A Bibliometric Analysis of Neonatal Condition Research in Africa: Volume, Impact, Themes, and Collaboration

Abstract

Background: The literature has addressed the negative impact of poor neonatal conditions (NCs) across regions. This has drawn attention to the need to improve NCs, particularly in Africa. NCs research can make an important contribution. However, there is no study dedicated to this topic in Africa. A bibliometric analysis of NCs research can assist scientists in planning ongoing and new NCs research and support those involved in developing and implementing strategies to combat poor NCs. Methods: This study used discipline-specific terms to identify articles on NCs published between 2000 and 2019 and indexed in the Web of Science Core Collection (WoS) with at least one African author. A bibliometric analysis was applied to determine the volume, visibility, topics, and collaboration activities related to NCs research. Results: The results show that knowledge on NCs increased between 2000 and 2019; NCs research is concentrated in a few African countries (Egypt, South Africa, Nigeria, Tanzania, and Kenya), and its visibility is below the world average. In general, maternal mortality is the most researched topic and collaborative activities are frequent, mainly international research collaboration (IRC), with the United States of America (USA) and the United Kingdom (UK) being the main partners (they participated in 57% and 28% of all articles with IRC). The collaboration networks are fragile as 43–67% of all links represent one article in 20 years. Conclusions: Ongoing and new NCs research in Africa should consider the main African players and their partners as important sources of knowledge. There is a need to implement strategies to increase NC knowledge in other African countries, expand and strengthen collaboration networks, and diversify the sources of knowledge.

1. Introduction

In 2015, the United Nations General Assembly agreed on the 2030 Agenda for Sustainable Development. The agenda comprises 17 Sustainable Development Goals (SDGs) and 169 targets. The third SDG, Ensure healthy lives and promote well-being for all at all ages, is of great importance for Africa. The high burden of disease in Africa is responsible for high DALYs (It is a measure of overall disease burden expressed as the number of years lost due to ill health, disability or early death. It is calculated as the sum of the years of life lost (YLLs) due to premature mortality and the years lost due to a disability (YLDs) for people living with a health condition or its consequences) and consequently high GDP losses. A study looking at the productivity costs of disease in Africa estimates 629 603 271 DALYs in 2015, with NCs responsible for 12% of those DALYs, and an estimated productivity loss of Int$347 336 223 573 [1].

Regarding under-five mortality, the mortality burden was highest in Africa in 2010 (3.6 million deaths) [2]. The authors found that neonatal deaths account for 30% of total mortality, and birth, complications and intrapartum-related complications as the main causes. Recent studies continue to conclude that neonatal deaths account for a significant proportion of total deaths in Africa, particularly in sub-Saharan Africa, accounting for 37% of all under-five deaths (e.g., [3,4,5]).

Considering these statistics, the international community recognized the need to develop and implement strategies to reduce the negative impact of limited NCs [6,7]. Regarding NCs, analysis of the research carried out is crucial for ongoing and future research and policy makers [8]. However, no study exists on the topic in Africa.

By looking at the volume of NCs research, scientists can gain a first impression of the dimension of the scientific community dedicated to NCs and, consequently, of the available scientific evidence. Policy makers can define strategies that align the scale of NCs research with the high burden of disease in Africa.

Through the visibility of NCs research, scientists researching NCs or looking for a topic of research can become aware of the importance that their scientific activities might have. Policy makers can set strategies to (1) improve the visibility of low-impact research and (2) maintain high-impact research.

Analyzing the topics researched enables scientists to locate their research interests in the thematic spectrum. Policy makers can define strategies to (1) draw the attention of the scientific community to topics that are less researched but of high relevance and (2) maintain interest in the most researched topics if they are of interest in the African context.

Collaborative activities and their networks enable researchers to identify future sources of knowledge by drawing on collaborative activities. Policy makers can set strategies for knowledge flow and exchange considering the necessities regarding the expansion and strengthening of research networks,

Bibliometrics enables meaningful analysis of a particular topic based on the metadata of publications. It is often used by international organizations to identify strengths, weaknesses, opportunities, and threats in science worldwide and by country (e.g., the UNESCO science reports). Therefore, in this paper, I resorted to a bibliometric analysis to investigate the volume, impact, thematic spectrum, and collaboration patterns regarding NCs research in Africa. Based on these results, I point out implications for practice, policy, and future research.

