Neutrophil-to-lymphocyte ratio as a low-cost triage marker for malaria in febrile patients in conflict-affected Southern Yemen

Neutrophil-to-lymphocyte ratio as a low-cost triage marker for malaria in febrile patients in conflict-affected Southern Yemen. Neutrophil-to-lymphocyte ratio as a low-cost triage marker for malaria in febrile patients in conflict-affected Southern Yemen Article Open access Published: 31 October 2026 Cite this article You have full access to this open access article Download PDF View saved research Neutrophil-to-lymphocyte ratio as a low-cost triage marker for malaria in febrile patients in conflict-affected Southern Yemen Download PDF Abstract In many fragile and conflict-affected settings, access to reliable laboratory diagnostics for febrile illnesses remains limited. Malaria and other infectious diseases continue to impose a major burden in Yemen.

This study evaluated the diagnostic performance of routinely available complete blood count (CBC)–derived indices, particularly the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR), as potential low-cost surrogate markers for infection in resource-constrained healthcare settings. A multicenter cross-sectional diagnostic accuracy study was conducted in primary and secondary healthcare facilities in two conflict-affected governorates in southern Yemen (Al-Dhalea and Lahej) between January and December 2025. A total of 700 consecutive patients aged ≥ 5 years for whom a complete blood count was clinically indicated (including those presenting with fever, fatigue, or general malaise) were enrolled.

Patients with chronic hematological disorders, active malignancy, recent blood transfusion, pregnancy, or critical illness were excluded. Diagnostic performance of NLR and PLR was evaluated using receiver operating characteristic (ROC) analysis. Multivariable logistic regression was used to assess their independent predictive value.

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