Determinant factors of vaccination timeliness and completeness for children under five in low and middle-income countries in the last fifteen years: A systematic review

Abstract

Background: Vaccination is one of the most effective disease prevention efforts in reducing morbidity and mortality in infants and children. In achieving health status for all, the World Health Organization (WHO) launched a policy aimed at achieving universal vaccination for children. As a result, this program succeeded in significantly reducing global child deaths from 12.6 million in 1990 to 6.3 million in 2013. Purpose: To explore the factors influencing of vaccination timeliness and completeness for children under five in low and middle-income countries in the last fifteen years. Method: A systematic review of articles searched through PubMed and Google Scholar from 2009 to 2024. Retrieved articles were screened using selected items from a systematic review and flow diagram meta-analysis (PRISMA). The inclusion criteria in this review were articles in English or Indonesian that discussed factors that influence the completeness of basic vaccinations for children under five. Results: Eight of the 244 articles were obtained from database searches. In general, the factors that influence the completeness of vaccination are divided into several levels, namely individual, family, community and country. At the individual and family level, the factors identified are knowledge, education, healthy living behavior, marital status, number of family members, number of children, child spacing, child birth order, economy, and family support. At the community and country level, several factors influence, among others, visits by health workers, providing information about vaccinations, officers' attitudes, living in poor, urban areas, illiterate communities, and the country's fertility rate. Conclusion: Socioeconomics is still a factor influencing the completeness of vaccination in low and middle income countries in the last 15 years. Various existing factors should be evaluated and solutions sought that can be adapted and implemented, such as training for health workers, communication training for health workers, health education approaches for heads of families, increasing access to health services by utilizing technology, and so on. Suggestion: Developing countries need innovative approaches to identify and understand factors associated with the social determinants of vaccination programs.