Step 1: Identify the type of data. Malnourished versus not malnourished is a qualitative (categorical) variable, and the result is expressed as a proportion: 30 of 100 rural and 20 of 100 urban.
Step 2: To test whether the difference between two proportions is statistically significant, the chi-square test is used. It compares observed and expected frequencies in a contingency table and also works when more than two groups are compared.
Step 3: Why not the others. The paired t-test and ANOVA compare means of quantitative data, not proportions. The standard error of the mean is a measure of precision, not a test of significance. With categorical proportions, chi-square is the right tool.
Ref: Park's PSM, 24e, p. 889.