Perceptions of immunisation adherence by caregivers in the Western Cape province, South Africa: A qualitative study.

Mosquito-borne diseases, particularly dengue, represent one of the most urgent challenges for sustainable cities and societies in tropical and subtropical regions. Globally, dengue incidence has increased more than eightfold in the past two decades, now placing nearly half of the world’s population at risk. In Malaysia, dengue is hyperendemic, with recurrent outbreaks causing significant morbidity, mortality, and economic burden. Despite decades of intensive vector control programs including fogging, larviciding, and environmental sanitation sustained reductions in mosquito populations remain elusive. This persistent failure highlights the limitations of reactive, top–down interventions and emphasizes the need for proactive, community-driven prevention strategies embedded within sustainable urban and rural systems. A critical barrier is the long-recognized knowledge–practice gap, where communities may possess strong awareness of dengue risks yet fail to consistently translate this knowledge into preventive action. Studies in Southeast Asia repeatedly show that while individuals understand mosquito breeding sites and transmission pathways, preventive behaviors such as container cleaning, larval control, and waste management are inconsistently practiced. Contributing factors include behavioral fatigue, socio-economic pressures, and reliance on government-led fogging operations. Such gaps undermine the sustainability of vector control and hinder resilience building in cities and communities. In Malaysia, most dengue KAP studies have been conducted at the district or city level, limiting their generalizability and obscuring broader socio-ecological disparities. Yet the burden of dengue is spatially uneven: highly urbanized states such as Selangor and Kuala Lumpur consistently report the highest case numbers, while rural states such as Kelantan and Terengganu remain vulnerable due to weaker infrastructure and limited community engagement. These disparities are shaped by rapid urbanization, high housing density, migration patterns, and differential access to health services and environmental management systems. Understanding these variations is essential not only for disease prevention but also for advancing sustainable development goals related to health (SDG 3), sustainable cities and communities (SDG 11), and climate action (SDG 13). Against this backdrop, the present study was designed to examine state-level and urban–rural variation in community knowledge and practices on mosquito control across Peninsular Malaysia. Specifically, it aimed to: (i) analyze sociodemographic determinants of mosquito control behaviors; (ii) compare knowledge and practices across states; (iii) evaluate the extent of the knowledge–practice gap; and (iv) assess urban–rural differences in mosquito control behaviors. By generating comparative evidence across diverse socio-ecological settings, this study extends beyond a single-country perspective to contribute to broader epidemiological and behavioral understanding of dengue prevention in rapidly urbanizing regions. The findings provide transferable insights into how contextual factors shape the translation of knowledge into preventive practices, offering implications for designing scalable, community-centered interventions in other dengue-endemic settings globally.