Impact of digital health interventions in improving pediatric immunization coverage and timeliness in low- and middle-income countries: a systematic review and meta-analysis

Introduction: Vaccine-preventable diseases disproportionately affect children in low- and middle-income countries (LMICs), where barriers to vaccine demand and access limit coverage. Digital health interventions have been increasingly implemented to address these gaps; however, evidence regarding their effectiveness remains heterogeneous. This systematic review and meta-analysis evaluated the impact of digital interventions on pediatric vaccination outcomes in LMICs. Methods: We systematically searched Scopus, PubMed, Cochrane Library, CINAHL, ClinicalTrials.gov, Ovid MEDLINE, and EMBASE, and screened the reference list of relevant studies. Randomized controlled trials evaluating the effect of digital interventions on pediatric vaccinations in LMICs were included. Statistical analyses computed pooled outcomes, heterogeneity, and subgroup effects. The complete protocol was registered in PROSPERO (CRD:420251101655). Results: Twenty-two studies involving 68,664 participants met the inclusion criteria. Meta-analysis of pooled data showed that digital interventions delivered via reminder-only (RR 1.273; 95% CI 1.086–1.492; I2 = 93.3%), education (RR 1.953; 95% CI 1.076–3.542; I2 = 62.3%), and reminder with education (RR = 1.721; 95% CI 1.377–2.152; I2 = 0%) strategies improved immunization coverage of target vaccines as compared with usual care. Digital reminders were more effective in urban (RR 1.141; 95% CI 1.079–1.207; I2 = 51.5%) than in rural (RR 1.050; 95% CI 0.994–1.109; I2 = 0%) settings. Digital interventions also improved the timely receipt of pentavalent vaccines (RR 1.547; 95% CI 1.104–2.167; I2 = 95.4%). Among studies assessing acceptability, caregivers perceived digital interventions as beneficial, with a pooled prevalence of 94.7% (95% CI 0.765–0.990; I2 = 96.5%). Conclusion: Integration of digital technologies into immunization programs enhances vaccination coverage and timeliness, supporting their wider adoption as effective and well-accepted tools for improving immunization outcomes. © 2026 Elsevier Ltd. All rights are reserved, including those for text and data mining, AI training, and similar technologies.