Doping Among African Athletes Across Competition Levels: Prevalence, Prohibited Substances, Detection Methods, and Evidence Gaps - A Systematic Review and Meta-analysis
This systematic review and meta-analysis estimates a pooled prohibited doping prevalence of 8.0% among African athletes based on limited data, while highlighting significant evidence gaps, methodological heterogeneity, and the urgent need for standardized surveillance and representative sampling across the continent.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer
In the world of competitive sport, the promise of a fair contest is built on a simple agreement: every athlete competes using only their own body and training, without artificial chemical help. When athletes break this rule by using banned substances, it is called doping. This practice threatens the health of the competitors, undermines the integrity of the games, and erodes the public's trust in sport. For decades, officials have tried to catch cheaters by testing urine and blood samples, looking for specific chemicals that should not be there. However, these tests only reveal what is in a sample at the exact moment it is taken. They cannot easily tell us how many athletes have used banned substances in the past, or how common the practice is across a whole continent. This gap in knowledge is particularly wide in Africa, a continent that produces some of the world's most celebrated runners, footballers, and boxers, yet where the true scale of doping has remained difficult to measure.
A team of researchers set out to fill this gap by gathering every available study on doping among African athletes. They did not simply look at positive test results from laboratories, which only catch a fraction of the problem. Instead, they sought out surveys where athletes were asked directly if they had ever used prohibited substances or methods. The team scoured medical databases and official reports from anti-doping agencies across the continent, looking for studies that clearly defined what counted as a banned substance and provided exact numbers of how many athletes were surveyed versus how many admitted to using them. Their goal was to create a clear picture of the situation, separating the use of illegal performance enhancers from the use of legal supplements or traditional herbal remedies, which are common in many African cultures but are not the same thing as doping.
After sifting through hundreds of records and removing duplicates, the researchers found nineteen reports that met their strict standards. From these, they identified four high-quality studies that could be compared directly. These studies covered a total of 850 athletes from Uganda, Ethiopia, Algeria, and Cameroon, ranging from university competitors to professional players. When the researchers combined the data from these four groups, they found that approximately eight out of every hundred athletes admitted to having used a prohibited substance or method at some point in their lives. This number is higher than the tiny percentage of athletes who usually get caught in routine drug tests, but it is far from a complete picture. The researchers emphasized that this eight percent figure is not a fixed rule for all of Africa. Because the studies came from different places and asked slightly different questions, the true number for any specific country or sport could be much lower or much higher. In fact, the uncertainty was so great that the real number could plausibly be anywhere from less than four percent to more than sixteen percent.
The types of substances athletes reported using varied, but two categories stood out. The most frequently mentioned were anabolic agents, which are drugs that help build muscle, and stimulants, which are substances that increase alertness and energy. These were the most common answers in the surveys. Other substances, such as growth hormones, diuretics, and drugs that mask the presence of other chemicals, appeared in specific studies but were not reported often enough to calculate a reliable average for the whole continent. The researchers also noted that in some studies, athletes reported using legal supplements or traditional herbs alongside illegal drugs. This mix made it difficult to count exactly how many people were breaking the rules, as some surveys grouped all performance-enhancing products together. The team was careful to separate the illegal from the legal, ensuring their final numbers only reflected the use of substances banned by the World Anti-Doping Agency.
The study also highlighted a major difference between what athletes say and what laboratories find. When the researchers looked at historical data from South African laboratories, where urine samples were tested over many years, they found that about four percent of the samples tested positive for banned substances. This number is lower than the eight percent admitted in the surveys. This gap is expected and well-known in the field: drug tests can only catch what is currently in the body, while surveys can capture past use that has already cleared the system. The researchers stressed that these two numbers should not be compared as if they were measuring the same thing. One measures a snapshot of current detection, while the other measures a history of admitted behavior.
Despite finding a clear signal that doping exists, the researchers concluded that the evidence is still too thin to make a definitive statement about the entire continent. The studies they found were concentrated in a few countries and focused on specific sports, leaving huge gaps in knowledge about elite endurance runners, professional footballers in other nations, and athletes in many other regions. They found that the most visible concerns in African sports, such as the use of blood-boosting drugs by long-distance runners, were not well represented in the survey data they could analyze. This lack of data does not mean these athletes are not doping; it simply means there is not enough research to measure it accurately. The researchers argue that future efforts must focus on getting better data, using standardized questions, and ensuring that athletes from all levels of competition are included in surveys. Until then, the eight percent figure remains a useful starting point, but it is a rough estimate of what has been found so far, not a final answer to the question of how widespread doping truly is in African sport.
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