Evaluating the Screening Efficiency and Assessment of Non-Communicable Disease Risk Factors Among Clients Attending Healthy Lifestyle Clinics in the Colombo District

Background: Non-communicable diseases (NCDs) present a critical global healthcare crisis, accounting for 74% of all annual deaths worldwide, with a disproportionate 86% of premature fatalities occurring in low- and middle-income countries (LMICs). In Sri Lanka, an accelerated epidemiological transition driven by rapid urbanization and a rapidly aging population has positioned NCDs as the leading public health challenge, responsible for an estimated 83% of annual deaths. Cardiovascular diseases alone dictate 34% of national mortality. In response, the Ministry of Health operationalized Healthy Lifestyle Clinics (HLCs) within the primary healthcare network to target individuals aged 35 and older. This strategy aims to shift the medical paradigm from expensive, tertiary-level curative interventions to localized, community-based risk modification. This study evaluates the screening performance, risk patterns, and institutional variances across 11 frontline centers in the Colombo Regional Health Services (RDHS) area during the 2024 screening period.
Methods: This evaluation utilized a mixed-methods, cross-sectional descriptive design. Quantitative data were retrospectively extracted from the formal 2024 HLC Annual Review Data across 11 selected facilities, consisting of two secondary care centers (District General Hospital Avissawella and Base Hospital Homagama) and nine primary care Divisional Hospitals (DH
Wethara, DH Piliyandala, DH Thalangama, DH Nawagamuwa, DH Padukka, DH Moratuwa, DH Maligawatta, DH Kosgama, and DH Athurugiriya). The study population encompassed all 17,212 eligible clients screened during the calendar year. Qualitative data were gathered via a systematic desk review of institutional documents (monthly returns and clinic logs) alongside semi-structured Key Informant Interviews (KIIs) with institutional stakeholders, Medical Officers, and Public Health Nursing Officers to contextualize administrative challenges and data recording fidelity.
Results: A total of 17,212 clients were screened across the region. Primary care centers bore the vast majority of the preventative volume, led by DH Moratuwa (20.80%) and DH Kosgama (14.05%). Conversely, specialized secondary care centers demonstrated very low preventative outreach; DGH Avissawella contributed only 2.25% of total regional screenings, acting primarily as an overburdened curative centre.
Tobacco smoking prevalence was highest in high-density urban or industrial zones, led by DH Moratuwa at 19.08% . Culturally embedded betel chewing showed strong clustering in agricultural or semi-urban cohorts, peaking proportionately at DGH Avissawella (21.65%) and DH Nawagamuwa (18.97%). Harmful alcohol consumption emerged as a widespread behavioral threat, with the highest relative density documented at DH Maligawatta (27.09%).
Elevated blood pressure represented an immense physiological burden, heavily concentrated at DH Kosgama where 32.34% () of the screened cohort presented with high blood pressure. Institutional obesity rates peaked at DH Wethara (18.65%) and DH Maligawatta (16.58%), reflecting an ongoing urban nutritional transition.
The evaluation exposed a critical operational vulnerability in diabetes tracking. While BH Homagama reported a realistic high FBS rate of 7.23%, high-volume clinics like DH Moratuwa reported an epidemiologically impossible rate of 0.34%, and DH Kosgama reported 0.00% across 2,418 clients. Qualitative triangulation revealed this gap was driven by frequent glucometer strip shortages and drop-outs among non-fasting walk-in clients requested to return a subsequent morning, leading to blank fields erroneously aggregated as zero cases.
Conclusion: While the HLC framework succeeds in shifting medical focus toward community-based screening, its execution remains highly uneven across the Colombo district. High-volume primary care centers effectively mobilize the community but are highly vulnerable to supply-chain disruptions and diagnostic recording failures. Secondary centers possess stable diagnostics but fail to establish proactive preventative outreach

Non communicable diseases, Healthy Lifestyle clinics, Screening efficiency, Primary healthcare, Obesity, Hypertension.

1. GBD 2019 Risk Factors Collaborators, 2020. Global burden of 87 risk factors in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. The Lancet, 396(10258), pp. 1223-1249. [Google Scholar] [Crossref]

2. United Nations General Assembly, 2015. Transforming our world: the 2030 Agenda for Sustainable Development. Resolution A/RES/70/1. New York: United Nations. [Google Scholar] [Crossref]

3. World Health Organization, 2022. Invisible numbers: The true scale of noncommunicable diseases. Geneva: World Health Organization. [Google Scholar] [Crossref]

4. Katulanda, P., Ranasinghe, P., Jayawardena, R. and Matthews, D.R., 2018. The prevalence, patterns and predictors of obesity among Sri Lankan adults. Diabetes & Metabolic Syndrome: Clinical Research & Reviews, 12(4), pp. 491-497. [Google Scholar] [Crossref]

5. Ministry of Health, Nutrition and Indigenous Medicine Sri Lanka, 2018. National Multisectoral Action Plan for the Prevention and Control of Non Communicable Diseases 2016-2020. Colombo: Ministry of Health. [Google Scholar] [Crossref]

6. World Health Organization, 2016. Noncommunicable Diseases Risk Factor Survey Sri Lanka 2015 (WHO STEPS Survey). Colombo: Ministry of Health, Sri Lanka and World Health Organization Regional Office for South-East Asia. [Google Scholar] [Crossref]

7. Directorate of Non-Communicable Diseases, 2024. Annual Review of Healthy Lifestyle Clinics and NCD Surveillance Data. Colombo: Ministry of Health, Sri Lanka. [Google Scholar] [Crossref]

8. Ministry of Health, Sri Lanka, 2011. Manual on Healthy Lifestyle Centers (HLC) for screening of Non-Communicable Diseases. Colombo: Management Development and Planning Unit, Ministry of Health, Sri Lanka. [Google Scholar] [Crossref]

9. Regional Department of Health Services (RDHS) Colombo, 2024. HLC Annual Review Data: Institutional Screening Profiles and Clinical Registries. Colombo: RDHS. (This directly references the local district dataset you analyzed). [Google Scholar] [Crossref]

• Measuring Waste of Patient Time in Health Care at Non-Digitized Hospital: An Observational Study in Bangabandhu Sheikh Mujib Medical University, Bangladesh
• Reaffirming Clinical Confidence in Atorvastatin Therapy: A Digital Outreach Case Study from Tamil Nadu, India
• Clinical Manifestations and Therapeutic Response in a Patient with Hypothyroidism: A Case Report
• Eranda (Ricinus Communis) In Gridhrasi (Sciatica): Classical Rationale, Pharmacology and Clinical Evidence- A Narrative Literature Review
• Magnetotherapy in Pain Management: Mechanisms, Clinical Applications, and Future Perspectives – A Review