Gender Distribution of Rheumatologists Across Africa (REACT): a Cross-Sectional Survey Study

Background Gender disparities in health care are pervasive worldwide, including the field of rheumatology in Africa, where there is a scarcity of rheumatologists. The heterogeneity of these disparities underscores the importance of addressing unmet needs at a regional level. We aimed to determine the number of rheumatologists in Africa, the gender distribution in the public and private sector, and participation in academia and leadership roles. Methods In this cross-sectional study, fully qualified rheumatologists in Africa were chosen by leadership position and role in national societies to distribute an online survey to members of the African League of Associations for Rheumatology (AFLAR). Data on the number of rheumatologists registered per country or in national rheumatology societies, gender distribution in private and the public sector, and academic involvement were collected from countries that are members of the AFLAR. Gender was self-reported in the survey as man, woman, or prefer not to disclose. Findings Between Feb 2 and March 16, 2022, we collected data from 44 (81%) of 54 African countries. We identified 2970 rheumatologists providing health-care services to 1·19 billion people in 44 countries, representing 0·25 rheumatologists per 100 000 population. There was a wide variation in the distribution of rheumatologists with 1·86 rheumatologists per 100 000 people in Tunisia and no rheumatologists recorded in 15 African countries. Most rheumatologists were from North Africa, with 2592 (87%) from four countries (Egypt, Algeria, Morocco, and Tunisia). 1772 (60%) of 2970 rheumatologists were women. 791 (71%) of 1112 rheumatologists involved in academia were women, 1041 (65%) of 1610 rheumatologists practicing in the public sector were women, and 201 (27%) of 756 in the private sector were women. 18 (41%) of 44 countries had a national society and women served as current or previous presidents in five of the 18 national societies. Interpretation This study highlights the low number and unequal distribution of rheumatologists in Africa. Women predominate and are well represented in academic settings, but not in leadership positions. AFLAR, national societies, and health-care policy makers need to develop a strategy to increase the number of rheumatologists at national and regional level. Gender inequality needs to be addressed to ensure that women are adequately represented and occupy leadership positions within national societies. Funding None.