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Vaccine coverage for children an important indicator of the performance of national health and immunization systems. There are still challenges that exist in achieving target vaccination coverage and inequalities in countries' access to immunization. Building on already produced literature, this study aims to determine the extent of immunization coverage among children in low and middle-income countries, as well as to fill in the gaps in awareness about system-level obstacles that currently hinder the effective delivery and uptake of immunization services through EPI. We conducted a systematic literature review on vaccination coverage by following PRISMA guidelines. The electronic databases were used PubMed and Google Scholar along with targeted grey literature. The search was limited to English language from 2000 and 2020. The search techniques for electronic databases used both Medical Subject Headings (Mesh) and free-text words and were tailored to each database's specific needs using controlled vocabulary. Of 689 records 11 articles were included in this review. In total, 5 articles related to vaccination coverage, 4 studies on components of the routine immunization system, 1 article on implementation of new and under-utilized vaccines and 1 were on vaccines financing. Specific strategies to reduce inequality may be required. Vaccine procurement and pricing strategies, as well as vaccine customization to meet the needs of LMICs are all critical components in strengthening immunization systems. Our findings could be used to establish practical strategies for countries and development partners to address coverage gaps and improve vaccination system effectiveness.
