Factors associated with caregivers' knowledge and home management of measles in children under five years in Tamale, Ghana: a cross-sectional study

¹Department of Epidemiology, Biostatistics and Disease Control, School of Public Health, University for Development Studies, Tamale, Ghana, ²Department of General Nursing, School of Nursing and Midwifery, University for Development Studies, Tamale, Ghana, ³Department of Social and Behavioral Science, School of Public Health, University for Development Studies, Northern Region, Tamale, Ghana

^&Corresponding author
Abdul-Manan Sumani, Department of Epidemiology, Biostatistics and Disease Control, School of Public Health, University for Development Studies, Tamale, Ghana

Introduction    

Measles remains a significant public health challenge, particularly in low- and middle-income countries, where it is a leading cause of morbidity and mortality among children under five years of age [1]. Despite the availability of an effective vaccine, measles continues to affect millions of children globally, with the World Health Organization (WHO) reporting over 140,000 measles-related deaths in 2018, the majority of which occurred in children under five years. The continued prevalence of measles is largely attributed to gaps in vaccination coverage, misinformation about vaccine safety, and socio-cultural factors that influence healthcare practices [2].

The management of measles, particularly in resource-limited settings, often involves a combination of formal healthcare and home-based treatment practices [3]. Caregivers play a pivotal role in the early detection, management, and prevention of measles. Their knowledge, attitudes, and practices regarding the disease directly impact the outcomes of infected children [4-8]. However, the level of knowledge among caregivers about measles symptoms, complications, and appropriate treatment methods varies significantly, influenced by factors such as education, access to healthcare information, cultural beliefs, and economic status [8,9].

In many communities, misconceptions about measles and its treatment prevail, leading to delays in seeking appropriate medical care and a reliance on ineffective home remedies [10]. These practices can exacerbate the severity of the disease, increase the risk of complications, and contribute to the continued spread of the virus. Furthermore, the decision-making process regarding when and how to treat measles at home versus seeking professional healthcare is complex and influenced by multiple factors, including the caregiver's educational background, trust in healthcare systems, and cultural norms.

Previous studies have explored the knowledge and practices of caregivers regarding various childhood illnesses, but there is a paucity of research specifically focusing on the factors associated with the knowledge and home treatment of measles. Understanding these factors is crucial for designing targeted interventions that can improve the management of measles at the household level and reduce the burden of the disease [9].

The recent measles outbreak in Northern Ghana prompted a call by Asumah et al. [9] for the need to investigate the factors associated with the knowledge and home treatment practices of caregivers of children under five years infected with measles. Incorporating these insights into measles elimination strategies ensures that biomedical interventions are complemented by community-centered approaches, ultimately strengthening both prevention and child survival outcomes [11]. Identifying the determinants of caregivers' knowledge and their treatment approaches can contribute to effective health education programs, enhance early detection and appropriate management of measles, and reduce measles-related morbidity and mortality among young children [12,13]. It is essential to raise awareness about measles, promote timely vaccination, and ensure that caregivers are equipped with the necessary knowledge and resources to manage measles effectively at home [14]. This is particularly important in settings with limited access to healthcare, as caregivers often serve as the first line of defense in protecting children from the severe consequences of measles.

Maternal knowledge about immunization and disease prevention was insufficient in Libya, with many mothers unaware of vaccination schedules and measles-related complications [14]. In sub-Saharan Africa, cultural norms and low health literacy also contribute to gaps in caregivers´ understanding of measles management. Studies emphasize the role of education and public awareness campaigns in addressing these challenges, noting that misinformation about vaccine safety often deters timely immunization [15]. Furthermore, the impact of urbanization has been highlighted, with slum environments identified as hotspots for vaccine hesitancy due to limited access to accurate health information [16]. Socioeconomic and geographic factors are critical determinants of caregivers' ability to manage measles effectively [17]. These disparities leave vulnerable children at a higher risk of measles infection. Similar factors contribute to the low second-dose measles-rubella vaccine coverage in Ghana. The study found that caregiver education, vaccine availability, and healthcare facility accessibility were key determinants [18].

Global measles elimination efforts have shown that robust immunization programs dramatically reduced cases between 2000 and 2020. However, the authors also noted significant regional variations, with sub-Saharan Africa and parts of South Asia continuing to lag behind due to healthcare inequities and underfunded vaccination efforts [19].

