Where there is no research: a bibliometric analysis of health research output from the resource-constrained Bihar state of India

# Background Significant gap exists in health research output globally, both in terms of geographic distribution and priorities. In India, wide inter-state disparity in health research output is reported and eight large states with a combined population of nearly half of India contribute to less than one-tenth of total research output. Bihar is one of the most resource-constrained states in this group with multiple health systems challenges. The objectives of this study were to understand the trend, distribution, focus, actors, and funding sources of health research on Bihar in order to propose policy recommendations. # Methods A bibliometric analysis was carried out for all PubMed indexed original research papers on health, which is either focused on Bihar or authored by an author from an organization in Bihar. Trend, author affiliation, location, theme, and funding source was analysed by review of either abstract or if required by review of the full text. # Results A total of 982 research papers were extracted, out of which 40% was basic or clinical research and nearly 60% was public health research. There was an extraordinary surge in research output during the last decade. Clinical subjects (25 %) followed by leishmaniasis (23%) were the most common theme. Medical institutions (45%) were the biggest contributor to health research. More than 60% of papers were authored by a lead author from outside Bihar and the majority do not have a local co-author. 11 leading organizations published more than 35% of total research papers. ‘Leishmaniasis’ contributed to more than 35% of the research output by the author based in Bihar and more than 90% research output of the leading research institution in Bihar. The majority of the funded research in the last decade was supported by international agencies. # Conclusions The health research output from Bihar is very limited. The recent surge in research output is driven by global actors or from actors located in bigger cities and more developed states within India. To strengthen the health research systems, a specific health research policy should be formulated to steward and improve the health research ouput from Bihar.