Puberty onset in rural and urban children

Main Article Content

Hariadi Edi Saputra
Hakimi Hakimi
Melda Deliana
Siska Mayasari Lubis
Karina Sugih Arto


Background Accelerated pubertal onset has been reported in recent years. Environmental factors are assumed to influence this condition.

Objective To assess differences in pubertal onset between children in rural and urban areas, as well as to evaluate body mass index (BMI) and socioeconomic status that affect pubertal onset.

Methods This cross-sectional study was conducted in July 2010 at junior high schools in Mandailing Natal and Medan, North Sumatera. Data were collected with purposive sampling of children aged 8 to 13 years. Sexual maturity was assessed by Tanner stage and risk factors was determined by questionnaires. The comparison between pubertal onset in rural and urban areas was assessed by Mann-Whitney U test. The relationships between nutritional status, socioeconomic status, sexual maturity, and pubertal onset were assessed by Spearman’s correlation.

Results Eighty-four subjects (38 boys and 46 girls) from a rural area and 87 subjects (40 boys and 47 girls) from an urban area participated in this study. There were significant differences in mean pubertal age of onset between subjects living in rural vs. urban areas, for both girls and boys [girls: 10.2 vs. 9.5 years, respectively (P=0.008); boys: 11.7 vs. 10.1 years, respectively, (P=0.001)]. We found weak negative correlations between BMI and pubertal onset in boys (r=-0.246; P=0.03) and in girls (r=-0.548; P=0.001). We also found weak negative correlations between socioeconomic status and  pubertal onset in boys (r=-0.406; P=0.0001) and in girls (r=-0.575; P=0.001).

Conclusion Pubertal onset is faster in girls and boys who lived in an urban area.  There are negative correlations between BMI and socioeconomic status with pubertal onset.

Article Details

How to Cite
Saputra H, Hakimi H, Deliana M, Lubis S, Arto K. Puberty onset in rural and urban children. PI [Internet]. 28Feb.2017 [cited 23Feb.2020];57(1):52-. Available from:
Received 2016-10-03
Accepted 2017-02-28
Published 2017-02-28