2. Methods

2.1. Data Identification

I searched the keywords related to NCs, validated by peers in [9], in titles, abstracts, and keywords to find the relevant articles indexed in the Web of Science Core Collection (WoS) and published between 2000 and 2019 (see the search query in the Support Information (SI)). I extracted the metadata of 1784 articles published by at least one scientist (not all authors of a publication are scientists in the strict sense of the word, but for simplicity, I use this word to refer to the authors in the publications) whose affiliation is with an African institution (hereafter African scientists). The use of discipline-specific terms imposes limitations that affect the accuracy of the methodology due to the multiple meanings and the variety of terms that can be used to represent a topic. I then analyzed each article and retrieved those referring to NCs in Africa. The final set comprises 1250 articles. The limitations of the methodology as well as the type of articles considered are described in the SI in Section S1.

The dataset presented here was used in an earlier study [10] that aimed to understand the role of research collaboration in shaping key developments in NCs research in Africa. Detailed information on this dataset can be found in [10]. In this study, the same dataset is used to provide a comprehensive picture of NCs research and, as mentioned earlier, to highlight implications for practice, policy, and future research.

2.2. Bibliometric Analysis

2.2.1. Volume

I used the number of articles to quantify the scientific knowledge on NCs in Africa. Where possible, I resorted to longitudinal analyses to identify trends. I also identified the African countries researching NCs.

2.2.2. Impact

I looked at the visibility of NCs research by using, as a proxy, the number of citations. The number of citations depends on the citation culture of each field, the type of document, and the year of publication [11,12]. Then, I resorted to a normalized indicator, the Category Normalized Citation Impact (CNCI), available in InCites [11].

The CNCI of a document is the ratio between the number of citations received and that expected for documents of the same type, published in the same year, and belonging to the same scientific field. If the CNCI for a particular document is above 1, the visibility of a document is above the world average; otherwise, it is below.

For article sets, I discussed their visibility using the median value of the CNCI of all articles (see Section S1 in the SI for the choice of the median value). The CNCI is only addressed for sets with 20 or more articles. When dealing with small sets of documents, the probability of finding a median value of zero is high, as many documents are never cited and others have not had time to be recognized by the scientific community due to their recent publication. Therefore, I only discuss these indicators for sets with 20 or more articles.

2.2.3. Thematic Spectrum

As for the thematic spectrum, I adopted the citation topics schema, a document-level classification available through the WoS (for more information on this schema, see Section S1 in the SI). I used the micro level to identify the topics covered in NCs research, where each article is categorized into only one topic.

For each topic with 20 or more articles, I used the median value of the CNCI to determine its visibility.

2.2.4. Collaboration

As for collaboration activities, I analyzed the patterns at the country and university level, as well as domestic research collaboration (DRC) and IRC. The heuristics I followed can be found in Section S1 in the SI.

After the identification of the countries, universities, and types of collaboration, I identified the following:

• The number of collaborative articles, the type of collaborations, and the partners. I supplemented the information with a longitudinal analysis where possible.
• DRC by African country.
• Visibility by type of collaboration.
• Areas with more collaboration.
• Collaboration networks, analyzing them using social network analysis.

In the networks, the nodes represent countries/universities and the links are the number of publications in which the scientists from the two countries/universities have participated. I used statistics of density, degree, and eigencentrality [13] to discuss the potential of these networks as enablers of knowledge flow and exchange.

3. Results and Discussion

3.1. Volume

Knowledge on NCs has increased over time. In 2000, there were 15 articles indexed in WoS, and in 2019, there were 196 (Figure 1). The growth can be described as exponential, with an annual growth rate of around 19%. This growth is also characterized by a greater geographical diversity concerning the researchers; in 2000–2004, we have scientists from 17 and 11 African and non-African countries, respectively, and in 2015–2019, from 40 and 88 African and non-African countries (SI, Tables S1 and S7).

