Background: Pesticides are widely used in agriculture across South Asia, including Bangladesh, increasing crop production but posing significant risks to environmental health and human well-being. Farmers in developing economies commonly misuse and overuse pesticides. This study sought to the knowledge, perception, and practice of pesticide use and associated adverse health Problems among farmers in a rural area of Bangladesh. Methods: This descriptive cross-sectional study was conducted in the Boalmari Upazilla of Faridpur, Bangladesh. A sample of 675 farmers was selected using a purposive sampling technique. Data were collected via face-to-face interviews using a pre-tested questionnaire and analyzed using descriptive statistics (frequency and percentage distribution). The study population was predominantly middle-aged males with low levels of formal education. Results: The findings indicate widespread, high-risk pesticide use behaviors. Almost all respondents (99.6%) applied pesticides. A significant majority reported unsafe practices, including mixing different pesticide brands together (82.4%) and increasing the dose over time (84.1%), suggesting a trend of overuse and reliance on personal judgment. The use of Personal Protective Equipment (PPE) was notably low; only 19% wore eye shields, and 44.7% mixed pesticides with bare hands. Furthermore, 62.5% lacked basic training in safe handling. The most frequently reported acute symptoms were eye irritation (40%), headache (17.8%), and skin irritation (12.1%). More than one fifth (22%) of farmers were bedridden and 18% required hospitalization due to pesticide-related health effects. Conclusion: Farmers in the study area demonstrate inadequate knowledge regarding safe pesticide handling and proper application practices. This knowledge deficit, compounded by limited access to training, drives unsafe behaviors and results in a high prevalence of acute health symptoms and loss of function. Strengthening farmer education, developing targeted training programs on integrated pest management (IPM) and safe pesticide use, and improving regulatory oversight are essential to mitigating occupational health hazards in rural Bangladesh.