Spatial Analysis of Maternal Mortality and Healthcare Access in Adamawa State

Maternal mortality in Adamawa State remains unacceptably high by both national and international standards, reflecting persistent deficits in healthcare infrastructure, skilled birth attendant coverage, and geographic access to emergency obstetric care across the state's diverse North East geopolitical zone terrain. This study analyses the spatial distribution of maternal mortality and its association with healthcare access indicators across all 21 local government areas in Adamawa State. Maternal mortality ratio estimates derived from the 2023 Adamawa State Demographic and Health Survey were linked to spatial data on health facility locations, road network conditions, and travel time to the nearest comprehensive emergency obstetric care centre. Bivariate Moran's I and geographically weighted regression were applied to test spatial associations between mortality patterns and access variables. Survey interviews with 280 women of reproductive age in Ganye, Lamurde, and Jada LGAs collected data on antenatal care utilisation, delivery location, and perceived barriers to facility-based birth. Results identify a strong geographic concentration of high maternal mortality ratios in the southern highland and south-eastern border LGAs of Adamawa State, which are characterised by the longest travel times to comprehensive emergency obstetric care, frequently exceeding three hours during the rainy season when road conditions deteriorate. Recommendations include targeted deployment of skilled midwives to underserved LGAs, investment in all-season rural roads, and community health volunteer programmes to promote early referral. Keywords: maternal mortality, healthcare access, Adamawa State, North East Nigeria, obstetric care.