Free school meals and children's social and nutritional status in Trinidad and Tobago

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Abstract
To evaluate the provision of free school meals in Trinidad and Tobago in relation to children's social and nutritional status.Design and methods: Cross-sectional survey of a nationally representative sample of 66 government schools, including children in the admissions classes (aged 4 to 7 years) and classes for ‘rising nines’ (aged 7–10 years). Data included questionnaire details of free school meals and children's social background, and measurements of children's heights, weights and skinfold thicknesses. Of 6731 eligible children, data were analysed for 5688 (85%). There were 2386 (42%) children receiving free meals provided at school. At different schools the proportion of all children receiving free meals ranged from 20% to 100%, P < 0.001. Receipt of free meals was associated with larger family size (one child, 32% received free meals; ≥6 children, 63%), lower paternal educational attainment (primary, 52% free; university, 30%), father's employment (employed, 39% free meals; unemployed <12 months, 59%) as well as maternal education and employment and household amenities. After adjusting for age, sex and ethnic group, children who received free meals were shorter (mean difference in height standard deviation score (SDS) –0.12, 95% confidence interval (CI) –0.17 to –0.06), lighter (body mass index SDS –0.21, –0.28 to –0.14) and thinner (subscapular skinfold SDS –0.13, –0.18 to –0.09). Free school meals were widely available, with some targeting of provision to children with less favourable social and nutritional status. Greater universality would reduce inequity, but more stringent targeting and reduction of school-level variation would increase efficiency.