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

Abstract

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