Production is concentrated in the period between 2010 and 2019, mainly in 2015–2019, when about 61% of the 1250 articles were published (Figure 1).

A large proportion of the scientific knowledge produced is the responsibility of a few African countries; Egypt, South Africa, Nigeria, Tanzania, and Kenya contributed 787 articles, representing about 63% of all articles (SI, Table S1). This suggests that knowledge may be concentrated in a few places, which is undesirable as the burden greatly affects the whole continent.

These countries are also consistently among the African leaders in the production of knowledge in general (e.g., [14,15,16]).

This can be partly explained by the investments that African countries make in their science and technology (S&T) system when analyzing gross domestic expenditure on research and development (GERD), the existence of science funding councils, and science, technology, and innovation (STI) policies.

In 2015, the GERD in Africa averaged 0.3 of the gross domestic product (GDP) [17,18], although there were large differences between countries. South Africa’s GERD in 2017 was 0.83% of the GDP, Egypt’s GERD in 2018 was 0.72% of the GDP, and Tanzania’s GERD in 2018 was 0.51% of the GDP, while in other African countries, the GERD was below 0.5% of the GDP, such as in Mozambique and Namibia (0.34% in 2018) [19].

The S&T systems of countries with an anglophone tradition (e.g., South Africa, Kenya) include science funding councils, while countries with a francophone tradition do not have such councils, although they have recognized their importance [20]. These councils are very important as they can have several functions. Although their roles vary across African countries, they contribute to the development of S&T systems by contributing to research capacity building through the allocation of grants, formulating and monitoring research agendas, formulating/revising national STI policies, managing STI agreements, monitoring/evaluating the impact of funded research, etc. These councils already exist in South Africa, Tanzania, and Kenya, while they are still in the development phase in Namibia and Mozambique [20].

Many African countries, such as Egypt, South Africa, Kenya, Nigeria, and Tanzania, have also developed STI policies, strategies, and plans [21]. However, most African countries do not have well-developed and implemented STI policies, which hinders the development of their S&T systems [21]. Some countries (e.g., Namibia, Lesotho, and Botswana) have resorted to international organizations to help formulate and revise their STI policy plans.

Over time, there have been no significant changes in the African countries with the highest contribution (SI, Table S1). Egypt has significantly increased its production; two papers were published in 2000–2004 and 150 in 2015–2019, constituting the country with the highest number. The changes in 2015–2019 indicate that other countries might play a crucial role in NCs research in the future. While Egypt, South Africa, and Nigeria remain in the top five, Tanzania and Kenya have been overtaken by Ethiopia. Uganda and Ghana have a similar number of articles to Tanzania.

3.2. Impact

The distribution of articles according to their impact is skewed (SI, Figure S1). There are a few articles with a high impact (60 articles have a CNCI of 5 or more), but many articles have a value below the world average (749 articles with a CNCI of less than 1 and 455 with 0.500 or less).

The impact of the articles is generally below the world average according to the median value (Figure 2, left plot). Considering all articles, it is 0.754 of the world average (SI, Table S2). The impact increased from 2000–2004 (articles published in this period) to 2010–214 and then declined (Figure 2, right plot), without reaching the world average, and in 2015–2019, the median value was 0.85 of the world average. However, as mentioned before and shown in the SI, Table S2, some articles have an outstanding impact (interquartile range (IQR) and P75).

3.3. Thematic Spectrum

The distribution by topic is skewed (SI, Table S3); of 159 topics, those in the top five account for 45% of the 1250 articles. For 83 topics, the number of articles is one.

Maternal Mortality, Group B Streptococcus, Bilirubin, Preterm Labor, and Gestational Diabetes Mellitus dominated the top five in 2000–2019 (Figure 3). This is partly a result of the unbalanced distribution of documents by period (these topics dominated the top five in 2015–2019, when the number of articles is highest). Over time, we see changes; Gastroschisis, Patent Ductus Arteriosus, Fetal Heart Rate, Malaria, and Preeclampsia were in the top five in the first two periods.

