 was constrained by transport challenges, fear of contracting COVID-19 at the facility, and delays at the facility. This resulted in missed clinic appointments, use of traditional medicine, borrowing money to access private facilities, and feelings of distress.

Challenges in accessing health services
Transport to the facility. Women reported experiencing COVID-19 related challenges in accessing maternal and child health services. These included delays in getting travel permission from local authorities and a high cost of transport due to travel restrictions. Consequently, some women opted to walk long distances to the facility while pregnant or carrying babies; others borrowed money to access services from private clinics, while others postponed facility visitations.
My baby fell sick; but as I was about to reach the hospital for treatment, the police told us that they don't allow people to use motorcycles because of COVID-19, so they stopped, yet my baby was convulsing. Also, I had already paid my hard-earned money to the motorcyclist as transport costs, who even charged double the normal fare. I felt so bad … I had no option but to borrow money for transport and treatment and take him to the private clinic where he was given injections. ∼ 30 years Some women reported feeling distressed as a result of failing to get travel permission to take their sick children to the clinic.

Discussion
In this study, the majority of women with limited or no education were severely affected by the COVID-19 pandemic. They expressed the need for more information about the COVID-19 presentation, had not taken COVID-19 vaccination, reported having missed clinic visitations, and suffered financial distress and food insecurity. These women identified three main challenges constraining access to maternal and child health services during the current COVID-19 pandemic: lack of transport to the facility, unnecessary delays, and fear of contracting COVID-19 at the facility. This resulted in missed clinic appointments, use of traditional medicine, borrowing money to access private facilities, and feelings of distress. What follows is a discussion of these challenges in relation to how the use of SNTs can potentially be used to support maternal and child health during the COVID-19 crisis. Previous mHealth studies before the COVID-19 pandemic indicate potential benefits of using mHealth technologies to support maternal health during these challenging times. mHealth technology in form of an app composed of educational video and audio files, and SMS appointment reminders improved uptake of exclusive breastfeeding (adjusted odds ratio (AOR), 2.10; 95% CI 1.06-4.15) in India. 21 The use of SMS texts for clinic appointment reminders and health education increased attendance to postpartum visits among Kenyan women living with HIV. 22 Additionally, it has previously been shown that a mHealth technology in form of mobile phonebased multimedia (video/audio) app is useful in providing tailored maternal health information to women of limited to no education in Uganda. 12,19 During the current COVID-19 crisis, some of the hospital visitation requirements could potentially be avoided if women have access to some of these technologies.
The proliferation of SNTs brings about a novel phenomenon in which communities based on physical proximity are complemented by a much wider type of community formed by people who are linked by certain mutual interests or activities. These are known as virtual communities. With virtual communities, the limits of social connections are substantially extended and reconstituted as the traditional geographies of social groupings are opened up and reconfigured. The US Center for Disease Control and Prevention 23 encourages the use of SNTs (e.g. video chats) to connect people infected with COVID-19 with their families and friends. Virtual communities or social support groups (e.g. using WhatsApp groups or chat rooms) can bring together the otherwise geographically disconnected people to mutually interact and obtain access to virtual health-related social support. 24 Women who are COVID-19 survivors, women challenged with maternal and child health issues, those with active infection, and other quarantined women can share experiences, coping strategies, encourage one another, and keep connected to friends and family. This virtual communication can reduce the potential psychological effects of COVID-19 and maternal and child health challenges by providing opportunities to share feelings and lessen anger, stress, and depression. To maintain confidentiality and social anonymity on such virtual platforms, user identification numbers or pseudonyms, rather than people's actual names, may be preferred. Women experiencing other COVID-19-related challenges, such as domestic violence, job loss, or loss of a relative or friend, can also be given emotional support through virtual communities. Through such communities, good practices such as COVID-19 vaccination can be encouraged and physical distancing can as well be easily observed.
