Abstract

Malaria continues to be a leading cause of morbidity and mortality worldwide, claiming over half a million lives 
annually, with sub-Saharan Africa accounting for the majority of deaths. Despite substantial global progress, 
differences in malaria transmission between urban and rural settings persist due to ecological, environmental, 
socioeconomic, and infrastructural disparities. This review examines how urbanization affects malaria 
epidemiology, vector habitats, insecticide resistance, healthcare infrastructure, and control strategies. In rural 
areas, malaria transmission is sustained by abundant natural breeding sites, agricultural practices, and limited 
healthcare access. Conversely, urban malaria is shaped by artificial breeding habitats such as drains and 
construction sites, high population density, and urban agriculture, which create localized but persistent 
transmission. Insecticide resistance particularly to pyrethroids, DDT, and organophosphates poses significant 
threats to control efforts across both settings, driven by continuous pesticide exposure and urban farming 
practices. Healthcare infrastructure gaps, including limited access to diagnostics and treatment, further exacerbate 
the burden in rural areas. Innovative control measures, such as larval management, environmental sanitation, 
repellent distribution, and integration of novel technologies, are essential to counteract resistance and sustain 
control gains. Future research should emphasize the spatial heterogeneity of transmission, impacts of climate and 
land-use change, and urban-rural migration dynamics. Strengthening surveillance systems, tailoring interventions 
to specific ecological and social contexts, and promoting sustainable, community-led strategies are vital steps 
toward malaria elimination across Africa.