For topics with 20 or more articles in 2000–2019, their visibility is below the world average, except for Bilirubin, HIV Prevalence & Prophylaxis, Malaria, and Antibiotic Resistance, which are slightly above the world average (SI, Tables S3 and S4). Articles on HIV Prevalence & Prophylaxis have the highest impact, with a median value of 1.105. The articles on Patent Ductus Arteriosus have the lowest visibility, at 0.586 of the world average.

3.4. Collaboration

3.4.1. Overview of Research Collaboration

Before I analyze the collaboration patterns, it is important to emphasize that in the African context, collaboration, especially with non-African scientists, has been widely discussed. On the one hand, it is argued that research collaboration in Africa is extremely important as it enables the production of high-quality science, which is fundamental to the socio-economic development of the continent [22]. On the other hand, there are several arguments related to the negative impact of IRC involving non-African scientists, which leads to the involvement of African scientists in research collaborations that do not address their local problems [23,24,25] and the exclusion of African scientists from various tasks related to the management and execution of projects (e.g., deciding on the allocation of financial resources, defining the research questions, planning and designing the various project components, or in the analysis, interpretation, and dissemination of results [25,26,27,28]).

Bibliometric studies have shown that in the total number of documents in most African countries (especially in the western, eastern, and central regions [26,29,30]), there is a high proportion of documents involving non-African scientists, and African countries consider their colonizers as the most important partners [26]. On the one hand, the existing literature has shown that the presence of colonial ties favors collaboration [15], which could explain, for example, why France and Belgium are strongly represented in central African publications [26]. On the other hand, the existing literature also points to practices of neocolonial science, “a spirit in science in which authors from the [industrialised] countries realise the importance of publications, recognise the contribution, but deliberately and systematically exclude co-authorship of [developing] countries” [31].

Given the historical context, I expect to find a high percentage of papers on NCs written in collaboration with non-African scientists (Figure 4); in 2000–2019, there were 555 articles produced via DRC and 669 via IRC (SI, Table S5). Collaborative activities have increased, and the growth can be characterized as exponential, with an annual growth rate of about 23% for IRC and 17% for DRC. In 2000, collaborative activities were present in all articles, and in 2019, in 98%. Considering the various 5-year periods, we see that DRC is more frequent than IRC in 2000–2004; it is about two times more frequent than IRC (Figure 4), although the number of articles is small. Over time, IRC became more frequent, accounting for 54% of all articles in 2015–2019, while DRC accounts for 45% (SI, Table S5). There is a difference between the values of DRC and IRC, but it is not as high as one might expect given the figures in the existing literature. We must take into account that the countries that contribute the most to NCs research (Egypt, South Africa, and Nigeria) are also the countries with the highest number of articles produced via DRC, as discussed in Section 3.4.3 below (articles involving DRC account for 72%, 54%, and 58% of all articles; see Tables S1 and S6 in the SI for the calculation of these data). Therefore, we can say that the observed pattern is a result of the unbalanced distribution of articles on NCs research by country.

Among the types of IRC, collaboration between African scientists without the participation of non-African scientists (IRC_intra) was rare. I found 19 articles in 2000–2019 and the majority (16 articles) were published in 2015–2019 (SI, Table S5).

Articles to which African scientists from various countries and non-African scientists (IRC_{inter_intra}) contributed were practically non-existent until 2009. After that, the number of these articles began to increase; in 2015–2019, they represented 18.5% of all articles (SI, Table S5).

This rare pattern of collaboration (IRC_intra and IRC_{inter_intra}) may not allow for the development and establishment of networks among African scientists that permit them to address their local challenges. These collaborations provide insights that can help us to answer current research questions and offer African scientists the opportunity to share their previous experiences, their acquired knowledge, and the challenges in their countries through informal communication. As they interact and understand each other’s capabilities and interests, trusting relationships are formed. These relationships and previous collaborations can lead to new joint projects that address local issues [15,28]. In addition, trusting relationships may spread among the collaborators of African scientists involved in IRC_intra and IRC_{intra_inter}, increasing opportunities for collaboration with these scientists’ partners [32]. In short, it is expected that all mechanisms involved in collaborative activities will contribute to building a stronger research network between African scientists from different countries with or without the presence of non-African scientists.

