Self-assessed puberty is reliable in a low-income setting in rural Pakistan

Susan C. Campisi, Khadija N. Humayun, Yaqub Wasan, Sajid Soofi, Muhammad Islam, Wendy Lou, Ashley Vandermorris, Olle Söder, Zulfiqar A. Bhutta

Research output: Contribution to journalArticlepeer-review

2 Citations (Scopus)


Objectives: Staging sexual maturation is an integral component of adolescent research. The Pubertal Development Scale (PDS) is commonly used as a puberty self-assessment tool because it avoids the use of images. Among the youth living in rural Pakistan, we determined the accuracy of self-reported pubertal assessments using a modified PDS compared to the 'gold standard' of physically assessed Tanner stages by a physician. Methods: The strength of agreement between self-assessed puberty using a modified PDS and the 'gold' standard of physician-assessed Tanner stages was reported using weighted kappa (κw) for girls (n = 723) of 9.0-14.9 years of age or boys (n = 662) of 10.0-15.9 years of age living in the rural District of Matiari. Results: Agreement between the gold standard and self-assessment for puberty was substantial, with a κw of 0.73 (95% confidence interval [CI]: 0.67; 0.79) for girls and a κw of 0.61 (95% CI: 0.55; 0.66) for boys. Substantial agreement was observed for both boys and girls classified as thinness but only for girls with a normal body mass index. Those who were classified as severely thin had moderate agreement. The prevalence of overestimation was 18.5% (95% CI: 15.9-21.5) for girls and 2.7% (95% CI: 1.7-4.3) for boys, while the prevalence of underestimation estimation was 8.0% (95% CI: 6.2-10.2) for girls and 29.0% (95% CI: 25.8-32.6) for boys. Conclusions: Most girls and boys assessed their pubertal development with substantial agreement with physician assessment. Girls were better able to assess their puberty, but they were more likely to overestimate. Agreement for boys was also substantial, but they were more likely to underestimate their pubertal development. In this rural Pakistan population, the PDS seems to be a promising tool for self-assessed puberty.

Original languageEnglish
Pages (from-to)1191-1196
Number of pages6
JournalJournal of Pediatric Endocrinology and Metabolism
Issue number9
Publication statusPublished - 1 Sept 2020


  • Puberty development scale
  • Self-assessment
  • Sexual maturity rating


Dive into the research topics of 'Self-assessed puberty is reliable in a low-income setting in rural Pakistan'. Together they form a unique fingerprint.

Cite this