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СпутникиРНSpaceXРоскосмосNASABackground The COVID-19 pandemic has profoundly transformed scientific publishing worldwide, making bibliometric analysis essential for evaluating the productivity, impact, and collaboration patterns of research output. This study aimed to outline the bibliometric profile of Tunisian medical COVID-19-related publications. Methods Bibliometric analysis of Tunisian medical COVID-19-related publications indexed in PubMed and Web of Science (WoS) between 11 March 2020 and 5 May 2024 was performed. COVID-19-related bilingual MeSH terms were combined using Boolean operators, and the data were automatically extracted. The analyzed variables included productivity, collaboration, funding, and radiance (total citations, citations per publication [CPP], and journal SJR/JIF quartiles). Results A total of 771 publications were included, yielding 14,024 citations (CPP 18.18). Output peaked in 2022 (n=264; 34%) and declined sharply by 2024. The leading categories were Environmental & Occupational Health (13.8%) and Immunology (13%). Descriptive designs dominated (50.3%), and analytical and experimental studies were underrepresented. Most of the publications were in English (97%), appearing in 414 journals across 38 countries, with more than 52% in SJR Q1 journals. There was a high percentage of collaboration (93.9%), 56.8% of which were international and led by the USA and France. No Tunisian funding was identified; 14 papers reported a conflict of interest, mostly linked to multinational pharmaceutical companies. Conclusion Tunisian medical COVID-19 research has shown meaningful engagement with the global scientific community, with strong English-language output, international collaboration, and publication in high-ranking journals, although the output has remained modest overall. Future efforts should enhance both the quantity and quality of Tunisian medical research.
Review
[version 1; peer review: awaiting peer review]
https://orcid.org/0009-0006-0257-5993
1, Hela Ghalihttps://orcid.org/0000-0001-5330-9069
1,2, Anis Touibi3, [...] Souhail Sboui3, Houyem Laatiri Said1,2, Asma Ben Cheikh1,2, Sana bhiri1,4https://orcid.org/0009-0006-0257-5993
1, Hela Ghalihttps://orcid.org/0000-0001-5330-9069
1,2, [...] Anis Touibi3, Souhail Sboui3, Houyem Laatiri Said1,2, Asma Ben Cheikh1,2, Sana bhiri1,41 University of Sousse Faculty of Medicine of Sousse, Sousse, Tunisia
2 Department of Preventive and Community Medicine, Sahloul Hospital, Sousse, Tunisia
3 Department of Research, Astrolab Agency, sousse, Tunisia
4 Department of Preventive and Community Medicine, Regional Hospital of Msaken, Msaken, sousse, Tunisia
Meriam Taktak
Roles: Conceptualization, Data Curation, Formal Analysis, Investigation, Methodology, Project Administration, Writing – Original Draft Preparation
Hela Ghali
Roles: Supervision, Validation
Anis Touibi
Roles: Conceptualization, Data Curation, Formal Analysis
Souhail Sboui
Roles: Conceptualization, Data Curation, Formal Analysis
Houyem Laatiri Said
Roles: Supervision, Validation
Asma Ben Cheikh
Roles: Supervision, Validation
Sana bhiri
Roles: Conceptualization, Data Curation, Formal Analysis, Investigation, Methodology, Project Administration, Writing – Review & Editing
OPEN PEER REVIEW
REVIEWER STATUS AWAITING PEER REVIEW
Corresponding author: Meriam Taktak Competing interests: No competing interests were disclosed.
Grant information: The author(s) declared that no grants were involved in supporting this work.
