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Writing a Literature Review

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A literature review is a document or section of a document that collects key sources on a topic and discusses those sources in conversation with each other (also called synthesis ). The lit review is an important genre in many disciplines, not just literature (i.e., the study of works of literature such as novels and plays). When we say “literature review” or refer to “the literature,” we are talking about the research ( scholarship ) in a given field. You will often see the terms “the research,” “the scholarship,” and “the literature” used mostly interchangeably.

Where, when, and why would I write a lit review?

There are a number of different situations where you might write a literature review, each with slightly different expectations; different disciplines, too, have field-specific expectations for what a literature review is and does. For instance, in the humanities, authors might include more overt argumentation and interpretation of source material in their literature reviews, whereas in the sciences, authors are more likely to report study designs and results in their literature reviews; these differences reflect these disciplines’ purposes and conventions in scholarship. You should always look at examples from your own discipline and talk to professors or mentors in your field to be sure you understand your discipline’s conventions, for literature reviews as well as for any other genre.

A literature review can be a part of a research paper or scholarly article, usually falling after the introduction and before the research methods sections. In these cases, the lit review just needs to cover scholarship that is important to the issue you are writing about; sometimes it will also cover key sources that informed your research methodology.

Lit reviews can also be standalone pieces, either as assignments in a class or as publications. In a class, a lit review may be assigned to help students familiarize themselves with a topic and with scholarship in their field, get an idea of the other researchers working on the topic they’re interested in, find gaps in existing research in order to propose new projects, and/or develop a theoretical framework and methodology for later research. As a publication, a lit review usually is meant to help make other scholars’ lives easier by collecting and summarizing, synthesizing, and analyzing existing research on a topic. This can be especially helpful for students or scholars getting into a new research area, or for directing an entire community of scholars toward questions that have not yet been answered.

What are the parts of a lit review?

Most lit reviews use a basic introduction-body-conclusion structure; if your lit review is part of a larger paper, the introduction and conclusion pieces may be just a few sentences while you focus most of your attention on the body. If your lit review is a standalone piece, the introduction and conclusion take up more space and give you a place to discuss your goals, research methods, and conclusions separately from where you discuss the literature itself.

Introduction:

• An introductory paragraph that explains what your working topic and thesis is
• A forecast of key topics or texts that will appear in the review
• Potentially, a description of how you found sources and how you analyzed them for inclusion and discussion in the review (more often found in published, standalone literature reviews than in lit review sections in an article or research paper)
• Summarize and synthesize: Give an overview of the main points of each source and combine them into a coherent whole
• Analyze and interpret: Don’t just paraphrase other researchers – add your own interpretations where possible, discussing the significance of findings in relation to the literature as a whole
• Critically Evaluate: Mention the strengths and weaknesses of your sources
• Write in well-structured paragraphs: Use transition words and topic sentence to draw connections, comparisons, and contrasts.

Conclusion:

• Summarize the key findings you have taken from the literature and emphasize their significance
• Connect it back to your primary research question

How should I organize my lit review?

Lit reviews can take many different organizational patterns depending on what you are trying to accomplish with the review. Here are some examples:

• Chronological : The simplest approach is to trace the development of the topic over time, which helps familiarize the audience with the topic (for instance if you are introducing something that is not commonly known in your field). If you choose this strategy, be careful to avoid simply listing and summarizing sources in order. Try to analyze the patterns, turning points, and key debates that have shaped the direction of the field. Give your interpretation of how and why certain developments occurred (as mentioned previously, this may not be appropriate in your discipline — check with a teacher or mentor if you’re unsure).
• Thematic : If you have found some recurring central themes that you will continue working with throughout your piece, you can organize your literature review into subsections that address different aspects of the topic. For example, if you are reviewing literature about women and religion, key themes can include the role of women in churches and the religious attitude towards women.
• Qualitative versus quantitative research
• Empirical versus theoretical scholarship
• Divide the research by sociological, historical, or cultural sources
• Theoretical : In many humanities articles, the literature review is the foundation for the theoretical framework. You can use it to discuss various theories, models, and definitions of key concepts. You can argue for the relevance of a specific theoretical approach or combine various theorical concepts to create a framework for your research.

What are some strategies or tips I can use while writing my lit review?

Any lit review is only as good as the research it discusses; make sure your sources are well-chosen and your research is thorough. Don’t be afraid to do more research if you discover a new thread as you’re writing. More info on the research process is available in our "Conducting Research" resources .

As you’re doing your research, create an annotated bibliography ( see our page on the this type of document ). Much of the information used in an annotated bibliography can be used also in a literature review, so you’ll be not only partially drafting your lit review as you research, but also developing your sense of the larger conversation going on among scholars, professionals, and any other stakeholders in your topic.

Usually you will need to synthesize research rather than just summarizing it. This means drawing connections between sources to create a picture of the scholarly conversation on a topic over time. Many student writers struggle to synthesize because they feel they don’t have anything to add to the scholars they are citing; here are some strategies to help you:

• It often helps to remember that the point of these kinds of syntheses is to show your readers how you understand your research, to help them read the rest of your paper.
• Writing teachers often say synthesis is like hosting a dinner party: imagine all your sources are together in a room, discussing your topic. What are they saying to each other?
• Look at the in-text citations in each paragraph. Are you citing just one source for each paragraph? This usually indicates summary only. When you have multiple sources cited in a paragraph, you are more likely to be synthesizing them (not always, but often
• Read more about synthesis here.

The most interesting literature reviews are often written as arguments (again, as mentioned at the beginning of the page, this is discipline-specific and doesn’t work for all situations). Often, the literature review is where you can establish your research as filling a particular gap or as relevant in a particular way. You have some chance to do this in your introduction in an article, but the literature review section gives a more extended opportunity to establish the conversation in the way you would like your readers to see it. You can choose the intellectual lineage you would like to be part of and whose definitions matter most to your thinking (mostly humanities-specific, but this goes for sciences as well). In addressing these points, you argue for your place in the conversation, which tends to make the lit review more compelling than a simple reporting of other sources.

What is a Literature Review? How to Write It (with Examples)

A literature review is a critical analysis and synthesis of existing research on a particular topic. It provides an overview of the current state of knowledge, identifies gaps, and highlights key findings in the literature. 1 The purpose of a literature review is to situate your own research within the context of existing scholarship, demonstrating your understanding of the topic and showing how your work contributes to the ongoing conversation in the field. Learning how to write a literature review is a critical tool for successful research. Your ability to summarize and synthesize prior research pertaining to a certain topic demonstrates your grasp on the topic of study, and assists in the learning process. 

Table of Contents

• What is the purpose of literature review? 
• a. Habitat Loss and Species Extinction: 
• b. Range Shifts and Phenological Changes: 
• c. Ocean Acidification and Coral Reefs: 
• d. Adaptive Strategies and Conservation Efforts: 

How to write a good literature review 

• Choose a Topic and Define the Research Question: 
• Decide on the Scope of Your Review: 
• Select Databases for Searches: 
• Conduct Searches and Keep Track: 
• Review the Literature: 
• Organize and Write Your Literature Review: 
• How to write a literature review faster with Paperpal? 
• Frequently asked questions 

What is a literature review?

A well-conducted literature review demonstrates the researcher’s familiarity with the existing literature, establishes the context for their own research, and contributes to scholarly conversations on the topic. One of the purposes of a literature review is also to help researchers avoid duplicating previous work and ensure that their research is informed by and builds upon the existing body of knowledge.

What is the purpose of literature review?

A literature review serves several important purposes within academic and research contexts. Here are some key objectives and functions of a literature review: 2  

1. Contextualizing the Research Problem: The literature review provides a background and context for the research problem under investigation. It helps to situate the study within the existing body of knowledge. 

2. Identifying Gaps in Knowledge: By identifying gaps, contradictions, or areas requiring further research, the researcher can shape the research question and justify the significance of the study. This is crucial for ensuring that the new research contributes something novel to the field. 

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3. Understanding Theoretical and Conceptual Frameworks: Literature reviews help researchers gain an understanding of the theoretical and conceptual frameworks used in previous studies. This aids in the development of a theoretical framework for the current research. 

4. Providing Methodological Insights: Another purpose of literature reviews is that it allows researchers to learn about the methodologies employed in previous studies. This can help in choosing appropriate research methods for the current study and avoiding pitfalls that others may have encountered. 

5. Establishing Credibility: A well-conducted literature review demonstrates the researcher’s familiarity with existing scholarship, establishing their credibility and expertise in the field. It also helps in building a solid foundation for the new research. 

6. Informing Hypotheses or Research Questions: The literature review guides the formulation of hypotheses or research questions by highlighting relevant findings and areas of uncertainty in existing literature. 

Literature review example

Let’s delve deeper with a literature review example: Let’s say your literature review is about the impact of climate change on biodiversity. You might format your literature review into sections such as the effects of climate change on habitat loss and species extinction, phenological changes, and marine biodiversity. Each section would then summarize and analyze relevant studies in those areas, highlighting key findings and identifying gaps in the research. The review would conclude by emphasizing the need for further research on specific aspects of the relationship between climate change and biodiversity. The following literature review template provides a glimpse into the recommended literature review structure and content, demonstrating how research findings are organized around specific themes within a broader topic. 

Literature Review on Climate Change Impacts on Biodiversity:

Climate change is a global phenomenon with far-reaching consequences, including significant impacts on biodiversity. This literature review synthesizes key findings from various studies: 

a. Habitat Loss and Species Extinction:

Climate change-induced alterations in temperature and precipitation patterns contribute to habitat loss, affecting numerous species (Thomas et al., 2004). The review discusses how these changes increase the risk of extinction, particularly for species with specific habitat requirements. 

b. Range Shifts and Phenological Changes:

Observations of range shifts and changes in the timing of biological events (phenology) are documented in response to changing climatic conditions (Parmesan & Yohe, 2003). These shifts affect ecosystems and may lead to mismatches between species and their resources. 

c. Ocean Acidification and Coral Reefs:

The review explores the impact of climate change on marine biodiversity, emphasizing ocean acidification’s threat to coral reefs (Hoegh-Guldberg et al., 2007). Changes in pH levels negatively affect coral calcification, disrupting the delicate balance of marine ecosystems. 

d. Adaptive Strategies and Conservation Efforts:

Recognizing the urgency of the situation, the literature review discusses various adaptive strategies adopted by species and conservation efforts aimed at mitigating the impacts of climate change on biodiversity (Hannah et al., 2007). It emphasizes the importance of interdisciplinary approaches for effective conservation planning. 

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Writing a literature review involves summarizing and synthesizing existing research on a particular topic. A good literature review format should include the following elements. 

Introduction: The introduction sets the stage for your literature review, providing context and introducing the main focus of your review. 

• Opening Statement: Begin with a general statement about the broader topic and its significance in the field. 
• Scope and Purpose: Clearly define the scope of your literature review. Explain the specific research question or objective you aim to address. 
• Organizational Framework: Briefly outline the structure of your literature review, indicating how you will categorize and discuss the existing research. 
• Significance of the Study: Highlight why your literature review is important and how it contributes to the understanding of the chosen topic. 
• Thesis Statement: Conclude the introduction with a concise thesis statement that outlines the main argument or perspective you will develop in the body of the literature review. 

Body: The body of the literature review is where you provide a comprehensive analysis of existing literature, grouping studies based on themes, methodologies, or other relevant criteria. 

• Organize by Theme or Concept: Group studies that share common themes, concepts, or methodologies. Discuss each theme or concept in detail, summarizing key findings and identifying gaps or areas of disagreement. 
• Critical Analysis: Evaluate the strengths and weaknesses of each study. Discuss the methodologies used, the quality of evidence, and the overall contribution of each work to the understanding of the topic. 
• Synthesis of Findings: Synthesize the information from different studies to highlight trends, patterns, or areas of consensus in the literature. 
• Identification of Gaps: Discuss any gaps or limitations in the existing research and explain how your review contributes to filling these gaps. 
• Transition between Sections: Provide smooth transitions between different themes or concepts to maintain the flow of your literature review. 

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Conclusion: The conclusion of your literature review should summarize the main findings, highlight the contributions of the review, and suggest avenues for future research. 

• Summary of Key Findings: Recap the main findings from the literature and restate how they contribute to your research question or objective. 
• Contributions to the Field: Discuss the overall contribution of your literature review to the existing knowledge in the field. 
• Implications and Applications: Explore the practical implications of the findings and suggest how they might impact future research or practice. 
• Recommendations for Future Research: Identify areas that require further investigation and propose potential directions for future research in the field. 
• Final Thoughts: Conclude with a final reflection on the importance of your literature review and its relevance to the broader academic community. 

Conducting a literature review

Conducting a literature review is an essential step in research that involves reviewing and analyzing existing literature on a specific topic. It’s important to know how to do a literature review effectively, so here are the steps to follow: 1  

Choose a Topic and Define the Research Question:

• Select a topic that is relevant to your field of study. 
• Clearly define your research question or objective. Determine what specific aspect of the topic do you want to explore? 

Decide on the Scope of Your Review:

• Determine the timeframe for your literature review. Are you focusing on recent developments, or do you want a historical overview? 
• Consider the geographical scope. Is your review global, or are you focusing on a specific region? 
• Define the inclusion and exclusion criteria. What types of sources will you include? Are there specific types of studies or publications you will exclude? 

Select Databases for Searches:

• Identify relevant databases for your field. Examples include PubMed, IEEE Xplore, Scopus, Web of Science, and Google Scholar. 
• Consider searching in library catalogs, institutional repositories, and specialized databases related to your topic. 

Conduct Searches and Keep Track:

• Develop a systematic search strategy using keywords, Boolean operators (AND, OR, NOT), and other search techniques. 
• Record and document your search strategy for transparency and replicability. 
• Keep track of the articles, including publication details, abstracts, and links. Use citation management tools like EndNote, Zotero, or Mendeley to organize your references. 

Review the Literature:

• Evaluate the relevance and quality of each source. Consider the methodology, sample size, and results of studies. 
• Organize the literature by themes or key concepts. Identify patterns, trends, and gaps in the existing research. 
• Summarize key findings and arguments from each source. Compare and contrast different perspectives. 
• Identify areas where there is a consensus in the literature and where there are conflicting opinions. 
• Provide critical analysis and synthesis of the literature. What are the strengths and weaknesses of existing research? 

Organize and Write Your Literature Review:

• Literature review outline should be based on themes, chronological order, or methodological approaches. 
• Write a clear and coherent narrative that synthesizes the information gathered. 
• Use proper citations for each source and ensure consistency in your citation style (APA, MLA, Chicago, etc.). 
• Conclude your literature review by summarizing key findings, identifying gaps, and suggesting areas for future research. 

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How to write a literature review faster with Paperpal?

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• Ask a question: Get started with a new document on paperpal.com. Click on the “Research” feature and type your question in plain English. Paperpal will scour over 250 million research articles, including conference papers and preprints, to provide you with accurate insights and citations. 
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• Cite with Confidence: Paperpal makes it easy to incorporate relevant citations and references into your writing, ensuring your arguments are well-supported by credible sources. This translates to a polished, well-researched literature review. 

The literature review sample and detailed advice on writing and conducting a review will help you produce a well-structured report. But remember that a good literature review is an ongoing process, and it may be necessary to revisit and update it as your research progresses. By combining effortless research with an easy citation process, Paperpal Research streamlines the literature review process and empowers you to write faster and with more confidence. Try Paperpal Research now and see for yourself.  

Frequently asked questions

A literature review is a critical and comprehensive analysis of existing literature (published and unpublished works) on a specific topic or research question and provides a synthesis of the current state of knowledge in a particular field. A well-conducted literature review is crucial for researchers to build upon existing knowledge, avoid duplication of efforts, and contribute to the advancement of their field. It also helps researchers situate their work within a broader context and facilitates the development of a sound theoretical and conceptual framework for their studies.

Literature review is a crucial component of research writing, providing a solid background for a research paper’s investigation. The aim is to keep professionals up to date by providing an understanding of ongoing developments within a specific field, including research methods, and experimental techniques used in that field, and present that knowledge in the form of a written report. Also, the depth and breadth of the literature review emphasizes the credibility of the scholar in his or her field.  

Before writing a literature review, it’s essential to undertake several preparatory steps to ensure that your review is well-researched, organized, and focused. This includes choosing a topic of general interest to you and doing exploratory research on that topic, writing an annotated bibliography, and noting major points, especially those that relate to the position you have taken on the topic. 

Literature reviews and academic research papers are essential components of scholarly work but serve different purposes within the academic realm. 3 A literature review aims to provide a foundation for understanding the current state of research on a particular topic, identify gaps or controversies, and lay the groundwork for future research. Therefore, it draws heavily from existing academic sources, including books, journal articles, and other scholarly publications. In contrast, an academic research paper aims to present new knowledge, contribute to the academic discourse, and advance the understanding of a specific research question. Therefore, it involves a mix of existing literature (in the introduction and literature review sections) and original data or findings obtained through research methods. 

Literature reviews are essential components of academic and research papers, and various strategies can be employed to conduct them effectively. If you want to know how to write a literature review for a research paper, here are four common approaches that are often used by researchers.  Chronological Review: This strategy involves organizing the literature based on the chronological order of publication. It helps to trace the development of a topic over time, showing how ideas, theories, and research have evolved.  Thematic Review: Thematic reviews focus on identifying and analyzing themes or topics that cut across different studies. Instead of organizing the literature chronologically, it is grouped by key themes or concepts, allowing for a comprehensive exploration of various aspects of the topic.  Methodological Review: This strategy involves organizing the literature based on the research methods employed in different studies. It helps to highlight the strengths and weaknesses of various methodologies and allows the reader to evaluate the reliability and validity of the research findings.  Theoretical Review: A theoretical review examines the literature based on the theoretical frameworks used in different studies. This approach helps to identify the key theories that have been applied to the topic and assess their contributions to the understanding of the subject.  It’s important to note that these strategies are not mutually exclusive, and a literature review may combine elements of more than one approach. The choice of strategy depends on the research question, the nature of the literature available, and the goals of the review. Additionally, other strategies, such as integrative reviews or systematic reviews, may be employed depending on the specific requirements of the research.

The literature review format can vary depending on the specific publication guidelines. However, there are some common elements and structures that are often followed. Here is a general guideline for the format of a literature review:  Introduction:   Provide an overview of the topic.  Define the scope and purpose of the literature review.  State the research question or objective.  Body:   Organize the literature by themes, concepts, or chronology.  Critically analyze and evaluate each source.  Discuss the strengths and weaknesses of the studies.  Highlight any methodological limitations or biases.  Identify patterns, connections, or contradictions in the existing research.  Conclusion:   Summarize the key points discussed in the literature review.  Highlight the research gap.  Address the research question or objective stated in the introduction.  Highlight the contributions of the review and suggest directions for future research.

Both annotated bibliographies and literature reviews involve the examination of scholarly sources. While annotated bibliographies focus on individual sources with brief annotations, literature reviews provide a more in-depth, integrated, and comprehensive analysis of existing literature on a specific topic. The key differences are as follows: 

References 

• Denney, A. S., & Tewksbury, R. (2013). How to write a literature review.  Journal of criminal justice education ,  24 (2), 218-234. 
• Pan, M. L. (2016).  Preparing literature reviews: Qualitative and quantitative approaches . Taylor & Francis. 
• Cantero, C. (2019). How to write a literature review.  San José State University Writing Center . 

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What is a literature review?

A literature review is an integrated analysis -- not just a summary-- of scholarly writings and other relevant evidence related directly to your research question.  That is, it represents a synthesis of the evidence that provides background information on your topic and shows a association between the evidence and your research question.

A literature review may be a stand alone work or the introduction to a larger research paper, depending on the assignment.  Rely heavily on the guidelines your instructor has given you.

Why is it important?

A literature review is important because it:

• Explains the background of research on a topic.
• Demonstrates why a topic is significant to a subject area.
• Discovers relationships between research studies/ideas.
• Identifies major themes, concepts, and researchers on a topic.
• Identifies critical gaps and points of disagreement.
• Discusses further research questions that logically come out of the previous studies.

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1. Choose a topic. Define your research question.

Your literature review should be guided by your central research question.  The literature represents background and research developments related to a specific research question, interpreted and analyzed by you in a synthesized way.

• Make sure your research question is not too broad or too narrow.  Is it manageable?
• Begin writing down terms that are related to your question. These will be useful for searches later.
• If you have the opportunity, discuss your topic with your professor and your class mates.

2. Decide on the scope of your review

How many studies do you need to look at? How comprehensive should it be? How many years should it cover? 

• This may depend on your assignment.  How many sources does the assignment require?

3. Select the databases you will use to conduct your searches.

Make a list of the databases you will search. 

Where to find databases:

• use the tabs on this guide
• Find other databases in the Nursing Information Resources web page
• More on the Medical Library web page
• ... and more on the Yale University Library web page

4. Conduct your searches to find the evidence. Keep track of your searches.

• Use the key words in your question, as well as synonyms for those words, as terms in your search. Use the database tutorials for help.
• Save the searches in the databases. This saves time when you want to redo, or modify, the searches. It is also helpful to use as a guide is the searches are not finding any useful results.
• Review the abstracts of research studies carefully. This will save you time.
• Use the bibliographies and references of research studies you find to locate others.
• Check with your professor, or a subject expert in the field, if you are missing any key works in the field.
• Ask your librarian for help at any time.
• Use a citation manager, such as EndNote as the repository for your citations. See the EndNote tutorials for help.

Review the literature

Some questions to help you analyze the research:

• What was the research question of the study you are reviewing? What were the authors trying to discover?
• Was the research funded by a source that could influence the findings?
• What were the research methodologies? Analyze its literature review, the samples and variables used, the results, and the conclusions.
• Does the research seem to be complete? Could it have been conducted more soundly? What further questions does it raise?
• If there are conflicting studies, why do you think that is?
• How are the authors viewed in the field? Has this study been cited? If so, how has it been analyzed?

Tips: 

• Review the abstracts carefully.  
• Keep careful notes so that you may track your thought processes during the research process.
• Create a matrix of the studies for easy analysis, and synthesis, across all of the studies.
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What is a Literature Review? | Guide, Template, & Examples

Published on 22 February 2022 by Shona McCombes . Revised on 7 June 2022.

What is a literature review? A literature review is a survey of scholarly sources on a specific topic. It provides an overview of current knowledge, allowing you to identify relevant theories, methods, and gaps in the existing research.

There are five key steps to writing a literature review:

• Search for relevant literature
• Evaluate sources
• Identify themes, debates and gaps
• Outline the structure
• Write your literature review

A good literature review doesn’t just summarise sources – it analyses, synthesises, and critically evaluates to give a clear picture of the state of knowledge on the subject.

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Table of contents

Why write a literature review, examples of literature reviews, step 1: search for relevant literature, step 2: evaluate and select sources, step 3: identify themes, debates and gaps, step 4: outline your literature review’s structure, step 5: write your literature review, frequently asked questions about literature reviews, introduction.

• Quick Run-through
• Step 1 & 2

When you write a dissertation or thesis, you will have to conduct a literature review to situate your research within existing knowledge. The literature review gives you a chance to:

• Demonstrate your familiarity with the topic and scholarly context
• Develop a theoretical framework and methodology for your research
• Position yourself in relation to other researchers and theorists
• Show how your dissertation addresses a gap or contributes to a debate

You might also have to write a literature review as a stand-alone assignment. In this case, the purpose is to evaluate the current state of research and demonstrate your knowledge of scholarly debates around a topic.

The content will look slightly different in each case, but the process of conducting a literature review follows the same steps. We’ve written a step-by-step guide that you can follow below.

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Writing literature reviews can be quite challenging! A good starting point could be to look at some examples, depending on what kind of literature review you’d like to write.

• Example literature review #1: “Why Do People Migrate? A Review of the Theoretical Literature” ( Theoretical literature review about the development of economic migration theory from the 1950s to today.)
• Example literature review #2: “Literature review as a research methodology: An overview and guidelines” ( Methodological literature review about interdisciplinary knowledge acquisition and production.)
• Example literature review #3: “The Use of Technology in English Language Learning: A Literature Review” ( Thematic literature review about the effects of technology on language acquisition.)
• Example literature review #4: “Learners’ Listening Comprehension Difficulties in English Language Learning: A Literature Review” ( Chronological literature review about how the concept of listening skills has changed over time.)

You can also check out our templates with literature review examples and sample outlines at the links below.

Download Word doc Download Google doc

Before you begin searching for literature, you need a clearly defined topic .

If you are writing the literature review section of a dissertation or research paper, you will search for literature related to your research objectives and questions .

If you are writing a literature review as a stand-alone assignment, you will have to choose a focus and develop a central question to direct your search. Unlike a dissertation research question, this question has to be answerable without collecting original data. You should be able to answer it based only on a review of existing publications.

Make a list of keywords

Start by creating a list of keywords related to your research topic. Include each of the key concepts or variables you’re interested in, and list any synonyms and related terms. You can add to this list if you discover new keywords in the process of your literature search.

• Social media, Facebook, Instagram, Twitter, Snapchat, TikTok
• Body image, self-perception, self-esteem, mental health
• Generation Z, teenagers, adolescents, youth

Search for relevant sources

Use your keywords to begin searching for sources. Some databases to search for journals and articles include:

• Your university’s library catalogue
• Google Scholar
• Project Muse (humanities and social sciences)
• Medline (life sciences and biomedicine)
• EconLit (economics)
• Inspec (physics, engineering and computer science)

You can use boolean operators to help narrow down your search:

Read the abstract to find out whether an article is relevant to your question. When you find a useful book or article, you can check the bibliography to find other relevant sources.

To identify the most important publications on your topic, take note of recurring citations. If the same authors, books or articles keep appearing in your reading, make sure to seek them out.

You probably won’t be able to read absolutely everything that has been written on the topic – you’ll have to evaluate which sources are most relevant to your questions.

For each publication, ask yourself:

• What question or problem is the author addressing?
• What are the key concepts and how are they defined?
• What are the key theories, models and methods? Does the research use established frameworks or take an innovative approach?
• What are the results and conclusions of the study?
• How does the publication relate to other literature in the field? Does it confirm, add to, or challenge established knowledge?
• How does the publication contribute to your understanding of the topic? What are its key insights and arguments?
• What are the strengths and weaknesses of the research?

Make sure the sources you use are credible, and make sure you read any landmark studies and major theories in your field of research.

You can find out how many times an article has been cited on Google Scholar – a high citation count means the article has been influential in the field, and should certainly be included in your literature review.

The scope of your review will depend on your topic and discipline: in the sciences you usually only review recent literature, but in the humanities you might take a long historical perspective (for example, to trace how a concept has changed in meaning over time).

Remember that you can use our template to summarise and evaluate sources you’re thinking about using!

Take notes and cite your sources

As you read, you should also begin the writing process. Take notes that you can later incorporate into the text of your literature review.

It’s important to keep track of your sources with references to avoid plagiarism . It can be helpful to make an annotated bibliography, where you compile full reference information and write a paragraph of summary and analysis for each source. This helps you remember what you read and saves time later in the process.

You can use our free APA Reference Generator for quick, correct, consistent citations.

To begin organising your literature review’s argument and structure, you need to understand the connections and relationships between the sources you’ve read. Based on your reading and notes, you can look for:

• Trends and patterns (in theory, method or results): do certain approaches become more or less popular over time?
• Themes: what questions or concepts recur across the literature?
• Debates, conflicts and contradictions: where do sources disagree?
• Pivotal publications: are there any influential theories or studies that changed the direction of the field?
• Gaps: what is missing from the literature? Are there weaknesses that need to be addressed?

This step will help you work out the structure of your literature review and (if applicable) show how your own research will contribute to existing knowledge.

• Most research has focused on young women.
• There is an increasing interest in the visual aspects of social media.
• But there is still a lack of robust research on highly-visual platforms like Instagram and Snapchat – this is a gap that you could address in your own research.

There are various approaches to organising the body of a literature review. You should have a rough idea of your strategy before you start writing.

Depending on the length of your literature review, you can combine several of these strategies (for example, your overall structure might be thematic, but each theme is discussed chronologically).

Chronological

The simplest approach is to trace the development of the topic over time. However, if you choose this strategy, be careful to avoid simply listing and summarising sources in order.

Try to analyse patterns, turning points and key debates that have shaped the direction of the field. Give your interpretation of how and why certain developments occurred.

If you have found some recurring central themes, you can organise your literature review into subsections that address different aspects of the topic.

For example, if you are reviewing literature about inequalities in migrant health outcomes, key themes might include healthcare policy, language barriers, cultural attitudes, legal status, and economic access.

Methodological

If you draw your sources from different disciplines or fields that use a variety of research methods , you might want to compare the results and conclusions that emerge from different approaches. For example:

• Look at what results have emerged in qualitative versus quantitative research
• Discuss how the topic has been approached by empirical versus theoretical scholarship
• Divide the literature into sociological, historical, and cultural sources

Theoretical

A literature review is often the foundation for a theoretical framework . You can use it to discuss various theories, models, and definitions of key concepts.

