The incidence, calf morbidity and mortality due to Theileria parva infections in smallholder dairy farms in Murang'a District, Kenya

A prospective observational study was conducted among smallholder dairy farmers in Murang'a District, Kenya, to estimate the incidence of Theileria parva infections, as well as calf morbidity and mortality caused by the infection. The study was conducted between March 1995 and August 1996, in five cohorts of female calves from birth to six months of age from different agro-ecological zones (AEZs) and grazing-system strata shown previously to have varying prevalences of T. parva infection. A total of 188 smallholder dairy farms with 225 female calves were selected purposively by five AEZ-grazing strata. All recruited calves were visited within the first two weeks of life and thereafter at biweekly intervals up to the age of six months. The mean number of cattle in these smallholder farms was 2.6. Both exotic and indigenous breeds of cattle and their crosses were present, with the former predominating. The incidence (27-54%) of sero-conversion to T. parva in an ELISA test was significantly different (p < 0.05) across the five AEZ-grazing strata and increased with lower elevation and unrestricted grazing. Calf morbidity and mortality were also variable across the AEZ-grazing strata. East Coast fever (ECF) was the highest-incidence cause calf morbidity and mortality (relative to other diseases). There are great differences in the epidemiology of ECF within a small area and this implies that there is need to carefully consider different ECF control strategies in different AEZ-grazing strata.     

Community Perceptions of Important Camel Diseases in Lapur Division of Turkana District,Kenya

This paper presents the results of a study conducted in Lapur Division of Turkana District, Kenya, to estimate the incidence and mortality of camel trypanosomosis using participatory methods. Four livestock camps ('adakars') were conveniently selected for the study. Four informant groups comprising 6 8 key persons were used for the participatory exercises. The camel diseases identified by the pastoralists in their order of importance according to annual incidence were: trypanosomosis (11.4%); mange (10.8%); tick infestation (7.9%); haemorrhagic septicaemia (7.7%); and non-specific diarrhoea (7.6%). Almost half (49.3%) of the camel population suffered from at least one disease over the previous year. The annual incidence and mortality rates of trypanosomosis were estimated at 15%, and 9.9%, in adult camels and 6.9% and 5.2%, in young camels, respectively. There was a seasonal occurrence of trypanosomosis, with most cases reported in the dry season. The prevalence levels of the disease reportedly declined from about 100%, in 1978 to an almost stable state of about 15% in 2002. This study revealed that camel trypanosomosis is still an important disease in Turkana District, exacting a heavy toll in terms of morbidity and mortality. The economic losses due to the disease were likely to have been great owing to the central role the camel plays in this arid district of Kenya.     

Constraints to cattle production in a semiarid pastoral system in Kenya

Livestock keeping is the mainstay for the pastoral community while also providing social and cultural value. This study ranked main production constraints and cattle diseases that impacted livelihood and estimated herd prevalence, incidence rate, and impact of diseases on production parameters in a semiarid pastoral district of Narok in Kenya. Data collection employed participatory techniques including listing, pairwise ranking, disease incidence scoring, proportional piling, and disease impact matrix scoring and this was disaggregated by gender. Production constraints with high scores for impact on livelihood included scarcity of water (19 %), lack of extension services (15 %), presence of diseases (12 %), lack of market for cattle and their products (10 %), and recurrent cycle of drought (9 %). Diseases with high scores for impact on livelihood were East Coast fever (ECF) (22 %) and foot and mouth disease (FMD) (21 %). High estimated incidence rates were reported for FMD (67 %), trypanosomosis (28 %), and ECF (15 %), while contagious bovine pleuropneumonia (CBPP) had an incidence rate <1 %. Milk yield was affected by FMD, ECF, and trypanosomosis, while ECF was the cause of increased mortality. FMD, ECF, CBPP, and brucellosis caused increased abortion, while effect of gender and location of study was not significant. Despite CBPP being regarded as an important disease affecting cattle production in sub-Sahara Africa, its estimated incidence rate in herds was low. This study indicates what issues should be prioritized by livestock policy for pastoral areas.     

Immunization of cattle against East Coast fever using Theileria parva (Marikebuni) and relaxation of tick control in North Rift, Kenya.

