Background <p>Childhood immunization is a vital component of public health, preventing the spread of infectious diseases and reducing child mortality. This study examines variations in basic immunization coverage across districts and explores socio-demographic disparities in immunization coverage among children aged 12–23 months in Malawi.</p> Methods <p>The study employed a cross-sectional design, utilizing data from the 2016 MDHS, a nationally representative survey. The analysis included 3,248 children aged 12–23 months. Socio-demographic variables, including the child’s sex, maternal age, marital status (currently married), education, place of residence, region, wealth status, and employment status, were analysed using multivariate logistic regression models and a choropleth map to assess variations in basic immunization coverage across all 28 districts in Malawi.</p> Results <p>The results showed that only 77.1% of children aged 12–23 months received basic immunization. The findings also highlighted significant variations in immunization coverage across different socio-demographic groups and among the 28 districts of Malawi. The highest coverage rates, ranging from 84.9 to 90.7%, were observed in Mwanza and Chiradzulu districts, while the lowest rates, between 65.3% and 68.0%, were found in Ntchisi, Blantyre, and Machinga districts. Multivariable analysis further indicated that children whose mothers were from a high household wealth index (OR = 1.45, 95% CI = 1.15–1.82), residing in rural areas (OR = 1.55, 95% CI = 1.20–2.01), currently married (OR = 1.33, 95% CI = 1.10–1.61), and with secondary or higher education (OR = 1.57, 95% CI = 1.11–2.21) were more likely to receive basic immunization.</p> Conclusion <p>The study highlights low coverage of basic immunization in some districts as well as socio-demographic disparities in under-two immunization coverage in Malawi, necessitating tailored interventions such as educational campaigns and region-specific strategies.</p>