A systematic electronic search for articles was conducted in May 2024 by Dr Skye Adams and Dr Kim Coutts, and all articles until then were included. Six databases were used: CINAHL, Medline, Academic Search Premier, Global Health, PubMed, as well as the first five pages of Google Scholar. The databases were chosen as they were most likely to have publications related to the topic. While Medline and PubMed both provide access to biomedical and health-related research, they differ in scope and indexing. Both databases were included to ensure no relevant records were overlooked, particularly pre-publication articles available on PubMed. To maintain a systematic and replicable approach, the Google Scholar search strategy involved screening the first five pages of results for each search term combination, as research indicates that most relevant and high-quality results are captured within this range. The search strategy, encompassing all identified keywords and index terms, was customised for each database or information source. BOOLEAN operators (AND and OR) as well as truncation were used in the search strings using subject headings (MeSH), and keywords with proximity operators, respectively. The search strategy included subject headings for dysphagia (MeSH) in PubMed and either subject headings for countries and continents or country names. Some articles contained authors from multiple countries or regions within one paper. However, the countries had to be clearly delineated to be included and therefore, it was possible to have an article that had multiple countries or regions.

The current review included published peer-reviewed journal articles, was limited to primary study designs (qualitative, quantitative and mixed-method approaches) and excluded grey literature, other reviews and non-academic sources. Grey literature and non-academic sources were excluded from the study to ensure the use of high-quality, reliable and peer-reviewed academic sources, maintaining focus and reproducibility within the constraints of time and resources.

Following the database searches conducted in June 2024 (SNA), all identified peer-reviewed results were collated and uploaded into Mendeley. All duplicates were removed. The initial search results yielded the following results: PubMed (n = 175), Medline (n = 126), CINAHL allied and nursing (n = 34), Global Health (n = 55), Academic Search Premier (n = 58), African Journal Archive (139) and Google Scholar articles from the first five pages (n = 40). Titles and abstracts were screened by two independent reviewers (K.C. and S.N.A.), with an additional reviewer providing an independent secondary review for assessment against the inclusion and exclusion criteria. Peer-reviewed results that did not meet the inclusion criteria were excluded. Articles were excluded if they did not focus on dysphagia (e.g. articles focused on stroke or nutritional intake only), were not conducted in Africa or were other systematic/scoping review methodologies. Any disagreements that arose between the reviewers were resolved through discussion and input from an independent reviewer until consensus was achieved. An iterative approach to study screening and selection was employed to emphasise a more inclusive final list of studies where after each round of screening, the authors met to provide feedback, and any adjustments were made. All articles were accessed electronically.

Quality was assessed using Quality Assessment for Diverse Studies (QuADS) to assess the methodological quality of the included studies whether qualitative, quantitative or mixed designs (Harrison et al., 2021). The QuADS is composed of 13 items for mixed methodology. Each study is scored on every item (0 = not at all; 1 = very slightly; 2 = moderately; and 3 = complete), and the total score was subsequently converted into a percentage. The QuADS was used as it allows for a comparison between the diverse methodologies used by providing a mean score. This method was selected for its reliability and validity when assessing the quality of diverse study designs. The QuADS is also the only tool that can be applied to mixed designs. Both investigators (K.C. and S.N.A.) assessed the quality of the included studies using the QuADS. Any discrepancy was discussed, and a consensus was reached.

The QuADS tool (Online Appendix Table 1-A1) revealed varying levels of quality. The average rating for the articles was 57% with a maximum of 92% and minimum of 18%. The authors noted that perhaps the quality of the articles was slightly lower because of the journal requirements and limited word counts, thus reducing some of the rationales needed in the methodology. Case studies had the lowest scores. Additionally, many studies may have been exploratory in nature, focusing on emerging themes without robust validation of tools or methods. The QuADS tool did not allow for adequate methodological quantification for these types of studies as it is more of a quantitative-focused tool. This also could have contributed to the lower quality outcomes. In the African context, resource limitations, the absence of standardised tools and the reliance on subjective assessments could also contribute to lower QuADS scores. Therefore, all studies were included regardless of their score.

The data charting template was created by K.C. and S.N.A. The data extracted included specific details about the study objectives to highlight current trends, gaps and future directions. The initial draft of the chart underwent a pilot test using three randomly selected articles. These were reviewed independently by each author, and with the support of an independent reviewer. Following minor revisions based on the pilot test feedback, the finalised chart was then used independently by both reviewers. Agreement between the two reviewers was 90% during the screening process. Any disagreements were resolved by consensus. As a scoping review methodology is iterative, this allowed for an adjustment to be made regarding the inclusion of relevant studies during consensus discussions (Levac et al., 2010).

