the case study of vanitas 52

The Case Study of Vanitas Manga Online

The case study of vanitas.

There once lived a vampire known as Vanitas, hated by his own kind for being born under a full blue moon, as most arise on the night of a crimson one. Afraid and alone, he created the “Book of Vanitas,” a cursed grimoire that would one day take his vengeance on all vampires; this is how the story goes, at least.

Vanitas no Karte follows Noé Archiviste, a young man who is traveling aboard an airship in 19th century Paris with one goal in mind: to find the Book of Vanitas. A sudden vampire attack leads him to meet the enigmatic Vanitas, a doctor who specializes in vampires and, much to Noé’s surprise, an entirely ordinary human. The mysterious doctor has inherited both the name and the infamous text from the Vanitas of legend, using the grimoire to heal his patients. But behind his kind demeanor lies something a bit more sinister…

All Chapters

• The Case Study of Vanitas, Chapter 63
• The Case Study of Vanitas, Chapter 62.2
• The Case Study of Vanitas, Chapter 62.1
• The Case Study of Vanitas, Chapter 62
• The Case Study of Vanitas, Chapter 61
• The Case Study of Vanitas, Chapter 60
• The Case Study of Vanitas, Chapter 59
• The Case Study of Vanitas, Chapter 58
• The Case Study of Vanitas, Chapter 57
• The Case Study of Vanitas, Chapter 56
• The Case Study of Vanitas, Chapter 55.5
• The Case Study of Vanitas, Chapter 55
• The Case Study of Vanitas, Chapter 54.5
• The Case Study of Vanitas, Chapter 54
• The Case Study of Vanitas, Chapter 53
• The Case Study of Vanitas, Chapter 52
• The Case Study of Vanitas, Chapter 51.5
• The Case Study of Vanitas, Chapter 51
• The Case Study of Vanitas, Chapter 50
• The Case Study of Vanitas, Chapter 49
• The Case Study of Vanitas, Chapter 48
• The Case Study of Vanitas, Chapter 47
• The Case Study of Vanitas, Chapter 46
• The Case Study of Vanitas, Chapter 45
• The Case Study of Vanitas, Chapter 44
• The Case Study of Vanitas, Chapter 43
• The Case Study of Vanitas, Chapter 42
• The Case Study of Vanitas, Chapter 41
• The Case Study of Vanitas, Chapter 40
• The Case Study of Vanitas, Chapter 39
• The Case Study of Vanitas, Chapter 38
• The Case Study of Vanitas, Chapter 37
• The Case Study of Vanitas, Chapter 36
• The Case Study of Vanitas, Chapter 35
• The Case Study of Vanitas, Chapter 34
• The Case Study of Vanitas, Chapter 33
• The Case Study of Vanitas, Chapter 32
• The Case Study of Vanitas, Chapter 31
• The Case Study of Vanitas, Chapter 30
• The Case Study of Vanitas, Chapter 29
• The Case Study of Vanitas, Chapter 28
• The Case Study of Vanitas, Chapter 27
• The Case Study of Vanitas, Chapter 26
• The Case Study of Vanitas, Chapter 25
• The Case Study of Vanitas, Chapter 24
• The Case Study of Vanitas, Chapter 23
• The Case Study of Vanitas, Chapter 22
• The Case Study of Vanitas, Chapter 21
• The Case Study of Vanitas, Chapter 20
• The Case Study of Vanitas, Chapter 19
• The Case Study of Vanitas, Chapter 18
• The Case Study of Vanitas, Chapter 17
• The Case Study of Vanitas, Chapter 16
• The Case Study of Vanitas, Chapter 15
• The Case Study of Vanitas, Chapter 14
• The Case Study of Vanitas, Chapter 13
• The Case Study of Vanitas, Chapter 12
• The Case Study of Vanitas, Chapter 11
• The Case Study of Vanitas, Chapter 10
• The Case Study of Vanitas, Chapter 9
• The Case Study of Vanitas, Chapter 8
• The Case Study of Vanitas, Chapter 7
• The Case Study of Vanitas, Chapter 6
• The Case Study of Vanitas, Chapter 5
• The Case Study of Vanitas, Chapter 4
• The Case Study of Vanitas, Chapter 3
• The Case Study of Vanitas, Chapter 2
• The Case Study of Vanitas, Chapter 1

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The Case Study of Vanitas #52 Kindle & comiXology

• Part of Series The Case Study of Vanitas
• Print length 29 pages
• Language English
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• Publication date 22 Jun. 2021
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• ASIN ‏ : ‎ B097FC6M9S
• Publisher ‏ : ‎ Yen Press (22 Jun. 2021)
• Language ‏ : ‎ English
• File size ‏ : ‎ 12907 KB
• Text-to-Speech ‏ : ‎ Not enabled
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• Print length ‏ : ‎ 29 pages
• 13,478 in Manga (Kindle Store)
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Vanitas no Karte

The Case Study of Vanitas

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The Case Study of Vanitas (Official)

Vanitas no shuki,vanitas no carte,les mémoires de vanitas (french),memoir of vanitas,the case study of vanitas,ヴァニタスの手記,瓦尼塔斯的手记,바니타스의 카르테.

Authors : Mochizuki jun

Status : Ongoing

Genres : Action , Adventure , Comedy , Drama , Fantasy , Historical , Manga , Mystery , Romance , Shounen , Super Power , Supernatural , Vampires

Chapters: 63

Last update: 4 weeks ago

You are reading The Case Study of Vanitas (Official) manga, one of the most popular manga covering in Action, Adventure, Comedy, Drama, Fantasy, Historical, Manga, Mystery, Romance, Shounen, Super Power, Supernatural, Vampires genres, written by Mochizuki jun at KaliScan , a top manga site to offering for read manga online free. The Case Study of Vanitas (Official) has 76 translated chapters and translations of other chapters are in progress. Lets enjoy. If you want to get the updates about latest chapters, lets create an account and add The Case Study of Vanitas (Official) to your bookmark.

There once lived a vampire known as Vanitas, hated by his own kind for being born under a blue full moon, as most arise on the night of a crimson one. Afraid and alone, he created the "Book of Vanitas," a cursed grimoire that would one day take his vengeance on all vampires; this is how the story goes at least. Vanitas no Carte follows Noé, a young man travelling aboard an airship in 19th century Paris with one goal in mind: to find the Book of Vanitas. A sudden vampire attack leads him to meet the enigmatic Vanitas, a doctor who specializes in vampires and, much to Noé's surprise, a completely ordinary human. The mysterious doctor has inherited both the name and the infamous text from the Vanitas of legend, using the grimoire to heal his patients. But behind his kind demeanor lies something a bit more sinister...

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• Chapter 63 4 weeks ago
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• Chapter 54 12 months ago
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• Chapter 42 12 months ago
• Chapter 41 12 months ago
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• Chapter 39 12 months ago
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• Chapter 37 12 months ago
• Chapter 36 12 months ago
• Chapter 35 12 months ago
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• Chapter 34 12 months ago
• Chapter 33 12 months ago
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• Chapter 31 12 months ago
• Chapter 30 12 months ago
• Chapter 29 12 months ago
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• Chapter 27 12 months ago
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• Chapter 25 12 months ago
• Chapter 24 12 months ago
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• Chapter 21 12 months ago
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Vanitas (ヴァニタス, Vanitasu ) is a protagonist and the titular character of Jun Mochizuki 's The Case Study of Vanitas . Contrary to the legend of Vanitas of the Blue Moon , Vanitas claims to be "an average human being" who happened to inherit the Book of Vanitas . It is his stated intention to save the Vampire race by any means possible, using the Book of Vanitas not to spread Malnomen but to cure it. As such, he refers to himself as a doctor who specializes in Vampires. He commissions the help of Noé Archiviste , a Vampire sent by his teacher to research the Book of Vanitas and the series' narrator, in finding cases of Malnomen and curing them. [1]

Originally the child of a former doctor and a performer, Vanitas's biological mother died in childbirth, leaving him to be raised by his father and the traveling players he worked with. Their party was eventually attacked by Vampires, leaving Vanitas as the only survivor. Subsequently, he was picked up by the Catholic Church , and trained to be a Chasseur . However, his death was faked by Doctor Moreau , [2] and he was kept as a test subject, renamed No. 69. [3] There he would meet Mikhail , known as No. 71, and come to regard him as a younger brother. The two were subjected to inhumane experimentation in hopes of turning them into Vampires, all to no avail. Eventually, it was revealed they had received the blood of the Vampire of the Blue Moon, being the only human subjects not to reject it. This gave them abilities somewhat beyond normal human capacity, allowing them to heal slightly faster. The two were to be forcibly linked to the Books of Vanitas in a procedure which would destroy their minds, but were rescued by Vanitas of the Blue Moon. [4]

