Clinicopathological Features, Management, and Outcomes of Zebra Spitting Cobra (Naja nigricincta nigricincta) and Puff Adder (Bitis arietans) Snakebites in Namibia.

Snakebite envenomation remains an important public health concern in Namibia, particularly following bites from the zebra spitting cobra (Naja nigricincta nigricincta) and the puff adder (Bitis arietans). However, the clinical presentations and management outcomes of these snakebites remain poorly characterized. This prospective, observational, descriptive study investigated the clinicopathological features, wound progression, management, and functional outcomes of snakebite patients treated at two major referral hospitals in Namibia. A total of 20 hospitalized patients were included. The majority of patients were male (65%) and children aged 0-15 years (65%). Zebra spitting cobra bites accounted for 60% of cases. Eighty percent of patients presented with predominantly cytotoxic envenomation. Neurological symptoms were documented in a small number of patients (33% of zebra spitting cobra cases and 13% of puff adder cases), but were mild and nonspecific. Antivenom was administered to only 15% of patients. Zebra spitting cobra envenomation was associated with laboratory abnormalities consistent with systemic involvement such as anemia, hemolysis, rhabdomyolysis, hepatic involvement, and renal impairment, whereas puff adder bites demonstrated minimal systemic involvement. Surgical intervention was frequently required, including debridement, fasciotomy, and amputations (15%); however, no fatalities were recorded. These findings highlight the substantial morbidity associated with snakebite envenomation in Namibia and emphasize the importance of early referral, appropriate wound management, and improved access to effective antivenom. However, these findings should be interpreted within the limitations of the small sample size, convenience sampling, and incomplete laboratory investigations in some patients. Nevertheless, this study provides important baseline clinical data to support future snakebite management strategies and region-specific treatment guidelines in Namibia.