Collaboration between African scientists, all from the same country, and non-African scientists (IRC_inter) is the most common, comprising 88.2% of all articles in 2000–2004 and 77.6% in 2015–2019 (SI, Table S5). The benefits of these joint activities can be maximized if the African scientists involved have well-established national and intra/inter-regional African networks. In this scenario, they can serve as a bridge between other African scientists representing their professional connections in Africa and the non-African scientists involved in IRC_inter.

3.4.2. Collaboration Networks

If we look at the network behind NCs research, we can speculate on the potential benefits of IRC from this perspective.

NCs research is characterized by high geographical dispersion as the network consists of 129 countries (89 non-African and 40 African countries, SI, Figure S5). There are 5059 links, which account for 61% of all possible interactions given the number of countries involved. The interactions between non-African countries (the links connecting two non-African countries) dominate the network as they account for 57.4% of all links (SI, Figure S5), followed by the interactions between African and non-African countries, which account for 36.3% of all links. Finally, interactions between African countries account for 6.3% of all links. In the network, 2192 links (43.3% of all links) represent a single publication in 20 years.

Collaborations between African countries appear to be fragile, as the subnetwork related to these interactions has 60% of its links representing only one article in 20 years (Figure 5). When these links are removed, the number of African countries with links to another African country drops from 40 to 25.

The subnetwork of the collaborations between African and non-African countries (SI, Figure S6) also shows weaknesses, as the links representing one publication in 20 years account for 49% of all its links. The Republic of Congo, Liberia, South Sudan, and Togo, which also have a fragile position in Figure 5, albeit Togo to a lesser extent, lose all their connections to non-African countries when the links representing one publication are deleted (SI, Figure S7). In addition, African countries have lost connections with 15 non-African countries (Albania, Armenia, Bhutan, Bosnia and Herzegovina, Haiti, Hungary, Jamaica, Kazakhstan, Latvia, Malta, Montenegro, Myanmar, North Macedonia, Syria, and Yemen).

The subnetworks indicate that Ghana, Nigeria, Tanzania, and Kenya can play an important role in the flow of knowledge in the continent and in establishing professional links between African countries. They are quite well connected with other African countries within and outside their region (28 countries in the case of Kenya and 29 for the others). South Africa can also be crucial but is not well connected within southern Africa. In 20 years, it co-authored a single publication with Botswana. If we ignore the links representing one article, the top five consist of the same countries, and Uganda also appears at the top.

These countries, in addition to Egypt and Zambia, have the highest number of connections to non-African countries. They are influential in the network, as they are connected to countries with many connections and are also supported by the high values of eigencentrality (SI, Table S8).

As for non-African countries, the USA and the UK are key players in the flow and access to knowledge, as shown by the high number of connections and centrality (they have the highest values for degree and eigencentrality, SI, Table S8).

The role of these countries becomes even clearer when analyzing the number of jointly authored articles by African countries (SI, Table S7). They are among the five countries that collaborated the most with Africa in 2000–2019 and within each 5-year period. In 2000–2019, about 57% and 28% of the articles produced via IRC involved the collaboration of scientists from the USA and the UK, respectively. It is important to mention the colonial relations between the UK and African countries. The literature emphasizes the importance of colonial ties in research collaboration [15,33], and the statistics on NCs research show that about 46% of all articles involving UK scientists were produced in collaboration with scientists from South Africa and Kenya. Articles involving scientists from Tanzania, Nigeria, and Egypt are also represented, albeit in smaller numbers.

Sweden, the Philippines, and Switzerland lost their positions in this top group. Their contribution is limited to two and three articles in 2000–2004 (SI, Table S7), while others such as India, Canada, Pakistan, and France emerged in the top group during that period, although Pakistan and France were no longer at the top group in 2015–2019. The research with multinational clinical trials conducted in India, Pakistan, African countries, and other regions could justify the high presence of India and Pakistan at the top.

