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Purpose: The Democratic Republic of Congo has one of the highest burdens of malaria in the world, accounting for 12.3% of malaria cases and 11.6% of malaria deaths. The country has been scaling up various malaria control interventions, but how the malaria burden and risk factors have evolved remains unclear. This study aimed to estimate the trend in the burden of malaria in different settings in Kinshasa Province and assess factors contributing to the infection., Participants: From 2018 to 2022, a cohort study was conducted in three health areas in Kinshasa Province known to have varying malaria endemicities: Voix du Peuple (urban), Kimpoko (peri-urban), and Bu (rural) health areas in Kinshasa Province. Participants 6 months of age and older were recruited and followed biannually through household visits and encouraged to visit study health centres whenever they felt ill. The participants' sociodemographic data, illness history and access to malaria interventions were collected along with blood specimens. During the same study period, mosquitoes and larvae were collected to study entomological characteristics that may contribute to malaria transmission., Findings: A total of 1635 participants were recruited from 239 households. The median number of participants per household was 6 (IQR, 5-9). Over half (54.7%) of the participants were female, 14.6% were under-5 children, and 33.3% were 5-14 years old. Household net ownership and reported use the previous night were 77.8% and 79.1%, respectively. Overall, malaria prevalence by rapid diagnostic test at baseline was 33.4%. Of the recruited participants, 1390 (85%) completed the 4 years of follow-up., Future Plans: Planned analyses include calculating malaria prevalence and incidence trends at follow-up as well as risk factors for infection. Continued analyses will link epidemiological and entomological data to understand malaria transmission evolution and the sustained high prevalence of malaria over time in various settings., Competing Interests: Competing interests: JBP reports research support from Gilead Sciences, non-financial support from Abbott Laboratories, and consulting for Zymeron Corporation, all outside the scope of this work, (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)