Studies utilizing SNTs (such as WhatsApp, Twitter, and Facebook) to support maternal and child health during this COVID-19 pandemic are lacking. In an online crosssectional survey conducted among 19,515 pregnant women in China, 91% (17,734) of the women used SNTs to obtain general health information, although only 3% (640) used online prenatal care services. 25 The authors also report that using online prenatal care services, making appointments with doctors electronically, or using social media to obtain health information was related to positive mental health outcomes (reduced depressive and anxiety symptoms). In addition, in China, access to antenatal care information via the hospitals' official social media accounts was associated with a significantly lower risk of perceived stress (adjusted odds ratio [aOR] 0.46; P =.001), anxiety (aOR 0.53; P <.001), and depression (aOR 0.73; P =.005). 26 In the United Kingdom, the use of social media-based support services (known as Facemums) hosted on Facebook during COVID-19 lockdown enabled pregnant women to access useful antenatal information and remote consultations, as well as reduced feelings of isolation. 27 Because the use of these technologies often does not involve traveling to the clinic, they can facilitate delivery of timely services, promote social distancing, improve access to health facilities, enable the provision of services to the isolated and/or contagious patients, and reduce overloading of health facilities. SNTs dedicated to providing maternal and child health services are lacking in Uganda, like in many other low-resourced settings (LRSs). Yet, such technologies would make it possible for women to access many forms of maternal health care with minimum COVID-19 exposure risk, which could potentially address the identified challenges of missed clinic visitations due to fears of contracting the virus.
Most countries especially in LRS rely on informal audience feedback through social media metrics (e.g. number of followers, number of likes), which do not provide proof of feasibility, acceptability, and impact analysis. There is a need for evaluation studies utilizing technology adoption models such as the Unified Theory of Acceptance and Use of Technology (UTAUT) model, which has a track record of predicting technology adoption in healthcare. 28 Moreover, the design and evaluation of SNTs should be informed by theories and frameworks related to social networking and behavioral change-an approach that has been shown to have positive effects on health behavioral change. 29 Importantly, health information disseminated through SNTs may not reach women who do not possess smartphones or who have no access to internet connections. This situation can result in a digital divide with inequity in access to important information and/or resources. Only 19% of people own smartphones in developing countries, compared to 72% in developed countries. 30 In Uganda, only 44% of the total population of Uganda has access to smartphones. 31 Audio files could also be used by those with feature phones, although this may require adding memory cards to the phones to extend their storage capacity.
Additionally, although access to affordable internet is increasingly becoming a development priority, the internet coverage rate of 45% in developing countries is low compared to the 81% in developed countries. 32 Access to the internet in Uganda is limited at just under 40%. 33 Using a stand-alone (offline) mHealth application to disseminate health education and promotion videos in the local language can enable access among illiterate populations and populations without access to the internet. 12 However, this automated approach constrains real-time interactions that can potentially minimize the effects of social isolation. Access is further restricted by unfavorable government regulations. For instance, in 2018, Uganda introduced social media tax of 200 Shilling (US$0.05) per day on all social media users-which potentially excludes poor populations from accessing health promotional messages shared on social media. Providing accessible and affordable SNTs requires collaborative efforts from all the key players including SNTs users, internet service (e.g. telephone companies) social media service providers (e.g. Google, Facebook), healthcare providers; and regulatory bodies.
Furthermore, technological usability skill gaps exist The low literacy levels in developing countries, standing at 50% in sub-Saharan Africa compared to 14% in developed countries also constrain technology usability skills. 34 Women may be affected more than men-10% of women, compared to 4% of men in Uganda have no education. 35 Only 33% of Ugandan women (aged 15-49) have achieved at least some secondary level of education. 36 Women with low levels of education are often unlikely to access reliable health information and utilize maternal and child services compared to women with secondary or higher education. 37 Moreover, most of SNTs sites often use the English language. Building local language-based SNTs can address the challenge of the language barrier for women with low levels of education.
Further, the ability of users (especially vulnerable populations) to understand the information shared on SNTs and to discern its quality warrants attention. For instance, there have also been concerns of misleading information about COVID-19 circulating on SNTs. 38 The desperate need for information during the crisis, the easiness of information dissemination via these technologies, and poor moderation of online content are the main drivers of misinformation dissemination. 39 The use of official SNTs (such as