Social determinants of immunization services uptake in developing countries: a systematic review

Introduction: Immunization is a strong pillar of community health. Attainment of the desired immunization coverage is always dependent on a range of determinants. These determinants are normally put into broad categories as immunization system based, clients based and service providers based. The objective of this study is to explore determinants of immunization services uptake in developing countries. This study reports magnitude of system, providers, and clients based determinants of immunization uptake in developing countries. Methods: Systematic documentary review was a method for this study. Literature searches were made using Research4Life, HINARI and other online publication sources to identify relevant research articles. Twenty-six articles were reviewed. Results: Seventeen Key Determinants were identified with frequencies in brackets: caregivers' social status (25); caregivers' knowledge on immunization (22); access to immunization services and information (20); health workers' knowledge attitude and practice (12); social influence and support (110); quality of immunization services (10); alternative strategies for hard-to-reach populations (9); caregivers' perceptions about immunization (7); gender (7); and care givers' beliefs and attitude towards immunization (6). Overall, 62.3% of the key determinants were clients based; 29.5% were immunization system based; 8.2% were providers based. Conclusion: Majority of immunization services uptake determinants are based on clients. Therefore, immunization interventions in developing countries should majorly focus on social behaviour change communication.