Chris Desmond, Centre for Rural Health, University of KwaZulu-Natal; ChrisDesmond@libstudies.com
Leslie L. Davidson, Department of Epidemiology, Mailman School of Public Health, Columbia University; firstname.lastname@example.org
University of KwaZulu-Natal: Gavin George, Jane D. Kvalsvig, Saloshni Naidoo
Columbia University: Jeremy C. Kane, Silvia S. Martin, Claude A. Mellins, Reuben N. Robbins
Inge Petersen, Centre for Rural Health at University of KwaZulu-Natal
Columbia University Mailman School of Public Health, New York, NY, USA
September 2008 – April 2023
Award number R01-DA023697 was funded by the National Institute on Drug Abuse and the Fogarty International Center Brain Disorders in Developing Countries Program. Award number R01-TW011228 was funded by the Fogarty International Center, the Office of Behavioral and Social Sciences Research and the Office of Disease Prevention of the National Institutes of Health. Opinions presented here are the sole responsibility of the authors and do not necessarily represent the official views of the NIH.
ASENZE STUDY BACKGROUND
The Asenze Study is a longitudinal, population-based study in contiguous peri-urban and peri-rural communities in KwaZulu-Natal. KwaZulu-Natal has one of the highest HIV/AIDS rates in the world. The study area is northwest of Durban and populated largely by Zulu people. The pilot study and the subsequent three waves of Asenze were led jointly by research teams at the University of KwaZulu-Natal and Columbia University’s Mailman School of Public Health. The Principal Investigators for the first two waves were Leslie Davidson and Shuaib Kauchali with Co-Investigators Meera Chhagan, Jane Kvalsvig, Myra Taylor, Zena Stein, Steve Arpadi and Claude Mellins. The name Asenze, meaning “let us act” in Zulu, was chosen to promote engagement with the participating communities.
ASENZE OVERVIEW AND MODELS
Children ages four to six identified in a defined population have been followed up to mid-adolescence. The information gathered about children and their primary caregivers allows an analysis of child health, behavior and neuro-development as well as household situation, primary caregiver health, mental health, education functioning.
Waves 1 and 2: We adopted a theoretical model outlined graphically (Solarsh et al. 2006) similar to models proposed by UNICEF (Stein and Richter 2005), with the central outcome of child neurodevelopment. It aimed to assess over time the ability of children to function physically, cognitively and socially. The study focused on how children are influenced by health-related (HIV, anemia, infections), contextual (socio-economic, environmental, access to care, intervention), and psychosocial (primary caregiver substance use and mental health problems, family functioning) factors.
Wave 3: We adopted a socio-ecological model of risk and protection linked to a life-course perspective in order to investigate, over time, predictors and modifiers of unprotected sex, substance use, binge drinking and school dropout. Wave 4 will assess adolescents one to two years after the completion of Wave 3.
ASENZE PROCEDURES AND METHODS
The pilot study and the subsequent three waves of Asenze were led jointly by research teams at the University of KwaZulu-Natal and Columbia University’s Mailman School of Public Health. This flow chart reports study participation by wave. This table reports measures by wave.
Pilot Study (2004): The pilot explored the feasibility and acceptability of a cohort study of children and their primary caregivers in this population and tested measures of disability and of mental health.
Initial door-to-door field survey (2008): Primary caregivers provided informed consent to obtain household information and completed the Ten Questions, a developmental screen for child disability in eligible children.
Wave 1 (2008 – 2010): Children received comprehensive medical, psychosocial and developmental assessments. Primary caregivers provided social, demographic and health information about themselves and their child.
Wave 2 (2010 – 2014): The measures in Wave 2 were nearly identical to Wave 1: the medical history and exam were abbreviated and two measures of cognitive achievement were added.
Wave 3 (2019 – 2021): Since the cohort of children had become adolescents, the study added assessment of broader aspects of function including experience of schooling, substance use, reproductive health, and of family functioning and support.
Wave 4 (begins 2022): Wave 4 will evaluate similar constructs as Wave 3 and will only assess the adolescent but not the primary caregivers.
STUDY COMMUNITY ENGAGEMENT
Initial community consultation: The Asenze study leaders met with the five local authorities, the local health officials and provincial health agencies to secure support and solicit input.
Workshop on identifying alcohol difficulties: In 2008 as a response to community concerns about alcohol misuse in the area, the Asenze team held a one-day workshop for over 40 district health officers and nurses to support skill building in identifying and assessing alcohol use disorders.
Community feedback following Wave 2: Well attended community feedback meetings were held in each of the five local authorities and discussed Asenze study health and developmental findings and stressed the importance of early nutrition and cognitive stimulation.
TVT Intervention based on wave 1 and 2 findings: The Valley Trust based their Child Health and Development Program, The Khulakahle Mntwana Program, on the findings of the first two waves of the Asenze study and participated in the community feedback meetings mentioned above.
Asenze Learning Feasibility Study: Working with the approval of the District Department of Basic Education and with assistance from the University of KwaZulu-Natal Discipline of Psychology as well as two local secondary schools, the Asenze team is completing a feasibility study on the use of NeuroScreen, an electronic tablet-based screen comprising 10 brief neuropsychological tests, to assist schools in assessing learners in need of academic assistance.
ASENZE PUBLICATIONS, ABSTACTS, AND PRESENTATIONS AS OF JANUARY 2022
Over 20 peer reviewed manuscripts and 7 published abstracts are available related to the Asenze Study as well as 10 presentations at recent national or international meetings given between 2019 and 2022. The entire list of Asenze publications, published abstracts, and recent presentations can be found in order of publication date.
Website Updated: January 2022