The dual impact of COVID-19 disruptions on measles outbreaks in sub-Saharan Africa reduced immunization rates and resource constraints [20,21]. Scientometrics analyses of vaccine-preventable diseases in sub-Saharan Africa have revealed the importance of advocating for tailored interventions that address the unique social and cultural dynamics in the region are paramount. Such strategies can improve caregivers´ acceptance of vaccines and foster better home management practices [20,22,23]. Hence, this study sought to examine factors associated with caregivers´ knowledge on home-based management of measles in children under five years in Tamale, Ghana.

Methods     

Study area: this study was conducted on seemingly healthy individuals residing in the Tamale Metropolis, one of the 26 districts in the Northern Region of Ghana. Centrally located within the region, the Tamale Metropolis is bordered by the Sagnarigu District to the northwest, Mion District to the east, East Gonja to the south, and Central Gonja to the southwest. The Metropolis covers an estimated area of 646.90 square kilometers and comprises approximately 115 communities. These rural communities have extensive land areas dedicated to agriculture, serving as the primary food source for the Metropolis and its neighboring districts.

Study design: this study employed a descriptive cross-sectional study design using a quantitative approach to generate data, to gain insight into study participants, awareness, and seeking home treatment of measles infection.

Study population

Inclusion criteria: 1) caregivers in the study area within the age of eighteen years and above; 2) caregivers who were willing to participate in the study; 3) caregivers with a sound mind.

Exclusion criteria: 1) caregivers who were referred from any part of the country to seek health care within the selected health facility; 2) caregivers who were on admission at the selected health facility; 3) caregivers who were not willing to participate in the study.

Sample size determination: the sample size of the study was determined using Cochran formula for sample size calculation:

N= sample size; Z= standard normal distribution=1.96; P= prevalence rate in the population; q= 1-p; d= the degree of the accuracy desired (0.05 for an acceptable error of margin of 5%).

Available literature indicated that the prevalence of measles infection among children under five years was 17.1% [12]. Based on this fact, the sample size was calculated using the Cochran formula [23] formula, standard normal 1.96, degree of accuracy 0.05, and a minimum sample size of 220 was required for the study.

Sampling process: a simple random sampling technique was employed to select study participants. The target population comprised caregivers of children under five years of age residing in Tamale, Ghana. A comprehensive sampling frame was developed using records obtained from community health workers and local health facilities, which included all households with eligible caregivers.

Each eligible caregiver was assigned a unique identification number. Using a computer-generated random number list, a predetermined number of caregivers were randomly selected to participate in the study. This approach ensured that each caregiver had an equal and independent chance of being selected, thereby minimizing selection bias and enhancing the representativeness of the sample. In cases where selected individuals declined participation, replacements were randomly drawn from the remaining list of eligible participants.

Data collection: data were collected using a standardized, structured questionnaire developed to obtain information on the socio-demographic characteristics of caregivers and their children, caregivers´ knowledge of the causes, signs, and symptoms of measles, immunization history, and the type of treatment administered at home. The questionnaire was adapted from a previously validated tool used in a similar study [6], ensuring content validity and alignment with the study objectives.

To further ensure contextual relevance and reliability, the questionnaire was pretested among 20 caregivers in a neighboring community with similar socio-demographic characteristics. Based on the feedback, minor adjustments were made to improve clarity, cultural sensitivity, and translation accuracy. The internal consistency of the questionnaire was assessed using Cronbach´s alpha, which yielded a coefficient of 0.83, indicating good reliability. Trained research assistants conducted face-to-face interviews with the respondents. Questions were read aloud and interpreted in the local language to ensure comprehension. Responses were recorded by the interviewers in real time. This approach helped to accommodate varying literacy levels and ensured consistency and accuracy in data collection.

Data analysis: data from the field were cleaned in Microsoft Excel and then imported into Statistical Package for Social Science (SPSS) version 22 for analysis. Analysis was also done using both descriptive and inferential statistics (Crude Odds Ratios (cOR)) and Adjusted Odds Ratios), and the results were presented in tables. People with a knowledge score of more than 50% were considered good, and otherwise were considered poor knowledge.

Study variable

Dependent variables

Knowledge of measles: this variable assessed caregivers´ knowledge of the causes, signs and symptoms, modes of transmission, complications, and prevention of measles.

Measurement: a knowledge score was computed based on correct responses to a series of knowledge-related questions. Scores were categorized into “good knowledge” and “poor knowledge” using a predefined cut-off point.

Immunization status of the child: this variable captured whether the caregiver reported that their child had received measles vaccination, including the number of doses received.