Copyright: © 2026 Taktak M et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. How to cite: Taktak M, Ghali H, Touibi A et al. Title: Profile of Medical Tunisian COVID-19 Publications Indexed in Pubmed and Web of Science: A Comprehensive Bibliometric Analysis (2020–2024) [version 1; peer review: awaiting peer review]. F1000Research 2026, 15:1358 (https://doi.org/10.12688/f1000research.186899.1) First published: 12 Aug 2026, 15:1358 (https://doi.org/10.12688/f1000research.186899.1) Latest published: 12 Aug 2026, 15:1358 (https://doi.org/10.12688/f1000research.186899.1)
The emergence of COVID-19 in late 2019 profoundly disrupted global systems. The rapid dissemination of the virus across continents has resulted in considerable human and socioeconomic consequences.1 After officially declaring the pandemic on March 11, 2020, by the World Health Organization (WHO),2 COVID-19 affected nearly every domain, including education, mental health, supply chains, and political relations. The health sector was particularly impacted, with medicine assuming a central role in generating evidence and guiding public health responses.3
Medical research has rapidly become indispensable for understanding the epidemiology of this disease, optimizing clinical management, and implementing effective preventive strategies. In Tunisia, as in other nations, the medical community contributed actively, producing scientific evidence that informed both local and regional decision-making during this health emergency.4 Tunisian researchers have engaged in multiple thematic areas, including early epidemiological characterizations, hospital organization, perceptions of vaccination, and psychological outcomes among healthcare workers.5 Despite limited resources and financial constraints, Tunisian teams managed to contribute meaningfully to the global scientific discourse on pandemic management.6
However, an enumeration of publications alone does not adequately reflect the scientific weight of such contributions. Bibliometrics, defined as the statistical evaluation of scientific literature, enables the measurement of research productivity, visibility, and collaboration patterns. Its indicators provide insights into the scientific relevance of research output.7
Comparable regional studies have already been conducted. In Morocco, bibliometric analysis revealed a significant increase in COVID-19 publications, with France and Spain being key collaborative partners.8 Algeria, while producing a smaller number of articles, concentrated its efforts on virology and public health themes.9 In contrast, Tunisia lacked a comprehensive bibliometric assessment of its COVID-19-related medical literature, making it difficult to compare its national scientific performance with that of neighboring countries or global trends.10
The objective of this study was to outline the bibliometric profile of medical Tunisian COVID-19-related publications indexed in PubMed and Web of Science during the period from March 11, 2020, to May 5, 2024, in terms of productivity, radiance, and collaboration.
This study is a bibliometric analysis of Tunisian medical research focused on COVID-19, covering the period from March 11, 2020, to May 5, 2024. Bibliometrics involves the statistical and mathematical evaluation of bibliographic data to measure a researcher's performance, visibility, and impact.11 The study period was defined starting from the WHO declaration of COVID-19 as a global pandemic and ending one year after the official announcement of its end12 to capture publications with heterogeneous submission-to-publication delays (median: 263.55 days).13
We selected PubMed (MEDLINE) as the primary bibliographic database because of its role as an optimal medical literature search tool and its validity for bibliometric studies.14,15 The Web of Science (WoS) served as the citation database, providing citation metrics and journal performance indicators not available in PubMed.16,17 Additional journal metrics were retrieved from the Journal Citation Reports (Clarivate) and the Scimago Journal and Country Rank platform using 2023 data (or 2022 when 2023 was unavailable).
We systematically searched the HeTOP platform (Rouen University Hospital/CISMeF) for COVID-19-related keywords to identify corresponding MeSH terms in both English and French.18 The PubMed search was launched in Advanced mode using all fields, combining all MeSH terms with the Boolean operator OR. The publication date (11/03/2020–05/05/2024) and affiliation (Tunisia OR Tunisie) filters were applied using the Boolean operator AND.
We automated the data extraction using a JavaScript program interfacing with the PubMed API, generating structured Excel files containing PubMed IDs; publication dates; titles; abstracts; authors; affiliations; language; journal titles; study designs; MeSH terms; ISSNs; conflict-of-interest declarations; and funding information. The collected PubMed IDs were then cross-referenced in the Web of Science Core Collection to retrieve citation counts. The query was launched on December 13, 2024.
We included publications if1 they were published between March 11, 2020, and May 5, 20242; at least one author was affiliated with a Tunisian institution3; they addressed topics related to pharmacy, medicine, dentistry, medical laboratory research, or veterinary science. Duplicates (with the same title, authors, and abstract) were removed. Publications outside the date range and non-COVID papers were excluded.
