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Pediatric Medical Research: Where is the Gap?

Article in Bahrain Medical Bulletin · June 2019

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Bahrain Medical Bulletin, Vol. 41, No. 2, June 2019

Pediatric Medical Research: Where is the Gap?

Hasan M. Isa, MBBCh, CABP* Huda M. Omran, MSc, Phd** Afaf M. Mohamed, MBBCh, MPH***
Zakareya M. AlSalman, MBBS**** Jasim A. Abdulhusain, MBBS****

Objective: To evaluate the trends in pediatric researches performed at the main hospital in
Bahrain and to identify existing research gaps.

Setting: Pediatric Department, Salmaniya Medical Complex, Bahrain.

Design: A Retrospective Study.

Method: All scientific contributions produced by the pediatric department were identified between
1 January 1977 and 31 May 2018. Annual and cumulative trends of scientific production were
calculated. Articles were stratified based on publication type, medical subspecialties and types
of publishing journals. Pediatrician’s gender, job description and current job were documented.

Result: Out of 416 scientific contributions, 309 scientific publications were analyzed (293 journal
articles, 5 books, 9 book chapters, 2 booklets). There was a significant increase in the number of
publications over the last four decades (P-value<0.0001). Hematology and gastroenterology were
the most researched specialties, 38 (12.3%) publications each. Publications on infectious diseases
were eight (2.6%) and seven (2.3%) on oncology. Out of 257 (83.2%) publications, 125 (40.5%)
articles were published in international journals. Forty-seven (51.1%) out of 92 pediatricians had
scientific publications. Of the 47 pediatricians, 36 (76.6%) were consultants and 11 (23.4%) were
residents (P-value <0.0001). Gender (P-value=0.838) and position (P-value=0.633) had no effects
on publication.

Conclusion: In the last four decades, there has been a remarkable increase in the number of
pediatric publications at the main hospital in Bahrain, with special emphasis on hematological
and gastrointestinal problems. Yet, there is a continuous need to study important health problems,
such as cancer and infections.

Bahrain Med Bull 2019; 41(2): 79 - 83

Medicine is an evolving science1. All scientists aim to discover better understanding of diseases, higher social or hospital
and disseminate truth via generating and testing hypotheses2. standing, and research grants or awards acquisition are the
In the era of evidence-based medicine (EBM), physicians are main benefits of conducting clinical research10. Furthermore,
required to deliver the best management to their patient1,3. the academic standard makes publication obligatory for an
Research is one of the pillars for patient management1,4. academic promotion1,11. Research and journal publications are
The importance of research in pediatric age groups is well also necessary for academic institutions11.
recognized5,6. Improvement of child health outcomes can be
strengthened by properly conducted research7,8. It is common Salmaniya Medical Complex (SMC) was established in 1970
that clinical decisions about pediatric care rely on adults and remains the main hospital that provides secondary and
research5. However, because of the physiological differences tertiary healthcare to all the citizens and residents of Bahrain at
between children and adults, it is not sufficient to rely on results the high-quality level12. Recently, in November 2016, a pediatric
obtained from adult studies and generalize them to children5,6. research committee has been established. Data management,
statistics and epidemiology, and study implementation are the
Research articles remain the most influential method of three main basic requirements necessary to support any clinical
spreading new knowledge and establishing academic research division13.
hierarchies at both individual and institutional levels9. Attaining

* Assistant Professor, Arabian Gulf University

Pediatric Gastroenterology Consultant, Pediatric Department
Salmaniya Medical Complex
** College of Medicine and Medical Sciences
Arabian Gulf University
*** Public Health Consultant, Public Health Directorate
Ministry of Health
**** Intern
Pediatric Department
Salmaniya Medical Complex
E-mail: [email protected]

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Bahrain Medical Bulletin, Vol. 41, No. 2, June 2019

The aim of this study is to evaluate trends in pediatric research

in Bahrain and to identify existing research gaps.
416 scientific
documents
METHOD

