Status, determinants and interventions on cardiovascular disease & diabetes in Sri Lanka: a desk review of research 2000 – 2018 October 2019 Ministry of Health, Nutrition and Indigenous Medicine Status, determinants and interventions on cardiovascular disease & diabetes in Sri Lanka: a desk review of research 2000 – 2018 October 2019 Ministry of Health, Nutrition and Indigenous Medicine Status, determinants and interventions on cardiovascular disease & diabetes in Sri Lanka: desk review of research 2000-2018, 2019 ISBN: 978-92-9022-737-3. © World Health Organization 2019 Some rights reserved. This work is available under the Creative Commons Attribution-NonCommercial- ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo). Under the terms of this licence, you may copy, redistribute and adapt the work for non-commercial purposes, provided the work is appropriately cited, as indicated below. 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The responsibility for the interpretation and use of the material lies with the reader. In no event shall WHO be liable for damages arising from its use. Joint publication with Ministry of Health, Nutrition and Indigenous Medicine, Sri Lanka Message from the WHO Representative to Sri Lanka Non-communicable diseases (NCDs) are a major threat to global health, accounting for nearly 72% of all deaths in 2016, of which nearly three quarters occurred in low- and middle-income countries. NCDs are to a large extent preventable, but little has been done to convert available knowledge or evidence into effective policies and actions. It is therefore important to prioritize issues pertaining to NCDs for research in the development of evidence-based interventions, with a view to translating these into action. In this backdrop, the comprehensive desk review on the Sri Lankan research evidence on cardiovascular diseases and diabetes and related risk factors, interventions and health system response during 2000-2018 is timely and valuable. It will help guide researchers, policy makers and administrators, and other stakeholders on evidence-based interventions to combat the burden of NCDs in the country. I congratulate the review team and the lead consultant for their effort in bringing out this publication. I am confident that this will serve as a valuable resource for tackling NCDs in Sri Lanka and beyond. Dr Razia Pendse World Health Organization Representative to Sri Lanka Foreword from Director General of Health Services I am pleased to send this message witnessing the successful completion of the bibliographic database related to research on major non-communicable diseases (NCDs), risk factors and interventions that prevent and control such diseases in Sri Lanka, as well as the desk review of research conducted on cardiovascular disease and diabetes during the period 2000-2018 in Sri Lanka. This comprehensive desk review gives us an overview of two major causes of premature mortality and extensive morbidity in the country. It elaborates the disease & economic burden imposed on individuals, family and the country. It further highlights the risky and protective health behaviour of apparently healthy adults as well as patients, through which at-risk population groups could be identified and activities prioritized, so that the onset of diseases and complications could be minimized or delayed. Finally, the review will enable us to revisit the health system response to ensure that no one is excluded in the provision of health care services across all age groups. Another unique outcome of this project would be the updates planned of the bibliography beyond 2018 at regular intervals, so that it would enable us to formulate timely evidence-based interventions. As the Director General of Health Services, I congratulate the review consultant and her team, and all those who had contributed to the scientific content, compilation and critical review of the bibliographic database and desk review of NCD related research for their enormous contribution Dr Anil Jasinghe Director General of Health Services Ministry of Health, Nutrition & Indigenous Medicine Message from Deputy Director General (Education, Training & Research) Health research is one of the most essential components towards enhancement of a health system. In accordance, the Ministry of Health Sri Lanka has identified the importance of developing a sustained research culture among healthcare professionals. To this end, collation and review of the available evidence-base is a priority, as it is the key for incorporating extensive, complex and unique evidence into policy and practice. This approach would further guide future research, providing clear insights into the gaps in knowledge that require further researching into. An increasing trend of non-communicable diseases has been noted over the recent past, which is expected to rise amidst newer threats in the disease epidemiology of Sri Lanka. To face this challenge, the delivery of healthcare is evolving, with more emphasis on primary care. In this backdrop, health research enriched both in quantity and quality could address some of the crucial issues pertaining to major NCDs in Sri Lanka. I congratulate the timely move of the Ministry of Health and World Health Organization, and the review team for undertaking this project. It is fervently hoped that utilization of this review for appropriate evidence-based decisions on the health system, would enhance the health of Sri Lanka. Dr Sudath Samaraweera Deputy Director General (Education, Training & Research) Ministry of Health, Nutrition & Indigenous Medicine Acknowledgements This report would not have been possible without the commitment and support from many individuals, health institutions and organizations. We greatly appreciate the administrative support extended by Dr Anil Jayasinghe, Director General Health Services. I appreciate with gratitude the hard work undertaken by Prof. Carukshi Arambepola, the project consultant in developing the bibliographic literature database and the desk review of NCD related research publications from 2000-2018 and writing the report, and Dr Yasaswi N Walpita, Dr Dushyanthi Jayawardena and Ms Suganya Yogeswaran for assisting her in the project. Reviewing a multitude of research publications published locally and internationally is not an easy task. The exceptional role played by Dr Nalika Gunawardena, National Professional Officer (Health Systems Analysis and Evidence) of the World Health Organization Country Office, Sri Lanka has been tremendous in giving the technical guidance to the review team, coordinating the work between the Ministry of Health and review team. I also thank the WHO Country Office Sri Lanka especially Dr Razia Pendse, WHO Representative for Sri Lanka for her support in making this publication a reality. I profusely thank Prof. Jennifer Perera, Dean of the Faculty of Medicine and