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At the beginning of Slaughterhouse-Five, the author discusses hisstruggle in writing the book, and a visit he paid to man who was with him inDresden during the war. His wife, Mary, is not happy about the visit. She isupset that the book will be about the war, and that the author will try toaggrandize his war memories, when in fact both men were "children" at the time.The author promises that the book will not glorify the war, and says he willname the book "The Children's Crusade."
The real children's crusade, we are told, was a kind of elaboratetrafficking scheme. Children were rounded up to "fight" for Christianity, butthe actual plan was to ship them off to Africa to be sold as slaves. So it waswith the war. The subtitle can be understood as a reference to thevictimization of the soldiers, who, like the children in the original crusade,are told that they are fighting for "democracy" but in reality are simply beingsacrificed for the war effort. The war itself is a kind of con, a way ofjustifying the incredible destruction of Dresden. Like real children, thesoldiers are easily led and victimized.
Every year, there are over 200 million global cases of malaria, resulting in over 600,000 deaths annually.17 In 2017, every twelfth child that died was a victim of malaria; in other words, another child dies of malaria approximately every 2 minutes.18, 19 However, illness and death from malaria can usually be prevented with appropriate prevention measures and treatments.20
A: While anyone can get malaria if bitten by an infected mosquito, the people most likely to get seriously ill and die are those with little or no malaria immunity. Malaria immunity is not well understood by the scientific community; however, it is clear that people who are regularly exposed to Plasmodium FalciparumThe deadliest species of parasite that causes malaria in humans.7 malaria have some resistance to becoming seriously ill or dying from malaria.21, 22 The individuals most likely to be seriously ill from malaria include children, pregnant women, and travelers from countries who have never been exposed to malaria before.23 People without access to healthcare are also at an increased risk of dying from malaria.24
A: It is estimated that over 90% of all malaria deaths occur in Sub-Saharan AfricaThe 48 African countries south of the Sahara Desert.9.28 One reason for these deaths is that Plasmodium FalciparumThe deadliest species of parasite that causes malaria in humans.7, the malaria parasite most likely to cause life-threatening illness, is very common in many Sub-Saharan African countries, in part because of a habitable climate.29 The lack of healthcare access in many areas of Sub-Saharan Africa also leads to an increased number of malaria deaths.30 In Nigeria in 2019, there were 191,106 deaths attributed to malaria. In contrast, there were no deaths attributed to malaria in the United States that same year.31 In 2020, just 4 Sub-Saharan African countries (Nigeria, the Democratic Republic of the Congo, Tanzania, and Mozambique) accounted for over half of all malaria deaths globally.32
A: Following the Second World War, the discovery and use of insecticides like Dichlorodiphenyltrichloroethane (DDT) and dieldrin (DLD) led to a sharp decline in malaria cases in some areas of Africa.33 By the 1950s, malaria had been eliminated in the United States.34 During this time, the price of chloroquine, an antimalarial drug, became more affordable, and chloroquine was widely used in Africa throughout the 1960s and 1970s. However, chloroquine-resistant parasites began to emerge in the 1970s, and by the 1980s, malaria was on the increase once again.35 Since the early 2000s, artemisinin-based combination treatments (drugs that use artemisinin in combination with a number of other drugs) have been generally accepted as the best first-line treatment for malaria.36
A: The oldest reference to malaria is found in a Chinese document from 2700 BC; Mesopotamian clay tablets, Egyptian papyri, and Hindu texts throughout the centuries all refer to malaria as well.40 The parasite was discovered in the blood of malaria patients by Alphonse Laveran, a French army officer working in Algeria, in 1880.41
The hot and humid climate of Sub-Saharan AfricaThe 48 African countries south of the Sahara Desert.9 contributes to malaria by providing an ideal environment for malaria parasites and malaria-carrying mosquitoes to thrive. Both the malaria parasite itself and the mosquitoes that transfer malaria to humans can only survive in certain conditions, which the tropical and subtropical environments of Sub-Saharan Africa provide.44, 45
The prevalence and behavior of mosquitoes in an area are highly dependent on the climate of the area. Mosquitoes are affected by climate at every stage of their life cycle.55 The climate of Sub-Saharan AfricaThe 48 African countries south of the Sahara Desert.9 is conducive to malaria transmission, which contributes to the prevalence of malaria in this region.
