BackgroundEthiopia has the highest neonatal tetanus mortality and morbidity rates in the world due to low TT immunization coverage coupled with the high amount of deliveries taking place at home. This study aimed to identify individual and community-level factors associated with protections of last live birth against neonatal tetanus among mothers age 15–49 in Ethiopia.MethodsThe P-value of less than 0.05 in the final model was considered as statistically significant. The interclass correlation coefficient and proportional change in variance were used to quantify the magnitude of the general contextual effect. The relative goodness-of-fit test was conducted using Akaike's information criterion.ResultHome delivery (AOR = 0.83; 95% CI: 0.72, 0.96), at least one ANC visits (AOR = 12.35; 95% CI: 10.42, 14.62) and wealth index (poorer (AOR = 1.27, 95% CI: 1.04, 1.54) and richer (AOR = 1.53, 95% CI: 1.21, 1.93). were the individual factors that had an association with the utilization of protection of last live birth against neonatal tetanus.ConclusionsUtilization of protection of last live birth against neonatal tetanus is affected both by the individual and community level factors with high state variation.

Background: Neonatal tetanus is still the major public health problem in about 25 countries, mainly in Africa. Ethiopia has the highest neonatal tetanus mortality and morbidity rates in the world due to low TT immunization coverage coupled with the high amount of deliveries taking place at home. In Ethiopia, only 49% of the pregnant mothers received TT2+ in 2016. Objective: The objective of this study is to identify individual and community level factors associated with protections of last live birth against neonatal tetanus among mothers 15-49 years age in Ethiopia, evidence from Ethiopia Demographic and Health Survey 2016. Methods: The data for this study was obtained from Ethiopia Demographic and Health Survey of 2016. Population based cross-sectional study was conducted. The data were analyzed using Stata version 14. Variables that were significant in the bivariate multilevel logistic regression analysis were entered to the final model. Variables with p-value of less than 0.05 in the final model were considered as statistically significant. Interclass correlation coefficient and proportional change in variance were used to quantify the magnitude of the general contextual effect. Receiver operating characteristics curve was used to assess general accuracy of the model. Relative goodness-of-fit test was conducted using akaike’s information criterion.Results: This study depicted that, a total of 7193 women nested in 643 clusters were included in the analysis. The odds of protection of last live birth against neonatal tetanus were 1.27 and 1.53 times higher in mothers with poorer and richer respectively than mothers with poorest wealth index. Mothers who had antenatal care visit one and above had 12.3 times higher odds of protections of neonatal tetanus than those who had no antenatal care visits. The other significantly associated factors were place of delivery, region and community media exposure.Conclusion and recommendation: It can be concluded from the current study that protection of last live birth against neonatal tetanus is affected both by the individual and community level factors. Therefore, efforts to increase protection of last live birth against neonatal tetanus need to target both at individual and community level factors.