Trends and determinants of taking tetanus toxoid vaccine among women during last pregnancy in Bangladesh: Country representative survey from 2006 to 2019

BACKGROUND: Tetanus occurring during pregnancy is still an important cause of maternal and neonatal mortality in developing countries. This study estimated the trend of tetanus toxoid (TT) immunization coverage from 2006 to 2019 in Bangladesh, considering socio-demographic, socio-economic, and geospatial characteristics. METHODS: The dataset used in this study was extracted from Multiple Indicator Cluster Surveys (2006, 2012–13, and 2019) including 28,734 women aged between 15–49 years. Data analysis was performed using cross-tabulation and logistic regression methods. Further, the spatial distribution of TT immunization coverage was also depicted. RESULTS: The trend of TT immunization (81.8% in 2006 to 49.3% in 2019) and that of taking adequate doses of TT (67.1% in 2006 to 49.9% in 2019) has gradually decreased throughout the study period. Among the administrative districts, North and South-West regions had lower coverage, and South and West regions had relatively higher coverage of both TT immunization and that of adequate doses. Antenatal TT immunization (any dosage, inadequate or adequate) was significantly associated with lower age (AOR = 3.13, 1.55–6.34), higher education (AOR = 1.20, 1.03–1.40), living in urban areas (AOR = 1.17, 1.03–1.34), having immunization card (AOR = 5.19, 4.50–5.98), using government facilities for birth (AOR = 1.41, 1.06–1.88), and receiving antenatal care (ANC) (AOR = 1.51, 1.35–1.69). In addition, living in urban areas (AOR = 1.31, 1.10–1.55), having immunization cards (AOR = 1.62, 1.36–1.92), and choosing others’ homes for birth (AOR = 1.37, 1.07–1.74) were significantly associated with adequate TT immunization. However, higher education (AOR = 0.57, 0.44–0.74), having poor wealth index (AOR = 0.65, 0.50–0.83), and receiving ANC (AOR = 0.76, 0.63–0.92) had lower likelihood of taking adequate TT immunization. CONCLUSIONS: The gradual decline in the TT immunization rate in the present study suggests the presence of variable rates and unequal access to TT immunization, demanding more effective public health programs focusing on high-risk groups to ensure adequate TT immunization.