A total of 90 animals was immunized against East Coast fever (ECF) using Theileria parva (Marikebuni) stock on three large-scale farms in Kiminini Division, Trans-Nzoia District, North Rift, Kenya. Another 90 cattle served as non-immunized controls. Following immunization the number of cattle with significant indirect fluorescent antibody (IFA) titres increased from 43.9% to 84.4% and 6.7% of the cattle developed clinical ECF reactions. Two months after immunization, the immunized and non-immunized cattle were divided into two groups one of which was dipped every 3 weeks and the other dipped when total full body tick counts reached 100. All the animals were monitored for 51 weeks for incidences of ECF and other tick-borne diseases. Twenty-four cases of ECF were diagnosed among the non-immunized cattle compared to four cases among the immunized cattle; a difference that was significant (P > 0.05). There was no significant difference in the incidences of babesiosis and anaplasmosis between the immunized and non-immunized cattle.     

Risk factors for smallholder dairy cattle mortality in Tanzania

A retrospective cross-sectional study of mortality was conducted on smallholder dairy farms in 2 separate regions (Iringa and Tanga) of Tanzania during the period of January to April 1999. A total of 1789 cattle from 400 randomly sampled smallholder dairy farms (200 each from Iringa and Tanga regions) were included in the study. These animals contributed a total risk period of 690.4 and 653.95 years for Tanga and Iringa, respectively. The overall mortality rates were estimated to be 8.5 and 14.2 per 100 cattle years risk for Tanga and Iringa regions, respectively; 57.7% of the reported deaths were of young stock less than 12 months old; 45% of reported young stock deaths (< or = 12 months old) were due to tickborne diseases, mainly East Coast Fever (ECF) and anaplasmosis. Disease events including ECF were reported to occur in all months of the year. Survival analysis using Cox proportional hazard models indicated that, in both regions, death rate and risk was higher in young stock less than 12 months than in older animals (relative risk RR = 4.92, P < 0.001 for Iringa; RR = 5.03 P = 0.005 for Tanga). In the Tanga region reported mortality rates were significantly higher for male animals (RR = 3.66, P = 0.001) and F2 compared with F1 animals (RR = 3.04, P = 0.003). In the Iringa region, reported mortality rates were lower for cattle on farms where the owner had attended a dairy development project training course (RR = 0.47, P = 0.012). Farms located in Iringa urban district and Pangani were associated with higher risk (mortality risk 21% for Iringa urban and 34% for Pangani). Our findings suggest that timely health and management interventions on these factors are necessary to alleviate losses from disease and emphasise that understanding variation in mortality risk within a population can enhance early response to potential outbreaks, reducing losses.     

Identification of a target population for immunisation against East Coast fever in coastal Kenya

Two experiments were carried out to identify the target population of cattle for immunisation against East Coast fever (ECF) using the infection-and-treatment method. Firstly, a sentinel-calf study was used to determine the age window for ECF immunisation by determining ages at clinical detection of infection with Theileria parva. Six groups of five naive cross-bred (Bos taurus/Bos indicus) male calves, introduced at intervals of 2 months at a mean age of 26 days, were exposed to natural tick challenge on a high ECF-risk, small-holder farm in the coastal lowland, coconut-cassava agro-ecological zone of coastal Kenya. Secondly, a challenge study evaluated the relationship between the presence of T. parva antibodies and immunity. Ten indigenous adult Zebu cattle and nine Zebu young stock purchased from farmers in the same zone, and eight cross-bred calves (survivors of the sentinel-calf study) were challenged with 10 times the immunising dose of T. parva Marikebuni stock. Twenty-four of these 27 cattle had high antibody titres before challenge. Two cross-bred calves, obtained from an ECF-free area and seronegative to T. parva schizont antigen, also were challenged and used as susceptible controls. Twenty-five (83%) of the 30 sentinel calves contracted ECF over an age range of 36-116 days (mean 72 days). The remaining five calves died of other causes within 2 months of arrival on the farm. Fourteen of the 25 calves survived the infection and developed antibodies to T. parva. Despite tick control, seven of these 14 calves had a second episode of ECF and two died. In total, 13 of the 25 calves that contracted ECF died. Only one of 19 indigenous Zebu animals developed clinical ECF when challenged with T. parva Marikebuni (mild clinical signs with spontaneous recovery). Of the eight cross-bred survivors from the first experiment, only one succumbed to ECF when challenged and it died. Both susceptible cross-bred calves developed severe clinical signs of ECF and one died. The experimental studies show that in the high ECF-risk areas of the coconut-cassava zone of coastal Kenya, immunisation against ECF in cross-bred (B. taurus/B. indicus) cattle should be targeted at an early age (preferably within 1-2 months of birth).     