Desperate, Vanitas and Mikhail went along with Vanitas of the Blue Moon, and were taken as their adoptive children. While Mikhail quickly warmed up to his new guardian, Vanitas remained distrustful, despite taking an active role in supporting them and Mikhail. After some time had passed, Vanitas of the Blue Moon confessed that Vanitas and Mikhail would likely soon die due to the strain the Moreau's experiments had put on their bodies. They said that, lacking any other options, the two could be saved by becoming the Vampire's Kin . While Mikhail, whose body had begun to break down, quickly accepted, Vanitas vehemently refused. He killed the Vampire of the Blue Moon after being Marked , in an event he believed to have killed Mikhail, thus leading him to believe he was the only legitimate Kin of the Blue Moon. [2]

• 1 Appearance
• 2 Personality
• 3 Powers and Abilities
• 5 Appearances
• 7 References
• 8 Navigation

Appearance [ ]

Vanitas is a slender, androgynous young man of average height. He has pale skin, large, expressive eyes, a round face, and a small chin. So blue are his eyes that they are used as an immediately identifiable trait, compared to the color of copper sulfate . An upper left canine tooth is especially pronounced, giving the appearance of fangs when his teeth were visible, though they are not as pronounced as vampires' fangs. His hair is long, black, and irregularly cut, his bangs falling into the center of his face. On either side of his face, his hair is straight cut, the left side to one level and the right side to two. Though he at times appears to wear a ponytail, his hair usually sits freely, the hair on either side of his head cut shorter than that down the middle. One cowlick sticks up from the right side of his head. Both of his ears are pierced, a simple stud worn in his right ear, while his left ear is pierced with a silver (gold, in the anime) hourglass-shaped earring that he inherited from Luna, and two rings through the helix.

Vanitas's reference sheet from volume 2.

While Vanitas wore several outfits over the course of the series, he usually wears a white shirt over black pants, a dark blue striped vest, a large blue bow tie, and an oversized black coat. As accessories, he wears a long, wide ribbon tied into a bow as a belt, short boots with white spats, and black gloves with claws embedded at the fingertips. His coat is long, with a wide collar and a single button, large enough to frequently fall over one shoulder. At its hem, it takes a baloon-like form, and is joked to float "through some mysterious power." Its sleeves are someone based on those of a furisode kimono . To his belt, he straps the Book of Vanitas, two knives, and two tool cases. His outfit is called "the outfit nobody understands." [5]

As a child, he looked much the same, though his hair was less cleanly cut. He was thin and physically diminutive, despite his active training as a chasseur. Prior to being Marked by Vanitas of the Blue Moon, his eyes were a darker shade of blue.

Personality [ ]

Vanitas seems to take nothing seriously, and almost always has a playful grin on his face. He acts impulsively most of the time, and his plans are normally reckless. Vanitas carries a mischievous air around him. He finds utmost amusement in Noé's abnormal reactions to things. However, he is capable of showing seriousness when the situation called for it, as well as anger. He is very flirtatious, as seen in the way he behaves around Jeanne.

Beneath his flippant attitude, Vanitas is a broken man who despises both humans and vampires, but hates himself more than either. Vanitas hates being vulnerable around people, refusing to go to sleep around anyone he doesn’t trust. He likes high places and is often seen hanging around rooftops.

Powers and Abilities [ ]

General: As a mere human, Vanitas is more often than not significantly less powerful than those around him who are Vampires , at least physically so. While he is demonstrably fit, athletic, and spry, his strength, speed, and endurance are only that of an average human being and no more. The exception is the rate at which he heals from injuries, which is accelerated due to Doctor Moreau 's experimentation. [4] To compensate for his generally inferior physical strength, Vanitas is extremely sharp, clever, and resourceful in battle. He can analyze situations and come up with appropriate solutions and counterattacks very fast, even in the middle of a dangerous battle. He makes use of every resource available to him and is not afraid to use underhanded tactics, to the dismay of those around him. [6]

Weapons: Vanitas's main weapons are a pair of knives whose hilts are rigged with wires. In addition, stored in some pockets on his belt are various "cheaters' implements" which he uses both in and out of battle. He has a tendency to try and keep his weapons and tools hidden, to allow himself the additional element of surprise should he need it, adding to his devious trickster-like fighting style. [5] He is also skilled in gathering information about his enemies and putting that to use in battle against them. [7] He favors being prepared and constantly having the upper hand against his enemies.

Chasseur Training: Vanitas's proficiency in combat seems to have originated from his training as a Chasseur. In addition to his combat abilities and weapons training, his brief time with the Chasseurs taught him in great detail the methods of fighting a Vampire. He knows that, as their eyes are the conduit with which they can access and rewrite the World Formula , the first step is to aim for a Vampire's eyes. [8] He has utilized this knowledge not only against Vampires he's attacked [2] but also against Chasseurs who have attacked him. [9] He also, through unknown means, has access to the drugs Chasseurs use to boost their physical abilities. He only uses them in the rare scenario where he has no choice but to fight a Vampire to the death. [10]

The Book of Vanitas : The main source of Vanitas's power is the Book of Vanitas and his control over it. The main method in which he uses the Book is in healing curse-bearers with what he calls an "Inverse Operation" ( 逆 ( ぎゃく ) 演 ( えん ) 算 ( ざん ) , Gyaku Enzan ). Contrary to Vampires' common belief and fears about the curse of the Blue Moon and the related Book, Vanitas uses the Book to interfere with True Names and heal them, extracting the Maladies that warp them into Malnomen . [1] He can also, before doing so, use the Book to identify exactly what Malnomen it is, though just as often Vanitas can name said Malnomen at the top of his head. This inverse operation requires a high amount of proficiency from the user, as the only other to own a Book of Vanitas cannot interfere with True Names on such a level. [11] On rare occasions the Malnomen will be too strong for him to heal on his own, and he will require the curse-bearer in question to reject it of their own volition and call upon the power of his Mark of Possession to complete the operation. [12]

Vanitas does not only use the Book for saving however, it is also his main weapon in battle. As the Book of Vanitas is able to rewrite the World Formula at will, he can use it to a variety of purposes. He can stun Vampires and render them immobile for a short period of time, [13] though a Vampire strong enough may be able to gain mobility sooner. [6] He can also interfere with Astermite , which allows him to manipulate automatons to do his bidding, go haywire, [14] even explode at his will. [15]

Menial: Aside from combat, Vanitas also has a number of skills in other areas of expertise. Despite his status as a doctor being largely self-proclaimed, Vanitas has had clear medical training and experience, likely from being raised by his doctor of a father. [2] He knows how to perform first aid, how to treat poisons, [16] and carries various medicines around with him. [5] He also knows a number of other practical skills, including how to cook, how to clean, [2] and has various knowledge about French history and culture, [17] even minor trivia such as different apple desserts. [18] He is familiar with the Latin language, likely the result of both his upbringing in the Church and his medical knowledge.

