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Background Acute respiratory infection (ARI) is one of the leading causes of childhood morbidity and mortality. In Mauritania, very few children who experience ARI receive medical treatment. Additionally, inequalities in the care-seeking behaviour for ARI have not been assessed in the country.Objective To examine inequalities in care-seeking behaviour for childhood ARI in Mauritania and assess the extent to which they have changed between 2000–2001 and 2019–2021.Design A population-based cross-sectional study using the WHO health equity assessment toolkit.Setting Mauritania.Participants Under-five children.Primary and secondary outcome measures We utilised inequality measures, including Difference (D), Ratio (R), Population Attributable Fraction (PAF) and Population Attributable Risk (PAR). The results were disaggregated based on five dimensions of inequality. We calculated these measures separately for each of the two surveys and then compared their estimates.Results The proportion of care-seeking behaviour for ARI rose slightly from 45.2% in 2000–2001 to 46.4% in 2019–2021, reflecting an increase of only 1.2%. Rural-urban inequalities showed the largest decline between 2000–2001 (D=30.0; R=2.0; PAF=33.5, PAR=15.2) and 2019–2021 (D=12.0; R=1.3; PAF=17.4, PAR=8.1). Disparities based on wealth (2000–2001: D=40.3; R=3.0; PAF=34.6, PAR=15.6; 2019–2021: D=30.5; R=2.1; PAF=25.1, PAR=11.6) and maternal education (2000–2001: D=25.1; R=1.6; PAF=49.8, PAR=22.5; 2019–2021: D=19.1; R=1.4; PAF=34.1, PAR=15.8) were also reduced. Inequalities related to the sex of the child were minimal. However, discrepancies across subnational regions were evident in both survey rounds.Conclusion Care-seeking behaviour for ARI in Mauritania has shown slow progress over the past 20 years. Large inequalities persist, particularly by place of residence, wealth and maternal education. Efforts to strengthen equitable health service access should prioritise reducing geographic and socioeconomic disparities by targeting children from poor households, with less educated mothers, and living in rural areas to ensure all children benefit equally from healthcare services.