the infant mortality rate (imr) has been determined as one of the most important health indicators by the alma-ata conference of the world health organization that also recognized primary health care as the key for health promotion. the united nations international childhood fund and the pan-american health organization devised low cost strategies for poor countries to reduce infant mortality rates such as growth monitoring, oral rehydration, breastfeeding, and vaccination. the assumption that substantial imr reduction is related to quality of life improvement has been questioned due to specific interventions of the health sector. in this scenario ceará and a large part of the northeast has historically coped with adversities in the social, economic and demographic areas including health care, thus establishing a causal relation among these sectors especially concerning infant mortality. macroepidemiological determinants for infant survival would be out of the health sector capacity of intervening therefore, only significant change of economic standards or social policies intensification, assuring continuity of education issues, of sanitation and generation of employment and income could have an impact on the population health and consequently on infant mortality. such hypothesis justifies a more in-depth investigation under a methodological viewpoint.