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Focus group discussions, key informant interviews and structured community interviews were used to describe the perceptions of caretakers of pre-school children in a predominantly rural district in Ghana. Over 75% considered ARI important in the community and there are a variety of local terms of describe various ARI illness entities. The perception of signs of severe ARI in children above two months of age was reasonably high; over 88% could mention at least one of two cardinal signs for severe ARI (difficulty in breathing, rapid breathing). The same cannot be said of their perception of signs for children less than two months of age. There was also a favourable perception of cause; a few misconceptions were however identified. There was no significant difference in perception between locality, age groups and educational levels. A high correlation between perception of cause and prevention of ARI was found. Health education programmes should re-enforce positive perceptions and address misconceptions. The difference in presentation of signs of severe ARI between older children and younger ones should also be stressed.