You might argue for the relevance of a specific theoretical approach, or combine various theoretical concepts to create a framework for your research.

Like any other academic text, your literature review should have an introduction , a main body, and a conclusion . What you include in each depends on the objective of your literature review.

The introduction should clearly establish the focus and purpose of the literature review.

If you are writing the literature review as part of your dissertation or thesis, reiterate your central problem or research question and give a brief summary of the scholarly context. You can emphasise the timeliness of the topic (“many recent studies have focused on the problem of x”) or highlight a gap in the literature (“while there has been much research on x, few researchers have taken y into consideration”).

Depending on the length of your literature review, you might want to divide the body into subsections. You can use a subheading for each theme, time period, or methodological approach.

As you write, make sure to follow these tips:

• Summarise and synthesise: give an overview of the main points of each source and combine them into a coherent whole.
• Analyse and interpret: don’t just paraphrase other researchers – add your own interpretations, discussing the significance of findings in relation to the literature as a whole.
• Critically evaluate: mention the strengths and weaknesses of your sources.
• Write in well-structured paragraphs: use transitions and topic sentences to draw connections, comparisons and contrasts.

In the conclusion, you should summarise the key findings you have taken from the literature and emphasise their significance.

If the literature review is part of your dissertation or thesis, reiterate how your research addresses gaps and contributes new knowledge, or discuss how you have drawn on existing theories and methods to build a framework for your research. This can lead directly into your methodology section.

A literature review is a survey of scholarly sources (such as books, journal articles, and theses) related to a specific topic or research question .

It is often written as part of a dissertation , thesis, research paper , or proposal .

There are several reasons to conduct a literature review at the beginning of a research project:

• To familiarise yourself with the current state of knowledge on your topic
• To ensure that you’re not just repeating what others have already done
• To identify gaps in knowledge and unresolved problems that your research can address
• To develop your theoretical framework and methodology
• To provide an overview of the key findings and debates on the topic

Writing the literature review shows your reader how your work relates to existing research and what new insights it will contribute.

The literature review usually comes near the beginning of your  dissertation . After the introduction , it grounds your research in a scholarly field and leads directly to your theoretical framework or methodology .

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Introduction

Literature reviews take time. here is some general information to know before you start.  .

•  VIDEO -- This video is a great overview of the entire process.  (2020; North Carolina State University Libraries) --The transcript is included --This is for everyone; ignore the mention of "graduate students" --9.5 minutes, and every second is important  
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What is a Literature Review?

A literature or narrative review is a comprehensive review and analysis of the published literature on a specific topic or research question. The literature that is reviewed contains: books, articles, academic articles, conference proceedings, association papers, and dissertations. It contains the most pertinent studies and points to important past and current research and practices. It provides background and context, and shows how your research will contribute to the field. 

A literature review should: 

• Provide a comprehensive and updated review of the literature;
• Explain why this review has taken place;
• Articulate a position or hypothesis;
• Acknowledge and account for conflicting and corroborating points of view

From  S age Research Methods

Purpose of a Literature Review

A literature review can be written as an introduction to a study to:

• Demonstrate how a study fills a gap in research
• Compare a study with other research that's been done

Or it can be a separate work (a research article on its own) which:

• Organizes or describes a topic
• Describes variables within a particular issue/problem

Limitations of a Literature Review

Some of the limitations of a literature review are:

• It's a snapshot in time. Unlike other reviews, this one has beginning, a middle and an end. There may be future developments that could make your work less relevant.
• It may be too focused. Some niche studies may miss the bigger picture.
• It can be difficult to be comprehensive. There is no way to make sure all the literature on a topic was considered.
• It is easy to be biased if you stick to top tier journals. There may be other places where people are publishing exemplary research. Look to open access publications and conferences to reflect a more inclusive collection. Also, make sure to include opposing views (and not just supporting evidence).

Source: Grant, Maria J., and Andrew Booth. “A Typology of Reviews: An Analysis of 14 Review Types and Associated Methodologies.” Health Information & Libraries Journal, vol. 26, no. 2, June 2009, pp. 91–108. Wiley Online Library, doi:10.1111/j.1471-1842.2009.00848.x.

Meryl Brodsky : Communication and Information Studies

Hannah Chapman Tripp : Biology, Neuroscience

Carolyn Cunningham : Human Development & Family Sciences, Psychology, Sociology

Larayne Dallas : Engineering

Janelle Hedstrom : Special Education, Curriculum & Instruction, Ed Leadership & Policy ​

Susan Macicak : Linguistics

Imelda Vetter : Dell Medical School

For help in other subject areas, please see the guide to library specialists by subject .

Periodically, UT Libraries runs a workshop covering the basics and library support for literature reviews. While we try to offer these once per academic year, we find providing the recording to be helpful to community members who have missed the session. Following is the most recent recording of the workshop, Conducting a Literature Review. To view the recording, a UT login is required.

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Literature reviews, what is a literature review, learning more about how to do a literature review.

• Planning the Review
• The Research Question
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A literature review is a review and synthesis of existing research on a topic or research question. A literature review is meant to analyze the scholarly literature, make connections across writings and identify strengths, weaknesses, trends, and missing conversations. A literature review should address different aspects of a topic as it relates to your research question. A literature review goes beyond a description or summary of the literature you have read. 

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What is a literature review? [with examples]

What is a literature review?

The purpose of a literature review, how to write a literature review, the format of a literature review, general formatting rules, the length of a literature review, literature review examples, frequently asked questions about literature reviews, related articles.

A literature review is an assessment of the sources in a chosen topic of research.

In a literature review, you’re expected to report on the existing scholarly conversation, without adding new contributions.

If you are currently writing one, you've come to the right place. In the following paragraphs, we will explain:

• the objective of a literature review
• how to write a literature review
• the basic format of a literature review

Tip: It’s not always mandatory to add a literature review in a paper. Theses and dissertations often include them, whereas research papers may not. Make sure to consult with your instructor for exact requirements.

The four main objectives of a literature review are:

• Studying the references of your research area
• Summarizing the main arguments
• Identifying current gaps, stances, and issues
• Presenting all of the above in a text

Ultimately, the main goal of a literature review is to provide the researcher with sufficient knowledge about the topic in question so that they can eventually make an intervention.

The format of a literature review is fairly standard. It includes an:

• introduction that briefly introduces the main topic
• body that includes the main discussion of the key arguments
• conclusion that highlights the gaps and issues of the literature

➡️ Take a look at our guide on how to write a literature review to learn more about how to structure a literature review.

First of all, a literature review should have its own labeled section. You should indicate clearly in the table of contents where the literature can be found, and you should label this section as “Literature Review.”

➡️ For more information on writing a thesis, visit our guide on how to structure a thesis .

There is no set amount of words for a literature review, so the length depends on the research. If you are working with a large amount of sources, it will be long. If your paper does not depend entirely on references, it will be short.

Take a look at these three theses featuring great literature reviews:

• School-Based Speech-Language Pathologist's Perceptions of Sensory Food Aversions in Children [ PDF , see page 20]
• Who's Writing What We Read: Authorship in Criminological Research [ PDF , see page 4]
• A Phenomenological Study of the Lived Experience of Online Instructors of Theological Reflection at Christian Institutions Accredited by the Association of Theological Schools [ PDF , see page 56]

Literature reviews are most commonly found in theses and dissertations. However, you find them in research papers as well.

There is no set amount of words for a literature review, so the length depends on the research. If you are working with a large amount of sources, then it will be long. If your paper does not depend entirely on references, then it will be short.

No. A literature review should have its own independent section. You should indicate clearly in the table of contents where the literature review can be found, and label this section as “Literature Review.”

The main goal of a literature review is to provide the researcher with sufficient knowledge about the topic in question so that they can eventually make an intervention.

Literature Reviews

What this handout is about.

This handout will explain what literature reviews are and offer insights into the form and construction of literature reviews in the humanities, social sciences, and sciences.

Introduction

OK. You’ve got to write a literature review. You dust off a novel and a book of poetry, settle down in your chair, and get ready to issue a “thumbs up” or “thumbs down” as you leaf through the pages. “Literature review” done. Right?

Wrong! The “literature” of a literature review refers to any collection of materials on a topic, not necessarily the great literary texts of the world. “Literature” could be anything from a set of government pamphlets on British colonial methods in Africa to scholarly articles on the treatment of a torn ACL. And a review does not necessarily mean that your reader wants you to give your personal opinion on whether or not you liked these sources.

What is a literature review, then?

A literature review discusses published information in a particular subject area, and sometimes information in a particular subject area within a certain time period.

A literature review can be just a simple summary of the sources, but it usually has an organizational pattern and combines both summary and synthesis. A summary is a recap of the important information of the source, but a synthesis is a re-organization, or a reshuffling, of that information. It might give a new interpretation of old material or combine new with old interpretations. Or it might trace the intellectual progression of the field, including major debates. And depending on the situation, the literature review may evaluate the sources and advise the reader on the most pertinent or relevant.

But how is a literature review different from an academic research paper?

The main focus of an academic research paper is to develop a new argument, and a research paper is likely to contain a literature review as one of its parts. In a research paper, you use the literature as a foundation and as support for a new insight that you contribute. The focus of a literature review, however, is to summarize and synthesize the arguments and ideas of others without adding new contributions.

Why do we write literature reviews?

Literature reviews provide you with a handy guide to a particular topic. If you have limited time to conduct research, literature reviews can give you an overview or act as a stepping stone. For professionals, they are useful reports that keep them up to date with what is current in the field. For scholars, the depth and breadth of the literature review emphasizes the credibility of the writer in his or her field. Literature reviews also provide a solid background for a research paper’s investigation. Comprehensive knowledge of the literature of the field is essential to most research papers.

Who writes these things, anyway?

Literature reviews are written occasionally in the humanities, but mostly in the sciences and social sciences; in experiment and lab reports, they constitute a section of the paper. Sometimes a literature review is written as a paper in itself.

Let’s get to it! What should I do before writing the literature review?

If your assignment is not very specific, seek clarification from your instructor:

• Roughly how many sources should you include?
• What types of sources (books, journal articles, websites)?
• Should you summarize, synthesize, or critique your sources by discussing a common theme or issue?
• Should you evaluate your sources?
• Should you provide subheadings and other background information, such as definitions and/or a history?

Find models

Look for other literature reviews in your area of interest or in the discipline and read them to get a sense of the types of themes you might want to look for in your own research or ways to organize your final review. You can simply put the word “review” in your search engine along with your other topic terms to find articles of this type on the Internet or in an electronic database. The bibliography or reference section of sources you’ve already read are also excellent entry points into your own research.

Narrow your topic

There are hundreds or even thousands of articles and books on most areas of study. The narrower your topic, the easier it will be to limit the number of sources you need to read in order to get a good survey of the material. Your instructor will probably not expect you to read everything that’s out there on the topic, but you’ll make your job easier if you first limit your scope.

Keep in mind that UNC Libraries have research guides and to databases relevant to many fields of study. You can reach out to the subject librarian for a consultation: https://library.unc.edu/support/consultations/ .

And don’t forget to tap into your professor’s (or other professors’) knowledge in the field. Ask your professor questions such as: “If you had to read only one book from the 90’s on topic X, what would it be?” Questions such as this help you to find and determine quickly the most seminal pieces in the field.

Consider whether your sources are current

Some disciplines require that you use information that is as current as possible. In the sciences, for instance, treatments for medical problems are constantly changing according to the latest studies. Information even two years old could be obsolete. However, if you are writing a review in the humanities, history, or social sciences, a survey of the history of the literature may be what is needed, because what is important is how perspectives have changed through the years or within a certain time period. Try sorting through some other current bibliographies or literature reviews in the field to get a sense of what your discipline expects. You can also use this method to consider what is currently of interest to scholars in this field and what is not.

Strategies for writing the literature review

Find a focus.

A literature review, like a term paper, is usually organized around ideas, not the sources themselves as an annotated bibliography would be organized. This means that you will not just simply list your sources and go into detail about each one of them, one at a time. No. As you read widely but selectively in your topic area, consider instead what themes or issues connect your sources together. Do they present one or different solutions? Is there an aspect of the field that is missing? How well do they present the material and do they portray it according to an appropriate theory? Do they reveal a trend in the field? A raging debate? Pick one of these themes to focus the organization of your review.

Convey it to your reader

A literature review may not have a traditional thesis statement (one that makes an argument), but you do need to tell readers what to expect. Try writing a simple statement that lets the reader know what is your main organizing principle. Here are a couple of examples:

The current trend in treatment for congestive heart failure combines surgery and medicine. More and more cultural studies scholars are accepting popular media as a subject worthy of academic consideration.

Consider organization

You’ve got a focus, and you’ve stated it clearly and directly. Now what is the most effective way of presenting the information? What are the most important topics, subtopics, etc., that your review needs to include? And in what order should you present them? Develop an organization for your review at both a global and local level:

First, cover the basic categories

Just like most academic papers, literature reviews also must contain at least three basic elements: an introduction or background information section; the body of the review containing the discussion of sources; and, finally, a conclusion and/or recommendations section to end the paper. The following provides a brief description of the content of each:

• Introduction: Gives a quick idea of the topic of the literature review, such as the central theme or organizational pattern.
• Body: Contains your discussion of sources and is organized either chronologically, thematically, or methodologically (see below for more information on each).
• Conclusions/Recommendations: Discuss what you have drawn from reviewing literature so far. Where might the discussion proceed?

Organizing the body

Once you have the basic categories in place, then you must consider how you will present the sources themselves within the body of your paper. Create an organizational method to focus this section even further.

To help you come up with an overall organizational framework for your review, consider the following scenario:

You’ve decided to focus your literature review on materials dealing with sperm whales. This is because you’ve just finished reading Moby Dick, and you wonder if that whale’s portrayal is really real. You start with some articles about the physiology of sperm whales in biology journals written in the 1980’s. But these articles refer to some British biological studies performed on whales in the early 18th century. So you check those out. Then you look up a book written in 1968 with information on how sperm whales have been portrayed in other forms of art, such as in Alaskan poetry, in French painting, or on whale bone, as the whale hunters in the late 19th century used to do. This makes you wonder about American whaling methods during the time portrayed in Moby Dick, so you find some academic articles published in the last five years on how accurately Herman Melville portrayed the whaling scene in his novel.

Now consider some typical ways of organizing the sources into a review:

• Chronological: If your review follows the chronological method, you could write about the materials above according to when they were published. For instance, first you would talk about the British biological studies of the 18th century, then about Moby Dick, published in 1851, then the book on sperm whales in other art (1968), and finally the biology articles (1980s) and the recent articles on American whaling of the 19th century. But there is relatively no continuity among subjects here. And notice that even though the sources on sperm whales in other art and on American whaling are written recently, they are about other subjects/objects that were created much earlier. Thus, the review loses its chronological focus.
• By publication: Order your sources by publication chronology, then, only if the order demonstrates a more important trend. For instance, you could order a review of literature on biological studies of sperm whales if the progression revealed a change in dissection practices of the researchers who wrote and/or conducted the studies.
• By trend: A better way to organize the above sources chronologically is to examine the sources under another trend, such as the history of whaling. Then your review would have subsections according to eras within this period. For instance, the review might examine whaling from pre-1600-1699, 1700-1799, and 1800-1899. Under this method, you would combine the recent studies on American whaling in the 19th century with Moby Dick itself in the 1800-1899 category, even though the authors wrote a century apart.
• Thematic: Thematic reviews of literature are organized around a topic or issue, rather than the progression of time. However, progression of time may still be an important factor in a thematic review. For instance, the sperm whale review could focus on the development of the harpoon for whale hunting. While the study focuses on one topic, harpoon technology, it will still be organized chronologically. The only difference here between a “chronological” and a “thematic” approach is what is emphasized the most: the development of the harpoon or the harpoon technology.But more authentic thematic reviews tend to break away from chronological order. For instance, a thematic review of material on sperm whales might examine how they are portrayed as “evil” in cultural documents. The subsections might include how they are personified, how their proportions are exaggerated, and their behaviors misunderstood. A review organized in this manner would shift between time periods within each section according to the point made.
• Methodological: A methodological approach differs from the two above in that the focusing factor usually does not have to do with the content of the material. Instead, it focuses on the “methods” of the researcher or writer. For the sperm whale project, one methodological approach would be to look at cultural differences between the portrayal of whales in American, British, and French art work. Or the review might focus on the economic impact of whaling on a community. A methodological scope will influence either the types of documents in the review or the way in which these documents are discussed. Once you’ve decided on the organizational method for the body of the review, the sections you need to include in the paper should be easy to figure out. They should arise out of your organizational strategy. In other words, a chronological review would have subsections for each vital time period. A thematic review would have subtopics based upon factors that relate to the theme or issue.

Sometimes, though, you might need to add additional sections that are necessary for your study, but do not fit in the organizational strategy of the body. What other sections you include in the body is up to you. Put in only what is necessary. Here are a few other sections you might want to consider:

• Current Situation: Information necessary to understand the topic or focus of the literature review.
• History: The chronological progression of the field, the literature, or an idea that is necessary to understand the literature review, if the body of the literature review is not already a chronology.
• Methods and/or Standards: The criteria you used to select the sources in your literature review or the way in which you present your information. For instance, you might explain that your review includes only peer-reviewed articles and journals.

Questions for Further Research: What questions about the field has the review sparked? How will you further your research as a result of the review?

Begin composing

Once you’ve settled on a general pattern of organization, you’re ready to write each section. There are a few guidelines you should follow during the writing stage as well. Here is a sample paragraph from a literature review about sexism and language to illuminate the following discussion:

However, other studies have shown that even gender-neutral antecedents are more likely to produce masculine images than feminine ones (Gastil, 1990). Hamilton (1988) asked students to complete sentences that required them to fill in pronouns that agreed with gender-neutral antecedents such as “writer,” “pedestrian,” and “persons.” The students were asked to describe any image they had when writing the sentence. Hamilton found that people imagined 3.3 men to each woman in the masculine “generic” condition and 1.5 men per woman in the unbiased condition. Thus, while ambient sexism accounted for some of the masculine bias, sexist language amplified the effect. (Source: Erika Falk and Jordan Mills, “Why Sexist Language Affects Persuasion: The Role of Homophily, Intended Audience, and Offense,” Women and Language19:2).

Use evidence

In the example above, the writers refer to several other sources when making their point. A literature review in this sense is just like any other academic research paper. Your interpretation of the available sources must be backed up with evidence to show that what you are saying is valid.

Be selective

Select only the most important points in each source to highlight in the review. The type of information you choose to mention should relate directly to the review’s focus, whether it is thematic, methodological, or chronological.

Use quotes sparingly

Falk and Mills do not use any direct quotes. That is because the survey nature of the literature review does not allow for in-depth discussion or detailed quotes from the text. Some short quotes here and there are okay, though, if you want to emphasize a point, or if what the author said just cannot be rewritten in your own words. Notice that Falk and Mills do quote certain terms that were coined by the author, not common knowledge, or taken directly from the study. But if you find yourself wanting to put in more quotes, check with your instructor.

Summarize and synthesize

Remember to summarize and synthesize your sources within each paragraph as well as throughout the review. The authors here recapitulate important features of Hamilton’s study, but then synthesize it by rephrasing the study’s significance and relating it to their own work.

Keep your own voice

While the literature review presents others’ ideas, your voice (the writer’s) should remain front and center. Notice that Falk and Mills weave references to other sources into their own text, but they still maintain their own voice by starting and ending the paragraph with their own ideas and their own words. The sources support what Falk and Mills are saying.

Use caution when paraphrasing

When paraphrasing a source that is not your own, be sure to represent the author’s information or opinions accurately and in your own words. In the preceding example, Falk and Mills either directly refer in the text to the author of their source, such as Hamilton, or they provide ample notation in the text when the ideas they are mentioning are not their own, for example, Gastil’s. For more information, please see our handout on plagiarism .

Revise, revise, revise

Draft in hand? Now you’re ready to revise. Spending a lot of time revising is a wise idea, because your main objective is to present the material, not the argument. So check over your review again to make sure it follows the assignment and/or your outline. Then, just as you would for most other academic forms of writing, rewrite or rework the language of your review so that you’ve presented your information in the most concise manner possible. Be sure to use terminology familiar to your audience; get rid of unnecessary jargon or slang. Finally, double check that you’ve documented your sources and formatted the review appropriately for your discipline. For tips on the revising and editing process, see our handout on revising drafts .

Works consulted

We consulted these works while writing this handout. This is not a comprehensive list of resources on the handout’s topic, and we encourage you to do your own research to find additional publications. Please do not use this list as a model for the format of your own reference list, as it may not match the citation style you are using. For guidance on formatting citations, please see the UNC Libraries citation tutorial . We revise these tips periodically and welcome feedback.

Anson, Chris M., and Robert A. Schwegler. 2010. The Longman Handbook for Writers and Readers , 6th ed. New York: Longman.

Jones, Robert, Patrick Bizzaro, and Cynthia Selfe. 1997. The Harcourt Brace Guide to Writing in the Disciplines . New York: Harcourt Brace.

Lamb, Sandra E. 1998. How to Write It: A Complete Guide to Everything You’ll Ever Write . Berkeley: Ten Speed Press.

Rosen, Leonard J., and Laurence Behrens. 2003. The Allyn & Bacon Handbook , 5th ed. New York: Longman.

Troyka, Lynn Quittman, and Doug Hesse. 2016. Simon and Schuster Handbook for Writers , 11th ed. London: Pearson.

You may reproduce it for non-commercial use if you use the entire handout and attribute the source: The Writing Center, University of North Carolina at Chapel Hill

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Introduction to Literature Reviews

Introduction.

• Step One: Define
• Step Two: Research
• Step Three: Write
• Suggested Readings

A literature review is a written work that :

• Compiles significant research published on a topic by accredited scholars and researchers;
• —Surveys scholarly articles, books, dissertations, conference proceedings, and other sources;
• —Examines contrasting perspectives, theoretical approaches, methodologies, findings, results, conclusions.
• —Reviews critically, analyzes, and synthesizes existing research on a topic; and,
• Performs a thorough “re” view, “overview”, or “look again” of past and current works on a subject, issue, or theory.

From these analyses, the writer then offers an overview of the current status of a particular area of knowledge from both a practical and theoretical perspective.

Literature reviews are important because they are usually a  required  step in a thesis proposal (Master's or PhD). The proposal will not be well-supported without a literature review. Also, literature reviews are important because they help you learn important authors and ideas in your field. This is useful for your coursework and your writing. Knowing key authors also helps you become acquainted with other researchers in your field.

Look at this diagram and imagine that your research is the "something new." This shows how your research should relate to major works and other sources.

Olivia Whitfield | Graduate Reference Assistant | 2012-2015

• Next: Step One: Define >>
• Last Updated: Jul 9, 2024 9:53 AM
• URL: https://libraryguides.missouri.edu/literaturereview

How To Structure Your Literature Review

3 options to help structure your chapter.

By: Amy Rommelspacher (PhD) | Reviewer: Dr Eunice Rautenbach | November 2020 (Updated May 2023)

Writing the literature review chapter can seem pretty daunting when you’re piecing together your dissertation or thesis. As  we’ve discussed before , a good literature review needs to achieve a few very important objectives – it should:

• Demonstrate your knowledge of the research topic
• Identify the gaps in the literature and show how your research links to these
• Provide the foundation for your conceptual framework (if you have one)
• Inform your own  methodology and research design

To achieve this, your literature review needs a well-thought-out structure . Get the structure of your literature review chapter wrong and you’ll struggle to achieve these objectives. Don’t worry though – in this post, we’ll look at how to structure your literature review for maximum impact (and marks!).

But wait – is this the right time?

Deciding on the structure of your literature review should come towards the end of the literature review process – after you have collected and digested the literature, but before you start writing the chapter. 

In other words, you need to first develop a rich understanding of the literature before you even attempt to map out a structure. There’s no use trying to develop a structure before you’ve fully wrapped your head around the existing research.

Equally importantly, you need to have a structure in place before you start writing , or your literature review will most likely end up a rambling, disjointed mess. 

Importantly, don’t feel that once you’ve defined a structure you can’t iterate on it. It’s perfectly natural to adjust as you engage in the writing process. As we’ve discussed before , writing is a way of developing your thinking, so it’s quite common for your thinking to change – and therefore, for your chapter structure to change – as you write. 

Need a helping hand?

Like any other chapter in your thesis or dissertation, your literature review needs to have a clear, logical structure. At a minimum, it should have three essential components – an  introduction , a  body   and a  conclusion . 

Let’s take a closer look at each of these.

1: The Introduction Section

Just like any good introduction, the introduction section of your literature review should introduce the purpose and layout (organisation) of the chapter. In other words, your introduction needs to give the reader a taste of what’s to come, and how you’re going to lay that out. Essentially, you should provide the reader with a high-level roadmap of your chapter to give them a taste of the journey that lies ahead.

Here’s an example of the layout visualised in a literature review introduction:

Your introduction should also outline your topic (including any tricky terminology or jargon) and provide an explanation of the scope of your literature review – in other words, what you  will   and  won’t   be covering (the delimitations ). This helps ringfence your review and achieve a clear focus . The clearer and narrower your focus, the deeper you can dive into the topic (which is typically where the magic lies). 

Depending on the nature of your project, you could also present your stance or point of view at this stage. In other words, after grappling with the literature you’ll have an opinion about what the trends and concerns are in the field as well as what’s lacking. The introduction section can then present these ideas so that it is clear to examiners that you’re aware of how your research connects with existing knowledge .

2: The Body Section

The body of your literature review is the centre of your work. This is where you’ll present, analyse, evaluate and synthesise the existing research. In other words, this is where you’re going to earn (or lose) the most marks. Therefore, it’s important to carefully think about how you will organise your discussion to present it in a clear way. 

The body of your literature review should do just as the description of this chapter suggests. It should “review” the literature – in other words, identify, analyse, and synthesise it. So, when thinking about structuring your literature review, you need to think about which structural approach will provide the best “review” for your specific type of research and objectives (we’ll get to this shortly).

There are (broadly speaking)  three options  for organising your literature review.

Option 1: Chronological (according to date)

Organising the literature chronologically is one of the simplest ways to structure your literature review. You start with what was published first and work your way through the literature until you reach the work published most recently. Pretty straightforward.

The benefit of this option is that it makes it easy to discuss the developments and debates in the field as they emerged over time. Organising your literature chronologically also allows you to highlight how specific articles or pieces of work might have changed the course of the field – in other words, which research has had the most impact . Therefore, this approach is very useful when your research is aimed at understanding how the topic has unfolded over time and is often used by scholars in the field of history. That said, this approach can be utilised by anyone that wants to explore change over time .

For example , if a student of politics is investigating how the understanding of democracy has evolved over time, they could use the chronological approach to provide a narrative that demonstrates how this understanding has changed through the ages.

Here are some questions you can ask yourself to help you structure your literature review chronologically.

• What is the earliest literature published relating to this topic?
• How has the field changed over time? Why?
• What are the most recent discoveries/theories?

In some ways, chronology plays a part whichever way you decide to structure your literature review, because you will always, to a certain extent, be analysing how the literature has developed. However, with the chronological approach, the emphasis is very firmly on how the discussion has evolved over time , as opposed to how all the literature links together (which we’ll discuss next ).

Option 2: Thematic (grouped by theme)

The thematic approach to structuring a literature review means organising your literature by theme or category – for example, by independent variables (i.e. factors that have an impact on a specific outcome).

As you’ve been collecting and synthesising literature , you’ll likely have started seeing some themes or patterns emerging. You can then use these themes or patterns as a structure for your body discussion. The thematic approach is the most common approach and is useful for structuring literature reviews in most fields.

For example, if you were researching which factors contributed towards people trusting an organisation, you might find themes such as consumers’ perceptions of an organisation’s competence, benevolence and integrity. Structuring your literature review thematically would mean structuring your literature review’s body section to discuss each of these themes, one section at a time.

Here are some questions to ask yourself when structuring your literature review by themes:

• Are there any patterns that have come to light in the literature?
• What are the central themes and categories used by the researchers?
• Do I have enough evidence of these themes?

PS – you can see an example of a thematically structured literature review in our literature review sample walkthrough video here.

Option 3: Methodological

The methodological option is a way of structuring your literature review by the research methodologies used . In other words, organising your discussion based on the angle from which each piece of research was approached – for example, qualitative , quantitative or mixed  methodologies.

Structuring your literature review by methodology can be useful if you are drawing research from a variety of disciplines and are critiquing different methodologies. The point of this approach is to question  how  existing research has been conducted, as opposed to  what  the conclusions and/or findings the research were.

For example, a sociologist might centre their research around critiquing specific fieldwork practices. Their literature review will then be a summary of the fieldwork methodologies used by different studies.

Here are some questions you can ask yourself when structuring your literature review according to methodology:

• Which methodologies have been utilised in this field?
• Which methodology is the most popular (and why)?
• What are the strengths and weaknesses of the various methodologies?
• How can the existing methodologies inform my own methodology?

3: The Conclusion Section

Once you’ve completed the body section of your literature review using one of the structural approaches we discussed above, you’ll need to “wrap up” your literature review and pull all the pieces together to set the direction for the rest of your dissertation or thesis.

