A Community-Led Central Kitchen Model for School Feeding Programs in the Philippines: Learnings for Multisectoral Action for Health

In devolved governments like the Philippines, local government units (LGUs) must be engaged to develop and coordinate responses to tackle the multisectoral problem of childhood undernutrition. However, current Philippine nutrition interventions, such as decentralized school feeding programs (SFPs), generally rely on the national government, public school teachers, or the private sector for implementation, with mixed results. The central kitchen model for SFPs was developed by 2 Philippine nongovernmental organizations and facilitated large-scale in-school feeding through community multisectoral action. This case study documented coordination processes in February 2018 for 1 urban city and 1 rural province-the model\u27s earliest large-scale implementation sites-that contributed to its institutionalization and sustainability. Data from 24-hour dietary recalls with 308 rural and 310 urban public school students and household surveys with their caregivers showed undernutrition was an urgent problem. Enabling factors and innovative local solutions were explored in focus group discussions with 160 multisector participants and implementers in health care, education, and government, as well as volunteers, parents, and central kitchen staff. The locally led and operated central kitchens promoted community ownership by embedding volunteer pools in social networks and spurring demand for related social services from their LGU. With the LGU as the face of implementation, operations were sustained despite political leadership changes, fostering local government stewardship over nutrition. Leveraging national legislation and funding for SFPs and guided by the Department of Education\u27s standards for SFP eligibility, LGUs had room to adapt the model to local needs. Central kitchens afforded opportunities for scale-up and flexibility that were utilized during natural disasters and the coronavirus disease (COVID-19) pandemic. The case demonstrated empowering civil society can hold volunteers, local implementers, and local governments accountable for multisectoral action in decentralized settings. The model may serve as a template for how other social services can be scaled and implemented in devolved settings

Disruptions in the Cystic Fibrosis Community’s Experiences and Concerns During the COVID-19 Pandemic: Topic Modeling and Time Series Analysis of Reddit Comments

BackgroundThe COVID-19 pandemic disrupted the needs and concerns of the cystic fibrosis community. Patients with cystic fibrosis were particularly vulnerable during the pandemic due to overlapping symptoms in addition to the challenges patients with rare diseases face, such as the need for constant medical aid and limited information regarding their disease or treatments. Even before the pandemic, patients vocalized these concerns on social media platforms like Reddit and formed communities and networks to share insight and information. This data can be used as a quick and efficient source of information about the experiences and concerns of patients with cystic fibrosis in contrast to traditional survey- or clinical-based methods. ObjectiveThis study applies topic modeling and time series analysis to identify the disruption caused by the COVID-19 pandemic and its impact on the cystic fibrosis community’s experiences and concerns. This study illustrates the utility of social media data in gaining insight into the experiences and concerns of patients with rare diseases. MethodsWe collected comments from the subreddit r/CysticFibrosis to represent the experiences and concerns of the cystic fibrosis community. The comments were preprocessed before being used to train the BERTopic model to assign each comment to a topic. The number of comments and active users for each data set was aggregated monthly per topic and then fitted with an autoregressive integrated moving average (ARIMA) model to study the trends in activity. To verify the disruption in trends during the COVID-19 pandemic, we assigned a dummy variable in the model where a value of “1” was assigned to months in 2020 and “0” otherwise and tested for its statistical significance. ResultsA total of 120,738 comments from 5827 users were collected from March 24, 2011, until August 31, 2022. We found 22 topics representing the cystic fibrosis community’s experiences and concerns. Our time series analysis showed that for 9 topics, the COVID-19 pandemic was a statistically significant event that disrupted the trends in user activity. Of the 9 topics, only 1 showed significantly increased activity during this period, while the other 8 showed decreased activity. This mixture of increased and decreased activity for these topics indicates a shift in attention or focus on discussion topics during this period. ConclusionsThere was a disruption in the experiences and concerns the cystic fibrosis community faced during the COVID-19 pandemic. By studying social media data, we were able to quickly and efficiently study the impact on the lived experiences and daily struggles of patients with cystic fibrosis. This study shows how social media data can be used as an alternative source of information to gain insight into the needs of patients with rare diseases and how external factors disrupt them