BACKGROUND: Pneumococcal infections are a major cause of morbidity and mortality globally, especially among children in low- and middle-income countries (LMICs). Although considerable research has been done on the frequency of pneumococcal infections and their risk factors, there are still many unanswered questions. The objective of this study is to offer fresh perspectives through systematic literature review on the shifting prevalence of and associated risk factors for pneumococcal colonization. METHODS: A systematic search of literature from January 2012 to December 2023 was conducted using PubMed and Scopus, with keywords related to Streptococcus pneumoniae colonization and risk factors, and references were manually screened. RESULTS: Studies from 41 different countries are included in the evaluation, which focuses on pediatrics patients who are most vulnerable to pneumococcal infections. The most frequent risk variables for pneumococcal colonization were having siblings, daycare centers, passive smoking, household characteristics, age, comorbidities, and vaccination status. The frequency of pneumococcal colonization was greatest among LMICs, which may be related to inadequate pneumococcal vaccination programs, densely populated areas, and a lack of knowledge about basic sanitation and hygiene. CONCLUSION: The study emphasizes how crucial it is to monitor serotype prevalence to direct vaccination campaigns in these regions. For creating efficient pneumococcal disease prevention and control strategies, it is essential to understand the risk factors connected to pneumococcal colonization. The review highlights the value of vaccination campaigns in lowering the prevalence of pneumococcal illness, to completely understand the relationship between immunization, serotype colonization, and the risk of pneumococcal colonization, more study is required especially in LIC and LMIC region.