The conclusion is where you’ll present the key findings of your literature review. In this section, you should emphasise the research that is especially important to your research questions and highlight the gaps that exist in the literature. Based on this, you need to make it clear what you will add to the literature – in other words, justify your own research by showing how it will help fill one or more of the gaps you just identified.

Last but not least, if it’s your intention to develop a conceptual framework for your dissertation or thesis, the conclusion section is a good place to present this.

Example: Thematically Structured Review

In the video below, we unpack a literature review chapter so that you can see an example of a thematically structure review in practice.

Let’s Recap

In this article, we’ve  discussed how to structure your literature review for maximum impact. Here’s a quick recap of what  you need to keep in mind when deciding on your literature review structure:

• Just like other chapters, your literature review needs a clear introduction , body and conclusion .
• The introduction section should provide an overview of what you will discuss in your literature review.
• The body section of your literature review can be organised by chronology , theme or methodology . The right structural approach depends on what you’re trying to achieve with your research.
• The conclusion section should draw together the key findings of your literature review and link them to your research questions.

If you’re ready to get started, be sure to download our free literature review template to fast-track your chapter outline.

Psst… there’s more!

This post is an extract from our bestselling short course, Literature Review Bootcamp . If you want to work smart, you don't want to miss this .

28 Comments

Great work. This is exactly what I was looking for and helps a lot together with your previous post on literature review. One last thing is missing: a link to a great literature chapter of an journal article (maybe with comments of the different sections in this review chapter). Do you know any great literature review chapters?

I agree with you Marin… A great piece

I agree with Marin. This would be quite helpful if you annotate a nicely structured literature from previously published research articles.

Awesome article for my research.

I thank you immensely for this wonderful guide

It is indeed thought and supportive work for the futurist researcher and students

Very educative and good time to get guide. Thank you

Great work, very insightful. Thank you.

Thanks for this wonderful presentation. My question is that do I put all the variables into a single conceptual framework or each hypothesis will have it own conceptual framework?

Thank you very much, very helpful

This is very educative and precise . Thank you very much for dropping this kind of write up .

Pheeww, so damn helpful, thank you for this informative piece.

I’m doing a research project topic ; stool analysis for parasitic worm (enteric) worm, how do I structure it, thanks.

comprehensive explanation. Help us by pasting the URL of some good “literature review” for better understanding.

great piece. thanks for the awesome explanation. it is really worth sharing. I have a little question, if anyone can help me out, which of the options in the body of literature can be best fit if you are writing an architectural thesis that deals with design?

I am doing a research on nanofluids how can l structure it?

Beautifully clear.nThank you!

Lucid! Thankyou!

Brilliant work, well understood, many thanks

I like how this was so clear with simple language 😊😊 thank you so much 😊 for these information 😊

Insightful. I was struggling to come up with a sensible literature review but this has been really helpful. Thank you!

You have given thought-provoking information about the review of the literature.

Thank you. It has made my own research better and to impart your work to students I teach

I learnt a lot from this teaching. It’s a great piece.

I am doing research on EFL teacher motivation for his/her job. How Can I structure it? Is there any detailed template, additional to this?

You are so cool! I do not think I’ve read through something like this before. So nice to find somebody with some genuine thoughts on this issue. Seriously.. thank you for starting this up. This site is one thing that is required on the internet, someone with a little originality!

I’m asked to do conceptual, theoretical and empirical literature, and i just don’t know how to structure it

Asking questions are actually fastidious thing if you are not understanding anything fully, but this article presents good understanding yet.

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How to Write a Literature Review

What is a literature review.

• What Is the Literature
• Writing the Review

A literature review is much more than an annotated bibliography or a list of separate reviews of articles and books. It is a critical, analytical summary and synthesis of the current knowledge of a topic. Thus it should compare and relate different theories, findings, etc, rather than just summarize them individually. In addition, it should have a particular focus or theme to organize the review. It does not have to be an exhaustive account of everything published on the topic, but it should discuss all the significant academic literature and other relevant sources important for that focus.

This is meant to be a general guide to writing a literature review: ways to structure one, what to include, how it supplements other research. For more specific help on writing a review, and especially for help on finding the literature to review, sign up for a Personal Research Session .

The specific organization of a literature review depends on the type and purpose of the review, as well as on the specific field or topic being reviewed. But in general, it is a relatively brief but thorough exploration of past and current work on a topic. Rather than a chronological listing of previous work, though, literature reviews are usually organized thematically, such as different theoretical approaches, methodologies, or specific issues or concepts involved in the topic. A thematic organization makes it much easier to examine contrasting perspectives, theoretical approaches, methodologies, findings, etc, and to analyze the strengths and weaknesses of, and point out any gaps in, previous research. And this is the heart of what a literature review is about. A literature review may offer new interpretations, theoretical approaches, or other ideas; if it is part of a research proposal or report it should demonstrate the relationship of the proposed or reported research to others' work; but whatever else it does, it must provide a critical overview of the current state of research efforts. 

Literature reviews are common and very important in the sciences and social sciences. They are less common and have a less important role in the humanities, but they do have a place, especially stand-alone reviews.

Types of Literature Reviews

There are different types of literature reviews, and different purposes for writing a review, but the most common are:

• Stand-alone literature review articles . These provide an overview and analysis of the current state of research on a topic or question. The goal is to evaluate and compare previous research on a topic to provide an analysis of what is currently known, and also to reveal controversies, weaknesses, and gaps in current work, thus pointing to directions for future research. You can find examples published in any number of academic journals, but there is a series of Annual Reviews of *Subject* which are specifically devoted to literature review articles. Writing a stand-alone review is often an effective way to get a good handle on a topic and to develop ideas for your own research program. For example, contrasting theoretical approaches or conflicting interpretations of findings can be the basis of your research project: can you find evidence supporting one interpretation against another, or can you propose an alternative interpretation that overcomes their limitations?
• Part of a research proposal . This could be a proposal for a PhD dissertation, a senior thesis, or a class project. It could also be a submission for a grant. The literature review, by pointing out the current issues and questions concerning a topic, is a crucial part of demonstrating how your proposed research will contribute to the field, and thus of convincing your thesis committee to allow you to pursue the topic of your interest or a funding agency to pay for your research efforts.
• Part of a research report . When you finish your research and write your thesis or paper to present your findings, it should include a literature review to provide the context to which your work is a contribution. Your report, in addition to detailing the methods, results, etc. of your research, should show how your work relates to others' work.

A literature review for a research report is often a revision of the review for a research proposal, which can be a revision of a stand-alone review. Each revision should be a fairly extensive revision. With the increased knowledge of and experience in the topic as you proceed, your understanding of the topic will increase. Thus, you will be in a better position to analyze and critique the literature. In addition, your focus will change as you proceed in your research. Some areas of the literature you initially reviewed will be marginal or irrelevant for your eventual research, and you will need to explore other areas more thoroughly. 

Examples of Literature Reviews

See the series of Annual Reviews of *Subject* which are specifically devoted to literature review articles to find many examples of stand-alone literature reviews in the biomedical, physical, and social sciences. 

Research report articles vary in how they are organized, but a common general structure is to have sections such as:

• Abstract - Brief summary of the contents of the article
• Introduction - A explanation of the purpose of the study, a statement of the research question(s) the study intends to address
• Literature review - A critical assessment of the work done so far on this topic, to show how the current study relates to what has already been done
• Methods - How the study was carried out (e.g. instruments or equipment, procedures, methods to gather and analyze data)
• Results - What was found in the course of the study
• Discussion - What do the results mean
• Conclusion - State the conclusions and implications of the results, and discuss how it relates to the work reviewed in the literature review; also, point to directions for further work in the area

Here are some articles that illustrate variations on this theme. There is no need to read the entire articles (unless the contents interest you); just quickly browse through to see the sections, and see how each section is introduced and what is contained in them.

The Determinants of Undergraduate Grade Point Average: The Relative Importance of Family Background, High School Resources, and Peer Group Effects , in The Journal of Human Resources , v. 34 no. 2 (Spring 1999), p. 268-293.

This article has a standard breakdown of sections:

• Introduction
• Literature Review
• Some discussion sections

First Encounters of the Bureaucratic Kind: Early Freshman Experiences with a Campus Bureaucracy , in The Journal of Higher Education , v. 67 no. 6 (Nov-Dec 1996), p. 660-691.

This one does not have a section specifically labeled as a "literature review" or "review of the literature," but the first few sections cite a long list of other sources discussing previous research in the area before the authors present their own study they are reporting.

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• Last Updated: Jan 11, 2024 9:48 AM
• URL: https://libguides.wesleyan.edu/litreview

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Literature Review: The What, Why and How-to Guide: Literature Reviews?

• Literature Reviews?
• Strategies to Finding Sources
• Keeping up with Research!
• Evaluating Sources & Literature Reviews
• Organizing for Writing
• Writing Literature Review
• Other Academic Writings

What is a Literature Review?

So, what is a literature review .

"A literature review is an account of what has been published on a topic by accredited scholars and researchers. In writing the literature review, your purpose is to convey to your reader what knowledge and ideas have been established on a topic, and what their strengths and weaknesses are. As a piece of writing, the literature review must be defined by a guiding concept (e.g., your research objective, the problem or issue you are discussing, or your argumentative thesis). It is not just a descriptive list of the material available or a set of summaries." - Quote from Taylor, D. (n.d)."The Literature Review: A Few Tips on Conducting it".

• Citation: "The Literature Review: A Few Tips on Conducting it"

What kinds of literature reviews are written?

Each field has a particular way to do reviews for academic research literature. In the social sciences and humanities the most common are:

• Narrative Reviews: The purpose of this type of review is to describe the current state of the research on a specific research topic and to offer a critical analysis of the literature reviewed. Studies are grouped by research/theoretical categories, and themes and trends, strengths and weaknesses, and gaps are identified. The review ends with a conclusion section that summarizes the findings regarding the state of the research of the specific study, the gaps identify and if applicable, explains how the author's research will address gaps identify in the review and expand the knowledge on the topic reviewed.
• Book review essays/ Historiographical review essays : A type of literature review typical in History and related fields, e.g., Latin American studies. For example, the Latin American Research Review explains that the purpose of this type of review is to “(1) to familiarize readers with the subject, approach, arguments, and conclusions found in a group of books whose common focus is a historical period; a country or region within Latin America; or a practice, development, or issue of interest to specialists and others; (2) to locate these books within current scholarship, critical methodologies, and approaches; and (3) to probe the relation of these new books to previous work on the subject, especially canonical texts. Unlike individual book reviews, the cluster reviews found in LARR seek to address the state of the field or discipline and not solely the works at issue.” - LARR

What are the Goals of Creating a Literature Review?

• To develop a theory or evaluate an existing theory
• To summarize the historical or existing state of a research topic
• Identify a problem in a field of research 
• Baumeister, R.F. & Leary, M.R. (1997). "Writing narrative literature reviews," Review of General Psychology , 1(3), 311-320.

When do you need to write a Literature Review?

• When writing a prospectus or a thesis/dissertation
• When writing a research paper
• When writing a grant proposal

In all these cases you need to dedicate a chapter in these works to showcase what has been written about your research topic and to point out how your own research will shed new light into a body of scholarship.

Where I can find examples of Literature Reviews?

Note:  In the humanities, even if they don't use the term "literature review", they may have a dedicated  chapter that reviewed the "critical bibliography" or they incorporated that review in the introduction or first chapter of the dissertation, book, or article.

• UCSB electronic theses and dissertations In partnership with the Graduate Division, the UC Santa Barbara Library is making available theses and dissertations produced by UCSB students. Currently included in ADRL are theses and dissertations that were originally filed electronically, starting in 2011. In future phases of ADRL, all theses and dissertations created by UCSB students may be digitized and made available.

Where to Find Standalone Literature Reviews

Literature reviews are also written as standalone articles as a way to survey a particular research topic in-depth. This type of literature review looks at a topic from a historical perspective to see how the understanding of the topic has changed over time. 

• Find e-Journals for Standalone Literature Reviews The best way to get familiar with and to learn how to write literature reviews is by reading them. You can use our Journal Search option to find journals that specialize in publishing literature reviews from major disciplines like anthropology, sociology, etc. Usually these titles are called, "Annual Review of [discipline name] OR [Discipline name] Review. This option works best if you know the title of the publication you are looking for. Below are some examples of these journals! more... less... Journal Search can be found by hovering over the link for Research on the library website.

Social Sciences

• Annual Review of Anthropology
• Annual Review of Political Science
• Annual Review of Sociology
• Ethnic Studies Review

Hard science and health sciences:

• Annual Review of Biomedical Data Science
• Annual Review of Materials Science
• Systematic Review From journal site: "The journal Systematic Reviews encompasses all aspects of the design, conduct, and reporting of systematic reviews" in the health sciences.
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Ten Simple Rules for Writing a Literature Review

Marco pautasso.

1 Centre for Functional and Evolutionary Ecology (CEFE), CNRS, Montpellier, France

2 Centre for Biodiversity Synthesis and Analysis (CESAB), FRB, Aix-en-Provence, France

Literature reviews are in great demand in most scientific fields. Their need stems from the ever-increasing output of scientific publications [1] . For example, compared to 1991, in 2008 three, eight, and forty times more papers were indexed in Web of Science on malaria, obesity, and biodiversity, respectively [2] . Given such mountains of papers, scientists cannot be expected to examine in detail every single new paper relevant to their interests [3] . Thus, it is both advantageous and necessary to rely on regular summaries of the recent literature. Although recognition for scientists mainly comes from primary research, timely literature reviews can lead to new synthetic insights and are often widely read [4] . For such summaries to be useful, however, they need to be compiled in a professional way [5] .

When starting from scratch, reviewing the literature can require a titanic amount of work. That is why researchers who have spent their career working on a certain research issue are in a perfect position to review that literature. Some graduate schools are now offering courses in reviewing the literature, given that most research students start their project by producing an overview of what has already been done on their research issue [6] . However, it is likely that most scientists have not thought in detail about how to approach and carry out a literature review.

Reviewing the literature requires the ability to juggle multiple tasks, from finding and evaluating relevant material to synthesising information from various sources, from critical thinking to paraphrasing, evaluating, and citation skills [7] . In this contribution, I share ten simple rules I learned working on about 25 literature reviews as a PhD and postdoctoral student. Ideas and insights also come from discussions with coauthors and colleagues, as well as feedback from reviewers and editors.

Rule 1: Define a Topic and Audience

How to choose which topic to review? There are so many issues in contemporary science that you could spend a lifetime of attending conferences and reading the literature just pondering what to review. On the one hand, if you take several years to choose, several other people may have had the same idea in the meantime. On the other hand, only a well-considered topic is likely to lead to a brilliant literature review [8] . The topic must at least be:

• interesting to you (ideally, you should have come across a series of recent papers related to your line of work that call for a critical summary),
• an important aspect of the field (so that many readers will be interested in the review and there will be enough material to write it), and
• a well-defined issue (otherwise you could potentially include thousands of publications, which would make the review unhelpful).

Ideas for potential reviews may come from papers providing lists of key research questions to be answered [9] , but also from serendipitous moments during desultory reading and discussions. In addition to choosing your topic, you should also select a target audience. In many cases, the topic (e.g., web services in computational biology) will automatically define an audience (e.g., computational biologists), but that same topic may also be of interest to neighbouring fields (e.g., computer science, biology, etc.).

Rule 2: Search and Re-search the Literature

After having chosen your topic and audience, start by checking the literature and downloading relevant papers. Five pieces of advice here:

• keep track of the search items you use (so that your search can be replicated [10] ),
• keep a list of papers whose pdfs you cannot access immediately (so as to retrieve them later with alternative strategies),
• use a paper management system (e.g., Mendeley, Papers, Qiqqa, Sente),
• define early in the process some criteria for exclusion of irrelevant papers (these criteria can then be described in the review to help define its scope), and
• do not just look for research papers in the area you wish to review, but also seek previous reviews.

The chances are high that someone will already have published a literature review ( Figure 1 ), if not exactly on the issue you are planning to tackle, at least on a related topic. If there are already a few or several reviews of the literature on your issue, my advice is not to give up, but to carry on with your own literature review,

The bottom-right situation (many literature reviews but few research papers) is not just a theoretical situation; it applies, for example, to the study of the impacts of climate change on plant diseases, where there appear to be more literature reviews than research studies [33] .

• discussing in your review the approaches, limitations, and conclusions of past reviews,
• trying to find a new angle that has not been covered adequately in the previous reviews, and
• incorporating new material that has inevitably accumulated since their appearance.

When searching the literature for pertinent papers and reviews, the usual rules apply:

• be thorough,
• use different keywords and database sources (e.g., DBLP, Google Scholar, ISI Proceedings, JSTOR Search, Medline, Scopus, Web of Science), and
• look at who has cited past relevant papers and book chapters.

Rule 3: Take Notes While Reading

If you read the papers first, and only afterwards start writing the review, you will need a very good memory to remember who wrote what, and what your impressions and associations were while reading each single paper. My advice is, while reading, to start writing down interesting pieces of information, insights about how to organize the review, and thoughts on what to write. This way, by the time you have read the literature you selected, you will already have a rough draft of the review.

Of course, this draft will still need much rewriting, restructuring, and rethinking to obtain a text with a coherent argument [11] , but you will have avoided the danger posed by staring at a blank document. Be careful when taking notes to use quotation marks if you are provisionally copying verbatim from the literature. It is advisable then to reformulate such quotes with your own words in the final draft. It is important to be careful in noting the references already at this stage, so as to avoid misattributions. Using referencing software from the very beginning of your endeavour will save you time.

Rule 4: Choose the Type of Review You Wish to Write

After having taken notes while reading the literature, you will have a rough idea of the amount of material available for the review. This is probably a good time to decide whether to go for a mini- or a full review. Some journals are now favouring the publication of rather short reviews focusing on the last few years, with a limit on the number of words and citations. A mini-review is not necessarily a minor review: it may well attract more attention from busy readers, although it will inevitably simplify some issues and leave out some relevant material due to space limitations. A full review will have the advantage of more freedom to cover in detail the complexities of a particular scientific development, but may then be left in the pile of the very important papers “to be read” by readers with little time to spare for major monographs.

There is probably a continuum between mini- and full reviews. The same point applies to the dichotomy of descriptive vs. integrative reviews. While descriptive reviews focus on the methodology, findings, and interpretation of each reviewed study, integrative reviews attempt to find common ideas and concepts from the reviewed material [12] . A similar distinction exists between narrative and systematic reviews: while narrative reviews are qualitative, systematic reviews attempt to test a hypothesis based on the published evidence, which is gathered using a predefined protocol to reduce bias [13] , [14] . When systematic reviews analyse quantitative results in a quantitative way, they become meta-analyses. The choice between different review types will have to be made on a case-by-case basis, depending not just on the nature of the material found and the preferences of the target journal(s), but also on the time available to write the review and the number of coauthors [15] .

Rule 5: Keep the Review Focused, but Make It of Broad Interest

Whether your plan is to write a mini- or a full review, it is good advice to keep it focused 16 , 17 . Including material just for the sake of it can easily lead to reviews that are trying to do too many things at once. The need to keep a review focused can be problematic for interdisciplinary reviews, where the aim is to bridge the gap between fields [18] . If you are writing a review on, for example, how epidemiological approaches are used in modelling the spread of ideas, you may be inclined to include material from both parent fields, epidemiology and the study of cultural diffusion. This may be necessary to some extent, but in this case a focused review would only deal in detail with those studies at the interface between epidemiology and the spread of ideas.

While focus is an important feature of a successful review, this requirement has to be balanced with the need to make the review relevant to a broad audience. This square may be circled by discussing the wider implications of the reviewed topic for other disciplines.

Rule 6: Be Critical and Consistent

Reviewing the literature is not stamp collecting. A good review does not just summarize the literature, but discusses it critically, identifies methodological problems, and points out research gaps [19] . After having read a review of the literature, a reader should have a rough idea of:

• the major achievements in the reviewed field,
• the main areas of debate, and
• the outstanding research questions.

It is challenging to achieve a successful review on all these fronts. A solution can be to involve a set of complementary coauthors: some people are excellent at mapping what has been achieved, some others are very good at identifying dark clouds on the horizon, and some have instead a knack at predicting where solutions are going to come from. If your journal club has exactly this sort of team, then you should definitely write a review of the literature! In addition to critical thinking, a literature review needs consistency, for example in the choice of passive vs. active voice and present vs. past tense.

Rule 7: Find a Logical Structure

Like a well-baked cake, a good review has a number of telling features: it is worth the reader's time, timely, systematic, well written, focused, and critical. It also needs a good structure. With reviews, the usual subdivision of research papers into introduction, methods, results, and discussion does not work or is rarely used. However, a general introduction of the context and, toward the end, a recapitulation of the main points covered and take-home messages make sense also in the case of reviews. For systematic reviews, there is a trend towards including information about how the literature was searched (database, keywords, time limits) [20] .

How can you organize the flow of the main body of the review so that the reader will be drawn into and guided through it? It is generally helpful to draw a conceptual scheme of the review, e.g., with mind-mapping techniques. Such diagrams can help recognize a logical way to order and link the various sections of a review [21] . This is the case not just at the writing stage, but also for readers if the diagram is included in the review as a figure. A careful selection of diagrams and figures relevant to the reviewed topic can be very helpful to structure the text too [22] .

Rule 8: Make Use of Feedback

Reviews of the literature are normally peer-reviewed in the same way as research papers, and rightly so [23] . As a rule, incorporating feedback from reviewers greatly helps improve a review draft. Having read the review with a fresh mind, reviewers may spot inaccuracies, inconsistencies, and ambiguities that had not been noticed by the writers due to rereading the typescript too many times. It is however advisable to reread the draft one more time before submission, as a last-minute correction of typos, leaps, and muddled sentences may enable the reviewers to focus on providing advice on the content rather than the form.

Feedback is vital to writing a good review, and should be sought from a variety of colleagues, so as to obtain a diversity of views on the draft. This may lead in some cases to conflicting views on the merits of the paper, and on how to improve it, but such a situation is better than the absence of feedback. A diversity of feedback perspectives on a literature review can help identify where the consensus view stands in the landscape of the current scientific understanding of an issue [24] .

Rule 9: Include Your Own Relevant Research, but Be Objective

In many cases, reviewers of the literature will have published studies relevant to the review they are writing. This could create a conflict of interest: how can reviewers report objectively on their own work [25] ? Some scientists may be overly enthusiastic about what they have published, and thus risk giving too much importance to their own findings in the review. However, bias could also occur in the other direction: some scientists may be unduly dismissive of their own achievements, so that they will tend to downplay their contribution (if any) to a field when reviewing it.

In general, a review of the literature should neither be a public relations brochure nor an exercise in competitive self-denial. If a reviewer is up to the job of producing a well-organized and methodical review, which flows well and provides a service to the readership, then it should be possible to be objective in reviewing one's own relevant findings. In reviews written by multiple authors, this may be achieved by assigning the review of the results of a coauthor to different coauthors.

Rule 10: Be Up-to-Date, but Do Not Forget Older Studies

Given the progressive acceleration in the publication of scientific papers, today's reviews of the literature need awareness not just of the overall direction and achievements of a field of inquiry, but also of the latest studies, so as not to become out-of-date before they have been published. Ideally, a literature review should not identify as a major research gap an issue that has just been addressed in a series of papers in press (the same applies, of course, to older, overlooked studies (“sleeping beauties” [26] )). This implies that literature reviewers would do well to keep an eye on electronic lists of papers in press, given that it can take months before these appear in scientific databases. Some reviews declare that they have scanned the literature up to a certain point in time, but given that peer review can be a rather lengthy process, a full search for newly appeared literature at the revision stage may be worthwhile. Assessing the contribution of papers that have just appeared is particularly challenging, because there is little perspective with which to gauge their significance and impact on further research and society.

Inevitably, new papers on the reviewed topic (including independently written literature reviews) will appear from all quarters after the review has been published, so that there may soon be the need for an updated review. But this is the nature of science [27] – [32] . I wish everybody good luck with writing a review of the literature.

Acknowledgments

Many thanks to M. Barbosa, K. Dehnen-Schmutz, T. Döring, D. Fontaneto, M. Garbelotto, O. Holdenrieder, M. Jeger, D. Lonsdale, A. MacLeod, P. Mills, M. Moslonka-Lefebvre, G. Stancanelli, P. Weisberg, and X. Xu for insights and discussions, and to P. Bourne, T. Matoni, and D. Smith for helpful comments on a previous draft.

Funding Statement

This work was funded by the French Foundation for Research on Biodiversity (FRB) through its Centre for Synthesis and Analysis of Biodiversity data (CESAB), as part of the NETSEED research project. The funders had no role in the preparation of the manuscript.

Writing Literature Reviews

• Literature Review Steps
• Types of Literature Reviews
• Research Question Format
• Managing Your Sources
• Library Resources

A literature review is a vital component of scientific research, serving as the foundation upon which new discoveries are built. Whether you are a budding scientist embarking on your first research project or an experienced researcher looking to refine your literature review skills, this guide is designed to be your compass through the intricate landscape of scientific literature.

In the ever-evolving world of science, staying current and informed is key to producing valuable and impactful research. A well-executed literature review is your ticket to understanding the existing body of knowledge, identifying gaps, and contributing to the advancement of your field.

So What is a Literature Review?

University of Houston Libraries. (2019, October 19). How to Write a Literature Review [Video]. Youtube. https://www.youtube.com/watch?v=6keepo3Kqcs

What is a Literature Review in The Sciences?

A literature review is not merely a summary of existing research; it's a dynamic process of exploration, analysis, and synthesis. It involves systematically examining published works, such as scientific articles, books, and reports, to comprehend the state of knowledge on a specific topic. Your literature review should not only showcase what is known but also critically evaluate the quality of the evidence and identify areas where further research is needed.

Why is it Important?

Knowledge Foundation: A literature review lays the groundwork for your research by providing context and helping you understand the history and evolution of your topic.

Identification of Gaps: By analyzing existing literature, you can pinpoint gaps in current knowledge and formulate research questions that contribute to your field.

Research Design: It aids in shaping your research methodology, helping you choose the most appropriate methods and tools based on previous studies.

Critical Thinking: A literature review requires you to evaluate and synthesize diverse sources, honing your critical thinking skills and enhancing your ability to assess the reliability of research findings.

• Next: Literature Review Steps >>

Writing the Literature Review

Barry Mauer and John Venecek

Note: Not all research papers contain literature reviews in their finished or published form. Check your assignment and guidelines to see if one is required. Even if a literature review is not required, you still need to read the available scholarly literature on your topic so you can join the scholarly conversation.

• The Literature Review

What is the Purpose of the Review?

What is the scope of the review, strategies for getting started, types of literature reviews, composition guidelines, how to locate reviews by discipline, key takeaways.

We also provide the following activities:

Types of Literature Reviews [Refresher]

Writing the literature review [refresher], the literature review [1].

Conducting a literary studies research project involves time and effort, with much of it going towards the development of a literature review . A literature review might fill several pages of your research paper and usually appears soon after an introduction but before you present your detailed argument. A literature review provides your audience with an overview of the available research about your area(s) of study, including the literary work, your theory, and methodology. The literature review demonstrates how these scholarly discussions have changed over time, and it allows you to position your research in relation to research that has come before yours. Your aim is to present the discussion up to this point. Depending on the nature of the assignment, you may also include your critical commentary on prior research, noting among this material the weaker and stronger arguments, breakthroughs and dead ends, blind spots and opportunities, the invention of key terms and methods, mistakes as well as misreadings, and so on.

Once you have gathered the research materials you need for your literature review, you have another task: conducting an analysis on the research to see where your original contribution fits into the scholarly conversation. As the saying goes, “we are standing on the shoulders of giants.” Your job is to show a portrait of these giants to your audience, and to show how your work relates to the portrait. On many scholarly topics, literature reviews already exist. You may refer to such existing reviews within your own, indicating any materials might have been overlooked, new developments that have arisen since the publication of the existing literature review, and new perspectives or insights you have about the materials.

Some beginning researchers try to tear down the work of other researchers in an effort to make their own work look good by comparison. It rarely works. First, it tends to make your audience skeptical of your claims. Second, it ignores the fact that even the mistakes, blind spots, and failures of other researchers contribute something to our knowledge. Albert Einstein didn’t disrespect Sir Isaac Newton by saying Newton’s theory of space was wrong and terrible and that Einstein’s own theory was great by comparison. He built upon Newton’s work, showing how it could be improved. If, however, a researcher willfully set out to deceive or distort or to tear down the work of other scholars without good reason, then their work does not deserve such deference.

Most literature reviews appear after the introduction. It presents your reader with relevant information about the scholarly discussion up to now. Later in your paper, you discuss your contribution. Before you begin work on your literature review, let’s discuss what we mean by “literature”; understand the purpose and scope of the review; establish criteria for selecting, organizing, and interpreting your findings; and discuss how to connect your findings to your research question.