A longitudinal study of disease incidence and case-fatality risks on small-holder dairy farms in coastal Kenya

A longitudinal study was carried out in the coastal lowlands coconut-cassava agro-ecological zone of Kaloleni Division, Coast Province, Kenya between June 1990 and December 1991 to estimate disease incidence and cause-specific case-fatality risk in an average of 120 cattle in 26 small-holder dairy herds kept in two grazing-management systems. East Coast fever (ECF) was the predominant disease diagnosed; the mean monthly incidence rate was 2.5 and 6.9% in animals < or = 18 months of age under stall-fed and herded-grazing systems, respectively. In cattle > 18 months of age, the monthly incidence rate was < 1%. The 6-month ECF incidence rate was 20+/-8% (S.E.) in the stall-feeding system compared with 39+/-7% in the herded-grazing systems. There was a gradual increase in antibody prevalence with age to over 90% in cattle over 18 months of age in herded-grazing systems, whilst less than a third of cattle in the stall-feeding systems were sero-positive at any age. Overall accumulated mortality to 18 months of age was estimated to be 56%. Annual mortality in cattle > 18 months averaged 9%. Cattle managed in the herded-grazing system had a 60% higher mortality, although not significantly so, than those fed in stalls. Deaths due to ECF accounted for over two-thirds of the deaths. ECF was then the major disease constraint to small-holder dairy production in the coconut zone of coastal Kenya. Clinical cases occur the whole year round (especially in young stock)--despite apparent tick control, and in both herded-grazing and stall-feeding system.     

Effect of agro-ecological zone and grazing system on incidence of East Coast Fever in calves in Mbale and Sironko Districts of Eastern Uganda

Between May 2002 and February 2003 a longitudinal survey was carried out in Mbale and Sironko Districts of Eastern Uganda to determine the influence of agro-ecological zones (AEZ) and grazing systems on tick infestation patterns and incidence of East Coast Fever (ECF) in bovine calves. The study area was stratified into AEZ (lowland, midland and upland) and grazing systems {zero grazing (ZG), restricted-outdoor grazing (ROG) and communal grazing (CG)}, whose strata had previously been shown to influence the prevalence of ECF, babesiosis and anaplasmosis. One hundred and eighty-five smallholder dairy farms with a total of 198 calves of both sexes, between the ages of 1 day and 6 weeks, were purposively selected from the AEZ–grazing system strata. Nine dynamic cohorts (11–51 calves in each) of these calves were examined and sampled monthly. Ticks infesting the calves were counted from one side of the animal body and categorized into the different species, sex and feeding status. Sera were collected at recruitment and monthly thereafter and antibodies against Theileria parva, T. mutans, Babesia bigemina, B. bovis and Anaplasma marginale were measured using ELISA. Tick challenge (total and specific) varied with AEZ and grazing system. The risk of infection with T. parva was higher in the lowland zone compared to the upland zone (hazard ratio (HR) = 2.59; 95% CI: 1.00–6.34). The risk of infection with T. parva was higher in the CG system than the ZG system (HR = 10.00; 95% CI: 3.61–27.92). The incidence risk for sero-conversion, over the 10 months study period, was 62, 16 and 9% in the lowland, midland and upland zones, respectively. Ninety-eight percent of the calves in lowland-CG stratum sero-converted by the age of 6 months, while 56 and 8% did so in the lowland-ROG and the lowland-ZG stratum, respectively. The results of this study show the need to consider farm circumstances and the variation in ECF risk, both spatially and temporally when designing control strategies for ECF.     

Treatment of East Coast fever: a comparison of parvaquone and buparvaquone

Two trials were conducted to compare the efficacy of parvaquone and buparvaquone for the treatment of naturally acquired East Coast fever (ECF, Theileria parva infection) which, if untreated, is almost invariably fatal in European breeds of cattle. In the first trial 28 naive cattle were exposed in a paddock infested with ticks carrying a virulent form of the disease. Twelve were treated with each drug when they developed clinical ECF. All 24 cattle were cured. In the second study, 100 cases of ECF occurring naturally on farms in Kenya were treated, 50 with each drug. Parvaquone cured 44 (88%) buparvaquone cured 45 (90%). Intercurrent infections, predominantly anaplasmosis and bacterial pneumonia or scour, were treated specifically. It is concluded that parvaquone and buparvaquone are similarly effective in curing ECF and cure rates are maximised by accurate diagnosis and prompt treatment of both ECF and intercurrent infections.     

