Most cases (111 or 45.3%) were treated at the Friendship University Hospital Center ( Table 1 ).

There were more patients aged 15 - 24 and 25 - 34. The average age was around 31 years old ( Table 2 ).

The majority of patients (53.9%) were illiterate ( Figure 1 ).

First-time mothers were the most represented (38%) ( Figure 2 ).

Most patients (73.1%) had made fewer than four contacts during prenatal follow-up ( Table 3 ).

The average working time was 3.16 days or approximately 75 hours ( Table 4 ).

The extremes were 0 days and 6 days, the maximum frequency corresponded to 3 - 4 days in 46.5% of cases.

Most patients had delivered vaginally (64%) ( Figure 3 ).

The fistulas were of vesico-vaginal location in 25.3% on a soft vagina in 23.5% ( Table 5 ).

Types V and I dominated in 17.4% and 9.2%, respectively.

In the majority of cases (50.2%), the fistula was treated via the upper route ( Table 6 ).

All areas of the CAR were represented: urban and rural. Bangui, an urban area, represents 52.2% (CHU de l’Amitié and Castors Health Center) and rural areas, 47.8%. This rate shows that the majority of fistulas are repaired in Bangui, where medical infrastructure is less poor, security relatively acceptable and qualified personnel available (gynecologists, urologists, anesthesiologists).

Educational level is a direct reflection of occupation and socio-economic level [7] . Indeed, 53.9% of our patients were illiterate and therefore unemployed with low income [8] . This lack of financial means for treatment in the event of a health problem would be the cause of prolonged working hours, thus causing OF. Our results are superimposable to those of Sheilla MY et al. Bangui [9] who found that 70.9% of patients were illiterate and 85.5% carried out household activities.

In our series, fistula occurred much more in primiparous women (38%) then in pauciparous women (30%). These results can be superimposed on certain data from the literature. Sanda in Niger also reports a predominance of first-time mothers (67.3%) without children among OF carriers [10] [11] . The same observation was made by Ouattara in Bamako in Mali, including 76.4% of carriers of vesico-vaginal fistulas were primiparous [12] .

The majority of patients (73.1%) had made fewer than four contacts during pregnancy compared to 26.9% of patients who had not followed a prenatal consultation. The average duration of work was 3.16 days or approximately 75 hours. The extremes were 0 days and 6 days, the maximum frequency corresponded to 3 - 4 days in 46.5% of cases. This poor performance of prenatal monitoring coupled with the poor quality linked to the absence of qualified personnel would be the cause of prolonged labor and other negative consequences due to lack of last contact during which the prognostic delivery plan of the child is established. In some studies, this average duration is similar, varying between 2.5 and 4 days [13] - [15] .

In relation to the mode of delivery, cesarean section was the most incriminated mode in our series with 64% of cases or 157 patients. The same observation was made following a previous study carried out in Bangui in the Central African Republic in 2005 by Nguembi et al. which reports the occurrence of OF caused by technical errors during cesarean section [16] . During the second conference of fistula surgeons in November 2009 in Yaoundé, the iatrogenic nature of obstetric fistulas was the subject of concern among the speakers [17] . Other authors have made the same observation with respectively 57.72% and 54.03% of cesarean sections [18] [19] . In our study, the high proportion of iatrogenic OF could be explained on the one hand by the insufficiency of the qualified personnel throughout the territory with a high concentration of competent personnel in urban areas [20] . On the other hand, the late arrival of parturients in the reference centers after several days of attempts of deliveries constitutes a significant factor in the genesis of fistulas of obstetric origin. Caesarean section being performed for maternal rescue. In health facilities, unqualified medical personnel could assist with acute deliveries but are sometimes unable to detect an obstetric emergency or obstructed labor that could prompt evacuation to a reference center [18] .