Scorpionism at the human-environment interface: an eco-epidemiological synthesis and conceptual framework.

Introduction: Scorpion envenomation is a major but persistently under-recognized public health problem in tropical and subtropical regions. Its occurrence arises from complex interactions among climatic, ecological, socioeconomic, and health-system drivers. Despite sustained high incidence and expanding risk associated with climate and land-use change, these relationships remain insufficiently synthesized. Addressing this gap requires an integrative framework capable of capturing the multi-level determinants shaping scorpionism risk and outcomes. Methods: Drawing on Human Ecology Theory and socio-ecological systems thinking, we developed an integrated conceptual model to organize determinants of scorpion envenomation. The framework synthesizes evidence from environmental science, climate impacts, scorpion biology, venom characteristics, epidemiology, and clinical and public health interventions. More than thirty determinants were categorized into six components: (1) physical-climatic variables, (2) scorpion behavior and ecology, (3) venom composition and toxicity, (4) human exposure and envenomation risk, (5) health impacts and public health response, and (6) socioeconomic factors. The model is structured in two stages: a risk-and-vulnerability stage and a scorpionism-occurrence stage. Results: The resulting conceptual model provides a unified systems-based framework that integrates environmental, ecological, behavioral, socioeconomic, and health-system determinants of scorpion envenomation. It clarifies pathways linking upstream drivers to exposure, clinical outcomes, and public health responses, enabling interpretation of regional heterogeneity in incidence. The framework also identifies priority leverage points for intervention and offers a structured basis for empirical research, risk mapping, and early-warning development. Discussion: This work highlights the importance of adopting a socio-ecological systems perspective to better understand and address scorpionism. By integrating diverse determinants into a coherent analytical framework, the model serves as a hypothesis-generating and interpretive tool rather than a predictive model. The approach supports the development of targeted prevention and control strategies and reinforces the need to recognize scorpionism within the broader agenda of neglected tropical health conditions, particularly given its substantial burden and strong socio-ecological determinants.