Many students seek to “find sources that agree with my claim or idea.” That approach is too narrow, in our view. If we use such an approach, we may get the following results:

• Because we can find sources that agree with almost any claim, readers will wonder whether your claims are weak and the sources are cherry picked.
• While literary scholars sometimes cite authorities to support their claims, they don’t rely only on authority. They respect authority, but not too much. Your own claims need to rely more on evidence (from the literary text, historical and biographical information), and your critical and creative reasoning skills.
• Scholarship is a conversation; thus, the goal is less about finding agreement and more about joining the conversation with the aim of making a valuable contribution to the discussion.

The literature review provides your reader with an overview of the existing research about your topic or problem. It provides the context necessary for your reader to catch up with the scholarly conversation and then to appreciate the value of your contribution to it. The literature review sharpens the focus of your research and demonstrates your knowledge and understanding of the scholarly conversation around your topic, which, in turn, helps establish your credibility as a researcher.

Creating the literature review involves more than gathering citations. It is a qualitative process through which you will discover what is already known about your topic, and identify the key authorities, methods, and theoretical foundations, so you can begin to position your contributions within the scholarly conversation.

Defining the scope of your review will also help you establish criteria to determine the relevance of the sources you are finding. At this stage, you are not reading in-depth; instead, you are skimming through what has already been published and identifying the major concepts, theories, methodologies, and methods present within these published works. You should also be identifying connections, tensions, and contradictions within the already published works of your topic or problem. This involves building on the knowledge of others and understanding what methods, measures, and models we have inherited from previous researchers in our field.

Literature Reviews: Common Errors Made When Conducting a Literature Review [12 min 22 sec]

Video provided courtesy of the Center for Quality Research (CQR)

A literature review helps your reader understand the relationship of your research project to the work of other scholars. It covers the existing knowledge about a problem, and allows you to show the relevance/significance of your contribution to the discussion. Your reader may or may not have read scholarly literature about the theories, methodologies, and literary works you are discussing. But they want to know that you have read it and have thought about it. Your literature review provides not only a summary of the existing scholarship for readers; it also offers your perspective on it.

Begin your work on the literature review by synthesizing the various sources in your annotated bibliography .

For advice on Synthesizing Sources, consider the following from The Purdue Online Writing Lab: [2]

Note that  synthesizing is not the same as summarizing .

• A summary restates the information in one or more sources without providing new insight or reaching new conclusions.
• A synthesis draws on multiple sources to reach a broader conclusion.
• Don’t force a relationship between sources if there isn’t one. Not all of your sources have to complement one another.
• Do your best to highlight the relationships between sources in very clear ways.
• Don’t ignore any outliers in your research. It’s important to take note of every perspective (even those that disagree with your broader conclusions).

Not all humanities research projects contain literature reviews, but many do. Keep in mind that the type of literature review you choose (see list below) pertains to the secondary research – other scholarly sources – and not to the primary literary work. For instance, a literature review about Kate Chopin’s writing will be your thoughts about the scholarship on Chopin and not about Chopin’s text itself. You are summarizing what you see in the scholarly literature about Chopin’s writing. The literature review puts you in the position of authority not just on Chopin’s writing but on the scholarship about her writing. You are seeking to understand what scholars have said about her work. Scholars might belong to different schools of thought (psychoanalytic, feminist, Marxist, etc.). They might make different arguments about Chopin. They might use different methodological approaches. 

If your research involves two or more theories, such as psychology and genre studies, you may need to create multiple literature reviews, one for each theory or methodology. If the theories overlap with each other significantly (i.e., Marxism and Cultural Studies), you may combine them. Your literature review need not include everything about the subject area – you would need to write a book to cover a single theory – but only those concepts and methods that are most relevant to your research problem.

Factors to Consider When Developing Your Literature Review

• Determine the Scope : How broad or narrow should your literature review be? You may want to focus on recent scholarship only, or on a particular school of thought in the literature. Your scope is determined by your purpose; what is it you aim to achieve with your research?
• Establish Criteria : We discussed the importance of defining the purpose and scope of your review on the previous page, but it’s worth reviewing here as well. This step will help you establish important criteria and focus your searching. For example, how many sources will you need? What types of sources (primary, secondary, statistics, media)? Is currency important? Do you know who the prominent authors or theorists are in your subject area? Take some time to map out these or other important factors before you begin searching journals and databases.
• Consider Your Audience : Unlike a work cited page or an annotated bibliography, both of which are lists of sources, a literature review is essayistic and can be considered a precursor to your final paper. Therefore, it should be written in your own voice, and it should be geared toward a specific audience. Considering audience during this early stage will help focus your final paper as well.
• Find Models : We’ll discuss the different types of literature reviews and how to locate examples in the section below. However, even if you’re undecided about what type of review will work best for you, you may want to review some example literature reviews to get a sense of what they look like before you begin your own.

One piece of advice before starting: look for existing literature reviews on your area of scholarship. You can build on the work that other scholars have put into reviewing the scholarly literature. There’s no need to completely “reinvent the wheel” if some of the work is already done.

Scholars sometimes publish “stand-alone” literature reviews that are not part of a larger work; such literature reviews are valuable contributions to the field, as they summarize the state of knowledge for other scholars.

Maria J. Grant and Andrew Booth’s “A Typology of Reviews” identifies 14 distinct types of literature reviews. Further, the UCLA library created a chart to complement the article and for easy comparison of those 14 types of reviews. This section provides a brief summary of the most common literature reviews. For a more complete analysis, please see the full article and the chart .

To choose the most appropriate structure, put yourself in your reader’s shoes and think through their need for information. The literature review is about providing context for your contribution. How much context do people need? Keep it to the minimum necessary; compressing a lot of information into a small amount of text is a must.

These structures are not meant to be straightjackets but tools to help you organize your research. If you find that the tool is working, then keep using it. If not, switch tools or modify the one you are using. Keep in mind that the types of literature reviews are just different ways of organizing information. So, you can discuss literary trends without organizing your review of secondary literature by trend; your discussion can be organized by theory or theme, for examples. In our literature reviews, we are not recounting other scholars’ arguments at length but merely providing key concepts so we can summarize the discussion so far and position our own claims. You don’t have to adhere strictly to one structure or another. They are just organizing tools that help you manage your material (and help your reader make sense of it).

Types of Reviews

• Traditional or narrative reviews : This approach will generate a comprehensive, critical analysis of the published research on your topic. However, rather than merely compiling as many sources as possible, use this approach to establish a theoretical framework for your paper, establish trends, and identify gaps in the research. This process should bring your research question into clearer focus and help define a thesis that you will argue for in your paper. This is perhaps the most common and general type of literature review. The examples listed below are all designed to serve a more specific purpose.
• Argumentative : The purpose of an argumentative literature review is to select sources for the purpose of supporting or refuting a specific claim. While this type of review can help the author make a strong case for or against an issue, they can also be prone to claims of bias. Later in this textbook, we will read about the distinction between warranted and unwarranted bias . One is ok and the other is not.
• Chronological : A chronological review is used when the author wants to demonstrate the progression of how a theory, methodology, or issue has progressed over time. This method is most effective when there is a clear chronological path to the research about a specific historical event or trend as opposed to a more recursive theoretical concept.
• By trend : This is similar to the chronological approach except it focuses on clearly-defined trends rather than date ranges. This would be most appropriate if you want to illustrate changing perspectives or attitudes about a given issue when specific date ranges are less important than the ebb and flow of the trend.
• Thematic : In this type of literature review, the author will select specific themes that he or she feels are important to understanding a larger topic or concept. Then, the author will organize the sources around those themes, which are often based on relevance or importance. The value of this method is that the process of organizing the review by theme is similar to constructing an argument. This can help the author see how resources connect to each other and determine how as well as why specific sources support their thesis.
• Theoretical : The goal of this type of review is to examine how theory has shaped the research on a given topic. It establishes existing theoretical models, their connections, and how extensively they have been developed in the published research. For example, Jada applied critical race theory to her analysis of Sonny’s Blues , but she might also consider conducting a more comprehensive review of other theoretical frameworks such as feminism, Marxism, or postmodernism. Doing so could provide insight into alternate readings, and help her identify theoretical gaps such as unexplored or under-developed approaches to Baldwin’s work.
• Methodological : The approach focuses on the various methodologies used by researchers in a specific area rather than an analysis of their findings. In this case, you would create a framework of approaches to data collection related to your topic or research question. This is perhaps more common in education or the social and hard sciences where published research often includes a methods section, but it is sometimes appropriate for the digital humanities as well.
• Scoping : The aim of a scoping review is to provide a comprehensive overview or map of the published research or evidence related to a research question. This might be considered a prelude to a systematic review that would take the scoping review one step further toward answering a clearly defined research question. See below for more details.
• Systematic : The systematic review is most appropriate when you have a clearly-defined research question and have established criteria for the types of sources you need. In this way, the systematic review is less exploratory than other types of reviews. Rather, it is comprehensive, strategic, and focused on answering a specific research question. For this reason, the systematic review is more common in the health and social sciences, where comprehensiveness is more important. Literature reviews in the Humanities are not usually exhaustive but tend to show only the most representative or salient developments in the scholarship.
• Meta-analysis : Does your research deal with statistics or large amounts of data? If so, then a meta-analysis might be best for you rather than providing a critical review, the meta-analysis will summarize and synthesize the results of numerous studies that involve statistics or data to provide a more comprehensive picture than would be possible from just one study.

An argumentative literature review presents and takes sides in scholarly arguments about the literary work. It makes arguments about other scholars’ work. It does not necessarily involve a claim that the literary work is itself making an argument. Likewise, a chronological literature review presents the scholarly literature in chronological order.

You don’t need to keep strictly to one type. Scholars often combine features from various types of literature reviews. A sample review that combines the follow types –

• Argumentative
• Theoretical
• Methodological

– is the excellent work of Eiranen, Reetta, Mari Hatavara, Ville Kivimäki, Maria Mäkelä & Raisa Maria Toivo (2022) “ Narrative and Experience: Interdisciplinary Methodologies between History and Narratology , ” Scandinavian Journal of History , 47:1, 1-15

When writing your literature review, please follow these pointers:

• Conduct systematic searches
• Use Evidence
• Be Selective
• Use Quotes Sparingly
• Summarize & Synthesize
• Use Caution when Paraphrasing
• Use Your Own Voice

Advice from James Mason University’s “Literature Reviews: An Overview”

A note on synthesizing : Don’t make the common mistake of summarizing individual studies or articles one after the other. The goal is to synthesize — that is, to make observations about groups of studies. Synthesis often uses language like this:

• Much of the literature on [topic x ] focuses on [major themes].
• In recent years, researchers have begun investigating [facets a , b , and c ] of [topic x ].
• The studies in this review of [topic x ] confirm / suggest / call into question / support [idea / practice / finding / method / theory / guideline y ].
• In the reviewed studies [variable x ] was generally associated with higher / lower rates of [outcome y ].
• A limitation of some / most / all of these studies is [ y ].

Please see this sample annotated literature review  from James Mason University.

Structure of a literature review [2]

• Problematization: The 2 to 3 pages of problematization are a distinct, iterative, step. It may take doing such a statement a few times before moving forward to writing the actual paper.
• Search: Write down your keyword sets, your updated keyword sets, and databases. It is perfectly within a reviewer’s rights to ask for these details.
• Summary: Really getting to know major themes requires some annotation of articles. You want to identify core papers and themes and write about them. This helps you really learn the material. [ChatGPT or Wikipedia are no substitute for deep engagement with a paper.]
• Argument: Either outline or create a slide deck that help you express the arguments in your paper. Read them out loud. Have friends look at them. Present them. [Every literature review has an argument. If not, it’s a summary. A summary does not merit publication in a top outlet.]
• Unpacking: Once you’ve nailed the short pitch, unpack the full argument. [ a) Take time in each major section to map out a) the argument, b) the supporting evidence, and the takeaway. b) Take those major sections, reconcile them, make sure they don’t overlap, then move on to writing. c) Sketch out the paper’s sections, tables, figures, and appendices.]
• Writing: Writing is the easy part. You can always put words to the screen. [Revising and improving is hard. Make time to write every day. Improving requires feedback. Find a writing partner to give feedback. Create your tables and figures. Write to them. Make sure the words in the paper align to the visuals.]
• Communicate: When the paper is done, go back and create a paper presentation. [I do this for the papers that I’m most serious about. The act of storyboarding helps me sort out the small pieces of the story that don’t fit together. If I really want it to succeed, I present it. The act of presenting helps me get it right. My best papers sometimes take seven or eight presentations to get it right. Then I return to the paper and fine tune it. Only then, does it have a shot at a top outlet.]

Literature reviews can be published as part of a scholarly article, often after the introduction and sometimes with a header, but they can also be published as a standalone essay. To find examples of what reviews look like in your discipline, choose an appropriate subject database (such as MLA for literary criticism) and conduct a keyword search with the term “Literature Review” added in quotes:

Not only do these examples demonstrate how to structure different types of literature reviews, but some offer insights into trends and directions for future research. In the next section, we’ll take a closer look at some reading strategies to help guide you through this process.

Since scholars already have produced literature reviews on various scholarly conversations, you don’t always need to “reinvent the wheel” (start a literature review from nothing). You can find a published literature review and update it or amend it; scholars do that all the time. However, you must properly cite work you incorporate from others.

• What types of literature review will you be using for your paper? Why did you make this selection over others? If you haven’t made a selection yet, which types are you considering?
• What specific challenges do you face in following a literature review structure?
• If there are any elements of your assignment that need clarification, please list them.
• What was the most important lesson you learned from this page? What point was confusing or difficult to understand?
• In the “Back Matter” of this book, you will find a page titled “Rubrics.” On that page, we provide a rubric for Creating a Literature Review ↵
• Richard West, Brigham Young University, amended by Jason Thatcher, Temple University - https://www.linkedin.com/posts/jason-thatcher-0329764_academicwriting-topten2023-activity-7146507675021766656-BB0O ↵

Writing the Literature Review Copyright © 2021 by Barry Mauer and John Venecek is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License , except where otherwise noted.

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Title: biomedical image segmentation: a systematic literature review of deep learning based object detection methods.

Abstract: Biomedical image segmentation plays a vital role in diagnosis of diseases across various organs. Deep learning-based object detection methods are commonly used for such segmentation. There exists an extensive research in this topic. However, there is no standard review on this topic. Existing surveys often lack a standardized approach or focus on broader segmentation techniques. In this paper, we conducted a systematic literature review (SLR), collected and analysed 148 articles that explore deep learning object detection methods for biomedical image segmentation. We critically analyzed these methods, identified the key challenges, and discussed the future directions. From the selected articles we extracted the results including the deep learning models, targeted imaging modalities, targeted diseases, and the metrics for the analysis of the methods. The results have been presented in tabular and/or charted forms. The results are presented in three major categories including two stage detection models, one stage detection models and point-based detection models. Each article is individually analyzed along with its pros and cons. Finally, we discuss open challenges, potential benefits, and future research directions. This SLR aims to provide the research community with a quick yet deeper understanding of these segmentation models, ultimately facilitating the development of more powerful solutions for biomedical image analysis.

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• Published: 26 August 2021

Advancing sustainable development goals through immunization: a literature review

• Catherine Decouttere 1 ,
• Kim De Boeck 1 &
• Nico Vandaele   ORCID: orcid.org/0000-0001-7687-7376 1  

Globalization and Health volume  17 , Article number:  95 ( 2021 ) Cite this article

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Immunization directly impacts health (SDG3) and brings a contribution to 14 out of the 17 Sustainable Development Goals (SDGs), such as ending poverty, reducing hunger, and reducing inequalities. Therefore, immunization is recognized to play a central role in reaching the SDGs, especially in low- and middle-income countries (LMICs). Despite continuous interventions to strengthen immunization systems and to adequately respond to emergency immunization during epidemics, the immunization-related indicators for SDG3 lag behind in sub-Saharan Africa. Especially taking into account the current Covid19 pandemic, the current performance on the connected SDGs is both a cause and a result of this.

We conduct a literature review through a keyword search strategy complemented with handpicking and snowballing from earlier reviews. After title and abstract screening, we conducted a qualitative analysis of key insights and categorized them according to showing the impact of immunization on SDGs, sustainability challenges, and model-based solutions to these challenges.

We reveal the leveraging mechanisms triggered by immunization and position them vis-à-vis the SDGs, within the framework of Public Health and Planetary Health. Several challenges for sustainable control of vaccine-preventable diseases are identified: access to immunization services, global vaccine availability to LMICs, context-dependent vaccine effectiveness, safe and affordable vaccines, local/regional vaccine production, public-private partnerships, and immunization capacity/capability building. Model-based approaches that support SDG-promoting interventions concerning immunization systems are analyzed in light of the strategic priorities of the Immunization Agenda 2030.

Conclusions

In general terms, it can be concluded that relevant future research requires (i) design for system resilience, (ii) transdisciplinary modeling, (iii) connecting interventions in immunization with SDG outcomes, (iv) designing interventions and their implementation simultaneously, (v) offering tailored solutions, and (vi) model coordination and integration of services and partnerships. The research and health community is called upon to join forces to activate existing knowledge, generate new insights and develop decision-supporting tools for Low-and Middle-Income Countries’ health authorities and communities to leverage immunization in its transformational role toward successfully meeting the SDGs in 2030.

With just one decade ahead to realize 17 ambitious but essential SDGs, most Sub-Saharan African (SSA) countries are struggling to meet and to sustain SDG3 Footnote 1 targets related to immunization: under-five mortality, elimination of vaccine-preventable diseases, and prevention of epidemics. There is a growing concern to support the transformation of immunization systems towards increased sustainability and resilience [ 1 , 2 ]. The 2020 Covid-19 pandemic supports this concern clearly, as it draws global attention and funds to restoring health systems across the globe and to the development of a vaccine, in an attempt to mitigate the devastating health and economic impact of the full-blown pandemic. Health care staff in Lower and Middle-Income Countries (LMICs) need to prepare their mostly weak health systems, already overburdened by ongoing struggles with active outbreaks of infectious diseases such as Measles, Ebola, and Lassa Fever, only to name a few.

Immunization directly impacts health (SDG3) and brings a contribution to 14 out of the 17 SDGs [ 3 ]. Moreover, it has proven to be one of the most cost-effective and long-lasting health interventions [ 4 ], protecting individuals and communities both in stable times and during humanitarian crises.

Advancing both the health-related and other SDGs in LMICs through immunization requires appropriate methods and tools that can support strategic decision-making and program implementation. Furthermore, a multi-sectoral perspective within a system-based approach, that involves the relevant SDG dimensions, seems mandatory to preserve sustainability. This entails the observation that immunization is at the interface between natural and human-made systems. Although the existence of many bi-directional links between the two systems, this paper will focus on the sustainable impact of immunization on the SDGs. A core element within this system-based approach is the notion of adaptability as a means to endorse resilience.

The natural system houses pathogens (e.g., bacteria, viruses, parasites) in reservoirs such as soil, water, plants, animals, and humans. When humans are exposed to pathogens, the immune system is activated. If the activation is not effective, an infection takes place including further transmission. An infection survivor gains immunity and if enough in number, a community can develop herd immunity. Susceptibility of the population is related to the strength of the immune response against the pathogen, which is linked to age, nutrition, previous infection, and general health status. This points to the impact of immunization on other SDGs than SDG3 and vice versa.

Driven by environmental change due to natural or anthropogenic causes, such as floods, river dam constructions, conversion of forest into farmland, or climate change, pathogen ecologies adapt accordingly. This adaptation is key and gives rise to the presence of pathogens in environments where they could not flourish before. The same happens when an infected human travels or migrates to uninfected areas. A pathogen entering a new area is not recognized by the population’s naïve immune systems. Therefore it can emerge in communities and result in outbreaks, larger epidemics, or even pandemics like Covid-19.

Zoonoses are diseases that are transmissible from vertebrate animals, such as pets, livestock, or wildlife, to humans. Driven by ecological disruption and increased contact between humans and wild reservoir species, these pathogens found the opportunity to “jump the species barrier”, leading to a new human infectious disease. In specific, anthropogenic environmental disturbance, including the increased livestock population in close contact with wildlife animal populations, increased the risk of zoonotic infection from wildlife [ 5 ]. Furthermore, emerging infectious diseases are fueled by increasing population density in urban areas and the interaction between humans and wildlife, through encroachment, road building, deforestation, hunting, and global wildlife trade [ 5 ]. In addition, loss of biodiversity following anthropogenic disturbance was shown to increase the abundance of rodent-borne pathogens in central Kenya [ 6 ]. Most pandemic threats have been caused by viruses from zoonotic or vector-borne sources [ 7 ]: Ebola, SARS, MERS, H1N1 pandemic flu, and eventually also Covid-19.

These phenomena represent adaptive behavior and are clearly bidirectional in their interaction with the human-made immunization system. Concluded, there is an intimate connection between environmental, animal, and human health. The typical behavior attributed to social-ecological systems, as described by Whitmee et al. [ 8 ] applies: these systems coevolve across spatial and temporal scales, which explains endemic and emerging disease behavior, nonlinearity in disease transmission outside and during outbreaks, and scale-free phenomena such as a single adapted virus in a single infected traveler that is capable of infecting entire continents.

By providing an analysis of the existing body of research dedicated to sustainable immunization and by showing directions for future research in this field, we contribute to support the strategic priorities of the Immunization Agenda 2030 and contribute to the other SDGs.

In this paper, we discuss insights based on a literature review in which we explored (a) how immunization impacts the SDGs, (b) the factors that endanger the sustainability of immunization in LMICs (c) the research gap to enhance decision making for SDG-promoting implementations related to immunization.

Search strategy and information sources

Considering the broad array of disciplines involved, including epidemiology, system research, operations management, and anthropology, both Scopus and Pubmed databases were initially searched between January 1st 1990 and March 21, 2021. As the search term based on the SDGs needed to be expanded in order to identify papers before 2015 and papers that clearly expressed the idea behind sustainable development without mentioning the SDGs, it was replaced by variations of sustainability and resilience, which finally resulted in 3401 papers as shown in Table  1 .

Similar searches were performed in Pubmed. While screening the papers based on titles and abstracts, additional papers were handpicked and found through snowballing from review papers.

Data extraction and synthesis

Title screening removed papers without a direct connection to the SDGs, such as theoretical topics in immunology and vaccinology, vaccine efficacy and clinical trials, technical papers on human or veterinary vaccine development, and papers related to cybersecurity.

Abstract screening mainly removed papers on livestock immunization or detailed human immunology. Similarly, papers that only briefly listed the sustainability aspect in the limitations section of their research were excluded at this point. in terms of eligibility, papers dealing with models and methods that qualify as applicable and relevant for decision-makers, implementers, and other stakeholders were included. the insights from all the resulting papers were extracted in excel for qualitative synthesis. The inclusion criteria were based on Kovacs and Moshtari [ 9 ] and Besiou, Stapleton, and Van Wassenhove [ 10 ], as shown in Table  2 .

The analysis turned out the paper structure as shown in Fig.  1 . All eligible and included papers, for which the numbers are listed in Table  3 , were manually allocated to three categories. This has been initiated by one researcher and reviewed independently by two other researchers. A final meeting was arranged to reach a consensus.

Paper structure. Paper structure combining literature analysis results with both the WHO Health System building blocks [ 11 ] and the WHO Immunization Agenda 2030 [ 2 ]

The insights from the qualitatively analyzed papers are categorized as follows: first (Cat1), insights that explain the essential role of immunization in LMICs for reaching the SDGs; second (Cat2), insights that represent challenges concerning the sustainability of the immunization system in LMICs; and third (Cat3), insights that propose model-based approaches to these challenges. From the Cat3 papers, modeling and methodological learnings could be drawn, which support strategies for immunization system improvement and for transformation towards achieving the SDGs. By comparing the challenges (Cat2) and model-based approaches (Cat3) found in the literature, under-addressed research fields were distilled and finally, recommendations are formulated. A synopsis is given in Table 3 .

Following the application of the inclusion criteria, a number of applied research papers that investigated the potential value of an intervention or optimal strategies within a single field, or in multiple fields but failing to make a connection with the SDGs, were not discussed in the Cat3 papers. However, the insights from these papers include promising elements to be leveraged by translational research in order to result in evidence-based decision support. Additionally, the interested reader is referred to De Boeck [ 19 ] for vaccine supply chain-related papers. Finally, the insights from the Cat1 papers have been used to formulate conceptual models, link the various elements and relate these elements to the SDGs, the Cat2 revealed the immunization challenges and the Cat3 allowed us to obtain an overview of model-based solutions. For each of these three steps, a focused group model building session was set up. The outcomes were iteratively validated until saturation was obtained.

The findings are structured according to the categories of Table 3 . First, the impact of immunization on the SDGs is discussed. Subsequently, the challenges for the sustainability of immunization are reviewed, and finally, the model-based approaches to solve these sustainability challenges are presented.

Impact of immunization on SDGs

The conceptual diagram in Fig.  2 represents the three pathways, identified from the reviewed papers, together with the ultimate impact these pathways have on the SDGs (both the pathways and the impact links are indicated in green). The first pathway (1) leads from the protection against vaccine-preventable diseases to a lower burden of disease and as such to a positive contribution to SDG3 and several other SDGs. A second pathway (2) leads from the vaccination service delivery to improved SDGs for the direct beneficiaries of immunization. A third pathway (3) also starts from vaccination service delivery and heads to SDG 17, 16, and 9, as the Expanded Program on Immunization (EPI) paves the way for partnerships in the context of health-related service delivery, that can be integrated with immunization and will lead to universal health coverage, ultimately contributing to SDG3. The indirect effects of immunization on the SDGs shown in blue, are only briefly discussed, as they lie outside the scope of this literature review.

Conceptual model. Green items depict the impact of immunization on sustainable development goals which is realized through the mechanisms of (1) protecting people and communities against infectious diseases, (2) providing access to immunization services for all and (3) creating an environment for health system development. Blue arrows indicate the indirect consequences of immunization on SDGs. Black items show the overarching elements of sustainable immunization

In the following sections, the three pathways are discussed based on the Cat1 papers, referenced in Table 3 , while Table  4 gives a summary of each contribution of immunization to the SDGs.

Impact of protecting people and communities against vaccine-preventable diseases

One of the joint creeds of WHO and GAVI, “Immunization leads to saving lives, protecting health, and contributing to healthy and productive populations” [ 2 , 39 ], summarizes the impact of protecting individuals and communities against vaccine-preventable diseases and refers primarily to SDG3 – health and well-being, but also to SDG8 - productivity. The health-related goals of the immunization system are expressed by SDG3.2 (End preventable deaths of newborns and children < 5 years of age), SDG3.3 (End epidemics of AIDS, TB, Malaria, Neglected Tropical Diseases (NTDs) and combat other communicable diseases), SDG3.8 (Universal Health Coverage (UHC)) and SDG 3.d (International Health Regulations (IHR) and increasing resilience to shocks). Immunization program outcomes are measured by immunization coverage levels and equity of immunization with respect to all vaccines in the national schedule, elimination of epidemic-prone diseases such as measles, mumps and rubella, eradication of polio, number of Human Immunodeficiency Virus (HIV) cases, new vaccines introduced against NTDs and other indicators from the Global Vaccine Action Plan (GVAP) [ 40 ] and National immunization programs [ 24 ].

Concerning SDG3.8 (UHC), the EPI programs are set up in order to immunize the target population in accordance with the GVAP targets, which propose 90% coverage rates at the national level for most vaccines, and 80% at the district level. Herd immunity, the level of immunization coverage in a population at which the chain of disease transmission is broken, is attained in most cases at around 90% immunization coverage rate (95% for measles), requiring Universal Health Coverage (UHC) and aiming at reducing under-five mortality and avoiding epidemics as stipulated by SDG3. However, it must be noted that even when national and district level GVAP targets are met, outbreaks can still occur due to under-immunization at the community level. The prevention of emerging infectious diseases (SDG3.d) is mainly focused on the development of new vaccines, and more specifically on preparing against an epidemic of disease ‘X’, for instance by the Coalition of Epidemic Preparedness Innovations (CEPI [ 41 ]).

Next to the direct goal of immunization, SDG3, the contribution to boosting the productivity of the population and economic development (SDG8) is highlighted, as a healthy workforce is critical for economic development [ 2 , 26 ], which is undoubtedly undermined in case of epidemics.

On the level of households and individuals, avoiding Vaccine-Preventable Diseases (VPD) cases saves people from income loss and out-of-pocket health expenses (SDG1). In addition to malnutrition following from poverty, VPDs can lead to weakened children not taking up nutrients (SDG2), for instance in the case of cholera.

Impact of providing access to immunization services for all

The universal access to vaccination services boosts equality (SDG5 and SDG10) and provides health education to caregivers (SDG4) together with its synergetic effects with zero hunger (SDG2), quality education (SDG4), clean water (SDG6), and climate action (SDG13) [ 3 , 13 , 29 ]. Furthermore, immunization’s contribution to building a productive workforce (SDG8) turns it into a core driver of country development [ 2 , 26 ]. While endemic diseases by far represent the most significant burden of disease, the increasing number of outbreaks of emerging infectious diseases poses a major international concern as epidemics may rapidly spread, or even turn into a pandemic, and cause massive health, economic and emotional damage [ 42 ], illustrated by the Covid-19 pandemic.

