Prevalence and factors associated with malaria among children aged 6–59 months in the Democratic Republic of the Congo: a nationwide cross-sectional survey

INTRODUCTION: Malaria is the leading cause of morbidity and mortality in the Democratic Republic of the Congo (DRC), posing a significant public health challenge, especially among children aged 6-59 months. This study aims to determine the prevalence and factors associated with malaria in this age group. METHODS: The study analyzed secondary data from a weighted sample of 10,013 children aged 6-59 months who underwent a malaria rapid diagnostic test, drawn from the 2023/24 DRC Demographic and Health Survey. Descriptive, bivariate, and multivariable modified Poisson regression analyses were conducted. A factor was considered significant if the p-value was less than 0.05, with a 95% confidence interval (CI). RESULTS: The overall prevalence of malaria among children aged 6-59 months in the DRC was 33% (95% CI = 30.2, 35.6), varying significantly between provinces, from 5% in Kinshasa to 61% in Bas-Uele province. Factors associated with malaria in this age group included children aged 24-59 months (APR = 1.25, 95% CI = 1.15, 1.36), children of mothers with no education (APR = 1.15, 95% CI = 1.03, 1.29) and those with primary education (APR = 1.13, 95% CI = 1.02, 1.30), children from the poor wealth quintile (APR = 1.52, 95% CI = 1.08, 2.13) and the middle wealth quintile (APR = 1.42, 95% CI = 1.03, 1.95), children who never slept under an insecticide-treated net (ITN) (APR = 1.18, 95% CI = 1.06, 1.30), children from households without a television (APR = 1.73, 95% CI = 1.22, 2.45), and those living in houses with unimproved floor material (APR = 1.54, 95% CI = 1.10, 2.08) or unimproved roof material (APR = 1.27, 95% CI = 1.04, 1.54). CONCLUSION: The prevalence of malaria remains high among children aged 6-59 months. The study highlights the need for strategies that include scaling up the distribution of insecticide-treated nets (ITNs) and educating caregivers on their proper use, improving access to timely diagnosis and treatment, and integrating multisectoral approaches that address socioeconomic vulnerabilities.