Conflict hotspot trajectories and immunization coverage in Nigeria: A descriptive spatial analysis of ACLED and DHS data from 2010 to 2024

Background In Nigeria, persistent conflict has disrupted essential health services, especially in regions affected by insurgency, communal violence, and banditry. Routine childhood immunization remains uneven, and coverage of the third dose of diphtheria, tetanus, and pertussis (DTP3), an indicator of health system performance, varies widely and lags in several states. This study examines the spatial relationship between conflict hotspot trajectories and DTP3 coverage across Nigerian states from 2010 to 2024 using publicly available geocoded data. Methods We conducted a descriptive spatial analysis using Armed Conflict Location and Event Data (ACLED, 2010–2024) and state-level DTP3 coverage from the 2018 Nigeria Demographic and Health Survey (DHS). Conflict events were aggregated by state and year via point-in-polygon attribution. We assessed global spatial autocorrelation with Moran’s I and identified annual hotspots using Local Getis–Ord Gi* (queen contiguity, row-standardized weights). We overlaid 2018 Gi* classifications on the 2018 DTP3 map for descriptive comparison. Results Conflict events showed significant positive spatial autocorrelation in 2012, 2014, 2015, and 2017, with the highest value in 2014 (I = 0.236, z = 4.23, p < 0.001). Local Gi* flagged four hotspot states in 2014 (Adamawa, Borno, Gombe, Yobe) and two in 2018 (Adamawa, Gombe); most states were neutral in mapped years, and no cold spots were detected. In 2018, DTP3 coverage ranged from 7.2% to 93.0% (mean 56.1%, median 58.7%). The 2018 hotspot states fell below the national mean, indicating geographic convergence of conflict clustering and immunization gaps. Conclusions Conflict hotspots in Nigeria tend to align with areas of suboptimal DTP3 coverage. Spatial surveillance can help identify fragile zones, strengthen situational awareness, and guide targeted immunization strategies to improve equity and health-system resilience.