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110 CHAPTER 5 ■ Tuberculosis: Keys to Success in Peru

Alaska (five-sixths), Peru is divided by the Andes Mountains into three sharply dif-
ferentiated zones: western coastlines, central mountains, and eastern forested slopes.
Extending 1,500 miles along the Pacific, Peru is an important link between Asia and
Brazil, and its rich and varied heritage includes the ancient Incan capital of Cuzco
and the lost city of Machu Picchu. Main exports are fish and fish products, copper,
zinc, gold, crude petroleum, lead, coffee, sugar, and cotton (BBC News, 2008). The
1993 constitution established a presidential democracy with a powerful executive,
elected for five years. A 120-member legislature, elected at the same time as the pres-
ident, also sits for five years. The major religion is Christianity, with more than 80%
of citizens Roman Catholic. Although the official languages are Spanish and
Quechua, Aymara is also spoken (CIA, 2009).
In the early 1990s, internal terrorism in the country was creating political, economic,
and social destabilization. By 2000, Peru’s economy suffered substantial losses, and many
families became even more impoverished. By 2002, more than half (54%) lived below
the poverty line, with 15% living in extreme poverty (Llanos-Zavalaga et al., 2004). To-
day, the country is seeing growth, but the lot of the rural poor is little improved.
Literacy rates are high, with 88% of adults able to read and write (Infoplease.com,
2008), and according to the World Bank, 99.9% of children complete primary educa-
tion and 92.4% complete secondary education (The World Bank, 2008).
Life expectancy for men is 71 years, and for women, 76 years (UN, 2009). The
infant mortality rate is 33 deaths for every 1,000 live births (Llanos-Zavalaga et al.,
2004), and the mortality rate for children under five is 25.2 per 1,000 live births.
Health concerns in Peru are compounded by a lack of basic health education
among the majority of the rural population, as well as physical and financial access
to medical care. Nutrition and sanitation tend to be the main causes of chronic
health issues (Foundation for Sustainable Development, 2008).

CASE STUDY
Tuberculosis Prevention and Treatment in Peru

PLAN B AC KG R O U N D , PU R PO S E , AN D FO C U S

In 1991, when Peru accounted for about 15% of TB cases in the Americas even
though it had only 3% of the population, there were approximately 190 cases
per 100,000 adults of TB in the country. The abandonment rate of drug therapy
was at 12.1% (Llanos-Zavalaga et al., 2004). Only 50% of people diagnosed with
TB were able to get treatment and, of those, only half were cured (WHO, 2008c).
Drugs were in short supply, record systems nonexistent, and health workers