Measurement: immunization status was categorized as “not immunized”, “partially immunized”, or “fully immunized” based on Ghana Health Service guidelines.

Home management practices for measles: this variable referred to the steps taken by caregivers in managing measles symptoms at home, including the use of home remedies, medications, or traditional practices.

Measurement: management practices were classified as “appropriate” or “inappropriate” based on adherence to WHO-recommended home care practices.

Independent variables: the independent variables included the socio-demographic characteristics of caregivers: age, religion, ethnicity/tribe, occupation, and educational level.

Ethical consideration: ethical clearance was acquired from the ethical review committee of the University for Development Studies with reference number UDS/RB/189/23. Permission was acquired from the directors of various health institutions. The aim of the research and all information regarding the research were explained to the participants for informed consent to be obtained. A prior visit was made to the research areas to officially inform the health directorates and health facilities, beforehand of the research project.

Results     

Socio-demographics characteristics: the majority of the respondents were females (80.4%), and a significant portion follows the Islamic faith (82.1%). The ethnic distribution is diverse, with the highest percentage belonging to the Dagomba ethnicity (54.7%). A notable proportion has no formal education (53.1%), and the majority were unemployed (74.3%). The data shows a predominantly single population (92.2%), and a substantial number live in polygamous family structures (93.3%). A significant portion has a monthly income below GH₵1000, and the majority live in family-owned houses (91.1%) and winged apartments (91.6%) (Table 1).

Knowledge of cause, symptoms, and signs, and complications of measles: respondents correctly identify that measles is common among children less than 9 months (100.0%) and between 9 months and 5 years (100.0%). However, there is confusion regarding its prevalence among children between 6 and 18 years (43.6%), adults (9.5%), and the elderly (0.0%). This suggests a need for education on the age groups susceptible to measles. The majority correctly attribute measles to infections with microorganisms/viruses (96.1%) and recognize lack of immunization as a cause (82.7%). Notably, some respondents associate measles with exposure to heat, spiritual attack, and mosquito bites, indicating potential misconceptions. Respondents accurately identify high body temperature (35.2%) and cough (63.1%) as primary symptoms (Table 2).

Prevalence of measles infection and immunization rates: the data in Table 3 indicate that 12.8% of respondents reported that any of their children had contracted measles before, while the majority (87.2%) stated that their children had not experienced measles. This suggests a relatively low prevalence of measles among the surveyed population. Surprisingly, all respondents (100%) reported that their children with measles did not receive measles immunization. This raises concerns about the overall immunization coverage within the surveyed community. The reasons provided for not receiving immunization include forgetting (12.3%), lack of knowledge (21.2%), not being informed (39.7%), and being too busy (26.8%). Addressing these barriers, especially through improved communication and awareness campaigns, could contribute to higher immunization rates. Respondents were asked how they knew their child had measles. Commonly identified symptoms include cough (50.8%), vomiting (65.4%), fever (51.4%), runny nose (53.6%), redness of eyes (67.0%), and rashes (28.5%).

Management of measles in children by caregivers at home: caregivers employed various home treatments for children with measles. Common approaches included tepid sponging, giving antibiotics, drugs for malaria, oral herbal concoction, paracetamol, and using local remedies such as bitter leaf, black soap, body cream, breast milk, eye drops, palm oil, shea butter, and urine mixture. Caregivers sought external help for specific symptoms or conditions such as chest indrawing, convulsion, dehydration, difficulty with breathing, ear discharge, inability to eat or drink, malnutrition, mouth ulcers, noisy breathing, pain and swelling behind the ear, rapid breathing, redness of eyes with pains, severe fever, swelling of the body and/or feet, and unconsciousness/lethargy. External treatment was sought from various sources, including chemists (12.8%), friends (13.4%), herbalists (20.1%), hospitals (27.9%), mosques (17.3%), and relatives (8.4%). The diverse range of sources indicates the different avenues caregivers explore for additional medical assistance. Complications reported by caregivers included mouth ulcers (60.3%), dehydration (52.0%), redness of eyes with pains (47.5%), ear discharge (36.9%), severe fever (100.0%), inability to eat or drink (63.1%), noisy breathing (57.0%), pain and swelling behind the ear (56.4%), malnutrition/severe weight loss (31.8%), convulsion (59.2%), rapid breathing (63.7%), swelling of the body and/or feet (100.0%), difficulty with breathing (46.9%), unconsciousness/lethargy (100.0%), and chest indrawing (12.8%) (Table 4).

