ArticleWorld journal of surgery2020
Validating the Global Surgery Geographical Accessibility Indicator: Differences in Modeled Versus Patient-Reported Travel Times.
Article in World journal of surgery, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 29 papers, 2 of them syntheses that pooled it.
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Who cites it
29 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- How applicable is geospatial analysis in maternal and neonatal health in sub-Saharan Africa? A systematic review.Journal of global health · 2022Pooled it
- Assessing trauma care systems in low-income and middle-income countries: a systematic review and evidence synthesis mapping the Three Delays framework to injury health system assessments.BMJ global health · 2021Pooled it
- What Is the Need for and Access to Trauma Surgery in Low- and Middle-Income Countries? A Scoping Review.World journal of surgery · 2025Article
- Community Perceptions of Accessing Surgical and Anesthetic Care in Rural Guatemala: A Cross-Sectional Survey.Cureus · 2025Article
- Expanding Global Surgery Services to Include Reduction Mammaplasty Procedures.Plastic and reconstructive surgery. Global open · 2025Article
- The Burden of Plastic Surgery in Rural Kenya: The Kapsowar Hospital Experience.Plastic and reconstructive surgery. Global open · 2024Article
- Improving accessibility to radiotherapy services in Cali, Colombia: cross-sectional equity analyses using open data and big data travel times from 2020.International journal for equity in health · 2024Article
- Travel time to cataract surgical services in Kenya, Malawi and Rwanda: demonstrating a standardised indicator of physical access to cataract surgery.Eye (London, England) · 2024Article
- Geospatial determinants of health: A global surgery lens.Journal of the colleges of medicine of South Africa · 2024Article
- Health system assessment for access to care after injury in low- or middle-income countries: A mixed methods study from Northern Malawi.PLoS medicine · 2024Article
- Impacts of seasonal flooding on geographical access to maternal healthcare in the Barotse Floodplain, Zambia.International journal of health geographics · 2023Article
- Geospatial Analysis of Accessibility to Surgical Care, a Brazilian Local Perspective.World journal of surgery · 2023Article
- Mapping population access to essential surgical care in Liberia using equipment, personnel, and bellwether capability standards.The British journal of surgery · 2023Observational
- Long travel times from health center to hospital reduce caesarean section access: a study from Kirehe District, Rwanda.The Pan African medical journal · 2023Article
- Estimating access to surgical care: A community centered national household survey from Pakistan.PLOS global public health · 2023Article
- Comparing absolute and relative distance and time travel measures of geographic access to healthcare facilities in rural Haiti.BMJ open · 2022Article
- Toward Equitable Access to Tertiary Cancer Care in Rwanda: A Geospatial Analysis.JCO global oncology · 2022Article
- Comparing modelled with self-reported travel time and the used versus the nearest facility: modelling geographic accessibility to family planning outlets in Kenya.BMJ global health · 2022Article
- Travel of pregnant women in emergency situations to hospital and maternal mortality in Lagos, Nigeria: a retrospective cohort study.BMJ global health · 2022Article
- Use of geospatial analysis for priority setting in surgical system investment in Guatemala.Lancet regional health. Americas · 2022Article
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Authors and funding
9 authors.
Funding
Abstract
backgroundSince long travel times to reach health facilities are associated with worse outcomes, geographic accessibility is one of the six core global surgery indicators; this corresponds to the second of the "Three Delays Framework," namely "delay in reaching a health facility." Most attempts to estimate this indicator have been based on geographical information systems (GIS) algorithms. The aim of our study was to compare GIS derived estimates to self-reported travel times for patients traveling to a district hospital in rural Rwanda for emergency obstetric care.
methodsOur study includes 664 women who traveled to undergo a Cesarean delivery in Kirehe, Rwanda. We compared self-reported 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.
resultsThe majority of patients used multiple modes of transportation (walking = 48.5%, public transport = 74.2%, private transport = 2.9%, and ambulance 70.6%). Self-reported times were longer than GIS estimates by a factor of 1.49 (95% CI 1.40-1.57). Concordance was higher when the GIS model took into account that all patients in Rwanda are referred via their health center (β = 1.12; 95% CI 1.05-1.18).
conclusionsTo our knowledge, in this largest to date GIS validation study for geographical access to healthcare in low- and middle-income 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-h access to surgery will need to be interpreted with caution, and future studies should take local travelling conditions into account.
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