based on previously published studies. Out of multiple other demographic and illness-related factors assessed, only having a secondary dengue infection was associated with a high risk of DHF (RR=3.077,95% CI 1.361, 6.954) Conclusion Persistent NS1 positivity on day three and beyond may not be indicative of disease severity. However, results need to be confirmed by a larger study with quantitative NS1 testing.

Aims 2 out of every 3 Malawians experience violence in childhood. Most acts of physical violence occur in the context of physical punishment. In a setting where physical punishment of children remains legal and is common, this study of Malawian adults sought to (1) evaluate participant's views of what constitutes reasonable chastisement versus physical child abuse (2) investigate if their attitude towards reasonable chastisement and physical abuse matched their practice. Methods We undertook a knowledge, attitude and practice (KAP) study amongst adults in a township in urban Malawi. KAP studies fundamentally assume a direct relationship between knowledge, attitude and practice. This study assumed that if an individual has sufficient knowledge about child abuse and viewed it negatively, they would not engage in that behaviour. A validated KAP questionnaire was modified for use in Malawi. KAP was explored through a series of scenarios presented to participants which they rated as either abusive or not. Following a pilot, a convenience sample of 121 consenting adults was recruited. Ethical approval was obtained.Results Hitting a child who did something wrong but leaving no injuries was considered acceptable punishment and not abusive by 87.6% of participants. If injuries were left as a result of the physical punishment 91.8% viewed this as abuse, even if the child did something wrong. Physically punishing a child who had done nothing wrong was viewed as abusive by 97.5%. However 73.6% admitting to practicing a form of physical punishment that did,or could easily, result in physical injury, including beating a child with a rod or thorny stick, throwing them to the ground or kicking them in the back. Conclusion Like adults in many settings, participants in Malawi viewed physical punishment of children as reasonable only if the child had done something wrong and it did not result in injury. However there was a striking discrepancy between attitudes and practice, suggesting a significant lack of awareness of, or capacity to engage with, other ways of disciplining children. Early years development programmes in Malawi should include guidance on appropriate childhood discipline. Consideration should be given to providing a legal definition of reasonable chastisement.

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