Vector-borne diseases in humans and animals: activities of the Swiss Tropical Institute and risks for Switzerland

The recent outbreak of anaplasmosis in a Swiss cattle herd triggered a discussion of the risk of vector-borne diseases in animals and humans in relation to climate changes and other factors. This overview presents the Swiss Tropical Institute's (STI) activities on vector-borne diseases (malaria, trypanosomosis, and leishmaniosis in humans and tick-borne diseases in livestock), describes the possible risks for humans and animals in Switzerland, and discusses options for action in the domains of public health, livestock production and companion animals. Switzerland is increasingly confronted with vector-borne diseases in humans and animals, but this is mainly due to an increase in imported cases. The emergence of a disease in one sector (human or veterinary medicine) may predict future trends in the other. A stronger intersectoral collaboration between public health and veterinary institutions at the federal and cantonal level is needed.     

Livestock farmers' perception and epidemiology of bovine trypanosomosis in Kwale District, Kenya

We did cross-sectional surveys in Kwale District, Kenya to determine the epidemiology of bovine trypanosomosis and livestock owners' perceptions of the disease. The surveys involved relative importance of trypanosomosis, examination of the current disease constraints, current control practices and drug-use patterns. Informal meetings were held with farmers and cattle census undertaken. Tsetse-fly densities and trypanosomosis prevalences in cattle were determined. A total of 132 farmers were interviewed. Trypanosomosis, anaplasmosis, East Coast fever, foot-and-mouth diseases were reported to be the major constraints to livestock production. Trypanosomosis was the most important compared to other diseases. Chemotherapy was the most widely used method of controlling the disease. Farmer-based tsetse-control technologies were poorly adopted. Respondents were quite knowledgeable on the symptoms, causes and treatment of trypanosomosis. Glossina austeni, G. brevipalpis and G. pallidipes were found in the area; the latter was the most common (0.2-738 flies/trap). Trypanosoma congolense and T. vivax were found in cattle with the former more prevalent. Infection prevalences in cattle varied between 0 and 25% (median: 22%).     

East Coast fever immunisation field trial in crossbred dairy cattle in Hanang and Handeni districts in northern Tanzania

East Coast fever (ECF) causes considerable mortality and production losses in the Tanzania smallholder dairy sector and limits the introduction of improved dairy breeds in areas where the disease is present. The infection and treatment method (ITM) was adopted by smallholder dairy farms for ECF immunisation in Hanang and Handeni districts of Tanzania. This study recorded incidence rates for ECF and other tick-borne diseases (TBDs) for ECF-immunised and non-immunised cattle between 1997 and 2000. Approximately 80% of smallholder households from both sites (n?=?167) participated in this longitudinal study, with immunisations carried out at the request of the livestock owners. Efficacy of ITM for preventing ECF cases in these crossbred dairy cattle was estimated at 97.6%, while that for preventing ECF deaths was 97.9%. One percent of the cattle developed clinical ECF as a result of immunisation. Since ECF immunisation permits a reduction in acaricide use, an increase in other TBDs is a potential concern. Sixty-three percent of farmers continued to use the same acaricide after immunisation, with 80% of these reducing the frequency of applications. Overall, 78% of farmers increased the acaricide application interval after immunisation beyond that recommended by the manufacturer, resulting in annual savings in the region of USD 4.77 per animal. No statistical difference was observed between the immunised and non-immunised animals in the incidence of non-ECF TBDs. However, immunised animals that succumbed to these diseases showed fewer case fatalities. ITM would therefore appear to be a suitable method for ECF control in Tanzania's smallholder dairy sector.     

