Masood Ali Shaikh  ( Independent Consultant, Gulshan-e-Iqbal, Karachi, Pakistan. )

Madam, daily brushing of teeth contributes towards good oral as well as general health.^1-3 Association of poor oral hygiene with poverty, tobacco use, age, and gender has been reported.^1-4 To determine these factors association with self-reported frequency of brushing/cleaning teeth in the past 30-days in Moroccan students aged 13-15 years, 2010 Global School-Based Health Survey (GSHS) data for Morocco was used. GSHS-Morocco was conducted by the Moroccan national authorities, Centers for Disease Control and Prevention (USA), and the World Health Organization, using two-stage cluster sample design to produce nationally representative estimates for all students in the 1st, 2nd, and 3rd Prep. Schools; the details of the survey and data are available, and were accessed from the CDC\'s GSHS website.⁵
Design-based analysis with STATA-13 was done using simple, and multiple logistic regressions; factors found to be statistically significant at p<0.05 level on simple logistic regression were included in the multiple logistic regression model. Responses to question "During the past 30 days, how many times per day did you usually clean or brush your teeth?" were used to determine oral hygiene status. Not cleaning or brushing teeth or doing so less than once per day in the past 30 days was defined as poor oral hygiene. Overall prevalence of poor oral hygiene, was 31.9% [95% confidence interval (CI): 26.9%, 37.4%] (n = 1972). In males the prevalence was 35.4% (95% CI: 29.4%, 41.8%), while among females the prevalence was 27.6% (95% CI: 23.3%, 32.2%).

Table provides the respondent\'s demographic, socioeconomic status (determined by going hungry due to unavailability of food in home), and tobacco use; associations with poor oral hygiene in bivariate and multivariate analyses. Age was not found to be statistically significant in the simple logistic regression model, and was not included in the multiple logistic regression model. Final model included sex, tobacco use, and socioeconomic status. However, tobacco use was not found to be statistically significant in the final multiple logistic regression model. Goodness-of-fit test result concluded that this model was a good fit for the data.
Prevalence of brushing/cleaning teeth once, twice, and three or more times per day in the past 30 days was 20.5% (95% CI: 18.3%, 22.8%), 17.7% (95% CI: 15.1, 20.6%), and 29.9% (95% CI: 26.7, 33.4%), respectively. Results from the GSHS-Morocco suggest the need for targeting health education campaigns specifically directed towards adolescents from low socioeconomic strata of society and males.

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2. Siziya S, Muula AS, Kazembe LN, Rudatsikira E. Harmful lifestyles\' clustering among sexually active in-school adolescents in Zambia. BMC Pediatr 2008; 8: 6.
3. Petersen PE. The world oral health report 2003: Continuous improvement of oral health in the 21st century - the approach of the WHO global oral health programme. Community Dent Oral Epidemiol 2003; 31(Suppl 1): 3-23.
4. Shaikh MA. Prevalence and correlates of oral hygiene among school attending adolescents in Pakistan. J Pak Med Assoc 2013; 63: 1564-5.
5. Centers for Disease Control and Prevention. Global School-based Student Health Survey (GSHS). [online] [cited 2014 April 11]. Available from: URL: http://www.cdc.gov/gshs/  [Accessed on April 11, 2014].