Timing and determinants of age at menarche in low-income and middle-income countries

Abstract

Introduction: Understanding the timing and determinants of age at menarche is key to determining potential linkages between onset of puberty and health outcomes from a life-course perspective. Yet, we have little information in low-income and middle-income countries (LMICs) mainly due to lack of data. The aim of this study was to analyse trends in the timing and the determinants of menarche in LMICs.

Methods: Using 16 World Fertility Survey and 28 Demographic and Health Surveys (DHS) from 27 countries, we analysed cohort trends and used fixed-effects models for DHS surveys to investigate sociodemographic and regional effects in the timing of age at menarche.

Results: Trends of the mean age at menarche across time within and between countries show a declining or stalling path. Results of the determinant modelling show the relationship with wealth changes over time although not consistently across countries. We see a shift from poorer women having earlier menarche in earlier surveys to richer women having earlier menarche in later surveys in Indonesia, the Philippines and Yemen, while in Egypt, the reverse pattern is evident.

Conclusions: There is a considerable gap in both literature and data on menarche. We see a trend which is declining rapidly (from 14.66 to 12.86 years for the 1932 and 2002 cohorts, respectively), possibly at a faster pace than high-income countries and with a strong link to socioeconomic status. This study calls for menarche questions to be included in more nationally representative surveys and greater use of existing data because of its impact on life-course health in fast-ageing settings. Further studies will need to investigate further the use of the age at menarche as an indicator of global health.

Keywords: child health; cross-sectional survey; public health; review.

Figure 1

Trends in MAM WFS and DHS datasets, 1976–2017. Birth cohorts 1932–2002. DHS, Demographic and Health Surveys; MAM, mean age at menarche; WFS, World Fertility Survey.

Figure 2

Fitted MAM and 95% CIs by birth cohort, WFS and DHS data 1976–2017. MAM, mean age at menarche.

Figure 3

Histogram distribution mean age at menache by country, 1976–2017

Figure 4

Logistic regression likelihood of having menarche before age 13, DHS data for countries with surveys asking about menarche (arranged alphabetically). Kyrgyz Republic: collapsed no education/primary/secondary due to small numbers in lowest two categories that gave spurious estimates (very small but significant effect sizes). Uzbekistan: collapsed no education/primary due to small numbers that gave spurious estimates (very small but significant effect sizes). Two 2017 Indonesia surveys available, standard and special, special used for these estimates (Nb: education categories slightly different in this survey: primary, junior high school, senior high school, academy/di/dii/diii, div/university). DHS, Demographic and Health Surveys.