Ecological and social contexts of scorpion stings in Manaus, the largest metropolis of the Brazilian Amazon

Scorpion stings remain a significant public health problem in tropical regions, particularly in Brazil, where an estimatied 117,000 cases are reported annually, reflecting a persistent and growing burden on the healthcare system. Globally, more than two million cases occur each year, especially in areas undergoing environmental disturbances such as deforestation and unplanned urbanization. This study investigates the ecological and social contexts of scorpion stings in Manaus, the largest metropolis of the Brazilian Amazon. This qualitative study was conducted at the Dr. Heitor Vieira Dourado Tropical Medicine Foundation (FMT-HVD), a reference center for scorpion stings, between January 2020 and March 2025. Data were collected through clinical questionnaires, in-depth interviews, and household field observations. Thematic analysis was performed using Atlas.ti. Thirty participants from different age groups were included. Most cases were clinically mild. Five themes emerged from the qualitative analysis that address perceptions and reactions to the sting, environmental risk factors, post-accident behaviors, emotional impacts, and patient care pathways. Participants reported overlap between domestic spaces and forest fragments, limited knowledge about prevention, emotional distress, and barriers to accessing care, including late referrals and transportation difficulties. Scorpion stings in the Amazon are shaped by environmental, social, and structural factors. Integrated strategies involving environmental management, health education, urban planning, and improved healthcare access are essential to reduce their burden.