Impact of creating an environment for health system development

Creating an environment that is beneficial for health system development is anything but trivial. Several elements from the literature can shape this pathway. First and foremost, there is the provision of resources to build capacity for immunization service delivery, disease surveillance, and early diagnosis. This last mile capacity building is further enhanced by strengthening national and regional public health systems. In this capacity building efforts, public-private partnership plays a central role. The latter accounts both for the vaccine production [ 33 ] as well as for partnership incentives for the delivery of integrated services [ 32 , 43 ], including in conflict settings where, for example, the implementation of the EPI program was found to create a “working encounter” with state and non-state actors in Myanmar which led to positive development and peacebuilding outcomes [ 30 , 31 , 35 ].

Indirect impact on the SDGs

In addition to SDGs that are directly impacted by immunization through the three pathways discussed above, a number of synergetic effects exist between SDG-promoting actions, such as access to clean water (SDG6) as a complementary factor to immunization in the prevention of cholera and adequate nutrition (SDG2), which improves the immune response triggered by immunization [ 3 , 39 ]. These indirect and synergetic effects are indicated in blue in Fig. 2 . Moreover, the emergence and prevalence of infectious diseases is often found to be related to environmental health and animal health conditions represented by SDG13, SDG14, and SDG15 and approached as Planetary Health [ 8 , 12 , 44 ]. Table  5 shows an overview of hurdles and strategies, identified from the Cat1 papers, in taking these synergetic and indirect effects of immunization on the SDGs into account.

Immunization system sustainability challenges

Immunization can only have a lasting impact on the SDGs in LMICs when immunization programs are intrinsically sustainable. Challenges observed concern the sustainability of the health outcomes reached [ 13 ], the difficulty of increasing SSA coverage levels over and above 85%, the important subnational under-immunization, and the reduced coverage rate of childhood immunization as a result of the COVID-19 pandemic [ 24 ]. Challenges for SDG3.3 are the delay in polio eradication and backward evolution in the elimination of TB, measles, and malaria, and the need for vaccine development for several NTDs such as Nipah Virus Infection and Lassa Fever, among others. In brief, at the current pace and based on the current strategies, it is expected that only SDG3.2 is likely to be achieved in SSA by 2030 [ 13 ]. Furthermore, the mechanisms that trigger epidemics and the emergence of infectious diseases related to the loss of biodiversity and climate change retrieved from the Cat1 papers will, even more, aggravate the risk of infectious diseases. In order to achieve sustainable protection against both endemic and Emerging Infectious Diseases (EIDs), there is a need for more focus on the resilience of the immunization system, than on the performance in an equilibrium state [ 58 ].

The Cat2 papers, as described in Table 3 , provide an overview of the challenges to the sustainable performance and continuation of immunization in LMICs. We found 104 papers raising issues endogenous to the national health system, 111 papers discussed topics beyond the national health system, and 9 papers dealing with issues covering both areas and counted in both, summarized in Fig. 3 .

Sustainability challenges papers. Distribution of included papers, dealing with sustainability challenges of immunization in LMICs, categorized according to the WHO Health System building blocks [ 11 ]

Sustainability challenges discussed in the papers were connected to the human-centered health system building blocks as defined by the WHO [ 11 ]: People, Governance, Financing, Human resources, Information, Medicines & Technology , and Service Delivery . These are visually represented in Fig.  4 , together with some selected, key illustrative sustainability challenges, derived from the extensive overview listed in Table  6 .

WHO Health System building blocks. Selected key sustainability challenges from the reviewed literature, according to the WHO Health System building blocks

Health system building-blocks

As an inherent feature of a complex system, the challenges discussed are often part of several building blocks. In our categorization, we opted for the dominating building block. The referenced papers, organized according to the respective building blocks, are summarized in Table 6 .

Although the acknowledgment of patient-centeredness and human-centered design as an essential approach to supporting SDGs achievement has been globally confirmed, only a limited number of papers were found which explicitly discussed the challenges related to engaging and empowering people in order to achieve the SDGs or the related sustainability. While small in number (28 papers), these papers contain the main issues related to giving a voice to the “demand-side”: the target population for vaccination, or, more broadly, the individuals and communities that need protection from infectious diseases.

Other human factors that play in the supply side of vaccination, such as motivation of staff or decision making by national authorities, are either discussed under “Human resources” or “Governance.” Papers dealing with implementation challenges were categorized under “Service delivery.”

Even though nearly all papers refer to a specific geographical setting and context, generic challenges still emerged from them. First, the challenge of vaccine acceptance, which was declared by WHO as one of the ten greatest health threats to human health in 2019 [ 71 ], leads to unsustainable immunization coverage and puts a significant burden on disease elimination programs [ 72 ]. Vaccine acceptance is also an essential condition for a successful new vaccine introduction [ 74 ]. In the course of countering the current Covid19 pandemic, vaccine hesitancy in all its aspects became a considerable roadblock for immunization success [ 249 ]. Experiences with Human Papilloma Virus (HPV) introduction in Uganda, Rwanda, and Bhutan underlined the basic conditions of correct information to the population, strong political commitment, and local involvement [ 75 ]. Nevertheless, remaining cultural barriers require anthropologic research before implementation [ 70 ].

Second, a strong community engagement is required for any type of social mobilization during vaccination campaigns or routine immunization in order to create access to immunization for all. Engagement is based on connecting with the relevant community-level stakeholders and offering successful incentives. Stakeholders are traditional leaders, community health committees, and health providers, such as community health workers or “village doctors” [ 80 , 81 ] Incentives are relevant when behavioral change is required for a sustainable solution. Cases of traditional nursing habits conflicting with medical insights regarding infectious disease prevention were discussed, like birth habits impacting early life bacterial exposures [ 89 ]. Further research is needed to understand the role of Community Health Workers (CHWs) in reaching the SDGs. To recover from measles resurgence after the COVID-19 pandemic, community engagement for tailored solutions must be considered [ 79 ].

Third, the challenge of universal immunization to overcome the inequality (SDG10) resulting from the socio-economic determinants of health, such as poverty and education (SDGs1–6), requires the provision of access to immunization for all [ 26 , 91 , 93 ]. Tied by the Environment – Economy – Health nexus [ 57 ], vicious cycles of poverty need to be broken since they lead to greater vulnerability for infectious diseases and NTDs as well as to poor access to healthcare services [ 23 ].

The Governance building-block houses decision-making entities and frameworks related to immunization target-setting, policy decision-making, and resource allocation. Moreover, the sustainability challenges found in the literature call for improved decision support based on fine-grained data and system-wide long-term models that connect interventions with SDG-level outcomes [ 95 , 96 , 103 ]. At the global level, it includes the immunization targets and strategies in preventing epidemic disease prevalence and outbreaks, in the broader context of Planetary Health. In addition, sustainability challenges were detected in measuring health systems’ strength for comparison between countries [ 95 ] and health systems resilience in defining and measuring performance indicators towards reaching Grand Convergence , and towards coping with the emerging Double burden of disease (the latter being the rise of non-communicable diseases in LMICs as they converge with infectious diseases as main causes of death) [ 13 , 97 , 98 , 99 ]. At the national level, it concerns the country-specific priority setting and transformation path of health prevention and promotion as a driver for sustainable development.

A major fraction of governance-related challenges expresses the need to capture the complexity, context, and long-term perspective of the health system using systems thinking [ 14 , 103 , 104 ]. This is reflected in the quest for system-wide impact analysis in order to model health outcomes that result from interventions to the health system and ensuring program sustainability. Examples include the effect of changing vaccine doses per vial and vaccine thermostability [ 105 , 106 ].

Similarly, political commitment (SDG16) is needed to support programs for which a direct effect is difficult to link with health outcomes, which is often the case for Health System Strengthening (HSS) programs and to synergistically integrate vertical disease-specific programs into horizontal HSS programs [ 21 , 90 ]. Systems thinking is proposed as a stepping stone to dynamic modeling. Long-term system models, which reach for the 2030 SDGs and beyond, are able to show dynamic effects resulting from adaptation, such as the role of vaccines to reduce anti-microbial resistance [ 62 ], and unintended consequences, such as the behavioral reaction following mandatory immunizations [ 102 ].

Following SDG3.2, a central governance element is the continuous update of the national immunization plan and the sustainability of the Expanded Program on Immunization by taking up new vaccines and deciding on the coverage target. Challenges discussed in the papers mention that the evidence-based decision support and cost-effectiveness studies brought to the National Immunization Technical Advisory Group (NITAG), often lack the sustainability dimension and long-term or indirect effects [ 76 , 109 , 110 , 112 , 113 , 114 ]. Based on these approaches, decisions on whether or not to adopt a vaccine are made without considering the full impact of the additional vaccine on the total vaccine supply chain and on the country’s epidemiology, which is impacted by all vaccines compiled in the national plan. Furthermore, the full public health value of vaccination should be measured on the population level, not only on the individual level, while taking into account the impact of non-medical elements and different SDGs, such as infrastructure works in combination with a vaccine against cholera or malaria [ 22 , 111 ]. Finally, even when the local burden of disease data are not available, the NITAG needs scientifically sound decision support that captures the complex adaptive nature of the health system.

Aiming at disease elimination and polio eradication initiatives, the global coordination and national commitment to the vertical programs are of crucial importance since the last remaining disease case must be identified, and continued universal vaccination coverage is required. At the same time, disease cases are dwindling in the endgame, but disease dynamics urge for counter-intuitive strategies while the government’s commitment to the program is at risk of fading. Decision-supporting models that capture both the epidemiological dynamics and the country’s contextual landscape are needed [ 59 , 116 , 250 ].

Reported challenges for decision support related to UHC and equity (SDG3.8 and 3.b) were the scarcity of disaggregated data, defining differentiated approaches and strategies tailored to reach the unreached. Under-immunized populations often find themselves in humanitarian settings where case-specific immunization interventions are needed or where underlying determinants of immunization, related to other SDGs, need further investigation [ 21 , 117 , 118 , 119 , 120 , 121 , 122 , 123 ].

In supporting the WHO’s Integrated People-Centered Health Services (IPCHS) strategy “Engaging and empowering people,” appropriate processes are needed to support decentralized decision making, enabling self-organized local solutions, and building resilience [ 109 , 127 , 128 , 129 , 130 ]. In the case of local decision-making for enhanced EPI performance, it has been found that three conditions should be fulfilled: availability of data, understanding of the complexities in the system, and availability of decision power at the operational level [ 126 ]. Looking from the global perspective, one views self-organized local solutions as country-specific development paths to health outcomes, possibly grounded in the upscaling of proven best practices in each country [ 13 ].

In building resilience and preparedness towards disruptive events, challenges were reported regarding the relevance of cost-effectiveness-oriented optimization models for humanitarian operations and the need for incorporation in the health system of small-scale people-centered initiatives [ 132 , 133 , 134 ]. Adaptive behavior in a post-Ebola epidemics era gave rise to transformation strategies that need to be further implemented [ 135 ]. And of course, currently, the Covid19 pandemic showed the high need for resilient health systems in general and immunization systems in particular. It proved in a dramatic way that unpreparedness pays back not only health (SDG3) but impacts almost all SDG as mentioned earlier in our Background section.

Collaboration (SDG17) and coordination of cross-sectoral activities, between public and private partners or between nations, are needed to tackle vector-borne diseases and aim for disease eradication, integrate nutrition into the health system, foster sustainable innovation initiatives, strengthen weaker systems through regional collaboration, or apply health diplomacy to connect economic, social, and political sectors [ 43 , 54 , 82 , 138 , 139 , 140 , 141 , 143 ]. Understanding the interactions of these private or cross-sectoral initiatives with the health system is key. Global future-oriented health governance (SDG16) demands alignment in priorities stemming from IHR and SDGs, consultation of the global health community, understanding the relationship between health and behavior, and the role of regulation in supporting global health, as exemplified by the response to the Zika epidemic [ 142 ], or on a more permanent basis, the need for global support of synergies between horizontal and vertical programs. Global health diplomacy is proposed to avoid violation of IHR, for instance in the case of the COVID-19 pandemic [ 125 ].

In the context of LMIC immunization, the term “sustainability” is almost always used implicitly for “financial sustainability”. Clearly, every resource employed for immunization needs to be financed and, although the return on investment of immunization is estimated to be substantial, the funds are not available to LMIC governments to make the investments without external support. Challenges reported relate to donor dependency [ 76 , 107 , 108 , 145 , 147 , 148 , 149 , 150 , 151 , 152 , 251 ], finding the budget from domestic sources [ 108 , 124 , 146 , 148 , 156 , 161 , 162 , 163 , 164 ], and increased efficiency in service delivery. From the global perspective, both the transition out of GAVI support as well as the aftermath of political instability are recognized as critical milestones in the development paths of LMICs [ 154 , 155 , 156 , 157 , 158 , 159 ].

Human resources

Challenges in Human Resources were related to building capacity, accountability, and resilience. Capacity building to strengthen the scarce African healthcare human capital is needed on the level of capacity in leadership and governance, technical healthcare and supply chain skills, and in cross-sectoral disciplines in the framework of Planetary Health approaches [ 13 , 46 , 99 , 163 , 165 , 167 , 168 , 170 , 252 ]. Training programs should make a stronger link with health outcomes (SDG3) and other relevant SDGs encountered in the Planetary Health paradigm. Further challenges lie in rolling out training programs for vast numbers of local health workers and community health workers while ensuring the continuity of operations. Furthermore, synergies are expected from standardization in certificates and training programs across organizations and countries.

In the quest to obtain accountability of staff, the challenge of including health outcomes, such as under-five mortality (SDG3), in evaluation frameworks is discussed. An all-but straightforward endeavor due to the delayed effect of functioning and outcomes, and the multitude of actors in the system that play a role. Equally delicate are the challenges of installing effective and fair incentives for health care staff, without triggering unintended or unsustainable effects [ 166 , 174 , 175 , 176 ].

A key element for health system resilience is achieved by workforce commitment and absorptive capacity, to avoid immunization service disruptions due to health workers’ frustration and subsequent strikes [ 174 ]. Therefore, an appropriate level of empowerment is needed to allow decentralized decision-making. Equally important is a balanced workload that provides buffering, and a safe environment in times of disease outbreaks involving personal risks such as during the Ebola outbreaks [ 172 ].

Information

Based on a review study by Kumar, routine Health Information Systems in LMICs are not utilizing their full potential of supporting the health-related SDGs (SDG3) due to Health Information System design barriers that lead to poor data quality and data use [ 177 ]. Specifically, the authors argue that user-related factors are not sufficiently embedded in the Health Information System design and propose a systems-thinking approach to cope with the Health Information System design-user reality gap [ 179 , 180 , 181 ]. An earlier study in Uganda pointed to the lack of standardization and strategic alignment between the health vision and the information system, on top of user-related engagement issues [ 178 ]. A principal concern in LMICs remains the considerable effort and risks involved in the transition from paper-based to electronic health registries and databases, and the consequences for improved performance in Maternal and Child Health, the cornerstone of national immunization programs. On the other hand, the availability of mobile technology has led to a proliferation of health apps resulting in 40.000 mobile health apps and hundreds of communication platforms while collaboration between health providers and the adoption of technology still experience high barriers [ 13 ].

Classified according to the twelve common applications to overcome UHC in Maternal and Child Health and the mHealth roadmap for UHC, a number of challenges for immunization were found [ 13 , 93 , 171 , 184 , 185 , 186 , 188 , 189 , 190 , 253 ]. First, immunization and surveillance data collection and reporting involve identifying immunization inequity and triggering the need for enhanced interventions through immunization dashboards, such as District Health Information Software 2 also known as DHIS2. Good practices and Artificial Intelligence (AI) applications from disease-specific programs focusing on Meningitis A, Polio, and disease outbreaks in humanitarian operations, have paved the way for high-standard disease surveillance. The implementation of electronic health records is challenged with contextual factors such as power outages and usability factors. On the data usage side, electronic decision support in the form of burden of disease data to the NITAG, diagnostics tools for comorbidities of infectious diseases and non-infectious diseases, and local determinants of vaccination to drive service delivery planning are reported to be lacking. It has been found that immunization information can positively impact trust in vaccination on individual and community levels, one of the important sustainability factors. However, the information systems need to be further strengthened at this point. Health providers’ collaboration could be supported more adequately by regional and global data exchange systems and support systems for decentral decision making. In addition, provider training formats can enhance efficiency and resilience in service delivery, provided they are well accepted by the health providers and are not regarded as a threat to their expertise and value. Finally, Health Information Systems in LMICs are underutilized for supply chain management, hence the combination of the Health Information System and the Logistics Management Information System bears great potential.

Medicines and technology

On the level of medicines and technology, challenges in vaccine distribution are found in reaching and maintaining a sufficient level of effectiveness and efficiency in vaccine distribution and delivery, under increasingly stringent conditions resulting from population growth and the growing number of vaccines to be administered per person [ 13 , 19 , 76 , 107 , 163 , 168 , 192 , 193 , 194 , 195 , 198 , 199 , 254 ]. Supply chain strengthening efforts to avoid out-of-stocks and to increase immunization equity experience difficulties in getting adopted beyond demonstration projects. In addition, they experience difficulties in relating to the real-life context of available data, human resources, and existing infrastructure at the lower levels of the supply chain. In specific, the introduction of new vaccines needs to be carefully considered on its full benefits and long-term sustainability, including the phase of implementation and impact on the existing immunization. A critical part of the immunization infrastructure concerns the cold chain equipment where the following sustainability challenges were detected: (i) performance of cold chain equipment ensuring the potency of the vaccines (SDG3), (ii) emissions, (iii) energy and material used during production, (iv) use, and (v) post-use stages of the cold chain equipment (SDG7, SDG13, and SDG15) depending on cooling technology applied and maintenance efforts. Future directions are the integration of vaccines with other medicines, redesign for efficiency and effectiveness, and elimination of the cold chain when vaccines would become thermostable.

Availability of vaccines to LMICs for routine or emergency situations has been troubled - on top of financing-related issues discussed earlier - by disruptions, e.g., BCG in 2014–2015 [ 201 ]. This calls for improved alignment and collaboration between immunization partners, in line with SDG17, to tackle global health risks. Similar needs occur for vaccine stockpiles against epidemic-prone diseases, which are needed even after the eradication of the disease [ 202 ]. In addition, advancements to intellectual property frameworks and optimization of regulatory pathways that can lead to a significant reduction of registration time for new vaccines for LMICs are desperately needed in order to reach UHC (SDG3) [ 203 ]. In the same context, the development and viability of domestic vaccine production appear to face a high barrier that will not be easily overcome, particularly in SSA [ 204 , 205 , 206 , 207 , 208 , 209 ]. Not only technological development but also trust in domestic vaccines needs to be ensured [ 33 , 211 ].

New vaccine development presents a range of challenges [ 13 , 97 , 106 , 111 , 164 , 212 , 213 , 214 , 215 , 216 , 217 , 218 , 219 , 220 ]2. First, being prepared with a vaccine to prevent outbreaks from turning into large epidemics or pandemics (SDG3.d) requires seizing the momentum for vaccine development as soon as signs of pathogenic emergence appear. However, in reality, this proved to be difficult for many reasons, not in the least due to the engagement and priority setting that needs to be set by political, scientific, and funding partners into a working coalition. Next to diseases related to visible epidemics, there is an ongoing need for vaccines against a range of endemic infectious diseases that cause a large burden of disease in LMICs amongst the most vulnerable in the population (SDG3 and SDG10), including malaria, NTDs, and HIV. Future-oriented priority setting for vaccine development, in the light of the Grand Convergence, local epidemiological needs, full public health value, and alignment with the SDGs, results in a complex decision problem. In order to safeguard the vaccine’s potency and sustainable immune response in LMICs, vaccine delivery innovations in technology or vaccination schedules are potential candidates for improvement, provided that their impact under real circumstances in LMICs can be investigated safely.

Service delivery

The building block of Service Delivery covers the tactical and operational roll-out of the programs and interventions approved and supported by Governance , making use of the available resources, and leading to the aspired Goals and Outcomes. As such, the sustainability challenges in immunization Service Delivery were grouped under the following three categories, reflecting the main goal related to the challenge: Equity, Continuity, and Resilience. Principles and methodologies from the fields of Systems Thinking, Implementation Research, and strategies from WHO’s Reaching Every District framework and IPCHS framework, were applied to operational research problems encountered in immunization service delivery. The following challenges to sustainability were noted:

Reaching equitable coverage (SDG3.2 and SDG3.8), with the aim to increase immunization above the 85% level at which it has been stagnating since 2013, is attempted by improving access through offering tailored solutions adapted to the local context. A first element that needs to be further explored is measuring vulnerability from different data sources and translating it into meaningful indicators to derive the need for immunization services, such as a fine-grained spatial vulnerability map based on a multi-dimensional poverty index, infection data, and environmental health data [ 67 , 117 , 118 , 229 , 230 ]. A second challenge concerns the design of tailored immunization delivery approaches to actually reach the under-reached, according to the accessibility of the area, population mobility, and immunization service needs [ 25 , 48 , 79 , 119 , 225 , 226 , 227 , 228 ]. This leads to often unique solutions regarding logistics or community engagement, which are effective in a specific context and which can be continuously improved when needed. Research papers, review papers as well as case-based research confirmed the relevance and need for an enabling environment to create tailored interventions, and to sustainably incorporate them into the health system, alongside standard interventions. A third research need lies in the configuration of an integrated delivery platform, which aims at improved people-centered care, without overstretching the health system [ 76 , 127 , 186 , 231 , 232 , 233 , 234 , 235 , 255 ]. Services, next to routine immunization, include nutrition, mass drug administration against NTDs, campaigns from vertical immunization programs that aim at very high coverage (Measles), or new vaccine introduction platforms. Later-age vaccinations (MMR2 Footnote 2 at 15 months) and adolescent school vaccinations (HPV Footnote 3 at 12 years) seem to reach lower coverage levels and are more costly. It is concluded that the design of the intervention and its implementation phase are equally important and should be considered in parallel.

Second, the continuity of immunization service delivery is challenged by the increased load on the immunization system resulting from the introduction of new vaccines and population growth [ 63 , 65 , 175 , 213 , 238 , 239 , 240 , 241 ]. Four types of challenges were found. First, the pressure is felt at the limits of resource-related health system building blocks: the supply of vaccines and commodities, the availability of human resources, the financing from domestic and external sources, and the availability of information. These challenges were discussed in the dedicated sections above. Second, demand-side continuity factors, already discussed under People -building-block, which include trust in vaccination and community engagement, are threatening continuity. Third, the cost-effectiveness of operations is mentioned to endanger continuity, in particular activities for defaulter tracing, outreach, and campaigns are in need of more cost-efficient alternatives. Fourth, the sustainability of the vaccine-induced immune response must be well understood in order to plan Supplemental Immunization Activities (SIA) when needed. In addition, the surveillance of vaccine safety and adverse reactions to vaccination needs to be supported in the LMICs and must be preserved after GAVI transition. Coordination of critical immunization services, such as the implementation of switching vaccine presentations for polio eradication and rolling out SIA campaigns, add to the complexity of service delivery.

Third, resilience challenges were found in the phases of preparedness, response, and recovery in acute humanitarian emergencies [ 100 , 172 , 242 , 243 , 244 , 245 , 246 , 247 , 256 ]. Preparedness is not restricted to the availability of vaccines. Equally important in times of epidemics or a pandemic is the availability of diagnostics. Experiences with preparedness for Ebola recommend mobile training for CHWs and the recognition that humanitarian organizations can contribute to developing weaker health systems in order to build resilience for acute emergencies. A number of challenges apply to the response phase, such as the competitive effect between immunization campaigns in response to disease outbreaks (e.g., meningitis A, Ebola) and routine immunization services or planned polio eradication activities. Furthermore, it was found that decision support tools for humanitarian transportation planning during emergencies should aim primarily at being implementable in acute crisis conditions, rather than aiming for optimal calculations at the expense of usability. Post-conflict and long-term conflict situations in Afghanistan and Syria showed the need for a differentiated approach to immunization to avoid dramatically low immunization coverage and loss of health gains or reemergence of conflict during the transition between emergency and development [ 133 , 248 ].

Model-based solutions to LMIC immunization sustainability challenges

Going beyond the observations of the described immunization system sustainability challenges in literature, we analyzed a third category of papers, offering model-based approaches to resolve the challenges observed in contributing to the SDGs through immunization. We specifically filtered the literature on solution approaches that comply with the inclusion criteria defined in the Methods section, and which are expected to be customizable to different LMICs and settings for re-use.

In contrast to the previous subsection, the solution approaches are classified by use of a different framework that reflects the most relevant immunization priorities in immunization for the next decade: the seven Strategic Priorities (SPs) of the WHO Immunization Agenda 2030 [ 2 ].

Based on the inclusion criteria, a total of 47 papers with models were identified, spread across the strategic priorities, as shown in Fig.  5 . The main contributors were Duintjer Tebbens and Thompson [ 59 , 116 , 202 , 250 , 257 , 258 , 259 , 260 , 261 , 262 ], who published several papers with research mainly dedicated to polio eradication strategies and vaccine stockpiling, and Rwashana [ 263 , 264 , 265 , 266 ] focusing on the dynamics of the Ugandese immunization system. Compared to the entire set of papers, the purpose of the identified papers was to (i) provide the stakeholders with insight into the system’s complex behavior, (ii) deliver evidence-based decision support, (iii) demonstrate a re-usable best-practice approach, or (iv) to assess the impact of existing WHO guidelines. Methods applied in these papers include a majority of quantitative modeling approaches next to a limited number of qualitative modeling papers and papers demonstrating projects without modeling. The majority of quantitative models are based on system dynamics (SD), followed by agent-based models (ABM), analytical models, and hybrid models (the ones listed above combined with other methods such as Geographical Information System (GIS)-based spatial modeling and statistical models). The majority of qualitative models are constructed around causal-loop diagrams (CLDs), while the remaining papers apply a range of different techniques. Now we turn to a content-focused analysis of the model-based solution papers with respect to immunization sustainability.

Strategic Priorities. Amount of papers with model-based solutions to Immunization system challenges classified according to the Strategic Priorities (SPs) of Immunization Agenda 2030 (version April 2020)

In support of SP1, immunization programs for Primary Health Care and Universal Health Coverage, through vaccine supply chain strengthening, Lennon et al. [ 193 ] provide a generic approach for root cause analysis and institutional learning for maintenance of refrigerators, using temperature monitoring technology. Besides sustainably improved reach and efficiency of immunization programs in LMICs, local employment and ownership are positively affected, and lower emissions are expected. Through the development of high-level CLDs and System Dynamics (SD) models, Rwashana et al. [ 263 , 264 , 265 , 266 ] identified country-specific impacting factors, both from the supply side and the demand side, on immunization coverage and neonatal mortality in Uganda, applicable for policy design at the national level. Recently, a modeling framework for decision tools for vaccine development, aiming at universal availability has been presented [ 267 ]. Furthermore, a decision-support platform for vaccine prioritization has been put forward, for use by NITAG, including financial and other dimensions [ 268 ].

Concerning the health workforce, the recurring questions of the sustainability of performance-based financing (PBF) and the causal link between immunization coverage and PBF as a financial incentive for the immunization personnel in the health facilities were approached by qualitative systems methods by different authors. Renmans et al. [ 269 ] applied both systems’ archetypes and theory-driven hypotheses in an intervention study in Uganda, whereby the CLDs increased transparency in the complexity of interactions. Another intervention study by Alonge et al. [ 270 ] in Afghanistan resulted in a system dynamics model, while the research by Sato and Belel [ 271 ] in Nigeria was based on statistical analysis. The sustainable effect of performance-based financing on the immunization rate appeared to depend on the specific context at hand, and PBF was found to be overshadowed by the financing of the polio eradication program. This leads us to the challenge of synergistically implementing vertical disease-specific programs to contribute to HSS at the point of service delivery, which was tackled by Doherty et al. [ 152 ] by relying on qualitative appraisal methods and by Utazi et al. [ 272 ] by applying geospatial statistical modeling. On the global scale, coordination of polio eradication was supported by the System Dynamics (SD) models of Thomson et al. [ 257 , 258 , 259 ], which translate the intricate transmission and adaptation mechanisms of poliovirus into clear support for policymaking. As a final element in SP1, a demonstration project of a cloud-based disease surveillance system for meningitis in Burkina Faso was evaluated by Diallo et al. [ 185 ] and the sustainability of the vaccine-induced immune response for pneumococcal disease in Kenya was monitored by Ojal et al. [ 65 ] using an extended susceptible-infectious-recovered (SIR) epidemiologic model.