As for universities, 627 participated in IRC (SI, Table S9), and they are present in 96% of all articles produced via IRC. The distribution of universities by region is asymmetrical, as non-African universities predominate, although those from Africa increased over time (SI, Table S10). In 2015–2019, there were 126 African universities involved in IRC, accounting for 22% of all universities. The distribution of universities by country is also skewed, as those from the USA represent 18.5% of all universities in 2000–2019, followed by the UK with 4.8%.

The University of London (UoL-GBR) is the leader given the number of articles in which it was involved in the entire period, followed by the University of California (UC-System-USA) (SI, Table S11). Other well-known universities are present in the top 10, such as Harvard University (HU-USA), Johns Hopkins University (JHU-USA), the University of North Carolina (UNC-System-USA), and the University of Oxford (OX-GBR). As for African universities, the University of Malawi (UNIMA-MWI), the University of Makerere (Mak-UGA), and the University of Witwatersrand (Wits Univ-ZAF) published more articles via IRC in 2000–2019. Over time, the changes in the top 10 are not significant. We see changes from the first to the second 5-year period, but the number of articles we are dealing with is so small that an in-depth discussion is impossible.

The collaboration network has 627 universities and 48,468 links (SI, Figure S8). The visible links represent 25% of the possible interactions between the participating universities. The interactions between non-African universities dominate the network as they account for 77% of all links (SI, Figure S8), followed by the interactions between African and non-African universities, which are 21% of all links. Finally, interactions between African universities account for 2% of the observed links.

The network is characterized by a dense core dominated by non-African universities. There are clusters of universities that are closely connected to this core. If we move from the core to the periphery, the network consists of small groups of universities with weak connections to each other and fragile connections to the core.

This network can be considered too fragile as 67% of the links represent a single publication in 20 years. If these links are deleted, the network consists of 477 universities (397 and 80 African and non-African universities, respectively).

Regarding the subnetwork among African universities, it cannot be said that it is a mature and well-established network, as several universities have a very fragile position (SI, Figure S9). A total of 17 out of 138 universities have no connections to other African universities; they are part of the network because they are only linked to non-African universities. Moreover, 557 out of 804 links represent one publication in 20 years. If we delete these links, only 48 African universities will still be connected, and most of the small groups of African universities, which are at the network periphery, disappear.

The University of Cairo in Egypt (CU-EGY), MUHAS-TZA in Tanzania, Wits Univ-ZAF in South Africa, the University of Kinshasa in the Democratic Republic of Congo (UNIKIN-ZAR), and the University of Cape Coast in Ghana (UCC-GHA), from different African regions, can play an important role in the flow of knowledge between African universities as they are linked to several universities in other countries from their region and also from other African regions, except Wits Univ-ZAF and UNIKIN-ZAR. Although they are linked to universities in other African regions, they have no joint publications with countries within their region.

It is important to know which African universities can play a crucial role in the flow of knowledge and the expansion of professional relationships within the continent and to identify those that stand out for their links with non-African universities. The role of the above universities is diminished by the absence or presence of a small number of links with non-African universities.

The subnetwork between African and non-African universities, which includes 600 universities (SI, Figure S10), is also fragile, as the number of links representing one publication is 6896 out of its 10,409 links. Most African universities have at least one publication with non-African universities, as 127 out of 138 are in the subnetwork. However, the presence of African universities seems delicate as only 74 remain in the subnetwork if the links representing one publication are deleted. In addition, many connections with non-African universities are lost as the number of these universities drops to 239.

Despite these weaknesses, we find African universities that occupy an outstanding position. The universities highlighted above (SI, Figure S9), as well as the University of Ahmadu Bello (ABU-NGA), the University of Stellenbosch (SU-ZAF), and the University of Cape Town (UCT-ZAF) (from Nigeria and South Africa), have the most connections with non-African universities. They are also among the universities with the highest centrality in the network (except for UNIKIN-ZAR), as shown by the eigencentrality values (SI, Table S12).

Finally, as far as non-African universities are concerned, outstanding universities such as UoL-GBR, OX-GBR, and UW-USA are important in NCs research, as shown by their high number of connections and their centrality in the network (SI, Table S12). These institutions have the most connections to African universities (about 14% of their total connections).

