Objective. To demonstrate proof of concept for a smart phoneempowered community health worker (CHW) model of care for breast health promotion, clinical breast examination (CBE), and patient navigation in rural Bangladesh. Methods. This study was a randomized controlled trial; July 1 to October 31, 2012, 30 CHWs conducted door-to-door interviews of women aged 25 and older in Khulna Division. Only women who disclosed a breast symptom were offered CBE. Arm A: smart phone with applications to guide interview, report data, show motivational video, and offer appointment for women with an abnormal CBE. Arm B: smart phone/ applications identical to Arm A plus CHW had training in "patient navigation" to address potential barriers to seeking care. Arm C: control arm (no smart phone; same interview recorded on paper). Outcomes are presented as the "adherence" (to advice regarding a clinic appointment) for women with an abnormal CBE. This study was approved by Women's College Hospital Research Ethics Board (Toronto, Ontario, Canada) and district government officials (Khulna, Bangladesh). Funded by Grand Challenges Canada. Results. In 4 months, 22,337 women were interviewed; ,1% declined participation, and 556 women had an abnormal CBE. Control group CHWs completed fewer interviews, had inferior data quality, and identified significantly fewer women with abnormal breast exams compared with CHWs in arms A and B. Arm B had the highest adherence. Conclusion. CHWs guided by our smart phone applications were more efficient and effective in breast health promotion compared with the control group. CHW "navigators" were most effective in encouraging women with an abnormal breast examination to adhere to advice regarding clinic attendance. The Oncologist 2014;19:177-185 Implications for Practice: In low-income countries such as Bangladesh, there are few opportunities for affordable, quality care for breast cancer. Gender inequity and cancer myths limit a woman's choice to seek care if she finds a breast lump.This is the first study to suggest that we can make an impact on breast cancer with basic training of community health workers guided by smart phone applications.With just 1 day of extra training in "patient navigation," we also show that social and cultural issues can be addressed, which improve the likelihood that women with a serious breast problem will attend for proper care.

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Background: Early child development is a crucial factor for children that controls health and well-being in later life. Aims: To determine the influence of sociodemographic factors on the Early Child Development Index (ECDI) among children aged < 5 years. Methods: The analysis was performed using cross-sectional survey data from 2019, 2017–2018 and 2018 Multiple Indicator Cluster Surveys from Bangladesh, Ghana and Costa Rica, respectively. We used the Chi-square test for bivariate analysis and binary logistic regression model for multivariate analysis for all 3 countries. All the statistical analyses were performed with IBM SPSS version 25 and R version 4.0.0. Results: Child age and sex, followed by maternal education level, economic status, child nutritional status, reading children’s books, and maternal functional difficulties had the greatest effect on ECDI. Children aged 36–47 months had lower odds of development than those aged 48–59 months, and boys had lower odds of development than girls in Bangladesh, Costa Rica and Ghana. Urban children had lower odds of development than rural children in Costa Rica but higher odds in Ghana. Conclusion: We recommend that governments should take the necessary steps to enhance children’s early development and well-being in all 3 countries by raising education, improving economic conditions and providing balanced nutrition.

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