SP2 revolves around Commitment and Demand, referring to the continued engagement of the providers of immunization services and the beneficiaries, respectively. Commitment is supported by strengthening evidence-based decision-making with modeling tools capable of showing the long-term health impact of disease control through vaccination uptake and disease elimination and eradication through intensified vaccination strategies. In their paper, Kivuti-Bitok et al. [ 273 ] developed an SD model to support policy-making for HPV vaccination and screening in Kenya. The model runs over a time horizon up to 2050 and was designed to evolve when new information becomes available. In two of their papers on polio eradication, Duintjer Tebbens and Thompson [ 59 , 250 ] focus on assisting policymaking from a long-term perspective and on acknowledging the counter-intuitive nature of the strategies proposed. Aimed at sustainably striving for UHC based on tailored solutions and empowering the district level to fulfill its role in this, Tetui et al. [ 274 ] propose an approach based on participatory action research to strengthening district health managers’ leadership capacity, as an improvement to non-participatory approaches. A comparable approach based on sense-making and discretionary power was found to sustainably support policy implementation at the Primary Health Center level in South Africa [ 275 ].

The demand for immunization relies heavily on creating sustainable public trust and vaccination confidence at the community level. To this end, Gilmore et al. [ 83 ] provided an approach based on realist evaluation to recognize the role and to support the engagement of the community health committee as a crucial stakeholder in the community-level immunization system. Sarriot et al. [ 276 ] derived a CLD for Rwanda’s integrated case management, revealing both organizational factors and context-dependent cultural motivational factors playing at national, district, and community levels in the system. In this way, they succeed in framing the role of performance-based financing in relation to political stability, sub-national program management, and utilization of services at the community level. Varghese et al. [ 277 ] also applied CLDs, among other methods applicable to complex adaptive systems, to reveal the basic triggers that led to stagnating vaccine acceptance in Kerala (India), resulting in dangerously low immunization coverage rates in certain districts. CLDs were also applied by Ozawa et al. [ 278 ] to explore pathways that lead to trust-building in vaccination. Through scenario analysis and mapping of health system experiences, communication, and social capital, reinforcing mechanisms and spill-over effects of distrust and the disruptive impact of the 2014 Ebola outbreak were revealed. A mathematical modeling approach in a non-LMIC context (US) was taken by Pananos et al. [ 279 ], who developed a measles outbreak prediction model based on immunization coverage and trust levels derived from social media. The approach is likely to be transferrable to LMICs. In order to activate people and communities from accepting vaccines to changing their health-related behavior Kumar et al. [ 89 ] show a community-centric design approach applied to India that aims at closing the evidence-practice gap and sustainably improving health impact. Sarriot et al. [ 280 ] investigated community learning of sustainability evaluation in a Northern Bangladesh urban health system.

Utazi et al. [ 272 , 281 ] pursued SP3, Coverage and Equity, by visualizing the under-immunized population on high-resolution age-structured geographical maps, using open source data, in order to reveal inequities in vaccination coverage. This information is applicable to guide geographical prioritization and immunization strategy design for increased equity. The implementation of a sustainable immunization service delivery based on local solutions, tailored to local needs, was investigated in Ethiopia by Manyazewal [ 227 ] using a continuous quality improvement approach. Duintjer Tebbens et al. [ 115 , 116 ] applied SD modeling to show the effect of polio under-vaccination on the immune response in populations of Pakistan and Afghanistan, thereby offering evidence for policymaking.

Except for the papers that provided decision support for the introduction of school-based HPV immunization targeting adolescents, no papers could be included, considering the inclusion criteria that were dedicated to supporting the delivery of SP4, Life-course and integration.

In the light of SP5, Outbreaks and Emergencies, two clusters of research resort [ 1 ]: anticipation and response to infectious disease outbreaks and [ 2 ] immunization during humanitarian crises.

First, related to anticipation and response, the prediction of disease outbreaks was tackled by Jaafar et al. [ 282 ] and Knerer et al. [ 283 ]. The authors present SD models to predict dengue outbreaks, in Malaysia and Thailand, respectively, and to evaluate combined vector-control and vaccination strategies taking into account weather conditions. In a cluster of papers, a vaccine stockpile design against a post-eradication polio outbreak was modeled by Duintjer Tebbens et al. [ 202 ] using an SD model. Later, a general vaccine stockpile design framework was proposed by Thompson et al. [ 260 ]. SD was also applied by Kalkowska et al. [ 262 ] to model polio immunity in northern Indian populations. To support outbreak response vaccination strategies during epidemics, Grais et al. [ 284 ] applied ABM to the 2003–2004 measles outbreak in Niamey. They concluded that early vaccination, and targeting a wider age range, has a larger effect with respect to managing the epidemic than putting effort and time in reaching a higher vaccination coverage in a specific age group. A similar conclusion was reached by Duijzer et al. [ 285 ] using an analytical model based on a generic case of an epidemic. In the aftermath of the 2009 H1N1 pandemic, model-based public health strategies for pandemic preparedness were investigated by Araz [ 286 ] using an SD model that considers vaccination, antiviral treatment, and non-medical interventions such as school closures. The economic impact and epidemic dynamics were evaluated on multiple criteria using Analytic Hierarchy Process along with different intervention strategies. Grefenstette et al. [ 287 ] applied ABM to census data in order to provide decision support to local authorities during epidemics. Learnings and data from the 2016 yellow fever epidemic in Angola led to the development of an adaptive vaccination strategy for Kinshasa, anticipating vaccine shortages, based on fractional dosing [ 288 ]. The 2014 outbreak in West Africa, the largest Ebola outbreak in history, exposed a painful need for a vaccine for this NTD and more adequate intervention policies. Based on data from Liberia, additional insights on missing data and human behavior during the epidemic, Pruyt et al. [ 289 ] and Auping et al. [ 290 ] developed SD models that are able to show the effect of different pro-active and reactive strategies based on available measures, such as quarantine, and -at the time- future measures, such as a vaccine. In a separate model, the authors investigate the effect of fear on health-seeking behavior and the effect of interventions on epidemic control.

Second, to support vaccination during humanitarian emergencies, research on implementable planning tools for humanitarian organizations by Gralla et al. [ 246 ] developed recommendations and concluded that heuristics-based approaches have a higher chance of being actually used compared to more complicated optimization approaches. A multi-sectoral perspective on the relations between extreme-weather-driven disasters, such as floods or droughts, and children’s health is mapped by Garcia and Sheehan [ 291 ] into a CLD which succeeds in providing an insightful overview of, on the one hand, risk factors (ecosystem and individual physical and mental health factors), and on the other hand, resilience factors (climate mitigation measures, health services, and individual coping factors). This research implies that reducing vulnerability and building individual child resilience is crucial, as immunity to VPDs under extreme-weather-driven disasters is often jeopardized.

To enable sustainable success for the immunization program, SP6 on Supply and Sustainability strives for a continued commitment to immunization materialized in vaccine supply and financial sustainability. The importance of safeguarding a national budget for health prevention and the vulnerability related to donor dependency was shown by the models of Bishai et al. [ 292 ] and Doherty et al. [ 152 ], respectively. However, broader and long-term planning models that cover multiple sectors related to different SDGs are required to design policies that encompass the EEH nexus. Similarly, these policies need to ensure fiscal sustainability needed to provide adequate health and immunization budgets.

The final strategic priority, SP7, covers Research & Innovation. A multitude of technical research papers was found, based on the search strategy, dedicated to innovations in vaccine cold chain technology, information technology, and vaccine delivery innovations. However, only the cloud-based surveillance demonstration project by Diallo et al. [ 185 ] contained a reusable demonstration project that sufficiently addressed the contributions to the SDGs, that involved human-related factors and that was context-relevant in order to be included.

In this Discussion section, we first examine the remaining hurdles in reaching the SDGs through immunization, along the lines and strategic priorities of the Immunization Agenda 2030. Second, we focus on hurdles specifically dealing with immunization sustainability, including the aspect of resilience and touching the current pandemic context. Third, we formulate some recommendations for future research.

Remaining hurdles in reaching the SDGs through immunization

Figure  5 in the Results shows large literature coverage differences across the SPs. These differences are as much a reflection of the magnitude of the topics behind the SPs as it is reflecting the historic emphasis on these SPs.

Indeed, as SP1 and SP2 jointly comprise the basis of the entire immunization system, including all of the systems building blocks, by bringing them together under two strategic priorities, de facto more focus is put on their functioning as a whole towards sustainable health outcomes instead of optimizing isolated subsystems. The model-based approaches that were found within this respect show promising approaches mainly based on CLDs and SD models. In addition, where SP1 represents the organization of the supply side of the immunization system as a human-made system, SP2 concerns leadership, decision making, and engagement from both the supply as well as the demand side. Moreover, the result of all efforts depends on the immune response, which belongs to the broader natural, biological system. Modeling these different dimensions requires transdisciplinary approaches and adequate modeling techniques that can deal with highly nonlinear phenomena resulting from feedback loops and delays. CLDs and SD models were found to be successful in this endeavor. A combination of systems thinking and implementation science can be put forward to accelerate universal access to vaccines for all children in Africa, even in the Covid19 situation [ 20 ]. In a related way, implementation design and intervention design are combined through a socio-ecological model of health, applied to routine immunization in Kyrgystan [ 293 ].

SP3, coverage and equity, gained more attention in recent years as it became clear that inequitable subnational coverage led to stagnating immunization levels and below-target health outcomes in SSA. Understanding and intervening in local under-immunization often require tailored approaches that combine context-specific vulnerability and limited access to immunization. Geographical information and spatial models combined with implementation science and human-centered design were deployed here. Moreover, these factors are interconnected in the SDG context, and their root causes largely lie outside the health system. Therefore, this strategy needs further research support both from the public health and from the Planetary Health community, in order to deliver feasible solutions to actual and future inequity in immunization coverage and health.

SP4, concerning lifelong immunization, has been added very recently to the strategic priorities, as it assumes an already functioning immunization system in place, in which an individual’s immunization status can be monitored. The duration of the protective effect of immunization determines the immunization efforts needed, and only targeting children for vaccination proves to be insufficient for the lifelong protection of a population against certain VPDs. In order to evaluate the feasibility and sustainability of lifelong immunization, the impact on the entire health system, from targeting adults and the elderly through new immunization delivery platforms to the acceptance by the population, must be understood and weighed against health outcomes depending on country-specific epidemiology. Lessons learned from HPV school-based vaccination provide an initial insight and a starting point for further research. SP5, outbreaks and emergencies, received more implementable research results as this SP is located at the crossing of disease surveillance and outbreak response immunization as part of the national immunization system. At the same time, it also includes research dedicated to humanitarian operations during crises. With respect to the speed and visibility of outbreaks and epidemics, the models are often centered around a SIR logic and focus exclusively on managing the epidemic. The challenges referring to the ability of the health system to cope with the outbreak and to continue routine immunization services, i.e., the existing health system’s resilience, has not been thoroughly investigated. Its importance, however, has been underlined again during the current COVID-19 pandemic [ 294 ].

Remaining hurdles with respect to sustainability

The challenges that came out of the literature review correspond with the Immunization Agenda 2030’s strategic priorities and core values. Under-addressed challenges include public-private partnerships, the role of sustainable innovation, cross-sectoral collaboration, and service coordination. In addition, root causes of infectious disease threat and mechanisms leading to inequitable immunization demand and access discussed in the Results section, are not directly addressed by the Immunization Agenda 2030 SPs, but appear as root causes for SP3, SP5, and SP6. Based on our review process, we did not find model-based solutions in the literature that relate interventions to these root causes with immunization and the SDGs. However, especially in the light of the COVID-19 pandemic, the need for actionable and sustainable policies to reduce the risk of future disease emergence is without a doubt.

Figure  6 represents the different stages in the immunization system and indicates challenges (A – F) when it comes to the sustainability of immunization, the prerequisite for realizing the impact on the SDGs by 2030 and beyond.

Immunization sustainability hurdles

It is interesting to observe that successful vaccination service boils down to the synchronization of the three fundamental flows that meet at the vaccination service point: (A) the person to be vaccinated needs to have proper access to the vaccination service in a fair and equitable way, (B) the vaccine has to be availability under the required conditions as a consequence of well-designed and operationally effective vaccine supply policies, and (C) the presence of a professional health care worker, supported by a well-performing health system benefiting from the transdisciplinary synergies of cross-sectoral collaboration and partnerships. Even after a successful vaccination, the job is not finished. Efficient surveillance needs to be in place to assess the local effectiveness of vaccination (D) and to detect possible pathogen adaptation, leading the complex interactions with the epidemiological part of the planetary-health system, such as the fact that vaccines can lead to an adapted, vaccine-derived strain of the pathogen, e.g., Polio. Furthermore, impacting the three flow confluent point, is the need for more regional and local production in LMICs (E), a sustainable way to increase resilience when it comes to global availability and equity. Also impacting are the efforts to develop affordable, safe and effective vaccines (F) through the appropriate and collaborative R&D actions in the field of existing and emerging vaccine technology platforms combined with technological innovations across the immunization system.

Unfortunately obvious, all of these vaccination hurdles are currently illustrated by the current pandemic. We can refer to limited access to vaccination for individuals within country-wide mass vaccination campaigns, including demand-side factors such as vaccine hesitancy (A); overloaded health care systems leading to multiple capacity-related bottlenecks, including human resources (B); the global availability of vaccines, not meeting both the time and volume expectations (C); the emergence of several local Covid19 variants, showcasing the importance of surveillance of local vaccine effectiveness (D); the absence of local vaccine production in LMICs, painfully highlighting the effects of vaccine nationalism and vaccine diplomacy (E); and the increased awareness that preparedness needs to kick-off with R&D efforts, manufacturing scale-up and country readiness, long before the outbreak, as promoted by global initiatives like CEPI, COVAX, etc. (F). Needless to state that CEPI’s quest for preparedness against disease ‘X’, is more than supported by the Covid19 vaccine development efforts.

Recommendations for future research

One of the main future contributions of the academic community lies in supporting decision-making and operational management by giving insight into how immunization contributes to the SDGs, and by supporting the design and implementation of valuable interventions to improve its long-term performance towards achieving the SDGs. In line with the core values of the Immunization Agenda 2030 and the criteria for relevant research by Kovacs & Moshtari [ 9 ] and Besiou et al. [ 10 ], the following recommendations for future research were derived, also illustrated in Fig.  7 .

First, in order to be sustainable, research should support the transformation of the immunization system towards stronger resilience to respond to highly nonlinear demand patterns (e.g., caused by information delays, the onset of an outbreak), adaptation mechanisms (e.g., triggered by pathogens or human behavior) and phase shifts (e.g., from routine immunization regimes to emergency response situations and back). The inherent complexity stems from the position of immunization at the interface between the natural system (the immune system) and the human-made system (the immunization system), in which the natural system ultimately sets the rules and determines the health outcomes (SDG3). Furthermore, research and humanitarian operations should support the immunization system not only to respond to but also to anticipate adaptation and increasing stress faced by the system (e.g., induced by climate change) by building resilience in stable times in between disruptive events.

Second, a transdisciplinary approach relying on systems thinking and involving both STEM (science, technology, engineering, and math) and SHAPE (social sciences, humanities, and the arts for people and the economy) experts is recommended [ 295 ] to realistically model the dynamic behavior of the immunization system, to model human behavior, to validate models, to accommodate missing data without relying on unreliable assumptions [ 296 , 297 ]. This approach often includes epidemiology, human-centered design, spatial modeling using GIS, health economics, operations management, and operational research. There is a huge opportunity to activate existing research results that focused on a single subsystem, e.g., the vaccine supply chain, as pieces of information to build the comprehensive systems models that connect the subsystems. High-leverage interventions can be found at the interfaces between the subsystems.

Third, interventions should be explicitly connected to the SDGs they contribute to, with a sufficiently long time horizon, e.g., till 2030 and beyond. Interventions based on innovations should be equally sustainable. Therefore, the introduction of a new vaccine, refrigerator technology, or vaccination strategy should be measured by their impact on the SDG3-indicators and other SDGs such as Local employment (SDG8), Equity (SDG10), or Clean energy (SDG7) throughout their lifetime. In this way, the effect of the intervention on overall system performance is measured by its impact on the SDGs, and interventions leading to optimal modes of operation for only a subsystem (e.g., measured by vaccine supply chain efficiency) will be differentiated from overall optimal interventions (e.g., measured by under-five mortality, epidemic risk, equity, employment).

Fourth, the implementation design must be part of the intervention design, such that the intervention is people-centered, feasible, and adapted to the context it is intended for. The investigation of the complexity of introduction, usage, and maintenance, as well as the necessary infrastructure and skills for the intervention to work, avoids under-target outcomes from theoretically sound but infeasible interventions. For instance, human-centered design with clear stakeholder engagement is needed in order to design the type of health information system that can work in a specific community, district, or country where a specific infrastructure, leadership style, or immunization demand exists. This is in line with the five-step health system design approach of Decouttere et al. [ 298 ].

Fifth, the result could be that tailored solutions are proposed instead of generic ones in case of different needs for immunization or accessibility. In such cases, when “home-grown” solutions lead to higher engagement and resilience, they may outperform generic solutions, especially under strain conditions. Only a bottom-up research approach is able to reveal these. Therefore, research needs to investigate the appropriate setting, characterized by communities, endemic regions of a specific disease (e.g., meningitis, malaria), urban settlements, districts, and humanitarian settings. These settings do not necessarily match the administrative unit, usually delineating the modeled setting.

Sixth, research that supports the coordination of programs and partnerships, taking into account the time dimension as well as the collaboration between public and private stakeholders, has hardly been found and is definitely needed.

Main insights

We performed a literature review covering (a) how immunization impacts the SDGs, (b) the factors that endanger the sustainability of immunization in LMICs (c) the research gap to enhance decision making for SDG-promoting implementations related to immunization.

By categorizing papers based on their SDG impact, it was confirmed that immunization can contribute to 14 of the 17 SDGs through direct and indirect mechanisms (see Background section, Fig. 1 ). SDG3 represents the core purpose of the immunization system, but due to the interconnectedness of the SDGs, investing in health entails increased productivity and economic development. This, in turn, reinforces the strengthening of the health system, creating a positive reinforcing relationship. In contrast, environmental health is not automatically positively impacted by both human health and economic development. For instance, population growth and anthropogenic disturbance of the natural system can trigger a change in disease ecology. This can lead to increased exposure to pathogens and infectious disease transmission. Moreover, both the exposure and the transmission occur in an inequitable fashion, further depriving already marginalized populations and thereby disproportionally increasing their vulnerability to infection. The way forward, as sketched by the SDGs, should reconcile the environment-economic-health effects without relying on trade-offs but by changing the paradigm from short-term human-focused Public health to SDG-supporting Planetary health . Such an approach takes into account the connections between the SDGs for intervention design and evaluation.

Sustainability challenges were found in all of the WHO’s Health Systems Building-Blocks, including population engagement and inequity in access to vaccination, resource limitations and workforce empowerment, vaccine supply sustainability, and governance and evidence-based decision support.

Model-based research found in literature offers implementable solutions to the sustainability challenges but needs to be further expanded in order to significantly support the WHO Immunization Agenda2030.

Recommendations for future research include a focus on resilience, transdisciplinary modeling, evaluating interventions based on the SDGs, modeling implementation along with intervention, design tailored solutions when needed, support coordination of services and partnerships.

For ease of reference, we list the basic insights from this paper in Table  7 .

Limitations

This work has several limitations when it comes to the completeness of the literature review. The keyword “sustainability” was not very effective, and even by applying exclusion and inclusion criteria, there were many more papers that could be mentioned. As the purpose was not a bibliographic review but rather an exploration of the SDG universe, the position of immunization in it, and how research can contribute to it, the paper sample was considered suitable for our purposes.

Relevance in times of COVID-19

As this work was written, the world witnessed the COVID-19 pandemic and its devastating effect, in line with what could be expected from the pre-2020 literature. The paths on the system map explain what is happening. However, as long as they have not led to solutions, they have no substantial impact in preparing the world for the humanitarian and economic shock wave that a pandemic causes on top of already existing epidemics, the threat of famine, and ongoing unrest. The current pandemic painfully exposes the weaknesses in existing health systems worldwide and affects the routine immunization services that will require great efforts to recover and avoid other disease outbreaks. For this reality, the research community needs to take up its role to support the transformation to more sustainable and resilient immunization systems.

Availability of data and materials

Not applicable.

Ensure healthy lives and promote well-being for all at all ages ( https://sustainabledevelopment.un.org/sdg3 )

2nd dose of measles-mumps-rubella vaccine

Human papillomavirus

Abbreviations

Agent Based Modeling

Community Health Workers

Causal Loop Diagram

Emerging Infectious Disease

Expanded Program on Immunization

Geographical Information System

Global Vaccine Action program

Human Immunodeficiency Virus

Human Papilloma Virus

Health System

Health System Strengthening

International Health Regulations

Integrated People-Centered Health Services

National Immunization Technical Advisory Group

Neglected Tropical Disease

Low and Middle Income Country

Official Development Assistance

Performance Based Financing

System Dynamics

Social sciences, Humanities and the Arts for People and the Economy

Supplemental Immunization Activities

Susceptible-Infectious-Recovered

Strategic Priorities

Sub Saharan Africa

Science, Technology, Engineering, and Maths

Universal Health Care

Vaccine Preventable Disease

Talisuna AO, Okiro EA, Yahaya AA, Stephen M, Bonkoungou B, Musa EO, et al. Spatial and temporal distribution of infectious disease epidemics, disasters and other potential public health emergencies in the World Health Organisation Africa region, 2016-2018. Glob Health. 2020;16(1):1–12.

Article   Google Scholar  

WHO. Immunization Agenda 2030. 2019.

Google Scholar  

World Health Organization. World Health Statistics 2017: Monitoring health for the sustainable development goals. World Health Organization. Geneva; 2017. 116.

Ozawa S, Clark S, Portnoy A, Grewal S, Brenzel L, Walker DG. Return on investment from childhood immunization in low- and middle-income countries, 2011–20. Health Aff. 2016;35(2):199–207.

Chiappelli F, Bakhordarian A, Thames AD, Du AM, Jan AL, Nahcivan M, et al. Ebola: translational science considerations. J Transl Med. 2015;13(1):11.

Article   PubMed   PubMed Central   Google Scholar  

Young HS, McCauley DJ, Dirzo R, Nunn CL, Campana MG, Agwanda B, et al. Interacting effects of land use and climate on rodent-borne pathogens in Central Kenya. Philos Trans R Soc B Biol Sci. 2017;372(1722):20160116.

Graham BS, Sullivan NJ. Emerging viral diseases from a vaccinology perspective: preparing for the next pandemic. Nat Immunol. 2018;19(1):20–8.

Article   CAS   PubMed   Google Scholar  

Whitmee S, Haines A, Beyrer C, Boltz F, Capon AG, de Souza Dias BF, et al. Safeguarding human health in the Anthropocene epoch: report of the Rockefeller Foundation–Lancet commission on planetary health. Lancet. 2015;386(10007):1973–2028.

Article   PubMed   Google Scholar  

Kovacs G, Moshtari M. A roadmap for higher research quality in humanitarian operations: a methodological perspective. Eur J Oper Res. 2019;276(2):395–408.

Besiou M, Stapleton O, Van Wassenhove LN. System dynamics for humanitarian operations. J Humanit Logist Supply Chain Manag. 2011;1(1):78–103.

de Savigny D, Adam T. Systems thinking for health systems strengthening; 2009.

Boischio A, Sánchez A, Orosz Z, Charron D. Health and sustainable development: challenges and opportunities of ecosystem approaches in the prevention and control of dengue and Chagas disease. Cad Saude Publica. 2009;25(suppl 1):S149–54.

Agyepong IA, Sewankambo N, Binagwaho A, Coll-Seck AM, Corrah T, Ezeh A, et al. The path to longer and healthier lives for all Africans by 2030: the lancet commission on the future of health in sub-Saharan Africa. Lancet. 2017;390(10114):2803–59.

Verguet S, Feldhaus I, Jiang Kwete X, Aqil A, Atun R, Bishai D, et al. Health system modelling research: towards a whole-health-system perspective for identifying good value for money investments in health system strengthening. BMJ Glob Heal. 2019;4(2):e001311.

Carey G, Malbon E, Carey N, Joyce A, Crammond B, Carey A. Systems science and systems thinking for public health: a systematic review of the field. BMJ Open. 2015;5(12):e009002.

Cassidy R, Singh NS, Schiratti P-R, Semwanga A, Binyaruka P, Sachingongu N, et al. Mathematical modelling for health systems research: a systematic review of system dynamics and agent-based models. BMC Health Serv Res. 2019;19(1):845.

Chughtai S, Blanchet K. Systems thinking in public health: a bibliographic contribution to a meta-narrative review. Health Policy Plan. 2017;32(4):czw159.

Cilenti D, Issel M, Wells R, Link S, Lich KH. System dynamics approaches and collective action for community health: an integrative review. Am J Community Psychol. 2019;63(3–4):527–45.

De Boeck K, Decouttere C, Vandaele N. Vaccine distribution chains in low- and middle-income countries: A literature review. Omega. 2020;97:102097.

Adamu AA, Jalo RI, Habonimana D, Wiysonge CS. COVID-19 and routine childhood immunization in Africa: leveraging systems thinking and implementation science to improve immunization system performance. Int J Infect Dis. 2020;98:161–5.

Article   CAS   PubMed   PubMed Central   Google Scholar  

Sheff MC, Bawah AA, Asuming PO, Kyei P, Kushitor M, Phillips JF, et al. Evaluating health service coverage in Ghana’s Volta region using a modified Tanahashi model. Glob Health Action. 2020;13(1):1732664.

Barnighausen T, Bloom DE, Cafiero-Fonseca ET, O’Brien JC. Valuing vaccination. Proc Natl Acad Sci. 2014;111(34):12313–9.

Bangert M, Molyneux DH, Lindsay SW, Fitzpatrick C, Engels D. The cross-cutting contribution of the end of neglected tropical diseases to the sustainable development goals. Infect Dis Poverty. 2017;6(1):73.

World health statistics 2020: monitoring health for the SDGs, sustainable development goals. Geneva: World Health Organization; 2020. Licence: CC BY-NC-SA 3.0 IGO.

Nelson KN, Wallace AS, Sodha SV, Daniels D, Dietz V. Assessing strategies for increasing urban routine immunization coverage of childhood vaccines in low and middle-income countries: a systematic review of peer-reviewed literature. Vaccine. 2016;34(46):5495–503.

Jimenez J. Vaccines - a wonderful tool for equity in health. Vaccine. 2001;19(17–19):2201–5.

Aung MN, Koyanagi Y, Yuasa M. Health inequality among different economies during early phase of COVID-19 pandemic. J Egypt Public Health Assoc. 2021;96(1):3.

Vale DB, Teixeira JC, Bragança JF, Derchain S, Sarian LO, Zeferino LC. Elimination of cervical cancer in low- and middle-income countries: inequality of access and fragile healthcare systems. Int J Gynecol Obstet. 2021;152(1):7–11.

Bowen KJ, Ebi KL. Governing the health risks of climate change: opportunities for regeneration in an age of planetary health. Curr Opin Environ Sustain. 2020;46:1–2.

Sami S, Mayai A, Sheehy G, Lightman N, Boerma T, Wild H, et al. Maternal and child health service delivery in conflict-affected settings: a case study example from upper Nile and Unity states, South Sudan. Confl Health. 2020;14(1):34.

Valadez JJ, Berendes S, Odhiambo J, Vargas W, Devkota B, Lako R, et al. Is development aid to strengthen health systems during protracted conflict a useful investment? The case of South Sudan, 2011–2015. BMJ Glob Heal. 2020;5(4):e002093.

Nyemba WR, Chinguwa S, Marango BL, Mbohwa C. Evaluation and feasibility assessment of the sustainability of refrigeration systems devoid of harmful refrigerants for storage of vaccines. Procedia Manuf. 2019;35:291–7.

Hartmann K, Pagliusi S, Precioso A. Landscape analysis of pharmacovigilance and related practices among 34 vaccine manufacturers’ from emerging countries. Vaccine. 2020;38(34):5490–7.

Pagliusi S, Ting CC, Lobos F, Datla M, Gao S, Homma A, et al. Vaccines: shaping global health. Vaccine. 2017;35(12):1579–85.

Décobert A. Partnerships for Universal Health Coverage in Myanmar: Power and Politics within ‘Immunisation Encounters’ in Kayah State and Kayin State. J Dev Stud. 2021;57(8):1267–81.

Mutabazi JC, Gray C, Muhwava L, Trottier H, Ware LJ, Norris S, et al. Integrating the prevention of mother-to-child transmission of HIV into primary healthcare services after AIDS denialism in South Africa: perspectives of experts and health care workers - a qualitative study. BMC Health Serv Res. 2020;20(1):582.

Andrus JK, Cochi SL, Cooper LZ, Klein JD. Combining global elimination of measles and rubella with strengthening of health systems in developing countries. Health Aff. 2016;35(2):327–33.

Mtema Z, Changalucha J, Cleaveland S, Elias M, Ferguson HM, Halliday JEB, et al. Mobile phones as surveillance tools: implementing and evaluating a large-scale Intersectoral surveillance system for rabies in Tanzania. PLoS Med. 2016;13(4):e1002002.

