Background: Tropical diseases research in general has played a vital role in finding solutions for many health threats faced by humankind especially in Sub Saharan Africa and other developing countries. Funding available for tropical disease research is not commensurate with the disease burden. Identifying knowledge gaps and priorities for clinical trials would encourage judicious investment of limited research funds on most important research questions. Cochrane systematic reviews on tropical diseases have addressed important questions that have relevance for health policy and practice, and involved rigorous searches of published and unpublished trials. The Cochrane Database of Systematic Reviews (CDSR) therefore represents a good source of information on gaps and priorities for clinical trials in tropical diseases. Objectives: To synthesise available information on knowledge gaps and priorities for clinical trials from Cochrane Systematic Reviews in tropical diseases. Methods: Cochrane Library Issue 1, 2010 was searched for systematic reviews of tropical infections.The words Malaria, Tuberculosis, Schistosomiasis, Onchocerciasis, Leishmaninasis, Chagas, Dengue, Meningitis, Lymphatic Filariasis and African Trypanosomiasis were used to search the Cochrane Library for anywhere they appeared in the Title, Abstract and Keywords of reviews. The search results were screened and reviews excluded based on title/or abstract and duplicates removed. Protocols and withdrawn reviews were also excluded. Full papers of remaining reviews were obtained and information on the included trials collected. Results: The search of the CDSR yielded 139 records. Figure 1 shows the review selection, inclusion/exclusion process. Sixty-four reviews (688 trials and over 432,791 participants) were found. Majority of the reviews were treatment interventions (73.4%) while the rest were prevention interventions. 70.3% (45/64) of the reviews authors’ expressed the need for more trials. 14.1% (9/64) of the reviews reported poorly done trials. Conclusions: There is a dire need for improved funding for larger, high quality trials in tropical infections with priority given to prevention interventions.