The network's highest hypertension prevalence, and its lowest rate of control.

Why Dominica

Dominica has the highest adult hypertension prevalence in the network at 47.7%, the lowest control rate of any operable site at 17.6%, and a two-and-a-half-fold sex differential in obesity — 45.2% of women against 17.8% of men. As a phenotype it is striking. As an operating environment it is the most constrained in the network, and we say so plainly below.

The disease burden

More than four in five hypertensive adults in Dominica are uncontrolled. Crude adult diabetes prevalence of 25.5% is among the highest recorded nationally anywhere. The sex gap in obesity — two and a half times — is among the widest in the network and has direct consequences for screening design and subgroup planning.

Sites and infrastructure

• Dominica–China Friendship Hospital, Roseau — the national hospital, with an eight-bed ICU and four operating theatres
• Portsmouth Hospital and the Marigot and Grand Bay cottage hospitals; seven health centres and 44 clinics in primary care
• Medical schools are offshore institutions — All Saints University School of Medicine and the American Canadian School of Medicine. Ross University operated here from 1978 to 2019 and relocated permanently to Barbados after Hurricane Maria
• No clinical research unit identified

Research heritage

A 35-year longitudinal study of child health and stress physiology in a rural Dominican community, led by Mark Flinn — anthropological and biomedical rather than interventional, with no trial infrastructure attached. No documented interventional trial history.

Regulatory & ethics

• PAHO's Pharmaceutical Country Profile states there is no Medicines Regulatory Authority in Dominica
• No national research ethics committee identified

The honest position: The most constrained regulatory environment in the network, and there is no version of this that reads well. PAHO records verbatim that Dominica has no medicines regulatory authority, that no legal provision requires marketing authorisation, that no legal provision requires authorisation for conducting clinical trials, that no law requires ethics committee agreement, and that trials need not be entered in any registry. A sponsor has no lawful counterparty to approve or inspect a study and no national REC to satisfy ICH-GCP or FDA/EMA expectations. Every ethics and regulatory function would have to be imported — through CARPHA-facilitated multi-country review plus written government no-objection. It is doable. It is not quick, and it is not something to discover mid-start-up.

Data quality: Moderate on risk factors, absent on mortality — Dominica falls below the WHO Global Health Estimates population threshold, so no NCD mortality data is published at all.

How this site fits the network

Network capacity — adds diversity and marginal enrolment to multi-country studies. Not a standalone proposition.

Our Dominica operation is contracted, trained and monitored under the same quality system as our UK and US sites. One master service agreement covers all three regions, one budget negotiation, one set of payment terms. Sites in this network can absorb enrolment from under-recruiting UK or US centres without a new vendor qualification cycle.