A case of post-caesarean vesico-uterine fistula: A rare entity becoming common?

Vesicouterine fistula (VUF) is rare, with an incidence estimated at 1-4% of all genitourinary fistulas. We report a case of VUF which was referred to our institute on the 6th postoperative day following an emergency repeat lower section caesarean section (LSCS) at 39 weeks, with complaints of hematuria and watery discharge per vaginum for further management. Patient had stable vitals with slight abdominal distension and tenderness and watery discharge per vaginum having an ammoniacal odour. USG examination showed Foley’s bulb inside uterine cavity. CT abdomen confirmed the findings and showed presence of contrast inside uterine cavity. Patient was re-operated on 9th postoperative day in concurrence with urologists. Cystoscopy showed a 2 cm size fistulous opening. Intra-operative findings revealed a fistulous track between posterior wall of bladder and uterine incision. Appropriate reparative surgery was done. Obstetricians need to be aware of this condition particularly while operating on previous caesarean sections

Impact of Irrigation Water Scarcity on Rural Household Food Security, Income and Poverty Levels in Pakistan

Pakistan is currently facing severe shortage of irrigation water. Current study is based on comprehensive cross sectional data set collected from 950 farmers from all the four major provinces of Pakistan. The paper analyzes the determinants of water scarcity and its impact on cereal crops yield (wheat, maize and rice), household income, food security and poverty levels by employing the propensity score matching approach. The empirical analysis indicated that farmers with water scarcity problem have lower yield (wheat, maize and rice) and household income and are food insecure. Poverty levels were higher in the range of 7-12% for the household facing water scarcity problem. Policy implications of the study is that public and private sector in Pakistan needs to invest in irrigation water management to maintain the productivity of cereal crops which is important for household food security and poverty reduction