3.4.3. DRC Activities

As for DRC, Egypt, Nigeria, South Africa, and Tunisia are among the top three countries with the highest number of documents in each period, although Tunisia’s presence is marginal as only two articles were identified in 2000–2004 (SI, Table S6). These countries account for 74% of all articles produced via DRC. Although the changes concerning DRC are positive for these countries, this concentration indicates a low level of interaction between African scientists within the boundaries of the remaining countries.

As for Egypt, Nigeria, and South Africa, it seems that each country is trying to solve its local problems by drawing on local knowledge, as the number of articles produced via DRC increased, albeit at different rates.

South Africa, which had the highest number of articles produced via DRC in 2000–2004, about 47% of all articles in that period, was displaced in the following period by Nigeria, which represented about 39% of all articles in 2005–2009. In 2010–2014, Nigeria lost its first place to Egypt, which retained the lead in 2015–2019. The relative weight of articles produced via DRC from South Africa decreased over time, while that from Egypt increased, accounting for about 34% of all articles produced via DRC in 2015–2019.

The data indicate that Ethiopia has made a significant commitment to DRC over the last five years. While there were no interactions within the borders in the previous periods (SI, Table S6), articles produced via DRC in 2015–2019 account for 14% of all articles with DRC in that period.

3.4.4. Visibility and Thematic Spectrum of Collaborative Activities

Research involving scientists from several countries leads to results with greater visibility than research conducted only within borders, as the CNCI values show (SI, Table S13). The median value is 0.5 of the world average for articles produced via DRC, and the value has not changed much over time. As for the articles produced via IRC, the median values are very close to the world average, and the highest value is recorded for articles published in 2010–2014, at 1.272 of the world average (SI, Table S13). The highest visibility of articles produced via IRC was also highlighted in previous studies [34], reinforcing the role of IRC as an instrument to elucidate knowledge of high impact.

Although articles with IRC_inter are prevalent in NCs research, articles with IRC_{inter_intra} have a higher visibility (articles published in 2010–2014 and 2015–2019, SI, Table S14). Articles with IRC_{inter_intra} and published in 2010–2014 have a median value that is twice as high as the world average and 1.5 times as high as for articles with IRC_inter in the same period. For the most recent articles (2015–2019), visibility decreased for both types of IRC.

Maternal Mortality, Group B Streptococcus, Bilirubin, Gestational Diabetes Mellitus, and Preterm Labor are the topics researched with more collaboration in the entire period (SI, Table S15). Therefore, the distribution is very similar to that in Figure 3.

Maternal Mortality and Group B Streptococcus have the largest number of collaborative articles in each 5-year period. However, the thematic spectrum is dynamic, with Bilirubin and Fetal Heart Rate emerging at the top in 2005–2009, Bilirubin maintaining its position, and Preterm Labor appearing in the last period (SI, Table S15).

It has been argued that the scientific production of publications in African countries is dependent on the contribution of foreign scientists [29]. However, the data show that different patterns can be found depending on the level of analysis.

Among the topics for which there are documents with IRC or DRC, IRC is the most common in 25 topics, and in the top five, we have Maternal Mortality, Gestational Diabetes Mellitus, HIV Prevalence & Prophylaxis, and Malaria. The number of articles produced via IRC is about three times as high as those produced via DRC (SI, Table S16). As for Fetal Heart Rate, the distribution is more balanced, and the difference is one document.

DRC is the most frequent in 24 topics, and in the top five, we find Group B Streptococcus, Bilirubin, Preeclampsia, Preterm Labor, and Patent Ductus Arteriosus (SI, Table S16). Still, the differences between DRC and IRC are not as pronounced as in the previous case, except for Patent Ductus Arteriosus.

The IRC articles’ visibility is above that of articles produced via DRC for the topics with 20 or more articles (SI, Table S17). Except for Group B Streptococcus and Gestational Diabetes Mellitus, the visibility of articles produced via IRC is twice as high as that of articles produced via DRC. For these topics, the visibility regarding the presence of IRC is also close to or slightly above the world average, except for Bilirubin, with a median value of 1.5 times the world average.

