Abstract
Adolescence is a critical point in the realization of human capital, as health and educational decisions with long-term impacts are made. We examined the role of early childhood experiences on health, cognitive abilities, and educational outcomes of adolescents followed up from a longitudinal cohort study in Pakistan, hypothesizing that early childhood experiences reflecting poverty would manifest in reduced health and development in adolescence. Adolescents/young adults previously followed as children aged under 5 years were interviewed. Childhood data were available on diarrhea, pneumonia, and parental/household characteristics. New data were collected on health, anthropometry, education, employment, and languages spoken; nonverbal reasoning was assessed. A multivariable Bayesian network was constructed to explore structural relationships between variables. Of 1,868 children originally enrolled, 1,463 (78.3%) were interviewed as adolescents (range 16.0-29.3 years, mean age 22.6 years); 945 (65%) lived in Oshikhandass. While 1,031 (70.5%) of their mothers and 440 (30.1%) of their fathers had received no formal education, adolescents reported a mean of 11.1 years of education. Childhood diarrhea (calculated as episodes/child-year) had no association with nonverbal reasoning score (an arc was supported in just 4.6% of bootstrap samples), health measures (with BMI, 1% of bootstrap samples; systolic and diastolic blood pressure, 0.1% and 1.6% of bootstrap samples, respectively), education (0.7% of bootstrap samples), or employment (0% of bootstrap samples). Relationships were found between nonverbal reasoning and adolescent height (arc supported in 63% of bootstrap samples), age (84%), educational attainment (100%), and speaking English (100%); speaking English was linked to the childhood home environment, mediated through maternal education and primary language. Speaking English (n = 390, 26.7% of adolescents) was associated with education (100% of bootstrap samples), self-reported child health (82%), current location (85%) and variables describing childhood socioeconomic status. The main limitations of this study were the lack of parental data to characterize the home setting (including parental mental and physical health, and female empowerment) and reliance on self-reporting of health status. In this population, investments in education, especially for females, are associated with an increase in human capital. Against the backdrop of substantial societal change, with the exception of a small and indirect association between childhood malnutrition and cognitive scores, educational opportunities and cultural language groups have stronger associations with aspects of human capital than childhood morbidity.
Highlights
Human capital is the knowledge, skills, and health that individuals accumulate over time that enables them to realize their potential as productive members of society [1]
Our study considers the following as outcomes of interest: nonverbal reasoning score, self-reported health status, body mass index (BMI), blood pressure, educational attainment, and employment
Compared to the 1,462 individuals who were re-enrolled as adolescents, individuals lost to follow-up (n = 381) tended to be male (57.2% versus 51.0%, p = 0.017, chisquared test) and to have more diarrheal episodes per child-year, less improved household construction (62.2% improved or somewhat improved versus 65.7%, p = 0.002, chi-squared test), and more likely to have improved toilets (3.9% versus 2.3%, p = 0.032, chi-squared test)
Summary
Human capital is the knowledge, skills, and health that individuals accumulate over time that enables them to realize their potential as productive members of society [1]. The World Bank created in 2018 a population-level indicator of human capital by indexing child survival and stunting, school attendance and performance, and adult survival. The Human Capital Index (HCI) describes how improvements to childhood health, nutrition, and early learning lay strong foundations for the future acquisition of cognitive, social, and behavioral skills [2]. The adolescent period is a critical stage between childhood and adulthood where formal education ends and key health decisions are made that have long-term impacts [3,4]. Pakistan ranks 134 of 157 countries in the 2018 World Bank HCI [1]. Adolescence is a critical point in the realization of human capital, as health and educational decisions with long-term impacts are made. We examined the role of early childhood experiences on health, cognitive abilities, and educational outcomes of adolescents followed up from a longitudinal cohort study in Pakistan, hypothesizing that early childhood experiences reflecting poverty would manifest in reduced health and development in adolescence
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