• “—Non! I am a doctor. One who specializes in Vampires. I came… to heal her!” [1]
• “I am Vanitas. I inherited this Book and the name from the Vampire of the Blue Moon, and I am… an average human being ! Lend me your strength, Noé!” [1]
• “I’ll do as I please… use methods I choose… and, no matter what you people want… I will save you without fail!!” [1]
• “You gave yourself something to protect. That’s why you’re weak.” [6]
• “But rest assured. There’s nothing to fear. You are truly fortunate! I—! I, who am Kin to the Blue Moon!! I tell you I will use the Book of Vanitas not to slaughter but to save you!! All you have to do… is tremble with humiliation and be saved!!” [19]
• “…No real reason. Right now… you could say I don’t much care what happens.” [20]
• “I have absolutely no interest in the sort of person who would fall for me.” [21]
• “Listen! I never act against my own wishes. The fact that I’m with the Vampires, that I infiltrated this place, that I just hurt you—I did it all of my own free will!” [9]
• “…If you ask me… there’s not much difference between humans and Vampires. They’re all terribly ugly, endlessly selfish creatures.” [14]
• “I… am a doctor. I am here to save Vampires!” [22]
• “Once there were no more curse-bearers, I stopped caring.” [22]
• “If that time comes, I’ll kill you. I promise… I’ll kill you. I love you. I’m the one who’ll make your wishes come true. It has to be me. So, Jeanne… there’s nothing to worry about.” [17]
• “I’m going. If there’s a chance I might find a curse-bearer, I’ll go anywhere.” [23]
• “‘Archiviste.’ I’m only going to say this once, so listen up. If you so much as try to drink my blood… I’ll kill you. Is that clear?” [23]
• “I came here to save Vampires. Are you here for some other reason?” [7]
• “‘Revenge is pointless, so don’t attempt it. It won’t make anyone happy.’ Is that what you’re getting at?” [24]
• “I’m telling you I’ll act on the assumption that you’re going to convince me . If you want them treated… make me feel like treating them.” [24]
• “I love you. I’m the one who’ll make your wishes come true. It has to be me. So spit it out. Tell me what you really want. No matter how trivial it is. Whether it’s an ugly emotion… or even a curse… I’ll accept it for you!” [25]
• “I know that face . It’s self-satisfaction… and self-absorption. The face of someone who’s made an arbitrary decision to die alone. It makes me sick!” [26]
• “Chloé d’Apchier!! Either vanish with this world… or live on in humiliation! Choose however you like!! Even if you survive, you’ll never regain your honor. The Church will never admit to the truth of the past, and you’ll continue to be hounded as the Beast. It’ll be hell either way! Even so—you make the choice!!” [12]
• “Don’t hesitate, Noé. Don’t think about whether Astolfo’s hate is justified or not. Both humans and Vampires act on their own concepts of justice. One’s just can be someone else’s evil. ‘Being right’… is ‘power.’ It can easily turn into violence that’s much harder to deal with than malice. Don’t brandish it. Keep it inside. Justice should merely be the light that illuminates the path ahead of you.” [12]
• “This isn’t about what’s ‘right.’ Base what you do on what you can’t concede. At any rate… in your case, that will work.” [12]
• “It’s revolting! The thought of someone falling for a person like me…” [27]
• “I’ll never become your Kin. No matter what. Even if I knew I’d die tomorrow… I want to stay human until the end.” [2]
• “Bring them… back to life? Don’t even joke about that. I’ve been working to erase their existence entirely. Do you have any idea… how much I’ve—!!” [10]
• “Enough of that. You’ve gotten the wrong idea about something. You and I were only working together because our interests happened to align. We’re strangers. If the other stops being useful, cut him loose. If he gets in the way, kill him. That’s all we are, and you know it.” [10]
• “‘If anyone tries to take my memories… no matter who they are… kill them. Kill them. Kill them. Without fail. Kill… Noé. Kill that Vampire !!’” [10]
• “…Why… can’t I… kill… Why!? Wh… why…?” [28]
• “I’ll never forgive Luna. I’ll erase every last fragment of the Vampire of the Blue Moon’s existence. I’ll consign them to oblivion. That… is my ‘revenge.’” [29]
• “If I— …get to choose how I die… If I can… wish, then… If I’m going to be killed I want Noé to do it.” [29]
• “As for the rest… nothing will change. I am a doctor. I’ll keep on treating curse-bearers. I’ll do as I please. I’ll save the Vampires, for the sake of my revenge.” [29]
• “He acts as if he prefers to resolve problems by talking them out… but he gets violent first thing. He marches right into others’ personal space with his muddy boots. He’s much too stubborn. What can I do but back down!?” [30]
• “The world’s brimming over with discrimination. Some think that’s how things naturally should be. Others aren’t aware that they discriminate. The targets of discrimination often discriminate against others, too.” [31]
• “When you interact with someone… you look straight at that ‘individual.’ Their race and social position don’t matter. You look and talk to them for yourself, and accept what you’ve felt just as it is. Most people aren’t like that, though. They focus on the person’s ‘category,’ not the individual. Are they a man or a woman? An adult or a child? How do they dress? Are they human? Vampire? Dham? In and of itself, that isn’t a bad thing. In order to decide whether the person you’re facing is a threat, you need that information.” [31]

Appearances [ ]

• Mémoire 1: Vanitas — In the Event of Rusty Hopes (First Appearance)
• Mémoire 2: Noé — In the City of Flowers
• Mémoire 3: Jeanne — The Hellfire Witch
• Mémoire 4: Femme Fatale — Love
• Mémoire 5: Archiviste — Fangs That Reveal Blood
• Mémoire 6: Altus — Other World
• Mémoire 7: Bal Masqué — Night of Sneering Masks
• Mémoire 8: Louis — Sinking in a Pool of Blood
• Mémoire 10: Salvatio — Uncertainty
• Mémoire 11: Deux Ombres — Point of Departure
• Mémoire 12: Pause 𝄻
• Mémoire 13: Glissando — Glissando
• Mémoire 14: Catacombes — Where the Dead Sleep
• Memoire 15: Chasseur — Those Who Hunt Crimson
• Entracte: Chambre d'enfants — A Dream of the Sound of Rain
• Mémoire 16: Galop — At the End of the Riot
• Mémoire 17: Cicatrice — No. 69
• Mémoire 18: Dos à Dos — The Shape of Salvation
• Mémoire 19: Serment — Spell-bound
• Mémoire 20: Serment — Promise (Part One)
• Mémoire 21: Serment — Promise (Part Two)
• Mémoire 22: Hurler — A Calling Voice
• Mémoire 23: Au Pas Camarade — Pace
• Mémoire 24: Forêt d'argent — Chance Encounter
• Mémoire 25: Endroit Approprié — Melee
• Mémoire 26: Dissonance — Creaking Laughter
• Mémoire 27: Cage de Neige — Dregs
• Mémoire 28: Dal Segno — Question Mark
• Mémoire 29: Chateau de Sorcière — The Witch and the Youth
• Mémoire 30: Strascinando — Tremolo
• Mémoire 33: Cauchemar — Rumble
• Mémoire 34: Jean-Jacques — The Vampire of the Chastels (Part One)
• Mémoire 34.5: Jean-Jacques — The Vampire of the Chastels (Part Two)
• Mémoire 35: Louisette — Pillar of Justice
• Mémoire 37: Vengeance — Hands That Touch a Nightmare
• Mémoire 38: Naenia — She Who Harbors Death (Part One)
• Mémoire 38.5: Naenia — She Who Harbors Death (Part Two)
• Mémoire 39: Poupée Fissurée — The Essence of the Witch
• Mémoire 40: Avec Toi — Alone Together
• Mémoire 41: Canorus — Snow Flower
• Mémoire 42: Encore une Fois — Love
• Mémoire 43: Encens Restant — Lingering Scent of the Dream
• Mémoire 44: Mal d'Amour — The Incurable Illness (Part One)
• Mémoire 45: Mal d'Amour — The Incurable Illness (Part Two)
• Mémoire 46: Un Autre — Scar
• Entracte: Jours Bruyants — Tales of Lost Children
• Mémoire 47: Hétérogène — Sneering Laughter*
• Mémoire 48: Rencontre — Blue Night*
• Mémoire 49: Douleur — Kind Child
• Mémoire 50: Petrichor — The Thread That Reels in the Past
• Mémoire 51: Tempest — A Silent Scream
• Extra: The Case Study of Vanitash!!!! —Expanded Edition— (Non-Canon)
• Mémoire 52: Sens Unique — Fall
• Mémoire 53: Pleuvoir — Rain Which Doesn't Know the Sky
• Mémoire 54: La nuit sans lune — Dark Night (Part One)
• Mémoire 54.5: La nuit sans lune — Dark Night (Part Two)
• Mémoire 55: Après la pluie — His Wish (Part One)
• Mémoire 55.5: Après la pluie — His Wish (Part Two)
• Mémoire 56: Faire un gâteau — Bittersweet
• Mémoire 57: Au Revoir — Again, Someday
• Mémoire 58: Observation — The Darkness in Between
• Mémoire 60: Bonne journée — Sweets, Complaints, and Reconciliation
• Entracte: Couche — On Clothing
• Mémoire 61: Jeu de paume — Court Tennis (Part One)
• Mémoire 61.5: Jeu de paume — Court Tennis (Part Two)
• Mémoire 62: Bourdonnement — Wingbeats of Scattered Thought (Part One)
• Mémoire 62.5: Bourdonnement — Wingbeats of Scattered Thought (Part Two)
• Mémoire 1: Vanitas -In the Event of Rusty Hopes- (First Appearance)
• Mémoire 2: Noé -In the City of Flowers-
• Mémoire 3: Archiviste -Fangs That Lay Bare Blood-
• Mémoire 4: Bal Masqué -Night of Mocking Masks-
• Mémoire 5: Réminiscence -Friends-
• Mémoire 6: Salvatio -Questions-
• Mémoire 7: Femme Fatale -Love-
• Mémoire 8: Catacombes -Where Death Slumbers-
• Mémoire 9: Chasseur -Those Who Hunt Crimson-
• Mémoire 10: Cicatrice -No.69-
• Mémoire 11: Serment -Promises-
• Mémoire 12: Deux Ombres -Point of Departure-
• Mémoire 13: Forêt d'argent -Chance Encounter-
• Mémoire 14: Château de Sorcière -The Witch and the Young Man-
• Mémoire 15: Oiseau et ciel -The d'Apchiers' Vampire-
• Mémoire 16: Chasse aux Vampires -The Beast-
• Mémoire 17: Vengeance -Hands Upon a Nightmare-
• Mémoire 18: Avec Toi -Just the Two of Us-
• Mémoire 19: Canorus -Snow Flower-
• Mémoire 20: Mal d'amour -The Incurable Disease-
• Mémoire 21: Un Autre -Scars-
• Mémoire 22: Rencontre -Blue Night-
• Mémoire 23: Pleuvoir -Tears like Rain-
• Mémoire 24: Après la pluie -His Wish-

