The study setting was Cross River State in the south-south geopolitical zone of Nigeria. It is one of the 36 States in Nigeria with approximately three million people. The State is divided into three senatorial districts: the northern, central and southern. There are 18 Local Government Areas (LGAs) which are unevenly distributed in the three senatorial districts of the State: south (seven LGAs), central (six LGAs) and north (five LGAs). Each LGA is further subdivided into Wards, with10 to 13 Wards in each LGA. Each Ward is comprised of villages. Every village is led by a village head (a traditional leader). Every Ward has a clan head, selected among the village heads within the Ward. The village heads, with their respective clan head, constitute the Council of Chiefs in each Ward.

Local Government Areas were eligible to be included in the study if they had a Primary Health Care Centre, and Ward Development Committees, and if they had no security issues. Eight were included in total, with four intervention and four control.

The study team paid courtesy visit to the selected participants for the training in the company of the Ward Focal Person. They were presented with an invitation letter and the purpose of the intervention explained to them.

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