Addressing the Diagnostic Gap: A Systematic Review of Post-Stroke Swallowing Disorders and Secondary Pulmonary Risks in the Indian Healthcare Context

Background: India experiences a significant stroke burden, with incidence rates estimated between 116 and 163 cases per 100,000 individuals—surpassing many Western statistics. Currently, stroke ranks as the fourth most common cause of death and the fifth major contributor to disability nationwide. While nearly half of all stroke survivors experience oropharyngeal dysphagia, which can lead to life-threatening aspiration pneumonia if left untreated, a comprehensive national estimate of these complications in India has remained elusive. Methods: Adhering to the PRISMA framework, a systematic search of contemporary literature on post-stroke swallowing disorders was performed across major academic databases. Two reviewers independently screened all retrieved records, and selected manuscripts were evaluated for methodological quality using the GRADE system. The review synthesized reported frequencies of dysphagia and pneumonia, calculated relative risks for pulmonary complications, and extracted secondary data concerning inpatient duration and mortality. Results: From an initial pool of 86 citations, four studies met the criteria for inclusion and data extraction. The findings revealed a wide but high prevalence of dysphagia among Indian stroke patients, ranging from 11.1 percent to 87.5 percent. Pneumonia incidence was documented in only two studies, varying between 22.8 percent and 32 percent. Based on the pooled data, patients with dysphagia faced a relative risk (RR) of 5.82 (95 percent CI: 4.6, 7.2) for developing pneumonia compared to those with intact swallowing. The review also identified correlations between these complications and both extended hospital stays and higher fatality rates. Conclusion: Although swallowing disorders and secondary pneumonia appear highly prevalent in the Indian stroke population, the existing body of research is characterized by low methodological quality. There is an urgent requirement for high-quality, standardized research to accurately quantify the impact of dysphagia and inform clinical guidelines for stroke rehabilitation in India.