(*) - Denotes that the character did not appear physically, but as a part of another character's memories.

• "Vanitas" is an artistic term referring to a symbolic work of art showing the transience of life, the futility of pleasure, and the certainty of death, often contrasting symbols of wealth and symbols of ephemerality and death. It derives from the Latin word "vānitās" which can translate to "emptiness," "nothingness," "falsity," or "vanity" in English. [32]
• Vanitas shares a character song with Noé, Le Formidable! , sung by their Japanese voice actors and composed by Sasanomaly.
• Around the Chasseurs, Vanitas uses the French name "Vincent" (in Japanese, ヴァンサン, Vansan ) as an alias. This is likely a reference to Vincent Nightray (using the English pronunciation, in Japanese, ヴィンセント, Vinsento ), a recurring antagonist from Mochizuki's previous series, Pandora Hearts .
• That said, oysters seem to be a favorite food of his. [33]
• When The Case Study of Vanitas was being first conceived, Vanitas was a vampire who took on the role of Holmes and Noé was a human who took on the role of Watson, inspired by Arthur Conan Doyle's Sherlock Holmes [34] novels. Mochizuki received criticism that this narrative setup was too standard and boring. Upon hearing the suggestion that she switch their races, she was captivated by the idea of a human Holmes and vampire Watson, resulting in the current story. The visible fangs in Vanitas's current design are an element that remained from the original idea for his race. [35]
• In the earliest drafts of Vanitas's design when he was still a vampire, he was supposed to look a bit older than his current version, and he smoked a pipe that he always carried attached to a chain and hung around his neck. He also carried around a fancy parasol, presumably to protect himself from the sun. Even after Mochizuki changed his race to human, she had him keep his parasol and pipe. [36]
• When coming up with Vanitas's personality, Mochizuki described him as "an unusual vampire with a bewitching smile, but a moron who falls in love with an idiot." [36]

References [ ]

• ↑ 1.0 1.1 1.2 1.3 1.4 Mémoire 1: Vanitas
• ↑ 2.0 2.1 2.2 2.3 2.4 2.5 Mémoire 49: Douleur
• ↑ Mémoire 47: Hétérogène
• ↑ 4.0 4.1 Mémoire 48: Rencontre
• ↑ 5.0 5.1 5.2 Volume 2 Additional Content: Vanitas reference sheet
• ↑ 6.0 6.1 6.2 Mémoire 4: Femme Fatale
• ↑ 7.0 7.1 Mémoire 25: Endroit Approprié
• ↑ Mémoire 14: Catacombes
• ↑ 9.0 9.1 Mémoire 15: Chasseur
• ↑ 10.0 10.1 10.2 10.3 Mémoire 50: Petrichor
• ↑ Mémoire 54: La nuit sans lune (Part One)
• ↑ 12.0 12.1 12.2 12.3 Mémoire 41: Canorus
• ↑ Mémoire 3: Jeanne
• ↑ 14.0 14.1 Mémoire 16: Galop
• ↑ Mémoire 51: Tempest
• ↑ Mémoire 27: Cage de Neige
• ↑ 17.0 17.1 Mémoire 21: Serment (Part Two)
• ↑ 18.0 18.1 Volume 3 Omake: "Apple desserts"
• ↑ Mémoire 7: Bal Masqué
• ↑ Mémoire 8: Louis
• ↑ Mémoire 12: Pause
• ↑ 22.0 22.1 Mémoire 18: Dos à Dos
• ↑ 23.0 23.1 Mémoire 23: Au Pas Camarade
• ↑ 24.0 24.1 Mémoire 34.5: Jean-Jacques (Part Two)
• ↑ Mémoire 39: Poupée Fissurée
• ↑ Mémoire 40: Avec Toi
• ↑ Mémoire 44: Mal d’Amour (Part One)
• ↑ Mémoire 53: Pleuvoir
• ↑ 29.0 29.1 29.2 Mémoire 55.5: Après la pluie (Part Two)
• ↑ Mémoire 60: Bonne journée
• ↑ 31.0 31.1 Mémoire 62: Bourdonnement (Part One)
• ↑ Wikipedia: Vanitas
• ↑ Volume 5 Omake: "What Mademoiselle Amelia saw!"
• ↑ Wikipedia: Sherlock Holmes
• ↑ Anime da Vinci Interview
• ↑ 36.0 36.1 Volume 11 Special Edition Booklet

Navigation [ ]

• 3 List of Characters (The Case Study of Vanitas)

Strongest Characters in The Case Study of Vanitas: Vanitas, Noe, & More

T he Case Study of Vanitas is a story based in a fictional 19th-century Paris where humans and vampires share the city. The story revolves around Vanitas and his companion, Noe Archiviste. They are on a quest to heal cursed vampires through the Book of Vanitas. It goes into detail about the Vampire born under the Blue Moon. He was isolated because of their fear, and thus, he swore vengeance against the vampires born under the Red Moon. His name was none other than Vanitas. The narrative is a memoir from the eyes of Noe Archiviste. He delves into how he came to meet Vanitas, their journey together, and how it eventually ends.  

Vanitas 

While he derives his name from an old vampire and uses his grimoire The Book of Vanitas. One wouldn't be harshly criticized if they had mistaken Vanitas for a vampire. And that speaks for Vanitas himself, who is a human first and foremost. While he isn't physically weak, he compensates for his lack of strength with his intelligence and grimoire. A combination of these two allows him to manipulate the actual names of vampires, making him a formidable presence within the series.

Noe Archiviste 

The sole survivor of the Archiviste clan, Noe is the narrator of the series and accompanies Vanitas on his journey of curing Vampires. While one may argue that Noe has been defeated several times within the series. It might be accurate, but his compassion and kindness prevent him from having a severe physical altercation.

Despite being a vampire himself, Noe treats vampires and humans as equally good creatures. It’s this good virtue that pulls him down from time to time. But make no mistake, with his ability to relive memories just by drinking the respective person's blood. It is safe to say one wouldn't want to get on his wrong side.

Lucius Oriflamme

He is one of the most powerful and influential characters in The Case Study of Vanitas. Despite his young age, he serves as the Grand Duke to the Vampire Queen herself. He's an aristocrat through and through.

Despite his childlike demeanor, he's quite skilled at manipulating others with his strategic ploys and engagement in political scenarios to further his motive and maintain his clan's position of power. To top it off, he holds Jeanne as his Chevalier.

Prolific, Revered, and the guardian of Lucius Oriflamme, Ruthven is often considered one of the most essential characters in The Case Study of Vanitas. Playing a pivotal role in ending the war between humans and vampires, he now finds himself as a member of the Senate and is well-known amongst humans as well.

He sought peace between humans and vampires during the war, even acting as a peacemaker. Having been betrayed by his students, he no longer shares the same passion and is ready to use any means to seek his desires. Cold, ruthless, and feared by vampire society, with his powers yet to be showcased, he's just a testament to the man that is Ruthven.