After extraction, the findings from the included studies were separated, grouped, abstracted and categorised into themes. Independent categorisation based on the study objectives, challenges and supports was conducted by the two reviewers. A content thematic analysis was conducted using Braun and Clark’s framework (Braun & Clarke, 2006). Two reviewers extracted information from each article, grouped and labelled findings, categorised themes and summarised general trends on research in dysphagia in Africa. The broad themes were related to the objectives of the study. The authors developed a code book (x) that provided different codes and descriptions, showing the relevant articles and the frequency of each code. Similar codes were then collated and organised into themes and sub-themes. Prominent themes from the reviewers were then selected, relabelled and finalised after a comprehensive review and discussion between both reviewers.

This article followed all ethical standards for research without direct contact with human or animal subjects.

A summary of all articles is presented in Table 1. Articles were from seven different countries (see Figure 2). More than half were from South Africa (n = 37, 60.7%), whilst others were from Egypt, Namibia, Tunisia, Burkina Faso, Kenya, and Nigeria. South Africa and Egypt appear to contribute the most to dysphagia research in Africa, with other countries contributing less frequently. The majority of studies were written by SLTs (n = 38, 62.3%), with the others being written by different specialists in the field of medicine (n = 16, 26.2%) and nursing (n = 7, 11.5%). Professional distribution regarding multidisciplinary authorship was determined using the first author.

The methodology types used in the articles were divided into quantitative (n = 42, 68.9%), qualitative (n = 13, 21.3%) and mixed methods (n = 6, 9.8%). The most popular quantitative methods used were survey designs (n = 5) and cross-sectional comparative studies (n = 10). In terms of the qualitative studies, descriptive studies (n = 10) were the most popular. Record reviews were the studies that tended to use mixed method designs. Sample sizes ranged from 1 to 4312, including those with dysphagia, healthcare professional perspectives and patient records.

The proportion of studies that reported subjective outcomes or objective outcomes depended on the specialty of the authors and article aims. The articles predominantly focused on practice (n = 39, 63.9%) but also looked at aspects around prevalence (n = 8, 13.1), screening (n = 6, 9.8%), assessment (n = 7, 11.5%) and teaching and learning (n = 1, 1.7%). Practice included studies that looked at the perceptions of healthcare professionals and caregivers, the development of tools and guidelines for the management of dysphagia, other medical conditions and the prevalence of dysphagia in certain populations.

The most common trends observed in the research related to (1) Participant descriptions, (2) Prevalence studies, (3) Screening and assessment, (4) Practice patterns and (5) Teaching and learning. These are all described in more detail further in the text.

The study highlights the current trends in dysphagia research in Africa. Our findings show that there is a paucity of research on dysphagia in the African context given the number of studies that were included in this review. As researchers working in the African context, the authors felt that it is important that SLTs produce research that can be used to extend and challenge existing theory and current practice guidelines, which often stem from the Global North. Despite the opportunity for research in the African setting, there has not been much published research from this context. From 627 articles, only 61 were included for final review. There may be several reasons for the number of articles included in the review, particularly around our current search strategy and the exclusion of grey literature. For instance, it is also important to acknowledge the limitations related to publication and acceptance in mainstream journals. This review is limited to published articles in peer-reviewed journals, and it does not imply that dysphagia research is not occurring in Africa; rather, it suggests that much of this research may not be getting published (Jayes et al., 2024). Many African researchers struggle to publish their findings because of high article processing charges and language and linguistic bias with majority of articles published in Africa coming from English-speaking African countries (Asubiaro & Onaolapo, 2023). Additionally, many journals may not find the research conducted in Africa to be contextually relevant to the Global South where majority of journals originate. Many international journals also have specific requirements that may not be appropriate when conducting research in the African context because of the context, participants and the research infrastructure (Olatunji et al., 2023). As a result, many submissions do not make it beyond the initial editor’s desk review as it often requires changes to comply more with Eurocentric views and western understandings of dysphagia (Draper et al., 2023; Jayes et al., 2024; Klingebiel & Stadler, 2015; Salihu Shinkafi, 2020). The current study highlighted the majority of research coming from South Africa and the inability to generalise findings to the broader African context. Reasons for more research from South Africa could be attributed to better funding, resources and academic support at these institutions in comparison to other African universities (Asubiaro & Onaolapo, 2023). Research from Africa is imperative to scrutinise changes to policy and ensuring findings are contextually and culturally responsive (Kasprowicz et al., 2020). Therefore, this article highlights the need to capacitate research from African researchers in our context and try to establish ways to support and provide appropriate platforms to share research findings. Ensuring that this new knowledge is freely available is imperative for transformation.

The clinical context of Africa’s complex healthcare systems has shaped the direction of research, with prominent themes centred on patient descriptors, the development of screening tools and practice patterns. The majority of studies were conducted in South Africa, with other research spanning Egypt, Namibia, Tunisia, Burkina Faso, Kenya, Ghana and Nigeria. These countries have distinct cultural, political, socioeconomic and linguistic landscapes, highlighting the urgent need for research led by African scholars to ensure that practices are contextually responsive. Such research should integrate indigenous knowledge systems to provide a more comprehensive understanding of dysphagia in these diverse contexts (Asubiaro & Onaolapo, 2023; Andrews & Pillay, 2017). Furthermore, these findings highlight the need to establish African-centered indices publication costs, and infrastructure to better support and amplify African research and scholars, particularly to ensure publication of African research in reputable and high-impact journals (Morris et al., 2023).

