Examining the relationships between early childhood experiences and adolescent and young adult health status in a resource-limited population: A cohort study

Zeba A Rasmussen* (Corresponding Author), Wasiat H Shah, Chelsea L Hansen, Syed Iqbal Azam, Ejaz Hussain, Barbara A Schaefer, Nicole Zhong, Alexandra F Jamison, Khalil Ahmed, Benjamin J J McCormick, Oshikhandass Water, Sanitation, Health and Hygiene Interventions Project

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

1 Citation (Scopus)
7 Downloads (Pure)


BACKGROUND: 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.

METHODS AND FINDINGS: 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.

CONCLUSIONS: 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.

Original languageEnglish
Article numbere1003745
Number of pages18
JournalPLoS Medicine
Issue number9
Publication statusPublished - 28 Sept 2021

Bibliographical note

The study was funded by the Pakistan US S&T Cooperative Agreement (https://sites.nationalacademies.org/pga/pakistan/index.htm) between the Pakistan Higher Education Commission (HEC, https://www.hec.gov.pk/english/pages/home.aspx) (No.4-421/PAK-US/HEC/2010/955, grant to the Karakoram International University, to KA) and US National Academies of Science (https://www.nationalacademies.org/) (Grant Number PGA-P211012 from NAS to the Fogarty International Center, to ZAR). Original study funding: The Applied Diarrheal Disease Research Program at Harvard Institute for International Development (Grants 063 and P033 to ZAR), and the Aga Khan Health Service, Northern Areas and Chitral, Pakistan (https://www.akdn.org/aga-khan-health-service-pakistan-0, in kind support to ZAR). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Data Availability Statement

Data is held in a public repository entitled the National Institute of Child Health and Human Development Data and Specimen Hub (DASH) at https://dash.nichd.nih.gov/study/416387.


Dive into the research topics of 'Examining the relationships between early childhood experiences and adolescent and young adult health status in a resource-limited population: A cohort study'. Together they form a unique fingerprint.

Cite this