title: Maternal tetanus toxoid vaccination and neonatal mortality in rural north India.
abstract: OBJECTIVE
  Preventable 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.
  
  
  RESULTS
  Using 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.
  
  
  CONCLUSIONS
  Substantial 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.
authors.affiliation: Global Health & Social Care Unit, School of Health Sciences & Social Work, University of Portsmouth, Portsmouth, United Kingdom. abhi_iips@yahoo.co.in
authors.forename: Abhishek
authors.initials: A
authors.lastname: Singh
authors.forename: Saseendran
authors.initials: S
authors.lastname: Pallikadavath
authors.forename: Reuben
authors.initials: R
authors.lastname: Ogollah
authors.forename: William
authors.initials: W
authors.lastname: Stones
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006306:Health Surveys / Q000706:statistics & numerical data; D006801:Humans; D007194:India / Q000453:epidemiology; D007226:Infant Mortality; D007231:Infant, Newborn; D008427:Maternal Health Services / Q000706:statistics & numerical data; D011247:Pregnancy; D012424:Rural Population; D013742:Tetanus / Q000453:epidemiology / Q000401:mortality*; D013745:Tetanus Toxoid / Q000276:immunology*; D055815:Young Adult
chemical_list: D013745:Tetanus Toxoid