Productivity
Total publications were assessed; annual publication count was calculated as follows: annual percentage change (APC) = [(new value – old value)/old value] × 100.
Category
The Web of Science (Clarivate) subject categories were assigned at the journal level.19 When multiple categories were assigned, manual review revealed the most relevant single category.
Study design
The following were classified from the MEDLINE publication types and manually verified from abstracts when needed: systematic reviews, meta-analyses, experimental studies (RCTs, nonrandomized studies, self-controlled studies), descriptive studies (case reports, case series, cross-sectional studies, retrospective studies), analytical studies (case–control studies, cohort), basic studies, and other studies (letters, editorials, errata).
Collaboration
We defined collaboration as the presence of any publication that included two or more distinct affiliations.
- National collaboration: All the authors were affiliated with different Tunisian institutions.
- International collaboration: If the list of authors includes at least one not affiliated with Tunisian institution.
Radiance
The publication parameters used were total citations, citations per year, and citations per publication (CPP). Journal radiance: SJR quartile (Q1–Q4), Journal Impact Factor (JIF) quartile, and H-index, analyzed for publications indexed in both WoS and Scimago.
Qualitative variables are presented as absolute, relative, and cumulative frequencies. Quantitative variables are expressed as counts and means. The chi-square test for linear trends was used to assess productivity trends. The chi-square test was used to compare independent proportions. There was no conflict of interest in conducting this study.
The PubMed query was launched on December 13, 2024 and captured 995 articles. After sequential exclusions (12 outside the study period; 163 non-COVID-19; 40 nonmedical; 7 duplicates), the final dataset comprised 771 publications, representing 6.5% of all Tunisian medical publications indexed in Medline during the same period (n=11,915).
3.2.1 Annual output
A total of 771 publications were found over the study period. The number of publications increased significantly from 103 in 2020 to 264 in 2022 (APC = +156.3%; p < 0.001) and then decreased sharply to 49 in 2024 (APC = −81.4%; p < 0.001). The overall trend showed a nonsignificant decrease (p =0.648).
3.2.2 Publication’s characteristics
Table 1 shows the principal publication characteristics. The leading category was Environmental & Occupational Health (13.8%), followed by Immunology (13.0%) and Biomedical Computer Science (8.8%). Descriptive studies predominated (50.3%), with cross-sectional studies accounting for 31.8%. Systematic reviews comprised 15.6%, and basic studies comprised 18.6%. Experimental studies were underrepresented at 2.0%. ( Table 1)
- Environmental & Occupational Health
- Immunology
- Biomedical Computer Science
- Psychiatry
- Pharmacology & Pharmacy
- Health Care Sciences & Services
- Medicine, General & Internal
- Neurology
- Infectious Diseases
- Virology
- Sport Sciences
- Other
- Total
- Systematic Review
- Meta-Analysis
- Experimental Studies
- Descriptive
- Analytical
- Basic Study
- Other
- Total
- RCT
- Non randomized controlled
- Self-controlled
- Case Report
- Case Series
- Cross-sectional
- Descriptive Retrospective
- Case–control
- Cohort
- Erratum
- Letter
- Editorial
- English
- French
- Total
- open access
- Not open access
- Total
Among all the publications, 97% (n=746) were written in English. No Arabic-language articles with English or French abstracts were identified. Approximately half of the publications were open access (n=386; 50.1%). ( Table 1)
3.2.3 Journals
Publications appeared in 414 journals. The Pan African Medical Journal was the most common (n=32; 4.2%).
“La Tunisie Médicale” was the only local Tunisian journal among the top publications (n=6; 0.8%) ( Table 2).
Overall, 93.9% of the papers (n=724) included either national or international collaboration. National collaboration was observed in 37.1% of the papers (n=286), while international collaboration was found in 56.8% (n=438).
3.3.1 National collaboration
Among the 286 nationally collaborative papers, 2,378 total national affiliations were recorded. The Faculty of Medicine of Tunis led with 40.3% of the affiliations. ( Table 3).
