Background <p>Studies on childhood pneumonia have rarely focused on the health literacy of mothers, who are at the center as core players in child care practices. This study provides a pre-post evaluation of how mothers appropriately recognize the clinical signs of childhood pneumonia.</p> Methods <p>The study was based on an exploratory qualitative design. A total of 23 purposively selected mothers attending the Child Welfare Clinic at the Komfo Anokye Teaching Hospital in Ghana were enrolled and trained in accurate illness identification, appropriate actions to take, and attitudes and perceptions related to child pneumonia. Data were collected three months before and three months after the training intervention. Training on breather rate counting at home using colored beads as breadth counters and supported with video on acute respiratory illnesses was conducted. A grounded theory analysis informed the study. The qualitative data were collected, coded openly and analyzed, with a focus on emerged themes.</p> Results <p>There was refinement in participants’ perceptions and changes in their world view of evil spirits as agents causing child pneumonia. There was improvement in mothers’ self-reported ability to apply the bead in detecting their children’s breathing rate after each month of training. The participants demanded a scale-up of the training for all mothers. This study demonstrated how simple local content-tailored education can potentially lead to early detection of pneumonia.</p> Conclusion <p>This study shows that targeted, culturally relevant training dramatically improves mothers’ capacity to recognize clinical indications of infant pneumonia and replaces harmful assumptions with factual information. We advocate expanding this community-based educational intervention into child welfare clinics to increase early detection and treatment of childhood pneumonia.</p>