Jean-Jacques Chastel

Chastel is the protector and longtime companion of Chloe d'Apchier and the last surviving member of the d'Apchiers. His loyalty knows no bounds, as he goes on to sign a contract with the devil itself just to realize Chloe's wish. He turns himself into the very beast the village feared in exchange for his actual name. He wreaks havoc on anyone who tries to hurt Chloe, a symbol of his genuine and sincere feelings towards her.

The post Strongest Characters in The Case Study of Vanitas: Vanitas, Noe, & More appeared first on ComingSoon.net - Movie Trailers, TV & Streaming News, and More .

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News The Case Study of Vanitas Manga Takes 2-Month Break

The manga went on hiatus in June 2022, and resumed in May 2023.

Yen Press has been publishing the manga simultaneously in English since its debut, and it describes the first volume:

Rumors revolving around The Book of Vanitas, a clockwork grimoire of dubious reputation, draw Noé, a young vampire in search of a friend's salvation, to Paris. What awaits him in the City of Flowers, however, is not long hours treading the pavement or rifling through dusty bookshops in search of the tome. Instead, his quarry comes to him...in the arms of a man claiming to be a vampire doctor! Thrust into a conflict that threatens the peace between humans and vampires, will Noé cast in his lot with the curious and slightly unbalanced Vanitas and his quest to save vampirekind?

Mochizuki ( Pandora Hearts , Crimson-Shell ) launched the manga in Gangan Joker in December 2015. Square Enix published the 11th volume on April 22.

BONES ' television anime of the manga premiered in July 2021. The anime's second part premiered in January 2022. Funimation streamed the first part, and it also streamed an English dub. Both Funimation and Crunchyroll streamed the second part as it aired, and Crunchyroll also added the first part.

Source: Gangan Joker 's X/Twitter account

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• Open access
• Published: 09 May 2024

Evaluation of integrated community case management of the common childhood illness program in Gondar city, northwest Ethiopia: a case study evaluation design

• Mekides Geta 1 ,
• Geta Asrade Alemayehu 2 ,
• Wubshet Debebe Negash 2 ,
• Tadele Biresaw Belachew 2 ,
• Chalie Tadie Tsehay 2 &
• Getachew Teshale 2  

BMC Pediatrics volume  24 , Article number:  310 ( 2024 ) Cite this article

127 Accesses

Metrics details

Integrated Community Case Management (ICCM) of common childhood illness is one of the global initiatives to reduce mortality among under-five children by two-thirds. It is also implemented in Ethiopia to improve community access and coverage of health services. However, as per our best knowledge the implementation status of integrated community case management in the study area is not well evaluated. Therefore, this study aimed to evaluate the implementation status of the integrated community case management program in Gondar City, Northwest Ethiopia.

A single case study design with mixed methods was employed to evaluate the process of integrated community case management for common childhood illness in Gondar town from March 17 to April 17, 2022. The availability, compliance, and acceptability dimensions of the program implementation were evaluated using 49 indicators. In this evaluation, 484 mothers or caregivers participated in exit interviews; 230 records were reviewed, 21 key informants were interviewed; and 42 observations were included. To identify the predictor variables associated with acceptability, we used a multivariable logistic regression analysis. Statistically significant variables were identified based on the adjusted odds ratio (AOR) with a 95% confidence interval (CI) and p-value. The qualitative data was recorded, transcribed, and translated into English, and thematic analysis was carried out.

The overall implementation of integrated community case management was 81.5%, of which availability (84.2%), compliance (83.1%), and acceptability (75.3%) contributed. Some drugs and medical equipment, like Cotrimoxazole, vitamin K, a timer, and a resuscitation bag, were stocked out. Health care providers complained that lack of refreshment training and continuous supportive supervision was the common challenges that led to a skill gap for effective program delivery. Educational status (primary AOR = 0.27, 95% CI:0.11–0.52), secondary AOR = 0.16, 95% CI:0.07–0.39), and college and above AOR = 0.08, 95% CI:0.07–0.39), prescribed drug availability (AOR = 2.17, 95% CI:1.14–4.10), travel time to the to the ICCM site (AOR = 3.8, 95% CI:1.99–7.35), and waiting time (AOR = 2.80, 95% CI:1.16–6.79) were factors associated with the acceptability of the program by caregivers.

Conclusion and recommendation

The overall implementation status of the integrated community case management program was judged as good. However, there were gaps observed in the assessment, classification, and treatment of diseases. Educational status, availability of the prescribed drugs, waiting time and travel time to integrated community case management sites were factors associated with the program acceptability. Continuous supportive supervision for health facilities, refreshment training for HEW’s to maximize compliance, construction clean water sources for HPs, and conducting longitudinal studies for the future are the forwarded recommendation.

Peer Review reports

Integrated Community Case Management (ICCM) is a critical public health strategy for expanding the coverage of quality child care services [ 1 , 2 ]. It mainly concentrated on curative care and also on the diagnosis, treatment, and referral of children who are ill with infectious diseases [ 3 , 4 ].

Based on the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) recommendations, Ethiopia adopted and implemented a national policy supporting community-based treatment of common childhood illnesses like pneumonia, Diarrhea, uncomplicated malnutrition, malaria and other febrile illness and Amhara region was one the piloted regions in late 2010 [ 5 ]. The Ethiopian primary healthcare units, established at district levels include primary hospitals, health centers (HCs), and health posts (HPs). The HPs are run by Health Extension Workers (HEWs), and they have function of monitoring health programs and disease occurrence, providing health education, essential primary care services, and timely referrals to HCs [ 6 , 7 ]. The Health Extension Program (HEP) uses task shifting and community ownership to provide essential health services at the first level using the health development army and a network of woman volunteers. These groups are organized to promote health and prevent diseases through community participation and empowerment by identifying the salient local bottlenecks which hinder vital maternal, neonatal, and child health service utilization [ 8 , 9 ].

One of the key steps to enhance the clinical case of health extension staff is to encourage better growth and development among under-five children by health extension. Healthy family and neighborhood practices are also encouraged [ 10 , 11 ]. The program also combines immunization, community-based feeding, vitamin A and de-worming with multiple preventive measures [ 12 , 13 ]. Now a days rapidly scaling up of ICCM approach to efficiently manage the most common causes of morbidity and mortality of children under the age of five in an integrated manner at the community level is required [ 14 , 15 ].

Over 5.3 million children are died at a global level in 2018 and most causes (75%) are preventable or treatable diseases such as pneumonia, malaria and diarrhea [ 16 ]. About 99% of the global burden of mortality and morbidity of under-five children which exists in developing countries are due to common childhood diseases such as pneumonia, diarrhea, malaria and malnutrition [ 17 ].

In 2013, the mortality rate of under-five children in Sub-Saharan Africa decreased to 86 deaths per 1000 live birth and estimated to be 25 per 1000live births by 2030. However, it is a huge figure and the trends are not sufficient to reach the target [ 18 ]. About half of global under-five deaths occurred in sub-Saharan Africa. And from the top 26 nations burdened with 80% of the world’s under-five deaths, 19 are in sub-Saharan Africa [ 19 ].

To alleviate the burden, the Ethiopian government tries to deliver basic child care services at the community level by trained health extension workers. The program improves the health of the children not only in Ethiopia but also in some African nations. Despite its proven benefits, the program implementation had several challenges, in particular, non-adherence to the national guidelines among health care workers [ 20 ]. Addressing those challenges could further improve the program performance. Present treatment levels in sub-Saharan Africa are unacceptably poor; only 39% of children receive proper diarrhea treatment, 13% of children with suspected pneumonia receive antibiotics, 13% of children with fever receive a finger/heel stick to screen for malaria [ 21 ].

To improve the program performance, program gaps should be identified through scientific evaluations and stakeholder involvement. This evaluation not only identify gaps but also forward recommendations for the observed gaps. Furthermore, the implementation status of ICCM of common childhood illnesses has not been evaluated in the study area yet. Therefore, this work aimed to evaluate the implementation status of integrated community case management program implementation in Gondar town, northwest Ethiopia. The findings may be used by policy makers, healthcare providers, funders and researchers.

Method and material

Evaluation design and settings.

