Introduction

The disparity in surgical research output between high-income countries and low- and middle-income countries, especially in Africa, is striking. Sub-Saharan Africa (SSA) currently produces only 0.9 publications per 100,000 population compared to a global average of 17.49 (1). Furthermore, more than 40 African countries have no journals indexed in the Web of Science and 20 lack presence in regional databases like AJOL and African Index Medicus (2).
Peer-reviewed publications are a critical measure of academic success in the surgical field, influencing certification, career advancement, and future academic output (3). Globally, African authors are underrepresented, which has a significant influence on the career progression and profile of African researchers (4).
The Annals of African Surgery was established in 2007, with the aim of encouraging and developing surgery-based research from the African continent. The journal currently receives manuscripts from within and beyond the continent. There are no comprehensive studies conducted to evaluate the trends in submission and publications in surgical research in an African journal. Therefore, we conducted this study to analyze the trends in the submission and publication of surgical research in a premier surgical journal in Africa between 2017 and 2023. The study aimed to map the growth of the surgical scholarly field in the continent over these 7 years.

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Materials and Methods

Study design
This is a retrospective audit of all manuscript submissions to the Annals of African Surgery since the journal adopted the ScholarOne manuscript management system in 2017.

Study population
The study reviewed all manuscripts that had been submitted to the journal from January 2017 to December 2023. 

Inclusion criteria
All manuscripts submitted to the journal were included in the study.

Exclusion criteria
Duplicate manuscripts and revised versions were excluded from the analysis. Only the final version was considered.

Data collection
From the ScholarOne manuscript management system, we generated manuscript status and summary reports with the following variables: manuscript ID, manuscript type (case report, original research—clinical vs. nonclinical), author names and number of authors, primary author affiliation, type of study, scope of manuscript, manuscript title, year of submission, author country/region.
From the generated list of study types, the manuscripts were further reclassified into the following:

1. Case reports/series/opinions/papers: case reports, commentaries, editorial reviews, perspective papers, narratives, short communication, video vignettes, and letters to the editor.

2. Observational studies: cross-sectional, retrospective and prospective studies, qualitative studies, and mixed methodology.

3. Interventional studies: experimental studies and clinical trials.

4. Systematic reviews and meta-analysis.

Data cleaning
A total of 5496 manuscript entries were retrieved from the ScholarOne manuscript management system. After excluding 5003 revised versions, a total of 493 unique, final submissions were included in the study dataset.
Surgical specialties were categorized based on the primary focus of each manuscript, using a predefined list of 21 thematic areas. Manuscripts were classified into one of these 21 scope categories based on keywords in the title and abstract. The category “Gastrointestinal/Abdominal/General Surgery” was applied as a single group for manuscripts covering overlapping topics commonly managed within general surgical practice. This grouping streamlined classification where content spanned multiple but related domains. In cases of ambiguity, categorization was determined by consensus among the study team, based on the dominant clinical focus.
The number of authors was tabulated from the manuscript management system. The first author was assumed to be the primary author as designated at the point of submission. The author’s gender was identified from further searches using social media handles and the institutional affiliation provided at submission. Authors whose gender could not be established were excluded from the analysis. Out of the 493 manuscripts, gender was identified for 492 primary authors. One manuscript was excluded from the gender analysis due to the inability to confidently determine the primary author’s gender.

Data analysis
Data on the scope of the manuscript, continent and country of origin, number of authors, and study design were summarized into frequencies and percentages using SPSS v27 (IBM, Chicago, IL, USA). Cross-tabulations were done for the number of authors against the type of study. Mean and standard deviation (SD) were used to summarize the data.

Ethical approval
The retrieval of data from the manuscript management system was approved by the Journal Research Committee.
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Results

A total of 493 manuscripts were submitted to the journal for the period under study. The number of manuscript submissions increased from 46 in 2017 to 114 in 2020, followed by 84 submissions in 2021, 49 in 2022, and 48 in 2023.
The journal received manuscripts predominantly from the African continent, with the largest contributor being local researchers; 33% of the manuscripts came from the international community (Table 1). The journal has also seen an increase in the number of submissions from the African continent (Figure 1).

 

Table 1.

Continent/country of origin of submitted manuscripts

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Figure 1.

Trends in diversity of manuscript country of origin (Africa)

 

Table 2.

Scope of manuscripts submitted to the Annals of African Surgery

The journal received manuscripts from a diverse array of surgical specialties, Gastrointestinal/Abdominal/General Surgery being the predominant category (32.3%) (Table 2).
The study designs submitted to the journal were predominantly observational and case studies (Figure 2), with this trend persisting throughout the study period (Figure 3).

 

Figure 2.

Frequency of manuscripts by study design submitted to the Journal.

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Figure 3.

Trends in study designs submitted to the Journal.

Of the submitted manuscripts, 55 (12.5%) had authors from different countries, indicating international collaboration. Among these, North–South collaborations were the most common (69.1%), followed by intra-African collaborations and Global South/Other collaborations (Table 3). Additionally, 340 manuscripts (77.4%) had authors affiliated with more than one institution, reflecting a high level of institutional collaboration.
The number of authors ranged from 1 to 12 authors per manuscript, with a mean (SD) of three authors (±2.04) per manuscript (Table 4). Interventional studies had, on average, a higher number of authors compared to the other study designs; however, the highest number of authors was reported in a case report (Table 4).
Female primary authors represented only 16% of overall primary authors; however, there was an upward trend in female primary authorship (Figure 4).

