Maternal vaccination is considered a key component of the antenatal care package for improving maternal and child health. Low- and middle-income countries (LMICs) fall short of global targets to prevent maternal and neonatal deaths, with a disproportionate burden of vaccine-preventable diseases. Strategies towards ending preventable maternal mortality necessitate a health systems approach to adequately respond to this burden. This review explores the health systems determinants of delivery and uptake of essential maternal vaccines in LMICs. We conducted a qualitative systematic review of articles on maternal vaccination in LMICs, published between 2009 and 2023 in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Thematic analysis was conducted to identify key themes in the literature, interpreted within a conceptual framing that explores the systems determinants influencing maternal vaccines. Our search yielded 1309 records, of which 54 were included, covering 34 LMICs. Most of the included studies were from South America (28/54) and included pregnant women as the primary study population (34/54). The studies explored influenza (25/54) and tetanus toxoid (20/54) vaccines predominantly. The findings suggest that systems hardware (lack of clear policy guidelines, ineffective cold-chain management, limited reporting and monitoring systems) are barriers to vaccine delivery. Systems software (healthcare provider recommendations, increased trust, higher levels of maternal education) are enablers to maternal vaccine uptake. Findings show that formulation, dissemination and communication of context-specific policies and guidelines on maternal vaccines should be a priority for decision-makers in LMICs.
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Univ Leeds, Leeds Inst Hlth Sci, Leeds, W Yorkshire, England
Univ Gadjah Mada, Yogyakarta, IndonesiaUniv Leeds, Leeds Inst Hlth Sci, Leeds, W Yorkshire, England
Hafidz, Firdaus
Ensor, Tim
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Univ Leeds, Leeds Inst Hlth Sci, Leeds, W Yorkshire, EnglandUniv Leeds, Leeds Inst Hlth Sci, Leeds, W Yorkshire, England
Ensor, Tim
Tubeuf, Sandy
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Univ Leeds, Leeds Inst Hlth Sci, Leeds, W Yorkshire, EnglandUniv Leeds, Leeds Inst Hlth Sci, Leeds, W Yorkshire, England
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Univ North Carolina Chapel Hill, Gillings Sch Global Publ Hlth, Chapel Hill, NC USABaylor Univ, Dept Publ Hlth, Waco, TX USA
Landrum, Kelsey R.
Schroeder, Kristin
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Duke Univ, Dept Pediat, Div Pediat Oncol, Durham, NC USA
Duke Univ, Duke Global Hlth Inst, Durham, NC USABaylor Univ, Dept Publ Hlth, Waco, TX USA
Schroeder, Kristin
Staton, Catherine
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Duke Univ, Duke Global Hlth Inst, Durham, NC USA
Duke Univ, Duke Sch Med, Dept Surg, Div Emergency Med, Durham, NC USABaylor Univ, Dept Publ Hlth, Waco, TX USA
Staton, Catherine
Majaliwa, Esther
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Kilimanjaro Christian Med Ctr, Div Pediat Oncol, Moshi, TanzaniaBaylor Univ, Dept Publ Hlth, Waco, TX USA
Majaliwa, Esther
Tang, Shenglan
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Duke Univ, Duke Global Hlth Inst, Durham, NC USA
Duke Univ, Duke Sch Med, Dept Surg, Div Emergency Med, Durham, NC USABaylor Univ, Dept Publ Hlth, Waco, TX USA
Tang, Shenglan
Rice, Henry E.
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Duke Univ, Duke Global Hlth Inst, Durham, NC USA
Duke Univ, Duke Sch Med, Dept Surg, Div Emergency Med, Durham, NC USA
Duke Univ, Duke Sch Med, Dept Surg, Div Pediat Surg, Durham, NC USABaylor Univ, Dept Publ Hlth, Waco, TX USA
Rice, Henry E.
Smith, Emily R.
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Duke Univ, Duke Global Hlth Inst, Durham, NC USA
Duke Univ, Duke Sch Med, Dept Surg, Div Emergency Med, Durham, NC USA
Duke Univ, Duke Sch Med, 40 Duke Med Circle, Durham, NC 27705 USABaylor Univ, Dept Publ Hlth, Waco, TX USA
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Univ Stellenbosch, Dept Psychol, ZA-7600 Stellenbosch, South AfricaUniv Cape Town, Dept Psychiat & Mental Hlth, ZA-7700 Rondebosch, South Africa
Breen, Alison
Flisher, Alan J.
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Univ Cape Town, Dept Psychiat & Mental Hlth, ZA-7700 Rondebosch, South AfricaUniv Cape Town, Dept Psychiat & Mental Hlth, ZA-7700 Rondebosch, South Africa
Flisher, Alan J.
Kakuma, Ritsuko
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Univ Cape Town, Dept Psychiat & Mental Hlth, ZA-7700 Rondebosch, South Africa
Univ Toronto, Hlth Syst Res & Consulting Unit, Ctr Addict & Mental Hlth, Toronto, ON M5S 1A1, CanadaUniv Cape Town, Dept Psychiat & Mental Hlth, ZA-7700 Rondebosch, South Africa
Kakuma, Ritsuko
Swartz, Leslie
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Univ Stellenbosch, Dept Psychol, ZA-7600 Stellenbosch, South Africa
Human Sci Res Council, Durban, South AfricaUniv Cape Town, Dept Psychiat & Mental Hlth, ZA-7700 Rondebosch, South Africa
Swartz, Leslie
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Joska, John
Corrigall, Joanne
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Univ Cape Town, Sch Publ Hlth, ZA-7700 Rondebosch, South AfricaUniv Cape Town, Dept Psychiat & Mental Hlth, ZA-7700 Rondebosch, South Africa
Corrigall, Joanne
Patel, Vikram
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London Sch Hyg & Trop Med, London, EnglandUniv Cape Town, Dept Psychiat & Mental Hlth, ZA-7700 Rondebosch, South Africa
Patel, Vikram
Consortium, MHapp Res Programme
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机构:Univ Cape Town, Dept Psychiat & Mental Hlth, ZA-7700 Rondebosch, South Africa