Proposal for a hierarchical framework applied to investigation of risk factors for neonatal mortality

Theoretical-conceptual models aim to integrate social, biological, behavioral, and other factors and to explain their interrelations in the determination of health outcomes. In the case of determination of neonatal death in Brazil, few studies have analyzed the mechanisms by which numerous variables and constructs interrelate. This article offers a theoretical discussion of the possible components of a hierarchical framework for studying neonatal mortality. The proposed model sought to include factors that have traditionally been identified as relevant to the occurrence of neonatal death and others that have been studied more recently ( like race, social support, and violence during pregnancy). The components were distributed in 11 dimensions allocated to four hierarchical levels ( one distal, two intermediary, and one proximal). The proposed framework should be adjusted to the Brazilian reality for neonatal death in large cities and raises various aspects for discussion that have not been explored previously in Brazil.