4. Conclusions

The literature shows that neonatal deaths account for a significant proportion of under-five deaths in Africa. Poor NCs are often cited as the main cause of neonatal death [35,36]. There have been several efforts to improve NCs in this region, but no study addresses the scientific knowledge of NCs. The quantity, impact, scientific spectrum, and collaboration patterns behind this knowledge can be used by scientists in ongoing and new NCs research and by policy makers for developing and implementing strategies to combat poor NCs.

I looked at the literature on NCs in Africa and used a bibliometric analysis to describe NCs research. The results are important for practice, policy, and future research.

NCs research has attracted the interest of the scientific community as the number of articles increased from 15 in 2000 to 196 in 2019, and the number of countries that have participated in NCs research has also increased (18 in 2000–2004 and 128 in 2015–2019). Scientists working in this domain, or close to it, have more knowledge available.

NCs research is concentrated in Egypt, South Africa, Nigeria, Tanzania, and Kenya, which shows a positive commitment to NCs issues. However, a rather negative picture emerges, which is related to a gap in the geographical distribution of engagement in Africa. Scientists should consider these countries as important sources of knowledge when setting their research agenda. Strategies are needed to increase research in other African countries and should consider involving these countries as partners.

NCs research has low visibility in general. However, some articles have aroused great interest. This is the case of Bilirubin research involving scientists from several countries. Future research should shed more light on this point. What can explain this low visibility? This could be because the results are not relevant in the context of high-income countries, as their scientific problems are different [37,38], potentially hindering global recognition of NCs research in Africa. Scientists setting their research agenda should consider the contribution of international research networks to produce knowledge of high impact, as should policy makers when defining strategies related to research of high impact.

Maternal Mortality, Group B Streptococcus, Bilirubin, Preterm Labor, and Gestational Diabetes Mellitus are the most studied topics (45% of all articles). Scientists who wish to work in other areas of interest within NCs should bear in mind that the available sources of knowledge may be limited. However, this should also be seen as an opportunity to create new research of interest.

Future research should investigate whether the top five topics represent the main challenges in NCs in Africa. If this is not the case, strategies are needed to focus on high-priority scientific problems. Policy makers should consider the possibility of designing strategies that promote more balanced research across the thematic spectrum to achieve more comprehensive strategies for healthcare in relation to NCs.

NCs research is highly collaborative, with IRC occurring most frequently, namely between African scientists from the same country and non-African scientists. IRC_intra and IRC_{intra_inter} are rare. Strategies to expand and strengthen research collaboration should focus on these collaborations.

The networks/subnetworks behind NCs research are fragile, as most links (43–67%) between countries/universities represent one publication in 20 years. Ghana, Nigeria, South Africa, Tanzania, Kenya, Egypt, and Zambia have high centrality in the network. CU-EGY, MUHAS-TZA, Wits Univ-ZAF, SU-ZAF, UCT-ZAF, UNIKIN-ZAR, UCC-GHA, and ABU-NGA have the most linkages with African and non-African universities, except UNIKIN-ZAR, which has no linkages with African universities from other countries. Ongoing and new NCs research may consider these countries/universities as sources of knowledge and partners. Strategies addressing the flow and exchange of knowledge and expansion of networks within the continent should consider these countries/universities as possible bridges.

The low level of collaboration between African countries/universities can be explained by the limited resources (human capital, infrastructures, and finances) available for research on the continent. Therefore, policy makers should prioritize strategies to strengthen inter- and intra-regional collaboration networks, taking into account the necessity of increasing resources. The existence of these networks will enable African scientists to respond better to local challenges, and at the same time, research involving non-African scientists will be more balanced. This collaboration will be mutually beneficial and focus on local problems.

The USA and the UK are the main partners, as are the universities of these countries, especially those known for their excellence (e.g., HU-USA, JHU-USA, UoL-GBR, OX-GBR). Ongoing and new NCs research may consider these countries as an important source of knowledge and partners but must ensure that the main research agenda is according to Africa needs regarding NCs. Strategies addressing knowledge sources should emphasize geographical diversification, while maintaining links with the US and UK, to reduce dependence on knowledge from these countries.