GAVI. Immunisation and the sustainable development goals. [cited 2021 Mar 23]. Available from: https://www.gavi.org/library/publications/gavi-fact-sheets/immunisation-and-the-sustainable-development-goals .

Decade of Vaccine Collaboration. Global Vaccine Action Plan 2011-2020, vol. 31: supp., Vaccine. Elsevier Ltd; 2013. p. B1–250. Available from: https://www.who.int/immunization/global_vaccine_action_plan/GVAP_doc_2011_2020/en/

COVAX: CEPI’s response to COVID-19 – CEPI [Internet]. [cited 2021 Mar 21]. Available from: https://cepi.net/COVAX/

Cleaveland S, Sharp J, Abela-Ridder B, Allan KJ, Buza J, Crump JA, et al. One health contributions towards more effective and equitable approaches to health in low- and middle-income countries. Philos Trans R Soc B Biol Sci. 2017;372(1725):20160168.

Salam RA, Das JK, Bhutta ZA. Integrating nutrition into health systems: What the evidence advocates. Matern CHILD Nutr. 2019;15(1, SI):e12738.

Myers SS. Planetary health: protecting human health on a rapidly changing planet. Lancet. 2017;390(10114):2860–8.

Antoine-Moussiaux N, Janssens de Bisthoven L, Leyens S, Assmuth T, Keune H, Jakob Z, et al. The good, the bad and the ugly: framing debates on nature in a one health community. Sustain Sci. 2019;14(6):1729–38.

Chatterjee P, Chauhan AS, Joseph J, Kakkar M. One health/EcoHealth capacity building programs in south and South East Asia: a mixed method rapid systematic review. Hum Resour Health. 2017;15(1):72.

Abbas SS, Kakkar M, Rogawski ET. Costs Analysis of a Population Level Rabies Control Programme in Tamil Nadu, India. PLoS Negl Trop Dis. 2014;8(2):e2721.

Canavese D, Ortega NRS. A proposal of a fuzzy rule-based system for the analysis of health and health environments in Brazil. Ecol Indic. 2013;34:7–14.

Morton S, Pencheon D, Squires N. Sustainable development goals (SDGs), and their implementation. Br Med Bull. 2017;124(1):1–10.

Bunch MJ. Ecosystem approaches to health and well-being: navigating complexity, promoting health in social-ecological systems. Syst Res Behav Sci. 2016;33(5):614–32.

Horton R, Beaglehole R, Bonita R, Raeburn J, McKee M, Wall S. From public to planetary health: a manifesto. Lancet. 2014;383(9920):847.

Lang T, Rayner G. Ecological public health: the 21st century’s big idea? An essay by Tim Lang and Geof Rayner. BMJ. 2012;345(aug21 1):e5466.

Hunter PR, Zmirou-Navier D, Hartemann P. Estimating the impact on health of poor reliability of drinking water interventions in developing countries. Sci Total Environ. 2009;407(8):2621–4.

Hsiao A, Hall AH, Mogasale V, Quentin W. The health economics of cholera: a systematic review. Vaccine. 2018;36(30):4404–24.

Brattig NW, Tanner M, Bergquist R, Utzinger J. Impact of environmental changes on infectious diseases: Key findings from an international conference in Trieste, Italy in May 2017. Acta Trop. 2021;213:105165.

Joffe M, Gambhir M, Chadeau-Hyam M, Vineis P. Causal diagrams in systems epidemiology. Emerg Themes Epidemiol. 2012;9(1):1.

Cerf ME. Sustainable development goal integration, interdependence, and implementation: the environment–economic–health Nexus and universal health coverage. Glob Challenges. 2019;3(9):1900021.

Chambers DA, Glasgow RE, Stange KC. The dynamic sustainability framework: addressing the paradox of sustainment amid ongoing change. Implement Sci. 2013;8(1):117.

Duintjer Tebbens RJ, Thompson KM. Priority shifting and the dynamics of managing eradicable infectious diseases. Manag Sci. 2009;55(4):650–63.

Barasa EW, Cloete K, Gilson L. From bouncing back, to nurturing emergence: reframing the concept of resilience in health systems strengthening. Health Policy Plan. 2017;32(suppl_3):iii91–4.

Blanchet K. Thinking shift on health systems: from blueprint health programmes towards resilience of health systems. Int J Heal policy Manag. 2015;4(5):307–9.

Jansen KU, Knirsch C, Anderson AS. The role of vaccines in preventing bacterial antimicrobial resistance. Nat Med. 2018;24(1):10–9.

Chen RT, Shimabukuro TT, Martin DB, Zuber PLF, Weibel DM, Sturkenboom M. Enhancing vaccine safety capacity globally: a lifecycle perspective. Am J Prev Med. 2015;33(4):D46–54.

Brandileone M-CC, Almeida SCG, Minamisava R, Andrade A-L. Distribution of invasive Streptococcus pneumoniae serotypes before and 5 years after the introduction of 10-valent pneumococcal conjugate vaccine in Brazil. Vaccine. 2018;36(19):2559–66.

Ojal J, Flasche S, Hammitt LL, Akech D, Kiti MC, Kamau T, et al. Sustained reduction in vaccine-type invasive pneumococcal disease despite waning effects of a catch-up campaign in Kilifi, Kenya: a mathematical model based on pre-vaccination data. Vaccine. 2017;35(35):4561–8.

Cleary S, Erasmus E, Gilson L, Michel C, Gremu A, Sherr K, et al. The everyday practice of supporting health system development: learning from how an externally-led intervention was implemented in Mozambique. Health Policy Plan. 2018;33(7):801–10.

Djukpen RO. Understanding the spatial and temporal patterns of measles infections in Nigeria. African Geogr Rev. 2005;24(1):71–91.

Oppenheim B, Gallivan M, Madhav NK, Brown N, Serhiyenko V, Wolfe ND, et al. Assessing global preparedness for the next pandemic: development and application of an epidemic preparedness index. BMJ Glob Heal. 2019;4(1):e001157.

Osakunor DNM, Sengeh DM, Mutapi F. Coinfections and comorbidities in African health systems: at the interface of infectious and noninfectious diseases. PLoS Negl Trop Dis. 2018;12(9):e0006711.

Banura C, Mirembe FM, Katahoire AR, Namujju PB, Mbidde EK. Universal routine HPV vaccination for young girls in Uganda: a review of opportunities and potential obstacles. Infect Agent Cancer. 2012;7(1):24.

Ratzan SC, Bloom BR, El-Mohandes A, Fielding J, Gostin LO, Hodge JG, et al. The Salzburg statement on vaccination acceptance. J Health Commun. 2019;24(5):581–3.

Handy LK, Maroudi S, Powell M, Nfila B, Moser C, Japa I, et al. The impact of access to immunization information on vaccine acceptance in three countries. PLoS One. 2017;12(8):e0180759.

Article   PubMed   PubMed Central   CAS   Google Scholar  

Larson HJ. The state of vaccine confidence. Lancet. 2018;392:2244–6.

Gatera M, Bhatt S, Ngabo F, Utamuliza M, Sibomana H, Karema C, et al. Successive introduction of four new vaccines in Rwanda: high coverage and rapid scale up of Rwanda’s expanded immunization program from 2009 to 2013. Vaccine. 2016;34:3420–6.

Dorji T, Tshomo U, Phuntsho S, Tamang TD, Tshokey T, Baussano I, et al. Introduction of a national HPV vaccination program into Bhutan. Vaccine. 2015;33(31):3726–30.

Guignard A, Praet N, Jusot V, Bakker M, Baril L. Introducing new vaccines in low- and middle-income countries: challenges and approaches. Expert Rev Vaccines. 2019;18(2):119–31.

Pool R, Munguambe K, Macete E, Aide P, Juma G, Alonso P, et al. Community response to intermittent preventive treatment delivered to infants (IPTi) through the EPI system in Manhiça, Mozambique. Trop Med Int Health. 2006;11(11):1670–8.

Pan WK, Seidman JC, Ali A, Hoest C, Mason C, Mondal D, et al. Oral polio vaccine response in the MAL-ED birth cohort study: considerations for polio eradication strategies. Vaccine. 2019;37(2):352–65.

Cutts FT, Ferrari MJ, Krause LK, Tatem AJ, Mosser JF. Vaccination strategies for measles control and elimination: time to strengthen local initiatives. BMC Med. 2021;19(1):1–8.

Huang W, Long H, Li J, Tao S, Zheng P, Tang S, et al. Delivery of public health services by community health workers (CHWs) in primary health care settings in China: a systematic review (1996–2016). Glob Heal Res Policy. 2018;3(1):18.

Walsh A, Matthews A, Manda-Taylor L, Brugha R, Mwale D, Phiri T, et al. The role of the traditional leader in implementing maternal, newborn and child health policy in Malawi. Health Policy Plan. 2018;33(8):879–87.

Al Gunaid M, Lami F, Jarour N. A collaborative initiative to strengthen sustainable public health capacity for polio eradication and routine immunization activities in the eastern Mediterranean region. JMIR Public Heal Surveill. 2019;5(4):e14664.

Gilmore B, McAuliffe E, Larkan F, Conteh M, Dunne N, Gaudrault M, et al. How do community health committees contribute to capacity building for maternal and child health? A realist evaluation protocol. BMJ Open. 2016;6(11):e011885.

Behl AS, Vijayaraghavan M, Nordin JD, Maciosek MV, Strebel PM. Community-level incentives to increase the use of vaccination services in developing countries: an idea whose time has come? Vaccine. 2010;28(38):6123–4.

Goga A, Feucht U, Zar HJ, Vanker A, Wiysonge CS, McKerrow N, et al. Neonatal, infant and child health in South Africa: reflecting on the past towards a better future. South African Med J. 2019;109(11b):83.

Article   CAS   Google Scholar  

Fiedler JL, Chuko T. The cost of child health days: a case study of Ethiopia’s enhanced outreach strategy (EOS). Health Policy Plan. 2008;23(4):222–33.

Tambo E, Ngogang JY, Ning X, Xiao NZ. Strengthening community support, resilience programmes and interventions in infectious diseases of poverty. East Mediterr Heal J. 2018;24(6):598–603.

Haines A, Sanders D, Lehmann U, Rowe AK, Lawn JE, Jan S, et al. Achieving child survival goals: potential contribution of community health workers. Lancet. 2007;369(9579):2121–31.

Kumar V, Kumar A, Ghosh AK, Samphel R, Yadav R, Yeung D, et al. Enculturating science: community-centric design of behavior change interactions for accelerating health impact. Semin Perinatol. 2015;39(5):393–415.

Amponsah-Dacosta E, Kagina BM, Olivier J. Health systems constraints and facilitators of human papillomavirus immunization programmes in sub-Saharan Africa: a systematic review. Health Policy Plan. 2020;35(6):701–17.

Srivastava S, Fledderjohann J, Upadhyay AK. Explaining socioeconomic inequalities in immunisation coverage in India: new insights from the fourth National Family Health Survey (2015-16). BMC Pediatr. 2020;20(1):295.

Chen YJ, Chindarkar N, Xiao Y. Effect of reliable electricity on health facilities, health information, and child and maternal health services utilization: evidence from rural Gujarat, India. J Heal Popul Nutr. 2019;38(1):7.

Arsenault C, Johri M, Nandi A, Mendoza Rodríguez JM, Hansen PM, Harper S. Country-level predictors of vaccination coverage and inequalities in Gavi-supported countries. Vaccine. 2017;35(18):2479–88.

Bosetti P, Poletti P, Stella M, Lepri B, Merler S, De Domenico M. Heterogeneity in social and epidemiological factors determines the risk of measles outbreaks. Proc Natl Acad Sci. 2020;117(48):30118–25.

Sherr K, Fernandes Q, Kanté AM, Bawah A, Condo J, Mutale W. Measuring health systems strength and its impact: experiences from the African health initiative. BMC Health Serv Res. 2017;17(S3):827.

Kruk ME, Ling EJ, Bitton A, Cammett M, Cavanaugh K, Chopra M, et al. Building resilient health systems: a proposal for a resilience index. BMJ. 2017;357(May):1–8.

Levine OS. What drivers will influence global immunizations in the era of grand convergence in global health? Vaccine. 2017;35:A6–9.

Jamison DT, Summers LH, Alleyne G, Arrow KJ, Berkley S, Binagwaho A, et al. Global health 2035: a world converging within a generation. Lancet. 2013;382(9908):1898–955.

Cerf ME. The sustainable development goals: contextualizing Africa’s economic and health landscape. Glob Challenges. 2018;2(8):1800014.

Mounier-Jack S, Burchett HED, Griffiths UK, Konate M, Diarra KS. Meningococcal vaccine introduction in Mali through mass campaigns and its impact on the health system. Glob Heal Sci Pract. 2014;2(1):117–29.

Haq Z, Shaikh BT, Tran N, Hafeez A, Ghaffar A. System within systems: challenges and opportunities for the expanded Programme on immunisation in Pakistan. Heal Res Policy Syst. 2019;17(1):51.

MacDonald NE, Harmon S, Dube E, Steenbeek A, Crowcroft N, Opel DJ, et al. Mandatory infant & childhood immunization: rationales, issues and knowledge gaps. Vaccine. 2018;36(39):5811–8.

Adam T. Advancing the application of systems thinking in health. Heal Res Policy Syst. 2014;12(1):50.

Bloom DE, Madhavan G. Vaccines: from valuation to resource allocation. Vaccine. 2015;33(S2):B52–4.

Heaton A, Krudwig K, Lorenson T, Burgess C, Cunningham A, Steinglass R. Doses per vaccine vial container: an understated and underestimated driver of performance that needs more evidence. Vaccine. 2017;35(17):2272–8.

Karp CL, Lans D, Esparza J, Edson EB, Owen KE, Wilson CB, et al. Evaluating the value proposition for improving vaccine thermostability to increase vaccine impact in low and middle-income countries. Vaccine. 2015;33(30):3471–9.

Dicko M, Souare B, Sarr LC, Gueye B. When technical achievements aren’t enough: lessons learned from efforts to catalyze policy action on supply chain in Senegal. Vaccine. 2017;35(17):2209–13.

Báscolo E, Cid C, Pablo Pagano J, Soledad Urrutia M, Del Riego A. The challenge of sustainability of expanded programs on immunization. Rev Panam Salud Pública. 2017;41:1.

González-Lorenzo M, Piatti A, Coppola L, Gramegna M, Demicheli V, Melegaro A, et al. Conceptual frameworks and key dimensions to support coverage decisions for vaccines. Vaccine. 2015;33(9):1206–17.

Pitman R, Fisman D, Zaric GS, Postma M, Kretzschmar M, Edmunds J, et al. Dynamic transmission modeling: a report of the ISPOR-SMDM modeling good research practices task Force-5. Value Heal. 2012;15(6):828–34.

Gessner BD, Kaslow D, Louis J, Neuzil K, O’Brien KL, Picot V, et al. Estimating the full public health value of vaccination. Vaccine. 2017;35(46):6255–63.

Howard N, Walls H, Bell S, Mounier-Jack S. The role of National Immunisation Technical Advisory Groups (NITAGs) in strengthening national vaccine decision-making: a comparative case study of Armenia, Ghana, Indonesia, Nigeria, Senegal and Uganda. Vaccine. 2018;36(37):5536–43.

Lee BY, Mueller LE, Tilchin CG. A systems approach to vaccine decision making. Vaccine. 2017;35:A36–42.

Dawa J, Chaves SS, Ba Nguz A, Kalani R, Anyango E, Mutie D, et al. Developing a seasonal influenza vaccine recommendation in Kenya: process and challenges faced by the National Immunization Technical Advisory Group (NITAG). Vaccine. 2019;37(3):464–72.

Duintjer Tebbens RJ, Pallansch MA, Cochi SL, Ehrhardt DT, Farag NH, Hadler SC, et al. Modeling poliovirus transmission in Pakistan and Afghanistan to inform vaccination strategies in Undervaccinated subpopulations. Risk Anal. 2018;38(8):1701–17.

Duintjer Tebbens RJ, Thompson KM. Evaluation of proactive and reactive strategies for polio eradication activities in Pakistan and Afghanistan. Risk Anal. 2019;39(2):389–401.

Brearley L, Eggers R, Steinglass R, Vandelaer J. Applying an equity lens in the decade of vaccines. Vaccine. 2013;31(SUPPL2):B103–7.

Rheingans R, Anderson JD, Bagamian KH, Laytner LA, Pecenka CJ, Gilani SSA, et al. Effects of geographic and economic heterogeneity on the burden of rotavirus diarrhea and the impact and cost-effectiveness of vaccination in Pakistan. Vaccine. 2018;36(51):7780–9.

Sadr-Azodi N, DeRoeck D, Senouci K. Breaking the inertia in coverage: mainstreaming under-utilized immunization strategies in the Middle East and North Africa region. Vaccine. 2018;36(30):4425–32.

Adedokun ST, Uthman OA, Adekanmbi VT, Wiysonge CS. Incomplete childhood immunization in Nigeria: a multilevel analysis of individual and contextual factors. BMC Public Health. 2017;17(1):236.

Eonomopoulou A, Pavli A, Stasinopoulou P, Giannopoulos LA, Tsiodras S. Migrant screening: lessons learned from the migrant holding level at the Greek-Turkish borders. J Infect Public Health. 2017;10(2):177–84.

Adams AM, Rabbani A, Ahmed S, Mahmood SS, Al-Sabir A, Rashid SF, et al. Explaining equity gains in child survival in Bangladesh: scale, speed, and selectivity in health and development. Lancet. 2013;382(9909):2027–37.

Phillips DE, Dieleman JL, Shearer JC, Lim SS. Childhood vaccines in Uganda and Zambia: determinants and barriers to vaccine coverage. Vaccine. 2018;36(29):4236–44.

Achoki T, Lesego A. The imperative for systems thinking to promote access to medicines, efficient delivery, and cost-effectiveness when implementing health financing reforms: a qualitative study. Int J Equity Health. 2017;16(1):53.

Javed S, Chattu VK. Strengthening the COVID-19 pandemic response, global leadership, and international cooperation through global health diplomacy. Heal Promot Perspect. 2020;10(4):300 –305–300–305.

Feldhaus I, Schütte C, Mwansa FD, Undi M, Banda S, Suharlim C, et al. Incorporating costing study results into district and service planning to enhance immunization programme performance: a Zambian case study. Health Policy Plan. 2019;34(5):327–36.

Goldhaber-Fiebert JD, Lipsitch M, Mahal A, Zaslavsky AM, Salomon JA. Quantifying Child Mortality Reductions Related to Measles Vaccination. PLoS One. 2010;5(11):e13842.

Kwamie A, van Dijk H, Agyepong IA. Advancing the application of systems thinking in health: realist evaluation of the leadership development Programme for district manager decision-making in Ghana. Heal Res Policy Syst. 2014;12(1):29.

Tumusiime P, Kwamie A, Akogun OB, Elongo T, Nabyonga-Orem J. Towards universal health coverage: reforming the neglected district health system in Africa. BMJ Glob Heal. 2019;4(Suppl 9):e001498.

Clements CJ, Watkins M, de Quadros C, Biellik R, Hadler J, McFarland D, et al. Researching routine immunization–do we know what we don’t know? Vaccine. 2011;29(47):8477–82.

Uzochukwu BSC, Okeke C, O’Brien N, Ruiz F, Sombie I, Hollingworth S. Health technology assessment and priority setting for universal health coverage: a qualitative study of stakeholders’ capacity, needs, policy areas of demand and perspectives in Nigeria. Glob Health. 2020;16(1):58.

De Vries H, Van Wassenhove LN. Do optimization models for humanitarian operations need a paradigm shift? Prod Oper Manag. 2019;29(1):55–61.

Akseer N, Rizvi A, Bhatti Z, Das JK, Everett K, Arur A, et al. Association of Exposure to civil conflict with maternal resilience and maternal and child health and health system performance in Afghanistan. JAMA Netw Open. 2019;2(11):e1914819.

Van Wassenhove LN. Humanitarian aid logistics: supply chain management in high gear. J Oper Res Soc. 2006;57(5):475–89.

Tambo E, Chengho CF, Ugwu CE, Wurie I, Jonhson JK, Ngogang JY. Rebuilding transformation strategies in post-Ebola epidemics in Africa. Infect Dis Poverty. 2017;6(1):71.

Shrivastava S, Shrivastava P. COVID-19 pandemic: ensuring health system sustainability through strengthening immunization activities. J Sci Soc. 2020;47(2):132.

Van Wassenhove LN. Sustainable innovation: pushing the boundaries of traditional operations management. Prod Oper Manag. 2019;28(12):2930–45.

Kirigia JM, Nabyonga-Orem J, Dovlo DYT. Space and place for WHO health development dialogues in the African region. BMC Health Serv Res. 2016;16(S4):221.

Shaikh BT, Hamid S, Hafeez A. Capacity building on health diplomacy: a training experience from Pakistan. East Mediterr Heal J. 2018;24(9):933–9.

Kamya C, Shearer J, Asiimwe G, Salisbury N, Waiswa P, Brinkerhoff J, et al. Evaluating Global Health partnerships: a case study of a Gavi HPV vaccine application process in Uganda. Int J Heal policy Manag. 2016;6(6):327–38.

Bennett B, Cohen IG, Davies SE, Gostin LO, Hill PS, Mankad A, et al. Future-proofing global health: governance of priorities. Glob Public Health. 2018;13(5):519–27.

Rasanathan JJKK, MacCarthy S, Diniz D, Torreele E, Gruskin S. Engaging human rights in the response to the evolving Zika virus epidemic. Am J Public Health. 2017;107(4):525–31.

Balabanova D, McKee M, Mills A, Walt G, Haines A. What can global health institutions do to help strengthen health systems in low income countries? Heal Res Policy Syst. 2010;8(1):22.

Arale A, Lutukai M, Mohamed S, Bologna L, Stamidis KV. Preventing Importation of Poliovirus in the Horn of Africa: The Success of the Cross-Border Health Initiative in Kenya and Somalia. Am J Trop Med Hyg. 2019;101(4_Suppl):100–6.

Kamya C, Abewe C, Waiswa P, Asiimwe G, Namugaya F, Opio C, et al. Uganda’s increasing dependence on development partner’s support for immunization – a five year resource tracking study (2012 – 2016). BMC Public Health. 2021;21(1):1–11.

Brenzel L. What have we learned on costs and financing of routine immunization from the comprehensive multi-year plans in GAVI eligible countries? Vaccine. 2015;33:A93–8.

Ozawa S, Grewal S, Portnoy A, Sinha A, Arilotta R, Stack ML, et al. Funding gap for immunization across 94 low- and middle-income countries. Vaccine. 2016;34(50):6408–16.

Griffiths UK, Bozzani FM, Chansa C, Kinghorn A, Kalesha-Masumbu P, Rudd C, et al. Costs of introducing pneumococcal, rotavirus and a second dose of measles vaccine into the Zambian immunisation programme: are expansions sustainable? Vaccine. 2016;34(35):4213–20.

Hanefeld J, Mayhew S, Legido-Quigley H, Martineau F, Karanikolos M, Blanchet K, et al. Towards an understanding of resilience: responding to health systems shocks. Health Policy Plan. 2018;33(3):355–67.

Haasis MA, Ceria JA, Kulpeng W, Teerawattananon Y, Alejandria M. Do Pneumococcal Conjugate Vaccines Represent Good Value for Money in a Lower-Middle Income Country? A Cost-Utility Analysis in the Philippines. PLoS One. 2015;10(7):e0131156.

Pfeiffer J, Gimbel S, Chilundo B, Gloyd S, Chapman R, Sherr K. Austerity and the “sector-wide approach” to health: the Mozambique experience. Soc Sci Med. 2017;187:208–16.

Doherty T, Besada D, Goga A, Daviaud E, Rohde S, Raphaely N. “If donors woke up tomorrow and said we can’t fund you, what would we do?” A health system dynamics analysis of implementation of PMTCT option B+ in Uganda. Global Health. 2017;13(1):51.

Nwude EC, Ugwoke RO, Uruakpa PC, Ugwuegbe US, Nwonye NG. Official development assistance, income per capita and health outcomes in developing countries: is Africa different? Cogent Econ Financ. 2020;8(1):1774970.

Cernuschi T, Gaglione S, Bozzani F. Challenges to sustainable immunization systems in Gavi transitioning countries. Vaccine. 2018;36(45):6858–66.

Saxenian H, Hecht R, Kaddar M, Schmitt S, Ryckman T, Cornejo S. Overcoming challenges to sustainable immunization financing: early experiences from GAVI graduating countries. Health Policy Plan. 2015;30(2):197–205.

Ikilezi G, Augusto OJ, Dieleman JL, Sherr K, Lim SS. Effect of donor funding for immunization from Gavi and other development assistance channels on vaccine coverage: evidence from 120 low and middle income recipient countries. Vaccine. 2020;38(3):588–96.

Akseer N, Salehi AS, Hossain SMMM, Mashal MT, Rasooly MH, Bhatti Z, et al. Achieving maternal and child health gains in Afghanistan: a countdown to 2015 country case study. Lancet Glob Health. 2016;4(6):e395–413.

McDonough A, Rodríguez DC. How donors support civil society as government accountability advocates: a review of strategies and implications for transition of donor funding in global health. Glob Health. 2020;16(1):1–18.

Fonjungo F, Banerjee D, Abdulah R, Diantini A, Kusuma ASW, Permana MY, et al. Sustainable financing for new vaccines in Indonesia: challenges and strategies. Sustain. 2020;12(21):1–14.

Griffiths UK, Asman J, Adjagba A, Yo M, Oguta JO, Cho C. Budget line items for immunization in 33 African countries. Health Policy Plan. 2020;35(7):753–64.

Chukwu E, Garg L, Eze G. Mobile health insurance system and associated costs: a cross-sectional survey of primary health centers in Abuja, Nigeria. JMIR mHealth uHealth. 2016;4(2):e37.

Blecher MS, Meheus F, Kollipara A, Hecht R, Cameron NA, Pillay Y, et al. Financing vaccinations - the south African experience. Vaccine. 2012;30(SUPPL.3):C79–86.

Brooks A, Habimana D, Huckerby G, Ma GH. Making the leap into the next generation: a commentary on how Gavi, the vaccine Alliance is supporting countries’ supply chain transformations in 2016-2020. Vaccine. 2017;35(17):2110–4.

Lee BY, Connor DL, Wateska AR, Norman BA, Rajgopal J, Cakouros BE, et al. Landscaping the structures of GAVI country vaccine supply chains and testing the effects of radical redesign. Vaccine. 2015;33(36):4451–8.

Blanchet K, Palmer J, Palanchowke R, Boggs D, Jama A, Girois S. Advancing the application of systems thinking in health: analysing the contextual and social network factors influencing the use of sustainability indicators in a health system – a comparative study in Nepal and Somaliland. Heal Res Policy Syst. 2014;12(1):46.

Falisse J-BBJ-BB, Ndayishimiye J, Kamenyero V, Bossuyt M. Performance-based financing in the context of selective free health-care: an evaluation of its effects on the use of primary health-care services in Burundi using routine data. Health Policy Plan. 2015;30(10):1251–60.

Nyirenda L, Flikke R. Frontline vaccinators and immunisation coverage in Malawi. Forum Dev Stud. 2013;40(1):27–46.

Burchett HED, Mounier-Jack S, Torres-Rueda S, Griffiths UK, Ongolo-Zogo P, Rulisa S, et al. The impact of introducing new vaccines on the health system: case studies from six low- and middle-income countries. Vaccine. 2014;32(48):6505–12.

Gallagher KE, Erio T, Baisley K, Lees S, Watson-Jones D. The impact of a human papillomavirus (HPV) vaccination campaign on routine primary health service provision and health workers in Tanzania: a controlled before and after study. BMC Health Serv Res. 2018;18(1):173.

Kasonde M, Steele P. The people factor: an analysis of the human resources landscape for immunization supply chain management. Vaccine. 2017;35(17):2134–40.

Etamesor S, Ottih C, Salihu IN, Okpani AI. Data for decision making: using a dashboard to strengthen routine immunisation in Nigeria. BMJ Glob Heal. 2018;3(5):e000807.

Mc Kenna P, Babughirana G, Amponsah M, Egoeh SG, Banura E, Kanwagi R, et al. Mobile training and support (MOTS) service-using technology to increase Ebola preparedness of remotely-located community health workers (CHWs) in Sierra Leone. mHealth. 2019;5:35.

Tesfaye B, Makam JK, Sergon K, Onuekwusi I, Muitherero C, Sowe A. The role of the Stop Transmission of Polio (STOP) program in developing countries: the experience of Kenya. BMC Public Health. 2020;20(1):1110.

Waithaka D, Kagwanja N, Nzinga J, Tsofa B, Leli H, Mataza C, et al. Prolonged health worker strikes in Kenya- perspectives and experiences of frontline health managers and local communities in Kilifi County. Int J Equity Health. 2020;19(1):1–15.

