Strengths and limitations of the study
The selected study design had the following strengths; Firstly, the facilities were their own controls hence buffering the effects of heterogeneity. Secondly, the stepped wedge design limited contamination of the intervention arm considering the socio nature of the intervention. Also, subgroup analysis of treatment effects of clusters and participants provided useful information for specific baseline characteristics of women. These findings could be used to tailor specific interventions for women.On the other hand, caution should be taken in generalizing the findings. The clusters were few and had a low power to determine true statistical differences. Secondly, observations collected soon after the roll-out of the intervention and observations collected after sometime could have been different which might have affected the overall treatment effect. Furthermore, only one session of orientation was done and this could have lessened the effect of the intervention. Also birth attendant details like sociodemographic characteristics and years of experience were not captured and could have affected the delivery of the intervention.