All scientific contributions produced by the pediatric 107 were excluded:

department at SMC between 1 January 1977 and 31 May 86 unpublished works

12 duplicates
2018 were identified through electronic databases and by 9 unretrievable articles
direct contact with all pediatric physicians for journal hard
copies. Shared works with other medical staff, such as rotating
physicians and trainees including family physicians, nurses, 309 published work

interns, and clinical attachment have been included. Duplicate

publications were excluded. The following were included:
293 retrieved full
journal articles, book chapters, books and booklets. The journal articles
9 book chapters

articles were stratified into original articles, case series, case

reports with literature review, case reports, review articles, 201 original
5 books
47 case reports
theses, audits and guidelines. Publication years were identified. articles

The annual incidence of scientific production and the overall 2 booklets

cumulative prevalence were calculated. In order to study the 18 case series
4 case reports
with literature
trend of scientific publications, the results were categorized review

into ten-year periods.

3 thesis, 1 audit,
4 review articles
1 guideline
Each scientific contribution was classified based on medical
subspecialties. Journals which published the articles were
classified into local (journals published in Bahrain), regional
Figure 1: Scientific Publications of the Pediatric Department,
(journals published from Arabian Gulf countries) and
SMC (January 1977 - May 2018)
international. Impact factors for published journal were
retrieved using Google search engine. Details about the current 18

job position and research activities for each pediatrician were 16

also recorded and compared. 14

12
SPSS version 21 was used. Data were expressed as frequency
No. of publications

and percentage or median and range. Kruskal Wallis test was 10

used to compare publication numbers in the four decades and to 8

compare the impact factors of local, regional and international 6

journals. Fisher’s exact and Pearson chi-square tests were 4

used to compare publication with gender and job descriptions 2
respectively. Two-sided P-value less than 0.05 was considered
0
statistically significant.
Year
RESULTS
Figure 2: Number of Scientific Publications per Year from
Four hundred sixteen scientific documents were identified. One the Pediatric Department at SMC (January 1977 - May 2018)
hundred seven articles were excluded; 86 were unpublished
work, 12 were duplicate publications and nine articles were
rejected because they could not be retrieved. The remaining
309 publications were analyzed, see figure 1. All the articles
were published using English language. The overall median of
publications was six publications per year (range from 0 to 17).
Two hundred ninety-three (94.8%) were journal articles 201
(65.1%) original article, 47 (15.2%) case reports, 18 (5.8%)
case report with literature review, four (1.3%) review articles,
three (0.97%) thesis, one (0.32%) audit and one (0.32%)
guideline); nine (2.9%) book chapters, five (1.6%) books and
two (0.7%) booklets. The publication year was recognized in
268 (86.7%) publications. The number of publications were
as follows: 13 (4.2%) in 1977-1986, 34 (11%) in 1987-1996,
89 (28.8%) in 1997-2006 and 132 (49.2%) in 2007-2018. Figure 3: Scientific Publications Per Decade at the Pediatric
There was a significant increase in the number of publications
Department, SMC (January 1977 - May 2018)
over the last four decades (P<0.0001), see figures 2 and 3.
The publication year was not recognized in the remaining 41 The publications covered different pediatric specialties.
(13.3%) (20 presented at local conferences, 10 presented at Hematology and gastroenterology were the most researched
international conferences, 6 posters, 4 diploma projects and 1 areas with a total of 38 (12.3%) publications for each, see figure
thesis). 4. Infection was represented only by eight (2.6%) publication

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Bahrain Medical Bulletin, Vol. 41, No. 2, June 2019 Pediatric Medical Research: Where is the Gap?

