Study design
WEST
The study was a pragmatic cluster randomized controlled trial, carried out between August 2013 and August 2014 at 70 health facilities in five districts in Oromiya Region, West Wollega Zone in Ethiopia. At the time of the trial the population was approximately 1,600,000 of which 90% lived in rural areas engaged in subsistence agriculture. The zone had 21 districts, of which 19 were rural. The zone had five hospitals (three governmental and two non-governmental), 53 health centres and 440 health posts (governmental). The area was characterized by long distances between villages and nearest towns and health facilities and a lack of infrastructure. The study was performed in the five districts of Nole Kaba, Haru, Homa, Genji and Gimbie. Utilization of maternal health services was generally low. In 2012 there were 2231 deliveries at the two hospitals, 1031 deliveries at health centres and 512 deliveries at health posts. The remaining births took place in villages unsupervised by trained health personnel. Only 30% receive antenatal care from skilled provider and less than 10% deliver supervised by a skilled birth attendant [