Distribution of management of measles by knowledge and socio-demographic characteristics: Table 5 illustrates the distribution of measles management by knowledge and various socio-demographic characteristics, using Fisher's exact test to determine the statistical significance of associations. Knowledge plays a crucial role, with poor knowledge resulting in poor management (51.5%) and good knowledge leading to better management outcomes (70.5%), showing a significant association (Fisher's exact test, p=0.003). Age also shows a strong correlation, with younger age groups (20 and below) exhibiting 100% poor management, while older groups (31-40 and 41+) had 100% good management (Fisher's exact test, p<0.001). Sex differences were noted, with females managing better (62.5%) compared to males (40.0%), indicating a significant association (Fisher's exact test, p=0.016).

Religious affiliation significantly impacts management, with Christians showing 78.1% poor management and Muslims 66.0% good management (Fisher's exact test, p<0.001). Ethnicity also matters, with Akan (64.4%), Ewe (100%), Frafra (100%), and Mumprusi (100%) showing good management, contrasted by Dagomba's poorer outcomes (55.1%) (Fisher's exact test, p<0.001). Education level is a critical factor; those with no education had poorer management (25.3%) compared to those with tertiary education (87.5% good management), revealing a significant association (Fisher's exact test, p<0.001).

Marital status showed significant differences, with divorced individuals exhibiting 100% good management, married individuals showing poorer outcomes (80% poor management), and single individuals having a 59.4% good management rate (Fisher's exact test, p=0.011). The occupation did not show a significant association (Fisher's exact test, p=0.134). However, the caregiver's relationship with the child is crucial, with grandparents providing better management (73.9%) compared to the father's sister (72.1% poor management) (Fisher's exact test, p<0.001).

Family type also influences management, with monogamous families showing poorer outcomes (91.7% poor management) compared to polygamous families (61.7% good management) (Fisher's exact test, p<0.001). Income levels reveal that higher incomes (>GH₵1000) are associated with better management (90.0% good management), whereas lower incomes (<500) correspond to poorer management (33.9%) (Fisher's exact test, p<0.001).

Regression analysis of the demographic characteristics: the multiple logistic regression model results highlight significant associations between various factors and the management of measles. Individuals with good knowledge about measles management are significantly more likely to manage the disease well, with an adjusted odds ratio (aOR) of 4.45 (95% CI: 2.34, 8.26, p < 0.001). Age groups 21-30 and 31-40 show higher odds of good management compared to the reference group (20 and below), with aORs of 1.35 (95% CI: 0.14, 3.50, p < 0.001) and 1.62 (95% CI: 0.42, 4.91, p = 0.014), respectively. Males are significantly less likely to manage measles well compared to females, with an aOR of 0.06 (95% CI: 0.01, 0.59, p < 0.001).

Religion also plays a significant role, as Muslims are more likely to manage measles well compared to Christians, with an aOR of 5.50 (95% CI: 2.17, 11.76, p = 0.015). Ethnicity-wise, Dagomba, Ewe, Frafra, and Mumprusi show higher odds of good management compared to Akan, with Mumprusi having the highest odds (aOR = 6.84, 95% CI: 3.52, 9.49). Education levels are positively associated with good management, particularly at the primary (aOR = 2.40, 95% CI: 1.24, 4.83, p = 0.013) and tertiary (aOR = 2.21, 95% CI: 1.26, 3.88, p = 0.006) levels. Marital status is also significant, with married and single individuals showing higher odds of good management compared to divorced individuals, with aORs of 1.86 (95% CI: 1.36, 2.55, p < 0.001) and 3.84 (95% CI: 2.50, 5.88, p < 0.001), respectively. Regarding the relationship of the caregiver to the child, grandparents and parents were more likely to manage measles well compared to the reference group (father's sister), with parents having an aOR of 3.72 (95% CI: 1.64, 8.24, p < 0.001). Family type and income levels also influence measles management. Individuals from polygamous families were more likely to manage measles well compared to those from monogamous families (aOR = 1.48, 95% CI: 0.73, 2.51, p = 0.009). Higher income levels are associated with better management, particularly for those earning over 1000, with an aOR of 1.19 (95% CI: 0.89, 1.58, p = 0.005) (Table 6).

Discussion     

The high level of knowledge among respondents compared to the Malaysian study by Voo et al. [24] suggests regional differences in awareness and educational outreach effectiveness. This emphasizes the importance of contextualizing health education programs to address specific regional misconceptions and knowledge gaps.

