Spatial Determinants of Maternal and Child Mortality in North West Nigeria: A Multi-Level Geographic Analysis

Maternal and child mortality rates in Nigeria's North West geopolitical zone remain among the highest globally, reflecting the compounded effects of geographic isolation, facility-level care quality deficits, and social-cultural barriers that are spatially differentiated across states and local government areas in ways that standard aggregate analyses fail to reveal. This study conducts a multi-level geographic analysis of the spatial determinants of maternal and under-five child mortality in three North West states: Katsina, Sokoto, and Zamfara. State-level mortality data disaggregated to 120 LGAs were obtained from the 2023 Nigeria Demographic and Health Survey and Nigeria Health Facility Assessments. Geographic predictor variables included travel time to the nearest comprehensive emergency obstetric care facility, road surface condition index, community-level female literacy rate, poverty headcount, and health facility density per 10,000 population. Multi-level logistic regression models with LGA random effects were specified to decompose mortality variance between individual, community, and structural spatial levels. Geographically Weighted Regression was further applied to identify local non-stationarity in predictor-mortality relationships. Results confirm that travel time to comprehensive obstetric care is the single strongest structural predictor of maternal mortality at LGA level (OR = 2.14 per additional hour, 95% CI: 1.87 to 2.45), while female literacy rate is the dominant protective factor. GWR reveals that the travel time effect is stronger in northern Katsina and Zamfara than in Sokoto, suggesting differential road quality effects. The study makes an analytical contribution by introducing geographically weighted regression into maternal mortality research in North West Nigeria. Keywords: maternal mortality, child mortality, spatial analysis, North West Nigeria, health geography.