40 38 38 and cancer was seven (2.3%). On stratifying the scientific

35 involvements according to the type of publishing journal, 125
31 Number Percentage
(40.5%) articles were published internationally, 90 (29%) in
Number and percentage of publications

30
26
25 local and 42 (13.4%) in regional journals. Two hundred two
25
(65.4%) were published in journals with an impact factor, see
23 23
22

figure 5. The median impact factor of the publishing journals

20

15
12.9 12.9 12
11
was 0.71 (range 0.03 to 10.3). International journals had higher
10.5
10 8.8
8.5 7.8 7.8 7.5 8 8
7
impact factors (median 2.4, range 0.2 to 10.3) compared to
6 6
5 4.1 3.7
2.7 2.7 2.4 2.0 2.0
5

1.7 3 2
regional (median 0.7, range 0.06 to 1.2) and local (median
0.15, range 0.03 to 0.66) journals (P<0.0001).
1.0 1
0.7 0.3
0

Ninety-two pediatricians were identified in the study, 47

Pedicatric Subspeciality
(51.1%) of them had scientific publications, see table 1. Thirty-
Figure 4: Number of Publications Per Subspecialty from six (76.6%) consultant physicians had published articles which
the Pediatric Department were significantly higher than chief, senior and junior residents
(P<0.0001). Gender (P=0.838) and position (P=0.633) had no
effects on publication.
140

120
119 DISCUSSION
Number Percehtage
Number and pecentage of publications

This study revealed a remarkable increase in the number of

100

80 pediatric publications over the last four decades. Medical

60
58.9
research and disease-specific data in Arab countries are
limited14. This study found 51% of the pediatricians had
40
28
published scientific papers. Sumi et al found that more than
20
13.9
22
14
two-thirds reported a current (68%) and past (74%) research
10.9
7 6
3
6
3 2 0.9 2 0.9 1 0.5 1 0.5 1 0.5
involvement10. In India, the number of research articles
0
<1 1-1.9 2-2.9 3-3.9 4-4.9 5-5.9 6-6.9 7-7.9 8-8.9 9-9.9 ≥10 published in the medical field is still limited, only 4% of the
Journal latest impact factor
residents had publications, 50% had participated in research
Figure 5: Number of Publications Per Journal Recent Impact and only 28% had made scientific presentations3.
Factor from the Pediatric Department
In this study, 68.8% were original articles followed by case
Table 1: Relationship Between Scientific Productivity reports (15.9%). Hamadah et al found that the most common
and Gender, Job Description and Current Position of 92 publication in the Arab world were case reports (34.8%)8. The
Pediatricians at SMC (January 1977 - May 2018) types of pediatric research differ according to the setting’s
level of income6. In high-income settings, pediatric research
Not
Published n Total n studies are likely to be smaller, early phase studies, in non-
Variable published n P-value
(%) (%) communicable diseases and performed in well-equipped
(%)
hospitals; they tend to be larger and more disease-management-
Gender type in low-income settings6. Research involvements deserve
Male 23 (52.3%) 21 (47.7%) 44 (47.8%) more attention7. Hamadah et al found that low-middle-income
countries were more likely to publish descriptive researches
Female 24 (50%) 24 (50%) 48 (52.2%) 0.838*
compared to high-income countries that produced more
Total 47 (51%) 45 (49%) 92 (100%) analytical and experimental researches8. In Arab countries,
Job description health ministries should encourage and support analytical and
experimental research8.
Consultant 36 (80%) 9.0 (20%) 45 (48.9%)
Chief resident 8.0 (32%) 17 (68%) 25 (27.2%) The present study revealed that hematological and
Senior resident 3.0 (20%) 12 (80%) 15 (16.3%) <0.0001† gastrointestinal subspecialties were the main subspecialties
which have produced research papers. On the other hand, we
Junior resident 0.0 (0.0) 7.0 (100%) 7.0 (7.6%) still lack research in infectious disease (2.7%) and oncology
Total 47 (51%) 45 (49%) 92 (100%) (2.4%). There is paucity in cancer research publications in
Position several developing countries including Bahrain despite the
fact that cancer poses a worldwide healthcare burden8. Cancer
In service 34 (49.3%) 35 (46.7%) 69 (75%) research is crucial for the development of effective, precise and
Out service 13 (56.5%) 10 (43.5%) 23 (25%) sustainable healthcare policies15.
0.633*
Retired 12 (60%) 8.0 (40%) 20 (21.7%)
In the present study, 40.5% of the articles were published in
Resigned 1.0 (33.3%) 2.0 (66.7%) 3.0 (3.3%) international journals, 29% in local and 13.%4 in regional
Total 47 (51%) 45 (49%) 92 (100%) journals. In addition, our study showed that the impact factors
of the involved journals were higher in international journals
*Fisher’s exact test, †Pearson chi-square. compared to the regional and local journals. Hamadah et

