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    • We wonder however why Riaz and colleagues state that

    2019-04-28

    We wonder however why Riaz and colleagues state that “there is no evidence to show that such an intervention in the home setting improves mortality”. Substantial rigorous evidence shows that use of oral rehydration solution, even in the home or full article settings, can reduce mortality from diarrhoea. Evidence for other recommended home fluids is scare, but in areas with low coverage of oral rehydration solution, home fluids are still recommended for rehydration.
    Lancet Glob Health —This Comment (published online July 29) was originally published with the wrong creative commons copyright owner, the copyright should read Bassat et al. This correction has been made to the online version as of August 23.
    Introduction Investigation of stroke burden by its major pathological types, and study of their secular trends in different regions of the world, is important for targeted region-specific health-care planning in stroke (eg, estimation of resources needed to care for patients with stroke, by type) and can inform priorities for type-specific prevention strategies. These data are also important for improving understanding of the health consequences and patterns of epidemiological transitions reported worldwide. Findings from systematic reviews suggest that low-income and middle-income countries have a greater proportion of haemorrhagic stroke than do high-income countries, that geographical variation is high in the incidence of major pathological types of stroke, and that no substantial changes have taken place in the incidence of haemorrhagic stroke in the past three decades. However, no detailed and systematic comprehensive estimates have been made of the global and regional incidence, case-fatality, disability-adjusted life-years (DALYs) lost, and secular trends of incidence of ischaemic or haemorrhagic stroke, especially for low-income and middle-income countries. We report estimates from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD 2010) for incidence, mortality, mortality-to-incidence ratio, and DALYs lost in ischaemic or haemorrhagic stroke in all 21 regions of the world in 1990, 2005, and 2010.
    Methods
    Results Characteristics of studies included in the analysis are described in the accompanying Lancet paper. We included 119 studies (58 from high-income countries and 61 from low-income and middle-income countries) in this analysis. Worldwide in 2010, an estimated 11 569 538 events of incident ischaemic stroke took place (63% in low-income and middle-income countries), and 5 324 997 events of incident haemorrhagic stroke (80% in low-income and middle-income countries); furthermore, 2 835 419 individuals died from ischaemic stroke (57% in low-income and middle-income countries) and 3 038 763 from haemorrhagic stroke (84% in low-income and middle-income countries; appendix). In 2010, 39 389 408 DALYs were lost because of ischaemic stroke (64% in low-income and middle-income countries) and 62 842 896 because of haemorrhagic stroke (86% in low-income and middle-income countries; appendix). In 2010, age-standardised incidence per 100 000 person-years of ischaemic stroke ranged from 51·88 in Qatar to 433·97 in Lithuania (table 1); incidence of haemorrhagic stroke ranged from 14·55 in Qatar to 159·81 in China; (table 2). Age-standardised mortality rates per 100 000 person-years for ischaemic stroke ranged from 9·17 in Qatar to 137·70 in Russia (table 1); the rate of haemorrhagic stroke ranged from 9·64 in the USA to 210·56 in Mongolia (table 2). DALYs lost per 100 000 people because of ischaemic stroke ranged from 163·89 in Israel to 2032·11 in Afghanistan (table 1); for haemorrhagic stroke the number of DALYs lost ranged from 178·20 in Switzerland to 4118·90 in Mongolia (table 2). In the past two decades in high-income countries, incidence of ischaemic stroke significantly reduced by 13% (95% CI 6–18), mortality by 37% (19–39), DALYs by 34% (16–36), and mortality-to-incidence ratios by 21% (10–27; table 3). Reductions shown for haemorrhagic stroke were 19% (1–15%) for incidence, 38% (32–43%) for mortality, 39% (32–44%) for DALYs, and 27% (19–35%) for mortality-to-incidence ratio (table 3). Reductions in incidence in both stroke groups were significant for the younger age group (<75 years, from 110·80/100 000 [95% CI 103·05–118·54] to 100·47/100 000 [94·03–107·16], p=0·021, for incidence of ischaemic stroke, and from 41·92/100 000 [38·89–45·15] to 38·46/100 000 [35·68–41·16], p=0·038, for incidence of haemorrhagic stroke). Worldwide, in the younger age group, the incidence of ischaemic stroke did not change, but we noted a significant increase in the incidence of haemorrhagic stroke, from 54·07 (48·56–60·22) to 64·07 (56·45–73·33; p=0·028). In the older age group (≥75 years) we noted no significant change in the incidence of ischaemic stroke (from 2614·89/100 000 [2426·49–2809·55] to 2472·93/100 000 [2279·15–2687·39], p=0·176), whereas a significant reduction was shown in the incidence of haemorrhagic stroke (from 558·61/100 000 [503·36–624·07] to 640·06/100 000 [569·10–724·72], p=0·046).