This study aimed to analyze factors associated with vaccine equity among children aged 12-23 months in Madagascar.

Data from the 2021 Madagascar Demographic and Health Survey were analyzed using descriptive and multivariate approaches. Variables included residence (urban/rural), maternal education, birth order, possession of a health card, and economic quintile. Associations were assessed using chi-square tests and logistic regression.

Overall vaccine coverage was 48.5% (95% CI = 46.4-50.5), higher in urban areas (58.4%) than rural areas (46.6%). Major disparities were observed according to maternal education (76.6% for educated mothers vs. 29.3% for uneducated) and birth order (56.1% for firstborns vs. 40.0% for birth order ≥4). Logistic regression showed that maternal education (OR = 5.6), birth order (OR = 2.3), and possession of a health card (OR = 0.1) were significantly associated with vaccine coverage.

Persistent social, economic, and geographic inequities continue to limit vaccine coverage. Targeted strategies, supported by digital tracking systems and adapted to local contexts, are essential to improve equitable access to vaccination services. Continuous evaluation and regular adjustment of interventions will be critical to ensure sustainable progress.