Refrigeration and Child Growth: What Is the Connection?

Abstract

Background: Child stunting in Latin America and the Caribbean (LAC) decreased from 22.9% in 1990 to 9.6% in 2017. While stunting rates in the region were falling, access to electricity and refrigeration were on the rise. In Bolivia, stunting declined 14 percentage points between 2005 and 2016, while over the same period the percent of households with refrigeration increased from 30.4% to 58.1%. Despite a large body of evidence surrounding the effects of refrigeration on food consumption, and separately of the importance of food consumption for child health and nutrition, surprisingly few studies explore the potential effects of refrigeration on child nutrition. Methods: We studied the relationship between refrigeration and child nutrition outcomes using a rich panel of 1,298 low-income households with children younger than 12 months at baseline in El Alto, Bolivia. We estimated the effects of refrigerator ownership on diet and nutrition outcomes using a difference-in-difference approach. Findings: Owning a refrigerator was associated with healthier food consumption and improved child nutrition. We found evidence that households that acquired a refrigerator were more likely to buy food that requires refrigeration, and children in households that acquired refrigerators were 0·18 standard deviations taller for their age after two years. We also found that refrigeration was associated with a 0·15 decline in BMI-for-age, an effect driven by increased height rather than changes in weight. Interpretation: Results suggest that refrigeration may play an important role in explaining reductions in under-nutrition observed in low- and middle-income countries in recent decades. Importantly, refrigeration did not appear to increase overweight or obesity. Given the rapid rise in obesity worldwide and in Latin America over the last decades, the need for interventions that can reduce undernutrition without perpetuating overweight or obesity is critical. Funding Statement: Basline data were funded by the Inter-American Development Bank (IDB) grant BOT1181 (ATN/JO-13606-BO), ‘Improving Child Nutrition Services in Bolivia’, a technical cooperation project financed through a donation from the IDB’s Japan Special Fund Poverty Reduction Program (JPO). Endline data collection was funded through the IDB grant BO-T1259 (ATN/OC-15554-BO), ‘Effectiveness of Community Interventions to Reduce Child Malnutrition.’ Declaration of Interests: All authors were employed by the Inter-American Development Bank at the time of the study’s conception and implementation. We declared no competing interests in the results of the study. All opinions in this paper are those of the authors and do not necessarily represent the views of the Government of Bolivia or the Inter-American Development Bank, its Executive Directors, or the governments they represent. Ethics Approval Statement: The survey questions were approved by the ethical review board of the National Bioethics Committee in Bolivia prior to the start of the program and informed consent was obtained from caregivers. We analyze de-identified public access baseline and follow-up data.