Anthrax is a worldwide environmentally transmitted fatal zoonotic disease with socioeconomic and public health impacts. It frequently occurs among livestock and wildlife in North Kivu province, Democratic Republic of the Congo. However, due to a poor animal health control system, it is poorly understood and managed and often underreported. Therefore, to understand, document, and report the epidemiology of anthrax in this province, a cross-sectional survey was conducted in 2015 involving arbitrarily selected 120 farmers to access their knowledge on clinical manifestations, transmission, prevention, attitudes, and practices concerning anthrax. Subsequently, a field investigation was conducted in 2021 during an anthrax outbreak to investigate the disease trend and routine practices. We established that most farmers know and can identify anthrax; they greatly fear and try to prevent it despite some unhealthy practices associated with handling and eating anthrax-contaminated meat. Extensive transhumance livestock management systems, anthropogenic activities, and the lack of a surveillance program have primarily contributed to anthrax outbreaks in North Kivu province. The presence of anthrax in this region was confirmed by detecting Bacillus anthracis, the etiological agent, during an outbreak investigation. Hence, the need for collaborative efforts for continued surveillance effectively manage anthrax outbreaks to reduce this serious threat to health and livelihood in this area.