Latar Belakang: Malaria masih menjadi salah satu penyebab utama morbiditas dan mortalitas pada anak usia di bawah lima tahun di Sub-Sahara Afrika. Democratic Republic of Congo (DRC) merupakan salah satu negara dengan beban malaria tertinggi di dunia. Distribusi malaria dipengaruhi oleh faktor individu, rumah tangga, dan komunitas yang bersifat hierarkis sehingga memerlukan pendekatan analisis multilevel. Metode: Penelitian ini menggunakan data sekunder dari Democratic Republic of Congo Demographic and Health Survey (DHS) 2023–2024 dengan desain potong lintang. Sebanyak 10.747 anak usia 6–59 bulan diikutsertakan dalam analisis. Status malaria ditentukan berdasarkan hasil Rapid Diagnostic Test (RDT). Analisis dilakukan menggunakan regresi Poisson multilevel dengan varians robust untuk mengestimasi prevalence ratio (PR) serta memperhitungkan pengelompokan data pada tingkat komunitas. Analisis subkelompok juga dilakukan pada provinsi konflik yaitu Ituri, North Kivu, dan South Kivu. Hasil: Prevalensi malaria pada anak usia 6–59 bulan di DRC adalah 36,3%. Analisis multivariat menunjukkan bahwa usia anak, status stunting, indeks kekayaan rumah tangga, kualitas lantai rumah, tempat tinggal pedesaan, dan ketinggian wilayah berhubungan secara independen dengan status malaria. Anak usia 48–59 bulan memiliki prevalensi malaria 88% lebih tinggi dibandingkan anak usia 6–11 bulan (APR = 1,88; 95% CI: 1,63–2,17). Anak stunting memiliki prevalensi malaria 9% lebih tinggi (APR = 1,09; 95% CI: 1,02–1,16), sedangkan anak dari rumah tangga miskin memiliki prevalensi malaria 34% lebih tinggi dibandingkan rumah tangga kaya (APR = 1,34; 95% CI: 1,11–1,62). Analisis multilevel menunjukkan adanya pengelompokan malaria yang bermakna antar komunitas dengan Intraclass Correlation Coefficient (ICC) sebesar 27,4% pada null model, yang menurun menjadi 23% setelah penyesuaian seluruh faktor. Analisis subkelompok menunjukkan bahwa wilayah konflik memiliki tingkat pengelompokan malaria yang lebih tinggi dibandingkan tingkat nasional. Kesimpulan: Malaria masih merupakan masalah kesehatan masyarakat yang besar pada anak usia 6–59 bulan di DRC. Faktor individu, rumah tangga, dan komunitas berkontribusi terhadap status malaria, sementara efek pengelompokan yang signifikan menunjukkan pentingnya pendekatan multilevel dalam penelitian malaria. Intervensi pengendalian malaria perlu difokuskan pada kelompok berisiko tinggi serta mempertimbangkan karakteristik komunitas dan wilayah konflik. Kata Kunci: malaria, anak usia 6–59 bulan, faktor penentu, prevalence ratio, analisis multilevel, Democratic Republic of Congo.

Background: Malaria remains one of the leading causes of morbidity and mortality among children under five years of age in sub-Saharan Africa. The Democratic Republic of Congo (DRC) is among the countries bearing the highest malaria burden globally. Malaria distribution is influenced by individual, household, and community level factors that are hierarchically structured, necessitating the use of multilevel analytical approaches, which remain underutilized. This study aims to determine the factors that are associated with malaria in children aged 6-59 months in the DRC while accounting for clustering.  Methods: This study used secondary data from the 2023–2024 DRC Demographic and Health Survey (DHS) and employed a cross-sectional design. A total of 10,747 children aged 6–59 months were included in the analysis. Malaria status was determined using Rapid Diagnostic Test (RDT) results. Multilevel Poisson regression with random intercept were used to estimate prevalence ratios (PRs) while accounting for clustering at the household and community level. A subgroup analysis was additionally conducted in the conflict-affected provinces of Ituri, North Kivu, and South Kivu to determine the varying or similar dynamics of factors associated with malaria in the conflict provinces compared to the national level.  Results: The prevalence of malaria among children aged 6–59 months in the DRC was 36.3%. Multivariable analysis showed that child age, stunting status, household wealth index, floor materials, rural residence, and altitude were independently associated with malaria status. Children aged 48–59 months had an 88% higher malaria prevalence compared with children aged 6–11 months (APR = 1.88; 95% CI: 1.63–2.17). Stunted children had a 9% higher malaria prevalence (APR = 1.09; 95% CI: 1.02–1.16), while children from poor households had a 34% higher malaria prevalence than those from rich households (APR = 1.34; 95% CI: 1.11–1.62). Multilevel analysis demonstrated substantial clustering of malaria across communities, with an Intraclass Correlation Coefficient (ICC) of 27.4% in the null model, which decreased to 23% after adjustment for all covariates. Subgroup analysis further indicated stronger clustering effects in conflict-affected provinces than at the national level. Conclusion: Individual, household, and community-level factors are associated with to malaria status, while significant clustering effects still persists, highlighting the importance of multilevel approaches in malaria research. Malaria control interventions should prioritize high-risk populations and household variables since they showed the greatest change in cluster variance and effect compared to individual and community level variables.