Study strengths and limitations
To the best of our knowledge, this study is one of a few studies that address improving the quality of intrapartum care in sub-Saharan Africa. Given the high rate of maternal mortality in the continent, it is surprising that many such interventions have previously not been conducted to improve the quality of care in labour, a period when women are most likely to die during childbirth. The adoption of a model based on initial formative research followed by co-design and implementation of the research by responsible health workers makes this approach particularly appealing and sustainable. The formative research, in particular, would help to identify areas of knowledge and skills gaps by health providers in the management of labour, which can then be rectified by specific training during the intervention.This study is limited by the fact that it was restricted to referral hospitals, rather than primary health centres that provide normal labour and delivery care. However, in view of the resource deficits currently prevailing in Nigeria’s primary health care system [