Observational studyBMJ open2026
Systemic inflammation and malaria co-infection in irritable bowel syndrome: a cross-sectional study of 142 Yemeni patients.
Observational study in BMJ open, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectiveTo determine the prevalence of malaria co-infection among patients with irritable bowel syndrome (IBS) in Yemen and to evaluate the association of systemic inflammatory biomarkers (neutrophil-to-lymphocyte ratio (NLR), mean platelet volume (MPV) and platelet-to-lymphocyte ratio (PLR)) with this co-infection.
designMulticentre, cross-sectional observational study conducted between April and December 2024.
settingPrimary and secondary healthcare facilities across 21 governorates in Yemen.
participants142 consecutive adult patients (aged 18-70 years) diagnosed with IBS according to the Rome IV criteria. OUTCOME MEASURES: The primary outcome was the prevalence of malaria infection, confirmed by a rapid diagnostic test . Secondary outcomes included differences in NLR, MPV and PLR between groups, assessed using independent t-tests, and the diagnostic performance of these biomarkers evaluated by receiver operating characteristic curve analysis with AUC calculation. Multivariate binary logistic regression was used to identify independent predictors of malaria co-infection, adjusting for potential confounders.
resultsThe mean age was 42.3 years (SD 11.7) with an equal gender distribution. The prevalence of malaria co-infection was 45.1% (64/142). Patients with malaria positivity had significantly higher NLR (mean difference 0.56, 95% CI 0.40 to 0.72; p<0.001) and PLR (mean difference 22.6, 95% CI 17.8 to 27.4; p<0.001) and lower MPV (mean difference -0.60 fL, 95% CI -0.77 to -0.43; p<0.001) compared with malaria-negative patients. In adjusted logistic regression, higher NLR (adjusted OR 3.21, 95% CI 1.89 to 5.45) and PLR (adjusted OR per 10-unit increase 4.02, 95% CI 2.24 to 7.18) were independently associated with malaria positivity.
conclusionsNearly half of the Yemeni patients with IBS in this study had malaria co-infection, with the highest burden in diarrhoea-predominant and mixed subtypes. Elevated NLR and PLR were strongly associated with co-infection, suggesting these readily available biomarkers could aid targeted screening in resource-limited, endemic settings.
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