Mathematical modeling of malaria transmission dynamics in children under five years of age facing innovative interventions in the Democratic Republic of the Congo

Abstract Background Malaria remains the leading cause of morbidity and mortality in the Democratic Republic of Congo (DRC), particularly among children under five years of age, who account for 67% of malaria-related deaths. Given the stationary trend in incidence despite current efforts, the National Strategic Plan (NSP) 2024–2028 introduces innovative interventions requiring rigorous prospective evaluation. This study aims to model transmission dynamics under different coverage scenarios to guide resource allocation for disease control and elimination in this vulnerable group. Methods We developed a deterministic discrete-time compartmental model of SEIR (Humans) and SEI (Mosquitoes) type, parameterized using data from the District Health Information Software 2 (DHIS2) from 2017 to 2023, covering 519 health zones. Transmission intensity was quantified by the basic reproduction number (R0), calculated using the next-generation matrix method, after adjusting the crude incidence for reporting, testing, and care-seeking. Results In the absence of intervention scale-up, morbidity saturates at critical endemic levels. With current coverage rates (21% for vaccine and chemoprevention), R0 values remain well above unity: R21 vaccine (R0 = 4.55), IPTi/PMC (R0 = 4.66), and ITNs (R0 = 3.71). Achieving 80% coverage for individual interventions is insufficient to interrupt transmission. Only the combined scenario ("Mix-intervention") at 80% coverage achieves an R0 of 0.48. Conclusion Interrupting malaria transmission among children under five in the DRC is mathematically feasible. However, it requires a synergy of innovative interventions reaching a critical coverage threshold.