A single-case study design with concurrent mixed-methods evaluation was conducted in Gondar city, northwest Ethiopia, from March 17 to April 17, 2022. The evaluability assessment was done from December 15–30, 2021. Both qualitative and quantitative data were collected concurrently, analyzed separately, and integrated at the result interpretation phase.

The evaluation area, Gondar City, is located in northwest Ethiopia, 740 km from Addis Ababa, the capital city of the country. It has six sub-cities and thirty-six kebeles (25 urban and 11 rural). In 2019, the estimated total population of the town was 338,646, and 58,519 (17.3%) were under-five children. In the town there are eight public health centers and 14 health posts serving the population. All health posts provide ICCM service for more than 70,852 populations.

Evaluation approach and dimensions

Program stakeholders.

The evaluation followed a formative participatory approach by engaging the potential stakeholders in the program. Prior to the development of the proposal, an extensive discussion was held with the Gondar City Health Department to identify other key stakeholders in the program. Service providers at each health facility (HCs and HPs), caretakers of sick children, the Gondar City Health Office (GCHO), the Amhara Regional Health Bureau (ARHB), the Minister of Health (MoH), and NGOs (IFHP and Save the Children) were considered key stakeholders. During the Evaluability Assessment (EA), the stakeholders were involved in the development of evaluation questions, objectives, indicators, and judgment criteria of the evaluation.

Evaluation dimensions

The availability and acceptability dimensions from the access framework [ 22 ] and compliance dimension from the fidelity framework [ 23 ] were used to evaluate the implementation of ICCM.

Population and samplings

All under-five children and their caregivers attended at the HPs; program implementers (health extension workers, healthcare providers, healthcare managers, PHCU focal persons, MCH coordinators, and other stakeholders); and ICCM records and registries in the health posts of Gondar city administration were included in the evaluation. For quantitative data, the required sample size was proportionally allocated for each health post based on the number of cases served in the recent one month. But the qualitative sample size was determined by data saturation, and the samples were selected purposefully.

The data sources and sample size for the compliance dimension were all administrative records/reports and ICCM registration books (230 documents) in all health posts registered from December 1, 2021, to February 30, 2022 (three months retrospectively) included in the evaluation. The registries were assessed starting from the most recent registration number until the required sample size was obtained for each health post.

The sample size to measure the mothers’/caregivers’ acceptability towards ICCM was calculated by taking prevalence of caregivers’ satisfaction on ICCM program p  = 74% from previously similar study [ 24 ] and considering standard error 4% at 95% CI and 10% non- responses, which gave 508. Except those who were seriously ill, all caregivers attending the ICCM sites during data collection were selected and interviewed consecutively.

The availability of required supplies, materials and human resources for the program were assessed in all 14HPs. The data collectors observed the health posts and collected required data by using a resources inventory checklist.

A total of 70 non-participatory patient-provider interactions were also observed. The observations were conducted per each health post and for health posts which have more than one health extension workers one of them were selected randomly. The observation findings were used to triangulate the findings obtained through other data collection techniques. Since people may act accordingly to the standards when they know they are observed for their activities, we discarded the first two observations from analysis. It is one of the strategies to minimize the Hawthorne effect of the study. Finally a total of 42 (3 in each HPs) observations were included in the analysis.

Twenty one key informants (14 HEWs, 3 PHCU focal person, 3 health center heads and one MCH coordinator) were interviewed. These key informants were selected since they are assumed to be best teachers in the program. Besides originally developed key informant interview questions, the data collectors probed them to get more detail and clear information.

Variables and measurement

The availability of resources, including trained healthcare workers, was examined using 17 indicators, with weighted score of 35%. Compliance was used to assess HEWs’ adherence to the ICCM treatment guidelines by observing patient-provider interactions and conducting document reviews. We used 18 indicators and a weighted value of 40%.

Mothers’ /caregivers’/ acceptance of ICCM service was examined using 14 indicators and had a weighted score of 25%. The indicators were developed with a five-point Likert scale (1: strongly disagree, 2: disagree, 3: neutral, 4: agree and 5: strongly agree). The cut off point for this categorization was calculated using the demarcation threshold formula: ( \(\frac{\text{t}\text{o}\text{t}\text{a}\text{l}\, \text{h}\text{i}\text{g}\text{h}\text{e}\text{s}\text{t}\, \text{s}\text{c}\text{o}\text{r}\text{e}-\,\text{t}\text{o}\text{t}\text{a}\text{l}\, \text{l}\text{o}\text{w}\text{e}\text{s}\text{t} \,\text{s}\text{c}\text{o}\text{r}\text{e}}{2}) +total lowest score\) ( 25 – 27 ). Those mothers/caregivers/ who scored above cut point (42) were considered as “satisfied”, otherwise “dissatisfied”. The indicators were adapted from the national ICCM and IMNCI implementation guideline and other related evaluations with the participation of stakeholders. Indicator weight was given by the stakeholders during EA. Indicators score was calculated using the formula \(\left(achieved \,in \%=\frac{indicator \,score \,x \,100}{indicator\, weight} \right)\) [ 26 , 28 ].

The independent variables for the acceptability dimension were socio-demographic and economic variables (age, educational status, marital status, occupation of caregiver, family size, income level, and mode of transport), availability of prescribed drugs, waiting time, travel time to ICCM site, home to home visit, consultation time, appointment, and source of information.

The overall implementation of ICCM was measured by using 49 indicators over the three dimensions: availability (17 indicators), compliance (18 indicators) and acceptability (14 indicators).

Program logic model

Based on the constructed program logic model and trained health care providers, mothers/caregivers received health information and counseling on child feeding; children were assessed, classified, and treated for disease, received follow-up; they were checked for vitamin A; and deworming and immunization status were the expected outputs of the program activities. Improved knowledge of HEWs on ICCM, increased health-seeking behavior, improved quality of health services, increased utilization of services, improved data quality and information use, and improved child health conditions are considered outcomes of the program. Reduction of under-five morbidity and mortality and improving quality of life in the society are the distant outcomes or impacts of the program (Fig.  1 ).

Integrated community case management of childhood illness program logic model in Gondar City in 2022

Data collection tools and procedure

Resource inventory and data extraction checklists were adapted from standard ICCM tool and check lists [ 29 ]. A structured interviewer administered questionnaire was adapted by referring different literatures [ 30 , 31 ] to measure the acceptability of ICCM. The key informant interview (KII) guide was also developed to explore the views of KIs. The interview questionnaire and guide were initially developed in English and translated into the local language (Amharic) and finally back to English to ensure consistency. All the interviews were done in the local language, Amharic.

Five trained clinical nurses and one BSC nurse were recruited from Gondar zuria and Wegera district as data collectors and supervisors, respectively. Two days training on the overall purpose of the evaluation and basic data collection procedures were provided prior to data collection. Then, both quantitative and qualitative data were gathered at the same time. The quantitative data were gathered from program documentation, charts of ICCM program visitors and, exit interview. Interviews with 21 KIIs and non-participatory observations of patient-provider interactions were used to acquire qualitative data. Key informant interviews were conducted to investigate the gaps and best practices in the implementation of the ICCM program.

A pretest was conducted to 26 mothers/caregivers/ at Maksegnit health post and appropriate modifications were made based on the pretest results. The data collectors were supervised and principal evaluator examined the completeness and consistency of the data on a daily basis.

Data management and analysis

For analysis, quantitative data were entered into epi-data version 4.6 and exported to Stata 14 software for analysis. Narration and tabular statistics were used to present descriptive statistics. Based on established judgment criteria, the total program implementation was examined and interpreted as a mix of the availability, compliance, and acceptability dimensions. To investigate the factors associated with ICCM acceptance, a binary logistic regression analysis was performed. During bivariable analysis, variables with p-values less than 0.25 were included in multivariable analysis. Finally, variables having a p-value less than 0.05 and an adjusted odds ratio (AOR) with a 95% confidence interval (CI) were judged statistically significant. Qualitative data were collected recorded, transcribed into Amharic, then translated into English and finally coded and thematically analyzed.

Judgment matrix analysis

The weighted values of availability, compliance, and acceptability dimensions were 35, 40, and 25 based on the stakeholder and investigator agreement on each indicator, respectively. The judgment parameters for each dimension and the overall implementation of the program were categorized as poor (< 60%), fair (60–74.9%), good (75-84.9%), and very good (85–100%).

