Encouraging high‐quality research publications from the developing world

Many of us are familiar with the allegory of the six blind men examining an elephant (Indian legend, popularized by John Godfrey Saxe [1816-1887]). Each of the men came to different conclusions regarding the nature of the elephant, depending on which part of the animal they touched. Likewise the diversity of challenges, constraints, epidemiology, requirements, priorities, and practices in that large part of the world described as “developing” is lost to us in the absence of good-quality research publications from such countries. Their approaches and outcomes may differ from those in the developed world but they are all part of the same “elephant” of transfusion medicine and their findings may be not just “interesting” but will also broaden general perspectives and could inform decisions made in more affluent countries. What do we mean by “developing” countries and what are the constraints that have restricted publication of research data from these countries? “Developing” countries have low per-capita incomes and are less wealthy overall, which restricts the national infrastructures together with the resources to achieve best practice in health care in general, let alone investment in expensive research. One can also include countries whose economies are now growing rapidly but where the benefits of this growth are still trickling down to the majority of the population who still have a low socioeconomic status. There is another important constraint, namely, that of language and translation. Because English is the language spoken in many parts of the developed world (and native English speakers are obviously privileged in this respect), many of the world class transfusion journals are written in English. TRANSFUSION is an obvious example! This problem hampers would-be research authors and also means that peer reviewers may miss the occasional nugget of gold in a manuscript they find difficult to read. Fortunately there are signs that the situation is slowly improving. Genuine research from the developing world is appearing in respected journals, and it goes beyond the “grab and run” approach we used to see when affluent institutions would raid the freezers of poorer countries (or merely collect “fresh” samples if freezers were not available), test for the rate of one or other marker such as hepatitis B, and then publish the data. In general there was no genuine collaboration and often precious little acknowledgment. We can see examples of good research from countries without a tradition of publication in, for example, the pages of this journal. In this current edition of TRANSFUSION Al Shaer and colleagues1 report on the impact of individual donation nucleic acid testing (NAT) between 2004 and 2009 on the prevalence, incidence, and residual risk of the key transfusion-transmissible viruses in the United Arab Emirates (UAE). The UAE have the resources and have worked hard to develop high-quality and state-of-the-art practice in transfusion medicine incorporating appropriate guidelines and international bench marking as well as the latest technologies. Despite some shortcomings in their presentation (e.g., the study was retrospective, rather than prospectively planned and confirmation of anti-HBc reactivity is lacking), international comparisons of their data can now be made with outcomes of practices in other parts of the world. We can now conclude that incidence rates and estimated residual risks from transfusion-transmitted viral infections are relatively low in the UAE. Furthermore, the authors recommend the parallel use of serologic assays together with NAT (on individual samples) for exclusion of viral infections. Unlike the situation in other countries that also have hepatitis B virus endemicity, they believe that the exclusion of anti-HBc–positive donations (in my opinion, more sensitive than NAT at the end of acute infection or carriage) would have only marginal effects on blood supplies in the UAE. Another article in this current issue2 deals with the transmission of human herpes virus 8 (HHV-8) by transfusion in Ghana, an endemic region of West Africa. The study was professionally conducted and 252 sets of donor samples paired with their corresponding pretransfusion and 3 months' posttransfusion samples were collected. Appropriate samples for both serology and NAT were tested using state-of-the-art technology for screening and confirmation. The really encouraging aspect of this study is the real collaboration between workers in a developing country and two respected laboratories in the developed world. All honors were equally shared by the participating institutions. The study detected one very likely transfusion transmission of HHV-8 and also identified a new genotype of the virus restricted only to Ghana, exemplifying the benefits of reliable research reports from developing countries. We certainly need more well-conducted studies on donor epidemiology, donor selection, and testing and the residual risk of transfusion, submitted by developing countries for publication in respected and reliable international journals. As Dr Cristina Martinez (director of the only regional transfusion center in Chile) pointed out, the safety of the blood supply in the developed world depends in part on the safety of the blood supply in the developing world. She made this comment at the International Society of Blood Transfusion's Congress in Vancouver in 2002. This observation remains true a decade later and underlines the need for relevant and reliable data from all parts of the world. Obtaining high-quality data from newly developed countries without an established tradition of publication in English language journals can be facilitated by international collaboration. As an example, the report in TRANSFUSION by Zeng and colleagues3 provides a detailed analysis of volunteer Chinese blood donors, studying the genotype diversity and profile of drug resistance mutations of HIV-1. This collaborative study conducted by workers from China and the United States of America was supported by a US Retroviral Epidemiology Donor Study-II contract. Many other developed countries' institutions and individuals provide similar aid and collaborative opportunities. So how can the developed world help developing countries (as well as more developed countries who do not have a tradition of publishing in international journals) to submit more and better manuscripts for publication? Despite the often gloomy global economic situation, strengthen collaborations with developing countries and seek to develop new partnerships. Encourage blood services in developing countries to enhance best practice in transfusion medicine. An example of one approach is the recently initiated International Society of Blood Transfusion's (ISBT) Award for Developing Countries.4 This award was a pet project of Professor Erhard Seifried (an ISBT past president) and is restricted to low or medium human development index countries as defined by the “United Nations” Development Program. Emulate the important initiative described by Murphy and coworkers5 who have been very successfully teaching transfusion medicine research methods in the developing world. An international consortium provides a 2-week research training course delivered in different countries. This effort is a major step beyond the acceptance of medium-term trainees from developing countries which many institutions undertake. Furthermore, a 2-week in-country scientific manuscript course provides a key vehicle for helping researchers in developing countries prepare manuscripts for submission to world-class journals. Work as partners and not mere “plunderers” of a developing country's resource material. Institutes, transfusion societies, and journals (or indeed, individuals) should consider ways of providing “mentors” to assist non–English-speaking researchers to prepare their manuscripts for submission. Likewise, peer reviewers might make an extra effort to see if there actually is useful information in manuscripts that might be difficult to read. Keep an open mind as to approaches and findings that may differ from the “traditional” and really consider the intrinsic value of alternative (maybe less expensive?) approaches. Then hopefully we will all get a clearer picture of what the elephant really looks like! None.

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