While dysphagia is a key area in SLT (Eng & Speyer, 2021), the interdisciplinary nature of this research, involving medicine and nursing, underscores the necessity of context-specific investigations in the African context as seen by multiple studies in this review (Bardien et al., 2021; Knight et al., 2020; Pierpoint & Pillay, 2020; Rhoda et al., 2015; Robbertse & De Beer, 2020; Seedat & Strime, 2022; Visser et al., 2018). Ebrahim et al. (2018) provide a clear example of the importance of interdisciplinary nature in understanding dysphagia-related health consequences in post-stroke pneumonia and the role of the nurses. Nursing staff are critical and were often the focus of research. Nurses support patients by identifying patients who are at risk for swallowing difficulties and managing SLT recommendations around positioning (Rowe et al., 2024). Given that the African context is a resource-constrained setting and that there is a limited number of SLTs, the most effective manner for dysphagia to be screened and identified early is with the use of other members of the MDT.

An MDT approach is important to improve patient outcomes, reduce length and cost of hospital stay and reduce patient load (Atkinson, 2022; Taberna et al., 2020) which are all critical within a resource-constrained setting (Jayes et al., 2024). However, the current review highlighted the lack of MDT support in managing patients with dysphagia and the limited knowledge the nurses had on the scope of SLT and dysphagia assessment and management (Knight et al., 2020; Robbertse & De Beer, 2020). This is significant as interdisciplinary work is not only seen as an advantage for the African context but globally as well (McGinnis et al., 2019) and highlights an opportunity for future research and collaborations across disciplines.

Studies utilised different methodologies, with the majority using quantitative methods. This variety is advantageous as the data obtained from varying methodologies have helped to create a comprehensive picture of dysphagia in Africa. Given the significant gaps in our understanding of dysphagia in Africa, there is a need to have a variety of methodologies to address these gaps. Quantitative studies are essential to gain an understanding of patient demographics and assessment tools. However, many of the limitations in the studies were around the small sample size and inability to generalise findings. There was one study by Schie et al. (2020) that had the largest cohort study and good generalisability of findings which was conducted through a record review at a hospital in South Africa. This study highlights the need and opportunities for necessary collaborations for universities and hospitals to be able to work together, particularly within an African context where funds for research and access to participants are often difficult (Klingebiel & Stadler, 2015; Salihu Shinkafi, 2020). Additionally, while prevalence studies are important, research has indicated the importance of using qualitative research methods in an African context. According to Watermeyer and Neille (2022) using qualitative methods can help decolonise research practices by acknowledging and addressing the unique social, cultural and historical contexts of African populations. Given the ICF framework and the diversity of our context, qualitative research is imperative to understand patient experiences and needs, which can then be addressed in dysphagia teachings, practices and policies. This approach is essential for ensuring that research and clinical practices are truly transformative and effective in Africa.

The review identified several studies that focused on screening and assessment, which are crucial components in the evaluation of swallowing physiology and the management of dysphagia (Elluru, 2024; Etges et al., 2014; Wilkinson et al., 2021). In Africa, the use of instrumental assessment tools, like videofluoroscopy (VFSS) or fibreoptic endoscopic evaluation of swallowing (FEES), is often challenging because of resource constraints and the fact that clinicians are reliant on more non-instrumental methods of assessment. Therefore, developing and adapting appropriate screening tools is essential. International tools may not always be suitable because of differences in populations, environments and healthcare systems, highlighting the need for contextually relevant assessments (Ostrofsky & Seedat, 2016). This development is crucial to ensure that screening tools are culturally and contextually appropriate, enhancing their effectiveness and reliability in African settings. Research on this needs to continue but access to this research for clinicians needs to be a focus to ensure that practices are contextually responsive.

Alarmingly, there was only one study that focused on aspects around teaching and learning in the field of dysphagia in Africa (Catania et al., 2023). There were also no studies that looked at how we can teach across fields of study, potentially addressing the need for interdisciplinary teaching in dysphagia which could translate into improved interdisciplinary practices. This needs to be addressed. Increasing the knowledge of nursing and other healthcare professionals related to the detection of swallowing difficulties may have a direct impact on patient outcomes (Blackwell & Littljohns, 2010) and should be better utilised in the African context and requires further exploration.

We recognise the need to address the limitations of this review, which was intended as an initial foundation for further research. The current review did not incorporate any grey literature, which may have excluded studies that are not published in peer-reviewed journals such as student theses and service delivery reports, highlighting the need for a more comprehensive review. We also acknowledge the language limitations of including only English articles and the fact that many African countries speak a multitude of languages. These limitations highlight that there may be additional dysphagia researches in Africa that were not included in the current review.