Dasgupta R, Sharma S, Sharma N, Banerjee K, Haran EGPGP, Muliyel JPP, et al. Successful switch (tOPV to bOPV) in India: tribute to a resilient health system. Vaccine. 2019;37(17):2394–400.

Farrenkopf BA, Lee C-W. Mapping health workforce development strategies across key global health agencies: an assessment of objectives and key interventions. Health Policy Plan. 2019;34(6):461–8.

Kumar M, Gotz D, Nutley T, Smith JB. Research gaps in routine health information system design barriers to data quality and use in low- and middle-income countries: a literature review. Int J Health Plann Manag. 2018;33(1):e1–9.

Odit MCA, Rwashana AS, Kituyi GM. Antecedents and dynamics for strategic alignment of health information Systems in Uganda. Electron J Inf Syst Dev Ctries. 2014;64(1):1–20.

Frøen JF, Myhre SL, Frost MJ, Chou D, Mehl G, Say L, et al. eRegistries: electronic registries for maternal and child health. BMC Pregnancy Childbirth. 2016;16(1):11.

Labrique AB, Vasudevan L, Kochi E, Fabricant R, Mehl G. Mhealth innovations as health system strengthening tools: 12 common applications and a visual framework. Glob Heal Sci Pract. 2013;1(2):160–71.

Mehl G, Labrique A. Prioritizing integrated mHealth strategies for universal health coverage. Science (80- ). 2014;345(6202):1284–7.

Mahadevan S, Broaddus-Shea ET. How should home-based maternal and child health records be implemented? A global framework analysis. Glob Heal Pract. 2020;8(1):100 –113–100–113.

Scobie HM, Edelstein M, Nicol E, Morice A, Rahimi N, MacDonald NE, et al. Improving the quality and use of immunization and surveillance data: summary report of the working Group of the Strategic Advisory Group of experts on immunization. Vaccine. 2020;38(46):7183–97.

Mihigo R, Okeibunor J, Anya B, Mkanda P, Zawaira F. Challenges of immunization in the African region. Pan Afr Med J. 2017;27(Suppl 3):12.

PubMed   PubMed Central   Google Scholar  

Diallo AO, Kiemtoré T, Bicaba BW, Medah I, Tarbangdo TF, Sanou S, et al. Development and Implementation of a Cloud-Based Meningitis Surveillance and Specimen Tracking System in Burkina Faso, 2018. J Infect Dis. 2019;220(Supplement_4):S198–205.

Patel JC, Soeters HM, Diallo AO, Bicaba BW, Kadadé G, Dembélé AY, et al. MenAfriNet: A Network Supporting Case-Based Meningitis Surveillance and Vaccine Evaluation in the Meningitis Belt of Africa. J Infect Dis. 2019;220(Supplement_4):S148–54.

Kim S, Lee J, Jung E. Mathematical model of transmission dynamics and optimal control strategies for 2009 a/H1N1 influenza in the Republic of Korea. J Theor Biol. 2017;412:74–85.

Fernandez-Luque L, Imran M. Humanitarian health computing using artificial intelligence and social media: a narrative literature review. Int J Med Inform. 2018;114:136–42.

Clarke KENN, Chibawe CP, Essiet-Gibson I, Mwansa FD, Jacenko S, Rhee C, et al. Strengths, pitfalls, and lessons learned in implementing electronic collection of childhood vaccination data in Zambia: the SmartCare experience. Int J Med Inform. 2019;129:146–53.

Aiga H, Nguyen VD, Nguyen CD, Nguyen TTT, Nguyen LTP. Fragmented implementation of maternal and child health home-based records in Vietnam: need for integration. Glob Health Action. 2016;9(1):29924.

Jarrett S, Wilmansyah T, Bramanti Y, Alitamsar H, Alamsyah D, Krishnamurthy KR, et al. The role of manufacturers in the implementation of global traceability standards in the supply chain to combat vaccine counterfeiting and enhance safety monitoring. Vaccine. 2020;38(52):8318–25.

Lloyd J, Cheyne J. The origins of the vaccine cold chain and a glimpse of the future. Vaccine. 2017;35(17):2115–20.

Lennon P, Atuhaire B, Yavari S, Sampath V, Mvundura M, Ramanathan N, et al. Root cause analysis underscores the importance of understanding, addressing, and communicating cold chain equipment failures to improve equipment performance. Vaccine. 2017;35(17):2198–202.

Robertson J, Franzel L, Maire D. Innovations in cold chain equipment for immunization supply chains. Vaccine. 2017;35(17):2252–9.

McCarney S, Robertson J, Arnaud J, Lorenson K, Lloyd J. Using solar-powered refrigeration for vaccine storage where other sources of reliable electricity are inadequate or costly. Vaccine. 2013;31(51):6050–7.

Friel S, Pescud M, Malbon E, Lee A, Carter R, Greenfield J, et al. Using systems science to understand the determinants of inequities in healthy eating. PLoS One. 2017;12(11):e0188872.

van den Ent MMVX, Yameogo A, Ribaira E, Hanson CM, Ratoto R, Rasolomanana S, et al. Equity and immunization supply chain in Madagascar. Vaccine. 2017;35(17):2148–54.

Jata Nyirenda L, Ingstad Sandberg K, Justice J. Forum for development studies when are health systems ready for new vaccines? The introduction of pneumococcal vaccine in Malawi when are health systems ready for new vaccines? The introduction of pneumococcal vaccine in Malawi. Forum Dev Stud. 2014;41:317–36.

Duijzer LE, van Jaarsveld W, Dekker R. Literature review: the vaccine supply chain. Eur J Oper Res. 2018;268(1):174–92.

Sato R, Thompson A, Sani I, Metiboba L, Giwa A, Femi-Ojo O, et al. Effect of vaccine direct delivery (VDD) on vaccine stockouts and number of vaccinations: case study from Bauchi state, Nigeria. Vaccine. 2021;39(9):1445–51.

Cernuschi T, Malvolti S, Nickels E, Friede M. Bacillus Calmette-Guérin (BCG) vaccine: a global assessment of demand and supply balance. Vaccine. 2017;36(4):498–506.

Duintjer Tebbens RJ, Pallansch MA, Alexander JP, Thompson KM. Optimal vaccine stockpile design for an eradicated disease: application to polio. Vaccine. 2010;28(26):4312–27.

Dellepiane N, Pagliusi S. Challenges for the registration of vaccines in emerging countries: differences in dossier requirements, application and evaluation processes. Vaccine. 2018;36(24):3389–96.

Buss PM, Chamas C, Faid M, Morel C. Development, health, and international policy: the research and innovation dimension. Cad Saude Publica. 2016;32(suppl 2):e00046815.

Cole CB, Trolle S, Edwards DJ. Developing the latest framework to measure and incentivise pharmaceutical industry contributions to health research and development. Heal Res Policy Syst. 2018;16(1):73.

Keith JA, Agostini Bigger L, Arthur PA, Maes E, Daems R. Delivering the promise of the decade of vaccines: opportunities and challenges in the development of high quality new vaccines. Vaccine. 2013;31:B184–93.

Plotkin S, Robinson JM, Cunningham G, Iqbal R, Larsen S. The complexity and cost of vaccine manufacturing – an overview. Vaccine. 2017;35(33):4064–71.

Pagliusi S, Dennehy M, Kim H. Vaccines, inspiring innovation in health. Vaccine. 2018;36(48):7430–7.

Luter N, Kumar R, Hozumi D, Lorenson T, Larsen S, Gowda B, et al. An updated methodology to review developing-country vaccine manufacturer viability. Vaccine. 2017;35(31):3897–903.

Jarrett S, Yang L, Pagliusi S. Roadmap for strengthening the vaccine supply chain in emerging countries: manufacturers’ perspectives. Vaccine X. 2020;5:100068.

Gadelha CAG, Braga PS da C, Montenegro KBM, Cesário BB. Access to vaccines in Brazil and the global dynamics of the health economic-industrial complex. Cad Saude Publica. 2020;36(suppl 2):e00154519.

Rappuoli R, Hanon E. Sustainable vaccine development: a vaccine manufacturer’s perspective. Curr Opin Immunol. 2018;53:111–8.

Eriksson P, Gessner BD, Jaillard P, Morgan C, Le Gargasson JB, Bernard J, et al. Vaccine vial monitor availability and use in low- and middle-income countries : a systematic review. Vaccine. 2017;35(17):2155–61.

Franceschi S, Clifford GM, Baussano I. Options for design of real-world impact studies of single-dose vaccine schedules. Vaccine. 2018;36(32):4816–22.

Kristensen D, Chen D. Strategies to advance vaccine technologies for resource-poor settings. Vaccine. 2013;31:B157–62.

Farmer P, Almazor CP, Bahnsen ET, Barry D, Bazile J, Bloom BR, et al. Meeting Cholera’s Challenge to Haiti and the World: A Joint Statement on Cholera Prevention and Care. PLoS Negl Trop Dis. 2011;5(5):e1145.

Le Menestrel M, Van Wassenhove LN. Subjectively biased objective functions. EURO J Decis Process. 2016;4(1–2):73–83.

Famakinde D. Mosquitoes and the lymphatic filarial parasites: research trends and budding roadmaps to future disease eradication. Trop Med Infect Dis. 2018;3(1):4.

Article   PubMed Central   Google Scholar  

Hotez PJ, Ferris MT. The antipoverty vaccines. Vaccine. 2006;24(31–32):5787–99.

Mackenzie GA, Plumb ID, Sambou S, Saha D, Uchendu U, Akinsola B, et al. Monitoring the introduction of pneumococcal conjugate vaccines into West Africa: design and implementation of a population-based surveillance system. PLoS Med. 2012;9(1):e1001161.

Homma A, da Silva Freire M, Possas C. Vaccines for neglected and emerging diseases in Brazil by 2030: the “valley of death” and opportunities for RD&I in Vaccinology 4.0. Cad Saude Publica. 2020;36(suppl 2):e00128819.

Vallès X, Stenseth NC, Demeure C, Horby P, Mead PS, Cabanillas O, et al. Human plague: An old scourge that needs new answers. PLoS Negl Trop Dis. 2020;14(8):e0008251.

Graham JE. Ebola vaccine innovation: a case study of pseudoscapes in global health. Crit Public Health. 2019;29(4):401–12.

Prausnitz MR, Goodson JL, Rota PA, Orenstein WA. A microneedle patch for measles and rubella vaccination: a game changer for achieving elimination. Curr Opin Virol. 2020;41:68–76.

Bazos DA, LaFave LRA, Suresh G, Shannon KC, Nuwaha F, Splaine ME. The gas cylinder, the motorcycle and the village health team member: a proof-of-concept study for the use of the microsystems quality improvement approach to strengthen the routine immunization system in Uganda. Implement Sci. 2015;10(1):30.

Hu Y, Luo S, Tang X, Lou L, Chen Y, Guo J, et al. Does introducing an immunization package of services for migrant children improve the coverage, service quality and understanding? An evidence from an intervention study among 1548 migrant children in eastern China. BMC Public Health. 2015;15(1):664.

Manyazewal T, Mekonnen A, Demelew T, Mengestu S, Abdu Y, Mammo D, et al. Improving immunization capacity in Ethiopia through continuous quality improvement interventions: a prospective quasi-experimental study. Infect Dis Poverty. 2018;7(1):119.

Manakongtreecheep K, Davis R. A review of measles control in Kenya, with focus on recent innovations. Pan Afr Med J. 2017;27(Suppl 3):15.

Deressa W, Kayembe P, Neel AH, Mafuta E, Seme A, Alonge O. Lessons learned from the polio eradication initiative in the Democratic Republic of Congo and Ethiopia: analysis of implementation barriers and strategies. BMC Public Health. 2020;20:1807.

Arsenault C, Harper S, Nandi A, Mendoza Rodríguez JM, Hansen PM, Johri M. Monitoring equity in vaccination coverage: a systematic analysis of demographic and health surveys from 45 Gavi-supported countries. Vaccine. 2017;35(6):951–9.

Fields R, Dabbagh A, Jain M, Sagar KS, Singh K. Moving forward with strengthening routine immunization delivery as part of measles and rubella elimination activities. Vaccine. 2013;31(2):B115–21.

Chauke-Moagi BE, Mumba M. New vaccine introduction in the east and southern African sub-region of the WHO African region in the context of GIVS and MDGs. Vaccine. 2012;30(SUPPL.3):C3–8.

Ngabo F, Levin A, Wang SA, Gatera M, Rugambwa C, Kayonga C, et al. A cost comparison of introducing and delivering pneumococcal, rotavirus and human papillomavirus vaccines in Rwanda. Vaccine. 2015;33(51):7357–63.

Soi C, Babigumira JB, Chilundo B, Muchanga V, Matsinhe L, Gimbel S, et al. Implementation strategy and cost of Mozambique’s HPV vaccine demonstration project. BMC Public Health. 2019;19(1):1406.

Clements CJ, Nshimirimanda D, Gasasira A. Using immunization delivery strategies to accelerate progress in Africa towards achieving the millennium development goals. Vaccine. 2008;26(16):1926–33.

Deconinck H, Hallarou M, Criel B, Donnen P, Macq J. Integrating acute malnutrition interventions into national health systems: lessons from Niger. BMC Public Health. 2016;16(1):249.

Riaz BK, Ali L, Ahmad SA, Islam MZ, Ahmed KR, Hossain S. Community clinics in Bangladesh: a unique example of public-private partnership. Heliyon. 2020;6(5):e03950.

Eze GU, Adeleye OO. Enhancing routine immunization performance using innovative Technology in an Urban Area of Nigeria. West Afr J Med. 2015;34(1):3–10.

CAS   PubMed   Google Scholar  

Dafilis MP, Frascoli F, McVernon J, Heffernan JM, McCaw JM. Dynamical crises, multistability and the influence of the duration of immunity in a seasonally-forced model of disease transmission. Theor Biol Med Model. 2014;11(1):43.

Bravo-Alcántara P, Pérez-Vilar S, Molina-León HF, Sturkenboom M, Black S, Zuber PLF, et al. Building capacity for active surveillance of vaccine adverse events in the Americas: a hospital-based multi-country network. Vaccine. 2018;36(3):363–70.

Amarasinghe A, Black S, Bonhoeffer J, Deotti SM, Dodoo A, Eskola J, et al. Effective vaccine safety systems in all countries : a challenge for more equitable access to immunization. Vaccine. 2013;31:B108–14.

Kelly-Cirino CD, Nkengasong J, Kettler H, Tongio I, Gay-Andrieu F, Escadafal C, et al. Importance of diagnostics in epidemic and pandemic preparedness. BMJ Glob Heal. 2019;4(Suppl 2):e001179.

World Health Organization. Vaccination in Acute Humanitarian Emergencies: Framework for Decision-Making. 2017. Available from: http://apps.who.int/iris/bitstream/10665/255575/1/WHO-IVB-17.03-eng.pdf?ua=1

Carland C, Goentzel J, Montibeller G. Modeling the values of private sector agents in multi-echelon humanitarian supply chains. Eur J Oper Res. 2018;269(2):532–43.

Mbengue MAS, Sarr M, Faye A, Badiane O, Camara FBN, Mboup S, et al. Determinants of complete immunization among senegalese children aged 12–23 months: evidence from the demographic and health survey. BMC Public Health. 2017;17(1):630.

Gralla E, Goentzel J. Humanitarian transportation planning: evaluation of practice-based heuristics and recommendations for improvement. Eur J Oper Res. 2018;269(2):436–50.

de Lima PA, Southgate R, Ahmed H, O’Connor P, Cramond V, Lenglet A. Infectious disease risk and vaccination in northern Syria after 5 years of civil war: the MSF experience. PLoS Curr. 2018;2:10.

Clarke A, Blidi N, Dahn B, Agbo C, Tuopileyi R, Rude MJ, et al. Strengthening acute flaccid paralysis surveillance post Ebola virus disease outbreak 2015–2017: the Liberia experience. Pan Afr Med J. 2019;33(Suppl 2):2.

Larson HJ, Lee N, Rabin KH, Rauh L, Ratzan SCOTTC. Building confidence to CONVINCE. J Health Commun. 2020;25(10):838–42.

Duintjer Tebbens RJ, Thompson KM. Using integrated modeling to support the global eradication of vaccine-preventable diseases. Syst Dyn Rev. 2018;34(1):78–120.

Brenzel L, Young D, Walker DG. Costs and financing of routine immunization: approach and selected findings of a multi-country study (EPIC). Vaccine. 2015;33(1):A13–20.

Gallagher KE, LaMontagne DS, Watson-Jones D. Status of HPV vaccine introduction and barriers to country uptake. Vaccine. 2018;36(32):4761–7.

Kim SS, Patel M, Hinman A. Use of m-health in polio eradication and other immunization activities in developing countries. Vaccine. 2017;35(10):1373–9.

Van Den Ent MMVX, Yameogo A, Ribaira E, Hanson CM, Ratoto R, Rasolomanana S, et al. Equity and immunization supply chain in Madagascar q. Vaccine. 2017;35(17):2148–54.

Deconinck H, Hallarou ME, Pesonen A, Gérard JC, Criel B, Donnen P, et al. Understanding factors that influence the integration of acute malnutrition interventions into the national health system in Niger. Health Policy Plan. 2016;31(10):1364–73.

World Health Organization (WHO), World Health Organization. Accessing Affordable and Timely Supply of Vaccines for use in Humanitarian Emergencies: the Humanitarian Mechanism. WHO working document. 2017.

Thompson KM, Duintjer Tebbens RJ. Using system dynamics to develop policies that matter: global management of poliomyelitis and beyond. Syst Dyn Rev. 2008;24(4):433–49.

Thompson KM, Duintjer Tebbens RJ. Modeling the dynamics of oral poliovirus vaccine cessation. J Infect Dis. 2014;210(Suppl 1):S475–84.

Thompson KM, Duintjer Tebbens RJ, Pallansch MA, Wassilak SGF, Cochi SL. Polio eradicators use integrated analytical models to make better decisions. Interfaces (Providence). 2015;45(1):5–25.

Thompson KM, Duintjer Tebbens RJ. Framework for optimal global vaccine stockpile Design for Vaccine-Preventable Diseases: application to measles and cholera vaccines as contrasting examples. Risk Anal. 2016;36(7):1487–509.

Duintjer Tebbens RJ, Pallansch MA, Kalkowska DA, Wassilak SGF, Cochi SL, Thompson KM. Characterizing poliovirus transmission and evolution: insights from modeling experiences with Wild and vaccine-related polioviruses. Risk Anal. 2013;33(4):703–49.

Kalkowska DA, Tebbens RJD, Thompson KM. Modeling strategies to increase population immunity and prevent poliovirus transmission in 2 high-risk areas in northern India. J Infect Dis. 2014;210(November):S398–411.

Rwashana AS. System dynamics modeling in healthcare: the Ugandan immunisation system. Int J Comput ICT Res Int J Comput ICT Res Spec Issue. 2008;1(1):85–98.

Semwanga Rwashana A, Willeese WD. Enhancing healthcare delivery through ICTs: A case study of the Ugandan immunisation system, International Journal of Education and Development using Information and Communication Technology (IJEDICT), vol. 4; 2008.

Rwashana AS, Williams DW, Neema S. System dynamics approach to immunization healthcare issues in developing countries: a case study of Uganda. Health Informatics J. 2009;15(2):95–107.

Rwashana AS, Nakubulwa S, Adam T. Applying a system dynamics modelling approach to explore policy options for improving neonatal health in Uganda. Heal Res Policy Syst. 2016;14(1):35.

Guttieres D, Sinskey AJ, Springs SL. Modeling framework to evaluate vaccine strategies against the COVID-19 pandemic. Systems. 2021;9(1):4.

McCormick BJJ, Waiswa P, Nalwadda C, Sewankambo NK, Knobler SL. SMART Vaccines 2.0 decision-support platform: a tool to facilitate and promote priority setting for sustainable vaccination in resource-limited settings. BMJ Glob Heal. 2020;5(11):e003587.

Renmans D, Holvoet N, Criel B. Combining theory-driven evaluation and causal loop diagramming for opening the ‘Black box’ of an intervention in the health sector: a case of performance-based financing in Western Uganda. Int J Environ Res Public Health. 2017;14(9):1007.

Alonge O, Lin S, Igusa T, Peters DH. Improving health systems performance in low- and middle-income countries: a system dynamics model of the pay-for-performance initiative in Afghanistan. Health Policy Plan. 2017;32(10):1417–26.

Sato R, Belel A. The effect of performance-based financing on child vaccinations in northern Nigeria. Vaccine. 2020;38(9):2209–15.

Utazi CE, Thorley J, Alegana VA, Ferrari MJ, Takahashi S, Metcalf CJE, et al. Mapping vaccination coverage to explore the effects of delivery mechanisms and inform vaccination strategies. Nat Commun. 2019;10(1):1–10.

Kivuti-Bitok LW, McDonnell G, Abdul R, Pokhariyal GP. System dynamics model of cervical cancer vaccination and screening interventions in Kenya. Cost Eff Resour Alloc. 2014;12(1):26.

Tetui M, Coe A-B, Hurtig A-K, Bennett S, Kiwanuka SN, George A, et al. A participatory action research approach to strengthening health managers’ capacity at district level in eastern Uganda. Heal Res Policy Syst. 2017;15(S2):110.

Gilson L, Elloker S, Olckers P, Lehmann U. Advancing the application of systems thinking in health: south African examples of a leadership of sensemaking for primary health care. Heal Res Policy Syst. 2014;12(1):30.

Sarriot E, Morrow M, Langston A, Weiss J, Landegger J, Tsuma L. A causal loop analysis of the sustainability of integrated community case management in Rwanda. Soc Sci Med. 2015;131:147–55.

Varghese J, Kutty VR, Paina L, Adam T. Advancing the application of systems thinking in health: understanding the growing complexity governing immunization services in Kerala, India. Heal Res Policy Syst. 2014;12(1):47.

Ozawa S, Paina L, Qiu M. Exploring pathways for building trust in vaccination and strengthening health system resilience. BMC Health Serv Res. 2016;16(S7):639.

Pananos AD, Bury TM, Wang C, Schonfeld J, Mohanty SP, Nyhan B, et al. Critical dynamics in population vaccinating behavior. Proc Natl Acad Sci U S A. 2017;114(52):13762–7.

Sarriot EG, Kouletio M, Jahan S, Rasul I, Musha A. Advancing the application of systems thinking in health: sustainability evaluation as learning and sense-making in a complex urban health system in northern Bangladesh. Heal Res Policy Syst. 2014;12(1):45.

Utazi CE, Thorley J, Alegana VA, Ferrari MJ, Takahashi S, Metcalf CJE, et al. High resolution age-structured mapping of childhood vaccination coverage in low and middle income countries. Vaccine. 2018;36(12):1583–91.

Jaafar IA, Zainal Abidin N, Mohd Jamil J. Modelling the prediction of dengue outbreak using system dynamics approach. J Teknol. 2016;78(6–4):107–13.

Knerer G, Currie CSM, Brailsford SC. Impact of combined vector-control and vaccination strategies on transmission dynamics of dengue fever: a model-based analysis. Health Care Manag Sci. 2015;18(2):205–17.

Grais RF, Conlan AJK, Ferrari MJ, Djibo A, Le Menach A, Bjørnstad ON, et al. Time is of the essence: exploring a measles outbreak response vaccination in Niamey, Niger. J R Soc Interface. 2008;5(18):67–74.

Duijzer LE, van Jaarsveld W, Dekker R. The benefits of combining early aspecific vaccination with later specific vaccination. Eur J Oper Res. 2018;271(2):606–19.

Araz OM. Integrating complex system dynamics of pandemic influenza with a multi-criteria decision making model for evaluating public health strategies. J Syst Sci Syst Eng. 2013;22(3):319–39.

Grefenstette JJ, Brown ST, Rosenfeld R, DePasse J, Stone NT, Cooley PC, et al. FRED (a framework for reconstructing epidemic dynamics): an open-source software system for modeling infectious diseases and control strategies using census-based populations. BMC Public Health. 2013;13(1):940.

Wu JT, Peak CM, Leung GM, Lipsitch M. Fractional dosing of yellow fever vaccine to extend supply: a modelling study. Lancet. 2016;388(10062):2904–11.

Pruyt E, Auping WL, Kwakkel JH. Ebola in West Africa: model-based exploration of social psychological effects and interventions. Syst Res Behav Sci. 2015;32(1):2–14.

Auping WL, Pruyt E, Kwakkel JH. Simulating endogenous dynamics of intervention-capacity deployment: Ebola outbreak in Liberia. Int J Syst Sci Oper Logist. 2017;4(1):53–67.

Garcia DM, Sheehan MC. Extreme weather-driven disasters and Children’s health. Int J Health Serv. 2016;46(1):79–105.

Bishai D, Paina L, Li Q, Peters DH, Hyder AA. Advancing the application of systems thinking in health: why cure crowds out prevention. Heal Res Policy Syst. 2014;12(1):28.

Schiavo R, Basu Roy U, Faroul L, Solodunova G. Grounding evaluation design in the socio-ecological model of health: a logic framework for the assessment of a national routine immunization communication initiative in Kyrgyzstan. Glob Health Promot. 2020;27(4):59–68.

Nelson R. COVID-19 disrupts vaccine delivery. Lancet Infect Dis. 2020;3099(20):30304.

Shah H. COVID-19 recovery: science isn’t enough to save us. Nature. 2021;591(7851):503.

Fisher MC, Murray KA. Emerging infections and the integrative environment-health sciences: the road ahead. Nat Rev Microbiol. 2021;19(3):133–5.

Adamu AA, Gadanya MA, Jalo RI, Uthman OA, Nnaji CA, Bello IW, et al. Assessing readiness to implement routine immunization among patent and proprietary medicine vendors in Kano, Nigeria: a theory-informed cross-sectional study. Expert Rev Vaccines. 2020;19(4):395–405.

Decouttere C, Vandaele N, Lemmens S, Bernuzzi M. The Vaccine Supply Chain Multathlon: the Reconciliation of Technology, Economy and Access to Medicines. In: Advances in Managing Humanitarian Operations. Cham: Springer International Publishing; 2016. p. 205–27. (International Series in Operations Research & Management Science).

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Acknowledgements

This research was supported by the GSK Research Chair on Re-Design of Healthcare Supply Chains in Developing Countries to increase Access-to-Medicines. KDB is funded by a PhD fellowship from the Research Foundation – Flanders. The funders had no role in the design and conduct of the study.

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CD analyzed and interpreted the literature, performed the analysis and did the major portion of the writing. NV constructed main structure of the body and joint writing. KDB was a contributor in writing and reviewing the manuscript. All authors read and approved the final manuscript.

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Decouttere, C., De Boeck, K. & Vandaele, N. Advancing sustainable development goals through immunization: a literature review. Global Health 17 , 95 (2021). https://doi.org/10.1186/s12992-021-00745-w

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DOI : https://doi.org/10.1186/s12992-021-00745-w

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Mechanism and application of fibrous proteins in diabetic wound healing: a literature review

Affiliations.

• 1 Shanghai Traditional Chinese Medicine Integrated Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
• 2 Institute of Interdisciplinary Integrative Medicine Research, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
• PMID: 39129915
• PMCID: PMC11309995
• DOI: 10.3389/fendo.2024.1430543

Diabetic wounds are more complex than normal chronic wounds because of factors such as hypoxia, reduced local angiogenesis, and prolonged inflammation phase. Fibrous proteins, including collagen, fibrin, laminin, fibronectin, elastin etc., possess excellent inherent properties that make them highly advantageous in the area of wound healing. Accumulating evidence suggests that they contribute to the healing process of diabetic wounds by facilitating the repair and remodel of extracellular matrix, stimulating the development of vascular and granulation tissue, and so on. However, there is currently a lack of a comprehensive review of the application of these proteins in diabetes wounds. An overview of fibrous protein characteristics and the alterations linked to diabetic wounds is given in this article's initial section. Next is a summary of the advanced applications of fibrous proteins in the last five years, including acellular dermal matrix, hydrogel, foam, scaffold, and electrospun nanofibrous membrane. These dressings have the ability to actively promote healing in addition to just covering wounds compared to traditional wound dressings like gauze or bandage. Research on fibrous proteins and their role in diabetic wound healing may result in novel therapeutic modalities that lower the incidence of diabetic wounds and thereby enhance the health of diabetic patients.

Keywords: diabetic foot ulcers; extracellular matrix; fibrous proteins; wound dressing; wound healing.

Copyright © 2024 Yan, Wang, Feng, Ni, Zhang, Cao, Zhou and Zhao.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Normal wound healing process, consisting…

Normal wound healing process, consisting of four main stages–hemostasis, inflammation, proliferation and remodeling…

Factors affecting diabetic wound healing.

Functions of fibrous proteins in…

Functions of fibrous proteins in four stages of normal wound healing.

Fibrous collagens; (A) Classification and…

Fibrous collagens; (A) Classification and sources, (B) Changes between normal wound and diabetic…

Functions of fibronection in diabetic…

Functions of fibronection in diabetic wound healing.

Mechanisms of fibrin in wound…

Mechanisms of fibrin in wound healing.

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