Asenze

Principle Investigators
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; lld1@columbia.edu (retiring)

Jeremy C. Kane, Department of Epidemiology, Mailman School of Public Health, Columbia University; jk4397@columbia.edu

Co-Investigators (past and present)
University of KwaZulu-Natal: Gavin George, Jane D. Kvalsvig, Saloshni Naidoo, Myra Taylor

University of Witwatersrand: Sahba Besharati

Human Sciences Research Council: Alude Mahili

Columbia University: Jeremy C. Kane, Silvia S. Martin, Claude A. Mellins, Reuben N. Robbins, Caleb Miles, Justin Knox

Host: Centre for Rural Health at University of KwaZulu-Natal

Collaborating Institution: Columbia University Mailman School of Public Health, New York, NY, USA

September 2008 – September 2026

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. Award RF1MH134561 is funded by the National Institute Mental 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 four waves of Asenze were led jointly by research teams at the University of KwaZulu-Natal and Columbia University’s Department of Epidemiology in the 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. Principal Investigators for the third and fourth waves were Chris Desmond and Leslie Davidson and are Chris Desmond and Jeremy Kane for the fifth wave. 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 adolescence. The broad range of 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, educational outcomes and functioning within their society.

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 and 4: 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.

Wave 5: Under development and scheduled to commence late in 2024.

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): A pilot study successfully 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 (2022-2023): Wave 4 will evaluated 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 PEER-REVIEWED PUBLICATIONS, ABSTRACTS, AND PRESENTATIONS AS OF JUNE 2024

Over 30 peer reviewed manuscripts are available related to the Asenze Study as well as 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 here in order of publication date.

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.

The study 1) identified support for and perceived need for such screening by teachers given the long waitlist for cognitive assessment of students in the province; 2) the screening process could be accommodated within the participating schools; 3) a majority of parents and students invited to participate consented and 4) that teachers accurately identified students in need of such assessment; and that NeuroScreen could shorten the initial processes required before referring students to the queue for professional psychological assessment. Given the sample size and the design for a feasibility study, we could not assess the sensitivity nor specificity of NeuroScreen to identify mild cognitive impairment. That would require a double blind randomized controlled trial. The full report on this study is available here.

Recent News

See News section for more information.

Asenze Impilo Stakeholder Meeting

The first Asenze Impilo Stakeholder Meeting was held on Tuesday, 15 April, at The Edward Hotel in Durban. This important session brought together key partners from the Departments of Basic Education, Health, Social Development, the Office of the Premier, President’s Emergency Plan for AIDS Relief (PEPFAR) as well as representatives from Civil society, South African Depression and Anxiety Group (SADAG) and Bridging the Gap South Africa. Together, we explored the current landscape of mental health and psychosocial support services for adolescents and young adults in eThekwini, identifying critical gaps, challenges, and opportunities for collaboration. We shared an overview of the Asenze Impilo study, laying the groundwork for ongoing engagement and partnership. The discussions were rich, insightful, and encouraging, highlighting a shared commitment to improving adolescent mental health services in KZN.

Asenze Impilo Study

The Asenze Impilo study is a sub-study of the Asenze longitudinal study, which has been running in waves since 2008 under the Centre of Research in Health Systems. The Asenze Impilo study comprises a series of nested qualitative studies which will provide an in-depth, complementary, and contextual understanding of adolescents and young adults’ mental health during and after COVID-19 and perceptions of the acceptability and appropriateness of interventions that target mechanisms and key populations.

This sub-study is run under the supervision of Asenze Co-Investigators Prof Gavin George (Health Economics and HIV and AIDS Research Division (HEARD), UKZN) and Prof Justin Knox (Clinical Implementation Science and Intervention (in Psychiatry and Sociomedical Sciences) at Columbia University)

Page Updated: May 2025