More Awareness Needed on Swallowing Disorders – UKZN Researcher

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Research conducted by Professor Mershen Pillay of UKZN’s Speech-Language Pathology has highlighted the need to raise more awareness on swallowing disorders, medically known as dysphagia.

Dysphagia describes a difficulty in swallowing whereby those affected take more time and effort to move food or liquid from their mouth to their stomach. This may be associated with pain and in certain cases the individual may not be able to swallow at all.

Doctors confirm that occasional difficulty in swallowing is usually not cause for great concern and may simply occur when people eat too fast or do not chew food well enough. However, persistent difficulty swallowing may indicate a serious medical condition requiring treatment.

Studies reveal that the life-threatening and debilitating condition affects millions of people worldwide.

Pillay explained that dysphagia usually happened within the context of a broader health problem where patients who have suffered strokes or heart injuries may acquire the condition or individuals with physical disabilities, as an example, may be born with it.

Individuals with disabilities who cannot eat and/or drink represent a food security risk, said Pillay. In 2011, the World Report on Disability from the World Bank and World Health Organization indicated that the majority of individuals with severe health disorders are in resource constrained countries and moreover, one in six people in the world live with disabilities.

To this end, Pillay called for two paradigm shifts in dysphagia management globally. He said there was a pressing need to grow awareness that dysphagia is a disability and that ‘gold standard’ dysphagia practices needed re-negotiation in economically constrained contexts.

In a qualitative study presented at the Dysphagia Research Society conference in Nashville in the United States which examined whether dysphagia research should focus on socio-economic issues, Pillay found that international organisations rarely reported dysphagia as a disability. ‘Practitioners position dysphagia as a biological and socio-economic reality. Dysphagics constitute an underserved population, receiving inequitable services and globally experience food security risks.’

Dysphagia was identified as food insecurity for people with disabilities and this implied a body-to-environment shift for researchers. Hence, a population-based approach to dysphagia practice and research was necessary.

Last year, Pillay presented on dysphagia services in resource constrained contexts at a seminar held by the International Association of Logopedics and Phoniatrics (IALP) and posed this question: ‘Should poor people, who cannot eat or drink safely, be treated differently?’ 

The rationale for this Seminar was two-fold: It was an attempt at shifting the bias of the IALP symposia/meetings that typically best catered for the needs of economically developed countries such as those in Europe and North America. It was also the first step toward creating a unifying theory and practice for work with swallowing disorders in contexts that were often either difficult to deal with and/or were avoided by relevant health care professionals.

Pillay said: ‘Resource constraints affect everyone across the world. It is an issue that needs to be addressed alongside concurrent technological advancements in the field of dysphagia practice.

‘South Africa had a quadruple burden of disease and needed service justice for all citizens. A top-down approach to treatment of dysphasia from the all-knowing doctor to patients lacked vision. Raising more awareness about the prevalence of dysphasia combined with a multidisciplinary effort between nurses, dieticians, occupational therapists and speech therapists and other health care professionals in the local setting were steps in the right direction,’ said Pillay.

Lunga Memela