Tourism in Africa was entangled with colonialism from the start. However, after the Second World War it became an integral part of the colonising powers’ development agenda, albeit one that has received little scholarly attention so far. This presented African states with a serious dilemma when most of them gained independence during the 1960s. On the one hand, tourism promised to stimulate economic growth, provide much needed foreign currency, and create employment opportunities. On the other hand, international tourism had the potential to threaten the economic independence of post-colonial states and perpetuate colonial stereotypes, as well as international and local power imbalances and inequalities. The newly elected governments had to deal with this “colonial baggage.” This article focusses on the transition from colonial to post-colonial tourism in two East African countries, Kenya and Tanzania. I explore how the late colonial government pursued tourism as a development strategy for the region. I also demonstrate how Kenya and Tanzania approached tourism and its colonial legacies in different ways after independence. To trace their respective tourism histories, I draw on published reports and newspaper articles, historical research literature, in particular, from tourism scholars of various disciplines, as well as archival sources.

This article analyzes the transformation of an image of ritual violence on the Kenyan coast from the sixteenth century to the present. Drawing on a range of sources, it shows how understandings of “mung'aro” — a ritual of senior male initiation among Mijikenda-speaking peoples — changed as it became an object of inquiry for generations of missionaries, explorers, colonial administrators, local intellectuals, and foreign historians and anthropologists. In the mid-twentieth century, mung'aro became a key feature of Mijikenda traditions of origin in Singwaya, but in such a way that it reversed the direction of a specific form of ritual violence described in nineteenth-century traditions. By focusing on the transposition and recombination of ritual motifs across practical and discursive modalities (namely, ritual and narrative), this article offers a new approach to “the limits of invention” regarding traditions of origin.

Mental health challenges are common following cancer diagnosis, negatively impacting treatment and quality of life for breast cancer (BC) patients. This pilot study provides an understanding of the impacts of BC diagnosis and care experiences on the mental health of patients seen at the Aga Khan University Hospital in Nairobi, Kenya. We conducted 40 in-depth interviews, including 10 women with newly diagnosed BC, 10 women with metastatic BC, 10 family members and 10 healthcare professionals. Data were transcribed, translated into English as needed and coded using Dedoose software. Following BC diagnosis, it was reported that patients faced various physical, social, psychological and spiritual factors affecting their mental health and quality of life. Our interviews with each group indicated that BC patients experienced feelings of stress, anxiety and depression related to treatments and accompanying side effects. Disclosure concerns, financial impacts, relationship strain and negative outlooks on life were common among BC patients. The findings indicate that BC diagnosis and care experiences influence mental health in this population. With this basis, understanding and addressing the mental health challenges of BC patients is crucial to improve mental health and quality of life.

Visceral leishmaniasis (VL) is a severe infectious disease caused by protozoan parasites of the Leishmania donovani complex. Blood cytokine concentrations in VL patients can inform us about underlying immunopathogenesis and may serve as a biomarker for treatment effectiveness. However, cytokine levels have not yet been studied in VL patients from Kenya, where case load is high. This study measured the serum cytokine profile, blood parasite load and clinical and haematological features of VL patients from West Pokot County, Kenya, over the course of treatment with sodium stibogluconate and paromomycin (SSG-PM). VL patients recruited at the hospital presented with splenomegaly and weight loss, and frequently had pancytopenia and anaemia. Median Leishmania parasite load in blood, determined with real-time polymerase chain reaction, was 2.6 × 104 parasite equivalents mL−1. Compared to endemic healthy controls, serum interferon gamma (IFN-γ), interleukin 5 (IL-5), IL-6, IL-10, IL-12p70, IL-17A and IL-27 were significantly elevated in untreated VL patients. Severe VL was associated with higher IL-10 and lower IFN-γ levels. After 17 daily injections with SSG-PM, disease symptoms disappeared, leukocyte and thrombocyte counts significantly increased, and blood parasite load decreased to undetectable levels in all VL patients. There was a significant decrease in IL-10 and IL-6, whereas IL-17A levels increased; the remaining cytokines showed no significant concentration change during treatment. In conclusion, the results suggest that SSG-PM treatment of VL patients from West Pokot was effective. Moreover, both inflammatory and regulatory immune responses appeared to decrease during treatment, although the increase in IL-17A could reflect a partial continuation of immune activation.

Estimating value of statistical life (VSL) is an important input to many benefit-cost analysis (BCA) approaches, but for many low- and middle-income countries, there are limited or no data estimating VSL. Current guidance relies on extrapolation of results from high-income settings, which may be unreliable, leading to low confidence applying VSL. During 2019, we surveyed 1,820 low-income individuals (average consumption per capita USD329) across four diverse regions in Ghana and Kenya, to inform recommendations about effective spending in the development sector. We elicited VSL using a stated-preference approach, capturing the willingness-to-pay to reduce the risk of death for themselves and their children. Additionally, we conducted multiple “policy choice experiments” (PCEs) in which we asked respondents to choose, from the perspective of a decision-maker, between programs that save lives of different ages, and save lives and provide cash transfers. VSL estimates for this population fell in the range of USD66,795–USD90,453 (PPP-adjusted). We found similar results in the PCE but uncovered much stronger preferences for saving younger lives. Overall, our results suggest that VSL in low-income countries may be higher than estimates based on extrapolations from wealthy countries and that within these communities, policymakers should place more weight on saving the lives of young children. We also explore methodological learnings about how to apply and collect data for BCA in particularly low-income, low-education settings. We find that through careful training and gatekeeping, it is feasible to elicit complicated preferences in this population, and both approaches have their benefits and drawbacks.

The current study evaluated the Kiswahili version of General Health Questionnaire (GHQ-12) in a Kenyan context comprising of women exposed to gender-based violence. Participants were randomly drawn from community sampling using household screening methods in peri-urban areas in Nairobi. A total of 1,394 participants with varying levels of literacy (years of education: mean [M] = 9.42; standard deviation [SD] = 3.73) and aged between 18 and 89 years were recruited for the study. The observed factor structure of the GHQ-12 was evaluated using six most tested models querying the dimensionality of the instrument insofar as the impacts of positive and negative wording effects in driving multidimensionality. Results from the confirmatory factor analysis supported a bifactor model, consisting of a general distress factor and two separate factors representing common variance due to the positive and negative wording of items. Overall, the findings support the use of the Kiswahili version of the GHQ-12 as a unidimensional construct with method-specific variance owing to wording effects. Importantly, GHQ-12 responses from a sample of Kenyan women with relatively low levels of literacy are congruent with the factor structure observed in other cross-cultural settings in low- and-middle-income countries.

Collaboration with African religious congregations can promote psychosocial well-being with greater accessibility. Effective collaboration requires studying congregations as unique intervention contexts. This study explored how an intervention in western Kenya fit within and altered congregational discussion patterns. We conducted a cluster-randomized trial of a church-based intervention to improve family relationships, mental health and sexual health. For each intervention topic covered, we describe baseline and post-intervention changes in church leaders’ beliefs and communication as well as discussion frequency between leaders and members and among members. Mixed-effects logistic regression assessed pre-post change in member-reported discussion frequency. At baseline, members and leaders reported already discussing family, parenting, and emotions frequently and sexuality and finances less frequently. Leaders generally felt they should discuss all topics but were less comfortable and knowledgeable about sexuality and finances than other topics. After the intervention, leader comfort and knowledge increased and discussion frequency increased for nearly all topics, especially those discussed less initially. Good fit between the desires and activities of church members and leaders suggests the potential for further collaboration, especially on mental health and family well-being. Increased discussion of sensitive topics underscores the potential of community-level interventions to affect social norms.