3.3.2 International collaboration
Among 438 internationally collaborative papers, 6,547 international affiliations were recorded. The USA led with 12.3%, followed by France (7.8%) and Italy (7.3%) ( Table 4).
Among all the publications, 27.7% (n=213) did not declare any conflicts of interest. For 70.5% (n=544) of the authors, there were no conflicts of interest. Fourteen publications (1.8%) reported actual conflicts of interest, all of which were linked to international collaboration. Of these, 11 received grants totaling 70 financial contributions from 14 funding agencies. Multinational pharmaceutical companies accounted for 69% of the funding contributions ( Table 5). No Tunisian public funding agency was identified.
3.5.1 Overall radiance
A total of 14,024 total citations were accumulated for the 771 publications, with a CPP of 18.18. Most of the publications (48.0%) were cited 1–9 times, 16.3% received zero citations, and 2.9% (n=22) were cited ≥100 times ( Table 6).
3.5.2 Radiance by category of Medical Tunisian COVID-19 publications
“Environmental & Occupational Health” was the most common, with 1570 citations and a CPP (citation per publication) value of 14.81. This was followed by psychiatry, with a total of 1565 citations and a CPP value of 16.31.
Although not outlined in this table, the highest CPP was 143.11, corresponding to the “nutrition & dietetics” category, which was 16th in terms of the number of publications ( Table 7).
3.5.3 Radiance by study design
Meta-analyses and systematic reviews showed the highest CPP values (40.37 and 26.69, respectively). Cross-sectional studies (CPP=21.14) and basic studies (CPP=22.17) were among the most cited original research types. Experimental studies have shown a lower average CPP (9.38). Letters and editorials had the lowest citation impact (CPP: 8.23 and 3.88) ( Table 8).
3.5.4 Radiance by language
Among all the articles, 99.8% were published in English (n=13,999; CPP=18.77), whereas only 25 were published in French (CPP=1.00).
3.5.5 Journal of radiance
Of the 718 publications analyzed for journal metrics, 52.4% were from SJR Q1 journals and 39.7% were from JIF Q1 journals ( Table 9). The journal with the highest SJR was JCI Insight (SJR=2.97). Among the journals featuring Tunisian COVID-19 publications, The Lancet had the highest JIF (98.4), and Science had the highest H-index (1,336). (Table 9,10).
3.5.6 Radiance by open access status
Paid publications generated more total citations (n=7,556; CPP=19.63) than open access publications (n=6,468; CPP=16.76), likely reflecting the concentration of high-impact journals in the paid-access category.
This comprehensive bibliometric analysis of 771 medical Tunisian COVID-19 publications indexed in PubMed and Web of Science (2020–2024) revealed several important patterns. The production followed a bell-shaped curve with a peak in 2022, consistent with global COVID-19 publication trends. The overall output represented 6.5% of all Tunisian medical publications during the period, reflecting substantial engagement but also identifying room for growth.
The bell-shaped publication curve observed in Tunisia mirrors international patterns, where pandemic urgency drove initial surges followed by postcrisis normalization.20 The peak APC of +156.3% in 2020–2022 confirms rapid mobilization, while the subsequent sharp decline (−81.4%) reflects the global trend of waning research momentum as COVID-19 became endemic.
Thematically, Environmental & Occupational Health and Immunology led the output, reflecting Tunisia's prioritization of workplace exposure and population-level immunity research. The notable presence of biomedical computer science (8.8%) and psychiatry (8.4%) underscores growing interest in digital epidemiology and mental health challenges during lockdowns—trends documented across the MENA region.21 The underrepresentation of virology (3.2%) likely reflects the limited availability of advanced sequencing platforms and specialized laboratories in Tunisia compared to Gulf countries.22
Descriptive studies dominated Tunisian COVID-19 output (>50%), a pattern characteristic of resource-limited settings where rapid observational evidence is more feasible than complex interventional research.23 The low proportion of RCTs (1.4%) and cohort studies (2.2%) stands in contrast to that of France, which produced more than 800 COVID-19 RCTs by 2022,24 reflecting structural differences in funding and research infrastructure. The high CPP values of meta-analyses (40.37) and systematic reviews (26.69) highlight the global value of evidence synthesis during health emergencies, confirming findings from similar bibliometric studies.25,26
The near-exclusive use of English (97%) was decisive in maximizing Tunisia's international scientific radiance. The stark citation disparity—a CPP of 18.77 for English versus 1.00 for French articles—reflects the predominance of English as the global language of science and the indexing advantages of English-language journals.26 The approximate parity between open access and paid publications, combined with the slightly higher CPP for paid articles (19.63 vs. 16.76), suggests strategic targeting of prestigious but paywalled journals rather than an exclusive open-access publishing strategy.
