Abstract
ObjectivesPreventable neonatal mortality due to tetanus infection remains common. We aimed to examine antenatal vaccination impact in a context of continuing high neonatal mortality in rural northern India.Methods and FindingsUsing the third round of the Indian National Family Health Survey (NFHS) 2005–06, mortality of most recent singleton births was analysed in discrete-time logistic model with maternal tetanus vaccination, together with antenatal care utilisation and supplementation with iron and folic acid. 59% of mothers reported receiving antenatal care, 48% reported receiving iron and folic acid supplementation and 68% reported receiving two or more doses of tetanus toxoid (TT) vaccination. The odds of all-cause neonatal death were reduced following one or more antenatal dose of TT with odds ratios (OR) of 0.46 (95% CI 0.26 to 0.78) after one dose and 0.45 (95% CI 0.31 to 0.66) after two or more doses. Reported utilisation of antenatal care and iron-folic acid supplementation did not influence neonatal mortality. In the statistical model, 16% (95% CI 5% to 27%) of neonatal deaths could be attributed to a lack of at least two doses of TT vaccination during pregnancy, representing an estimated 78,632 neonatal deaths in absolute terms.ConclusionsSubstantial gains in newborn survival could be achieved in rural North India through increased coverage of antenatal TT vaccination. The apparent substantial protective effect of a single antenatal dose of TT requires further study. It may reflect greater population vaccination coverage and indicates that health programming should prioritise universal antenatal coverage with at least one dose.
Highlights
Neonatal tetanus is an important preventable cause of neonatal mortality
Substantial gains in newborn survival could be achieved in rural North India through increased coverage of antenatal tetanus toxoid (TT) vaccination
We aimed to examine antenatal vaccination impact in a context of continuing high neonatal mortality in rural northern India using data from a statistically generalisable population sample survey
Summary
Neonatal tetanus is an important preventable cause of neonatal mortality. Estimates from the year 2000 of the distribution of direct causes of death indicate that the infection accounts for 7% of neonatal deaths worldwide [1]. Despite a considerable global mortality decline over the last two decades, continued high incidence in some countries results in a continued high burden of deaths, with an estimated 130,000 newborn deaths in the year 2004 from neonatal tetanus [2]. Most of these deaths occur in a limited number of populous countries such as India and Nigeria [3,4] that have not yet managed to assure comprehensive health cover especially to rural communities. A recent systematic review estimated that neonatal tetanus contributed to between zero and 21% of the all neonatal deaths in India [6]
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