Background: Measles remains a significant public health threat, particularly in developing countries where it causes substantial morbidity and mortality among children under five. Despite global efforts to increase immunization coverage, low uptake of the second dose of the measles vaccine (Measles II) persists in various regions, including the Sefwi Wiawso Municipality in Ghana. This study investigates the factors contributing to low Measles II immunization coverage among children aged 0-59 months in this municipality.

Methods: This cross-sectional study employed a quantitative approach to gather data from 321 caregivers of under-five children attending Child Welfare Clinics (CWC) in Sefwi Wiawso Municipality. A structured questionnaire, designed in both English and the local dialect, was used to collect information on caregivers' sociodemographic characteristics, knowledge of Measles II immunization, and health system and community factors influencing vaccine uptake. Data were analyzed using SPSS version 23.0, with descriptive statistics and bivariate analysis employed to determine the association between variables.

Results: The study revealed high overall awareness of immunization among caregivers, with all respondents having attended CWC and being aware of the Measles II vaccine. Health workers were the primary source of information (69.2%), followed by radio (24.3%). Despite high awareness, several barriers to vaccine uptake were identified. The leading cause for not receiving Measles II was caregivers' busy schedules (51.7%), followed by concerns about side effects (33.3%) and lack of awareness about the second dose (15.0%). Sociodemographic analysis showed that age was a significant factor, with older caregivers demonstrating higher knowledge levels. The cost of immunization, although minimal (GH₵1.00), was a notable barrier, suggesting that even nominal fees could impede vaccine coverage in resource-limited settings.

Conclusion: The study concludes that both knowledge and accessibility significantly influence Measles II immunization coverage. While awareness is generally high, practical barriers such as caregivers' time constraints and vaccine cost hinder full immunization coverage. To improve Measles II uptake, it is recommended that immunization services be provided free of charge and that health education campaigns be intensified, focusing on flexible scheduling and addressing vaccine safety concerns.

Implications: The findings highlight the need for targeted interventions by health policymakers and stakeholders to address both knowledge and logistical barriers. Enhancing free access to vaccines and conducting comprehensive education campaigns can significantly improve immunization rates, thereby reducing the risk of measles outbreaks and enhancing child health outcomes in the Sefwi Wiawso Municipality and similar settings.