The accurate identification of measles symptoms, such as high body temperature and cough, by a substantial portion of respondents aligns with previous studies showing awareness of primary symptoms. However, the lack of recognition of other critical symptoms, such as a runny nose, redness of the eyes, rashes, and inability to eat, underscores a gap in comprehensive symptom knowledge. This gap in knowledge is critical as it may affect timely and accurate diagnosis and management of measles cases, as emphasized by Gastañaduy et al. [10] in their discussion on the importance of symptom recognition for effective measles control.

The findings from the respondents' knowledge and misconceptions about measles highlight the critical need for improved educational initiatives. The confusion regarding the prevalence of measles among older age groups and the incorrect associations with heat, spiritual attack, and mosquito bites reflect significant gaps in understanding. This is consistent with the challenges identified by Crocker-Buque et al. [14] who found that caregivers in low-income urban communities often have limited and sometimes incorrect knowledge about measles.

The high level of awareness regarding the role of microorganisms/viruses and the importance of immunization is encouraging. However, the persistence of misconceptions mirrors the findings of Crocker-Buque et al. [14], who noted that urbanization and socio-economic factors contribute significantly to the variance in immunization knowledge and practices. Furthermore, the need for targeted education is supported by Allan et al. [15] who identified socio-economic, geographic, and maternal characteristics as key factors influencing childhood immunization coverage in Kenya. These factors likely play a role in the observed misconceptions among the respondents.

This study also revealed that caregivers of children with measles employed a wide variety of home treatments, ranging from tepid sponging and paracetamol use to antibiotics, malaria drugs, herbal concoctions, and local remedies such as bitter leaf, black soap, palm oil, shea butter, and even urine mixtures. Our findings align with previous research demonstrating that caregiver knowledge and cultural beliefs strongly shape child health practices. In Ghana, Sheriff et al. [4] reported that despite progress in measles surveillance, community-level treatment behaviors remain a barrier to elimination efforts. Similarly, Frimpong et al. [5] found that caregiver perceptions and socio-cultural influences play an important role in adherence to child immunization schedules. The current study extends these insights by showing that the same determinants influence household responses when children contract measles, with some practices delaying professional care until symptoms become severe, such as convulsions, dehydration, chest indrawing, or unconsciousness.

Global evidence reinforces the importance of caregiver practices in sustaining measles elimination. Wang et al. [2] highlighted that uneven knowledge and treatment behaviors contribute to ongoing measles outbreaks in countries with otherwise strong immunization programs. In India, Wong et al. [1] demonstrated that vaccination campaigns significantly reduced measles-related child deaths, yet emphasized the need for complementary health education to address treatment misconceptions. Likewise, Toure et al. [6] observed in France that knowledge and risk perception influenced both vaccination decisions and responses to measles illness, suggesting that behavioral determinants transcend resource settings.

The persistence of unsafe or ineffective home treatments observed in this study underscores the importance of strengthening health education as part of measles control strategies. Hoffman et al. [3] emphasized in the midterm review of the Measles and Rubella Global Strategic Plan that education and community engagement are critical for sustaining elimination alongside immunization and surveillance. Addressing misconceptions, promoting safe home care, and reinforcing timely health-seeking behaviors could reduce measles-related morbidity and mortality among children under five in Ghana and beyond.

Additionally, the observed misconceptions about measles etiology and symptoms highlight the critical role of continuous education and public health campaigns. As noted by the European Centre for Disease Prevention and Control [10,17,18]. Ongoing education is vital for maintaining high immunization rates and reducing the incidence of measles, particularly in light of rising measles cases in various regions.

The relatively low prevalence of measles (12.8%) among the surveyed population suggests effective initial measures in controlling the disease. However, the complete lack of immunization among children who contracted measles is concerning, indicating significant gaps in vaccination coverage [9]. This discrepancy highlights a critical issue in public health efforts, as effective measles control relies heavily on high vaccination rates [21].

Barriers to immunization identified in the study, such as forgetting, lack of knowledge, not being informed, and being too busy, underscore the need for robust communication and education strategies. These barriers are consistent with findings from other regions. Dalaba et al. [16] identified similar factors contributing to low vaccination coverage in Bolgatanga Municipality, Ghana. Additionally, Dalaba et al. [16] noted the influence of socio-economic, geographic, and maternal characteristics on immunization coverage in Kenya, suggesting that similar socio-demographic factors might be affecting vaccination rates in the surveyed community.

