Swallowing difficulty and its association with nutritional risk among stroke patients in a primary healthcare facility

Background: Swallowing difficulty is common in stroke patients and is associated with prolonged inadequate food intake. This eventually leads to malnutrition and dehydration and contributes appreciably to stroke complications and mortality rates. The associated nutritional risk is often undetermined. Objective: To determine the prevalence of swallowing difficulty among stroke patients and its association with their dietary intake and nutritional risk. Methods: The study design was cross-sectional, involving 57 stroke inpatients recruited from the Polyclinic, Korle-Bu Teaching Hospital. Swallowing difficulty and dietary intake were assessed using the water swallowing test and 24-hour recall interviews respectively. Nutritional risk was determined using the Nutritional Risk Screening tool (NRS-2002). Data were analysed using SPSS version 21.0 at a 95% confidence interval. Significance was set at p < 0.05. Results: Mean age was 64.3 ± 15.9 years. The majority (57.9%) had swallowing difficulty with an 8-fold higher nutritional risk compared to those without swallowing difficulty [R² = 0.754; OR= 8.40; p = 0.010 (CI = 2.177-32.128)] after adjusting for age, gender, education and occupation. Median daily energy intake was significantly lower in the former [628kcal; (483-1003)] compared to the latter [(1,017 kcal; 600-1586); p = 0.025]. Conclusion: More than half of the participants had swallowing difficulty with a significantly higher nutritional risk and lower daily energy intake. Early routine assessment of nutritional risk, followed with timely appropriate interventions, is strongly advocated as part of standard operating procedures for stroke management in primary care to reduce stroke complications and mortality.