The clinical significance of monocyte-to-lymphocyte and neutrophil-to-lymphocyte ratios in malaria infection and parasitaemia among pregnant women in Nanoro, Burkina Faso

Abstract

BACKGROUND: Malaria during pregnancy remains a major public health challenge in endemic regions, contributing to maternal anaemia, low birth weight, and neonatal mortality. Inflammatory markers such as the neutrophil-to-lymphocyte ratio (NLR) and monocyte-to-lymphocyte ratio (MLR), derived from routine blood counts, have gained attention in infectious disease research. However, their role in pregnancy-associated malaria is poorly understood. METHODS: We investigated the behaviour and relevance of NLR and MLR in 270 third-trimester pregnant women attending antenatal care in two health centres in Nanoro District, Burkina Faso. Malaria was diagnosed using light microscopy and rapid diagnostic tests. Haematological parameters were analysed using a Sysmex XN350 analyser. Associations between NLR/MLR and malaria status or parasitaemia were assessed via receiver operating characteristic (ROC) analysis and logistic regression. RESULTS: MLR was significantly higher in malaria-infected women (0.48 vs 0.40; p=0.021), while NLR was elevated in those with high parasitaemia (3.06 vs 2.55; p=0.029). MLR yielded ROC values of 0.60 for infection and 0.61 for parasitaemia. MLR independently predicted malaria (OR=4.19) and high parasitaemia (OR=7.16), although diagnostic performance was modest. CONCLUSIONS: MLR and NLR may serve as supportive markers for malaria in pregnancy. Their integration into antenatal care could aid early risk stratification in resource-limited, malaria-endemic settings. Further validation is needed.