Descriptive epidemiology of morbidity and mortality in Minnesota dairy heifer calves

A prospective study was carried out on 845 heifer calves born during 1991 on 30 Holstein dairy farms in southeast Minnesota. The objectives of the study were to describe the epidemiology of morbidity and mortality in dairy calves from birth to 16 weeks of age (with an emphasis on respiratory disease), to examine individual calf and herd management practices as risk factors for calf morbidity and mortality, and to validate producer diagnosis of mortality. Incidence rates for all morbidity, enteritis, and pneumonia were 0.20, 0.15, and 0.10 cases per 100 calf-days at risk for the period of the study. Risk of enteritis was highest in the first 3 weeks of life, with pneumonia risk highest at 10 weeks of age. Case fatality rates averaged 11.8%, 17.9%, and 9.4% for all diagnoses, enteritis, and pneumonia, respectively. Average daily rates of gain from birth to 16 weeks of age differed between farms that had inadequate calf housing (0.8 kg day⁻¹) versus those with adequate calf housing (1.0 kg day⁻¹). Approximately half of the calves in the cohort (418) had blood samples taken monthly from birth until 16 weeks of age. Of the calves sampled, only 19 calves showed a four-fold rise in serum titers to respiratory viruses. Sixteen calves seroconverted to BVDV, two calves to IBRV, and one calf to PI3 virus. Of 98 calves less than 10 days of age tested for adequacy of passive transfer, 35 (35.7%) had serum immunoglobulin levels of less than 800 mg dl⁻¹. There were no significant differences in mortality or morbidity between calves that had adequate passive transfer and those that did not. The incidence of mortality was 0.08 deaths per 100 calf-days at risk; 64 calves died during the 16 months of the study. The risk of death was highest at 2 weeks of age. Enteritis was the most common cause of death (28 deaths, 44% of all deaths) followed by pneumonia (19 deaths, 30% of all deaths). Comparing producer diagnosis of mortality with necropsy results yielded sensitivities of 58.3% and 56% and specificities of 93% and 100% for producer diagnoses of enteritis and pneumonia, respectively. The kappa statistic comparing producer diagnosis with necropsy result was 0.47. The most common pathogens isolated from calves that died of enteritis were rotavirus (five calves), and Escherichia coli (four calves). Pathogens isolated from pneumonic lungs included Pasteurella multocida (three calves), Haemophilus somnus (three calves), and Pasteurella haemolytica (one calf).     

Perception of cattle farmers of the efficacy of east coast fever immunization in Southern Zambia

A study using a structured questionnaire was conducted to assess the perception of cattle farmers of the efficacy of East Coast fever (ECF) immunization in southern Zambia. One hundred and seventy-nine farmers from five districts in southern Zambia were interviewed. The majority of farmers (85%) perceived ECF immunization as being very effective and about half of them (51.4%) preferred immunization to other ECF control strategies. The study showed that the number of calves immunized was strongly associated with the farmer's perception of the benefits of immunization. There was no association between the number of calves immunized and the number of veterinary assistants in a given district or their transport situation. Overall mortality in ECF-immunized calves from various causes stood at 4.2%. Based on farmers' reports, the majority of these deaths seemed to have been caused by anaplasmosis, another tick-borne disease, and might have resulted from relaxation of tick control after ECF immunization. The reasons identified by farmers for not immunizing their animals included failure by immunizing teams to reach certain areas, not having calves of immunization age, and lack of money. These findings provide valuable information on how livestock farmers perceive and adopt new animal disease control strategies and the information could be useful in their planning and implementation.     

The performance of Orma Boran and Maasai Zebu crossbreeds in a trypanosomosis endemic area of Nguruman, south western Kenya

Studies on the trypanotolerance of Orma Boran X Maasai Zebu (Orma Zebu) crossbred cattle (F1 progeny) and pure-bred Maasai Zebu contemporaries were carried out in Nguruman, south western Kenya. The two groups were monitored from birth for a period of 2 years. The incidence of trypanosomosis, parasitaemia, packed cell volume (PCV), body mass and average daily mass gain were monitored. During the study period, overall trypanosomosis incidence was low (3%). The crossbred cattle had a higher incidence of infection (61% vs 39%). The mean PCV and mean mass gain for the crossbred cattle was higher than that of the Maasai Zebu. The mean calf body mass at weaning (8 months) for the Orma Zebu and Maasai Zebu was 72 kg and 64 kg, respectively, while at 18 months of age their mean body mass was 164 kg and 123 kg, respectively. During the rainy season significant differences in average daily mass gains were noted (P < 0.05). The superior mass gain of the Orma Zebu observed during the rainy season, despite higher infection rates, indicate an enhanced trypanotolerance. Moreover, the better performance of the Orma Zebu is an attribute that could be exploited in the adoption of the trypanotolerance genotype, as a sustainable trypanosomosis control strategy.     

