JMIR Publications

ABSTRACT

Background:

The Asenze Cohort is a population-based, longitudinal study established in 2008 in KwaZulu-Natal, South Africa, to examine how early-life adversity and social contexts shape health and developmental trajectories in an area of high HIV prevalence

Objective:

To describe the rationale, design, and methods ofWaves 4 and 5 of the Asenze Cohort, including changes in the cohort over time and patterns of attrition.

Methods:

The cohort enrolled 1,581 children (average age 5 years old) and their primary caregivers in a designated study area and has now followed participants from early childhood into young adulthood across five waves of data collection. This paper describes the protocol and rationale for the most recent waves: Wave 4 (2022) and Wave 5 (2024-2026), which were conducted during and after the COVID-19 pandemic. These waves focus on adolescent and young adult mental health and substance use outcomes in relation to changes in social determinants of health, including education, employment, food security, household stability, and access to health services. Data collection includes repeated quantitative assessments of mental health, psychosocial functioning, substance use, HIV prevalence, prevention and treatment, family functioning, and socioeconomic conditions, complemented by qualitative interviews.

Results:

Waves 4 and 5 extend longitudinal follow-up from early childhood into adolescence and young adulthood, capturing a period marked by major developmental, social, and contextual change, including the COVID-19 pandemic. The cohort provides repeated measures across multiple domains of health and social circumstances, alongside information on participant retention and attrition over time.

Conclusions:

The longitudinal design enables investigation of mechanisms linking early adversity, pandemic-related shocks, and mental health across critical developmental transitions. Data from Waves 1–2 are publicly available, and data from Waves 3–5 may be accessed upon request.