A continuing dilemma for medical and public health professionals is the apparent lack of fit between global and local knowledge systems and technologies. This is illustrated in relationship to malaria, with implications in the management of the disease. Ethnographic research was conducted from 2003-2005 in urban Abidjan, Cote d'Ivoire, on community understandings of malaria and the relationship of this to its prevention and control. Malaria is referred to locally as palu, reflecting the incorporation of malaria into a local illness taxonomy. Although the labeling of malaria-related symptoms as palu has wide currency, preventive measures such as bed nets, as advocated by public health authorities, have not been accepted readily or evenly. Drawing on theoretical understandings of the introduction, transfer, and appropriation of concepts and material objects, we examine the processes of localization in relation to malaria in Abidjan, and in doing so, highlight the challenges for health professionals seeking to scale-up public health interventions.