These days, cholera is largely an African disease, with over 95 percent of all cases worldwide over the past two decades occurring in Africa. In his informative history of the seven cholera pandemics that have hit the continent since 1817, Echenberg shows that this was not always so. Epidemiologists agree that cholera originated in South Asia. Its arrival in Africa at the beginning of the nineteenth century was testimony to the region’s growing insertion into global economic and social systems, as successive pandemics followed trade routes, colonial armies, and African Muslims making pilgrimage to Mecca. Back then, cholera was one of the most devastating diseases known, killing millions. But over time, the virulence of dominant strains of the disease have abated, and mortality rates have dropped sharply, particularly since a highly effective oral rehydration therapy was mastered. Echenberg argues that the 5,000–7,000 cholera deaths every year in Africa represent a failure to provide public sanitation systems and access to clean water, often in failing states that are riven by civil war. Indeed, in 2006, four countries accounted for three-quarters of all cases on the continent: Angola, the Democratic Republic of the Congo, Ethiopia, and Sudan.
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