Strengths and limitations of the study
To the best of our knowledge, this is the first study in rural Gamo zone, southern Ethiopia to evaluate the impact of a package of community-based interventions on institutional delivery. However, the study had some limitations. First, the reliance on participant reports could have introduced social desirability bias. Second, although the clusters were randomly assigned to the intervention and control arms, there was cluster-level variability in background characteristics. These differences could have resulted in control arm participants having better access to information and resources than those in the intervention arm. Nevertheless, it is remarkable that the intervention arm achieved awareness of obstetric danger signs, birth preparedness practices, and selection of health facilities for childbirth comparable to or even higher than the control arm.