Background <p>Anemia among children under five remains a major public health problem in the Democratic Republic of Congo (DRC), affecting growth, cognitive development, and overall child health. We estimated the prevalence, spatial distribution, and determinants of anemia and identified high-risk geographic areas using multilevel and spatial analyses.</p> Methods <p>We analyzed data from 11,393 children aged 6–59 months from the 2023–24 Democratic Republic of Congo Demographic and Health Survey (DHS). Weighted prevalence estimates were calculated, and multilevel mixed-effects logistic regression was used to assess individual- and community-level determinants of anemia. We applied Moran’s I, hotspot detection, Kriging interpolation, and SaTScan analyses to identify high-risk areas. Model performance was evaluated using AIC, BIC, and log-likelihood ratio tests to ensure the results were reliable.</p> Results <p>Overall, 51.7% of children (95% CI: 49.5%–53.9%) were anemic, most cases were mild (25.6%) or moderate (25.0%), while severe anemia was rare (1.1%). Prevalence was highest among infants 0–5 months (56.2%) and boys (52.5%) than girls (50.8%). Key risk factors for anemia included wasting (AOR = 1.29), malaria infection (AOR = 1.21), high community malaria risk (AOR = 1.42), and low altitude (AOR = 1.39). Children were less likely to be anemic if their mothers were overweight (AOR = 0.66), if they came from wealthier households (AOR = 0.77), or if they lived in moderately sized families (AOR = 0.84). Spatial analysis revealed high-prevalence areas in Haut-Lomami, Maniema, and Tshuapa, whereas lower prevalence was seen in Haut-Uele and Nord Ubangi.</p> Conclusion <p>Anemia among under-five children in the DRC is geographically clustered and influenced by both individual- and community-level factors. Targeted and integrated interventions focusing on malaria prevention, nutrition, and maternal health are needed in high-burden areas.</p>