Calf morbidity and mortality in smallholder dairy farms in Ada’a Liben district of Oromia,Ethiopia

A longitudinal observational study on calf morbidity and mortality was conducted in smallholder dairy farms in Ada’a Liben district of Oromia, Ethiopia. A total of 185 calves from 112 market oriented smallholder dairy farms were selected randomly and regularly monitored for clinical health problems up to six months of age. Information on potential risk factors was collected by personal observation during the regular visit to farms and from questionnaire survey conducted during the study period. The overall incidences of crude morbidity and crude mortality were 62 % and 22%, respectively. The most frequent disease syndrome was calf diarrhea with the incidence of 39% followed by joint ill 6%. The other disease conditions/syndromes diagnosed include navel ill, pneumonia, septicemic conditions, congenital problems and miscellaneous cases. Age of the calves, age at first colostrum ingestion and cleanness of the calf barns significantly influenced morbidity. Older calves (greater than three months of age) were at lower risk of crude morbidity than younger calves (less than three months of age) (HR = 0.42, P = 0.001). Higher risk of crude morbidity was observed in calves that ingested their first colostrum meal later than 6 hours of age compared to those that ingested colostrum earlier (HR = 2.24, P = 0.001). Similarly, calves housed in unclean barns were at higher risk of morbidity than calves housed in clean barns (HR = 1.75, P = 0.024). Of the 20 potential risk factors investigated, age was the only factor that was found significantly associated with mortality (HR = 0.04, P = 0.001). Calves older than three months of age were at lower risk of mortality than younger calves.     

Disease incidence in ranch and pastoral livestock herds around Lake Mburo National Park,in South Western Uganda

A longitudinal study was done to monitor incidence of livestock diseases in ranch and pastoral herds around Lake Mburo National Park, in South-western Uganda with a high level of wildlife (impala and zebra) and livestock (cattle and goats) interactions. East Coast Fever (ECF), abortions, helminthosis and starvation due to drought were major livestock disease problems encountered. ECF was a major disease affecting mainly calves, causing mortality both in ranch (8.5%) and pastoral (8.2%) herds. Meanwhile, drought was a more serious in pastoral than ranch herds (p < 0.05), killing 28.5 % and 5.8% of adult female cattle in respective production systems. Other endemic diseases found and controlled by vaccination were FMD, CBPP and blackquarter. In both cattle and goats helminthosis was causing mortalities, 3.3% and 0.8% among calves in pastoral and ranches respectively; and 4.8% and 6.9% among kids and sub-adult goats respectively. Many cases of abortions occurred among pastoral herds. In conclusion, the disease incidence among livestock was the same or relatively low as compared to other areas without wildlife.     

Attempted transmission to cattle of Anaplasma marginale from overwintered Dermacentor andersoni ticks.

Since the 1983 summer outbreak of anaplasmosis in southern Saskatchewan, the role of the tick, Dermacentor andersoni as an overwintering reservoir for Anaplasma marginale has been questioned. The purpose of this study was to determine if spring-collected ticks carried virulent A. marginale. Sixteen splenectomized calves were assigned randomly to two groups of 14 principals and two controls. Adult D. andersoni, collected in April from areas having high transmission rates of A. marginale, were confined to the ears of the principals by special bags and allowed to feed for eight days. The two control calves were subsequently challenged intravenously with blood from a calf infected with the Virginia strain of A. marginale. Principals and controls were monitored for 60 and 50 days postexposure respectively for signs of infection by clinical, hematological and serological procedures. None of the principals developed anaplasmosis but both control calves developed signs of disease.     

单舍单犊饲养模式提高腹泻犊牛成活率的回顾性分析

为探讨单舍单犊饲养模式对犊牛成活率、腹泻发生率和死亡率的影响,采用回顾性队列研究方法,对两个饲养条件类似牛场2013—2018年的犊牛腹泻资料进行统计学分析.结果显示:采用单舍单犊饲养模式的A场与对照B场的犊牛成活率分别为98.11％(468/477)、70.83％(306/432),OR=0.047(95％CI,0....