Abstract
Abstract
Background
To quantify travel-time accessibility to Emergency Obstetric and Newborn Care (EmONC) facilities across Adamawa State, Nigeria, and characterise referral connectivity between Basic EmONC (BEmONC) and Comprehensive EmONC (CEmONC) facilities.
Methods
Travel-time surfaces were computed using AccessMod version 5, a WHO-endorsed least-cost path modelling platform, incorporating a validated facility database, satellite-derived land cover, digital elevation data, road network data, and WorldPop 2020 population estimates across all 21 Local Government Areas (LGAs). Transport speed parameters were established through a participatory Travel Scenario Workshop. Population coverage was estimated at 30-, 60-, and 120-minute thresholds; inter-facility referral travel times were computed for all active BEmONC-to-CEmONC pathways.
Results
Against a state population of 5,444,999, motorized coverage was 81.2% within 30 minutes, 93.6% within 60 minutes, and 99.4% within 120 minutes; 0.6% remained beyond two hours. LGA-level disparities were pronounced: 30-minute coverage ranged from 100% in Yola North to 54% in Fufore and 56% in Mayo-Belwa, while Toungo remained below 93% at 120 minutes. The referral analysis identified 388 active pathways with a mean travel time of 50.8 minutes and a peak of 121 minutes; one-third exceeded 60 minutes.
Conclusions
Aggregate coverage figures conceal clinically significant access gaps in Adamawa's southern and peripheral LGAs. Some women face total care-seeking durations exceeding three hours when initial and referral journeys are combined. CEmONC upgrading at strategically identified sites, formalised emergency transport, and integration of geospatial evidence into health planning are required to close these gaps.