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Table 3.

Summary of collaboration types among submitted manuscripts

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Table 4.

Number of authors against manuscript study design

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Figure 4.

Trends in gender of primary author

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Discussion

Most of the journal’s submissions were from Africa, predominantly Kenya, where the journal is domiciled. Globally, there is a great disparity in surgical research output between high-income countries and low- and middle-income countries, especially within the sub-Saharan region (1). These findings are in keeping with the agenda of the journal, which is to encourage publication, visibility, and scientific influence of surgically related research from the African continent (5); however, further efforts are needed for the journal to be more representative of the African continent.
The evaluation of journal publications highlighted a diverse spectrum of surgical specialties with a significant predominance in Gastrointestinal/Abdominal/General Surgery with limited submissions from other surgical specialties. This could be a reflection of the low research capacity in these fields (6, 7) or an increasing number of subspecialty journals (8).
Our study on surgical research submissions highlighted a predominance of observational studies. This may be a reflection of the type of ongoing research activity in the continent (9). Randomized clinical trials and quality systematic reviews are regarded as the gold standard of clinical research (10); however, only 20–30% of global clinical trials are conducted in LMICs, with <10% occurring in SSA (11). The labor-intensive and costly nature of these trials also hinders effective conduct, interpretation, and ultimately publication of these studies (12). Beyond logistical and resource constraints, the predominance of observational studies may also reflect a research ecosystem that inadvertently incentivizes simpler, lower-barrier study designs. Academic promotion systems in many African institutions often prioritize publication quantity over methodological quality, encouraging researchers to focus on rapidly publishable outputs. Despite these challenges, well-designed observational studies can yield valid results and offer distinct advantages such as larger sample sizes and lower costs and can provide valuable complementary evidence. Continuous efforts to improve study design, reporting, and analysis are essential for advancing surgical research and improving patient outcomes (10).
There was also evidence of collaboration among authors. Manuscripts with international collaboration were relatively few, with most involving North–South partnerships. This finding reflects broader patterns in global surgical research, where high-income countries often lead or dominate collaborative initiatives with African partners, and African researchers are frequently relegated to supportive roles such as data collection or local implementation (13). Intra-African collaborations were notably limited, a trend also observed across other disciplines, often attributed to funding disparities, limited infrastructure, and linguistic and regional divides (14). The limited intra-African collaboration observed in our data may also stem from entrenched research silos and the absence of structured funding mechanisms that prioritize regional partnerships. This reflects a broader missed opportunity to build cross-country research capacity within the continent, an issue that could be addressed through African-led funding initiatives and regional research consortia. On a more positive note, the high proportion of manuscripts with authors from multiple institutions reflects encouraging progress in national and institutional collaboration, which may provide a foundation for strengthening regional networks and building sustainable research ecosystems within Africa (15).
There is a notable gender disparity among primary authors with a low representation of female authors at merely 16.4%. This pattern of underrepresentation is consistent with findings from other studies globally (16). The underrepresentation of women in surgical research has far-reaching consequences on the diversity of perspectives and research topics within the field of surgery (17). It also mirrors a larger pattern of underrepresentation of women in the surgical workforce (18–20). The observation of gender disparities in surgical research extends beyond authorship roles to funding and access to resources (20, 21). Improving the representation of females in research, publishing, and sciences in Africa calls for handling both social and political barriers (22). A substantial change in policy and practice is needed to truly support and integrate women in research leadership and participation (22).
Our findings highlight the urgent need for intentional strategies to support women in academic surgery. These should go beyond passive encouragement and include structured mentorship programs, targeted research funding, and journal-level initiatives to monitor and promote gender equity in authorship. Journals can play an active role by tracking gender metrics, inviting more women to peer review and editorial roles, and offering dedicated platforms or mentorship pipelines for early-career female authors. Without systemic change, the gender gap in surgical research output is likely to persist, with implications not just for fairness but for the relevance and inclusivity of surgical science across the continent.

Limitations 
The country of origin was based on the information entered by the submitting author. This method may not fully capture the collaborative nature of manuscripts that involve multiple authors from different countries, potentially underrepresenting international partnerships and contributions to the research.

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Conclusion

The Annals of African Surgery receives representative manuscript submissions predominantly from the African continent. However, there remains a need to broaden geographic representation and strengthen the quality and design of submitted research.

 

Recommendations
The journal should put in more effort to encourage the conduct and submission of high-level study designs. In addition, there is a need to encourage gender-balanced authorship with support and mentorship for female surgical researchers. 

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Author contributions

JK led in the writing of the original draft. JK and MW led in conceptualization. CM led in data curation, formal analysis, methodology and visualization. CM, JK and MW led in validation. JK led in software. JK and MW led in funding acquisition, project administration and supervision. All authors led in the writing, reviewing & editing of the original draft.

 

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