least one NCD risk factor, 73.5% have 1–2 risk factors, and 18.3% have 3–5 risk factors, the prevalence being similar in males and females. The changing epidemiology has prompted a reorganization of the health services, focusing on equitable, patient-centred quality care at the primary and secondary levels.
1.1 Geography and sociodemography Sri Lanka is an island situated at the southern tip of India and separated from it by a strip of sea about 20 km in width at its narrowest point (Madduma Bandara, 2007). Historically, it has been referred to by many names. The British, the last colonial rulers, called it Ceylon. The country was officially renamed Sri Lanka in 1972, Lanka being the country’s ancient name and the prefix meaning resplendent. The island’s strategic position in relation to the ancient sea routes of the Indian Ocean and its close proximity to India has led to waves of immigration, invasion and colonization throughout its history. This diversity of influences has shaped the social, cultural, political and demographic picture of the country. The total land area of the country is 65 625 sq.km and includes the main island and several small islands in close proximity to the main land mass. The mainland extends 433 km from north to south and 226 km from east to west at its widest point (Madduma Bandara, 2007). Administratively, the country is divided into nine provinces (Figure 1.1), which are subdivided into 25 districts. The districts are divided into 330 divisional secretary (DS) divisions and these are subdivided into grama niladhari (GN) divisions. There are 14 022 GN divisions constituting the smallest administrative units of the country (Ministry of Public Administration and Home Affairs, 2018).
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