Malaria can no longer be considered as just a rural issue in Africa. A significant and increasing proportion of the African population lives in urban areas. There are already 40 cities in Africa with over one million inhabitants and the United Nations Environmental Programme estimates that by 2025 there will be 800 million people living in urban areas of the continent. Urban malaria prevalence rates are highly variable, even within a single city. Prevalences are highest among the poorest sections of society, since they cannot afford protection from malaria through improved housing, and are particularly vulnerable to the impact of ineffective diagnosis and treatment. As urban centres in Africa continue to grow, the scale and impact of urban malaria is increasing. Despite this threat, control of the problem is feasible: urban malaria is uniquely amenable to prevention and control as the existing health, planning, agricultural and governance structures present opportunities for collaborative approaches that can include both the community and the substantial private sector. The Malaria Knowledge Programme convened a multi-sectoral technical consultation on urban malaria in Pretoria, South Africa, from 2 to 4 December 2004. The aim of the meeting was to identify a strategy for the assessment and control of urban malaria.