Availability of resources

A total of 26 HEWs were assigned within the fourteen health posts, and 72.7% of them were trained on ICCM to manage common childhood illnesses in under-five children. However, the training was given before four years, and they didn’t get even refreshment training about ICCM. The KII responses also supported that the shortage of HEWs at the HPs was the problem in implementing the program properly.

I am the only HEW in this health post and I have not been trained on ICCM program. So, this may compromise the quality of service and client satisfaction.(25 years old HEW with two years’ experience)

All observed health posts had ICCM registration books, monthly report and referral formats, functional thermometer, weighting scale and MUAC tape meter. However, timer and resuscitation bag was not available in all HPs. Most of the key informant finding showed that, in all HPs there was no shortage of guideline, registration book and recording tool; however, there was no OTP card in some health posts.

“Guideline, ICCM registration book for 2–59 months of age, and other different recording and reporting formats and booklet charts are available since September/2016. However, OTP card is not available in most HPs.”. (A 30 years male health center director)

Only one-fifth (21%) of HPs had a clean water source for drinking and washing of equipment. Most of Key-informant interview findings showed that the availability of infrastructures like water was not available in most HPs. Poor linkage between HPs, HCs, town health department, and local Kebele administer were the reason for unavailability.

Since there is no water for hand washing, or drinking, we obligated to bring water from our home for daily consumptions. This increases the burden for us in our daily activity. (35 years old HEW)

Most medicines, such as anti-malaria drugs with RDT, Quartem, Albendazole, Amoxicillin, vitamin A capsules, ORS, and gloves, were available in all the health posts. Drugs like zinc, paracetamol, TTC eye ointment, and folic acid were available in some HPs. However, cotrimoxazole and vitamin K capsules were stocked-out in all health posts for the last six months. The key informant also revealed that: “Vitamin K was not available starting from the beginning of this program and Cotrimoxazole was not available for the past one year and they told us they would avail it soon but still not availed. Some essential ICCM drugs like anti malaria drugs, De-worming, Amoxicillin, vitamin A capsules, ORS and medical supplies were also not available in HCs regularly.”(28 years’ Female PHCU focal)

The overall availability of resources for ICCM implementation was 84.2% which was good based on our presetting judgment parameter (Table  1 ).

Health extension worker’s compliance

From the 42 patient-provider interactions, we found that 85.7%, 71.4%, 76.2%, and 95.2% of the children were checked for body temperature, weight, general danger signs, and immunization status respectively. Out of total (42) observation, 33(78.6%) of sick children were classified for their nutritional status. During observation time 29 (69.1%) of caregivers were counseled by HEWs on food, fluid and when to return back and 35 (83.3%) of children were appointed for next follow-up visit. Key informant interviews also affirmed that;

“Most of our health extension workers were trained on ICCM program guidelines but still there are problems on assessment classification and treatment of disease based on guidelines and standards this is mainly due to lack refreshment training on the program and lack of continuous supportive supervision from the respective body.” (27years’ Male health center head)

From 10 clients classified as having severe pneumonia cases, all of them were referred to a health center (with pre-referral treatment), and from those 57 pneumonia cases, 50 (87.7%) were treated at the HP with amoxicillin or cotrimoxazole. All children with severe diarrhea, very severe disease, and severe complicated malnutrition cases were referred to health centers with a pre-referral treatment for severe dehydration, very severe febrile disease, and severe complicated malnutrition, respectively. From those with some dehydration and no dehydration cases, (82.4%) and (86.8%) were treated at the HPs for some dehydration (ORS; plan B) and for no dehydration (ORS; plan A), respectively. Moreover, zinc sulfate was prescribed for 63 (90%) of under-five children with some dehydration or no dehydration. From 26 malaria cases and 32 severe uncomplicated malnutrition and moderate acute malnutrition cases, 20 (76.9%) and 25 (78.1%) were treated at the HPs, respectively. Of the total reviewed documents, 56 (93.3%), 66 (94.3%), 38 (84.4%), and 25 (78.1%) of them were given a follow-up date for pneumonia, diarrhea, malaria, and malnutrition, respectively.

Supportive supervision and performance review meetings were conducted only in 10 (71.4%) HPs, but all (100%) HPs sent timely reports to the next supervisory body.

Most of the key informants’ interview findings showed that supportive supervision was not conducted regularly and for all HPs.

I had mentored and supervised by supportive supervision teams who came to our health post at different times from health center, town health office and zonal health department. I received this integrated supervision from town health office irregularly, but every month from catchment health center and last integrated supportive supervision from HC was on January. The problem is the supervision was conducted for all programs.(32 years’ old and nine years experienced female HEW)

Moreover, the result showed that there was poor compliance of HEWs for the program mainly due to weak supportive supervision system of managerial and technical health workers. It was also supported by key informants as:

We conducted supportive supervision and performance review meeting at different time, but still there was not regular and not addressed all HPs. In addition to this the supervision and review meeting was conducted as integration of ICCM program with other services. The other problem is that most of the time we didn’t used checklist during supportive supervision. (Mid 30 years old male HC director)

Based on our observation and ICCM document review, 83.1% of the HEWs were complied with the ICCM guidelines and judged as fair (Table  2 ).

Acceptability of ICCM program

Sociodemographic and obstetric characteristics of participants.

A total of 484 study participants responded to the interviewer-administered questionnaire with a response rate of 95.3%. The mean age of study participants was 30.7 (SD ± 5.5) years. Of the total caregivers, the majority (38.6%) were categorized under the age group of 26–30 years. Among the total respondents, 89.3% were married, and regarding religion, the majorities (84.5%) were Orthodox Christian followers. Regarding educational status, over half of caregivers (52.1%) were illiterate (unable to read or write). Nearly two-thirds of the caregivers (62.6%) were housewives (Table  3 ).

All the caregivers came to the health post on foot, and most of them 418 (86.4%) arrived within one hour. The majority of 452 (93.4%) caregivers responded that the waiting time to get the service was less than 30 min. Caregivers who got the prescribed drugs at the health post were 409 (84.5%). Most of the respondents, 429 (88.6%) and 438 (90.5%), received counseling services on providing extra fluid and feeding for their sick child and were given a follow-up date.

Most 298 (61.6%) of the caregivers were satisfied with the convenience of the working hours of HPs, and more than three-fourths (80.8%) were satisfied with the counseling services they received. Most of the respondents, 366 (75.6%), were satisfied with the appropriateness of waiting time and 431 (89%) with the appropriateness of consultation time. The majority (448 (92.6%) of caregivers were satisfied with the way of communicating with HEWs, and 269 (55.6%) were satisfied with the knowledge and competence of HEWs. Nearly half of the caregivers (240, or 49.6%) were satisfied with the availability of drugs at health posts.

The overall acceptability of the ICCM program was 75.3%, which was judged as good. A low proportion of acceptability was measured on the cleanliness of the health posts, the appropriateness of the waiting area, and the competence and knowledge of the HEWs. On the other hand, high proportion of acceptability was measured on appropriateness of waiting time, way of communication with HEWs, and the availability of drugs (Table  4 ).

Factors associated with acceptability of ICCM program

In the final multivariable logistic regression analysis, educational status of caregivers, availability of prescribed drugs, time to arrive, and waiting time were factors significantly associated with the satisfaction of caregivers with the ICCM program.

Accordingly, the odds of caregivers with primary education, secondary education, and college and above were 73% (AOR = 0.27, 95% CI: 0.11–0.52), 84% (AOR = 0.16, 95% CI: 0.07–0.39), and 92% (AOR = 0.08, 95% CI: 0.07–0.40) less likely to accept the program as compared to mothers or caregivers who were not able to read and write, respectively. The odds of caregivers or mothers who received prescribed drugs were 2.17 times more likely to accept the program as compared to their counters (AOR = 2.17, 95% CI: 1.14–4.10). The odds of caregivers or mothers who waited for services for less than 30 min were 2.8 times more likely to accept the program as compared to those who waited for more than 30 min (AOR = 2.80, 95% CI: 1.16–6.79). Moreover, the odds of caregivers/mothers who traveled an hour or less for service were 3.8 times more likely to accept the ICCM program as compared to their counters (AOR = 3.82, 95% CI:1.99–7.35) (Table  5 ).

