Trial design
We implemented a two-arm parallel cluster randomized controlled trial (CRCT), in which a cluster was defined as a health center (HC). According to the Ethiopian Ministry of Health classification of health facilities, a primary health care unit (PHU) is composed of a health center and five satellite health posts (HPs). A health center provides services to approximately 25,000 people altogether and provides both preventive and curative services. This study had two arms: intervention and control, and the clusters were randomized and assigned in a 1:1 ratio to the two arms. In the control health centers, the pregnant women received the routine Ethiopian government (EG) ANC, while in the intervention health centers, they received the ENAT intervention on top of the usual EG routine services. This study enrolled and followed up pregnant women from ANC booking to the end of pregnancy or loss to follow-up. As part of enrollment, this study collected baseline enrollment information via individual interviews at ANC booking, and after enrollment, data were extracted regularly from the routine ANC and delivery registration books.