High collaboration rates (93.9%) positioned Tunisian research within well-established global norms for middle-income countries.22 International collaboration (56.8%) was predominantly with historical and linguistic partners (the USA, France, Italy), reflecting preexisting academic relationships. However, this also signals persistent asymmetries, where Tunisia often contributed data and patient samples while intellectual leadership remained abroad.27 Limited engagement in South–South collaboration represents a missed opportunity to build more equitable scientific partnerships.
The absence of Tunisian public funding among COVID-19 publications is a critical structural finding. All the disclosed funding originated from international and private sources, primarily multinational pharmaceutical companies (69%). This exclusive dependence on foreign sponsors—particularly during a health emergency—raises concerns about research agenda autonomy and the risk of publication bias toward industry-favorable results.28 This deficit is especially noteworthy given that some countries with comparable resources (South Africa, Palestine) managed to appear as funding entities. Tunisia must urgently establish a dedicated national research funding mechanism, especially for health emergency preparedness.
Compared to North African and MENA neighbors, Tunisia demonstrated a competitive bibliometric profile in several dimensions: a greater share of SJR Q1 publications than did Algeria, a stronger English-language output than did Morocco, and meaningful international collaboration. However, Tunisia lags significantly behind France (CPP >34) and Gulf countries (Saudi Arabia CPP ~22.3, Qatar CPP for national cohort studies >60) in absolute citation impact, reflecting differences in research infrastructure, funding, and international partnerships.29,30,31
This study has several limitations. First, restriction to PubMed and WoS may have excluded articles in nonindexed journals, particularly those published in Arabic. Second, citation counts from the WoS may underestimate the true impact of publications in non-clarivate-indexed journals. Third, manual interventions in study design classification and funding source identification introduce potential subjectivity. Fourth, temporal lag in journal metric updates (using 2022 data points for some 2023 publications) may slightly affect journal quality interpretation. Finally, the complexity of institutional affiliation reporting and no standardized institutional signatures may have led to the omission of some publications.
This bibliometric analysis provides a comprehensive overview of Tunisia's medical research response to COVID-19 (2020–2024). The country demonstrated meaningful scientific engagement, with 771 publications accumulating more than 14,000 citations, strong English-language output, high collaboration rates, and publication in reputable international journals. Over 52% of the publications appeared in SJR Q1 journals, underscoring strategic publication targeting despite resource constraints.
Nevertheless, critical challenges persist: an absence of national research funding, underrepresentation of experimental and analytical study designs, low thematic diversification in high-impact fields such as virology, and insufficient standardization of institutional affiliations limiting traceability. To strengthen its scientific visibility and research autonomy, Tunisia must implement structural reforms, including establishing a national research funding agency, enforcing mandatory and standardized conflict-of-interest declarations, promoting multidisciplinary and South–South collaborations, and supporting researchers with scientific English writing training and publication cost waivers.
The COVID-19 pandemic, while challenging, has provided a critical opportunity to identify institutional gaps and redirect national scientific policy toward greater independence, quality, and global impact.
Not applicable. This study analyzed publicly available bibliographic metadata from PubMed and Web of Science and did not involve human participants, human data, or animal subjects.
The full Medline search query used to generate the dataset is provided in Appendix A.
No extended data are associated with this study. The full Medline search query used to generate the dataset is provided in Appendix A of this article.
The author(s) declared that no grants were involved in supporting this work.
© 2026 Taktak M et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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