Background: Maternal tetanus toxoid (MTT) vaccination during pregnancy remains an important factor for reducing infant mortality globally, especially in developing nations, including Bangladesh. Despite commendable progress in reducing child mortality through widespread MTT vaccination during pregnancy, the issue still exists. This analysis explores the impact of MTT vaccination on neonatal mortality in Bangladesh and identifies associated factors.

Methods: This research utilizes data from the 2019 Bangladesh Multiple Indicator Cluster Survey (MICS). The dataset consists of 23,402 cases; among them, 587 cases resulted in infant death. The outcome variable was infant mortality, which was binary. The independent variables identified as potential contributors to the cause of death included tetanus toxoid vaccination status, mode of delivery (cesarean section or not), and mother's education level, among others. The Poisson model was employed to analyze the data.

Results: The analyses showed that the neonatal mortality rate was 2.51%. Notably, 45.90% of mothers received the MTT vaccination during pregnancy. Among them, 23.07% received a single dose, and 22.82% took adequate doses (receiving more than two doses) and adhered to WHO guidelines. The adjusted incidence rate ratio (IRR) was 1.36, which indicates that there was a 36% higher risk of neonatal mortality for those children whose mothers did not take TT (IRR = 1.36, p = 0.081). We also found that women from middle-class households (IRR = 1.58, 95% CI = 0.98, 2.54) and women with higher parity (IRR = 1.96, 95% CI = 0.95, 4.03) also had a higher risk of newborn fatalities. A comparable trend has been observed regarding the correlation between the number of tetanus doses administered and neonatal mortality, where it also emphasizes the importance of receiving adequate doses (a minimum of 2 doses of tetanus vaccine) to mitigate neonatal mortality (adjusted IRR = 0.54, 95% CI = 0.29, 1.01) in comparison to no doses received.

Conclusion: Administering a minimum of one maternal tetanus dose significantly lowers the risk of neonatal mortality. Other than Maternal Tetanus Toxoid vaccination, the analyses underscore various contributors to neonatal mortality, encompassing maternal healthcare, delivery procedures, socio-economic status, and education. Targeted interventions addressing these factors have the potential to efficiently decrease neonatal mortality rates and improve overall maternal and child health.