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The aim of our study was to compare GIS derived estimates to self\u2010reported travel times for patients traveling to a district hospital in rural Rwanda for emergency obstetric care.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Our study includes 664 women who traveled to undergo a Cesarean delivery in Kirehe, Rwanda. We compared self\u2010reported travel time from home to the hospital (excluding waiting time) with GIS estimated travel times, which were computed using the World Health Organization tool AccessMod, using linear regression.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The majority of patients used multiple modes of transportation (walking\u2009=\u200948.5%, public transport\u2009=\u200974.2%, private transport\u2009=\u20092.9%, and ambulance 70.6%). Self\u2010reported times were longer than GIS estimates by a factor of 1.49 (95% CI 1.40\u20131.57). Concordance was higher when the GIS model took into account that all patients in Rwanda are referred via their health center (<jats:italic>\u03b2<\/jats:italic>\u2009=\u20091.12; 95% CI 1.05\u20131.18).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>To our knowledge, in this largest to date GIS validation study for geographical access to healthcare in low\u2010 and middle\u2010income countries, a standard GIS model was found to significantly underestimate real travel time, which likely is in part because it does not model the actual route patients are travelling. Therefore, previous studies of 2\u2010h access to surgery will need to be interpreted with caution, and future studies should take local travelling conditions into account.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00268-020-05480-8","type":"journal-article","created":{"date-parts":[[2020,4,9]],"date-time":"2020-04-09T19:02:47Z","timestamp":1586458967000},"page":"2123-2130","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":38,"title":["Validating the Global Surgery Geographical Accessibility Indicator: Differences in Modeled Versus Patient\u2010Reported Travel Times"],"prefix":"10.1002","volume":"44","author":[{"given":"Niclas","family":"Rudolfson","sequence":"first","affiliation":[{"name":"Program in Global Surgery and Social Change, Department of Global Health and Social Medicine Harvard Medical School Boston USA"},{"name":"World Health Organization Collaborating Center for Surgery and Public Health, Department of 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Approvals were received from the Partners In Health\/Inshuti Mu Buzima (PIH\/IMB) Research Committee and the Rwandan National Health Research Committee, and ethical approvals from the Rwanda National Ethics Committee (Kigali, Rwanda; no. 848\/RNEC\/2016) and Partners Human Research Committee (Boston, Massachusetts, USA; no. 2016P001943\/MGH). The study was approved by the Rwandan Ministry of Health before the start of data collection.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Statement of informed consent and study approval"}}]}}