1. Styne D. Puberty, obesity and ethnicity. Trends Endocrinol Metab. 2004;15:472-8.
2. Styne D. Puberty. In: Greenspan FS, Gardner DG, editors. Basic and clinical endocrinology. 5th ed. San Fransisco: McGraw-Hill Companies; 1997. p. 521-45.
3. Zacharias L, Wurtman RJ. Age at menarche. N Engl J Med. 1969;280:868-75.
4. Rini EA, Desdamona E. Usia awitan pubertas dan beberapa faktor yang berhubungan pada murid SD di Kota Padang 2007. Sari Pediatri. 2007;9:227-32.
5. Papadimitriou A, Pantsiotou S, Douras K, Padimitriou DT, Nicolaidou P, Fretzayas A. Timing of pubertal onset in girls: evidence for non–Gaussian distribution. J Clin Endocrinol Metab .2008;93:4422-5.
6. Centers for disease control and prevention. Table of BMI for age charts. National center for health statistics. 2001 (cited 2013 Jan 12). Available from :
7. Pulungan AB. Pertumbuhan di masa pubertas. In: Batubara JL, AAP T, Pulungan AB, editors. Buku ajar endokrinologi anak 1st ed. Jakarta: IDAI; 2010. p. 85-95.
8. Biro Statistik Jakarta. Bagian statistik kesejahteraan rumah tangga. Statistik kesejahteraan rakyat. Jakarta: Badan Pusat Stastistik ;2000. p. 5-6.
9. Badan pusat statistik. Profil kemiskinan di Indonesia. Berita Resmi statistik. Jakarta; Badan pusat statistik ;2009. p. 1-9.
10. Lailani D, Hakimi. Pertumbuhan fisik anak obesitas. Sari Pediatri 2003;5:99-102.
11. Kaplowitz PB. Link between body fat and the timing of puberty. Pediatrics. 2008;121:S208-17.
12. Deardorff J, Ekwaru JP, Kushi LH, Ellis BJ, Greenspan LC, Mirabedi A, et al. Father absence, body mass index, and pubertal timing in girls: differential effects by family income and ethnicity. J Adolesc Health. 2011;48:441-7.
13. Marshall WA, Tanner JM . Variations in the pattern of pubertal changes in boys. Arch Dis Child 1970 ;46:13–23.
14. Herman-Giddens ME, Slora EJ, Wasserman RC, Bourdony CJ, Bhapkar MV, Koch GG, et al. Secondary sexual characteristics and menses in young girls seen in office practice: a study from the Pediatric Research in Office Settings network. Pediatrics 1997;99:505–12
15. Tanner JM, Davies PSW. Clinical longitudinal standards for height and height velocity for North American children. J Pediatr 1985;107:317–329.
16. Lindgren G. Pubertal stages of Stockholm school children. Acta Paediatr 1996;85:1365–7
17. Mul D, Fredriks M, van Buuren S, Oosdijk W, Verloove-Vanhorick SP, Wit JM. Pubertal development in The Netherlands 1965–1997. Pediatr Res 2001;50:479–486.
18. Hakimi, Siregar CD, Deliana M, Rahmawati L. Ukuran besar testis anak laki-laki pada saat awitan pubertas. Sari Pediatri. 2005;7:68-72.
19. Golub MS, Collman GW, Foster PM, Kimmel CA, De Meyts ER, Reiter EO, et al. Public health implications of altered puberty timing. Pediatrics. 2008;121:S218-30.
20. Dattani MT, Hindmarsh PC. Normal and abnormal puberty. In: Brook CG, Clayton PE, Brown RS, editors. Clinical pediatric endocrinology. 5th ed. Massachusetts: Blackwell Publishing; 2005. p. 183-201.
21. Garilbadi L. Physiology of puberty. In: Behrman RE, Kliegman RM, Jenson HB, editors. Nelson text book of pediatrics. 18th ed. Philadelpia: Saunders Corporation; 2008. p. 2308-10.
22. Ebling FJ. The neuroendocrine timing of puberty. Reproduction. 2005;129:675-83.
23. Herman-Giddens ME, Slora EJ, Wasserman RC, Bourdony CJ, Bhapkar MV, Koch GG, et al. Secondary sexual characteristics and menses in young girls seen in office practice: a study from the Pediatric Research in Office Settings network. Pediatrics. 1997;99:505-12.
24. Blum WF, Englaro P, Hanitsch S, Juul A, Hertel NT, Muller J, et al. Plasma leptin levels in healthy children and adolescents: dependence on body mass index, body fat mass, gender, pubertal stage and testosterone. J Clin Endocrinol Metab. 1997;82:2904-10.
25. Silventoinen K, Haukka J, Dunkel L, Tynelius P, Rasmussen F. Genetics of pubertal timing and its associations with relative weight in childhood and adult height: the Swedish Young Male Twins Study. Pediatrics. 2008;121:885-91.
26. Indaryani W, Susanto R, Susanto JC. Hubungan awitan pubertas dan status sosial ekonomi serta status gizi pada anak perempuan. Sari Pediatri. 2010;11:374-8.
27. Pacarada M, Lulaj S, Kongleji G, Obertinca B. Impact of socio-economic factors on the onset of menarche in Kosovar girls. J Chin Clin Med. 2008;3:541-9.
28. Gentry JH, Campbell M. Reference for Professionals developing adolescents. Washington, DC: American Psychological Association, 2002 [cited 12 February 2013]. Available at:
29. Weingarden H, Renshaw KD. Early and late perceived pubertal timing as risk factors for anxiety disorders in adult women. J Psychiatr Res. 2012;46:1524-9.