangladesh (1.4%). In terms of the mean South Asia number of the citations and h-index, India led with 1775 citations per institute with a mean h-index of 12.1. Conclusion: Despite the immense health problems facing the countries, the overall research output from the South Asian countries is poor as evidenced by the cumulative number of publications or a com- parison on a global scale. This needs urgent and serious attention. We suggest that intercountry research collaborations, student exchanges, compulsory research projects in undergraduate and postgraduate curricula, adequate funding, and incentives for research publication may be some of the ways forward. © 2019 Sir Ganga Ram Hospital. Published by Elsevier, a division of RELX India, Pvt. Ltd. All rights reserved. 1. Introduction treatment and the distribution of health facilities. The evidence for the most aspects of the region's health care is largely derived from South Asia consists of eight countries e Afghanistan, the experience of research carried out in Western countries and Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan, and Sri Lanka published in Western journals, much of which is of little relevance e which are related to each other historically and comprise almost to countries where patients are generally poor and have very a quarter of the world's population. The region has many similar different diseases and little access to expensive technology. There is socioeconomic, cultural, educational, and political characteristics as thus a pressing need for research into health care in South Asia well as challenges.1,2 Its health systems are generally inaccessible, which is relevant to the region's needs. However, this has been inadequate, and unequally distributed. There is also a scarcity of sadly lacking. data on not only the prevalence of disease but also the results of Although South Asian countries have a large number of medical institutes and teaching hospitals, with most of them in its most populous countries India, Pakistan, and Bangladesh, their research * Corresponding author. Department of Surgical Gastroenterology and Liver output is generally minuscule compared with most advanced na- e Transplantation, Sir Ganga Ram Hospital, New Delhi, India. tions and is often not relevant to the region's needs.3 6 Factors such E-mail address: [email protected] (S. Ray). https://doi.org/10.1016/j.cmrp.2019.07.005 2352-0817/© 2019 Sir Ganga Ram Hospital. Published by Elsevier, a division of RELX India, Pvt. Ltd. All rights reserved. 130 S. Ray et al. / Current Medicine Research and Practice 9 (2019) 129e137 as overwhelming patient numbers, paucity of doctors, a lack of 3. Comparison of the top 20 institutes from South Asia with 10 incentive to perform research, and the absence of training in best-known medical institutes worldwide. research methodology as a part of the curriculum in undergraduate and most of the postgraduate training programs have been cited as e some of the major reasons why the output has been so poor.7 9 2.3. Patient and public involvement Some of us had previously carried out a quantitative analysis of the research output from the 579 medical institutes in India and The present study did not involve any cohort of patients or found that 57% of them had not published a single article which was public. Therefore, informed consent was not applicable to the same. included in the Scopus database between 2005 and 2014.10 The authors calculated the total number of publications and the In this study, we have extended this analysis to include the other quality indicators of all the individual institutions during the study countries in South Asia over a more recent period, 2012e2017, and period and presented an analysis of the same. have assessed the quantity and quality of their research output. 3. Results 2. Materials and methods The publications from a total of 828 medical institutes in the Using the Scopus database, we: region were studied. Of these, 580 (70%) were from India, 105 (12.5%) from Bangladesh, 71 (8.5%) from Pakistan, 52 (6.2%) from Analyzed the total number publications from the individual Nepal, 8 (0.9%) from Sri Lanka, 7 (0.8%) from Bhutan, 4 (0.5%) from medical institutes and teaching hospitals from the South Asian the Maldives, and 1 (0.1%) from Afghanistan. They together pro- countries over the last six years, duced a total of 97,170 articles during this period, with the largest Assessed the quality of publications using the total number of contribution of 83,892 (86.3%) from India, followed by 9665 citations and the h-index, (9.9%) from Pakistan, 1402 (1.4%) from Bangladesh, 1367 (1.4%) from Compared the research output of the countries, both in terms of Nepal, 837 (0.9%) from Sri Lanka, and 6, 4, and 3 articles from < quantity and quality, and Afghanistan, Bhutan, and the Maldives, respectively, ( 0.1%). Of the Compared the research output with some of the best-known 828 total institutes from the South Asian Association for Regional academic medical centers in the world. Cooperation (SAARC) nations, there was research output from only 354 according to the records of the Scopus database (42.7%). Fig. 1 shows the comparison of the nations in terms of the total number of medical institutes analyzed, the mean number of pub- 2.1. Quantitative analysis lications during 2012e2017, and the average number of citations and h-index. India led in the mean number of publications (n ¼ 376), The total number of documents (including randomized followed by Pakistan (n ¼ 136) and Sri Lanka (n ¼ 104). In terms of controlled trials [RCTs], systematic reviews and meta-analyses, the average number of citations, India led again with 1775 citations original articles, review articles, case series, case reports, confer- per institute, followed in sequence by Sri Lanka (n ¼ 532) and Nepal ence proceedings, and symposia reports) produced by the medical (n ¼ 503). India also had the highest mean h-index (n ¼ 12.1), fol- institutes from the eight nations was calculated over the period of lowed in sequence by Pakistan (n ¼ 7.4) and Nepal (n ¼ 4.4). six years and tabulated on an Excel sheet. Table 1 shows the list of the top 30 institutes in South Asia, in The institutes were searched according to the various format- terms of the total number publications from 2012 to 2017. These ting permutations and combinations of their respective names, contributed to 53.3% of the total (n ¼ 51,774). The top 10 institutes fi using the af liation search on the Scopus database. (For example, Sir were from India, which contributed to 32% of the total research. Ganga Ram Hospital or Sir gangaram hospital or Sir ganga ram These were the All India Institute of Medical Sciences (AIIMS), New fi hospital, etc). The total number of documents retrieved was ltered Delhi; Post Graduate Institute of Medical Education and Research from 2012 to 2017, and the number tabulated. The average number (PGIMER), Chandigarh; Christian Medical College (CMC), Vellore; of publications (per institute) was calculated for the individual Sanjay Gandhi Postgraduate Institute of Medical Sciences nations and compared. (SGPGIMS), Lucknow; Kasturba Medical College (KMC), Manipal; The subsequent ranking was done as follows: Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry; Tata Memorial Hospital (TMH), 1. The total number of publications from the top 30 institutes was Mumbai; Maulana Azad Medical College (MAMC), New Delhi; ranked in a descending order. Amrita Institute of Medical Sciences (AIMS), Kochi; and Medical 2. Top 10 institutes from the individual nations were listed in a College, Kolkata in the descending order. Two institutes from descending order according to their total number of Pakistan also featured in this list, with the Aga Khan University publications. Hospital and the Dow University of Health Sciences being placed at 3. The top 25 institutes in the region were compared with 10 of the the 13th and 25th positions, respectively.