Overall ICCM program implementation and judgment

The implementation of the ICCM program in Gondar city administration was measured in terms of availability (84.2%), compliance (83.1%), and acceptability (75.3%) dimensions. In the availability dimension, amoxicillin, antimalarial drugs, albendazole, Vit. A, and ORS were available in all health posts, but only six HPs had Ready-to-Use Therapeutic Feedings, three HPs had ORT Corners, and none of the HPs had functional timers. In all health posts, the health extension workers asked the chief to complain, correctly assessed for pneumonia, diarrhea, malaria, and malnutrition, and sent reports based on the national schedule. However, only 70% of caretakers counseled about food, fluids, and when to return, 66% and 76% of the sick children were checked for anemia and other danger signs, respectively. The acceptability level of the program by caretakers and caretakers’/mothers’ educational status, waiting time to get the service and travel time ICCM sites were the factors affecting its acceptability. The overall ICCM program in Gondar city administration was 81.5% and judged as good (Fig.  2 ).

Overall ICCM program implementation and the evaluation dimensions in Gondar city administration, 2022

The implementation status of ICCM was judged by using three dimensions including availability, compliance and acceptability of the program. The judgment cut of points was determined during evaluability assessment (EA) along with the stakeholders. As a result, we found that the overall implementation status of ICCM program was good as per the presetting judgment parameter. Availability of resources for the program implementation, compliance of HEWs to the treatment guideline and acceptability of the program services by users were also judged as good as per the judgment parameter.

This evaluation showed that most medications, equipment and recording and reporting materials available. This finding was comparable with the standard ICCM treatment guide line [ 10 ]. On the other hand trained health care providers, some medications like Zink, Paracetamol and TTC eye ointment, folic acid and syringes were not found in some HPs. However the finding was higher than the study conducted in SNNPR on selected health posts [ 33 ] and a study conducted in Soro district, southern Ethiopia [ 24 ]. The possible reason might be due to low interruption of drugs at town health office or regional health department stores, regular supplies of essential drugs and good supply management and distribution of drug from health centers to health post.

The result of this evaluation showed that only one fourth of health posts had functional ORT Corner which was lower compared to the study conducted in SNNPR [ 34 ]. This might be due poor coverage of functional pipe water in the kebeles and the installation was not set at the beginning of health post construction as reported from one of ICCM program coordinator.

Compliance of HEWs to the treatment guidelines in this evaluation was higher than the study done in southern Ethiopia (65.6%) [ 24 ]. This might be due to availability of essential drugs educational level of HEWs and good utilization of ICCM guideline and chart booklet by HEWs. The observations showed most of the sick children were assessed for danger sign, weight, and temperature respectively. This finding is lower than the study conducted in Rwanda [ 35 ]. This difference might be due to lack of refreshment training and regular supportive supervision for HEWs. This also higher compared to the study done in three regions of Ethiopia indicates that 88%, 92% and 93% of children classified as per standard for Pneumonia, diarrhea and malaria respectively [ 36 ]. The reason for this difference may be due to the presence of medical equipment and supplies including RDT kit for malaria, and good educational level of HEWs.

Moreover most HPs received supportive supervision and performance review meeting was conducted and all of them send reports timely to next level. The finding of this evaluation was lower than the study conducted on implementation evaluation of ICCM program southern Ethiopia [ 24 ] and study done in three regions of Ethiopia (Amhara, Tigray and SNNPR) [ 37 ]. This difference might be due sample size variation.

The overall acceptability of the ICCM program was less than the presetting judgment parameter but slightly higher compared to the study in southern Ethiopia [ 24 ]. This might be due to presence of essential drugs for treating children, reasonable waiting and counseling time provided by HEWs, and smooth communication between HEWs and caregivers. In contrast, this was lower than similar studies conducted in Wakiso district, Uganda [ 38 ]. The reason for this might be due to contextual difference between the two countries, inappropriate waiting area to receive the service and poor cleanness of the HPs in our study area. Low acceptability of caregivers to ICCM service was observed in the appropriateness of waiting area, availability of drugs, cleanness of health post, and competence of HEWs while high level of caregiver’s acceptability was consultation time, counseling service they received, communication with HEWs, treatment given for their sick children and interest to return back for ICCM service.

Caregivers who achieved primary, secondary, and college and above were more likely accept the program services than those who were illiterate. This may more educated mothers know about their child health condition and expect quality service from healthcare providers which is more likely reduce the acceptability of the service. The finding is congruent with a study done on implementation evaluation of ICCM program in southern Ethiopia [ 24 ]. However, inconsistent with a study conducted in wakiso district in Uganda [ 38 ]. The possible reason for this might be due to contextual differences between the two countries. The ICCM program acceptability was high in caregivers who received all prescribed drugs than those did not. Caregivers those waited less than 30 min for service were more accepted ICCM services compared to those more than 30 minutes’ waiting time. This finding is similar compared with the study conducted on implementation evaluation of ICCM program in southern Ethiopia [ 24 ]. In contrary, the result was incongruent with a survey result conducted by Ethiopian public health institute in all regions and two administrative cities of Ethiopia [ 39 ]. This variation might be due to smaller sample size in our study the previous one. Moreover, caregivers who traveled to HPs less than 60 min were more likely accepted the program than who traveled more and the finding was similar with the study finding in Jimma zone [ 40 ].

Strengths and limitations

This evaluation used three evaluation dimensions, mixed method and different data sources that would enhance the reliability and credibility of the findings. However, the study might have limitations like social desirability bias, recall bias and Hawthorne effect.

The implementation of the ICCM program in Gondar city administration was measured in terms of availability (84.2%), compliance (83.1%), and acceptability (75.3%) dimensions. In the availability dimension, amoxicillin, antimalarial drugs, albendazole, Vit. A, and ORS were available in all health posts, but only six HPs had Ready-to-Use Therapeutic Feedings, three HPs had ORT Corners, and none of the HPs had functional timers.

This evaluation assessed the implementation status of the ICCM program, focusing mainly on availability, compliance, and acceptability dimensions. The overall implementation status of the program was judged as good. The availability dimension is compromised due to stock-outs of chloroquine syrup, cotrimoxazole, and vitamin K and the inaccessibility of clean water supply in some health posts. Educational statuses of caregivers, availability of prescribed drugs at the HPs, time to arrive to HPs, and waiting time to receive the service were the factors associated with the acceptability of the ICCM program.

Therefore, continuous supportive supervision for health facilities, and refreshment training for HEW’s to maximize compliance are recommended. Materials and supplies shall be delivered directly to the health centers or health posts to solve the transportation problem. HEWs shall document the assessment findings and the services provided using the registration format to identify their gaps, limitations, and better performances. The health facilities and local administrations should construct clean water sources for health facilities. Furthermore, we recommend for future researchers and program evaluators to conduct longitudinal studies to know the causal relationship of the program interventions and the outcomes.

Data availability

Data will be available upon reasonable request from the corresponding author.

Abbreviations

Ethiopian Demographic and Health Survey

Health Center/Health Facility

Health Extension Program

Health Extension Workers

Health Post

Health Sector Development Plan

Integrated Community Case Management of Common Childhood Illnesses

Information Communication and Education

Integrated Family Health Program

Integrated Management of Neonatal and Childhood Illness

Integrated Supportive Supervision

Maternal and Child Health

Mid Upper Arm Circumference

Non-Government Organization

Oral Rehydration Salts

Outpatient Therapeutic program

Primary health care unit

Rapid Diagnostics Test

Ready to Use Therapeutic Foods

Sever Acute Malnutrition

South Nation Nationalities People Region

United Nations International Child Emergency Fund

World Health Organization

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Acknowledgements

We are very grateful to University of Gondar and Gondar town health office for its welcoming approaches. We would also like to thank all of the study participants of this evaluation for their information and commitment. Our appreciation also goes to the data collectors and supervisors for their unreserved contribution.

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Geta Asrade Alemayehu, Wubshet Debebe Negash, Tadele Biresaw Belachew, Chalie Tadie Tsehay & Getachew Teshale

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All authors contributed to the preparation of the manuscript. M.G. conceived and designed the evaluation and performed the analysis then T.B.B., W.D.N., G.A.A., C.T.T. and G.T. revised the analysis. G.T. prepared the manuscript and all the authors revised and approved the final manuscript.

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Geta, M., Alemayehu, G.A., Negash, W.D. et al. Evaluation of integrated community case management of the common childhood illness program in Gondar city, northwest Ethiopia: a case study evaluation design. BMC Pediatr 24 , 310 (2024). https://doi.org/10.1186/s12887-024-04785-0

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DOI : https://doi.org/10.1186/s12887-024-04785-0

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