Inequalities in Second-Dose Measles Vaccination Coverage Among Children Aged 24–35 Months in Ethiopia

Background: Measles remains a significant public health challenge in Ethiopia, and the country has not achieved measles elimination despite the commitments outlined in the Immunization Agenda 2030. This study assessed inequalities in MCV2 vaccination among children aged 24–35 months in Ethiopia. Methods: This study used nationally representative data from the 2022/23 National Health Equity Survey, which employed a two-stage stratified cluster sampling design across all regions and city administrations. A total of 1987 mothers/caregivers of eligible children were interviewed. Descriptive statistics, bivariable analyses, and multivariable logistic regression were conducted using Stata 17 software, and determinants of MCV2 uptake were identified. Wealth-related inequality was assessed using concentration index analysis. Statistical significance was set at p < 0.05. Results: Overall MCV2 coverage was 60.4%. The multivariable analysis identified a significant inequality in second-dose measles vaccination (MCV2) in Ethiopia. Children born in health facilities had higher odds of vaccination (AOR = 1.88; 95% CI: 1.49–2.38), and maternal age of 25–34 years was associated with increased uptake compared to younger mothers (AOR = 2.03; 95% CI: 1.18–3.48). Postnatal care utilization and vitamin A supplementation strongly improved vaccination coverage, with children receiving vitamin A showing markedly higher odds of MCV2 uptake (AOR = 16.74; 95% CI: 9.61–29.14). Female children were more likely to be vaccinated than males (AOR = 1.50; 95% CI: 1.01–2.24), and higher maternal education (college or above) significantly increased uptake (AOR = 2.78; 95% CI: 1.02–7.73). Wealth status also influenced coverage. Conclusions: Improving MCV2 coverage in Ethiopia requires strengthening of maternal and child health services and promotion of integrated care, including PNC, vitamin A supplementation, and routine immunization. Early and consistent contact with the health system, along with addressing gaps in health education and supporting younger mothers, is essential. Persistent inequalities by place of birth, household wealth, and region highlight the need for targeted interventions. Strengthening equitable immunization services remains critical to achieving national and global measles elimination goals.