The awareness of common measles symptoms among respondents, including cough, vomiting, fever, runny nose, redness of eyes, and rashes, indicates a reasonable level of knowledge. However, the persistence of misconceptions, such as associating measles with heat exposure, spiritual attack, and mosquito bites, reflects ongoing gaps in public health education. Studies like those by Gastañaduy et al. [10] and Crocker-Buque et al. [14] emphasize the importance of addressing these misconceptions through targeted education programs.

Improving immunization coverage and health outcomes requires addressing the identified barriers through targeted interventions. For instance, Voo et al. [24] discussed the necessity of enhancing vaccine knowledge and reducing hesitancy among parents, which is directly applicable to the findings of this study. Furthermore, the systematic review by Crocker-Buque et al. [14] on urbanization and slums highlights the need for tailored strategies to reach underserved populations and improve vaccine uptake.

Caregivers employ a diverse range of treatments for children with measles, including traditional remedies and biomedical interventions. This aligns with findings that show caregivers often rely on local practices such as herbal concoctions and local remedies like shea butter and bitter leaf [6,21]. These practices are rooted in cultural beliefs and accessibility to local resources, underscoring the need for culturally sensitive healthcare approaches [18].

The multiple logistic regression model results provide insights into factors influencing measles management among caregivers. Caregivers with good knowledge about measles management, as highlighted in previous studies [6], are significantly more likely to manage the disease effectively. This underscores the critical role of health education in empowering caregivers to recognize symptoms early and implement appropriate treatments. Additionally, higher education levels, as supported by Allan et al. [15], particularly at primary and tertiary levels, are associated with better measles management, emphasizing the importance of education in healthcare decision-making.

Limitations of the study: the study was cross-sectional, capturing caregivers´ knowledge and practices at a single point in time. However, longitudinal studies could track changes in knowledge, behaviors, and measles outcomes over time would provide stronger evidence for effective interventions. The studies relied on self-reported data from caregivers, which may be subject to recall bias or social desirability bias, where respondents provide answers, they believe are expected rather than reflecting actual practices. The absence of a standardized framework makes it challenging to compare findings across different populations and settings.

Recommendations: the Ghana Health Service should create educational campaigns that address the specific gaps and misconceptions caregivers have about measles. These materials should be easy to understand, available in local languages, and tailored to different regions and income levels. The Ghana Health Service should also work with community-based organizations and local leaders to share correct information about measles. They should use trusted community members and influencers to encourage parents to vaccinate their children and seek care early. Health training institutions should include cultural understanding in the training of health workers. This will help health workers respect caregiver beliefs while still guiding them toward safe and effective treatment. The Health Promotion Division of the Ghana Health Service should work with the Ministry of Health and partners like WHO and UNICEF to make sure vaccines are always available. They should improve vaccine delivery, especially in hard-to-reach areas. The Ghana Health Service and research institutions should regularly check how well these programs are working. The results should be used to improve education, communication, and vaccination services over time.

Conclusion     

The results indicate that while there is a solid foundational knowledge of measles among caregivers, significant gaps and misconceptions remain a major challenge. Addressing these through targeted educational interventions, considering regional and socio-economic factors, is crucial for improving measles management and vaccination uptake. The study highlights significant challenges in achieving optimal measles immunization coverage in the surveyed community. Addressing these challenges through improved communication, education, and targeted interventions, as recommended by global and regional studies, is crucial for enhancing vaccination rates and ensuring better health outcomes for children. By implementing these strategies, informed by comprehensive research, public health initiatives can more effectively combat measles and other vaccine-preventable diseases. The study highlights the complexity of caregiver practices in managing measles and underscores the importance of integrating cultural competence into healthcare delivery. By respecting and supporting caregivers' treatment choices while promoting evidence-based practices, health systems can improve measles management and reduce associated morbidity and mortality.

Competing interests     

The authors declare no competing interests.

Authors' contributions     

All the authors contributed to the conception of the research, its design, analysis, and interpretation of data. All the authors read and approved the final version of this manuscript.

Acknowledgments     

The authors acknowledge the mayor of Tamale Metropolis for his warm reception and for granting us the opportunity to conduct this study under his watch.

Tables     

Table 1: demographic characteristics of respondents

Table 2: knowledge of cause, symptoms, signs, and complications of measles

Table 3: prevalence of measles infection and immunization rates

Table 4: management of measles in children by caregivers at home

Table 5: distribution of management of measles by knowledge and socio-demographic characteristics

Table 6: factors influencing the management of measles

References