Background: Aspiration pneumonia is an infection of the lung that induced by the inhalation of gastrointestinal contents. Globally, its incidence is ranging from five to eight three percent with hospital mortality rates of up to 70 percent. To prevent and reduce the risk, there is need of evidence regarding to incidence and factors of post-stroke aspiration pneumonia. However, there is no enough evidence regarding to post stroke aspiration pneumonia. As a result, this study was aimed to bring evidence on the incidence and predictors of post-stroke aspiration pneumonia. Objective: To assess the incidence and predictors of aspiration pneumonia among stroke patients admitted at Felege Hiwot referral hospital, Bahir Dar, North West Ethiopia, 2021 Methods and Materials: An institution-based retrospective follow-up study was conducted at Felege Hiwot compressive specialized hospital and charts of 568 stroke patients were reviewed through a simple random sampling technique. Both bi-variable and multi-variable log binomial regressions were applied. Predictors that had p-value < 0.25 on bi-variable regression analysis, they were entered to final model. The data were presented in the form of texts and tables. Result: In this study, 568 charts reviewed, of those a cumulative incidence of aspiration pneumonia was 23.06%. Variables like age, sex, dysphagia, oxygen therapy, etc. were significant predictors of aspiration pneumonia. Males were 1.71 times more risky than females to acquire aspiration pneumonia (ARR = 1.71, (95 percent CI 1.07-2.74). Patients with vomiting and dysphagia were more risky to acquire aspiration pneumonia as compared to patients without vomiting and dysphagia (ARR = 1.81, 95 percent CI 1.04-3.14) and (ARR = 1.95, 95 percent CI 1.10-3.48) respectively. Patients who received antibiotic prophylaxis and Glasgow Comma Scale greater than twelve were less risky to acquire aspiration pneumonia as compare to who not received antibiotic prophylaxis and Glasgow Comma Scale less than eight (ARR = 0.10, 95 percent CI 0.04-0.28), (ARR = 0.45, 95 percent CI 0.22-0.94) respectively. Conclusion and recommendation: The cumulative incidence of aspiration pneumonia was 23.06%. Vomiting, low level Glasgow Comma Scale, dysphagia, etc. found as the risk factors of aspiration pneumonia. Therefore, health care providers better to give special attention for patients with those risk factors to prevent post-stroke aspiration pneumonia. Keywords: incidence, predictors, aspiration pneumonia, stroke patients