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With rapid urbanisation, the need for HIAs to expand to lower and middle-income countries is increasing. By 2050, an estimated 2.5 billion people will have moved to cities, 90% of which concentrated in Asia and Africa. There is scattered evidence on the parameters, the strength and limitations of HIA methodologies exploring how exposure pathways affect morbidity and mortality in these regions.The systematic review is performed to take note of visions, methods and experiences in the field of HIA in LMICs. Systematic database searches of Medline, Scopus and Web of Science are performed and yield peer-reviewed studies, case studies, evaluation studies, reviews and opinion papers. As a complement, the database searches are augmented by bibliographic review, grey literature web search and expert consultation for identifying all relevant studies since December 2002.Results of this systematic review identify health impact assessments that have been conducted in LMICs and critically appraise them. The theoretical and practical underpinning for specific methods are presented and categorised across sectors relevant to population and environmental health. Particular attention is paid to the use of qualitative and quantitative methods in different scenarios and conditions. The approaches and experiences described in the papers build an evidence-based knowledge that will help assess the value and practicability of HIA processes across tropical regions.Despite the current application of different HIA methodologies worldwide, their relevance is dependent on geographical context and local socio-economic realities. The areas that afford more methodological robustness show potential to increase local human and technical capacity to integrate HIA as a regulatory mechanism in LMICs.