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Bahrain Medical Bulletin, Vol. 41, No. 2, June 2019

al found that 90.9% of researches from Arab countries were for a resident. Time for research activities should be allocated
published in international journals while publications in in the curriculum as requested by most residents (86%)3.
local and regional journals account only for 4.6% each8.
This might be explained by the fact that articles published in Academic institutions, faculty and fellowship programs must
local and regional journals are unlikely to be indexed in the be armed with well-trained research fellows using collaborative
commonly used online databases, especially those written in and interdisciplinary approaches22. A clinical research support
Arabic8. Moreover, some academic institutions consider only center should be established to provide initial advice regarding
publications from indexed and abstracted biomedical journals research design10. Financial assistance is also needed for the
or from internationally recognized media such as Medline, research itself and for the publishing process11.
PubMed, ISI Web, etc11. However, top quality manuscripts
of some inexperienced authors are published in non-indexed The study was limited by missing details related to the type
journals11. and year of some publications. Another limitation is that most
of the research producers were from a consultant level which
In the current study, 76.6% of pediatricians who published does not reflect the entire pediatric staff.
scientific papers were consultants and faculties at universities
and only 23.4% were residents. This could be due to the lack CONCLUSION
of research training within the pediatric residency program at
SMC. Sumi et al found that faculties (89.1%) were more likely The last four decades have witnessed a remarkable increase
to have past participation in clinical research compared to in the number of pediatric research publications in the main
residents (53.5%)10. Programs that involve high-school, college, hospital in Bahrain, with special emphasis on hematological
and medical students into pediatric research led to a long-term and gastrointestinal problems among the pediatric age
interest in research7. However, there is still a shortage of young group. Pediatricians in Bahrain needs more support and
pediatricians whose aim is to carry out fundable research7. training on the how to conduct clinical research.
__________________________________________________
Although this study did not show any gender difference in
publication, there are several evolving trends in pediatric Author Contribution: All authors share equal effort
research related to gender16. Spector et al found that fewer contribution towards (1) substantial contributions to conception
women enter research compared to men16. Therefore, as the and design, acquisition, analysis and interpretation of data;
proportion of females increases in pediatric departments, (2) drafting the article and revising it critically for important
the number of pediatric researchers might decrease16. The intellectual content; and (3) final approval of the manuscript
overall underrepresentation of females as main editors and on version to be published. Yes.
the editorial boards may partially explain the gender gap in
Potential Conflict of Interest: None.
authorship17.
Competing Interest: None.
Our study showed that 48.9% of pediatricians did not publish
any scientific papers. Many ethical and practical problems Sponsorship: None.
have led to a paucity of high quality pediatric research5. The
evolution of children’s medical care depends on their inclusion Acceptance Date: 30 March 2019.
in clinical trials18. However, children’s involvement in research
and exposure to risk might be difficult to be ethically justified Ethical Approval: Approved by the Secondary Care Medical
especially that they could not give their own informed Research Subcommittee, Salmaniya Medical Complex,
consent15,19. Over the years, ethical guidelines started to be Ministry of Health, Kingdom of Bahrain and conducted in
embodied in regulations20. In developing countries, pediatric accordance with the principles of the Helsinki Declaration.
research regulations are often rigid, confusing or even non-
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