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Author(s): Bruijns, Stevan R.; Maesela, Mmapeladi; Sinha, Suniti; Banner, Megan | Abstract: Introduction: Based on relative population size and burden of disease, emergency care publicationoutputs from low- and middle-income regions are disproportionately lower than those of high-incomeregions. Ironically, outputs from regions with higher publication rates are often less relevant in the Africancontext. As a result, the dissemination of and access to local research is essential to local researchers,but the cost of this access (actual and cost-wise) remains unknown. The aim of this study was to describeaccess to African emergency care publications in terms of publisher-based access (open access orsubscription) and alternate access (self-archived or author provided), as well as the cost of access.Methods: We conducted a retrospective, cross-sectional study using all emergency medicinepublications included in Scopus between 2011 and 2015. A sequential search strategy describedaccess to each article, and we calculated mean article charges against the purchasing power parityindex (used to describe out-of-pocket expense).Results: We included 666 publications from 49 journals, of which 395 (59.3%) were open access. Forsubscription-based articles, 106 (39.1%) were self-archived, 60 (22.1%) were author-provided, and105 (38.8%) were inaccessible. Mean article access cost was $36.44, and mean processing chargewas $2,319.34. Using the purchasing power parity index it was calculated that equivalent out-ofpocketexpenditure for South African, Ghanaian and Tanzanian authors would respectively be $15.77,$10.44 and $13.04 for access, and $1,004.02, $664.36 and $830.27 for processing. Based on this,the corrected cost of a single-unit article access or process charge for South African, Ghanaian andTanzanian authors, respectively, was 2.3, 3.5 and 2.8 times higher than the standard rate.Conclusion: One in six African emergency care publications are inaccessible outside institutional librarysubscriptions; additionally, the cost of access to publications in low- and middle-income countries appearsprohibitive. Publishers should strongly consider revising pricing for more equitable access for researchersfrom low- and middle-income countries.