We agree that this method

We agree that this method is an appropriate way to assess whether Buruli ulcer is over-represented in children, but this issue was not central to our study. We also felt that the introduction of external data, the quality of which we cannot assess and which might not be relevant to areas where Buruli ulcer is endemic—ie, remote rural areas of tropical countries—could lead to bias. Nevertheless, our Article reports that the median age of the AM251 in Benin in 2010 is significantly higher than the median age of our cohort, leading to the same conclusion as the IRRs. Landier and colleagues also define elderly people as a high incidence group. We would be cautious about this conclusion because their report and others do not provide the number of patients in each age group to assess the uncertainty of their measure. As an example, consideration of the low number of patients older than 60 years in our study (one of the largest worldwide) enticed us not to draw conclusions in that age category. With respect to the variation of the sex ratio with age, we are mindful that the national census correction is correct but negligible, because the general population sex ratio does not differ from 1 in Benin, whatever the age group considered. Therefore, Landier and colleagues reach the same overall conclusions as us, an extremely valuable confirmation. Landier and colleagues note, as we did, that unbalanced age-gender distribution among patients with Buruli ulcer had previously been reported. However, the reference they quote is misleading, because it does not identify differential incidence by sex before the age of 60 years. The research group stated in a later 2009 review that “there are no sex differences in disease instance among children and adults”, as did another independent review cited by Landier and colleagues. This is regrettable because this important issue of the variation of the sex ratio with age, although repeatedly reported in research articles on Buruli ulcer, has been disregarded or even denied by most authors of review papers (see discussion in our Article for details). This denial has far too long hampered the research on the causes of this age-dependent variation of the sex-ratio in Buruli ulcer, understanding of which will be of great physiopathological, clinical, and, as pointed out by Landier and colleagues, public health relevance. We declare no competing interests. We thank staff at the Centre de Dépistage et de Traitement de l\'Ulcère de Buruli, Pobè, Benin; staff of the Laboratoire de Bactériologie, CHU, Angers, France; and staff from the Institut National de la Santé et de la Recherche Médicale (INSERM) U1163 for helpful discussions; and acknowledge support from la Fondation Raoul Follereau. QBV acknowledges support from the Fondation Imagine. LM and AA acknowledge support from the Agence Nationale de la Recherche. AA acknowledges support from the . AA and LM acknowledge support from INSERM.
The Millennium Development Goals (MDGs) have been criticised for being created by developed countries for developing ones. For its post-2015 Sustainable Development Goals (SDGs), the UN Development Group (UNDG) undertook 88 national consultations to “widen the net of engagement” and include the views of vulnerable groups. We examined the national consultation reports on to assess how well inflammation accessed and represented the views of marginalised populations. Our analysis focused on the consultation process, and we reviewed reports written in English only (n=70). Adapting the methods of Peterson for our analysis, we categorised inclusion either as external inclusion, indicating proactive efforts to invite and facilitate the participation of all stakeholders, or internal inclusion, indicating culturally welcoming and procedurally unrestrictive consultation methods. We added a third category, inclusion in policy development, to assess whether marginalised views were separately communicated and fed into national policy processes. The categories were assessed by means of 13 indicators on a scale of to 4 (where indicates an absent indicator, 1 limited inclusion, 2 reasonable inclusion, 3 strong inclusion, and 4 best practice). The indicators were: efforts to invite marginalised groups, to facilitate the attendance of marginalised groups, participation from the early stages of the consultation, and systematic methods to identify the marginalised (external inclusion); culturally comfortable space to contribute ideas, procedures or topics that do not restrict communication, sufficient and early access to information, highly participatory methods used, and allowing consultation participants to review the meeting transcripts to confirm that they were not misrepresented (internal inclusion); and marginalised views reported separately, feeds into local processes, results shared back with community, and sustained participation in later phases such as implementation (inclusion in policy development). The first two indicators in each category were deemed essential and were weighted twice as much as the other indicators.