Rather than attending a formal clinic, many people in Sub-Saharan AfricaThe 48 African countries south of the Sahara Desert.9 go to medicine vendors for drugs to treat malaria.62 In Togo, for example, only 20% of children under the age of 5 who had a fever were taken to a formal health clinic; 83% were treated at home using an antimalarial drug from a street or market vendor.63 On the Kenyan coast, 69% of childhood fevers were first or solely treated with shop-bought medicine.64 Medicine vendors are generally closer to home than formal health facilities.65 A study of mothers in rural Kenya found that 87% lived within 1 kilometer of a medicine shop, while only 32% lived within 2 kilometers of a private clinic or government dispensary.66
Drug resistance in the malaria parasite and malaria-carrying mosquitoes contributes to malaria in Sub-Saharan AfricaThe 48 African countries south of the Sahara Desert.9 by making eradication more difficult. Over time, malaria and mosquitoes adapt to become more resistant to drugs and insecticides that were once effective against them. This growing resistance has resulted in malaria re-emerging in places where it was once eradicated, such as India, Peru, and the Kenyan highlands.77, 78, 79, 80
Mosquitoes have also developed resistance against insecticides that are used to prevent malaria. There are 4 classes of insecticides: pyrethroids, organochlorines, carbamates, and organophosphates. In 2020, of the 82 countries with malaria, 28 detected resistance to all 4 of these insecticide classes, and 73 of these countries detected resistance to at least 1 insecticide class. Resistance to pyrethroids, the class of insecticides used to treat mosquito nets, was especially widespread, with resistance detected in 69.9% of sites where data was available.95 As insecticide resistance increases, it becomes more difficult for people to protect themselves from malaria-carrying mosquitoes. These instances of drug resistance lead to an increase in the prevalence of malaria in Sub-Saharan AfricaThe 48 African countries south of the Sahara Desert.9.
Malaria is fatal for many people who contract it. Falciparum malaria, the most common strain in Sub-Saharan AfricaThe 48 African countries south of the Sahara Desert.9, is extremely dangerous. In severe cases of malaria, fatality rates can be as high as 20%.96
Malaria impedes economic growth as it causes children to miss school and adults to miss work.115 Studies in Mali, the Democratic Republic of the Congo, Kenya, and Senegal have all demonstrated a clear correlation between malaria and school absenteeism among children.116, 117, 118, 119, 120 For example, in a school in Senegal, malaria was found to be the cause of up to 36% of medically-related school absences, depending on the seasonal prevalence of malaria.121 When malaria causes children to miss school, those children are then more likely to fail their classes, repeat grades, and drop out of school; this trend results in lost human capital, as those people are then less able to contribute to the economy.122 Absenteeism due to malaria is also a problem for adults in the workforce. Whether adults miss work because they themselves are sick or because they need to care for a sick child, absenteeism due to malaria hinders the productivity of businesses.123 For example, a study of businesses in 3 regions of Ghana found that businesses lost an average of 1,304 work days a year due to malaria.124 A survey of 8,000 business leaders globally found that, among business leaders in Sub-Saharan AfricaThe 48 African countries south of the Sahara Desert.9, 72% reported that malaria harms their businesses; 39% reported serious detriments due to malaria.125
On the micro level, malaria also causes individuals and households to become poorer. Poor households in Sub-Saharan AfricaThe 48 African countries south of the Sahara Desert.9 sometimes spend large proportions of their income on malaria treatment. Research estimates that the direct cost of one episode of malaria to a household is about $6.87 USD in Ghana, $4.80 USD in Uganda, and $4.50 USD in Mali.126 This cost is proportionally very expensive; as stated above, 41% of the Sub-Saharan African population makes less than $1.90 USD a day.127 A study in Malawi found that very low-income households, with an average annual income of $68.00 USD, spent 32% of their annual income on malaria treatment.128
Some economists have argued that malaria also hinders the economy through its effects on fertility, population growth, and foreign investment.129 However, further data is needed to support this argument.
Even people who survive malaria may experience long-term health consequences after their recovery. Long-term complications following cerebral malariaThe most severe neurological complication of Plasmodium FalciparumThe deadliest species of parasite that causes malaria in humans.7, which is characterized by the patient going into a coma.1 are especially well-documented. One serious aftereffect of cerebral malaria is neurological sequelae or damage to the central nervous system.130 Five-point-six percent of children who had cerebral malaria and recovered were found to have long-term sequelae 6 months later, including hemiplegia or hemiparesis (weakness in one or both limbs on one side of the body), speech disorders, behavioral disorders, blindness, hearing impairment, cerebral palsy, and epilepsy.131 Epilepsy is an especially serious health issue because, if untreated, it may lead to other mental or physical impairments.132 The exact percentage of children who are left with neurological damage after surviving cerebral malariaThe most severe neurological complication of Plasmodium FalciparumThe deadliest species of parasite that causes malaria in humans.7, which is characterized by the patient going into a coma.1 is unknown; estimates vary from 2% to 25%.133, 134, 135, 136
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